Les représentations de la maladie : choix des outils de mesure et applications dans le champ du cancer

Objectif : Dresser un bilan des outils quantitatifs disponibles pour mesurer les représentations de la maladie et analyser leur utilisation empirique auprès de patients atteints de cancer.

Matériel et méthodes : Revue de la littérature.

Résultats : Sept outils de mesure des représentations de la maladie existent dont un spécifique au cancer. L’Illness Perception Questionnaire est utilisé dans 29 des 33 études retenues.

Conclusion : Associer ces échelles avec des méthodes reposant sur des approches davantage centrées sur le contexte socioculturel semble à privilégier.

Access to emergency care units by socially vulnerable patients: a qualitative research

Background

The increasing prevalence of chronic diseases, the decline in medical demography, the ramp up of new information and diagnosis technologies, together with the growing health social inequalities urge decision makers to rethink the access to emergency care units (ECU) and reduce the rate of multiple admissions, especially for people living in vulnerable conditions. Beyond the medical causes of access to ECU, it is crucial to understand the psychosocial representations of patients and health professionals.

Methods

23 socially vulnerable patients who have already been admitted within the last 3 months and ECU health/social professionals were interviewed face-to-face by a psychosocial scientist using a semi-directed approach, in 3 hospitals. The thematic content of data was analyzed in order to identify salient social representations of access to ECU.

Results

27 themes emerged to understand the issue of the access to ECU, joining into 5 main categories: perceived needs for access to ECU, perception of precariousness, the relationship of patients and professionals with the healthcare system, the shared experience of aggressiveness in ECU, expectations in post-emergency support. As regards the needs for access to ICU, several issues were identified: exemption from making upfront payments, needs for listening, support, reinsurance, privacy and consideration of emergency professionals, referral by general practitioners (GP), difficult access to GP, needs for immediacy and timely healthcare services, permanent opening of ECU. As regards the experience of ECU professionals: ambivalent emotions towards socially vulnerable patients, a recurrence of passages leading to a reduced medical attention, a feeling of failure to care for vulnerable patients, coping strategies in caring for these patients.

Conclusions

Our results bring several leads to improve the organization and the management of healthcare in ECU and in primary care for socially vulnerable patients.

Key messages

To identify the psychosocial rationales of access to emergency care units provides several leads to build a more efficient healthcare policy and reduce the burden of overloaded services. To reduce the overburden of emergency services can only be achieved by a global approach of the access to both emergency and primary care and a better support after emergency discharge.

Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia

BACKGROUND

Increasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless.

METHODS

In a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument.

RESULTS

Although the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets.

CONCLUSIONS

Less intrusive questions, more readily understandable vocabulary and greater relevance to subjects' living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward.

Time perspective and quality of life among HIV-infected patients in the context of HAART

We explored associations between time perspective (TP) and quality of life (QOL) among HIV-infected patients. With the French validated version of the Zimbardo Time Perspective Inventory, we evaluated the TP of patients. A self-administered questionnaire gathered information about QOL (WHOQOL-HIV), TP, relationship with medical staff and self-reported side effects of HAART. Six scores of QOL - physical, psychological, social relationship, environment, patient independence and spirituality were used as dependent variables in the linear regressions to identify factors associated with QOL. The sample (n=72) for this study was recruited from a hospital department specialising in HIV care and consisted of 48 (67%) HIV-infected women and 24 (33%) HIV-infected men with a mean age of 42 years. Using hierarchical regression analysis adjusted on socio-demographic characteristics, clinical characteristics and co-factors, significant relationships were observed between the several TP orientations and an impaired physical, environmental QOL as well as level-of-independence QOL. Specific dimensions of QOL are influenced by specific orientations of TP, which provides information on self-perception and subjective evaluation of QOL. The TP construct provides keys to managing HIV infection in order to improve QOL.

[Study of the social representations of drugs and cannabis: motivation for prevention]

Drugs and cannabis are two complex, multifaceted social objects. Two exploratory research projects were conducted from semi-directive interviews (n = 50) and questionnaires (n = 300) in order to investigate the social representations contained in these two objects according to both the social characteristics of individuals (gender, age) and their proximity to cannabis (consumption versus non-consumption). The study of their representations allows for emphasis to be placed upon the socio-cognitive reconstruction that individuals maneuver, reconstruction largely influenced by the social insertion of individuals but also by their method of cannabis consumption. Knowledge of these representations seems to be a tool for understanding the often complex realities linked to the world of drugs and allows for reflection upon more adapted prevention methods.

