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Varela LE, Arias MM, Martorell-Poveda MA, Giraldo CV, Estrada-Acuña RA. Beyond the clinical context: the process of losing oneself living with Huntington's disease. Orphanet J Rare Dis 2022; 17:184. [PMID: 35526033 PMCID: PMC9077866 DOI: 10.1186/s13023-022-02330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People with Huntington's disease (HD) have increased functional and cognitive dependence. While numerous clinical, genetic, and therapeutic management studies have been carried out, few studies have investigated the disease from the personal experience and the context of people living with HD. To better serve these patients, our purpose is to understand, from the perspective of the patient and their families, how people with HD cope with their daily lives outside the clinical setting. METHODS Thirty-three affected or at-risk people participated in this study. Participants were interviewed at their homes on distinct occasions during a family visit. We analyzed the data using Grounded Theory, which allowed us to understand how people live with the disease on their own terms. RESULTS Living with HD is a process that begins with acceptance or denial that one is at risk for the disease or, growing awareness of the condition due to motor, behavioral, and cognitive changes, and, finally, loss of autonomy with physical dependence on another person, and loss of sense of self and family. CONCLUSION While the daily life of patients before disease onset was characterized by physical and mental/cognitive independence, with HD they become increasingly trapped in their bodies, and their complications are due to the lack of effective curable therapy.
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Affiliation(s)
| | | | | | - Clara V Giraldo
- Nursing Faculty, University of Antioquia, Medellín, Colombia
| | - Rosa A Estrada-Acuña
- Bio3Science Research Network, Belonging to Geography and Urban Studies, Temple University, Philadelphia, USA
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Feral-Pierssens AL, Toury G, Sehimi F, Peschanski N, Laribi S, Carpentier A, Kraif M, Carbonnier C, Duchateau FX, Freund Y, Juvin P. Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study. BMC Geriatr 2020; 20:355. [PMID: 32957921 PMCID: PMC7507819 DOI: 10.1186/s12877-020-01742-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources' use and patients' outcome. METHODS A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for "having difficulties coping at home". The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints. RESULTS One thousand one hundred sixty-eight patients were included, median age 86(83-89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68-2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65-1.30]). Assisted patients had a lower risk of being admitted for "having difficulties coping at home" (OR = 0.59;95%CI [0.38-0.92]). CONCLUSION Professional home services which assist one-third of elderly patients visiting EDs, were not associated to lower in-hospital mortality or to an increased admission rate. Assisted patients were associated to a lower risk of being admitted for «having difficulties coping at home».Professional home services could result in avoiding some admissions and their corollary complications. TRIAL REGISTRATION Clinicaltrial.gov - NCT02900391 , 09/14/2016, retrospectively registered.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France. .,IMProving Emergency Care academic federation, Paris, France. .,CR-CSIS, Université de Sherbrooke, Longueuil, Québec, Canada.
| | - Gustave Toury
- Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fatima Sehimi
- Emergency department, Saint-Antoine hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Peschanski
- Emergency department, Charles Nicolle University Hospital, Rouen, France
| | - Saïd Laribi
- Tours University, Tours, France.,Emergency department, Tours University Hospital, Tours, France
| | - Amélie Carpentier
- Emergency department and Emergency Medical Service, Jean-Bernard Hospital, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Magali Kraif
- Emergency department, La Timone hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Clément Carbonnier
- Sciences Po, LIEPP, Paris, France.,Chaire en fiscalité et finances publiques, Université de Sherbrooke, Longueuil, Canada
| | - François-Xavier Duchateau
- Emergency Medical Service, Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris, Garches, France
| | - Yonathan Freund
- IMProving Emergency Care academic federation, Paris, France.,Sorbonne Université, Paris, France.,Emergency department, Pitié-Salpétrière hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Philippe Juvin
- Emergency department, Georges Pompidou european hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,IMProving Emergency Care academic federation, Paris, France.,Université de Paris, Paris, France
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Vernerey D, Anota A, Vandel P, Paget-Bailly S, Dion M, Bailly V, Bonin M, Pozet A, Foubert A, Benetkiewicz M, Manckoundia P, Bonnetain F. Development and validation of the FRAGIRE tool for assessment an older person's risk for frailty. BMC Geriatr 2016; 16:187. [PMID: 27855641 PMCID: PMC5114762 DOI: 10.1186/s12877-016-0360-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/09/2016] [Indexed: 11/14/2022] Open
