Temporomandibular disorders among Brazilian adolescents: reliability and validity of a screening questionnaire

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Psychoendocrine validation of a short measure for assessment of perceived stress management skills in different non-clinical populations

BACKGROUND: We investigated the psychometric properties of a short questionnaire for combined assessment of different perceived stress management skills in the general population and tested whether scores relate to physiological stress reactivity. METHODS: For psychometric evaluation, we determined the factor structure of the questionnaire and investigated its measurement invariance in the participant groups and over time in three different independent samples representing the general population (total N=332). Reliability was tested by estimating test-retest reliability, internal consistency, and item reliabilities. We examined convergent and criterion validity using selected criterion variables. For endocrine validation, 35 healthy non-smoking and medication-free men in a laboratory study and 35 male and female employees in a workplace study underwent an acute standardized psychosocial stress task. We assessed stress management skills and measured salivary cortisol before and several times up to 60 min (workplace study) and 120 min (laboratory study) after stress. Potential confounders were controlled. RESULTS: The factor structure of the questionnaire consists of five scales reflecting acceptably distinct stress management skills such as cognitive strategies, use of social support, relaxation strategies, anger regulation, and perception of bodily tension. This factor structure was stable across participant groups and over time. Internal consistencies, item reliabilities, and test-retest reliabilities met established statistical requirements. Convergent and criterion validity were also established. In both endocrine validation studies, higher stress management skills were independently associated with lower cortisol stress reactivity (p's<.029). CONCLUSIONS: Our findings suggest that the questionnaire has good psychometric properties and that it relates to subjective psychological and objective physiological stress indicators. Therefore, the instrument seems a suitable measure for differential assessment of stress management skills in the general population.

A gestão e o controlo do grupo de crianças

Relatório da Prática Profissional Supervisionada Mestrado em Educação Pré-Escolar

Improving appropriateness of antibiotic therapy: randomized trial of an intervention to foster reassessment of prescription after 3 days.

OBJECTIVES: Reassessment of ongoing antibiotic therapy is an important step towards appropriate use of antibiotics. This study was conducted to evaluate the impact of a short questionnaire designed to encourage reassessment of intravenous antibiotic therapy after 3 days. PATIENTS AND METHODS: Patients hospitalized on the surgical and medical wards of a university hospital and treated with an intravenous antibiotic for 3-4 days were randomly allocated to either an intervention or control group. The intervention consisted of mailing to the physician in charge of the patient a three-item questionnaire referring to possible adaptation of the antibiotic therapy. The primary outcome was the time elapsed from randomization until a first modification of the initial intravenous antibiotic therapy. It was compared within both groups using Cox proportional-hazard modelling. RESULTS: One hundred and twenty-six eligible patients were randomized in the intervention group and 125 in the control group. Time to modification of intravenous antibiotic therapy was 14% shorter in the intervention group (adjusted hazard ratio for modification 1.28, 95% CI 0.99-1.67, P = 0.06). It was significantly shorter in the intervention group compared with a similar group of 151 patients observed during a 2 month period preceding the study (adjusted hazard ratio 1.17, 95% CI 1.03-1.32, P = 0.02). CONCLUSION: The results suggest that a short questionnaire, easily adaptable to automatization, has the potential to foster reassessment of antibiotic therapy.

Examining non-response bias in substance use research-Are late respondents proxies for non-respondents?