The 1999 Balkan war: changes in ratings of values and prowar attitudes among French students

This study investigated the association of Kosovo's 1999 war with a value rating of 56 female French students and links between values evaluated at two times (before and during the war) and attitudes towards the Balkan war. Subjects completed a survey of 15 values by means of a 9-point Likert-type scale one month before the beginning of the Balkan war (Time 1) and during the war, 3 mo. later (Time 2). Attitude towards the war was also measured by means of a 4-item scale completed at Time 2. Analysis indicated two slight unpredicted shifts: Universalism and Stimulation value-types were rated higher at Time 2 than at Time 1. Moreover, two value-types were consistently correlated both at Times 1 and 2 with prowar attitudes: conformity (r = .29 and .27) and universalism (r = -.29 and -.43). This latter result, consistent with our hypothesis, suggested that individuals' values represent modest but significant correlates of prowar attitudes.

The development of gender schemata about heterosexual and homosexual others during adolescence

Perceptions of heterosexual and homosexual individuals were investigated among 12-, 16-, and 20-year-old French adolescents. Participants described heterosexual and homosexual males and females with typical masculine and feminine personality traits. Overall, they perceived heterosexual males as having more masculine traits than homosexual males. The 16- and 20-year-olds perceived homosexual males as more feminine than heterosexual males, whereas the reverse was observed in 12-year-olds. Furthermore, the 12-year-olds perceived heterosexual females as more feminine than homosexual females, a difference that disappeared in the older age groups. Results support the view of early adolescence as a crucial period in the development of gender schemata about sexually significant others.

[Combined therapy of locally advanced squamous epithelial cancers in the area of the head and neck]

In an effort to improve treatment results in locally advanced squamous cell carcinoma of head and neck, we designed a multimodality treatment programme consisting of three cycles of inductive chemotherapy, after 2-3 weeks loco-regional therapy (surgery and/or radiotherapy), two more cycles of adjuvant chemotherapy with the same regimen were given finally. The chemotherapeutic regimen included cis-platinum 100 mg/m2 on day 1, 5-fluorouracil 100 mg/m2 on days 2-6 as a continuous infusion, bleomycin 15 units on days 15, 29; mitomycin-C 4 mg/m2 on day 2 and hydroxyurea 100 mg/m2 on days 22-26. From August 1984 onwards, 37 patients entered in this study. The group included 31 men and 6 women with a medium age of 54 (18-71) and a performance status of 80 (60-90). Primary sites were nasopharynx (13), oropharynx (5), hypopharynx (3), sinus (3), ethmoids (2), tongue (2), floor of the mouth (2), larynx (6) and unknown (1). 25 patients received 3 cycles of induction therapy whereas 22 completed the whole treatment programme. Following induction therapy, 28% of the patients demonstrated histologically confirmed CR, 40% PR and 32% SD, while after the full multimodality therapy 59% demonstrated CR, 36% PR and 5% SD. Follow-up is 9-36 months. Actual survival at 3 years is 80% for those with a CR post loco-regional therapy. Toxicities were leukopenia (40%), thrombocytopenia (20%), anaemia (40%), nausea and vomiting (60%), stomatitis (52%) diarrhoea (16%) and alopecia (79%). There was one death related to chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mixed tumors of the nasal cavity. Report of 2 cases]

Two cases of pleomorphic adenomas of the interior of the nose (minor salivary glands) are described. In one case a cylindroma was found. The rareness of this tumour in the interior of the nose and its treatment by lateral rhinotomy are discussed.

[Sarcoidosis of the larynx (author's transl)]

The isolated case of sarcoidosis of the larynx is very rare. We are referred to a case of histologically confirmed by the kweim-test of sarcoidosis of the false vocal cord. The problems of the case are discussed.

Liability of ultrasound in maxillary sinus disease

For the first time liability of of ultrasonography in diagnosing paranasal sinus disease was controlled in 256 patients with acute maxillary sinusitis as compared to irrigation findings and in 150 patients with persistent maxillary sinus disease using x-rays, sinoscopy and sinumanometry as controls. Confidence in diagnosing the presence of discharge ranges up 90%. In cases of total opacity of the sinus, ultrasonography helps differentiating mucosal swelling, tumor and discharge.