Social perceptions and the stigmatization towards fifteen mental illnesses in France: a preliminary study on the role of vital force and burden.

Introduction: This study examined social perceptions and rejection towards fifteen mental illnesses, as well as a preliminary test of the SUBAR model, that hypothesized perceptions of both vital forces and burden would be negatively and positively related to social rejection, respectively. Methods: Using an online survey with participants from France (n = 952), social rejection was assessed using a feeling thermometer and a social distance scale, while social perceptions were measured using visual analog scales. Results: A stigma map for these different disorders is drawn up, revealing the social perceptions and levels of stigmatization specific to certain mental illnesses. Controlling for relevant social perceptions (i.e., danger, warmth, competence), we found that perception of burden was positively and significantly associated to social distance and negative feeling for 73% and 67% of mental illnesses, respectively. The perception of vital force was negatively and significantly related to social distance and negative feeling for 87% and 20% of mental illnesses, respectively. The change in R2 between model 1 (i.e. perception of danger, warmth, competence) and model 2 (i.e. model 1 + perceptions of vital force and burden) significantly improved in 100% of cases for social distance and 67% of cases for negative feeling. Conclusion: These preliminary data provide support for the SUBAR model and call for further investigations to better understand the social rejection of people with mental illnesses.

Is patient education helpful in providing care for patients with rheumatoid arthritis? A qualitative study involving French nurses.

This French study explored nurses' involvement in patient education for patients with rheumatoid arthritis. The study design was qualitative. Semistructured interviews were conducted with 16 hospital nurses. Data analysis was performed according to Giorgi's descriptive phenomenological method, and supported by specific qualitative analysis software (Sphinx). The results showed the important role of hospital nurses in rheumatoid arthritis care. Patient education is a core part of nurses' work, allowing them to give patients information and emotional support. The interviewees displayed skills in helping patients learn to care for themselves. However, patient education mostly concerned patients who are already committed to their health care. Non-adherent patients warrant special attention; their acceptance of their disease, perceptions about disease and treatment, motivation, and autonomy should be specifically addressed. French nurses could benefit from more training, and could be aided by psychologists. Ambulatory services could also be developed for patient education in France, based on examples from other countries.

Refillable oxygen cylinders may be an alternative for ambulatory oxygen therapy in COPD.

STUDY OBJECTIVES: To compare, in clinical conditions, the efficacy of refilled oxygen cylinders (O2-HFs) in improving oxygenation and exercise capacity of patients with COPD during a 6-min walking test. DESIGN: Prospective randomized study with a cross-over design. SETTING: A university teaching hospital. PATIENTS: Ten patients with COPD, in a stable state and previously treated with long-term domiciliary oxygen therapy. Baseline characteristics were as follows: age, 65 +/- 7 years; PaO2 on room air, 55.4 +/- 6.3 mm Hg; PaCO2 on room air, 46.2 +/- 7.4 mm Hg; FEV1/vital capacity, 47 +/- 7%; and FEV1, 30 +/- 7% of predicted value (mean +/- SD). DESIGN: All patients performed three successive 6-min walking tests, the first test in room air and the other tests in a randomized order with either a conventional oxygen cylinder (O2-C) or an O2-HF. MEASUREMENTS AND RESULTS: The fraction of inspired oxygen (FIO2) delivered by O2-HFs was significantly lower than the FIO2 delivered by O2-Cs (94.2 +/- 2.6% vs 98.8 +/- 4.9%, p = 0.02). Mean O2-HF and O2-C weights before the walking tests were similar (3,510 +/- 251 g and 3,770 +/- 142 g, respectively; p = 0.09). Mean transcutaneous oxygen saturation was similarly improved with both oxygen delivery systems. Mean distances with O2-C (373.5 +/- 81 m) and O2-HF (375 +/- 97 m) were not different but significantly improved, as compared with room air (334.5 +/- 90 m; p = 0.03 and 0.02, respectively). Dyspnea sensations were similar for the three tests. CONCLUSION: O2-HFs are as efficient as O2-Cs for performing short-term exercises. Because of a lower cost, pressurizing units may be worthwhile for improving ambulatory oxygen therapy and pulmonary rehabilitation programs.

Mood and personality-based models of substance use.

Mood and personality-based vulnerabilities have been extensively examined in patients with substance use disorders, but their relevance as models of etiology remains to be fully investigated. The present investigation examined mood and personality-based models of substance use in a nonclinical sample of young adults. Two-hundred and twelve individuals were assessed for personality and clinical characteristics and participated in computerized ambulatory monitoring of mood states and substance use over a 1-week period. Personality factors were strong predictors of substance use frequency over the previous 30 days, as well as of substance use in daily life using ambulatory monitoring. A linear increase was also observed in the intensity of novelty seeking and antisocial personality traits as a function of the social deviance of substances used. However, mood disorder history was related only to the use of illicit drugs other than cannabis, and fluctuations in mood states did not prospectively predict daily use of substances in a manner consistent with self-medication. Moreover, there was little evidence that personality characteristics moderated relations between mood states and substance use in daily life. The relevance of results for mood and personality models of substance use etiology is discussed.

Outcomes from primary care management of alcohol dependence in France.

A prospective study assessed the outcome in a sample of 122 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol-dependent patients in primary care. Standardized questionnaires collected clinical, social, and management data during 875 visits over an 18-month follow-up. A time-event analysis identified outcome predictors. Forty-three percent of patients attempted at least one detoxification during follow-up, one out of three in a hospital. Despite a very high relapse rate (83%), only 14% of the patients attempted a repeated abstinence. Longest and cumulative durations of abstinence appeared to be very close, corresponding to 29% of the follow-up time. The frequency of visits (risk ratio [RR] = 1.08) and visits addressing alcohol consumption (RR = 1.73) significantly lead to detoxification. In this French sample, management by the general practitioners appears to be a positive predictor of outcome in alcohol dependence. Future research could (a) enlighten the relationship between detoxification and frequency or circumstances of the visits and (b) tell whether formal planned follow-up by general practice physicians could improve outcome in alcohol dependence.