BACKGROUND: Non-response is a major concern among substance use epidemiologists. When differences exist between respondents and non-respondents, survey estimates may be biased. Therefore, researchers have developed time-consuming strategies to convert non-respondents to respondents. The present study examines whether late respondents (converted former non-participants) differ from early respondents, non-consenters or silent refusers (consent givers but non-participants) in a cohort study, and whether non-response bias can be reduced by converting former non-respondents. METHODS: 6099 French- and 5720 German-speaking Swiss 20-year-old males (more than 94% of the source population) completed a short questionnaire on substance use outcomes and socio-demographics, independent of any further participation in a cohort study. Early respondents were those participating in the cohort study after standard recruitment procedures. Late respondents were non-respondents that were converted through individual encouraging telephone contact. Early respondents, non-consenters and silent refusers were compared to late respondents using logistic regressions. Relative non-response biases for early respondents only, for respondents only (early and late) and for consenters (respondents and silent refusers) were also computed. RESULTS: Late respondents showed generally higher patterns of substance use than did early respondents, but lower patterns than did non-consenters and silent refusers. Converting initial non-respondents to respondents reduced the non-response bias, which might be further reduced if silent refusers were converted to respondents. CONCLUSION: Efforts to convert refusers are effective in reducing non-response bias. However, converted late respondents cannot be seen as proxies of non-respondents, and are at best only indicative of existing response bias due to persistent non-respondents.

Population-based registration of phenotypic anatomic and familial data for melanoma: results from a Swiss multicentric study

CONTEXT AND OBJECTIVES: A multicentric study was set up to assess the feasibility for Swiss cancer registries of actively retrieving 3 additional variables of epidemiological and a etiological relevance for melanoma, and of potential use for the evaluation of prevention campaigns. MATERIAL AND METHODS: The skin type, family history of melanoma and precise anatomical site were retrieved for melanoma cases registered in 5 Swiss cantons (Neuchâtel, St-Gall and Appenzell, Vaud and Wallis) over 3 to 6 consecutive years (1995-2002). Data were obtained via a short questionnaire administered by the physicians - mostly dermatologists - who originally excised the lesions. As the detailed body site was routinely collected in Ticino, data from this Cancer Registry were included in the body site analysis. Relative melanoma density (RMD) was computed by the ratio of observed to expected numbers of melanomas allowing for body site surface areas, and further adjusted for site-specific melanocyte density. RESULTS: Of the 1,645 questionnaires sent, 1,420 (86.3%) were returned. The detailed cutaneous site and skin type were reliably obtained for 84.7% and 78.7% of questionnaires, and family history was known in 76% of instances. Prevalence of sun-sensitive subjects and patients with melanoma affected first-degree relatives, two target groups for early detection and surveillance campaigns were 54.1% and 3.4%, respectively. After translation into the 4th digit of the International Classification of Diseases for Oncology, the anatomical site codes from printed (original information) and pictorial support (body chart from the questionnaire) concurred for 94.6% of lesions. Discrepancies occurred mostly for lesions on the upper, outer part of the shoulder for which the clinician's textual description was "shoulder blade". This differential misclassification suggests under-estimation by about 10% of melanomas of the upper limbs and an over-estimation of 5% for truncal melanomas. Sites of highest melanoma risk were the face, the shoulder and the upper arm for sexes, the back for men and the leg for women. Three major features of this series were: (1) an unexpectedly high RMD for the face in women (6.2 vs 4.2 in men), (2) the absence of a male predominance for melanomas on the ears, and (3) for the upper limbs, a steady gradient of increasing melanoma density with increasing proximity to the trunk, regardless of sex. DISCUSSION AND CONCLUSION: The feasibility of retrieving the skin type, the precise anatomical location and family history of melanoma in a reliable manner was demonstrated thanks to the collaboration of Swiss dermatologists. Use of a schematic body drawing improves the quality of the anatomical site data and facilitate the reporting task of doctors. Age and sex patterns of RMD paralleled general indicators of sun exposure and behaviour, except for the hand (RMD=0.2). These Swiss results support some site or sun exposure specificity in the aetiology of melanoma.

Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland.

