Impact of a single 10 min education session on asthma control as measured by ACT.

BACKGROUND: Aim: Despite the availability of effective treatments for asthma, many patients still suffer from uncontrolled asthma. This study evaluates whether a single educational session could improve asthma control assessed by Asthma Control Test (ACT) score as well as knowledge of the inhaler device, knowledge of medication and inhalation technique. METHODS: This prospective single blinded randomized controlled trial of 160 adults with asthma, examined the effectiveness of a single standardized, educational intervention, performed by a respiratory nurse specialist. The education provided to the intervention group consisted of basic information about asthma treatment and instructions on inhalation technique for about 10min. This additional education was not offered to the control group. In both groups ACT scores, knowledge of medication, knowledge of inhaler device and inhalation technique were assessed at baseline and after three months. Asthma was considered well-controlled when the ACT score exceeded 19. RESULTS: At baseline there were no significant differences in patient demographics, degree of asthma control, knowledge of medication or device and inhalation technique between the intervention group and the control group. In the intervention group the educational session resulted in a significantly higher proportion of well-controlled asthma patients with an ACT>19 (43% versus 77%) (p < 0.001) after three months. In the control group this proportion remained similar (57% versus 67%) (p > 0.1). We also observed improvements in knowledge of medication (p < 0.001), knowledge of device (p < 0.001) and inhalation technique (p = 0.004) in the intervention group and not in the control group. CONCLUSION: A single 10 min, educational session provided by a respiratory nurse specialist can substantially improve asthma control determined by the ACT score after three months.

Measurement of flow of thought in 68 patients monitored in post-emergency outpatient consultations: Role of ideational turmoil in the anxiety depressive symptomatology.

INTRODUCTION: Rumination, cognitive control deficits, cognitive saturation, and loss of inhibition are the major hypotheses used to explain depressive disorders. A few studies have nevertheless looked at the form of thought. In this study, we will test a double measurement of the number of thoughts and a double measurement of the flow of thought together with their correlation with well-being, mental pain, and depression. MATERIAL AND METHODS: Between May and September 2015, 68 subjects, initially admitted as emergencies for acute anxiety depressive disorders and/or suicide attempts and subsequently monitored as post-emergency outpatients in medico-psychological consultations agreed to complete a set of Visual Analogue Scales measuring their well-being, their mental pain, their estimated number of thoughts and the how agitated these thoughts are estimated to be. A double evaluation of the cognitive activity consisted of representation intrusive thoughts by filling a drawing of an aquarium to reflect the number of thoughts (by drawing fish) and cognitive turmoil (by drawing wavy lines). The depressive illness was evaluated using the Beck depression inventory and by rater-administered assessments using MADRS (Montgomery-Asberg Depression Scale). RESULTS: These measurements are of good psychometric quality (sensitivity, accuracy, validity). The mental pain is related to mental turmoil. These results reveal positive correlations between the mental turmoil and the total score on the depression. The use of the aquarium makes it possible to distinguish the feeling of having "a lot of thoughts" from the feeling of having "agitated thoughts". So, the total score of wavy lines shows positive correlation with the total score on the depression inventory (BDI) and the total MADRS score. DISCUSSION: The results suggest that the phenomena of cognitive saturation and the sensation of mental restlessness play a major role in the etiopathogensis of depression. The analyses show that the cognitive dysregulation is situated more precisely at the level of the flow of thought rather than the level of the number of thoughts. A deterioration in the flow of thought increases the mental pain and the depressive symptoms, and reduces well-being. The sample is nevertheless small, and some bias appears in the filling of the aquarium boxes.

[Restorative Justice: Neither care nor repression? The case study of Louis, a multi-recidivist, neither "dangerous" nor "sick"]. / La Justice restaurative : ni soigner, ni réprimer ? Le cas Louis, multirécidiviste ni « dangereux ¼ ni « malade ¼.

