Use of Distress and Depression Thermometers to Measure Psychosocial Morbidity Among Southern European Cancer Patients

GOALS OF WORK: Recent literature has indicated the need for rapid evaluation of psychosocial issues secondary to cancer. Because of the problems of routine use of psychometric instruments, short instruments such as visual analogue scales or one-item 0-10 scales have been developed as valid assessment alternatives. PATIENTS AND METHODS: A study was conducted to examine the role of two 0-10 scales in measuring emotional stress (distress thermometer, DT) and depressed mood (mood thermometer, MT), respectively, in a multicenter study carried out in southern European countries (Italy, Portugal, Spain, and Switzerland). A convenience sample of 312 cancer outpatients completed the DT and MT and the Hospital Anxiety Depression Scale (HADS). MAIN RESULTS: DT was more significantly associated HADS anxiety than HADS depression while MT was related both to HADS anxiety and depression. The correlation of MT with HADS was higher than DT. A cutoff point >4 on the DT maximized sensitivity (65%) and specificity (79%) for general psychosocial morbidity while a cutoff >5 identified more severe "caseness" (sensitivity=70%; specificity=73%). On the MT, sensitivity and specificity for general psychosocial morbidity were 85% and 72% by using the cutoff score >3. A score >4 on the MT was associated with a sensitivity of 78% and a specificity of 77% in detecting more severe caseness. CONCLUSIONS: Two simple instruments, the DT and the MT, were found to have acceptable levels of sensitivity and specificity in detecting psychosocial morbidity. Compared to the HADS, however, the mood MT performed better than the DT.

Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

Background: Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS). Objective: To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Methods: Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged <65 years, hospitalized with diagnosis of ACS. The Burnout Syndrome was evaluated with the Burnout Syndrome Inventory (BSI), which assesses workplace conditions and four dimensions that characterize the syndrome: emotional exhaustion (EE), emotional distancing (EmD), dehumanization (De) and professional fulfillment (PF). The Lipp’s Stress Symptoms Inventory for Adults (LSSI) was applied to evaluate global stress. Results: Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. Conclusion: We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital.

Ambulatory blood pressure measurement and antihypertensive therapy.

The traditional basis for assessing the effect of antihypertensive therapy is the blood pressure reading taken by a physician. However, several recent trials have been designed to evaluate the blood pressure lowering effect of various therapeutic agents during the patients' normal daytime activities, using a portable, semi-automatic blood pressure recorder. The results have shown that in a given patient, blood pressure measured at the physician's office often differs greatly from that prevailing during the rest of the day. This is true both in treated and untreated hypertensive patients. The difference between office and ambulatory recorded pressures cannot be predicted from blood pressure levels measured by the physician. Therefore, a prospective study was carried out in patients with diastolic blood pressures that were uncontrolled at the physician's office despite antihypertensive therapy. The purpose was to evaluate the response of recorded ambulatory blood pressure to treatment adjustments aimed at reducing office blood pressure below a pre-set target level. Only patients with high ambulatory blood pressures at the outset appeared to benefit from further changes in therapy. Thus, ambulatory blood pressure monitoring can be used to identify those patients who remain hypertensive only when facing the physician, despite antihypertensive therapy. Ambulatory monitoring could thus help to evaluate the efficacy of antihypertensive therapy and allow individual treatment.

Psychosocial care for the caregivers of primary malignant brain tumor patients.

Despite clinical experience that suggests a high burden of care among relatives of individuals with a primary malignant brain tumor (PMBT), little is known about their actual needs. In this study, the caregivers' personal experiences, quality of life, burden of care, and psychological well-being were examined. Fifty-nine percent did not receive any financial aid for home care, 33% had increased risk for psychosomatic problems, 45% had anxiety, and 33% increased depression levels. The caregiver's quality of life was most strongly affected by the burden of care (p < .001) and the patient's mental state (p < .03). To improve the situation, empathetic professionals and an early implementation of palliative care and social work are required.

