La recherche sur l'association entre l'expérience traumatique et la suicidalité est un domaine en pleine expansion dans la littérature depuis vingt ans. Cette thèse avait originalement pour but d’identifier les conditions suffisantes ou nécessaires de différents types de suicidalité chez les personnes traumatisées. Une procédure d'extraction de règles d'association a été mise en œuvre sur une base de données issue d'une enquête nationale française. Considérant le manque de conditions suffisantes ou nécessaires de suicidalité, deux autres questions liées à la suicidalité ont été envisagées. La première étude porte sur l'ordonnancement empirique des profils de suicidalité et la détection des symptômes qui modèrent les niveaux de risque. En utilisant la tentative de suicide dans le mois passé comme critère prédictif, trois niveaux de risque ont été établis. Tous les niveaux de suicidalité sont systématiquement modérés par le symptôme d'anxiété chronique. La deuxième étude visait à tester la robustesse de l'association entre les niveaux de traumatisme et la fréquence de la tentative de suicide dans le mois passé par l'identification des symptômes modérateurs de l'incidence de tentative de suicide dans chaque niveau de trauma. Sept symptômes concernant l'envie de mourir, l’intention d’automutilation, l’idéation suicidaire, la tentative de suicide au cours de la vie, l'humeur dépressive, la perte d'intérêt, et l'expérience de l'attaque de panique ont démontré un effet «d’éventail». Un examen détaillé de la littérature a révélé la difficulté d'obtenir une vue d'ensemble des types de suicidalité et leurs facteurs de risque dans le contexte «traumatisme-suicidalité». La troisième étude met en avant l’idée d’une plate-forme graphique visant à récapituler les connaissances empiriques obtenues par 26 études portant sur 20 facteurs de risque de six types de suicidalité dans différents échantillons de personnes traumatisées. Les principaux facteurs de risque sont la dépression majeure et le trouble de stress post-traumatique. Cette étude souligne l'importance d'un cadre descriptif commun et de la disponibilité des bases de données recueillies dans les études précédentes. / Research on the association between the experience of trauma and suicidality has been a growing field in the literature since two decades. The current dissertation was originally aimed at identifying sufficient or necessary conditions of suicidality outcomes among individuals exposed to trauma. A procedure of association rule extraction was implemented on a database from of a French national survey. Considering lack of sufficient or necessary conditions of suicidality outcomes, two other suicidality related issues were addressed. The first study focuses on the evidence-based ordering of the suicidality profiles and the detection of symptoms that moderate suicidality levels. Using ‘past month suicide attempt’ as the criterion, three suicidality levels were established. All suicidality levels were systematically moderated by the chronic anxiety symptom. The second study aimed at testing the robustness of the association between the trauma levels and the frequency of past month suicide attempt by identification of the symptoms moderating the incidence of outcome in every trauma level. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited a moderating effect with the fan-shaped pattern. A comprehensive review of the literature revealed the difficulty to obtain an overall picture of the investigated outcomes and their risk factors in the trauma-suicidality background. The third study puts forward a graphical platform aimed at recapitulating the evidence found by 26 studies concerning 20 risk factors of six suicidality outcomes among traumatized individuals. The main risk factors are major depression, and post-traumatic stress disorder. This review highlighted the importance of a common descriptive framework and the availability of the databases collected in previous studies.