OBJECTIVES: The proposed criminological hypothesis is that the restorative justice approach would allow offenders to recognize the victims with more empathic feelings, assuming a decreasing effect on the needs and risks of recidivism (Griffiths and Murdoch, 2007). Authors of aggravated robbery raise several psychological issues (i.e. incomprehension of the causes of their act, euphemistic labelling and moral disengagement, lack of empathy) that the restorative program proposes to work through scriptwriting of personal histories, better comprehension of the conflict in the past and exchanges focused on the personal and social consequences of the acts (emotional chain). The aim of the process is to encourage persons weakened by their social and delinquent situations to elaborate, plan and realize new personal goals. METHODOLOGY: With the collaboration of the service de l'application des peines de Tours (service for the execution of sentences), the service pénitentiaire d'insertion et de probation 37 (probation and social reintegration service) and the service d'aide aux victimes d'infractions pénales (association for victims of crime) of the French department 37, centre, the program PARIS attempted an implementation and evaluation of the relational or restorative justice process in the context of non-custodial sentences and in particular in the cases of aggravated theft (art. 311-1 to 311-16 of the French penal code). Its particularity was to touch the three spheres of victimization: (1) financial, (2) physical and (3) psychological prejudices. After the admission of the participants, a preliminary (psycho)criminological diagnosis served to evaluate the suitability for the perpetrator and the victim to be confronted in following settings. In this context we met Louis, a recidivist of aggravated thefts but causing minimal harm and punished with minimal sentences. He presented no mental illness but showed severe existential problems involved in his delinquent behaviour. His delinquent acts presented similarities marked by auto-punitive tendencies. For example, he remained on site until being arrested and joked with the police. RESULTS: The case Louis revealed what neither the care nor repression succeeded to reach, namely the quality of the relationship which can in itself confine or on the contrary repair. Relational Justice, by seeking neither to "suppress" nor to "care", allows the participants to reconstruct and understand the other with empathy, and strengthened the protective factors. Mediation as a method or purpose held a prominent place in the reconstruction process of the participants as it allowed us to act on both the "frame" (scenario of the problem-situation) and the "drama" ((non)-effectiveness of cognitive strategies and experienced emotions) of the original problem-situation. So the restorative program was an alternative to the socio-judicial measures inducing potential therapeutic effects on the future path of the participant. CONCLUSION: If the question of the relevance of direct, or perhaps better indirect, confrontations between the author and the victim still remains the (psycho-)criminological diagnosis of the penal couple's - author and victim - relationship investigates the psychosocial and delinquent process in terms of motivation. A satisfaction survey at the end of the program helps to analyse the future prospects of the participants. Based on dynamic and structured methods, the PARIS relational Justice program offers a Third Way between care and punishment: restoration of existential and relational links.

[Homicide-suicide: Clinical review and psychological assumptions]. / Homicide-suicide : revue clinique et hypothèses psychologiques.

OBJECTIVES: Suicide-homicide could be defined as a "suicidal" behaviour, which also includes the death of at least one other individual and sometimes up to hundreds. This literature review intends to highlight some characteristic features that might be found amongst the various types of suicide-homicide. It is a complex phenomenon which can occur in different situations, from a familial and somehow intimate setting (filicide, uxoricide, marital homicide…) to a public one (workplace shooting, school shooting), including a wide range of victims, from a single victim in marital cases of suicide-homicide to hundreds of victims in certain types, such as suicide by aircraft or warrior-like multi-homicids in terrorist acts. This literature review offers a combination of data emanating from scientific publications and case studies from our practices in an attempt to insulate some common factors. A thorough examination of the offenses unravels complex processes, ideations, M.O and peculiar cognitive impairments in which the familial suicide-homicide could be rooted. Mass murders might be caused also by a psychopathological alloy, made of Grandiose Self and sub-depressive and even paranoid ideations. Concerning the terrorism and multi-homicide-suicide, this is far more complex phenomenon and is defined by a group-process enrolment and ideological conviction. Beyond epidemiological studies, both descriptive and statistical, this paper's objective is to isolate a hypothesis about a psychopathological ground from which a criminological mechanism could emerge. Despite the lack of blatant psychosis, some traits might be identified in suicide-homicide cases - such as paranoid, psychopathic, narcissistic, melancholic - which can intertwine, potentiate one with another forming a distorted view of the world. The offense dynamic is possibly composed of preparatory behaviours, triggers, the use of death as a narcissistic support, identity choices… METHODS: The data were collected from scientific publications, personal cases, and open source. RESULTS: Despite the variety of behaviours included in this typology, we were able to identify a few mechanisms that could be found in two types of suicide-homicide [Private suicide-homicide (within the family circle) vs. Public space suicide-homicide (suicide by aircraft, school shooting…)]. DISCUSSION: Suicide-homicide phenomenon is the result of the interaction of societal, ideological, psychopathological and criminological elements which burst out in a lethal and paroxystic gesture. Psychiatrists and psychologists may have an important part to play in modelling a pattern to better understand it.

