Un pilote avec groupe témoin : effets de la méditation de pleine conscience sur la qualité de vie, le sommeil et l’humeur chez des adolescents atteints de cancer

L’annonce d’un diagnostic de cancer provoque souvent une forte réaction émotionnelle et un stress important tant chez les adultes que chez les adolescents et leurs parents. Certains d’entre eux cherchant à soulager cette détresse se tournent vers des méthodes alternatives positives de gestion de stress, dans le but d’atténuer les effets psychologiques indésirables du cancer. Les thérapies ciblant à la fois le corps et l’esprit gagnent en popularité dans ces populations. Une avenue prometteuse est la méditation de pleine conscience (MPC), inspirée de la philosophie bouddhiste et adaptée dans le cadre d’interventions thérapeutiques pour améliorer la qualité de vie des patients souffrant de maladies chroniques. À ce jour, des études dans le domaine de la santé ont suggéré que la MPC pouvait avoir des effets bénéfiques sur les symptômes et la gestion de plusieurs maladies chroniques dont le cancer, faisant d’elle une avenue thérapeutique intéressante dans le traitement des effets psychologiques indésirables liés à ces maladies. La recherche émergente en pédiatrie suggère des effets comparables chez les enfants et adolescents. L’objectif de la présente thèse a été de développer un essai clinique randomisé visant à évaluer les effets de la MPC sur la qualité de vie, le sommeil et l’humeur chez des adolescents atteints de cancer, en documentant les étapes d’implantation du projet, les embuches qui ont été rencontrées durant son implantation et les résultats obtenus. La thèse est présentée sous la forme de deux articles scientifiques. Le premier article présente la méthodologie qui avait été planifiée pour ce projet mais qui n’a pu être réalisée en raison d’embuches rencontrées dans la complétion de ce pilote. Ainsi, les étapes préliminaires du développement de ce projet de recherche, en accordant une place prépondérante au manuel d’intervention rédigé à cette fin. La mise en place et la structure de ce projet, nommément le devis méthodologique employé, la taille d’échantillon visée, les méthodes de recrutement mises en place et les stratégies de randomisation prévues, sont décrites en détail dans cet article. Pour les fins de ce projet, un manuel d’intervention de MPC a été rédigé. L’intervention en MPC, menée par deux instructeurs formés en MPC, s’est échelonnée sur une durée de huit semaines, à raison d’une séance d’une heure trente par semaine. Une description détaillée de chaque séance est incluse dans cet article, dans un but de dissémination du protocole de recherche. Des analyses intragroupe serviront à évaluer l’impact de l’intervention en méditation de pleine conscience sur la qualité de vie, le sommeil et l’humeur pré-à-post intervention et au suivi à six mois. Des analyses intergroupes prévues sont décrites afin de comparer les effets de l’intervention entre les participants du groupe contrôle et du groupe expérimental. Les limites potentielles de ce projet, notamment la participation volontaire, le risque d’attrition et la petite taille d’échantillon sont décrites en détail dans cet article. Le deuxième article présente, dans un premier temps, le déroulement du projet de recherche, en mettant en lumière les embuches rencontrées dans son implantation. Ainsi, les leçons à tirer de l’implantation d’un tel essai clinique en milieu hospitalier au Québec sont décrites selon trois axes : 1) les défis liés au recrutement et à la rétention des participants; 2) l’acceptabilité et la compréhensibilité de l’intervention en pleine conscience; et 3) le moment où l’intervention s’est déroulée (timing) et l’impact sur l’engagement requis des participants dans le projet. Durant une période de recrutement de neuf mois, 481 participants potentiels ont été filtrés. 418 (86,9 %) d’entre eux ont été exclus. 63 participants potentiels, vivant à moins d’une heure de Montréal, ont été approchés pour prendre part à ce projet. De ce nombre, seulement 7 participants (1,4%) ont accepté de participer aux rencontres de MPC et de compléter les mesures pré-post intervention. Un bassin d’éligibilité réduit, ainsi que des taux de refus élevés et des conflits d’horaire avec les activités scolaires ont eu un impact considérable sur la taille d’échantillon de ce projet et sur l’absentéisme des participants. Malgré l’intérêt manifeste des équipes médicales pour la recherche psychosociale, les ressources requises pour mener à terme de tels essais cliniques sont trop souvent sous- estimées. Les stratégies de recrutement et de rétention des participants méritent une attention spéciale des chercheurs dans ce domaine. Dans un deuxième temps, le deuxième article de cette thèse a pour objectif de présenter les résultats de l’intervention en MPC chez des jeunes ayant le cancer, en examinant spécifiquement l’impact de l’intervention sur la qualité de vie, le sommeil et l’humeur des jeunes pré-post intervention et lors du suivi à six mois. Faisant écho aux embuches décrites préalablement décrites, les analyses statistiques n’ont permis de déceler aucun effet statistiquement significatif de notre intervention. Aucune différence significative n’est notée entre les participants du groupe expérimental et les participants du groupe contrôle. Les difficultés rencontrées dans de la complétion des devoirs et de la pratique de techniques de méditation entre les séances, décrites en détail cet article, expliquent en partie ces résultats. Globalement, le contexte développemental spécifique à l’adolescence, ayant possiblement eu un impact sur l’adhérence des participants à la thérapie proposée et à leur motivation à prendre part aux rencontres, les scores sous-cliniques lors du premier temps de mesure, l’impact du soutien social inhérent au contexte de thérapie de groupe, ainsi que les caractéristiques personnelles des thérapeutes, pourraient avoir influencé les résultats de ce pilote. Les résultats de ce projet pilote nous laissent croire que la prudence est de mise dans la généralisation des bienfaits et de l’efficacité de la pleine conscience observés chez les adultes atteints de cancer dans son application aux adolescents en oncologie. En conclusion, la présente thèse contribue à enrichir la recherche dans le domaine de la MPC chez les jeunes en questionnant néanmoins la pertinence d’une telle intervention auprès d’une population d’adolescents souffrant de cancer. Ainsi, il convient d’analyser les résultats obtenus en tenant compte des limites méthodologiques de ce projet et de poser un regard critique sur la faisabilité et la reproductibilité d’un projet d’une telle envergure auprès d’une même population. Les leçons tirées de l’implantation d’un tel projet en milieu hospitalier pédiatrique se sont avérées d’une importance centrale dans sa complétion et feront partie intégrante de toute tentative de réplication. D’autres essais cliniques de cette nature seront inévitablement requis afin de statuer sur l’efficacité de la MPC chez des adolescents atteints cancer et sur la faisabilité de l’implantation de cette méthode d’intervention auprès d’une population pédiatrique hospitalière.