The research reported in the thesis investigated exergaming acceptance and expe-rience in older people with special reference to technology acceptance, flowstate, chronic pain and balance control. In recent years, there has been an increasing amount of literature on the beneficial effects of exergaming on older people’s health, well-being and balance, including the use of exergaming as a method of pain con-trol. Nevertheless, when taken separately, specific studies vary in methodology and in type(s) of exergaming topics studied. Health benefits from exergaming may only be gained if older people take part in it. There is evidence in the literature to indicate that usage of a technology is preceded by user acceptance. Few studies, to date, have investigated how older people perceive and experience exergaming in relation to their perceived abilities and future intention to use it, from a technology acceptance point of view. Therefore, the purpose of this thesis was to see if (1) the exergaming technology was acceptable to healthy older people and older people with chronic pain and (2) it had any effect in the self-reported health status, pain conditions and balance in older people with chronic pain. The current thesis consists of two separate studies. In Study 1, twenty-eight healthy older people participated in six 40-minute exergaming sessions within a three-week period. In Study 2, fifty-four older people with chronic musculoskeletal pain attended a twelve 40-minute exercise intervention within a six-week period, either randomised into an exergaming group (IREXTMsystem) or standard physical exercises. A modified version of the Unified Theory of Acceptance and Use of Technology (UTAUT) was analysed at baseline and upon completion of the intervention, including specific time points throughout the study. Self-perceived chronic pain and flow state were analysed at baseline and after exercise intervention. Rate of perceived expended physical and mental effort was recorded after every exercise session and compared between groups. Heart rate was recorded in the second study. Postural sway was assessed at the start and the end of the intervention with Centre of Pressure data being extracted via a Kistler force plate (AP SD, AP range ,ML SD, ML range and CoP velocity), where the conditions were quiet bipedal standing with eyes open and eyes closed. Evidence from both studies showed that exergaming technology was acceptable to healthy older people and older people with chronic musculoskeletal pain. Recorded high levels of flow indicated the occurrence of flow during the intervention. Perfor-mance expectancy emerged as the strongest predictor of older people’s behavioural intention to use exergaming. Previous behaviour was an important influence of future behaviour, within the context of exergaming. In Study 1, there were significant increases throughout the intervention in most of the flow state variables except challenge-skill-balance, paradox of control and transformation of time. Thematic analysis of olde rpeople’s responses relating to exergaming revealed that enjoyment was the most frequently cited theme. The significant increase of perceived physical exertion suggested that exergaming provided light-to-moderate intensity exercise for this cohort of healthy older people. In Study 2, an interesting pattern emerged over time where earlier on in the interven-tion, effort expectancy significantly predicted older people’s behavioural intention to use exergaming (instead of performance expectancy). This role was then taken over by performance expectancy midway through the intervention. This indicated that this sample of older people with chronic pain prioritised their personal ability to play the exergames, after which, they then considered the usability of the exergaming technology in choosing whether to use it in future, if it were readily made available. In addition, there was evidence of improvement in post-intervention pain intensity in the exergaming group, suggesting that exergaming may have alleviated older people’s experience of pain to some extent. Flow levels significantly increased from the start to the end of the intervention. Significant improvements over time in postural sway parameters in the control and exergaming groups suggested that short-term exercise contributed to improved balance in older people with chronic musculoskeletal pain. The indication of improved postural sway due to significant mediolateral reductions in the eyes-closed condition in the both groups suggested that older people with chronic pain could benefit from at least subtle improvements in balance after taking part in short-term exercise. Nevertheless, exergaming may have an effect on postural sway when visual sensory information is removed, as found in the experimental group that demonstrated a statistically significantly lower reduction of CoP excursion in the medio-lateral direction, than in the control group.

The primary objective of this study was to examine the association between the theory of planned behavior (TBP) and adherence to a multidisciplinary pain center (MPC) treatment program for chronic pain. While the results of several studies have provided support for the efficacy of MPC treatment in chronic pain, the problems of adherence and attrition are important. TPB is a cognitive/social model of behavior that has been used to predict a variety of behaviors, although it has never been used to predict adherence to a multidisciplinary chronic pain treatment program. It was predicted that Adherence would be predicted by Intentions and that Intentions would be predicted by 1) Perceived Social Norms, 2) Perceived Behavioral Control, 3) Attitudes Toward New Behavior (completing the treatment program), and 4) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). It was found that the total Intentions scores did not predict the total Adherence scores. However, Intentions was predicted by 1) Perceived Behavioral Control, 2) Attitudes Toward New Behavior (completing the treatment program), and 3) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). The finding that Perceived Social Norms did not predict Intentions was consistent with results of previous studies with the TBP. The secondary objective was to examine the extent to which MPC treatment affects patients' attitudes towards behaviors that are associated with successful pain management. The majority of the patients (82%) developed a more favorable attitude toward the program and their average report of the importance of the program was 6.78 on a 10-point scale. The majority of patients (74%) reported experiencing a greater decrease in pain than expected, and the average amount of pain decrease was 5.39 on a 10-point scale.