[Revealing three psychological states before an acting out in 32 patients hospitalized for suicide attempt]. / Mise en évidence de trois états psychologiques pré-passage à l'acte chez 32 patients hospitalisés pour tentative de suicide.

OBJECTIVE: The purpose of this study was to reconstruct the psychological state of suicidal subjects at the time of the execution of the gesture according to their thoughts, their emotions, their actions, their fantasy life and consciousness. METHODOLOGY: Thirty-three adult subjects agreed, just days after their suicide attempt, to answer the Interview Method for Suicidal Acts (IMSA). This object of this semi-structured interview is to invite the suicidal to reconstruct mentally and chronologically their suicide attempt. IMSA can follow the thoughts, behavior, consciousness, emotions and activity of the suicidal scenario by helping the patient to reconstruct the phenomenology of his/her actions until the final suicidal gesture. RESULTS: The data were processed using the method of Classification TwoStep on SPSS, based on Schwarz Bayesian criterion. The results highlight three main types of psychological state: (1) a "kinesthetic" psychological state (called "type K") is characterized by a rupture between the subjective sensation of motor movement and effective motility (motor automatism), the presence of a dissociative state, an "empty" feeling of thought and the absence of an external triggering factor; (2) a "cognitive" psychological state (called "type C") is characterized by a significant reflection on the decision to die and infiltration of the morbid thought, an intense fantasy life around the suicidal scenario, a clear state of consciousness, and an absence of loss of motor control; (3) an "emotional" psychological state (called "type E") is characterized by confusing and chaotic emotional processes, the emergence of a dissociative state, and a significant impact of external events on the onset of the suicide attempt. CONCLUSION: This classification of suicide attempts allows us to identify the different combinations of the suicidal process and opens up new therapeutic strategies.

Knowledge and attitudes about vaccinations among adolescents.

PURPOSE: The aim of this study was to investigate among adolescents in Antwerp their knowledge about vaccination and to describe their information sources, motives and barriers for vaccination. METHODS: In March 2009, adolescents aged between 14 and 17 years from three schools with a mixed Belgian and immigrant population in Antwerp completed a written questionnaire concerning vaccination. The questionnaire was already used and validated in a study in five European countries: France, Italy, Spain, Germany and the United Kingdom. RESULTS: In total 186 adolescents completed the questionnaire. Most of them (93%) knew that vaccination is a method to prevent disease. Most adolescents knew about the existence of vaccines against tetanus (94%), hepatitis B (91%) and human papillomavirus (87%). The most important sources for information were the family physician (83%), the school (79%) and the parents (70%). Their knowledge about vaccinations was not related to courses about vaccination at school. CONCLUSIONS: The physician, the school and the parents play a key role in the vaccination of adolescents. Our results are in many aspects similar to those in the other European countries.

[Dynamic of ideation and preparatory behavior in the suicidal act: concerning a standardised and qualitative methodology]. / Dynamique de l'idéation et des comportements préparatoires dans le passage à l'acte suicidaire: vers une méthodologie qualitative standardisée.