BACKGROUND: In 2004, complementary and alternative medicine (CAM) was offered by physicians in one-third of Swiss hospitals. Since then, CAM health policy has changed considerably. This study aimed to describe the present supply and use of CAM in hospitals in the French-speaking part of Switzerland, and to explore qualitatively the characteristics of this offer. METHODS: Between June 2011 and March 2012, a short questionnaire was sent to the medical directors of hospitals (n = 46), asking them whether CAM was offered, where and by whom. Then, a semi-directive interview was conducted with ten CAM therapists. RESULTS: Among 37 responses (return rate 80%), 19 medical directors indicated that their hospital offered at least one CAM and 18 reported that they did not. Acupuncture was the most frequently available CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology and obstetrics, palliative care, psychiatry, and anaesthetics. In eight out of ten interviews, it appeared that the procedures for introducing a CAM in the hospital were not tightly supervised by the hospital and were mainly based on the goodwill of the therapists, rather than clinical/scientific evidence. CONCLUSION: The number of hospitals offering CAM in the French-speaking part of Switzerland seemed to have risen since 2004. The selection of a CAM to be offered in a hospital should be based on the same procedure of evaluation and validation as conventional therapy, and if the safety and efficiency of the CAM is evidence-based, it should receive the same resources as a conventional therapy.

Offer and use of complementary and alternative medicine in hospitals of the French-speaking part of Switzerland.

Background: In 2004, complementary and alternative medicine (CAM) was offered by physicians in one third of Swiss hospitals. Since then, CAM health policy has considerably changed. This study aims at describing the present supply and use of CAM in hospitals of the French-speaking part of Switzerland, and qualitatively explores the characteristics of this supply. Methods: Between June 2011 and March 2012, a short questionnaire was sent to the medical directors of hospitals (N=46), asking them whether a CAM was offered, where and by whom. Then, a semi-directive interview was conducted with 10 CAM therapists. Results: Among 37 responses (return rate 80%), 19 medical directors indicated that their hospital offered at least one CAM and 18 reported that they did not. Acupuncture was the most frequently proposed CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology- obstetrics, palliative care, psychiatry and anaesthesiology. In eight out of ten interviews, it appeared that the procedures for introducing a CAM in the hospital were not tightly supervised by the hospital but were mainly based on the goodwill of the therapists, rather than clinical/scientific evidence. Conclusion: Hospitals offering CAM in the French-speaking part of Switzerland seems to have risen since 2004. The selection of CAM to be offered in a hospital should be based on the same procedure of evaluation and validation as conventional care, and if their safety and efficiency is evidence-based, they should receive the same structural resources.

Need for informed consent in substance use studies--harm of bias?

OBJECTIVE: The aim of this study was to examine the differences between those who gave informed consent to a study on substance use and those who did not, and to analyze whether differences changed with varying nonconsent rates. METHOD: Cross-sectional questionnaire data on demographics, alcohol, smoking, and cannabis use were obtained for 6,099 French- and 5,720 German-speaking 20-year-old Swiss men. Enrollment took place over 11 months for the Cohort Study on Substance Use Risk Factors (C-SURF). Consenters and nonconsenters were asked to complete a short questionnaire. Data for nearly the entire population were available because 94% responded. Weekly differences in consent rates were analyzed. Regressions examined the associations of substance use with consent giving and consent rates and the interaction between the two. RESULTS: Nonconsenters had higher substance use patterns, although they were more often alcohol abstainers; differences were small and not always significant and did not decrease as consent rates increased. CONCLUSIONS: Substance use currently is a minor sensitive topic among young men, resulting in small differences between nonconsenters and consenters. As consent rates increase, additional individuals are similar to those observed at lower consent rates. Estimates of analytical studies looking at associations of substance use with other variables will not differ at reasonable consent rates of 50%-80%. Descriptive prevalence studies may be biased, but only at very low rates of consent.

Effects of P300-based BCI use on reported presence in a virtual environment

Brain-computer interfaces (BCIs) are becoming more and more popular as an input device for virtual worlds and computer games. Depending on their function, a major drawback is the mental workload associated with their use and there is significant effort and training required to effectively control them. In this paper, we present two studies assessing how mental workload of a P300-based BCI affects participants" reported sense of presence in a virtual environment (VE). In the first study, we employ a BCI exploiting the P300 event-related potential (ERP) that allows control of over 200 items in a virtual apartment. In the second study, the BCI is replaced by a gaze-based selection method coupled with wand navigation. In both studies, overall performance is measured and individual presence scores are assessed by means of a short questionnaire. The results suggest that there is no immediate benefit for visualizing events in the VE triggered by the BCI and that no learning about the layout of the virtual space takes place. In order to alleviate this, we propose that future P300-based BCIs in VR are set up so as require users to make some inference about the virtual space so that they become aware of it,which is likely to lead to higher reported presence.

