[Prospective study of the worry's effects on the psychological adjustment among parents of a child with type 1 diabetes.] / Étude prospective des effets de l'inquiétude sur l'ajustement psychologique des parents d'un enfant atteint d'un diabète de type 1.

The continuous and multidisciplinary care of children with type 1 diabetes contributes improving their quality of life. Nevertheless, psychological follow-up issues among parents of a diabetic child are less developed in studies. At present, there is a need to develop research on psychological parental adjustment in order to identify risk and protective factors for understanding the parental experience and improving the initiatives to prevent the parental distress. Our results argue for a crucial role of intolerance of uncertainty in parental concerns. This study supports the continuous psychological follow-up of parents in close collaboration with medical teams.

La prise en charge continue et pluridisciplinaire des enfants atteints de diabète de type 1 contribue à l'amélioration de leur qualité de vie. Cependant, les enjeux du suivi psychologique des parents d'un enfant diabétique sont moins développés dans les travaux de la littérature. À l'heure actuelle, il est nécessaire de réaliser des recherches portant sur l'ajustement psychologique parental afin d'identifier les facteurs de risque et de protection dans la compréhension du vécu des parents dans le but d'améliorer les initiatives de prévention de la détresse parentale. Nos résultats plaident pour un rôle non négligeable du facteur d'intolérance à l'incertitude au maintien des inquiétudes parentales. Cette étude confirme l'intérêt d'un suivi psychologique continu des parents en étroite collaboration avec les équipes médicales.

Parents' Perceived Impact of the Societal Lockdown of COVID-19 on Family Well-Being and on the Emotional and Behavioral State of Walloon Belgian Children Aged 4 to 13 Years: An Exploratory Study.

This exploratory study assessed parents' perceptions of the emotional and behavioral impacts of the COVID-19 lockdown on their children. The total sample included 749 children, aged 4 to 13 years old (353 girls, 396 boys); 524 parents took part. The emotional and behavioral changes observed during the societal lockdown, family coexistence, the impact of COVID-19 on family well-being, and the frequency of social contacts before and during this lockdown were investigated. Results show that the most frequently reported difficulties were worry, agitation, anxiety, sadness, loneliness, nervousness, arguing, anger, frustration, boredom, irritability, behavioral problems, and laziness. Family coexistence declined significantly during this lockdown, and parents mentioned that COVID-19 had an impact on family well-being. Various ordinal logistic regressions showed that family coexistence, children's nervousness due to COVID-19, the impact of COVID-19 on family well-being, age, and social contacts before and during this lockdown seemed to explain the various emotional and behavioral changes observed in children during the societal lockdown. These results are discussed and recommendations are made.

[Perception by the oncologist of the parental distress in childhood cancer survivor]. / Perception par l'oncologue de la détresse des parents d'un enfant en rémission de cancer.

The aim of the study was to assess the degree of similarity between the distress expressed by parents of a child cancer survivor and the distress perceived by the oncologist. Overall, 61 parents of a child cancer survivor (between 4 and 6 years of cancer remission) were recruited in Belgian hospitals (Province of Liège). Parents filled out questionnaires about the intolerance of uncertainty (IUS), positive beliefs about worry (WW-II), parental worries about the evolution of their child's health (QIPS-R15), problem orientation (NPOQ), cognitive avoidance (CAQ), ruminations (Mini-CERTS), and anxiety/depression (HADS). Eight oncologists who having taken care of the child filled out the «OncoMed¼ questionnaire that examines their perception of the parental distress (e.g. anxiety, worries). Parents suffered from anxiety,worries about their child's health and showed a low level of tolerance of uncertainty. Overall, oncologists demonstrated a low perceived distress compared to the level of parental distress. The study highlights the need to detect early parents who are intolerant of uncertainty in order to offer them an efficient psychological follow-up. This study underlines finally the necessity to develop medical perception tools about the distress in order to strengthen the medical communication and the follow-up of these families.