Continuation and discontinuation of local institution in community based natural resource management

Currently the push toward frontier areas, which until twenty years ago were still largely untouched by commercial agriculture, is taking place on a massive scale. This push is being driven not the least by global economic developments, such as the price increase of agriculture commodities like coffee and cocoa. In most cases the indigenous communities become trapped between the state monopoly in natural resource management and the competition for resources by external actors. In this processes the indigenous communities start to lose their access to resources. Another victim in this process is the environment where the natural resources are imbedded. International and national organizations working to conserve environment have became conscious of the important role that indigenous people could fulfill as partners in this endeavour. This partnership in struggle has produced a new discourse on the relationship between indigenous people and their environment. As a further consequence, programs were set up to develop what became known as Community Based Natural Resource Management (CBNRM) with its numerous variations. Based on a case study in a village on the eastern border of the Lore Lindu National Park in Central Sulawesi, this study questioned the basic assumption behind the concept of Community Based Natural Resource Management (CBNRM). Namely the assumption that communities living at the margin of forest are socially and culturally homogenous, still more or less egalitarian, and basically living in harmony with their natural environment. This study was inspired by the persistent critique – although still a minority – on the basic assumption the CBNRM from academicians and practitioners working through the Entitlement perspective. Another inspiration was the mounting critique toward the participatory approach. In its effort the study explore further the usefulness of certain approaches. One of the approach much relied on in this study was the local history of the community studied, through exerting oral and local written documents on local history, legends and local stories. These sources proofed quite capable in bringing the local history into the light. Another was the actor oriented approach, which later came to be supported by the concept of Social Pool Resources. The latter concept proofed to be useful as analytical instrument to integrate social institutions and the common pool resources, as a field of action for the different actors as human agencies.

