Introduction : La gestion d'une urgence vitale requiert la réalisation de gestes techniques et une communication entre les soignants en condition de stress. La simulation permet cet enseignement en sécurité.Objectif : Analyser l'association entre stress et performance et l'effet de la simulation répétée. Méthodes : Deux groupes expérimental et contrôle de 6 équipes pluri-professionnelles de SAMU (n = 48), avaient respectivement 9 (1/6 semaines) et 3 (1/6 mois) simulations, avec 3 scénarios communs : initial, intermédiaire à 6 mois, final à 1 an. Le stress a été évalué par la fréquence cardiaque et sa variabilité, le cortisol salivaire et des paramètres psychologiques (échelles de : stress aigu STAI et SOM ; stress post-traumatique IES-R et PCLS) ; la performance technique par les scores de pose de voie intra-osseuse (VIO), de performance globale (TAPAS) ; la performance non-technique par les scores BAT du leader, CTS de l'équipe.Résultats : Le stress augmentait durant la simulation (p < 0,02) et baissait lors du débriefing (p < 0,01) quelle que soit la fréquence de répétition, sans stress post-traumatique. Les performances étaient corrélées entre elles (p < 0,001) avec un lien étroit entre les scores BAT (leader) et CTS (équipe) (R² = 0,93). Stress et performance n'étaient pas corrélés. La performance était supérieure dans le groupe expérimental dès le scénario intermédiaire pour les scores techniques (TAPAS : p = 0,02, VIO : p = 0,03) et pour tous les scores lors du scénario final (TAPAS et IO : p = 0,01, CTS : p = 0,03, BAT : p = 0,02).Conclusion : La répétition de séances de simulation toutes les 6 semaines apportait un bénéfice majeur. La performance d'équipe était liée à celle du leader. / Introduction: The management of a life-threatening event by caregivers requires technical and non-technical skills under stress conditions. Simulation-based education allows this training in a safe environment. Objective: To analyze the association between stress and performance and the effect of repeated simulation.Methods: Two experimental and control groups of 6 MDTs of EMS (n=48) had respectively 9 (1session/6 weeks) and 3 (1session/6 months) simulations with 3 common sessions: initial, intermediate after 6 months, and final session after 1 year. Stress was assessed by heart rate and variability, salivary cortisol and psychological parameters (acute stress: STAI and SOM, and PTSD: IES-R and PCLS). The technical performance was evaluated by Intra-Osseous Access Performance Assessment Scale (IO), overall performance (TAPAS); non-technical performance by BAT score for leader and CTS score for teamwork.Results: Stress increased during simulation (p<0.02) and decreased during debriefing (p<0.01) regardless of the frequency of repetition. There was no PTSD. The performances were correlated between each other (p<0.001) with a strong link between the non-technical performance of leader and team (R²=0.93). Stress and performance were not correlated. The performance was higher in the experimental group during the intermediate scenario for technical scores (TAPAS: p=0.02, IO: p=0.03) and for all scores during the final scenario (TAPAS and IO: p=0.01 CTS: p=0.03, BAT : p=0.02).Conclusion: The benefit was greater when performing simulations every six weeks in terms of technical and non-technical performance. The team performance was linked to the leader performance.