L'objectif de l'étude est de mesurer le degré de concordance entre la détresse exprimée par les parents d'un enfant en rémission de cancer et la détresse perçue par l'oncologue. Au total, 61 parents d'un enfant en rémission de cancer (de 4 années à 6 années de rémission) sont recrutés dans les hôpitaux belges (Province de Liège). Les parents remplissent des questionnaires relatifs à l'intolérance à l'incertitude (QII), aux croyances positives à l'égard de l'inquiétude (PSI-II), aux inquiétudes relatives à l'évolution de la santé de l'enfant (QIPS-R15), à l'orientation de l'attitude face à un problème (QAP), à l'évitement cognitif (QEC), aux ruminations (Mini-CERTS) et à l'anxiété/dépression (HADS). Huit oncologues ayant pris en charge l'enfant répondent au questionnaire «OncoMed¼ évaluant leur perception de la détresse du parent (e.g. anxiété, inquiétudes). Les parents souffrent d'anxiété, d'inquiétudes relatives à la santé de leur enfant et ont une faible tolérance à l'incertitude. Les oncologues perçoivent en moyenne, une détresse moins élevée que celle rapportée par les parents. L'étude souligne l'importance de détecter, dès la prise en charge de l'enfant, le facteur d'intolérance à l'incertitude chez le parent afin de lui proposer un suivi psychologique adéquat. Cette étude souligne enfin la nécessité de développer des outils de perception médicale de la détresse afin de renforcer la communication médicale et le suivi de ces familles.

[Health literacy, a way to reduce social health inequalities]. / La «Health Literacy¼ - un moyen pour réduire les inégalités sociales de santé.

Health Literacy (HL) is defined as «the knowledge, motivation, and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life¼. This concept begins to be recognized as a priority area for action at political level in Belgium. Indeed, a limited HL may affect health by leading, for example, with poorer management of chronic diseases, more hospital admissions and premature deaths. This paper addresses the question of HL evaluation, improvement interventions as well as the many challenges that remain in this area. HL seems fundamental to the development of better health management. It would allow patients to play a more active role in health care, to involve all health stakeholders, and to contribute to a more sustainable health system. Improving HL could allow better equal access to health care.e.

La Health Literacy (HL) se définit comme 'la connaissance, la motivation et les compétences des individus à accéder, comprendre, évaluer et appliquer l'information en matière de santé en vue de porter des jugements et de prendre des décisions de tous les jours en ce qui concerne la santé, la prévention des maladies et la promotion de la santé, de manière à maintenir ou améliorer la qualité de vie'. Au niveau politique belge, ce concept commence à être reconnu comme étant un domaine d'action prioritaire. En effet, une HL limitée peut affecter la santé en conduisant, par exemple, à une moins bonne gestion des maladies chroniques, à davantage d'hospitalisations et de décès prématurés. Cet article aborde la question de l'évaluation de la HL, des interventions pour l'améliorer ainsi que les nombreux défis qui restent à relever dans ce domaine. La HL semblerait fondamentale pour le développement d'une meilleure gestion de la santé. Elle permettrait au patient de jouer un rôle plus actif dans la prise en charge de sa santé, de responsabiliser tous les acteurs de la santé, et de contribuer à un système de santé plus viable. Améliorer la HL devrait permettre une meilleure égalité d'accès aux soins de santé.

[Experimental study on the intolerance of uncertainty and cognitive biases in parents of child cancer survivor]. / Étude expérimentale sur l'intolérance à l'incertitude et biais cognitifs chez les parents d'un enfant survivant de cancer.