Die Arbeit: eine Re-Vision = Le travail: une re-vision

Was ist Arbeit? Ein notwendiges Übel, eine den Menschen erst zum Menschen machende Notwendigkeit, ein Mittel sich selbst zu verwirklichen, eine notwendige Struktur, die den Menschen gesund hält, ja sogar therapiert oder bloss eine unter vielen Möglichkeiten, mit dem Leben etwas anzufangen? Arbeit wurde schon immer mehrdeutig gefasst. Zwölf Autoren aus dem französischen und deutschen Kulturkreis diskutieren, was Arbeit ist und war. Die Beiträge aus Philosophie, Recht, Sozialwissenschaften, aber auch Kunstwissenschaften kreisen um vier wesentliche Spannungen des Begriffs Arbeit: die Arbeit der Frau, die Sichtbarkeit oder Sichtbarmachung der Arbeit, das Verhältnis von Arbeit zu anderen menschlichen Tätigkeiten, der Sinn und das Erleben der Arbeit mit dem allgegenwärtigen Stress, mit dem die heutige Arbeit verknüpft wird. Qu'est-ce que le travail? Un mal nécessaire, une nécessité pour faire des hommes des êtres humains, un moyen de se réaliser, une structure nécessaire qui maintient les êtres humains en santé, voire même les soigne, ou simplement une possibilité parmi d'autres de faire quelque chose de sa vie? Le terme de travail comprend un large éventail de significations. Douze auteurs de culture française et allemande discutent de ce qu'est le travail et de ce qu'il était. Les contributions issues de la philosophie, du droit, des sciences sociales, mais aussi des arts s'articulent autour de quatre dimensions essentielles du concept de travail: le travail des femmes, la visibilité ou la mise en évidence du travail, le lien entre le travail et les autres activités humaines, la recherche de sens et le vécu du travail avec le stress quotidien qui est aujourd'hui étroitement lié au travail.

Adolescent's suicide attempts: populations at risk, vulnerability, and substance use.

Adolescence corresponds to a transition period that requires adaptation and change capacities and skills. Most young people succeed with this challenge, whereas a minority fail. In order to identify with the teenage culture, become autonomous, and differentiate from their parents, some adolescents choose to use drugs, beginning with the use of cigarettes, alcohol, cannabis, followed by other illicit drugs such as opiates and stimulants. A high proportion of these adolescents attempt suicide, which is the primary cause of death during adolescence in many European countries. Who are the "vulnerable" adolescents? What are the mechanisms that can explain the varieties of drug-use initiation or suicide attempts? Can "protective factors" be identified? What kind of strategies might be developed at a social and political level in order to prevent or to minimize drug abuse and suicide attempts, among other harmful behaviors? These issues will be discussed on the basis of the recent literature and in the light of a recent study carried out in the French-speaking part of Switzerland on large cohorts of adolescent drug users. Unresolved critical issues are noted and future needed research is suggested.

Hyperventilation in anticipatory music performance anxiety

Objectives and Methods: Self-report studies have shown an association between music performance anxiety (MPA) and hyperventilation complaints. However, hyperventilation was never assessed physiologically in MPA. This study investigated the self-reported affective experience, self-reported physiological symptoms, and cardiorespiratory variables including partial pressure of end-tidal CO(2) (Petco(2)), which is an indicator for hyperventilation, in 67 music students before a private and a public performance. The response coherence between these response domains was also investigated.ResultsFrom the private to the public session, the intensity of all self-report variables increased (all p values < .001). As predicted, the higher the musician's usual MPA level, the larger were these increases (p values < .10). With the exception of Petco(2), the main cardiorespiratory variables also increased from the private to the public session (p values < .05). These increases were not modulated by the usual MPA level (p values > .10). Petco(2) showed a unique response pattern reflected by an MPA-by-session interaction (p < .01): it increased from the private to the public session for musicians with low MPA levels and decreased for musicians with high MPA levels. Self-reported physiological symptoms were related to the self-reported affective experience (p values < .05) rather than to physiological measures (p values > .17).ConclusionsThese findings show for the first time how respiration is stimulated before a public performance in music students with different MPA levels. The hypothesis of a hyperventilation tendency in high-performance-anxious musicians is supported. The response coherence between physiological symptoms and physiological activation is weak.

