Effects of standardized mindfulness programs on burnout: a systematic review and original analysis from randomized controlled trials.

According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully managed. It is characterized by emotional exhaustion, cynicism toward work, and a lack of personal accomplishment at work. Recent WHO guidelines on mental health suggest that mindfulness could have beneficial effects in a professional environment, but to the best of our knowledge, there is currently no study that has made a large inventory of research focused specifically on the effects of standardized programs on burnout. Which professional populations have already been studied? What are the characteristics of the programs? Have studies shown a significant effect and on what indicator? Objective: To assess the effects of standardized programs of mindfulness on burnout, we carried out a systematic review using an exhaustive inventory of the international literature based on randomized controlled trials (RCTs). Methods: The articles were selected according to PRISMA recommendations. The Embase, PubMed/MEDLINE, EBSCOhost, HAL databases were searched with the keywords "mindfulness," "burnout," and "randomized" in the title and abstract of each article. The data were all collected in an Excel spreadsheet and analyzed in pivot tables, which were then presented in graphs and maps. Results: A total of 49 RCTs were thus selected, the majority of which were of good methodological quality, of American origin (43% of studies), concerned professionals in the health sector (64% of participants included), and mostly women (76%). The RCTs assessed the effects of 31 different mindfulness programs, mostly with the Maslach Burnout Inventory (78% of RCTs). More than two-thirds of RCTs (67%) showed a significant beneficial effect on burnout measurement indicators, with emotional exhaustion being the most impacted component. Conclusion: This systematic review shows that mindfulness-based interventions could be approaches of choice to prevent emotional distress of burnout. Further studies are still needed to determine which type of program is best suited to impact the two other components of burnout.

La conscience et le corps.

Consciousness and the body. Life is expressed in the body through physical, chemical and biological processes as well as through the emergence of immaterial dimensions such as consciousness and subjectivity. These material and immaterial dimensions, connected and interdependent, form the basis of our humanity and should be considered together in the case of a global and personalised approach to the care practice.

[Body-mind therapies in addictology: contributions of psychomotricity]. / Thérapies corps-esprit en addictologie : apports de la psychomotricité.

Addictive disorders restrict addicts' physical activity. On a neurobiological level, the reward system is disrupted. Pleasure is transformed into a constraint and patients lose control of themselves. Differing from a physical activity technique, psychomotor therapy, by drawing on the body's experience, in relation to the environment, can form part of the care plan. It is based on sensation, tonus, posture and tonico-emotional engagement.

[Use of placebo in French hospitals: data from polyvalent medicine units]. / Le placebo à l'hôpital - Regard sur son utilisation dans les services de médecine polyvalente.

A placebo drug is defined as a treatment without any specific pharmacological efficacy, that works when the patient thinks to receive an active treatment, through a psychological and physiological mechanism. This study aimed to evaluate the use of placebo in French hospitals, in Polyvalent Medicine units. A questionnaire comprising 15 items was sent to 372 units. The analysis of 153 responses was conducted from dynamic crosstabs in Excel and using the R software available online. The survey confirmed that the use of placebos in hospital is frequent, with nearly 2/3 of professionals answering the questionnaire declared to use it. The oral capsule is the most commonly used form. Placebo is mainly administered at night, in case of pain, insomnia or anxiety, to so-called "difficult" patients. Placebo is not always given after medical prescription. In most cases, patients are not informed that they receive a placebo. The majority of professionals believed in the placebo effect but considered to be insufficiently informed and trained in the use of placebo in current practice. Although the placebo effect is now demonstrated, ethical and legal considerations recommend placebo treatment only on medical prescription, with the prior information of the patient. The placebo could be used as complementary therapy to conventional treatment in the cases of this therapeutic effectiveness has been demonstrated. Professionals should be trained in the use of placebo in order to avoid nocebo effect and potentiate beneficial effects of placebo.

