Dynamic Ecosystem Adaptation through Allostasis (DEA-A) Model: Conceptual Presentation of an Integrative Theoretical Framework for Global Health Change.

Achieving ambitious goals in Global Health first requires an integrative understanding of how individuals and organizations adapt in a living ecosystem. The absence of a unified framework limits the consideration of the issues in their complexity, which further complicates the planning of Global Health programs aimed at articulating population-based prevention and individual-level (clinical) interventions. The aim of the conceptual contribution is to propose such a model. It introduces the Dynamic Ecosystem of Adaptation through Allostasis (DEA-A) theoretical framework, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. The DEA-A framework articulates two central components to grasp the complexity of adaptation: the internal dynamics (intrasystem level) and the environmental dynamics (ecosystem level). It bridges diverse conceptual approaches, including stress and adaptation models, behavior-change models, and ecosystem-based perspectives. Epistemological considerations raised in the conceptual article prompt a reconsideration of methods and tools for the planning of intervention. Further contributions will present a suitable methodology for the application of the DEA-A framework along with practical recommendations.

Planning Individual and Population-Based Interventions in Global Health: Applying the DEA-A Framework to Promote Behavioral, Emotional, and/or Cognitive Change among Stakeholders.

Addressing health challenges that impact human well-being requires a comprehensive, interdisciplinary approach that would be at the crossroad of population-based prevention and individual-level clinical care, which is in line with a Global Health perspective. In the absence of a unifying theoretical framework to guide such interventions, a Dynamic Ecosystem Adaptation through the Allostasis (DEA-A) framework has been proposed, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. While a conceptual model has been presented, this methodological contribution aims at illustrating the practical application of the DEA-A framework for planning Global Health interventions. The methodology combines Intervention Mapping and Cognitive and Behavioral Theory, extended to the ecosystem. Practical guidelines and supporting tools are provided to help public health providers and clinicians in establishing a functional ecosystem diagnosis of the issue; defining not only behavioral, but also emotional and cognitive change objectives (allostasis targets) expected for each stakeholder; and designing intervention plans targeting determinants of these allostasis. The discussion addresses implementation and evaluation perspectives of interventions based on the DEA-A framework, emphasizing the importance of considering change in its processual and ecosystem complexity. Lastly, encouragements for a deeper understanding of individual and ecosystem homeostasis/allostasis processes are made in order to promote more functional interventions.

"Green et al. Paranoid Thoughts Scale-revised": Structural invariance and clinical utility of a brief version in schizophrenia.

OBJECTIVE: Persecutory ideas are highly frequent in psychotic disorders and particularly in schizophrenia. Although several measures exist to assess persecutory ideas in both clinical and non-clinical samples, there is a need for brief and psychometrically sound measures to capture the multidimensional aspects of paranoia in people diagnosed with schizophrenia. Our aim was to validate a brief version of the revised Green et al., Paranoid Thoughts Scale (R-GPTS) in schizophrenia in order to minimize time-consuming assessment. METHODS: 100 individuals with schizophrenia and 72 non-clinical controls were recruited. We used the GPTS-8, a brief 8-item version of the R-GPTS recently developed and validated in the French general population. Psychometric properties of the scale were investigated including its factor structure, internal consistency, and convergent/divergent validities. RESULTS: Confirmatory factor analysis supported the original two-factor structure (social reference and persecution subscales) of the GPTS-8. The GPTS-8 was positively and moderately correlated with the Positive and Negative Syndrome Scale (PANSS) suspiciousness item indicating good internal consistency. Concerning divergent validity, no correlations were found between the GPTS-8 and the Montreal cognitive assessment (MoCA). Importantly patients with schizophrenia reported higher scores on the GTPS-8 than controls demonstrating its clinical validity. CONCLUSIONS: The French GPTS 8-item brief scale-8 retains the psychometric strengths of the R-GPTS in schizophrenia with relevant clinical validity. The GPTS-8 can consequently be used as a short and quick measure of paranoid ideations in individuals with a diagnosis of schizophrenia.

What Do EURO-D Scores Capture? Disentangling Trait and State Variances in Depression Symptoms Across the Adult Life Span in Nine European Nations.