Suicidal risk factors are nowadays well known. We often detect many of these risk factors in clinical situations, but their interaction and their writing in the suicidal sequence are still largely unrecognized. Building on narratives from suicidal patients, the authors propose a method for investigating the upstream components of suicide in an attempt to understand how the risk factors and the state of the person interact and converge on the suicidal action better. The interview is divided into the following four sections. (1)The patient is invited to mentally go back to the hours immediately preceding the suicide attempts and reconstruct the sequence of thoughts, feelings and doings of the day. Here, we explore the dynamic progression of his cognitions, emotions, actions and state of consciousness. We also note the social affective context of the suicidal act. (2) Proceeding backwards into the memory, the patient is invited to retrieve all foreshadowing elements, situating them on two axes: behavioural planning, that is, effective or contemplated actions in relation to suicide (stocking drugs, seeking information about substance toxicity, weapon training, etc.). (3) The second axis focuses on the phenomenology of the suicidal ideation, that is, intensity, frequency, proximity/availability of suicidal ideation, etc. These are assessed by means of an analogical rule. Finally, the current attempt is situated in the context of the suicidal history of the patient: previous attempts, severity, operative mode, etc. Our clinical experience using this semi-structured interview has shown that the method gives an insight into the unique combination of factors leading to the suicidal act in a given person and permits to understand and foresee relapses better. A new model of suicide is emerging from our data, suggesting the importance of the preparatory phase, which combines a progressive non-conscious learning of the gestures to accomplish, rumination of suicidal ideations and alteration of consciousness and the sense of self. The method is illustrated through an example. The necessity to further test this interview method is called for.

Forced vital capacity and forced expiratory volume in six seconds as predictors of reduced total lung capacity.

The present study aims to derive guidelines that identify patients for whom spirometry can reliably predict a reduced total lung capacity (TLC). A total of 12,693 lung function tests were analysed on Caucasian subjects, aged 18-70 yrs. Restriction was defined as a reduced TLC. Lower limits of normal (LLN) for TLC were obtained from the European Respiratory Society recommended reference equations. Reference equations from the National Health and Nutrition Examination Survey III were used for forced vital capacity (FVC) and forced expiratory volume in six seconds (FEV(6)). The performance of FVC and FEV(6) to predict the presence of restriction was studied as follows: 1) using two-by-two (2x2) tables; and 2) by logistic regression analysis. Both analyses were performed in obstructive (defined as forced expiratory volume in one second (FEV(1))/FVC or FEV(1)/FEV(6) 100% pred (males) or >85% pred (females). In obstructive patients, spirometry cannot reliably diagnose a concomitant restrictive defect, but it can rule out restriction for patients with forced vital capacity or forced expiratory volume in six seconds >85% pred (males) or >70% pred (females).

Obstructive and restrictive spirometric patterns: fixed cut-offs for FEV1/FEV6 and FEV6.

The purpose of this study was to determine fixed cut-off points for forced expiratory volume in one second (FEV(1))/FEV(6) and FEV(6) as an alternative for FEV(1)/forced vital capacity (FVC) and FVC in the detection of obstructive and restrictive spirometric patterns, respectively. For the study, a total of 11,676 spirometric examinations, which took place on Caucasian subjects aged between 20-80 yrs, were analysed. Receiver-operator characteristic curves were used to determine the FEV(1)/FEV(6) ratio and FEV(6) value that corresponded to the optimal combination of sensitivity and specificity, compared with the commonly used fixed cut-off term for FEV(1)/FVC and FVC. The data from the current study indicate that FEV(1)/ FEV(6) <73% and FEV(6) <82% predicted can be used as a valid alternative for the FEV(1)/FVC <70% and FVC <80% pred cut-off points for the detection of obstruction and restriction, respectively. The statistical analysis demonstrated very good, overall, agreement between the two categorisation schemes. For the spirometric diagnosis of airway obstruction (prevalence of 45.9%), FEV(1)/FEV(6) sensitivity and specificity were 94.4 and 93.3%, respectively; the positive and negative predictive values were 92.2 and 95.2%, respectively. For the spirometric detection of a restrictive pattern (prevalence of 14.9%), FEV(6) sensitivity and specificity were 95.9 and 98.6%, respectively; the positive and negative predictive values were 92.2 and 99.3%, respectively. This study demonstrates that forced expiratory volume in one second/forced expiratory volume in six seconds <73% and forced expiratory volume in six seconds <82% predicted, can be used as valid alternatives to forced expiratory volume in one second/forced vital capacity <70% and forced vital capacity <80% predicted, as fixed cut-off terms for the detection of an obstructive or restrictive spirometric pattern in adults.