Gestor de contenidos del geoportal de la IDE del Calbildo Insular de la Palma

Dos de los problemas más comunes presentes en las Administraciones que gestionan Información Territorial a través de una IDE, son la dificultad de que los técnicos para gestionar y actualizar la información, y la dependencia tecnológica de terceros. Parte del problema de la actualización y gestión de la información lo hemos solucionado con el desarrollo de un Gestor de Contenidos del Geoportal y de los servicios WMS, que se liberará como software libre. El Gestor funciona a través de una navegador web estándar donde el usuario, tras validarse, accede a la configuración y publicación de servicios que le permite entre otras: crear nuevos WMS, gestionar los WMS existentes, gestionar las capas del Geoportal, generar leyendas, gestionar usuarios, etc. De este modo, un usuario no técnico y sin conocimientos avanzados de geomática puede publicar capas como servicios WMS sin dificultad

Tradició i llegenda: Sant Narcís i les mosques

Presentació d’un dossier que tracta l’acostament crític a la figura del bisbe Narcís i als prodigis que li han estat atribuïts, així com a la producció historiogràfica i artística que ha generat el mite

Mosques, sants i política a la Catalunya moderna. L’episodi del setge de 1653

Repàs de les posteriors referències en documents d’arxiu al miracle de les mosques als setges de Girona

Mindfulness en psicoterapia

Tradicionalmente, en la cosmovisión budista la práctica de mindfulness ha sido un elemento central tendiente a producir un cambio radical en la conciencia de quien la práctica. Al introducirse mindfulness en la cultura de occidente, lo hace a través del camino de la psicología, en donde gran parte de su uso es difundido desde una perspectiva funcional, incluyendo la operacionalización del término y algunos rasgos de comprensión occidental que lo catalizan como una herramienta útil en la consecución de objetivos psicoterapéuticos, principalmente. La presente revisión aborda mindfulness desde su contexto budista, y su paso a occidente, mencionando aspectos imprescindibles de su aplicación en la psicoterapia, la neurociencia, la ciencia en general y además, las implicaciones de su uso.

Los estados modificados de conciencia y su uso en la psicología contemporánea

La conciencia, sus diversos estados y las propiedades específicas de estado han sido materia de indagación en prácticamente todas las culturas. Como producto de ello, se han generado multiplicidad de perspectivas sobre el valor de estos estados de conciencia y sobre los modos adecuados de producirlos y utilizarlos. A éstos últimos se les conoce como prácticas de transformación o tecnologías de la conciencia. En el presente trabajo, luego de presentar las posturas contemporáneas básicas utilizadas para el estudio de la conciencia, se revisan las concepciones que sobre ella surgen desde la psicología transpersonal y en el budismo mahayana. Le sigue la presentación del concepto de estados y estados alterados de conciencia en la psicoterapia. Tras discutir la noción de prácticas de transformación de la conciencia se concluye con una presentación más detallada de la meditación y la oración como ejemplos de tecnologías de conciencia utilizadas como medio de sanación y de crecimiento personal.

LEGENDiary: web 2.0 y app móvil

LEGENDiary es un geoportal 2.0 que permite compartir y explorar las leyendas y cuentos característicos de las ciudades de una manera dinámica y colaborativa. Muchas veces las leyendas forman parte de la historia y cultura de nuestros pueblos o ciudades, LEGENDiary nos permite conocerlas según el territorio donde se ubican. La iniciativa promueve nuevas formas de conocer y explorar el territorio, en general, y las leyendas y cuentos de nuestros pueblos y ciudades, en particular. Un proyecto que permite a los usuarios interactuar y ser protagonistas de esta experiencia. El proyecto parte inicialmente de un contexto español, y se trata de un proyecto hecho a medida de todas aquellas personas interesadas y con curiosidad en compartir, conocer y explorar las leyendas en el territorio. La combinación de las Tecnologías de la Información Geográfica y las Tecnologías 2.0 es el escenario donde surge LEGENDiary, aportando la componente geográfica a las leyendas y cuentos de los pueblos y ciudades en un contexto colaborativo. La iniciativa se lanza el día 16 de noviembre de 2011 en formato concurso con motivo del Día Internacional de los Sistemas de Información Geográfica (GISDay). Para llevar a cabo la aplicación se han utilizado dos librerías Javascript (Leaflet y jQuery) de código abierto y gratuito que permiten crear de forma rápida y ligera aplicaciones de mapas interactivos a través de navegadores web (de escritorio y móvil). Como mapa base se ha utilizado Open Street Map.LEGENDiary es una iniciativa del Servicio de SIG y Teledetección (SIGTE) de la Universidad de Girona en colaboración con el Departamento de Geografía y la Facultad de Turismo de la misma universidad, y con elapoyo del Hotel Llegendes de Girona