The primary purposes of the present study were to determine (a) whether the EURO-D measures trait (i.e., time-invariant) versus state (i.e., time-variant) aspects of depression and (b) whether these aspects are stable across countries and ages. In five waves of the SHARE survey (a nationally representative Survey of Health, Ageing, and Retirement in Europe), we estimated trait-state-occasion models (TSO), including multiple-nation TSO, based on data from nine European nations over a 10-year period. Also, we used local structural equation modeling to test for the moderating effects of age on the TSO parameters. Our main findings were: (a) there were differences in the trait/state variances of depressive symptoms across nations. The amount of trait variance was above 60% for Belgium, Denmark, and France. It was between 50% and 60% for Austria, Germany, Sweden, and Switzerland, while it was below 50% for Italy and Spain. (b) The effects of trait and state were almost equally the source of variance for depression symptoms across ages, with a slight advantage for the effects of trait (56% of the variance). This trend showed substantial stability across the adult life course (from age 40 up to age 95).

Endometriosis diagnosis buffers reciprocal effects of emotional distress on pain experience.

OBJECTIVES: Emotional profile is involved in the experience of chronic pain related to endometriosis. Following the Örebro Model of Behavioral Emotion Regulation of Pain, the aim of this study was to understand the processes involved in the psychological adaptation to pain experienced during menstruations in women either diagnosed or not diagnosed with endometriosis. METHODS: The study was conducted on a sample of 545 women, either diagnosed with endometriosis or not, during their menstruations. Functional repercussions and intensity of pain, catastrophic thinking, difficulties in emotional regulation and emotional distress were assessed through an online questionnaire. Structural equation modeling (SEM) was carried out. RESULTS: Women diagnosed with endometriosis experience more suffering than women who have not had such a diagnosis. The model we adapted from Örebro's model fits the data well. A differential effect is observed regarding the retroactive effect of depression on pain. Although emotional distress increases functional repercussions among women both with and without the diagnosis, growing pain intensity only occurs among those without. CONCLUSIONS: A woman presenting pain during menstruation faces emotional regulation issues that make her more vulnerable to the development of emotional distress. Pain impacts emotional distress, but emotional distress does not impact pain among women for whom the origin of the pain was known (i.e., a diagnosis of endometriosis). Having a diagnosis allows women to externalize the origin of their pain, attributing it to the disease and not to their psychological state.

A questionable version of the Post-Traumatic growth inventory-Short form in women diagnosed with breast cancer.

OBJECTIVES: Because the full version of the Post-Traumatic Growth Inventory was considered too long, a short English version (10 items/five factors) was initially proposed in the literature (PTGI-SF). Thereafter another short Italian version (10 items/five factors) and a unidimensional English version (11 items) were proposed. This study aimed at evaluating which of these three versions of the PTGI-SF could be best adapted to women diagnosed with breast cancer. DESIGN: Cross-sectional and psychometrics study. METHODS: A total of 239 breast cancer patients or survivors were included in the study. To assess all items related to the different PTGI-SF candidate versions; the full-length PTGI has been used to measure PTG. A set of psychometric analyses, including a confirmatory factor analysis, composite reliability and construct validity has been performed. RESULTS: The English unidimensional version did not fit the data (SB-Chi2  = 184.47, df = 42, p < .001; SB-RMSEA = .119; SB-CFI = .814; SB-TLI = .757; SRMR = .083). Both the English (SB-Chi2  = 61.40, df = 25, p < .001; SB-RMSEA = .078; SB-CFI = .948; SB-TLI = .907; SRMR = .048) and Italian (SB-Chi2  = 26.52, df = 25, p > .05; SB-RMSEA = .016; SB-CFI = .998; SB-TLI = .996; SRMR = .026) versions (10 items/five factors, respectively) showed satisfactory psychometric results. CONCLUSION: Further investigations are thus required to identify which of these two versions of the PTGI-SF is the most appropriate for women diagnosed with breast cancer.

Attention-Deficit/Hyperactivity Disorder, Insomnia, and Sleepiness Symptoms among a Community Adult Sample: The Mediating Effect of Executive Behavioral Regulation and Metacognition Abilities.