Travailler dans l'urgence au quotidien : quels impacts sur les employés et sur l'organisation ? Etude qualitative au siège d'une ONG humanitaire

A l'occasion d'une intervention en santé au travail au siège d'une ONG humanitaire, nous avons constaté la présence d'une souffrance au travail importante parmi le personnel. Nous avons alors effectué une recherche sur l'organisation du travail et l'activité des employés dans le but de proposer des pistes de compréhension de cette souffrance. Nous avons collecté des données à l'aide d'un questionnaire, de 20 entretiens semi-directifs et de 26 jours d'observation non-participante. Nous avons mis en évidence un type de fonctionnement spécifique s'articulant en permanence autour de l'urgence. Celui-ci se nourrit de la nature des interventions de cette ONG ainsi que de la très forte valorisation des activités liées aux missions sur les terrains : tout se passe comme si le mode d'intervention " en situation d'urgence ", propre aux activités du terrain, contaminait l'organisation du travail au niveau du siège. Les employés sont pris dans un rythme effréné, ce qui les empêche de rester attentif à l'importance des tâches et de discriminer entre ce qui relève de " vraies " urgences et d'urgences " fantasmées ". Ceci génère un environnement potentiellement pathogène, où il est d'une part peu légitime de se préoccuper de sa propre santé et où d'autre part la charge de travail et le rythme ne laissent pas le temps à l'employé de mettre en place des stratégies de préservation de sa santé. [Auteures]

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Musculoskeletal disorders (MSD) are the most prevalent pain disorders in industrialized countries, and their costs can represent up to 2% of gross national product. MSD are often work associated and recurrent and may lead to disability. In occupational health we are interested in the opposite process : in the return to work (RTW). Different models of disability and RTW exist with different conceptions of psychosocial factors. We therefore propose to analyze the influence of factors from work, patient, health care providers, and broader societal domains along the different phases of the MSD process, adopting a biopsychosocial approach. The analysis of risk factors for the different phases of MSD indicate that work stress factors have an impact on the occurrence of MSD and RTW with MSD, but their effect is low to moderate and nonspecific. Physical work demands, work place adaptation, and pain experience are much stronger predictors of RTW. Lack of modified or adapted work is one of the major factors that hinder RTW. The longer the pain lasts, the longer the patient is out of work, the more personal factors and broader context factors become dominant. There is a clear lack of RTW studies concerning neck and upper limb pain. MSD and especially chronic MSD should be viewed as public health concerns, implying a wider socio-economic and insurance and disability problem. Adequate medical support tailored to the different dimensions and phases of MSD must be on offer, and work accommodations must be promoted and supported.

Urgences préhospitalières: mieux valoriser le travail des professionnels pour prévenir les troubles mentaux

On savait déjà que la détresse psychique touchait souvent les professionnels des interventions d'urgence préhospitalières. Voici qu'une étude chez des ambulanciers suisses, qui, à l'instar des pompiers français, prennent en charge les patients avant leur admission à l'hôpital, montre que le surinvestissement dans le travail et la perception d'un travail faiblement valorisé sont des facteurs nettement associés à des troubles de la santé mentale. [Auteurs]

Le mobbing, une pathologie de la solitude

Le mobbing est devenue une des plaintes les plus récurrentes de employés et de cet un problème de santé publique et de santé au travail. Les secteurs les plus touchés sont les secteurs de la santé, du social et de l'enseignement. L'article vise à montrer que ces agissements sont moins le fruit de mauvaises relations interpersonnelles que le signe d'une désagrégation sociale au travail. [Auteur]