Escola Mãe Hilda: um estudo sobre a pedagogia da (re)construção da identidade negra

RESUMO: Objetivo - apresentar o contributo da Escola Mãe Hilda para a afirmação da identidade afro-brasileira na população estudantil da Cidade do Salvador. Especificamente: a) conhecer os fundamentos pedagógicos-curricular da Escola Mãe Hilda; b) analisar os materiais didáticos utilizados pela Escola Mãe Hilda; c) apresentar as metodologias de trabalho da Escola Mãe Hilda. Metodologia - quanto ao percurso metodológico, em razão da questão básica desta dissertação, optou-se por realizar pesquisa qualitativa de natureza etnográfica, envolvendo uma abordagem empírica voltada para a abordagem de distúrbios identitários, em suas diversas dimensões na auto-estima de afro-descendentes. Foram estudados aspectos que envolvem o currículo, a sala de aula e atividades a que estão expostas as crianças da Escola Mãe Hilda. Resultados - examinando- se os conteúdos dos Cadernos de Educação do Ilê Aiyê como proposta pedagógica da Escola Mãe Hilda, observou- se que seus fudamentos dão ressignificação aos alunos, em termos de superação de distúrbios identitários, isto é , proporcionar o desenvolvimento e construção da identidade negra naqueles afro-descendentes, devido à valorização estética do universo cultural africano e afro-brasileiro, reconhecendo a África como uma das matrizes legítimas da cultura humana, em geral, e da brasileira, em particular. Conclusão- a pedagogia da (re) construção da identidade negra na Escola Mãe Hilda pode contribuir para a desconstrução dos distúrbios identitários; sendo assim, recomendada para escolas em Salvador-Bahia e em outras regiões do Brasil. ABSTRACT: Objective- study Escola Mãe Hilda (EMH - Mother Hilda School) contribution to the affirmation of an African-Brazilian identity in Bahia’s black student population. In particular: a) understand EMH’s pedagogical and curricula core; b) analyze teaching materials used at EMH; c) show EMH’s work methodology. Methodology- due to the very nature of this dissertation’s basic inquiry, ethnography in nature qualitative research targeted at identity disturbances in its various dimensions regarding African descendents self-esteem was performed. Aspects regarding EMH curriculum and classroom activities were studied. The choice of ethnography as an observation tool followed empirical analysis of whether Ilê Aiyê’s Educational Booklets as adopted by EMH aids students with identity disturbances and how it promotes the development of a black identity in those black descendants. Results- it has been observed that EMH utilizes methodological and pedagogical resources such as: story-telling, written reports, images, objects, dances, music, letters, myths, gestures, legends, craftsmanship, and clothing as vehicles to re-assign students self esteem, as well as, build their critical and self-aware knowledge of black descendants identity. Conclusion.- EMH pedagogical work, by encompassing various types of cultural and artistic expressions, as detailed in the aforementioned booklets, values African and Brazilian-African references. This aesthetic valuation therefore promotes an identity ressignification and the reintegration of the black descendent since it works within the symbolic and cultural universe of the African and African-Brazilian culture recognizing Africa as a legitimate matrix of human culture, in general, and of Brazilian in particular. Conclusively, EMH black identity (re)construction pedagogy can contribute to deconstruct identity disturbances; and as such, can be recommended to be adopted at other schools in Salvador, Bahia and other regions in Brazil.

Lugares de Memória da Escravatura e do Tráfico Negreiro (Angola, Cabo Verde, Guiné-Bissau, Moçambique, São Tomé e Príncipe)

Throughout the lengthy duration of this extremely violent slavery phenomenon where man's cruelty is made evident, it gave rise to places of memory: monuments, toponyms, ethnonymns, stories, legends and myths. Collective memory has constantly recycled this basic fabric. The aim of this Catalogue, dedicated to acknowledging the memory of places in the Portuguese-speaking African countries, is to identify, list, map and give information about the different sites of memory: those that can be seen and touched, without however forgetting those which have re-enacted the creative process thanks to oral tradition.