The search for circadian clock components in humans: new perspectives for association studies

Individual circadian clocks entrain differently to environmental cycles (zeitgebers, e.g., light and darkness), earlier or later within the day, leading to different chronotypes. In human populations, the distribution of chronotypes forms a bell-shaped curve, with the extreme early and late types _ larks and owls, respectively _ at its ends. Human chronotype, which can be assessed by the timing of an individual's sleep-wake cycle, is partly influenced by genetic factors - known from animal experimentation. Here, we review population genetic studies which have used a questionnaire probing individual daily timing preference for associations with polymorphisms in clock genes. We discuss their inherent limitations and suggest an alternative approach combining a short questionnaire (Munich ChronoType Questionnaire, MCTQ), which assesses chronotype in a quantitative manner, with a genome-wide analysis (GWA). The advantages of these methods in comparison to assessing time-of-day preferences and single nucleotide polymorphism genotyping are discussed. In the future, global studies of chronotype using the MCTQ and GWA may also contribute to understanding the influence of seasons, latitude (e.g., different photoperiods), and climate on allele frequencies and chronotype distribution in different populations.

L’expérience vécue à domicile par les conjointes de partenaires atteints de la démence de type Alzheimer au moment des soins d’hygiène

Suite à une recension des écrits sur les soins d’hygiène des personnes atteintes de démence de type Alzheimer (DTA), force est de constater la rareté, voire l’absence de recherches sur la question des soins d’hygiène (SH) dispensés à domicile par les conjointes. Pourtant, la conjointe à domicile est confrontée aux mêmes difficultés que les intervenants des établissements de santé et doit ainsi faire face aux comportements, parfois difficiles de la personne atteinte. Dans la pratique, les infirmières questionnent peu les difficultés rencontrées par les aidantes au moment des soins d’hygiène, ce qui permet difficilement de prendre conscience de leurs sentiments d’isolement et de détresse et de les réduire, le cas échéant. Pour pallier cette lacune, la présente recherche vise à comprendre l’expérience que vivent des conjointes d’hommes atteints de DTA lorsqu’elles leur dispensent des SH à domicile. Un second objectif vise à identifier les dimensions qui sont associées à cette expérience. Une approche de recherche qualitative est utilisée. Les participantes ont été recrutées par l’entremise des Sociétés Alzheimer de Laval et des Laurentides. La stratégie de collecte des données a impliqué la réalisation de deux entrevues individuelles, face à face, de même que l’administration d’un court questionnaire portant sur les aspects sociodémographiques. La démarche retenue pour l’analyse de l’ensemble de données est inspirée de l’approche proposée par Miles et Huberman (2003). Les résultats permettent d’abord de mettre en évidence des profils de conjointes qui, tout en étant variables, présentent certaines similarités. Eu égard aux SH, toutes ont à consacrer des efforts soutenus, quotidiens et intenses. Elles doivent faire montre de patience et compter sur des capacités personnelles les amenant à ressentir des sentiments positifs malgré les situations difficiles. Les résultats montrent par ailleurs que la dispensation des SH provoque aussi des sentiments négatifs associés au fardeau que ces soins impliquent. Les conjointes mettent toutefois en œuvre une variété de stratégies d’adaptation au stress telles la résolution de problème, la recherche de soutien social et le recadrage. Cinq ensembles de dimensions personnelles et contextuelles sont associés à l’expérience des aidantes : 1) En ce qui a trait aux caractéristiques personnelles des conjointes, l’avancement en âge et l’état de santé physique ou psychologique influencent négativement l’expérience lors des SH. Par contre, les ressources personnelles intrinsèques (acceptation de la réalité, capacité de trouver un sens à l’évènement, habileté à improviser et sens de l’humour) sont utilisées de manière naturelle ou acquise; 2) Les caractéristiques personnelles du conjoint (année du diagnostic, pertes d’autonomie et troubles de comportement) affectent négativement l’expérience vécue; 3) La relation conjugale présente un intérêt important puisqu’il apparaît qu’une relation conjugale pré-diagnostic positive semble favoriser des sentiments positifs chez la conjointe en ce qui a trait aux SH; 4) Les dimensions familiales ont un impact favorable, étant donné le soutien psychologique reçu de la famille; 5) Les dimensions macro-environnementales, incluant l’aide reçue du réseau informel plus large de même que du réseau formel, ainsi que les divers aménagements matériels de l’environnement physique du couple, ressortent enfin comme ayant un impact positif. Au terme de l’analyse des résultats, l’auteure est en mesure de proposer une synthèse de l’expérience des conjointes. La discussion aborde quatre enjeux qui se dégagent des résultats observés : impacts des difficultés rencontrées lors des SH dans la décision d’hébergement, réticence des aidantes à faire appel aux ressources du réseau formel pour obtenir de l’aide eu égard aux SH, importance des ressources personnelles des aidantes et potentiel de l’approche relationnelle humaine (human caring) pour faire face aux défis que pose la dispensation des SH.

