The roles of French community pharmacists in palliative home care

BACKGROUND

The World Health Organization identifies pharmacists as a key resource in palliative care. However, the roles of these professionals in end-of-life care at home remain poorly understood, and community pharmacists themselves sometimes struggle to recognize their true role in this care. The aim of our study was to analyze community pharmacists' representations of their roles in palliative care at home in France.

METHODS

The methodology was qualitative and based on semi-structured interviews with community pharmacists (n = 26). The analysis of the interviews was carried out using a qualitative content approach with thematic and lexical analysis.

RESULTS

Three main elements of the community pharmacist's role were identified: drug expertise, care management, and psychosocial support for patients and their families.

CONCLUSIONS

This study highlights a wide variety of roles adopted by French community pharmacists in palliative care at home. Some of these roles, which are in line with WHO recommendations on palliative care, have been little described to date. These roles of community pharmacists in home-based palliative care could be better recognized, and the players better integrated into end-of-life care systems at home, in order to improve such care.

TRIAL REGISTRATION

This work was carried out within the framework of a call for projects from the Fondation de France and has received the approval of the University Clermont Auvergne Research Ethics Committee (no. IRB00011540-2021-60).

The Prospective Effects of Coping Strategies on Mental Health and Resilience at Five Months after HSCT

OBJECTIVES

Hematopoietic stem cell transplantation (HSCT) is a stressful event that engenders psychological distress. This study examines the prospective effects of coping strategies during hospitalization on resilience and on various mental-health dimensions at five months after transplantation.

METHODS

One hundred and seventy patients (M_age = 52.24, SD = 13.25) completed a questionnaire assessing adjustment strategies during hospitalization, and 91 filled out a questionnaire five months after HSCT (M_age = 51.61, SD = 12.93).

RESULTS

Multiple regression analyses showed that a fighting spirit strategy positively predicted resilience (p < 0.05), whereas anxious preoccupations predicted anxiety (p < 0.05), poorer mental QoL (p < 0.01), and were associated with an increased risk of developing PTSD (OR = 3.27, p < 0.01; 95% CI: 1.36, 7.84) at five months after transplantation. Hopelessness, avoidance, and denial coping strategies were not predictive of any of the mental health outcomes. Finally, the number of transplantations was negatively related to a fighting spirit (p < 0.01) and positively related to hopelessness-helplessness (p < 0.001): Conclusions: These results highlight the importance of developing psychological interventions focused on coping to alleviate the negative psychological consequences of HSCT.

Psychological resources and flexibility predict resilient mental health trajectories during the French covid-19 lockdown

The implementation of lockdowns and the Covid-19 pandemic situation have negatively impacted mental health (anxiety, depression). However, little is known about individual differences in the longitudinal reactions to lockdown. We designed a longitudinal study (a) to identify the various trajectories of symptoms of depression and anxiety in the general population during and after lockdown; (b) to determine which positive psychological resources prevent individuals from falling into groups with the most severe trajectories; (c) to test the mediating role of psychological flexibility. We collected and analysed longitudinal data on a sample of French participants (N = 1399, M_age = 43.4; SD_age = 12; 87.8% women) during the end of the first lockdown. Participants were asked to report their psychological resources and (in)flexibility at baseline and symptoms of anxiety and depression at each measurment occasion (five weekly observations from 17 March to 11 May 2020, including baseline). Using growth mixture modelling, seven dynamic profiles of symptoms were identified: four for depression and three for anxiety. Resilience emerged as the most frequent trajectory. Wisdom, optimism, hope, self-efficacy and peaceful disengagement significantly prevented individuals from belonging to the symptomatic groups. Moreover, psychological flexibility emerged as a significant mediator of these effects. This study highlights the importance of cultivating protective factors and psychological flexibility to prevent mental health damage during potentially traumatic events (PTE) and to favour resilience trajectories.

Basic human values during the COVID-19 outbreak, perceived threat and their relationships with compliance with movement restrictions and social distancing

This study examines the evolution of Schwartz's Basic Human Values during the COVID-19 outbreak, and their relationships with perceived threat, compliance with movement restrictions and social distancing. An online questionnaire was administered to a heterogeneous sample of French citizens (N = 1025) during the first French lockdown related to the outbreak. Results revealed a significant evolution of values; the conservation value was higher during the outbreak than usual, and both self-enhancement and openness-to-change values were lower during the COVID-19 outbreak than usual. Conservation and perceived threat during the outbreak were robustly and positively related to both compliance with movement restrictions and social distancing. Conservation during the outbreak emerged as a significant partial mediator of the relationship between perceived threat and outcomes (i.e., compliance with movement restrictions and social distancing). Implications of these results for the malleability of values and the COVID-19 modelling are discussed.