Orientador: Milva Maria Figueiredo De Martino / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T01:27:20Z (GMT). No. of bitstreams: 1 Souza_EmiliaFerreirade_M.pdf: 1834559 bytes, checksum: cd4da6190829f2741a78bb8f6fd1d670 (MD5) Previous issue date: 2004 / Resumo: O tratamento hemodialitico provoca uma sucessão de situações para o cliente renal crônico, que compromete o aspecto não só físico, como psicológico, com repercussões pessoais, familiares e sociais. O objetivo deste estudo foi identificar os diagnósticos de enfermagem mais freqüentes no cliente renal crônico, tendo como referencial o Marco Conceituai e a Teoria do Alcance dos Objetivos de Imogene King onde ela considera alguns conceitos básicos essenciais para a enfermagem e define os três sistemas que são à base do modelo - sistema pessoal, interpessoal e social. Foi aplicado um instrumento de coleta de dados a 20 clientes de uma unidade dialítica com acompanhamento supervisionado, com questões relacionadas ao sistema pessoal, interpessoal e social, objetivando conhecer a necessidade do paciente, através do levantamento dos dados. Os diagnósticos foram discutidos e determinados a partir da discussão dos casos com uma especialista em diagnósticos de enfermagem e tendo como referência a Taxonomia II da NANDA. Os resultados mostraram a identificação dos diagnósticos de enfermagem presente em todos os clientes estudados. A faixa etária em que ocorreu maior comprometimento com a patologia esteve entre 41 a 50 anos. A causa principal da doença foi para hipertensão arterial sistêmica e diabetes. Os diagnósticos de enfermagem encontrados em 50% ou mais dos pacientes hemodialíticos foram: risco para infecção, proteção alterada e conforto alterado. Foram considerados alguns diagnósticos com menor freqüência por terem sido relevantes para a assistência do paciente hemodialitico: desobediência, distúrbio do padrão do sono, medo, ansiedade e desempenho de papel a Iterado. Conclui-se que o instrumento utilizado nos permitiu identificar os diagnósticos de enfermagem baseados na teoria de Imogene King e Taxonomia da NANDA, mas como a coleta de dados ocorreu somente uma vez, recomenda-se a realização de estudos longitudinais para a confirmação ou não dos achados / Abstract: Hemodialysis provokes various conditions in chronic renal clients that compromise not only the client's physical but also the psychological aspect together with personal, familial and social repercussions. The purpose of this study was to identify the most common nursing diagnoses in chronic renal clients using as reference the Imogene King's Conceptual Model and the Theory of Goal Attainment in which she deals with some basic concepts essential to nursing and describes the three systems that form the basis of her model - personal, interpersonal and social. In order to verify the needs of clients (n=20) in a dialytic unit, a data collecting tool based on the NANDA nursing diagnoses and composed of questions related to the personal, interpersonal and social systems was applied to the clients with a supervised follow up. The results detected the presence of nursing diagnoses in all the clients in this study sample. The highest pathological compromise occurred in the 41 to 50 year age group. The main cause of disease was due to hypertension and diabetes. The nursing diagnoses found in 50% of the clients were: risk of infection, ineffective protection and altered contort. Some diagnoses, such as: noncompliance, disturbed sleep pattern, fear, anxiety and ineffective role performance, had less frequency by had been relevant to the clients attendance. Therefore, it can be concluded that the data-collecting tool helped identify nursing diagnoses that were based on the Imogene King theory and the NANDA Taxonomy, but as the data collecting had been done just once, it is recommended longitudinal study to confirm there findings / Mestrado / Enfermagem e Trabalho / Doutor em Enfermagem

abstract: Post-Traumatic Stress Disorder (PTSD) is characterized by intrusive memories from a traumatic event. Current therapies rarely lead to complete remission. PTSD can be modeled in rodents using chronic stress (creating vulnerable phenotype) combined with fear conditioning (modeling a traumatic experience), resulting in attenuated extinction learning and impaired recall of extinction. Studies typically investigate cognition soon after chronic stress ends; however, as days and weeks pass (“rest” period) some cognitive functions may improve compared to soon after stress. Whether a rest period between chronic stress and fear conditioning/extinction would lead to improvements is unclear. In Chapter 2, male rats were chronically stressed by restraint (6hr/d/21d), a reliable method to produce cognitive changes, or assigned to a non-stressed control group (CON). After chronic stress ended, fear conditioning occurred within a day (STR-IMM), or after three (STR-R3) or six weeks (STR-R6). During the first three extinction trials, differences emerged in fear to the non-shock context: STR-R3/R6 showed significantly less fear to the context than did STR-IMM or CON. Differences were unlikely attributable to generalization or to second-order conditioning. Therefore, a rest period following chronic stress may lead to improved fear extinction and discrimination between the