Abstract
Background Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults. Methods A prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially helped group (NFH, without any financial assistance), considering FH subjects are more frail than the NFH group and thus representing an acceptable surrogate population for frailty. Psychometric properties of the FRAGIRE grid were assessed including discrimination between the FH and NFH groups. Items reduction was made according to statistical analyses and experts’ point of view. The association between items response and tests with “help requested status” was assessed in univariate and multivariate unconditional logistic regression analyses and a prognostic score to become frail was finally proposed for each subject. Results Between May 2013 and July 2013, 385 subjects were included: 338 (88%) in the FH group and 47 (12%) in the NFH group. The initial FRAGIRE grid included 65 items. After conducting the item selection, the final grid of the FRAGIRE was reduced to 19 items. The final grid showed fair discrimination ability to predict frailty (area under the curve (AUC) = 0.85) and good calibration (Hosmer-Lemeshow P-value = 0.580), reflecting a good agreement between the prediction by the final model and actual observation. The Cronbach's alpha for the developed tool scored as high as 0.69 (95% Confidence Interval: 0.64 to 0.74). The final prognostic score was excellent, with an AUC of 0.756. Moreover, it facilitated significant separation of patients into individuals requesting for help from others (P-value < 0.0001), with sensitivity of 81%, specificity of 61%, positive predictive value of 93%, negative predictive value of 34%, and a global predictive value of 78%. Conclusions The FRAGIRE seems to have considerable potential as a reliable and effective tool for identifying frail elderly individuals by a public health social worker without medical training. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0360-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dewi Vernerey
- Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - Amelie Anota
- Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.,National clinical research Platform for Quality of life in Oncology, Besançon, France
| | - Pierre Vandel
- Department of psychiatry, EA 481, University Hospital of Besançon, Besançon, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - Michele Dion
- Centre Georges Chevrier «Knowledge: norms and sensitivities», UMR CNRS 7366, University of Burgundy, Dijon, France
| | - Vanessa Bailly
- Interregional Gerontology Pole from Burgundy and Franche-Comté, Dijon, France
| | - Marie Bonin
- Interregional Gerontology Pole from Burgundy and Franche-Comté, Dijon, France
| | - Astrid Pozet
- Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - Audrey Foubert
- Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | | | - Patrick Manckoundia
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.,Inserm/U1093 Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, Dijon, France
| | - Franck Bonnetain
- Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France. .,National clinical research Platform for Quality of life in Oncology, Besançon, France.
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Bahelah R, DiFranza JR, Ward KD, Fouad FM, Eissenberg T, Ben Taleb Z, Jaber R, Osibogun O, Maziak W. Correlates of nicotine dependence among adolescent waterpipe smokers. Drug Alcohol Depend 2016; 168:230-8. [PMID: 27716576 DOI: 10.1016/j.drugalcdep.2016.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Waterpipe smoking is addictive and its use is increasing globally among youth, yet little is known about the factors associated with nicotine dependence (ND) among waterpipe smokers. We investigated the factors associated with ND symptoms among a sample of Lebanese adolescents who smoke a waterpipe. METHODS We collected data on factors potentially associated with ND (individual, socio-demographic, environmental, smoking patterns) among 160 current (past 30days) waterpipe smokers recruited from 8th and 9th school grades in Lebanon. We assessed the loss of autonomy over tobacco using the Hooked on Nicotine Checklist (HONC), ND using the International Classification of Diseases, 10th revision (ICD-10), and the number of ND symptoms endorsed. RESULTS Depressive symptoms, lower self-esteem, and having at least one sibling who smokes a waterpipe were associated with the presence of ND symptoms, while enrollment in public schools, smoking a waterpipe ≥30min per session, and believing that cigarette smoking is harmful to health were associated with endorsement of a higher number of ND symptoms. Smoking a whole waterpipe head without sharing and being in 9th grade in this study were associated with the presence and endorsement of a higher number of ND symptoms. CONCLUSIONS We identified specific social and psychological characteristics, waterpipe smoking patterns, and beliefs about harmful effects of smoking associated with the presence of ND among adolescent waterpipe smokers. Considering these factors when planning policies to prevent ND among waterpipe smokers is warranted.
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