Enjeux éthiques, défis dans les soins de santé et prise de décisions pour les patients souffrant de troubles neurologiques de la conscience

Le coma, l’état végétatif et l’état de conscience minimale sont classés comme « troubles de la conscience ». La caractéristique commune à ces diagnostics est un état de conscience altéré. La technologie permet désormais de maintenir en vie les individus affligés de ces diagnostics. La nature même de leur condition et les soins disponibles pour ces patients conduisent à des dilemmes médicaux et éthiques importants. Ce mémoire propose une brève introduction des troubles de la conscience suivie d’une recension des écrits sur les enjeux éthiques et sociaux en lien avec ces diagnostics. Force est de constater que certains enjeux perdurent depuis des années comme le retrait de traitement. D’autres sont apparus plus récemment, comme l’enjeu lié à l’usage de la neuroimagerie. Un deuxième volet présente les résultats d’une étude qualitative examinant les perspectives et l’expérience des professionnels de la santé face aux enjeux éthiques lors de la prise en charge des patients atteints de troubles de la conscience. Cette étude a été réalisée par le biais d’un court questionnaire et d’entrevues semi-dirigées qui furent enregistrées puis analysées à l’aide du logiciel Nvivo. Les résultats démontrent entre autres que les répondants éprouvent un niveau de certitude élevé face au diagnostic bien qu’il soit souvent signalé comme un défi important dans la littérature. Le pronostic représente un enjeu crucial, y compris sa divulgation aux proches. Enfin, la relation avec la famille est un élément clé dans la prise en charge des patients et celle-ci est teintée par de multiples facteurs.

Acciones de promoción de la salud organizacional y su relación con variables estructurales y el bienestar de los trabajadores: análisis desde un modelo de organizaciones saludables

El bienestar de los trabajadores es un imperativo categórico para las organizaciones tanto por razones éticas como por razones de competitividad. La creación de organizaciones o entornos laborales que promuevan el bienestar de los trabajadores constituye un gran reto para las organizaciones y un ámbito de estudio académico. En el presente artículo se describe la relación que existe entre un conjunto de factores organizacionales y su impacto en el bienestar de un grupo de trabajadores, expresado a través del engagement, la satisfacción con el trabajo y la ansiedad relacionada con el trabajo. Para probar las relaciones hipotetizadas se empleó un modelo de ecuaciones estructurales y los resultados obtenidos señalan que las acciones de promoción de la salud organizacional tiene un impacto significativo en los valores culturales y en la adopción de prácticas organizacionales