Adaptations to support occupational engagement with age-related vision loss: A metasynthesis study.

BACKGROUND.: Age-related vision loss (ARVL) is a progressive process that adversely affects older adults' occupational engagement. As such, older adults often employ a variety of psychological adaptation strategies. PURPOSE.: The purpose of this study was to identify those psychological adaptation strategies employed by older adults aging with ARVL. METHOD.: This metasynthesis searched and identified 21 qualitative articles that described a link between psychological adaptation strategies and occupational engagement. FINDINGS.: The psychological strategies identified were categorized into five themes. The strategies of persisting with hope, positivity, and acceptance and portraying a self-image consistent with independence, competence, and self-reliance were well established in the literature, while other themes were more emerging, such as using humour, relying on religious/spiritual beliefs, and comparing the self to others. IMPLICATIONS.: By understanding the psychological adaptation strategies employed by older adults with ARVL, occupational therapists will be better positioned to guide their clients toward positive adaptive patterns.

How affordable is TB care? Findings from a nationwide TB patient cost survey in Ghana.

OBJECTIVES: Tuberculosis (TB) is known as a disease of the poor. Despite TB diagnosis and care usually being offered for free, TB patients can still face substantial costs, especially in the context of multi-drug resistance (MDR). The End TB Strategy calls for zero TB-affected families incurring 'catastrophic' costs due to TB by 2025. This paper examines, by MDR status, the level and composition of costs incurred by TB-affected households during care seeking and treatment; assesses the affordability of TB care using catastrophic and impoverishment measures; and describes coping strategies used by TB-affected households to pay for TB care. METHODS: A nationally representative survey of TB patients at public health facilities across Ghana. RESULTS: We enrolled 691 patients (66 MDR). The median expenditure for non-MDR TB was US$429.6 during treatment, vs. US$659.0 for MDR patients (P-value = 0.001). Catastrophic costs affected 64.1% of patients. MDR patients were pushed significantly further over the threshold for catastrophic payments than DS patients. Payments for TB care led to a significant increase in the proportion of households in the study sample that live below the poverty line at the time of survey compared to pre-TB diagnosis. Over half of patients undertook coping strategies. CONCLUSION: TB patients in Ghana incur substantial costs, despite free diagnosis and treatment. High rates of catastrophic costs and coping strategies in both non-MDR and MDR patients show that new policies are urgently needed to ensure TB care is actually affordable for TB patients.

Impact of pharmaceutical intervention on quality of life and coping strategies in patients with haematological malignancies.

OBJECTIVES: We conducted a prospective study approved by the local ethics committee to determine the impact of a pharmaceutical intervention (PI) on pain, fatigue, quality of life (QoL) and coping strategies in patients with HMs starting chemotherapy sessions. MATERIAL AND METHODS: Patients received either usual care (UC)+PI (PI group) or UC alone (UC group). They had to complete 2 questionnaires, QLQ-C30 and MAC 21, at 3 different time points: before starting the 1st chemotherapy session (T1), during the intercure (T2) and the day before starting the 2nd chemotherapy session (T3). To determine predictive factors of pain, fatigue, QoL and coping scores at T3, a multivariate ANOVA was used. QoL and coping scores were analysed longitudinally using a linear mixed model. RESULTS: Sixty-eight patients were included in the PI (n=34) or UC groups (n=34). Ninety-two percent of the patients returned all the questionnaires. At inclusion, QoL was significantly better in the PI group (P=0.047). At T3, the group had no influence on pain, fatigue, nor coping scores but a trend towards a better QoL was observed in the PI group (P=0.090). Longitudinally, the PI group did not present significantly better scores on pain, fatigue but both a trend toward better Qol scores and lower anxious preoccupations scores. CONCLUSION: A PI at the beginning of chemotherapy sessions did not have any significant impact on pain and fatigue but a trend towards better Qol scores and lower anxious preoccupations scores.

Intimidation homophobe, stratégies d'adaptation et intégration de l'orientation sexuelle / Homophobia, coping strategies, and sexual identity formation among LGBT youths

Cette étude examine l'impact de l'intimidation homophobe et des stratégies d'adaptation sur 6 dimensions de l'intégration de l'orientation sexuelle (OS) à partir d'un échantillon de 262 jeunes LGBT. Un modèle de régression linéaire a été réalisé pour chaque dimension, avec la victimisation homophobe et les stratégies d'adaptation comme principales variables indépendantes d'intérêt. La victimisation homophobe était associée à une plus faible affirmation de l'OS et à davantage d'homophobie/biphobie intériorisée, de préoccupations relatives au jugement d'autrui, de confusion identitaire, de dissimulation et de difficultés d'acceptation de l'OS. Les stratégies d'adaptation centrées sur la résolution de problèmes étaient associées à davantage de préoccupations relatives au jugement d'autrui alors que celles centrées sur l'évitement étaient associées à davantage de préoccupations relatives au jugement d'autrui et de difficulté d'acceptation de l'OS. Les résultats appuient l'importance de poursuivre la lutte à l'homophobie/biphobie et de mieux outiller les jeunes pour soutenir l'intégration positive de leur OS