TITLE: Le placebo à l'hôpital - Regard sur son utilisation dans les services de médecine polyvalente. ABSTRACT: Un placebo est défini comme un traitement sans efficacité pharmacologique propre qui agit, lorsque le patient pense recevoir un traitement actif, par des mécanismes psychologiques et physiologiques. Notre étude avait pour but d'évaluer l'utilisation du placebo dans les unités de médecine polyvalente des hôpitaux français. Pour cela, un questionnaire comprenant 15 items a été transmis à plusieurs unités. L'analyse des réponses reçues confirme que l'utilisation de placebos à l'hôpital est fréquente, près des deux tiers des professionnels ayant répondu déclarent en faire usage. L'administration du placebo en gélule par voie orale est la forme la plus couramment utilisée. À l'hôpital, il est administré principalement la nuit, le plus souvent sans prescription médicale, en cas de douleur, d'insomnie ou d'anxiété, à des patients dits « difficiles ¼ (solliciteurs d'attention et de soin). Dans la plupart des cas, les patients ne sont pas informés qu'il s'agit d'un placebo. La majorité des professionnels « croit ¼ en l'effet placebo, mais se considèrent cependant insuffisamment informés et formés à son utilisation. Fréquemment utilisé à l'hôpital, son efficacité thérapeutique étant largement admise, des considérations éthiques et juridiques imposent de recommander que sa nature soit précisée au patient lors de sa prescription (au même titre que les autres préparations hospitalières). On parlera alors de « placebo ouvert ¼, c'est-à-dire que des explications sur les effets et les mécanismes d'action du placebo seront données au patient. Des études récentes montrent que dire au patient qu'il reçoit un placebo ouvert n'affecte en rien son effet.

Le placebo, entre éthique et soins.

THE PLACEBO, BETWEEN ETHICS AND CARE: A placebo is used to fight pain, insomnia or anxiety. The placebo effect is said to be this one produced by this 'fake' medication. However, could it not chiefly be the effect produced by the trust relationship established between a patient and a caregiver at a given moment? This article reflects on the results of a survey carried out in the hospital sector.

[Placebo and professional practices in nursing care in hospital]. / Placebo et pratiques professionnelles en soins infirmiers à l'hôpital.

While the placebo is a pharmacologically inert substance, the effect it can produce is undeniable and unquestioned and all hospitals use it. This article presents the results of a survey carried out with nurses from Dreux general hospital, aiming to assess the place of the placebo in their professional practices.

Growth screening in children aged 3-5 years: a useful tool for public health programs in community pediatrics.

Background About 90% of children grow up normally and attain a final height within their genetic target. In children with intrauterine growth restriction (IUGR), up to 10% will not catch up spontaneously. Turner syndrome is often diagnosed late, and a number of growth-stunted children go undiagnosed and untreated. Objectives Our primary aim was to evaluate the prevalence of stunted growth in preschool-aged children. Our secondary aim was to evaluate growth patterns in children belonging to four ethnic groups in Dreux district, France. Methods Body weight, height and body mass index (BMI) were collected for children aged 3-5 years during systematic community visits. Birth variables, family history of short stature, maternal smoking, ethnic origin, etc. were also recorded. Pubertal status was staged as per Tanner's method. Parents were instructed to attend the hospital growth clinics if their child's height was <-2.0 standard deviation score (SDS). Results Five hundred ninety-three children were screened (301 boys, 289 girls). The mean age was 4.33 ± 0.76 standard deviation (SD) years, and 48% were Caucasians, 13.7% were North Africans, 2.5% were Black Africans, 0.8% were Asians, 1.5% included others and the ethnicity was not specified in 33.5% of the cases. 91.5% of children were term-born and 8.5% were preterm. 84.2% of children were appropriate for gestational age (AGA) and 9.4% were small for gestational age (SGA). At 5 years of age, 22.2% of macrosomic North African children were overweight. Catch-up growth was complete in 98% children, 11/540 were short statured, 8/11 attended our growth clinics (seven short statured and one micropenis) and three were started on recombinant human growth hormone (rhGH). Conclusions Growth screening programs are important and useful tools for public health. There is a need for clear objectives, proper training and automated data collection tools, along with easy access to growth specialists.

[A universal control unit for people with disabilities]. / Une commande universelle au service du handicap.

Home automation in the area of disability is a rapidly developing field. A hospital rehabilitation unit and a university institute of technology have formed an experimental partnership with the aim of improving patient care management. This collaboration resulted in the development of a control interface in a hospital room equipped with certain home automation systems, opening up perspectives for the return home of patients with a disability.

[Nurse and dietitian: effective collaboration in rehabilitation]. / Infirmière et diététicienne : une collaboration efficace en service de rééducation.

In functional rehabilitation service, the dietician, as educator, contributes to preventing recidivism and return to independence. A hospital team demonstrates the benefits of collaboration with dietitians in coordinated care for patients with various pathologies causing functional impairment.