Studies in pediatric oncology describe a relative good quality of life in child cancer survivor. However, few studies were interested in the parents of a child cancer survivor. 61 parents are recruited in the Belgian hospitals. Three groups of parents are constituted : the parents whose child is in 4 years of survivorship (group 1), in 5 years of survivorship (group 2) and in 6 years of survivorship (group 3). Clinical scales and a Stroop emotion task are administered. Parents (of the 3 groups) present a low tolerance of uncertainty, have excessive worries about the evolution of the health of their child, and suffer from anxious symptoms. The Stroop emotion tasks reveals a cognitive bias of the attention in favour of threatening stimuli. The study highlights the importance to detect parents who are intolerant of uncertainty at the cancer diagnosis stage and their continuous psychological follow-up once the treatments are ended.

Les études en oncologie pédiatrique décrivent une relativement bonne qualité de vie chez les enfants survivants de cancer. À ce jour, peu d'études se sont intéressées aux parents d'un enfant survivant de cancer. Soixante-et-un parents sont recrutés dans les hôpitaux belges. Trois groupes de parents sont constitués : les parents dont l'enfant est à 4 ans de rémission (groupe 1), à 5 ans de rémission (groupe 2) et à 6 ans de rémission (groupe 3). Des échelles cliniques et une tâche de Stroop émotion sont administrées. Les parents (des 3 groupes) présentent une faible tolérance à l'incertitude, ont des inquiétudes excessives quant à l'évolution de la santé de leur enfant et souffrent de symptômes anxieux. Le Stroop émotion révèle un biais cognitif de l'attention en faveur des stimuli de nature menaçante. L'étude met en exergue l'importance de détecter les parents intolérants à l'incertitude lors du diagnostic d'annonce du cancer et leur suivi psychologique continu une fois les traitements terminés.

[How I treat ... out-of-hospital cardiac arrest. The role of the emergency medical dispatcher]. / Comment je traite ... l'arrêt cardio-respiratoire extrahospitalier: la fenêtre du centraliste 112.

Sudden cardiac arrest is an event associated with a very low survival rate. The latter is inversely proportional to the duration of the cardiovascular arrest. The chain of survival concept is a sequence of 4 events to be carried out as fast as possible with a view to ensure the patient's survival. This sequence consists of early access to and activation of the emergency medical system, early initiation of basic cardiopulmonary resuscitation, early defibrillation and early specialized care. The number of potential witnesses trained in Basic Life Support (BLS) does not guarantee an adequate basic resuscitation before the arrival of medical aid. In order to optimize the management of victims and callers, the concept of dispatching-assisted cardiopulmonary resuscitation based on a structured protocol has been implemented. The implementation of this plan to improve the quality of call handling required training and assessment of impacts on beneficiaries. The research datashow a reduction of the duration of cardiac arrest, an increase in resuscitation initiated by a witness, an improved survival rate, and a decreased stress and unanimous approval of dispatchers. Currently, the process is being improved and sustained.

[Quality of life in children with cancer history and parental adaptation]. / Qualité de vie de l'enfant avec antécédents oncologiques et adaptation parentale.

This study assesses quality of life (Qol) in children with cancer history as well as Qol of their parents and examines the relationship between parental adjustment and children Qol. Two groups were formed: an experimental group composed by children with cancer antecedents and their parents and a control group with healthy children and their parents. Children have filled a questionnaire about their Qol. Parents have completed questionnaires about their coping, their illness perceptions, their parenting stress and their Qol. The results show that Qol was satisfactory and similar in both groups. Significant correlations were found between parental illness representations (threat and personal control) and children Qol as well as between coping strategies based on maintaining family cohesion and children Qol. This study highlights the need to assess the adjustment of parents after child cancer and to develop interventions targeting parental representations and coping strategies.

Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study.