Primary prevention of coronary heart disease in general practice: a cross sectional population study.

The aim of this study was to assess the interventions by general practitioners on cardiovascular risk factors among persons without a history of cardiovascular disease attending for a cardiovascular check-up. All inhabitants of three Belgian towns aged between 45 and 64 years were invited for a cardiovascular check-up and blood test. Of all the attending persons without a history of cardiovascular disease (n = 898), 51% received at least one prescription, diet or health advice: 28% for hyperlipidaemia, 23% for physical activity, 22% for caloric intake, 9% for blood sugar, 5% for blood pressure and 4% for smoking. Interventions on lipoproteins, blood sugar and smoking habits were significantly more often proposed to persons with a medium or high cardiovascular risk compared to those at low cardiovascular risk. For persons at low cardiovascular risk, therapeutic lifestyle changes are often not advised, and isolated risk factors often remain untreated.

Prevention and follow-up of cardiovascular disease among patients without a personal GP.

OBJECTIVE: This paper describes the characteristics of Belgian people who declare that they have a personal GP (PGP) compared with those who do not. Furthermore, patterns of cardiovascular prevention and care are described for these two groups. METHODS: The data are derived from the 1997 Belgian Health Interview Survey (HIS) in which a representative sample (n = 10 221) of the Belgian population was questioned. The HIS data about physical activity, food, blood pressure, cholesterol, cardiovascular diseases, diabetes and stroke are analysed. RESULTS: After standardization for age and gender, 7.0% of the subjects declared that they did not have a PGP. The mean age of patients without a PGP (33.2 +/- 20.4 years) is significantly lower than for those with a PGP (40.4 +/- 22.7 years) (P < 0.001). More smokers (38.5% compared with 28.5%) were reported among the subjects without a PGP (P < 0.001). For 14.8% of the subjects without a PGP, their blood pressure had never been measured, and for 51.1% their cholesterol had never been measured (6.7% and 35.7%, respectively in subjects with a PGP). Among the subjects without a PGP, 3.8% had high blood pressure and 1.5% had a coronary heart disease. Among the hypertensive patients without a PGP, 43.6% are not treated by any physician. CONCLUSION: Subjects without a PGP were less likely to have a healthy way of life. Having a PGP seemed to have a beneficial influence on the screening for and the follow-up of cardiovascular risk factors. However, it has never been confirmed that providing people who do not have a PGP with one would result in health improvements. In particular, cardiac patients without a PGP sought their medical treatment directly from specialists.

Results from a cardiovascular prevention campaign in persons aged 45-64 years.

The aim of this study was to screen a target population for modifiable cardiovascular risk factors and to find out how treatment goals were achieved in the treated population. All inhabitants aged between 45 and 64 years in the town of Lede in Belgium were invited by the local authorities for a free health check-up. In total, 629 subjects were screened. Total cholesterol > or = 250 mg/dl or triglycerides > or = 200 mg/dl was found in 38%, increased fasting glucose (> or = 110 mg/dl) in 8.6%, diabetes in 2.8%, increased systolic blood pressure (SBP) (> or = 140 mmHg) in 22% and increased diastolic blood pressure (DBP) (> or = 90 mmHg) in 8%. The low-density lipoprotein cholesterol (LDL-C) target level of 115 mg/dl was attained in 13% of treated women and 34% of treated men. Target levels for SBP and DBP were attained in 40% and 75% respectively of those treated. Fasting glucose < 120 mg/dl was found in 33% of the diabetic participants.