Maillard reaction products from highly heated food prevent mast cell number increase and inflammation in a mouse model of colitis.

Links between food and inflammatory bowel diseases (IBDs) are often suggested, but the role of food processing has not been extensively studied. Heat treatment is known to cause the loss of nutrients and the appearance of neoformed compounds such as Maillard reaction products. Their involvement in gut inflammation is equivocal, as some may have proinflammatory effects, whereas other seem to be protective. As IBDs are associated with the recruitment of immune cells, including mast cells, we raised the hypothesis that dietary Maillard reaction products generated through heat treatment of food may limit the colitic response and its associated recruitment of mast cells. An experimental model of colitis was used in mice submitted to mildly and highly heated rodent food. Adult male mice were divided in 3 groups and received nonheated, mildly heated, or highly heated chow during 21 days. In the last week of the study, each group was split into 2 subgroups, submitted or not (controls) to dextran sulfate sodium (DSS) colitis. Weight variations, macroscopic lesions, colonic myeloperoxidase activity, and mucosal mast cell number were evaluated at the end of the experiment. Only highly heated chow significantly prevented DSS-induced weight loss, myeloperoxidase activity, and mast cell number increase in the colonic mucosa of DSS-colitic mice. We suggest that Maillard reaction products from highly heated food may limit the occurrence of inflammatory phases in IBD patients.

Polycystic ovary syndrome: Pelvic MRI as alternative to pelvic ultrasound for the diagnosis in overweight and obese adolescent girls.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common reproductive endocrinopathy in women of childbearing age, affecting 5-15% women in this age group. Suggestive cardinal features comprise hyperandrogenism, ovulatory dysfunction and/or polycystic ovary appearance. The gold standard radiological tool is the pelvic ultrasound (PUS) whose yield may be limited in overweight and obese adolescent girls. OBJECTIVE AND HYPOTHESES: To evaluate the contribution of pelvic MRI to the diagnosis of PCOS in a specific group of virginal overweight and obese adolescent girls. METHOD: Eight adolescent girls seen for menstrual irregularities or amenorrhea, with features of hyperandrogenism were biochemically screened (LH, FSH, testosterone, S-DHEA, delta-4 androstenedione, 17 (OH) P, SHBG, TSH, free T4, prolactin and lipid profile, fasting blood sugar and HOMA-IR and HOMA-B). Each had PUS and/or pelvic MRI (PMRI) performed. Other causes of hyperandrogenism were excluded. IMAGING: PUS with the trans-abdominal transducer was attempted in only one patient Acuson© scanner, using 3.5-7.5 MHz transducer; PMRI was performed in all patients with phased array coil of 1.5 T Siemens MRI scanner, with T1 and T2-weighted axial and coronal images. PCOS was defined according to the Rotterdam PCOS consensus Workshop. RESULTS: Eight girls (mean age 14,6 ± 1.47 years) are reported, one was overweight (BMI Z-score > 1 SDS), seven others were obese (BMI Z-score > 2 SDS). Mean age at menarche was 11.58 ± 1.11 years, except for one who had not yet entered menarche. All had menstrual irregularities, acanthosis nigricans, acne, hirsutism, and biochemical characteristics of PCOS (high plasma androgens, insulin resistance, glucose/insulin ratio <4.5, decreased SHBG).PUS was not contributive to the diagnosis of PCOS, whereas PMRI showed typical aspect (well delineated peripheral ovarian cysts), with increased ovarian volume and stroma. CONCLUSION: Although PUS remains the gold standard for the diagnosis of PCOS in most cases, its limitations in overweight and obese girls are real and must be considered.If utilization of endovaginal transducer not being feasible in young virginal girls, PMRI could be a useful alternative, allowing greater delineation of structural components of the ovary and better appreciation of both its volume and structural alterations.

Streptococcus pneumoniae serotype 19A meningitis in well-vaccinated immunocompetent 13-month-old child: a case of PCV13 failure.

We report a 13-month-old immune-competent male child who was diagnosed with pneumococcal serotype 19A meningitis despite having received three PCV13 injections. Clinicians are reminded that bacterial meningitis can still occur, even in correctly vaccinated children. Investigations should include immune system screening along with abdominal ultrasound to exclude asplenia.

Pseudohypoparathyroidism Type 1A-Subclinical Hypothyroidism and Rapid Weight Gain as Early Clinical Signs: A Clinical Review of 10 Cases.