OBJECTIVE: Adult attention-deficit/hyperactivity disorder (ADHD) is characterized by a dysexecutive syndrome reflected in cognitive, emotional, and behavioral areas. Independently of a formal diagnosis of ADHD, higher ADHD symptoms are associated with higher levels of insomnia and sleepiness symptoms in adult population-based samples. Insomnia and sleepiness are sleep disorders that are both associated with deficits in several aspects of executive functions which in turn are likely to mimic a range of ADHD symptoms. Our objective was to explore the interrelationships between ADHD, insomnia, and sleepiness symptoms and executive functioning in community-dwelling adults. METHOD: A total of 442 participants (18-89 years, 56% females) underwent a semistructured clinical interview and completed questionnaires for insomnia, sleepiness, and everyday behaviors in which executive functions are implicated. Mediation Models were applied. RESULTS: Insomnia and sleepiness symptoms did not play a mediating role between ADHD symptoms and executive functioning. Conversely, our results highlighted a mediating effect of daytime insomnia consequences and sleepiness on ADHD symptoms via behavioral regulation executive symptoms (respectively, ß = -0.32, p < .001, 95% CI [-0.46, -0.20]; ß = 0.09, p < .05, 95% CI [0.02, 0.16]) and metacognitive executive symptoms (respectively, ß = -0.30, p < .001, 95% CI [-0.44, -0.18]; ß = 0.12, p < .01, 95% CI [0.04, 0.22]). CONCLUSIONS: Daytime insomnia consequences and sleepiness symptoms could lead to ADHD-like symptoms through their associated executive symptoms expressed in daily life. When faced with symptoms suggestive of ADHD in adults, insomnia and sleepiness should be systematically screened with standardized instruments.

Barriers and facilitators on hand hygiene and hydro-alcoholic solutions' use: representations of health professionals and prevention perspectives.

BACKGROUND: Healthcare-associated infections pose a serious problem in terms of health and mortality. Their prevention is a necessity, and healthcare professionals are one of their main vectors. Thus, they must be at the centre of preventative strategies. As hydro-alcoholic solutions (alcohol-based hand rub) represent the most effective means of preventing these infections, it is necessary to identify the representations, barriers, and facilitators of their use. METHOD: Forty-six healthcare professionals from two areas in France, New Aquitaine and Guadeloupe, were questioned about their practices through semi-structured registered interviews and four focus groups. Each interview and focus group were transcribed then analysed through lexicometric and thematic content analyses. RESULTS: The interviewed identified several barriers and facilitators related to the composition and characteristics of hydro-alcoholic solutions (unpleasantness, harmfulness, personal preferences for other hand hygiene products), personal factors (work habits, cognitive bias, lack of knowledge and communication) and organizational (professional constraints, product accessibility, financial resources). CONCLUSION: Strategies to prevent healthcare-associated infections should be constructed with consideration of psychosocial facilitators and barriers for healthcare professionals in using hydro-alcoholic solutions. These strategies should also ensure that they are well informed about the effectiveness of alcohol-based solutions, through prevention campaigns and scientific articles. This awareness should equally be conveyed with educational tools that involve healthcare professionals and use the social dynamics of their work environment.

Facilitators of and obstacles to consultation in patients with advanced basal cell carcinoma: a French pilot study.

Basal cell carcinoma is the most common skin cancer for which surgery is usually the unique and definitive treatment. Advanced basal cell carcinoma is not eligible to surgery when underlying structures are destroyed. Delayed consultation is the principal cause of advanced basal cell carcinoma. It is questionable why some patients seek care only when the tumour is advanced. The objective of this study was to identify the psychosocial factors involved in delayed consultation. We used a qualitative approach, conducting semi-structured interviews with advanced basal cell carcinoma patients and the healthcare staff of a dermatology unit to explore why some patients consult only when basal cell carcinoma is advanced. We then put our findings into perspective and created a logical model for change. We interviewed 14 patients and 12 healthcare staff. The first lesion was associated with banalization. Then, denial and fear of diagnosis or treatment were post common. Finally, the advanced basal cell carcinoma's symptoms, along with social pressure, created the intention to seek medical help and improved disease awareness. We developed a logical model that summarizes these findings. In this pilot study, we modelled factors that delayed consultation. This will aid future research and targeted interventions reducing delay, in particular by improving knowledge and by using social pressure as facilitators. Trial registration: NCT04124796.

Measuring the Sense of Agency: A French Adaptation and Validation of the Sense of Agency Scale (F-SoAS).

