Le sentiment de solitude dans le couple et l'impact de la crise sanitaire : une revue de la littérature

Résumé Cette revue a pour objectif de faire état de la littérature sur le sentiment de solitude au sein du couple, tout en comprenant les facteurs qui conduisent une personne à se sentir seule dans un couple ou dans une relation amoureuse. Il s'agit de considérer les effets du sentiment de solitude sur les couples et les différentes formes qu'il peut prendre durant la période de pandémie liée au COVID-19. Ainsi, cette revue de littérature met en lumière le fait que la solitude peut entraîner des conséquences psychologiques positives ou négatives et que les types d'attachement se révèlent être le fondement de la tolérance au sentiment de solitude. Au sein du couple, la solitude et ses impacts déprendront du niveau de qualité relationnelle, du genre et du statut matrimonial. Sous certains aspects, le mariage peut protéger du sentiment de solitude, mais il peut être malmené, comme ce fut le cas durant la pandémie mondiale de COVID-19. Le manque de communication entre les partenaires, l'anxiété liée à la pandémie et le fait de se retrouver avec soi-même ont renforcé un sentiment de solitude parfois déjà existant, au détriment de la durabilité des couples. Objective The purpose of this review is to define the feeling of loneliness within a couple while taking into consideration the factors that lead a person to feel lonely in a couple or in a romantic relationship. Our goal is to understand the effects of the feeling of loneliness on these individuals during the global health crisis brought on by COVID-19 and to take these factors into account in designing effective therapeutic care. The different manifestations of loneliness in a couple should also be highlighted. Methods We used the PRISMA methodology to select the relevant studies. The keywords ("Solitude” or "Loneliness”) and ("Couple” or "Married” or "Partnership”) allowed us to select 19 references dealing with the theme. We conducted searches of the following databases: "Cairn”, "PsychInfo and Psycarticle”, "PubMed and Medline”, "ScienceDirect” and finally, "Web of Science” in order to find articles covering a ten-year period. Results There are different definitions for the subjective experience of loneliness. The review of the literature highlights the fact that loneliness can lead to positive or negative psychological consequences (it can lead to the development of creative capacity or, on the contrary, result in depression in some cases). Attachment patterns have been shown to be the basis for the tolerance of feelings of loneliness. Indeed, an anxious attachment would encourage the couple to avoid the feeling of loneliness. According to the literature, this defensive mechanism of seeking presence in the couple would make it possible to limit the impact of loneliness. This solitude depends on the level of relational quality within the couple. A poor relational quality would lead to greater loneliness and would impact intimate relationships. Loneliness is supposedly not experienced in the same way by men and women: Men seem to be more protected by marriage while women's level of loneliness may be higher because of the household chores they have to do. Men and women would nevertheless remain subject to the phenomena of contamination, i.e., when one of the partners feels lonely, the other will also be lonely. However, it seems that marriage protects against feelings of loneliness and its negative consequences. Loneliness does not have only negative effects. It can be beneficial for developing creativity and finding oneself. The periods of confinement during the COVID-19 crisis provided people with an increase in the amount of time they didn't normally have on a daily basis. This may have been beneficial for some people and can be associated with positive emotions. Individuals who spent the lockdowns with others felt less alone and experienced less psychological distress. However, confinements did produce some negative effects on couples. The increased stress of the pandemic and the constant proximity led to an increase in spousal abuse. The consequences of confinement for couples whose relationships were already troubled resulted in frequent separation and/or divorce. The potential for conflict was related to limited financial resources, not working, and the significant risk of contracting SARS COV-2. Conclusion The articles dealing with the feeling of loneliness that we reviewed presented quantitative methods to the detriment of qualitative aspects and focused largely on the negative aspects of the feeling of loneliness. Other academic disciplines, such as sociology, demonstrate a lack of understanding concerning what is at stake with the feeling of loneliness. The articles intersect and tend to highlight the attachment relationships that are formed in childhood as a determining factor in the feeling of solitude later in life. The quality of the relationship, gender, and marital status are also factors to be considered. Loneliness has a clear influence on the well-being of the relationship but it is not an individual characteristic of the relationship itself. It finally appears as an individual characteristic with an impact on the assessment of the quality of the relationship and on the appreciation of the spouse.