Selflessness and Happiness in Everyday Life

Abstract. Using the experience sampling method (ESM), this study examines the relationship between experienced selflessness and experienced happiness. Based on the self-centered/selflessness happiness model (SSHM), we hypothesized that: (a) these two constructs would be positively related and (b) harmony feeling would mediate this relation. Using ESM, the participants ( N = 63) filled in a short survey, five times a day during 2 days (response rate = 79.2%; 482 observations). A linear mixed-model analysis showed that selflessness and harmony feelings were significant predictors of happiness. Finally, a mediation analysis indicated that harmony feeling emerged as a significant mediator of the relationship between selflessness and happiness at the experienced level. Overall, the study supports the idea that happiness does not depend solely on the satisfaction of one’s expectations but experiencing the self as an interdependent and relational entity also plays an important role. The implications of this study are discussed.

Authoritarian attitudes are associated with higher autonomic reactivity to stress and lower recovery

Right-wing authoritarianism (RWA) and social dominance orientation (SDO) both predict generalized prejudice, dehumanization, intergroup discrimination, oppression, violence, right-wing political party preference, and generally punitive attitudes. Authoritarian attitudes have been theorized to involve maladaptive emotional, cognitive, and social self-regulation. However, there is no study of authoritarianism using the functioning of the parasympathetic nervous system (PNS) as a physiological index of self-regulation, thus leaving it unclear whether regulation is "impaired" with authoritarian attitudes per se. PNS functioning is commonly assessed by examining tonic and phasic heart rate variability (HRV). These two components are recognized to be important in terms of adaptation to stress. Decreased HRV has been associated with hypoactive prefrontal regulation, hyperactive subcortical structures, maladaptive self-regulation, hyper-vigilance, decreased prosocial tendencies, defensiveness, impulsive behaviors, and aggression. Previous research suggests that self-regulatory failure may favor hostile attitudes and prejudicial intergroup behaviors. In a first study, we found that high RWA was associated with lower tonic HRV at rest. In a second study, stress-induced autonomic reactivity and poststress autonomic recovery were examined as potential pathways linking authoritarian attitudes to self-regulation. We found that high RWA and high SDO were associated with (i) lower tonic HRV during stress, (ii) greater autonomic reactivity during stress, and (iii) lower autonomic recovery. Overall, our results suggest that autonomic dysregulation during and following stress is a plausible physiological pathway connecting RWA and SDO to self-regulation. Implications of such results for research on political attitudes are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reliability and validity of an equanimity questionnaire: the two-factor equanimity scale (EQUA-S)

Background

Many studies have revealed the positive impact of mindfulness training on mental health and proposed equanimity as a general outcome in contemplative research. Despite recent interest, relatively few studies have empirically examined equanimity and measurement instruments are still lacking. The main goal of this study was to develop an Equanimity Scale (the EQUA-S) in a Western population with or without meditation experience, based on previous definitions of equanimity, in order to investigate its relations with the relevant psychological constructs and health outcomes.

Methods

Adults from the general population (N = 265; M _age = 34.81) completed various measures: the EQUA-S, mindfulness, hyper-sensitivity, avoidance and fusion, impulsivity, personality, alexithymia, sensitivity to punishment and reward and frequency of problematic addictive behaviors. The dimensionality of the EQUA-S was examined using Factor Analyses. The convergent validity of this new scale was investigated using Pearson's Correlations.

Results

The results of a factor analysis revealed two dimensions of equanimity: an even-minded state of mind (E-MSM) and a hedonic independence (HI) component. While the E-MSM was positively related to emotional stability, adaptive emotional regulation and several mindfulness-related abilities, HI was found to correlate negatively with addictive issues.

Discussion

The relations with personality constructs and possible related cognitive processes are discussed.

Effects of Mindfulness Meditation on Self-Transcendent States: Perceived Body Boundaries and Spatial Frames of Reference

Objectives

Mindfulness training is believed to encourage self-transcendent states, but little research has examined this hypothesis. This study examined the effects of mindfulness training on two phenomenological features of self-transcendence: 1) perceived body boundary dissolution, and 2) more allocentric spatial frames of reference.