Quantitation of carcinoembryonic antigen in the lung lining fluid of normal smokers and nonsmokers.

Bronchoalveolar lavage was performed in 47 volunteers: 19 nonsmokers and 28 smokers. Total protein, albumin, immunoglobulins G and A, and carcinoembryonic antigen (CEA) were measured in the concentrated lavage effluent. Although a significant increase (p < 0.001) in the ratio of CEA to total protein recovered from the group of smokers was found, this increase primarily reflected the greater increase that occurred in a subgroup of 7 smokers. However, the increases in lavage CEA correlated weakly (p = 0.096) with smoking history in pack-years, and not at all with plasma CEA concentrations. Results regarding the number of cells recovered and immunoglobulin-to-albumin concentration ratios in these subjects were similar to those reported by others. Thus, CEA was increased in the lavage fluid of a subgroup of otherwise normal young smokers. It is possible that CEA might serve as a useful indicator of future airway disease in certain young smokers.

Carcinoembryonic antigen-like substance derived from human prostate.

Carcinoembryonic antigen-like substance, previously detected in large amounts in the medium from cultures of human prostatic epithelial cells, also is present in extracts of benign and malignant human prostate. By column chromatography, the prostate-derived carcinoembryonic antigen-like substance derived from cultured prostate is the same as that in tissue extracts and is distinctly different from colon-derived carcinoembryonic antigen. The molecular weight of prostate-derived carcinoembryonic antigen-like substance is estimated to be greater than 5 x 10(5). Prostate-derived carcinoembryonic antigen-like substance may be a prostate-specific substance.

Evaluation of carcinoembryonic antigen as a plasma monitor for human breast carcinoma.

Plasma CEA levels have been determined in 92 normal women and 768 women with benign or malignant breast diseases. Only one of 92 normal women had a CEA level above 5 ng/ml. Of 253 women with benign breast diseases (gross cystic disease, adenofibroma, fibrosis, etc.) only one had a CEA level above 5 ng/ml. Ninety-four percent of the above two groups of women had CEA levels below 3 ng/ml. Of 164 women operated upon for Columbia Clinical Classification Stage A or B breast carcinoma, preoperative CEA levels were above 5 ng/ml in seven (4%). Patients with a preoperative CEA level above 3 ng/ml seemed to have an increased incidence of tumor recurrence. Elevated CEA levels (greater than 10 ng/ml) in our postmastectomy population of 288 patients have correlated with development of metastases in 14 of 46 subjects. Of 216 patients under treatment for metastatic breast carcinoma, CEA levels above 10 ng/ml have been detected in 15 percent of patients with soft tissue metastases, 38% of patients with visceral metastases and 50% of patients with osseous metastases. Of metastatic breast carcinoma patients with CEA levels above 10 ng/ml serial measurements have correlated with the patients response to therapy, progressively increasing in treatment failures and decreasing in treatment responders.

Carcinoembryonic antigen (CEA) in the cancer family syndrome.

We present findings on plasma CEA in relatives and spouses from six kindreds manifesting the Cancer Family syndrome. The CEA distributions per se were transformed to square root CEA to correct for skewness and kurtosis. Significant effects of age and duration of smoking were adjusted for by linear regression. Relatives were classified as: 1) cancer patients, 2) individuals at high genetic cancer risk (one or more first-degree relatives affected, and 3) individuals at low genetic cancer risk (no first-degree relatives affected) for statistical comparisons. Unrelated spouses were also classified into corresponding groups according to their directline mate's status. Cancer patients and relatives at high genetic risk had significantly greater mean square root CEA than relatives at low genetic risk, and, surprisingly, unrelated spouses had mean levels of square root CEA which were similar to that in the corresponding cancer risk class of their direct-line mates. Our results suggest the existence of both a genetic and connubial effect on CEA, presumably due to a common environmental agent acting in concert with the degree of genetic predisposition to oncogenesis in this syndrome.