OBJECTIVE: To evaluate the clinical signs and symptoms that would help clinicians to consider pseudohypoparathyroidism (PHP) type 1A as a diagnosis in a child. METHODS: A retrospective review of the medical records of children diagnosed by erythrocyte Gsα activity and/or GNAS1 gene study and followed-up for PHP type 1A. Clinical and biochemical parameters along with epidemiological data were extracted and analyzed. Weight gain during infancy and early childhood was calculated as change in weight standard deviation score (SDS), using the French growth reference values. An upward gain in weight ≥0.67 SDS during these periods was considered indicative of overweight and/or obesity. RESULTS: Ten cases of PHP type 1A were identified (mean age 41.1 months, range from 4 to 156 months). In children aged ≤2 years, the commonest clinical features were round lunar face, obesity (70%), and subcutaneous ossifications (60%). In older children, brachydactyly was present in 60% of cases. Seizures occurred in older children (3 cases). Short stature was common at all ages. Subclinical hypothyroidism was present in 70%, increased parathormone (PTH) in 83%, and hyperphosphatemia in 50%. Only one case presented with hypocalcemia. Erythrocyte Gsα activity tested in seven children was reduced; GNAS1 gene testing was performed in 9 children. Maternal transmission was the most common (six patients). In three other cases, the mutations were de novo, c.585delGACT in exon 8 (case 2) and c.344C>TP115L in exon 5 (cases 6&7). CONCLUSION: Based on our results, PHP type 1A should be considered in toddlers presenting with round face, rapid weight gain, subcutaneous ossifications, and subclinical hypothyroidism. In older children, moderate mental retardation, brachydactyly, afebrile seizures, short stature, and thyroid-stimulating hormone resistance are the most suggestive features.

[Preventing swallowing disorders in neurological patients]. / Prévenir les troubles de la déglutition chez les patients présentant des pathologies neurologiques.

Swallowing disorders in neurological rehabilitation are common and important as they can have harmful consequences. A multi-disciplinary hospital team was created to study ways of preventing their occurrence. This article presents the areas to focus on and the main orientations of patient management.

A focus on mast cells and pain.

Mast cells (MCs) are immunocytes with secretory functions that act locally in peripheral tissues to modulate local hemodynamics, nociceptor activation and pain. They are also able to infiltrate the central nervous system (CNS), especially the spinal cord and the thalamus, but their cerebral function remains an enigma. A role in regulating the opening of the blood-brain barrier has been proposed. Paracrine-like action of MCs on synaptic transmission might also signal a modulation of the nervous system by the immune system. In this review, we examine the link between MCs and nociceptive process, at the periphery as well as in the CNS.

Decrease of cerebral mast cell degranulation after systemic administration of lipopolysaccharide.

INTRODUCTION: The mast cell is an immunocyte, but its functions in the brain remain unclear. MATERIALS AND METHODS: In a rat model of weak inflammation, we analyzed the effect of a gram-negative bacterial lipopolysaccharide injection (100 µg/kg) on thalamic mast cell (MC) population. CONCLUSION: We demonstrate a significant decrease of their degranulation, which suggests the implication of MC in preventing sepsis on the brain.

N-methyl-D-aspartate receptor antagonists enhance histamine neuron activity in rodent brain.

The modulation of histamine neuron activity by various non-competitive NMDA-receptor antagonists was evaluated by changes in tele-methylhistamine (t-MeHA) levels and histidine decarboxylase (hdc) mRNA expression induced in rodent brain. The NMDA open-channel blockers phencyclidine (PCP) and MK-801 enhanced t-MeHA levels in mouse brain by 50-60%. Ifenprodil, which interacts with polyamine sites of NR2B-containing NMDA receptors, had no effect. PCP also increased hdc mRNA expression in the rat tuberomammillary nucleus. The enhancement of t-MeHA levels elicited by MK-801 (ED50 of approximately 0.1 mg/kg) was observed in the hypothalamus, cerebral cortex, striatum and hippocampus. Control t-MeHA levels and the t-MeHA response to MK-801 were not different in male and female mice. Double immunostaining for HDC and NMDA receptor subunits showed that histamine neurons of the rat tuberomammillary nucleus express NMDA receptor subunit 1 (NR1) with NMDA receptor subunit 2A (NR2A) and NMDA receptor 2B subunit (NR2B). In addition, immunoreactivity for the neuronal glutamate transporter EAAC1 was observed near most histaminergic perikarya. Hence, these findings support the existence of histamine/glutamate functional interactions in the brain. The increase in histamine neuron activity induced by NMDA receptor antagonists further suggests a role of histamine neurons in psychotic disorders. In addition, the decrease in MK-801-induced hyperlocomotion observed in mice after administration of ciproxifan further strengthens the potential interest of H3-receptor antagonist/inverse agonists for the symptomatic treatment of schizophrenia.