BACKGROUND: Although patients with cancer are often accompanied by a relative during breaking bad news (BBN) consultations, little is known regarding the efficacy of training programmes designed to teach residents the communication skills needed to break bad news in a triadic consultation. METHODS: Residents were randomly assigned to a 40-h dyadic and triadic communication skills training programme (n=48) or a waiting list (n=47). A simulated BBN triadic consultation was audiotaped at baseline, and after training for the training group, and 8 months after baseline for the waiting list group. Transcripts were analysed using content analysis software (LaComm). A coder determined the moment of bad news delivery and the relative's first turn of speech regarding the bad news. A generalised estimating equation was used to evaluate residents' communication skills, BBN timing, and the relative's inclusion in the consultation. RESULTS: Ninety-five residents were included. After training, the duration of the pre-delivery phase was found to be longer for the trained residents (relative risk (RR)=3.04; P<0.001). The simulated relative's first turn of speech about the bad news came more often during the pre-delivery phase (RR=6.68; P=0.008), and was more often initiated by the trained residents (RR=19.17; P<0.001). Trained residents also used more assessment (RR=1.83; P<0.001) and supportive utterances (RR=1.58; P<0.001). CONCLUSION: This study demonstrates that a training programme that focuses on the practice of dyadic and triadic communication skills can improve the communication skills of the participating residents in a BBN triadic consultation. Such a training should be included in resident curriculum.

Quality of work life in doctors working with cancer patients.

BACKGROUND: Although studies have shown that medical residents experience poor psychological health and poor organizational conditions, their quality of work life (QWL) had not been measured. A new tool, the Quality of Work Life Systemic Inventory (QWLSI), proposes to fill the gap in the definition and assessment of this concept. AIMS: To confirm the convergent validity of the QWLSI, analyse Belgian medical residents' QWL with the QWLSI and discuss an intervention methodology based on the analysis of the QWLSI. METHODS: One hundred and thirteen medical residents participated between 2002 and 2006. They completed the QWLSI, the Maslach Burnout Inventory and the Job Stress Survey to confirm the correspondence between these three tools. RESULTS: Residents' low QWL predicted high emotional exhaustion (ß = 0.282; P < 0.01) and job stress (ß = 0.370; P < 0.001) levels, confirming the convergent validity. This sample of medical residents had an average QWL (µ = 5.8; SD = 3.1). However, their QWL was very low for three subscales: arrangement of work schedule (µ = 9; SD = 6.3), support offered to employee (µ = 7.6; SD = 6.1) and working relationship with superiors (µ = 6.9; SD = 5.3). CONCLUSIONS: The results confirm that the QWLSI can provide an indication of workers' health well-being and of organizational performance in different areas of work life. The problem factors found among Belgian medical residents suggest that prevention should focus on reduction of work hours, development of support and change in leadership style.

[The role of psychological interventions in dialysis: an exploratory study]. / Intérêt des interventions psychologiques en dialyse : étude exploratoire.

Patients suffering from end-stage renal disease (ESRD) have a very reduced quality of life accompanied by a severe emotional distress (high worries-anxiety-depression). However, in Belgium, no regular psychological intervention is proposed to dialyzed patients. Our objective is to show that psychological intervention can significantly decrease the emotional distress of patients with ESRD. Eleven sessions of structured interventions are proposed to ESRD patients. Eligibility criteria are to be major, to not present confusion or/and dementia, to have been on dialysis treatment for at least 3months, to have obtained 14 or more on HAD-scale. Interventions carry on the management of anxious and depressive symptoms and of the disease itself. This constitutes three independent modules. Questionnaires are filled in by the patients at various stages to evaluate the anxiety and the depression (HADS), the worries (Penn State) and the quality of life (KDQoL-SF). Results for the 47 ESRD patients show a significant reduction of the scores of anxiety, depression and worries and a significant growth of quality of life. In parallel, a decrease in the serum calcium-phosphorus product analyzed before dialysis has been noted.

Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program.