Some factors influencing in France the prescribers and public perception of the Drug marketing authorization decisions

The sacrosanct image that the prescriber and the public had of the Marketing Authorization (AMM) three or four decades ago has changed significantly in recent years, following the consideration – sometimes controversial – some of its shortcomings or weaknesses. The text of this article discusses some of the factors that may explain this change in mentality, which is harmful to patient safety. Among these factors, mention should be made of the quite understandable lag of certain MAs on the data acquired from science, a sometimes excessive and counterproductive formalism or even possible disagreements between the Agencies responsible for the registration of medicinal products. But it is especially necessary to retain certain fragile marketing authorizations, with a degraded image, prematurely granted on non-optimal levels of evidence with the aim of accelerating patients' access to new so-called "promising” drugs. Finally, the intervention of patients, now very important in the field, is a social phenomenon that should not be overlooked, either because they are wary of the drug and its evaluation or because they put pressure on the prescriber to obtain a prescription. off-label touted in social networks. The fact remains that MA remains the reference and benchmark to be respected for optimal, secure and responsible drug prescription. A positive point is that the pandemic due to COVID-19 will have enabled journalists to better master the notions of level of proof and balance between benefits and risks. At the same time, it will have enabled the public, for the most part, to understand what an MA is and to admit the need for it, despite the erosion of its confidence in scientific expertise and its suspicion towards to health institutions. If there is no reason to regret that more transparency and health democracy allow the citizen to appropriate the meaning and the determinants of MAID, there is reason, for evaluation specialists, to call for the maintenance of its rigor in the very interest of patients and for the health authorities to maintain it. © 2022 l'Académie nationale de médecine;L'image sacro-sainte que le prescripteur et le public se faisaient de l'Autorisation de mise sur le marché (AMM) il y a trois ou quatre décennies a notablement évolué depuis quelques années, suite à la prise en compte – parfois polémique – de certaines de ses insuffisances ou de ses faiblesses. Le texte de cet article évoque quelques-uns des facteurs pouvant expliquer cette évolution des mentalités, délétère pour la sécurité des patients. Parmi ces facteurs, on mentionnera le retard bien compréhensible de certaines AMM sur les données acquises de la science, un formalisme parfois excessif et contre-productif ou encore de possibles discordances d'avis entre Agences responsables de l'enregistrement des médicaments. Mais il faut surtout retenir certaines AMM fragiles, d'image dégradée, prématurément octroyées sur des niveaux de preuve non optimaux dans le but d'accélérer l'accès des malades aux nouveaux médicaments dits « prometteurs ». Enfin, l'intervention des patients, désormais très importante dans le domaine, est un phénomène de société à ne pas méconnaître, soit qu'ils se méfient du médicament et de son évaluation ou qu'ils fassent pression sur le prescripteur pour obtenir une prescription hors AMM vantée dans les réseaux sociaux. Il n'en demeure pas moins que l'AMM reste la référence et le repère à respecter pour une prescription médicamenteuse optimale, sécurisée et responsable. Un point positif est que la pandémie due au COVID-19 aura permis aux journalistes de mieux maîtriser les notions de niveau de preuve et de balance bénéfices/risques. Par la même occasion, elle aura permis au public, dans sa très grande majorité, de comprendre ce qu'est une AMM et d'en admettre la nécessité, malgré l'érosion de sa confiance dans l'expertise scientifique et sa suspicion vis-à-vis des institutions de santé. S'il n'y a pas lieu de regretter que davantage de trans arence et de démocratie sanitaire permettent au citoyen de s'approprier la signification et les déterminants de l'AMM, il y a lieu, pour les spécialistes de l'évaluation, d'appeler au maintien de sa rigueur dans l'intérêt même des patients et pour les autorités de santé de la maintenir. © 2022 l'Académie nationale de médecine

À propos des prescriptions hors Autorisation de mise sur le marché (AMM) : réflexions sur l'évolution de l'image de l'AMM chez le prescripteur et dans le public en France