conditioned stimulus and environment. In Chapter 3, the infralimbic cortex (IL) was investigated due to the IL’s importance in fear extinction. Rats were infused with chemogenetics to target IL glutamatergic neurons and then assigned to CON, STR-IMM or STR-R3. During the rest period of STR-R3 and the restraint for STR-IMM, the IL was inhibited using CNO (1mg/kg BW, i.p., daily), which ended before behavioral testing. STR-R3 with IL inhibition failed to demonstrate a tone-shock association as spontaneous recovery was not observed. CON with IL inhibition behaved somewhat like STR-IMM; freezing to the extinction context was enhanced. Consequently, inhibiting IL function during the rest period following chronic stress was particularly disruptive for learning in STR-R3, impaired freezing to a safe context for CON, and had no effect in STR-IMM. These studies show that time since the end of chronic stress (recently ended or with a delay) can interact with IL functioning to modify fear learning and response. / Dissertation/Thesis / Doctoral Dissertation Psychology 2020

Background: Chronic pain conditions are pervasive, debilitating, and costly problems across the globe, yet medical treatments often fail to relieve the patients of pain. As a result, complementary treatments, such as yoga, are often used in an attempt to reduce pain and disability. Yoga seems to be effective in short-term relief of pain and, in some cases, helps alleviate psychological comorbidities associated with pain, such as depression and anxiety. The purpose of the current study was to evaluate the efficacy of an eight-week Forrest Yoga intervention on pain interference, pain severity, and psychological outcomes. Methods: Seventy-nine participants were randomly assigned to yoga or usual care and completed a battery of self-report assessments at baseline, mid-intervention (4-weeks), post-intervention (8-weeks), and follow-up (16-weeks). Measures of pain interference, pain severity, number of painful body parts, sensory and affective experience of pain, psychological flexibility, pain catastrophizing, fear of movement, depression and anxiety, and social support were included. Results: There were significant reductions in pain interference and activity avoidance in the yoga group compared to usual care post-intervention. Differences trended towards significance for pain severity and number of painful body parts. Compared to usual care, yoga participants showed significant early reductions in pain interference, pain severity, number of painful body parts, affective experience of pain, depression, overall fear of movement, and activity avoidance. Compared to usual care, these changes were not maintained at 16-weeks (2 months following the intervention). Conclusions: The yoga intervention provided some relief of pain and pain-related problems while the intervention was ongoing but did not provide sustained relief.

Les phases de transitions entre les différentes stratégies de prise en charge de l'insuffisance rénale chronique terminale peuvent être associées à une augmentation de la morbidité et de la mortalité lorsqu’elles ne sont pas anticipées. Il faut donc pouvoir définir des trajectoires de patient et faire en sorte de maîtriser les changements d’état afin d’améliorer la prise en charge du patient insuffisant rénal chronique. Cela ne peut être atteint sans une phase exploratoire préalable visant à étudier les phases de transition du parcours de soins intégrés. L’objectif de ce travail était donc d’étudier trois transitions présentes dans le parcours de soins du patient atteint d’insuffisance rénale chronique.Nous avons montré que chez le patient qui débute la dialyse péritonéale, le temps passé au préalable dans un autre traitement de suppléance, que ce soit en hémodialyse ou en transplantation rénale, peut précocement impacter son devenir dans la technique. Cette importance du traitement antérieur renforce notre conviction qu’il faut avoir une vision globale et intégrée de la prise en charge du patient insuffisant rénal chronique terminal. De même, la survenue d’une péritonite dans les premiers mois en dialyse péritonéale est associée à l’arrêt précoce de la technique. Il est donc indispensable à la prise en charge initiale et au cours des premiers mois de traitement en dialyse péritonéale de s’interroger sur le risque de transfert précoce en hémodialyse du patient et sur la nécessité de lui créer une fistule artério-veineuse. Nous avons également rapporté le fait que les infections liées à la fistule en dialyse hors centre sont des événements relativement peu fréquents. Cependant, une approche différente de ces infections, en distinguant le risque de première infection et le risque de récidive infectieuse chez un patient, permettra de diminuer la fréquence de ces événements responsables de transition non programmée entre les différentes structures de dialyse. Enfin, nous avons choisi d’étudier la transition entre stade V de l’insuffisance rénale et le traitement par dialyse dans la population des patients atteints de cancer. Nous avons montré que l’incidence de la dialyse dans cette population n’est pas plus importante que dans la population générale. La survie en dialyse de ces sujets semble également comparable à celle des dialysés sans cancer diagnostiqué. Nos résultats suggèrent