[Pain within the healthcare team, a source of dyscommunication]

The subjective nature and complexity of the pain phenomenon make it a difficult symptom to take into consideration, regardless of where the patient is being cared for, leading to multiple sources of dyscommunication between professionals. Despite the undeniable progress that has been made, this recurring theme has received little attention in the professional literature. It is therefore worthwhile analyzing the causes of these relational problems and proposing avenues of reflection and work that could help remedy them.

Some Questions Raised by the Practice of Online Analysis

In this paper the author explores some of the issues raised by the practice of online analysis. In particular, he emphasizes the difference between the setting and the frame and proposes a theoretical approach of the latter as emerging within the transferential dynamic.

Devouring and Asphyxia: Paradigm Crisis, the Depletion of the Hero and Complex Thought1

This article deals with the profound paradigm crisis that affects modernity and threatens the destiny of humanity. This crisis results from the lack of perspective offered by the paradigm of modernity with its emphasis on unilateral rationality, scientific objectivity, and exploitation of natural resources by a hyper development of an inflated Hero archetype. The emergence of a new paradigm of complexity, C. G. Jung's complex psychology, and Ameridian perspectivism, may offer new paths to approach these serious problems lived by modern man. A clinical vignette illustrates how complex psychology may also help with individual patients suffering from psychosomatic complaints.

[Suspension of judgment, play and creativity in helping relationships]

The relational field does not only concern psychiatric professionals. A school teacher has carried out a university research work on the specificity of the psychic processes which are the basis of the helping relationship. Situations experienced in a kindergarten class describe the relational complexity involved, as well as the questioning and doubts of the professional. Finally, constructive approaches propose alternatives for maintaining the link in the relationship.

Cross-sectional Study of Prevalence and Correlates of Urinary Incontinence in Older Home-Care Clients With Type 2 Diabetes in Ontario, Canada

OBJECTIVES

Urinary incontinence (UI) is a burdensome condition for older adults with diabetes receiving home-care services, yet little is known about the prevalence and correlates of UI in this population. The objective of this cross-sectional study, informed by a complexity model, was to determine the prevalence and correlates of UI in older adults with diabetes receiving home care in Ontario, Canada.

METHODS

In this study, we analyzed population-level data of the most recently completed Resident Assessment Instrument for Home Care from 2011 to 2016 for older (≥65 years) home-care clients with diabetes. Older adults with daily or multiple daily episodes of UI were compared with adults who were continent or had less than daily UI on sociodemographic, functional, psychosocial and clinical variables. Multiple logistic regression was used to determine correlates of UI in this population.

RESULTS

Of 118,519 older adults with diabetes, 39,945 (33.7%) had daily or multiple daily episodes of UI. Correlates of UI included: impaired function in activities of daily living (odds ratio [OR], 5.31; 95% confidence interval [CI], 5.14‒5.50), cognitive impairment (OR, 2.37; 95% CI, 2.28‒2.47), female sex (OR, 1.87; 95% CI, 1.82‒1.93), multiple (≥2) chronic conditions (OR, 1.83; 95% CI, 1.74‒1.93), presence of a distressed caregiver (OR, 1.31; 95% CI, 1.27‒1.35), making economic trade-offs (OR, 1.23; 95% CI, 1.11‒1.34) and falls (OR, 1.22; 95% CI, 1.19‒1.26).

CONCLUSIONS

Urinary incontinence is common among older adults with diabetes using home-care services. Targeted interventions are required to address the social, functional and clinical factors associated with UI in this population.

[Occupational activities or therapeutic activities, a complex distinction]

The distinction between therapeutic activities and occupational activities seems obvious. On what is this difference based? How can we predict whether an activity will or will not be therapeutic? Using the question of the meaning of our activities as a basis, we can consider what care in psychiatry entails.

[Families and psychiatry: models and evolving links]

The role of the families of persons with severe psychiatric disorders (schizophrenia in particular) in the care of their relatives has recently evolved: once seen as pathogenic to be kept at a distance, the family is now recognised by professionals as a partner in the care process. The links between families and psychiatric institutions remain complex and marked by ambivalence and paradoxes.