Glial activation in white matter following ischemia in the neonatal P7 rat brain.

This study examines cell death and proliferation in the white matter after neonatal stroke. In postnatal day 7 injured rat, there was a marked reduction in myelin basic protein (MBP) immunostaining mainly corresponding to numerous pyknotic immature oligodendrocytes and TUNEL-positive astrocytes in the ipsilateral external capsule. In contrast, a substantial restoration of MBP, as indicated by the MBP ratio of left-to-right, occurred in the cingulum at 48 (1.27 +/- 0.12) and 72 (1.30 +/- 0.18, P < 0.05) h of recovery as compared to age-matched controls (1.03 +/- 0.14). Ki-67 immunostaining revealed a first peak of newly generated cells in the dorsolateral hippocampal subventricular zone and cingulum at 72 h after reperfusion. Double immunofluorescence revealed that most of the Ki-67-positive cells were astrocytes at 48 h and NG2 pre-oligodendrocytes at 72 h of recovery. Microglia infiltration occurs over several days in the cingulum, and a huge quantity of macrophages reached the subcortical white matter where they engulfed immature oligodendrocytes. The overall results suggest that the persistent activation of microglia involves a chronic component of immunoinflammation, which overwhelms repair processes and contributes to cystic growth in the developing brain.

Cloning and expression of the mouse histamine H3 receptor: evidence for multiple isoforms.

The existence of mouse H3-receptor isoforms was investigated by PCR analysis and cDNA cloning. Splicing mechanisms previously reported in various species are conserved in the mouse. The retention/deletion of a fragment in the third intracellular loop of the mouse receptor leads to the existence of three isoforms designated mH(3(445)), mH(3(413)) and mH(3(397)) according to the length of their deduced amino acid sequence. PCR analysis showed that mouse H3-receptor isoforms display different expression patterns in the brain. Following expression in Cos-1 cells, [125I]iodoproxyfan binding indicated similar pharmacological profiles of the mH(3(445)), mH(3(413)) and mH(3(397)) isoforms. The pharmacological profile of the mouse H3 receptor is more similar to the rat receptor than to the human receptor, although some differences were also observed between the mouse and rat receptors. For example, the potency of thioperamide and ciproxifan is slightly higher at the mouse receptor than at the rat receptor but 40-100-fold higher than at the human receptor. In situ hybridization histochemistry showed that the distribution of H3-receptor mRNAs in the mouse brain is rather similar to that previously reported in the rat brain. However, the autoradiographic and cellular expression patterns observed in several brain areas such as the thalamus or hippocampus reveal important differences between the two species.

Ciproxifan, a histamine H3-receptor antagonist/inverse agonist, modulates the effects of methamphetamine on neuropeptide mRNA expression in rat striatum.

We have explored the effect of histamine H3-receptor ligands on the regulation of neuropeptide mRNA expression in the striatum by using in situ hybridization performed with proenkephalin, prodynorphin, substance P and proneurotensin riboprobes. Acute administration of ciproxifan, an H3-receptor antagonist/inverse agonist, or (R)-alpha-methylhistamine, an H3-receptor agonist, did not modify the striatal expression of the neuropeptides by itself. However, ciproxifan strongly and differentially modulated the effect of a single administration of 3 mg/kg methamphetamine on neuropeptide mRNA expression. This modulation was suppressed by the administration of (R)-alpha-methylhistamine and occurred in both the caudate-putamen and nucleus accumbens. Ciproxifan strongly potentiated the decrease of proenkephalin mRNA expression induced by methamphetamine. In contrast, it suppressed the increase in prodynorphin and substance P mRNA expression induced by methamphetamine. Methamphetamine alone or with ciproxifan did not modify proneurotensin mRNA expression. These neurochemical findings indicate that ciproxifan differentially regulates the effect of methamphetamine on the neuropeptides contained in striatonigral and striatopallidal neurons. They suggest that endogenous histamine and dopamine cooperate to modulate the activity of striatal projection neurons and strengthen the interest of H3-receptors as new targets for the treatment of psychotic disorders and drug abuse.