Methods

A sample of healthy, young adults (n=45) were randomized to five sessions of mindfulness training or an active listening control condition.

Results

Results indicated mindfulness training decreased perceived body boundaries (F _4,172=6.010, p<.001, η ²=.12) and encouraged more allocentric frames of reference (F _4,168=2.586, p=.039, η ²=.06). The expected inverse relationship was observed between perceived body boundaries and allocentric frames of reference ((β=-.58, p=.001)), and path analysis revealed the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries (β=.24, se=.17, CI: 0.11 to 0.78).

Conclusions

Taken together, study results suggest that mindfulness training alters practitioners' experience of self, relaxing the boundaries of the self and extending the spatial frame of reference further beyond the physical body. Future studies are needed to explore the psychophysiological changes that co-occur with phenomenological reports of self-transcendence and the behavioral consequences following self-transcendent experiences.

Suicide among physicians and health-care workers: A systematic review and meta-analysis

Background

Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers.

Method

The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet).

Results

The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I² = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers.

Conclusion

Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

Importance of considering interoceptive abilities in alexithymia assessment

Background

Recent studies have shown that people with high alexithymia scores have decreased interoceptive abilities, which can be associated with psychological and physical disorders. Early assessments of the alexithymia trait included the evaluation of these abilities through the dimension measuring the difficulty in identifying and distinguishing between feelings and bodily sensations (the 26-item Toronto Alexithymia Scale; TAS-26). The revised version of the TAS, the TAS-20, contains a three-factor solution that does not involve a dimension assessing interoceptive abilities. However, the three items allowing the evaluation of these abilities are still present in the TAS-20. In this context, we hypothesized that the 3 items which assess interoceptive abilities in the TAS-20 should constitute an independent factor. In addition to exploring the internal structure of the TAS-20, we examined its external validity by assessing the relationships between the new factors and self-reported measures of personality trait and psychological and physical health.

Method

Two online studies (N = 253 and N = 287) were performed. The participants completed the TAS-20 and a set of psychological questionnaires (e.g., anxiety, depression) and health questions (e.g., “Do you suffer from a somatic disorder?”). The structure of the TAS-20 was examined using exploratory factor analysis (EFA), followed by an investigation of the relationships between the resulting new factors and other psychological and health data using regressions. In both studies, EFA revealed a new structure of the questionnaire consisting of four dimensions: (1) difficulty in the awareness of feelings, (2) externally oriented thinking, (3) difficulty in interoceptive abilities, and (4) poor affective sharing. The first factor was positively associated with all self-reported psychological and personality trait measures while the third factor was associated more with somatic disorders and medication intake.

Results

Our results suggest the presence of a new latent factor in the assessment of alexithymia that reflects interoceptive abilities specifically related to health and personality trait outcomes. In accordance with the results and the literature, it seems important to include an assessment of interoceptive abilities when considering the evaluation of alexithymia. The next step would be to develop a valid measure of these abilities.

[Seroprevalence of Toxoplasmosis among Pregnant Women in Benin: Meta-Analysis and Meta-Regression]

To assess the seroprevalence of toxoplasmosis among pregnant women in Benin, we conducted a meta-analysis using the PRISMA criteria. Al research published between 1990 and 2018 on toxoplasmosis among pregnant women Benin were eligible. A total of five databases were investigated, and the extracted data were subjected to a meta-analysis under R 3.1 using both random effect model and fixed effect model. The overall prevalence of toxoplasma-specific IgG among pregnant women was 47% (CI 95%: 40-53) and that of specific IgM was 2% (CI 95%: 1-3). The infection rate in urban areas (52%) was significantly higher than in rural areas (33%). The two main risk factors identified by the various eligible studies were the age of the pregnant women and the consumption of raw vegetables. We show that toxoplasmosis is endemic in pregnant women in Benin, implying that primary prevention measures must be put in place by the competent authorities to control this infection.

Blood pressure and psychological distress among North Africans in France: The role of perceived personal/group discrimination and gender

OBJECTIVES

The purpose of this study was to examine the associations between perceived ethnic discrimination and (physical and mental) health indicators among North African women and men living in France.

METHODS

This study included 82 North Africans, aged 18-64 years. Perceived discrimination was measured at both group level (PGD) and personal level (PPD). The physical health indicator was blood pressure. The mental health indicator was self-reported psychological distress.