Honorarios [adaptaciones y refundiciones en De la Cuadra y Aguilera-Malta] (Dossier: Cuatro narradores del 30, relecturas en su centenario)

Se contrasta Honorarios, obra dramática de Aguilera-Malta, y «Honorarios», el cuento de José de la Cuadra que la inspiró. El diálogo entre los dos autores fue explícito en diversos textos, así como en sus respectivos mundos literarios: nombres de personajes, motivos, leyendas, mitos, formas, ideología y demandas, actitudes e intereses. De la Cuadra dialogó a su vez con otros creadores. «Honorarios», e.g., recrea y reinterpreta la figura del mítico fetiche Moloch, según lo representan Metrópolis, del cineasta Fritz Lang, y Salambó, de Gustave Flaubert, la narración aludida es también una refundición en torno al tema del poder omnipresente y cruel, que requiere insaciablemente de víctimas propiciatorias. De igual manera, en su proceso creativo y de búsqueda expresiva, Aguilera-Malta acostumbró remozar y reformular temas en diferentes géneros literarios –como el de la lucha del ser humano frente a las fuerzas hostiles de la naturaleza y la sociedad, interpretado en La isla virgen, El tigre y Jaguar–. En Honorarios, Aguilera-Malta se concentró en hallar la manera de transferir la trama del relato «Honorarios» al género dramático. El resultado es una eficaz refundición, en términos de la perspectiva histórico-política y de reflexiones sobre la función de la literatura.

Traditional medicine use by cancer patients in Thailand

Ethnobotanical relevance Cancer patients commonly use traditional medicines (TM) and in Thailand these are popular for both self-medication and as prescribed by TM practitioners, and are rarely monitored. A study was conducted at Wat Khampramong, a Thai Buddhist temple herbal medicine hospice, to document some of these practices as well as the hospice regime. Materials and methods Cancer patients (n=286) were surveyed shortly after admission as to which TMs they had previously taken and perceptions of effects experienced. They were also asked to describe their current symptoms. Treatment at the hospice is built upon an 11-herb anti-cancer formula, yod-ya-mareng, prescribed for all patients, and ideally, its effects would have been evaluated. However other herbal medicines and holistic practices are integral to the regime, so instead we attempted to assess the value of the patients׳ stay at the hospice by measuring any change in symptom burden, as they perceived it. Surviving patients (n=270) were therefore asked to describe their symptoms again just before leaving. Results 42% of patients (120/286; 95% CI 36.4%, 47.8%) had used herbal medicines before their arrival, with 31.7% (38/120; 95% CI 24%, 40.4%) using several at once. Mixed effects were reported for these products. After taking the herbal regime at Khampramong, 77% (208/270 95% CI; 71.7%, 81.7%) reported benefit, and a comparison of the incidence of the most common (pain, dyspepsia, abdominal or visceral pain, insomnia, fatigue) showed statistical significance (χ2 57.1, df 7, p<0.001). Conclusions A wide range of TMs is taken by cancer patients in Thailand and considered to provide more benefit than harm, and this perception extends to the temple regime. Patients reported a significant reduction in symptoms after staying at Khampramong, indicating an improvement in quality of life, the aim of hospices everywhere. Based on this evidence, it is not possible to justify the use of TM for cancer in general, but this study suggests that further research is warranted. The uncontrolled use of TMs, many of which are uncharacterised, raises concerns, and this work also highlights the fact that validated, robust methods of assessing holistic medical regimes are urgently needed.

Why cancer patients choose in-patient complementary therapy in palliative care: a qualitative study at Arokhayasala Hospice in Thailand