Résumé L'image sacro-sainte que le prescripteur et le public se faisaient de l'Autorisation de mise sur le marché (AMM) il y a trois ou quatre décennies a notablement évolué depuis quelques années, suite à la prise en compte – parfois polémique – de certaines de ses insuffisances ou de ses faiblesses. Le texte de cet article évoque quelques-uns des facteurs pouvant expliquer cette évolution des mentalités, délétère pour la sécurité des patients. Parmi ces facteurs, on mentionnera le retard bien compréhensible de certaines AMM sur les données acquises de la science, un formalisme parfois excessif et contre-productif ou encore de possibles discordances d'avis entre Agences responsables de l'enregistrement des médicaments. Mais il faut surtout retenir certaines AMM fragiles, d'image dégradée, prématurément octroyées sur des niveaux de preuve non optimaux dans le but d'accélérer l'accès des malades aux nouveaux médicaments dits « prometteurs ». Enfin, l'intervention des patients, désormais très importante dans le domaine, est un phénomène de société à ne pas méconnaître, soit qu'ils se méfient du médicament et de son évaluation ou qu'ils fassent pression sur le prescripteur pour obtenir une prescription hors AMM vantée dans les réseaux sociaux. Il n'en demeure pas moins que l'AMM reste la référence et le repère à respecter pour une prescription médicamenteuse optimale, sécurisée et responsable. Un point positif est que la pandémie due au COVID-19 aura permis aux journalistes de mieux maîtriser les notions de niveau de preuve et de balance bénéfices/risques. Par la même occasion, elle aura permis au public, dans sa très grande majorité, de comprendre ce qu'est une AMM et d'en admettre la nécessité, malgré l'érosion de sa confiance dans l'expertise scientifique et sa suspicion vis-à-vis des institutions de santé. S'il n'y a pas lieu de regretter que davantage de transparence et de démocratie sanitaire permettent au citoyen de s'approprier la signification et les déterminants de l'AMM, il y a lieu, pour les spécialistes de l'évaluation, d'appeler au maintien de sa rigueur dans l'intérêt même des patients et pour les autorités de santé de la maintenir. Summary The sacrosanct image that prescribers and the public had of Drug Marketing Authorization (AMM) three or four decades ago has changed significantly over the past few years, following the recognition, – sometimes controversial – of some of its shortcomings or weaknesses. The text of this article discusses some of the factors that may explain this change in mentality, which is harmful to patient safety. Among these factors, we can mention the understandable delay of some AMMs on the data acquired from science, a sometimes excessive and counterproductive formalism, or even possible disagreements between the Agencies responsible for the registration of medicinal products. But above all, it is necessary to retain that some AMMs are fragile, with a degraded image, prematurely granted on sub-optimal levels of evidence with the aim of accelerating patients' access to new, so-called "promising” drugs. Finally, the intervention of patients, now very important in this field, is a social phenomenon that should not be overlooked, either because they are wary of the drug and its evaluation or because they put pressure on the prescriber to obtain an off-label prescription touted in social networks. The fact remains that the AMM remains the reference and the benchmark to be respected for an optimal, secure and responsible drug prescription. A positive point is that the pandemic due to COVID-19 has enabled journalists to better master the notions of level of proof and benefit/risk balance. At the same time, it will have enabled the vast majority of the public to understand what AMM is and to accept, for the most part, the need for it, despite the erosion of their confidence in scientific expertise and their suspicion towards the health institutions. If there is no reason to regret that more transparenc and health democracy allow the citizen to appropriate the meaning and the determinants of AMM, there is reason, for the evaluation specialists to call for maintaining its rigor in the very interest of patients and for health authorities to maintain it.

Where is the journal at and where it is going after thirty-five years of publication: a forward-looking vision

On the occasion of its 35th anniversary, the editors of the Revue internationale PME asked us, as its founders, to take stock of its career and its future. We return, on the one hand, to its role in the development of the discipline affecting this research theme, and on the other hand, to its foreseeable evolution in the coming years. This exercise allows us to stress once again the importance of such a theme not only because of the very large number of these enterprises in all economies, but because of their increasingly recognized impact on their development. In this article, we summarize the choices of themes chosen by researchers in the early years of the journal. Subsequently, we focus on the themes that were expanded in the following decade, marking in particular the specificity and complexity of the subject. To then make some projections on what is possibly coming in this world of SMEs. Finally, we stop at the scientific importance of French precisely for the enrichment of this science as for any other science.