Sexual minority youths (SMY) face challenges in consolidating their sexual identity because of heterosexism. The role of homophobic bullying and coping strategies in the formation of sexual identity has been explored within a convenient sample of 262 sexual minority youths. Six dimensions of sexual identity formation have been tested, independent variables being: homophobic bullying, coping strategies (avoidance and problem-solving), age, gender, migration trajectory, residency, sexual attraction and time elapsed since the realization of the sexual identity difference. Homophobic bullying was associated with a lower score of sexual identity affirmation and higher scores of identity concealment, internalized homo/bi-phobia, acceptance concern, identity uncertainty and process difficulty. Problem-solving coping strategies were associated with acceptance concerns. Avoidance coping strategies were associated with higher scores of acceptance concern and process difficulty in accepting non-heterosexual identity. Results confirm the importance of homo/bi-phobia prevention in order to help SMY in sexual identity consolidation

Intimidation homophobe, stratégies d’adaptation et intégration de l’orientation sexuelle / Homophobia, coping strategies, and sexual identity formation among LGBT youths

Cette étude examine l’impact de l’intimidation homophobe et des stratégies d’adaptation sur 6 dimensions de l’intégration de l’orientation sexuelle (OS) à partir d’un échantillon de 262 jeunes LGBT. Un modèle de régression linéaire a été réalisé pour chaque dimension, avec la victimisation homophobe et les stratégies d’adaptation comme principales variables indépendantes d’intérêt. La victimisation homophobe était associée à une plus faible affirmation de l’OS et à davantage d’homophobie/biphobie intériorisée, de préoccupations relatives au jugement d’autrui, de confusion identitaire, de dissimulation et de difficultés d’acceptation de l’OS. Les stratégies d’adaptation centrées sur la résolution de problèmes étaient associées à davantage de préoccupations relatives au jugement d’autrui alors que celles centrées sur l’évitement étaient associées à davantage de préoccupations relatives au jugement d’autrui et de difficulté d’acceptation de l’OS. Les résultats appuient l’importance de poursuivre la lutte à l’homophobie/biphobie et de mieux outiller les jeunes pour soutenir l’intégration positive de leur OS.(AU)

Sexual minority youths (SMY) face challenges in consolidating their sexual identity because of heterosexism. The role of homophobic bullying and coping strategies in the formation of sexual identity has been explored within a convenient sample of 262 sexual minority youths. Six dimensions of sexual identity formation have been tested, independent variables being: homophobic bullying, coping strategies (avoidance and problem-solving), age, gender, migration trajectory, residency, sexual attraction and time elapsed since the realization of the sexual identity difference. Homophobic bullying was associated with a lower score of sexual identity affirmation and higher scores of identity concealment, internalized homo/bi-phobia, acceptance concern, identity uncertainty and process difficulty. Problem-solving coping strategies were associated with acceptance concerns. Avoidance coping strategies were associated with higher scores of acceptance concern and process difficulty in accepting non-heterosexual identity. Results confirm the importance of homo/bi-phobia prevention in order to help SMY in sexual identity consolidation.(AU)

[Adolescents and young adults with cancer between adaptation and addiction: state of the question]. / Adolescents et jeunes adultes atteints de cancer, entre adaptation et addiction: un état de la question.

The purpose of this literature review is to make a point on the state of health of adolescents and young adults (15-25 years) suffering from cancer. The adaptation strategies and the impact of the announcement of cancer will be discussed. In addition, we are going to consider the characteristics of teenagers and young adults, given the fact that development is still in progress. This period is especially punctuated by various experiments and the emergence of some clinical signs. Also, we have identified various studies concerning the use of licit and illicit substances. Furthermore, we have taken interest in behavioral addictions, particularly cyber addiction. While trying to cross these variables with a population of teenagers and young adults in the context of somatic diseases, it occurred that this population was not well known and studied. The interest of this synthesis is to underline the importance to make future researches in these perspectives.

Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

OBJECTIVES: This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. METHODS: A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. RESULTS: Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. CONCLUSION: Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication.

[Cognitive behavior therapy after first-episodes psychosis]. / Thérapies cognitives et comportementales après les premiers épisodes psychotiques.

Cognitive behavior therapy (CBT) is recommended for the treatment of first-episode psychosis (FEP) patients. It can be offered in acute state or during the remission of the episode. Up to date, effects of CBT have been examined in several controlled and randomized trials in FEP. Combined with antipsychotic medications, results have demonstrated that CBT decreases positive psychotic symptoms, enhances quality of live, self-esteem and insight, and diminishes the intensity of comorbide symptoms, such as trauma or suicide behavior. CBT might be particularly efficient in individuals wishing to reintegrate premorbide functioning and those with low duration of untreated psychosis. Despite these encouraging results, psychosis orientated CBT are underused in France. The validation of group CBT specifically designed for FEP should enhance the range of patients receiving this treatment. Moreover, early CBT interventions for people at ultra high-risk for psychosis and assertive community treatments should be developed.