Cancer patients often choose complementary and alternative medicine (CAM) in palliative care, often in addition to conventional treatment and without medical advice or approval. Herbal medicines (HM) are the most commonly used type of CAM, but rarely available on an in-patient basis for palliative care. The motivations which lead very ill patients to travel far to receive such therapies are not clear. A qualitative study was therefore carried out to investigate influences on choosing to attend a CAM herbal hospice, to identify cancer patients’ main concerns about end-of-life care. Semi-structured interviews with 32 patients were conducted and analysed using thematic analysis. Patients were recruited from Arokhayasala, a Buddhist cancer hospice in Thailand which provides CAM, in the form of HM, a restricted diet, Thai yoga, deep-breathing exercises, meditation, chanting, Dhamma, laughter and music therapy, free-of-charge. The main factors influencing decision-making were a positive attitude towards HMs and previous use of them, dissatisfaction with conventional treatment, the home environment and their relationships with hospital doctors. Patients’ own perceptions and experiences were more important in making the decision to use CAM, and especially HM, in palliative cancer care than referral by healthcare professionals or scientific evidence of efficacy. Patients were prepared to travel far and live away from home to receive such care, especially as it was cost-free. In view of patients’ previously stated satisfaction with the regime at the Arokhayasala, these findings may be relevant to the provision of in-patient cancer palliative care to other patients.

La thématique de l’eau dans l’œuvre de Marguerite Duras

The aim of this thematic study is to examine how the water motif is used in Marguerite Duras’s literary work. The study shows that water has multiple functions in these texts: it is linked to major themes and creates an enigmatic atmosphere by its association with the unknown, the inexplicable and the unconscious. The strong presence of water in Duras’s texts is striking. References to the water element can be found in several titles throughout her career, from early works such as Un barrage contre le Pacifique (1950) to La mer écrite (1996), published just after her death. Almost all of her fiction take place near water – and the rain or the sound of waves serve as leitmotifs in specific novels. The water motif can play a metonymic as well as a metaphoric role in the texts and it sometimes takes on human or animalistic characteristics (Chapter 4). Several emblematic Durassian characters (e.g. the beggar-woman, Anne-Marie Stretter and Lol V. Stein) have a close relationship to water (Chapter 5). The water motif is linked to many major Durassian themes, and illustrates themes with positive connotations, for example, creation, fecundity, maternity, liberty and desire, as well as themes with negative connotations such as destruction and death (Chapter 6). A close reading of three novels, La vie tranquille (1944), L’après-midi de Monsieur Andesmas (1962) and La maladie de la mort (1982), shows that the realism of the first novel is replaced by intriguing evocations of the sea and the pond in the second text, motifs which resist straightforward interpretation. The enigmatic feeling persists in the last novel, in which the sea illustrates the overall sombre mood of the story (Chapter 7). Finally, the role of the water element in psychoanalytic theory is discussed (Chapter 8), and a parallel is drawn between the Jungian concept of the mother archetype and the water motif in Duras’s texts. The suggestion is made in this last chapter that water is used to illustrate an oriental influence (Taoist or Buddhist) of some of the female characters in Duras’s work.

Beyond the Threshold: Life in the New Russia

Amanda Sprang spent nine months, from September of 1995 to May of 1996, studying at Colby College's program in St. Petersburg, Russia. Through contacts made during previous trips to Russia in middle and high school, Amanda was able to quickly rekindle her old friendships and make new ones with many young Russians from different backgrounds. The following work is a collection of twelve essays about life in the New Russia. The essays are framed by a foreword and an epilogue that help place the entire work in a historical context. Although the theme of each essay emerges from a particular incident, within every story Amanda has addressed numerous topics relating to Russian life in today’s changing society. Her first essay, “Art Klinika," takes place in an avant-garde night club in St. Petersburg, and includes a brief yet impressionable, encounter with three young Russian men. “The Birthday Party” recalls a wild evening at the home of her close friend, showing how the Russians greet special occasions. Both the third and fourth essays take place in Moscow, where Amanda returns to visit old friends. These two essays portray the lives of the new economic elite in comparison with the average citizen, as well as show how young Russians face the new challenges that greet them. "Politics Russian Style" recalls a political rally in St. Petersburg, and attempts to shed light on the wacky political world of an infant democracy. Chapters Six through Ten take place away from the western cities of St. Petersburg and Moscow, as Amanda brings us to the cold, mysterious land of Siberia in the dead of winter. She recounts her five day train ride with a retired, high-powered, Communist party official, her experiences in the provincial city of Irkutsk, and a brief trip to a Buddhist monastery and, later, an excursion to Lake Baikal. Back in St. Petersburg, Chapter Eleven gives a humorous account of a ski trip with several Russian friends. Amanda finishes her work with her final chapter, “The Dacha," which describes a weekend spent at a Russian country home with her friend's family.