Urgences psychiatriques chez les 15–25 ans durant la première année de la crise sanitaire : une étude épidémiologique descriptive dans le plus grand centre d’urgences psychiatriques français

Résumé Depuis le 16 mars 2020, date de l’annonce du premier confinement en France dans le contexte de pandémie liée à la COVID-19 et de crise sanitaire, les Français ont connu un bouleversement brutal et durable de leurs rythmes et habitudes. La crise sanitaire a eu un impact fort sur la population générale et sur les patients souffrant de troubles psychiatriques. La demande de prise en charge en santé mentale est particulièrement accrue chez les jeunes, qui semblent les plus impactés par cette crise. Dans la première partie de cet article, nous décrirons l’impact de la crise sanitaire sur la santé mentale des jeunes et sur la fréquentation des urgences psychiatriques, avec une revue exhaustive de la littérature française et internationale. La littérature traitant de la santé mentale des enfants et des jeunes durant la crise sanitaire est vaste et régulièrement actualisée. Au 31 décembre 2021, seules quelques données concernant l’état de santé mentale des jeunes sont chiffrées et publiées. Dans la seconde partie, nous présenterons une étude épidémiologique descriptive réalisée dans le plus grand centre d’urgences psychiatriques français, afin de mettre en évidence les changements des flux de consultations des patients âgés de 15 à 25 ans durant la première année de la crise sanitaire, comparativement aux trois années précédentes. En conclusion, nous évoquerons les mesures et adaptations du système de soins français mises en place pour prendre en charge les besoins accrus en santé mentale de cette population spécifique des 15–25 ans, particulièrement malmenée par la crise sanitaire, véritable enjeu national de santé publique. Introduction Since March 16, 2020, the date of the announcement of the first confinement in France in the context of the COVID-19 pandemic and health crisis, French residents have experienced a brutal and lasting disruption in their rhythms and habits. The health crisis has had a strong impact on the general population and especially on patients suffering from psychiatric disorders. The demand for mental health care has particularly heightened among young people, who seem to be the most affected by this crisis. In the first part of this article, we will describe the impact of the health crisis on the mental health of young people and on the attendance of psychiatric emergencies, with a review of French and international literature. In the second part, we will present a descriptive epidemiological study carried out in the largest French psychiatric emergency center. Methods and objective Our sample included 9,771 young patients from 15 to 25 years old. The main objective of our study is to highlight the changes in the flow of consultations of patients aged 15 to 25 years during the first year of the health crisis, compared to the three previous years. We calculated and compared the proportion of the target population consulting between the period of the first year of the health crisis (COVID period) and the period encompassing the previous three years (pre-COVID period). We also compared different variables, between the 2,179 young people consulting during the first year of COVID-19 health crisis and the 7,592 young people during the three last years: age, sex, marital status, symptoms, environmental context and CIM-10 diagnoses. Results We observed a significant increase in the proportion of patients aged 15 to 25 during the COVID period (n=29.4% vs. 27.6%;P<0,001). The patients during the COVID period were predominantly female. We have seen a significant increase in patients coming for consultations for anxiety (+4.3%;P<0.001), sleep disorders (+2.8%;P<0.001) and suicidal thoughts (+2.7%;P=0.006) during the COVID period. During the first year of the health crisis, the target population consulted less for claustration, withdrawal or odd behavior. Family conflicts, traumatic events and other life events were more frequent. Schizophrenia, schizotypal and delusional disorders were less frequently diagnosed. Conclusion The health crisis has had a considerable impact on the mental health of the youth population. The mental health of young people is a current subject of concern and a major public health issue. Data from the literature warns of the impact of the health crisis on the mental health of this population and the need for early treatment, even as the supply of psychiatric care is decreasing.

A Scoping Review of Care Trajectories across Multiple Settings for Persons with Dementia.

Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.

[COVID-19 and medical publications: How three articles have influenced the media and public decisions in France]. / Littérature médicale et COVID-19 : comment trois articles ont influencé les médias et la décision publique en France.

The present article details the publication process and the vicissitudes of three articles about SARS-CoV-2 and its related disease (COVID-19). The three articles were published one month apart between March and May 2020. Their mediatization led French health authorities to intervene. Our article does not focus on and does not assess the scientific quality of the articles presented, but only aims to open the reflection on medical publication. Beyond the description of these three specific cases, this article raises issues about article retraction, peer-reviewing, preprints, authorship and the dissemination of scientific medical information, including through the mass media. It discusses new publishing modes and the dissemination of published information in clinical research.