que seuls les patients avec un cancer en bonne condition générale ont la possibilité d’être traité par dialyse chronique. Il existe un réel rationnel scientifique à considérer le parcours de soins du patient insuffisant rénal chronique stade V comme un parcours intégré, comprenant plusieurs états et de nombreuses phases de transition, qui doivent être explorées finement tout en tenant compte de l’ensemble de la trajectoire du patient. / Transitions between treatment strategies in chronic kidney disease are often not prepared and can lead to morbidity and mortality. It is necessary to anticipate these transitions to improve patients outcomes and health care organisation. We aimed at studying three pathways observed in the career of chronic kidney disease patients.We have shown that patients treated by hemodialysis before peritoneal dialysis start and failed transplant patients had a higher risk of early peritoneal dialysis failure. Early peritonitis was also associated with a higher risk of early technical failure. It is therefore important to evaluate the necessity to create an arterio-venous fistula in peritoneal dialysis patients during the first months on dialysis, to avoid transfer in hemodialysis on a central venous catheter.We reported that the rate of arterio-venous fistula infections in satellite dialysis units was low. However, it seems necessary to distinguish the risk for having a first infection and the risk for having a relapse of infection. This consideration can help decreasing the number of fallback between stallite units and hospital dialysis centers.Finally, we studied transition between end-stage renal disease and dialysis in cancer patients. We showed that incidence of chronic dialysis initiation in that population was not higher then the one observed in the general population. Survival in dialysis was not different in cancer patients compared to matched patients without malignancy. We can hypothesise that only cancer patients in good condition are proposed for dialysis programs.It is necessary to consider the chronic kidney disease patients' care as an integrated care program, with transitions between treatment strategies that can be improved and anticipated.

The purpose of the study is to examine the relationship between the location of the initial onset of back pain as revealed by the subject's pain drawing and the site of maximum muscle tension at rest, while jaw-clenching and during a cold stressor, in men and women. Subjects were 30 males and 30 females divided into three groups of 10 males and 10 females each and designated according to back pain history as no back pain (NBP), upper back pain onset (UBP) and lower back pain onset (LBP). Six bipolar, bilateral electromyographic (EMG) recording sites were instrumented on each subject. EMG levels were recorded from the forehead, forearm, upper back, lower back, thighs and ankles under conditions of rest, jaw-clenching and a cold stressor. Seven hypotheses predicted that EMG levels would distinguish groups and gender of the subjects and that interactions would exist between site of pain onset and EMG elevations.

The effects of a computer program (Health Imagery Technology Systems, HITS) designed to promote attitude and cognitive changes through elicitation of evoked response potentials were evaluated with chronic pain patients. A treatment and control group were used for comparison (52 patients, 22 females, 32 males, mean ages 47). Wechsler Adult Intelligence Scale-Revised subtests, a Semantic Differential scale, the Health Attribution Test, an imagery protocol, the McCoy-Lawlis Pain Drawing, and the Zung Depression scale were used at admission and discharge to measure change. A pre- post-mood thermometer was used with the treatment group. The hypotheses that the treatment group would show significant changes on these measures were tested with a two group repeated measures analysis of variance design. No significant changes were noted for either group on the intellectual measures, on health attitudes, or reports of pain. The similarities subscale showed significant within group variance (F = 5.46, p < .023). One bipolar adjective pair indicated significant differences (F = 4.79, p < .035), possibly a result of chance. One of seven imagery measures suggested a significant improvement in strength of imagery for the treatment group (F = 18.2, p < .00008). Both groups showed significantly improved imagery of body defenses (F = 4.58, £ < .037) and significantly reduced depression scores (F = 15.93, p < .000021). A mood thermometer was measured for the treatment group alone and five situational mood changes were significant in predicted directions. Post hoc discriminant analysis showed significant differences only on one adjective pair (F = 9.75, p < .0029). No combination of variables added to the prediction of group membership. Overall, the effects of the HITS program did not seem strong enough to indicate its value as a treatment modality in chronic pain populations beyond current treatment. It did indicate some significant situational mood effects in positive directions.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22147号 / 医博第4538号 / 新制||医||1039(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 濵﨑 洋子, 教授 竹内 理, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM