Familial effects account for association between chronic pain and past month smoking.

BACKGROUND: Smoking is associated with chronic pain, but it is not established whether smoking causes pain or if the link is due to familial effects. One proposed mechanism is that smoking strengthens maladaptive cortico-striatal connectivity, which contributes to pain chronification. We leveraged a twin design to assess direct effects of smoking on pain controlling for familial confounds, and whether cortico-striatal connectivity mediates this association. METHODS: In a population-based sample of 692 twins (age = 28.83 years), we assessed past-month smoking frequency (n = 132 used in the past month), presence and severity of a current pain episode (n = 179 yes), and resting-state functional connectivity of the nucleus accumbens and medial prefrontal cortex (NAc-mPFC). RESULTS: Smoking was significantly associated with pain, but the association was not significantly mediated by NAc-mPFC connectivity. In a co-twin control model, smoking predicted which families had more pain but could not distinguish pain between family members. Pain risk was 43% due to additive genetic (A) and 57% due to non-shared environmental (E) influences. Past-month smoking frequency was 71% genetic and 29% non-shared environmental. Smoking and pain significantly correlated phenotypically (r = 0.21, p = 0.001) and genetically (rg = 0.51, p < 0.001), but not environmentally (re = -0.18, p = 0.339). CONCLUSIONS: Pain and smoking are associated; however, the association appears to reflect shared familial risk factors, such as genetic risk, rather than being causal in nature. The connectivity strength of the reward pathway was not related to concurrent pain and smoking in this sample. SIGNIFICANCE: Smoking does not appear to directly cause chronic pain; rather, there may be shared biopsychosocial risk factors, including genetic influences, that explain their association. These findings can be integrated into future research to identify shared biological pathways of both chronic pain and smoking behaviours as a way to conceptualize pain chronification.

[Feasibility study: The medical imaging as a tool for therapeutic education in radiotherapy]. / Étude de faisabilité : l'utilisation de l'imagerie médicale en éducation thérapeutique en radiothérapie.

PURPOSE: Assess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy. MATERIALS AND METHODS: Experimental feasibility trial of "RCT" type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software "Stone of Orthanc". RESULTS: Forty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 - 2.2)) vs (+ 1.4 (1.4 - 1.8)), as well as a decrease in scores related to anxiety (- 3.0 (-4.5 - (-2.0)) vs - 1.0 (-5.0 - 0.0)) and emotional distress ((- 5.0 (- 7.5 - (- 3.5)) vs (- 2.0 (- 5.0 - (- 1.0)) A significant reduction (p=0.043) is observed for the depression score ((- 2.0 (-3.0 - (-1.5)) vs (0.0 (0.0 - 0.0)). CONCLUSION: This study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.

[Learnings from the use of CEdRIC strategy in the context of COVID-19 pandemic]. / Face à la COVID-19. Utilisation de la stratégie CEdRIC dans le contexte de la pandémie à coronavirus : retour d'expérience.

This article relates the experience of mobilisation of the CEdRIC strategy by health promotion staff of the Province of Liège, Belgium between June and September 2020. The perception of the beneficiaries is also approached. Four key messages are discussed in the article: the adjustment of a brief educational intervention strategy to the context of the pandemic and integration into primary care; the need for the citizen to be heard and accompanied in times of crisis; the need to go beyond information to health education embedded in a health promotion approach; the role that a structure such as the Province of Liège can play in the health promotion landscape. This article relates the experience of mobilisation of the CEdRIC strategy by health promotion staff of the Province of Liège, through the eyes of the beneficiaries (citizen) contacted by telephone in the days following the intervention. The results indicate an over-information concerning the rules to be respected and a good knowledge of preventive measures. The participants consider these measures useful, easy to apply and declare that they have a role to play in the fight against the pandemic. Nevertheless, not all of the recommendations made by the government are implemented by all participants. Future research should focus on adherence to preventive measures and the factors that can influence this adherence so that future and sustainable actions can be put in place.

La pandémie de coronavirus (COVID-19) a mis en évidence l'importance de développer des stratégies de prévention pour éviter la propagation du virus en adoptant des mesures d'autogestion sanitaires. La stratégie CEdRIC consiste en un protocole en 5 étapes visant à aider le personnel soignant des centres de dépistage à structurer leur communication afin d'éduquer brièvement les citoyens sur les conduites à tenir pour préserver leur santé et prévenir la propagation du virus. Dans cet article est relatée l'expérience de mobilisation de la stratégie CEdRIC menée entre juin et septembre 2020 par du personnel de promotion de la Santé de la Province de Liège. La perception des bénéficiaires est également approchée. Quatre messages clés sont discutés dans l'article : l'ajustement d'une stratégie d'intervention éducative brève au contexte de la pandémie et d'intégration en première ligne de soins; le besoin pour le citoyen d'être entendu et accompagné en temps de crise; la nécessité de dépasser l'information pour passer à de l'éducation en santé inscrite dans une approche de promotion de la santé; le rôle qu'une structure comme la Province de Liège peut tenir dans le paysage de la promotion de la Santé.

[Fixed combination of mometasone, indacaterol, glycopyrronium for the treatment of severe asthma : Enerzair® Breezhaler®]. / Le médicament du mois. Combinaison fixe mométasone, indacatérol, glycopyrronium pour le traitement de l'asthme sévère : Enerzair® Breezhaler®.

Here we present pharmacological and clinical properties of a new fixed triple inhaled combination including an inhaled corticoid, a long acting ?2 agonist and a long acting anticholinergic for the treatment of severe asthma. Enerzair® is the name of this triple combination which contains 160 µg mometasone, 150 µg indacaterol and 50 µg glycopyrronium administered by a Breezhaler®. As compared to an ICS/LABA combination Enerzair® improves expiratory flow rates and reduces exacerbation rate. The Breezhaler® device may be coupled to a sensor (Propeller Health) that, through a bluetooth system, allows to control patient adherence and provides recall to the patient to take his aerosol.

Nous présentons, dans cet article, les propriétés pharmacologiques et les effets cliniques d'une nouvelle triple combinaison fixe inhalée comprenant un corticoïde inhalé, un ?2 mimétique à longue durée d'action et un anticholinergique à longue durée d'action destinée au traitement de l'asthme sévère. Cette combinaison qui porte le nom d'Enerzair® regroupe dans le même dispositif (le Breezhaler®) 160 µg de mométasone, 150 µg d'indacatérol et 50 µg de glycopyrronium. Par rapport à une combinaison corticoïde inhalé et ?2 mimétique, l'Enerzair® améliore la valeur des débits expiratoires et réduit la fréquence des exacerbations. Le dispositif peut être couplé à un capteur (Propeller Health) qui, par un système bluetooth, offre la possibilité de surveiller l'adhérence au traitement et fournit un rappel de prise au patient.

[Quality of life in the medical field : a brief overview of its origin, semantics, measuring instruments and clinical use]. / La qualité de vie dans le champ médical. Bref aperçu de son origine, de sa sémantique, de ses instruments de mesure et de leur utilisation en clinique.

Since the early 1970s, the concept of quality of life has been the subject of increasing interest in the medical field, although no scientific consensus has emerged on how to define and measure it. The aim of this narrative review of the literature is to decrypt the notion of quality of life in the medical field, in order to enable clinicians-researchers and clinicians who use quality of life measurement instruments in clinical practice to form an informed and nuanced opinion on the issue. To do so, the paper is divided into three parts. Firstly, a brief overview of the origin of the concept in the medical field is given by exposing the main factors explaining its emergence and its rise in importance. Next, the plurality of definitions of quality of life and its derivatives (e.g. health-related quality of life), as well as its measurement instruments in the medical field, are explored. Finally, some benchmarks for the use of health-related quality of life instruments in clinical practice are presented.

Depuis le début des années 70, la notion de qualité de vie fait l'objet d'un intérêt croissant dans le champ médical, sans pour autant que n'émerge un consensus scientifique sur une manière de la définir et de la mesurer. L'objectif de cette revue narrative de la littérature consiste à décrypter la notion de qualité de vie dans le champ médical afin de permettre aux cliniciens-chercheurs et aux cliniciens, qui utilisent des instruments de mesure de la qualité de vie en pratique clinique, de se forger un avis éclairé et nuancé sur la question. Pour ce faire, le papier se décline en trois parties. Tout d'abord, il fait état d'un bref aperçu de l'origine de la notion dans le champ médical en exposant, notamment, les principaux facteurs expliquant son émergence et son importance grandissante. Ensuite, il explore la pluralité de définitions de la qualité de vie et de ses dérivés (e.g. qualité de vie liée à la santé), ainsi que ses instruments de mesure dans le champ médical. Enfin, il présente quelques repères pour l'utilisation d'instruments de mesure de la qualité de vie liée à la santé en pratique clinique.

"Patient participation" and related concepts: A scoping review on their dimensional composition.

OBJECTIVES: Several concepts on collaboration between patients and healthcare systems have emerged in the literature but there is little consensus on their meanings and differences. In this study, "patient participation" and related concepts were studied by focusing on the dimensions that compose them. This review follows two objectives: (1) to produce a detailed and comprehensive overview of the "patient participation" dimensions; (2) to identify differences and similarities between the related concepts. METHODS: A scoping review was performed to synthesize knowledge into a conceptual framework. An electronic protocol driven search was conducted in two bibliographic databases and a thematic analysis was used to analyse the data. RESULTS: The search process returned 39 articles after exclusion for full data extraction and analysis. Through the thematic analysis, the dimensions, influencing factors and expected outcomes of "patient participation" were determined. Finally, differences between the included concepts were identified. CONCLUSION: This global vision of "patient participation" allows us to go beyond the distinctions between the existing concepts and reveals their common goal to include the patient in the healthcare system. PRACTICE IMPLICATIONS: This scoping review provides useful information to propose a conceptual model of "patient participation", which could impact clinical practice and medical training programs.

[Alcohol consumption : from epidemiology to prevention]. / La consommation d'alcool : de l'épidémiologie à la prévention.

The epidemiological data about alcohol consumption show that the current preventive measures have their limits. Worryingly, the morbidity and mortality associated remain significant in the world. Two main types of preventive approaches, based on individual affect exist: the negative approach based on fear and threat and the so-called Social Norm Approach (SNA). The last original and more positive approach has been used across the Atlantic for thirty years and shows to be efficient. It aims to reduce an individual's consumption of addictive substance by confronting his own social norm (what he thinks people drink, quantities generally overestimated) to the real norm of consumption by a reference social group. A cross-border project is currently evaluating the feasibility of this approach in the Euregio Meuse-Rhin.

Les données épidémiologiques de la consommation d'alcool les plus récentes montrent que les mesures préventives actuelles connaissent leurs limites. De façon inquiétante, la morbidité et la mortalité qui lui sont associées restent importantes dans le monde. Deux grands types d'approches préventives ciblant directement les affects des individus existent : l'approche négative basée sur la peur et la menace et l'approche dite par la norme sociale (SNA pour Social Norm Approach). Cette dernière approche originale et plus positive de la santé est utilisée depuis une trentaine d'années outre-Atlantique et montre une certaine efficacité. Elle vise à réduire la consommation d'une substance addictive par un individu en confrontant sa norme sociale (ce qu'il pense que les gens boivent, quantités généralement surestimées) à la norme réelle de consommation du groupe social de référence. Un projet transfrontalier évalue actuellement la faisabilité de ce genre d'approche dans l'Eurégio Meuse-Rhin.

[Patient partner approach into question]. / L'Approche Patient Partenaire de Soins en question.

Patient engagement in health care system can be regarded as a lever for the general improvement of people's health, the quality and safety of care. Among the many approaches that co-exist, the model of Patient Partner is relatively recent and declares itself as the most successful to promote this engagement. The authors of this article propose to present briefly the above model and to raise the remaining questions on its operational application. We will then present the research program «Patient Partner Approach to Care¼ (INTERREG Va) that questions the Patient Partner model in an interregional context (Wallonia - Grand Duchy of Luxembourg - Lorraine - Rhineland-Palatinate and Saarland).

L'engagement des patients dans le système de santé peut être considéré comme un levier pour l'amélioration générale de la santé des populations ainsi que la qualité et la sécurité des soins. Parmi les nombreuses approches qui co-existent, le modèle du « Patient Partenaire ¼ est relativement récent et se déclare le plus abouti pour favoriser cet engagement. Les auteurs de cet article proposent de présenter, brièvement, le modèle susmentionné et de soulever les questions qui demeurent sur son application opérationnelle. Nous présenterons ensuite le programme de recherche «Approche Patient Partenaire de Soins¼ (INTERREG Va) qui questionne ce modèle de Patient Partenaire dans un contexte interrégional (Wallonie - Grand-Duché du Luxembourg - Lorraine - Rhénanie- Palatinat et Sarre).

[A virtual patient to improve doctor-patient communication : reality or fiction ?] / Un patient virtuel pour améliorer la communication médecin-patient : réalité ou fiction ?

The transformations of the health system and the preferences of the patients themselves have led healthcare professionals to rethink the place and role of the patient in the healthcare system, putting the caregivercare relationship and communication at the heart of public health issues. The literature shows that empathic communication is associated with better adherence to treatment, better patient satisfaction and less litigation. However, the initial training programs of health professionals are little oriented towards this field. Moreover, they are mainly based on a direct transition from theory to clinical practice with all the risks that this entails for patients. Some recent studies suggest an interest in virtual reality simulation for the development of these communication skills. This article offers an overview of the potential of virtual clinical simulation as a complementary or even alternative method to traditional teaching methods. Different studies will illustrate these innovations in the training of physicians in clinical reasoning, empathic communication, and in a highly emotional situation such as breaking bad news.

Les transformations du système de santé et les préférences des patients eux-mêmes ont conduit les professionnels de santé à repenser la place et le rôle du patient dans le système de soins, mettant la relation soignant-soigné et la communication au coeur des enjeux de santé publique. La littérature montre qu'une communication empathique est associée à une meilleure adhérence au traitement, une meilleure satisfaction des patients et moins de litiges. Pourtant, les programmes de formation initiale des professionnels de santé sont peu orientés vers ce domaine. De plus, ils se basent principalement sur un passage direct de la théorie à la pratique clinique, avec tous les risques que cela comporte pour les patients. Quelques études récentes suggèrent un intérêt de la simulation en réalité virtuelle pour le développement de ces compétences communicationnelles. Cet article propose un aperçu du potentiel de la simulation clinique virtuelle comme méthode complémentaire, voire alternative, aux méthodes pédagogiques traditionnelles. Différentes études illustreront ces innovations dans le cadre de la formation des médecins au raisonnement clinique, à la communication empathique, et dans une situation hautement émotionnelle telle que l'annonce de mauvaises nouvelles.

A central mechanism enhances pain perception of noxious thermal stimulus changes.

Pain perception temporarily exaggerates abrupt thermal stimulus changes revealing a mechanism for nociceptive temporal contrast enhancement (TCE). Although the mechanism is unknown, a non-linear model with perceptual feedback accurately simulates the phenomenon. Here we test if a mechanism in the central nervous system underlies thermal TCE. Our model successfully predicted an optimal stimulus, incorporating a transient temperature offset (step-up/step-down), with maximal TCE, resulting in psychophysically verified large decrements in pain response ("offset-analgesia"; mean analgesia: 85%, n = 20 subjects). Next, this stimulus was delivered using two thermodes, one delivering the longer duration baseline temperature pulse and the other superimposing a short higher temperature pulse. The two stimuli were applied simultaneously either near or far on the same arm, or on opposite arms. Spatial separation across multiple peripheral receptive fields ensures the composite stimulus timecourse is first reconstituted in the central nervous system. Following ipsilateral stimulus cessation on the high temperature thermode, but before cessation of the low temperature stimulus properties of TCE were observed both for individual subjects and in group-mean responses. This demonstrates a central integration mechanism is sufficient to evoke painful thermal TCE, an essential step in transforming transient afferent nociceptive signals into a stable pain perception.

[Health literacy, a way to reduce social health inequalities]. / La «Health Literacy¼ - un moyen pour réduire les inégalités sociales de santé.

Health Literacy (HL) is defined as «the knowledge, motivation, and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life¼. This concept begins to be recognized as a priority area for action at political level in Belgium. Indeed, a limited HL may affect health by leading, for example, with poorer management of chronic diseases, more hospital admissions and premature deaths. This paper addresses the question of HL evaluation, improvement interventions as well as the many challenges that remain in this area. HL seems fundamental to the development of better health management. It would allow patients to play a more active role in health care, to involve all health stakeholders, and to contribute to a more sustainable health system. Improving HL could allow better equal access to health care.e.

La Health Literacy (HL) se définit comme 'la connaissance, la motivation et les compétences des individus à accéder, comprendre, évaluer et appliquer l'information en matière de santé en vue de porter des jugements et de prendre des décisions de tous les jours en ce qui concerne la santé, la prévention des maladies et la promotion de la santé, de manière à maintenir ou améliorer la qualité de vie'. Au niveau politique belge, ce concept commence à être reconnu comme étant un domaine d'action prioritaire. En effet, une HL limitée peut affecter la santé en conduisant, par exemple, à une moins bonne gestion des maladies chroniques, à davantage d'hospitalisations et de décès prématurés. Cet article aborde la question de l'évaluation de la HL, des interventions pour l'améliorer ainsi que les nombreux défis qui restent à relever dans ce domaine. La HL semblerait fondamentale pour le développement d'une meilleure gestion de la santé. Elle permettrait au patient de jouer un rôle plus actif dans la prise en charge de sa santé, de responsabiliser tous les acteurs de la santé, et de contribuer à un système de santé plus viable. Améliorer la HL devrait permettre une meilleure égalité d'accès aux soins de santé.

[Exploratory population study of overweight and obese subjects' perceptions: Searching for improved management practices]. / L'exploration des perceptions relatives à l'excès de poids pour mieux comprendre les difficultés dans la prise en charge de l'obésité : une étude populationnelle exploratoire.

BACKGROUND: Overweight and obesity are major public health problems of growing concern. Few studies have investigated the representations and perceptions of subjects with overweight and obesity, especially in the general population, as compared to people in a medical weight loss process. The objective of this study was to fill this gap by enabling participants to express their feelings and experience about their overweight, and to assess the extent of the body mass index (BMI) as a determinant of these perceptions. METHODS: A total of 4155 persons participated in an exploratory study conducted in Wallonia (Belgium). Data were collected by means of a web-based questionnaire. This study investigated the following parameters: sociodemographic and anthropometric factors, perceived health, quality of life, diet perception, enrolment in a weight loss process and weight loss target. The influence of BMI was considered, on one hand, looking at how the above variables evolve according to BMI category, secondly, as a mediation factor in the relationship between socioeconomic level and these same variables. RESULTS: A large majority (87.5%) of subjects were overweight (32.2%) or obese (obese class I 29.9%, class II 14.8%, class III 10.6%). Perceived health was found to deteriorate with the BMI (P<0.0001); obese class III had a 5.9-fold risk to present bad perceived health compared to subjects with normal weight. The physical and psychological quality of life reported by the subjects decreased significantly with the BMI (P<0.0001) particularly for the physical quality of life. The percentage of poor diet perception (frustration, weight gain, aggressiveness, inefficacy and impossibility) as well as the weight loss targeted by the subjects increased with the BMI. Between overweight subjects and obese class III subjects, weight loss target increased from 13% to 34% of the initial weight. The majority of subjects judged that diet represents "aggressiveness", "weight gain" and "impossibility". A partial mediation role of BMI was identified in the relationship between social status and the variables of interest. CONCLUSIONS: This study focused on a sample of people from the general population. It confirmed previous results of others studies. All results gave a feeling of resignation and powerlessness which can seize obese individuals (especially when BMI increases). As a consequence, there is a need for more adapted weight management to achieve a genuine therapeutic alliance.

Structure of the Sec23p/24p and Sec13p/31p complexes of COPII.

COPII-coated vesicles carry proteins from the endoplasmic reticulum to the Golgi complex. This vesicular transport can be reconstituted by using three cytosolic components containing five proteins: the small GTPase Sar1p, the Sec23p/24p complex, and the Sec13p/Sec31p complex. We have used a combination of biochemistry and electron microscopy to investigate the molecular organization and structure of Sec23p/24p and Sec13p/31p complexes. The three-dimensional reconstruction of Sec23p/24p reveals that it has a bone-shaped structure, (17 nm in length), composed of two similar globular domains, one corresponding to Sec23p and the other to Sec24p. Sec13p/31p is a heterotetramer composed of two copies of Sec13p and two copies of Sec31p. It has an elongated shape, is 28-30 nm in length, and contains five consecutive globular domains linked by relatively flexible joints. Putting together the architecture of these Sec complexes with the interactions between their subunits and the appearance of the coat in COPII-coated vesicles, we present a model for COPII coat organization.