RESULTS

Multiple regression analyses showed that higher levels of PGD predicted higher blood pressure. PPD was not related to blood pressure. PPD was positively related to psychological distress among women, but not among men.

CONCLUSION

PPD and PGD are associated with physical and mental health indicators in different ways among North African women and men in France.

Self-centeredness and selflessness: happiness correlates and mediating psychological processes

The main objective of this research was to test central assumptions from the Self-centeredness/Selflessness Happiness Model. According to this model, while self-centered psychological functioning induces fluctuating happiness, authentic–durable happiness results from selflessness. Distinct mediating processes are supposed to account for these relationships: afflictive affects (e.g., anger, fear, jealousy, frustration) in the case of the former, and both emotional stability and feelings of harmony in the case of the latter. We tested these hypotheses in two studies based on heterogeneous samples of citizens (n = 547). Factor analyses revealed that self-centeredness (assessed through egocentrism and materialism) and selflessness (assessed through self-transcendence and connectedness to other) were two distinct psychological constructs. Second, while self-centeredness was positively and significantly related to fluctuating happiness, selflessness was positively and significantly related to authentic–durable happiness. Finally, distinct psychological processes mediated these relationships (study 2). On one hand, the relationship between self-centeredness and fluctuating happiness was fully mediated by afflictive affects. On the other hand, emotional stability and the feeling of being in harmony partially mediated the relation between selflessness and authentic–durable happiness.

Destructive Obedience Without Pressure

Abstract. Studies on obedience to authority highlight the power of the situation by showing how an experimental setting can trap participants and force them to commit acts contrary to their values ( Bocchiaro & Zimbardo, 2010 ). The source of obedience has generally been represented by an institutional scientific authority. In the present experiment, we tested a more widespread form of authority: a managerial authority implemented in the form of an administrative violence paradigm ( Meeus & Raaijmakers, 1986 ). Specifically, we compared two forms of authority: obedience to authority as manipulated by Meeus and Raaijmakers (1986) , where the requests are made in an authoritarian manner, and compliance without pressure, where the participant is told that he is free to do what is requested ( Enzle & Harvey, 1982 ). The results illustrate that a substantial level of obedience can be elicited even in the absence of explicit authoritarian pressure.

Mindfulness meditation and relaxation training increases time sensitivity

Two experiments examined the effect of mindfulness meditation and relaxation on time perception using a temporal bisection task. In Experiment 1, the participants performed a temporal task before and after exercises of mindfulness meditation or relaxation. In Experiment 2, the procedure was similar than that used in Experiment 1, except that the participants were trained to mediate or relax every day over a period of several weeks. The results showed that mindfulness meditation exercises increased sensitivity to time and lengthened perceived time. However, this temporal improvement with meditation exercises was primarily observed in the experienced meditators. Our results also showed the experienced meditators were less anxious than the novice participants, and that the sensitivity to time increased when the level of anxiety decreased. Our results were explained by the practice of mindfulness technique that had developed individuals' abilities in devoting more attention resources to temporal information processing.

Systematic screening for PRKAR1A gene rearrangement in Carney complex: identification and functional characterization of a new in-frame deletion

BACKGROUND

Point mutations of the PRKAR1A gene are a genetic cause of Carney complex (CNC) and primary pigmented nodular adrenocortical disease (PPNAD), but in 30% of the patients no mutation is detected.

OBJECTIVE

Set up a routine-based technique for systematic detection of large deletions or duplications of this gene and functionally characterize these mutations.

METHODS

Multiplex ligation-dependent probe amplification (MLPA) of the 12 exons of the PRKAR1A gene was validated and used to detect large rearrangements in 13 typical CNC and 39 confirmed or putative PPNAD without any mutations of the gene. An in-frame deletion was characterized by western blot and bioluminescence resonant energy transfer technique for its interaction with the catalytic subunit.

RESULTS

MLPA allowed identification of exons 3-6 deletion in three patients of a family with typical CNC. The truncated protein is expressed, but rapidly degraded, and does not interact with the protein kinase A catalytic subunit.

CONCLUSIONS

MLPA is a powerful technique that may be used following the lack of mutations detected by direct sequencing in patients with bona fide CNC or PPNAD. We report here one such new deletion, as an example. However, these gene defects are not a frequent cause of CNC or PPNAD.