Sense of Agency (SoA) is the subject of growing attention. It corresponds to the capacity to claim authorship over an action, associate specific consequences with a specific action, and it has been claimed to be a key point in the development of consciousness. It can be measured using the Sense of Agency Scale (SoAS), originally proposed by Tapal et al. (2017), who distinguished it into two-factor: Sense of Positive Agency (SoPA) and Sense of Negative Agency (SoNA). This study reports on the first adaptation of the SoAS into another language, French. For this French version of the Sense of Agency Scale (F-SoAS), we analyzed responses from a sample of 517 native French-speakers. Our results indicate that the scale has good psychometric properties. Factor analysis confirms the same two-factor model as Tapal et al. (2017). However, some items were removed due to insufficient loadings with factors, leading to a short version of the scale (7-item). Furthermore, we observed gender differences that are consistent with findings in the literature. Specifically, women report higher SoNA scores and lower SoPA scores than men. We conclude by discussing possible uses and future directions for the scale.

Breast cancer specialists' perspective on their role in their patients' return to work: A qualitative study.

Objectives This study aimed to explore the views of breast cancer (BC) specialists as to their role in the return-to-work (RTW) process of their BC patients. Methods A qualitative study using semi-structured interviews was conducted in a sample of 20 BC specialists selected according to age, gender, medical specialty (medical oncology, radiation oncology, gynecological surgery), and healthcare organization (regional cancer center, university or private hospital). All interviews were audiotaped and transcribed for qualitative thematic content analysis. Results BC specialists had heterogeneous representations and practices regarding their role in their patients` RTW process, ranging from non-involvement to frequent discussion. Most BC specialists had concerns regarding the "right time and right way" to address patient`s RTW. They hardly mentioned workplace and job factors as potential barriers but rather stressed motivation. The main reported barriers to involvement in the RTW process were lack of time, lack of knowledge, lack of skills, and a professional attitude exclusively focused on cancer care issues. Conclusion While our study showed varying representations and practices among BC specialists, participants consistently identified barriers in supporting BC survivors` RTW. The results will guide the development of an intervention to facilitate the role of BC specialists in the RTW process as part of a multicomponent intervention to facilitate BC survivors` RTW.

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment.

Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.

The Geriatric Depression Scale: does it measure depressive mood, depressive affect, or both?

OBJECTIVE: Self-report measures of depression are highly important tools used in research and in various healthcare settings for the diagnosis of different levels of depression. The Geriatric Depression Scale (GDS) is the first and the most popular scale used to screen for late-life depression. It is endorsed by the Royal College of Physicians and the British Geriatric Society (1992). The purpose of the present research was to investigate whether scores on the GDS15 capture depressive mood (i.e. trait depression), depressive affect (i.e. short-term depressive state), or both. METHODS: For this purpose, a trait-state model (stable trait, autoregressive trait, and state model) was applied to GDS15 scores obtained at four time points over a 6-year period among a sample of community-dwelling older persons (N = 753). This model allows decomposing the GDS15 scores into three different variance components: stable trait variance, autoregressive trait variance, and state variance. RESULTS: Our findings revealed a general pattern of a major proportion of stable trait (69%) and autoregressive trait (22%) variance and a very smaller amount of state variance (9%) in the GDS scores across 6 years. Age and gender (i.e. being female) were shown to be positively linked to more stable trait variance. CONCLUSIONS: Depression, as assessed with the GDS15 , should be regarded as a relatively stable and enduring trait construct, reflecting a stable core of a person's depressivity. The negligible amount of state elements in the variation of the GDS15 scores provides evidence that changing the context will not be enough to cause significant changes in depressive symptoms. Copyright © 2016 John Wiley & Sons, Ltd.

Decision-making in rectal and colorectal cancer: systematic review and qualitative analysis of surgeons' preferences.