BACKGROUND: This study aims to assess the efficacy of a 40-h training programme designed to teach residents the communication skills needed to break the bad news. METHODS: Residents were randomly assigned to the training programme or to a waiting list. A simulated patient breaking bad news (BBN) consultation was audiotaped at baseline and after training in the training group and 8 months after baseline in the waiting-list group. Transcripts were analysed by tagging the used communication skills with a content analysis software (LaComm) and by tagging the phases of bad news delivery: pre-delivery, delivery and post-delivery. Training effects were tested with generalised estimating equation (GEE) and multivariate analysis of variance (MANOVA). RESULTS: The trained residents (n=50) used effective communication skills more often than the untrained residents (n=48): more open questions (relative rate (RR)=5.79; P<0.001), open directive questions (RR=1.71; P=0.003) and empathy (RR=4.50; P=0.017) and less information transmission (RR=0.72; P=0.001). The pre-delivery phase was longer for the trained (1 min 53 s at baseline and 3 min 55 s after training) compared with the untrained residents (2 min 7 s at baseline and 1 min 46 s at second assessment time; P<0.001). CONCLUSION: This study shows the efficacy of training programme designed to improve residents' BBN skills. The way residents break bad news may thus be improved.

Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians.

BACKGROUND: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety. PATIENTS AND METHODS: Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P < 0.001). An increase in anxiety was linked with breaking bad news (P = 0.050) and with supportive skills (P = 0.013). No impact of the training programme was observed. CONCLUSIONS: This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences.

[Stop smoking help: keys to long term success]. / L'aide a l'arrêt du tabagisme: la réussite au long terme. Aspects psychologiques et pharmacologiques.

This review deals with the pharmacological and psychological means to help in smoking cessation and compares the efficacy of the different methods. Pharmacological support results in a smoking cessation rate reaching at best 20-25%. The efficacy of behavioural and cognitive therapy have been much less validated so far. Multidisciplinary specialized centres for helping smokers have been raised under the care of FARES in the French Community of Belgium.

[Stop smoking help: a need]. / L'aide a l'arrêt du tabagisme: une nécessité.

Today the smoker carries a risk of mortality 70% higher compared to the nonsmoker. In Belgium active smoking is indisputably the most important cause of avoidable death. In 2004 it appears that 27% of the belgian population was smoking. This review describes the comorbidity associated with active tobacco consumption and defines the concepts of dependence and smoking cessation. It also identifies the three factors which determine the success of smoking cessation, i.e. the degree of nicotinic dependence, the presence of anxio-depressive disorders and the importance of the motivation to the stop.

Impact of medical specialists' locus of control on communication skills in oncological interviews.

Although is it widely recognised that physicians' characteristics could influence their communication styles, no empirical evidence is currently available. No studies are available on the impact of physicians' locus of control (LOC) on their communication skills. LOC is a generalised belief regarding the extent to which life outcomes are controlled by an individual's actions (internal LOC) or by external forces such as luck, fate or other individuals (external LOC). It was hypothesised that physicians with external LOC would take more into account others' concerns than physicians with internal LOC and would consequently use more appropriate assessment, informative and supportive functions. A total of 81 medical specialists were assessed in a simulated interview and a clinical interview. Communication skills were rated according to the Cancer Research Campaign Workshop Evaluation Manual. LOC was assessed using the Rotter I-E scale. Communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student's t-test. Results show that physicians with external LOC give more appropriate information than physicians with internal LOC in simulated interviews (P=0.011) and less premature information than physicians with internal LOC in clinical interviews (P=0.015). This result provides evidence that physicians' LOC can influence their communication styles in oncological interviews and in particular the way they provide information to the patient.

[Sense of coherence and commitment to a cardiac rehabilitation program after a myocardial infarction: preliminary results]. / Le sens de la cohérence et l'engagement dans un programme de revalidation cardiaque suite à un infarctus du myocarde: résultats préliminaires.

This study investigate the impact of the sense of coherence or SOC (1) on the commitment to health behaviors, as the participation in a revalidation program (physical training) after a first myocardial infarction. Fifteen subjects have been assessed three times after their myocardial infarction. The data indicate a possible effect of the sense of coherence which is higher among participants in comparison with subjects who refused to be involved in the program.