Surgeons are experiencing difficulties implementing recommendations not only owing to incomplete, confusing or conflicting information but also to the increasing involvement of patients in decisions relating to their health. This study sought to establish which common factors including heuristic factors guide surgeons' decision-making in colon and rectal cancers. We conducted a systematic literature review of surgeons' decision-making factors related to colon and rectal cancer treatment. Eleven of 349 identified publications were eligible for data analyses. Using the IRaMuTeQ (Interface of R for the Multidimensional Analyses of Texts and Questionnaire), we carried out a qualitative analysis of the significant factors collected in the studies reviewed. Several validation procedures were applied to control the robustness of the findings. Five categories of factors (i.e. patient, surgeon, treatment, tumor and organizational cues) were found to influence surgeons' decision-making. Specifically, all decision criteria including biomedical (e.g. tumor information) and heuristic (e.g. surgeons' dispositional factors) criteria converged towards the factor 'age of patient' in the similarity analysis. In the light of the results, we propose an explanatory model showing the impact of heuristic criteria on medical issues (i.e. diagnosis, prognosis, treatment features, etc.) and thus on decision-making. Finally, the psychosocial complexity involved in decision-making is discussed and a medico-psycho-social grid for use in multidisciplinary meetings is proposed.

Dyadic Cross-Sectional Associations Between Negative Mood, Marital Idealization, and Relationship Quality.

This study aimed to evaluate (a) dyadic associations between relationship quality (RQ) and both depressive and anxious mood (DM and AM), (b) reciprocity hypotheses of negative mood within dyadic interactions, and (c) mediational role of marital idealization between negative mood and relationship quality. Actor-partner interdependence models (APIMs) were performed using data from a sample of 198 dyads. Our results showed that (a) these two facets of negative mood did not have the same weight on RQ and that they had a gender-specific effects pattern, and (b) there was no support for the mood transmission hypothesis. Men's DM displayed direct and indirect (via marital idealization) actor as well as partner effects on RQ, whereas women's DM displayed only a direct actor effect on RQ. There were no significant direct actor effects of AM on RQ, meaning that this link is fully mediated by marital idealization. However, only women's AM showed such indirect effects on RQ.

Subjective wellbeing and longevity: Findings from a 22-year cohort study.

OBJECTIVE: The health implications of positive affect (PA) are still a matter of debate. The present study examined the longitudinal relationships between subjective wellbeing (SWB) components (i.e., Life satisfaction, PA and negative affect (NA)) and all-cause mortality in older adults. METHODS: Discrete-time survival analysis within the structural equation modeling framework was applied to data from the PAQUID Cohort (n=3777, baseline age 62-101years) including ten time periods spanning 22years. Time-invariant (age, gender, baseline life satisfaction, diabetes mellitus and hypercholesterolemia status) and lagged time-varying (PA, NA, dementia, functional status and self-rated health) predictors were included sequentially in the analyses. RESULTS: When included together in the model, only PA among the SWB components showed a significant association with longevity, which persisted (OR=.962, 95% CI=.938, .986) even after adjustment for the interaction between PA and NA, and after additional adjustment for prior medical conditions, functional status and self-rated health. CONCLUSIONS: In congruence with positive psychology, PA proved to be an independent protective factor regardless of variations in NA, which did not seem to be a mortality risk factor.

As long as you've got your health: Longitudinal relationships between positive affect and functional health in old age.

OBJECTIVE: Reciprocal relationships between positive affect (PA) and health are now subject of a heuristic debate in psychology and behavioral medicine. Two radically opposed approaches address the link between subjective well being (SWB) and physical health: top-down (i.e., psychosomatic hypothesis) and bottom-up (i.e., disability/ability hypothesis) approaches. The aim of the present study was to test these two approaches by investigating thirteen-year longitudinal relationships between PA, as an affective dimension of SWB, and functional health in older people. METHODS: The study included 3754 participants aged 62-101 years assessed 6 times over a thirteen-year period. PA was measured by the mean of the positive affect subscale of the CES-D scale. Functional health was assessed by four composite items: a single-item self-rating of hearing impairment, a single-item self-rating of vision impairment, the number of medically prescribed drugs, and a single-item self-rating of dyspnoea. We used cross-lagged modeling with latent variables, which is appropriate for testing specific theories. Mean arterial pressure, diabetes mellitus and hypercholesterolemia status, sequelae of stroke, gender, level of education, and age at baseline were use as control variables in the models. RESULTS: Results indicated that good health significantly predicted subsequent levels of PA (average ß = -0.58, p < 0.001), but PA did not predict subsequent levels of good health (ß = 0.01, ns). CONCLUSION: This finding, obtained from a sample of older people, is in keeping with the bottom-up approach, and supports the popular adage "As long as you've got your health". Limitations of this finding are reviewed and discussed. Models including longitudinal mediators, such as biomarkers and life style patterns, are needed to clarify the nature of the link between these constructs.