Limited research has investigated the stress-related experiences of South African nursing students. Moreover, there is a scarcity of empirical studies that have reported on the development and evaluation of psycho-educational stress-management programmes that focus on both pathogenic, as well as positive and meaning-related factors among nursing students. The aim of this investigation was to study compassion fatigue, burnout, compassion satisfaction and meaning in life among a sample of nursing students with the aim of developing, and then empirically evaluating, a psycho-educational stress-management programme. The psycho-educational stress-management programme was articulated from a logotherapy-based perspective. A research design, consisting of three interdependent phases, was used to pursue the aim of the study. The aim of phase 1 was to describe the (1) prevalence of, and (2) correlations between, the deleterious and positive and meaningful effects of caring and among a sample of 80 nursing students (Mage = 22.40 years, SD = 11.1, female = 91.25%). The results indicated that participants may benefit from a logotherapy-based psycho-educational stress-management programme. The purpose of phase 2 of the study was to develop a logotherapy-based psycho-educational stress-management programme for nursing students. The goal of the logotherapy-based psycho-educational stress-management programme was to assist participants to develop the skills, knowledge and abilities that may be required to address deleterious challenges, and enhance positive and meaning-related opportunities. In phase 3 the logotherapy-based psycho-educational stress-management programme was presented to a sample of 42 first year nursing students (Mage = 20.21, SD = 1.57, female = 79.31%). A convergent parallel mixed methods research design was used to evaluate the efficacy of the logotherapy-based psycho-educational stress-management programme. Quantitative results indicated (1) a reduction in compassion fatigue and burnout, and (2) an increase in compassion satisfaction and meaning in life, scores over the course of the programme. Qualitative analysis supported the quantitative results. It was subsequently concluded that the logotherapy-based psycho-educational stress-management programme was effective in assisting participants to address the deleterious , as well embrace the positive and meaning-related effects of caring. However, ongoing support may be required to fully assist nursing students to address stressful challenges. / Psychology / D. Litt. et Phil. (Psychology)

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

Operation Enduring Freedom (OEF) (Afghanistan) and Operation Iraqi Freedom (OIF) represent one of the longest wartime deployments in the history of the American military. To date, 1.6 million American military members have deployed. Of these, an estimated 300,000 have returned with a mental health condition, such as depression or PTSD. The Department of Defense has established a robust screening program to identify and track deployment-related physical and psychiatric illnesses. The Post-Deployment Health Reassessment (PDHRA) is a primary tool to identify physical and psychiatric risk following a deployment. The PDHRA is a web-based survey, which is administered between 90-180 days after a deployment. This study seeks to evaluate the psychometric properties and clinical utility of the Post-Deployment Health Reassessment (PDHRA) for accurately identifying truama and depression among Airmen following a deployment. Descriptive statistics, confirmatory factor analysis and structural equation modeling were used to address separate research aims. Study aims assessed the impact of deployment on military members and the clinical utility and psychometric properties of the Post-Deployment Health Reassessment. Findings suggest that the Post-Deployment Health Reassessment is a useful triage tool to identify trauma and depression among Airmen following deployment. The study makes recommendations for improving the clinical utility and psychometric properties of the Post-Deployment Health Reassessment (PDHRA). / text

Wildfires in Canada and around the world are increasing in frequency each year from factors such as accumulated fuel load, climate changes, and pine beetle infestation. Due to an increased proportion of individuals living in the wildland–urban interface areas within Canada and due to the increasing need for firefighters to fight the growing number of fires that burn each year, the potential threat for humans is also becoming greater. Conducted on the 2009 West Kelowna, British Columbia wildfires, this descriptive, exploratory, qualitative study incorporates quantitative validity measurements to investigate factors related to individual variations in psychological distress and posttraumatic growth (PTG). The findings revealed that perception of control, social support, compounding stressors (i.e., dual roles, ongoing responsibilities and personal issues), and coping methods (i.e., debriefing, humour, self-care behaviours, and reflection) were precursors to psychological health and resilience. Since wildfires are increasing in Canada as well as on a global scale, understanding how they affect residents and firefighting personnel from a mental health perspective is important to research, as it can lead to identifying more effective interventions, better provision of disaster relief services, and increase individual resilience. / xi, 193 leaves ; 29 cm

PROBLÉMATIQUE La violence collective, à travers les guerres civiles et autres conflits politiques violents, constitue un lourd fardeau pour la santé publique. Plus de la moitié des décès causés par l’ensemble des conflits dans le monde entier se trouvent en Afrique. L’une des conséquences est le déplacement massif des populations qui se réfugient vers l’extérieur du pays, mais aussi de plus en plus à l’intérieur des frontières nationales. Ceux qui ne traversent pas sont appelés déplacés internes. Leur état de santé est au moins aussi vulnérable que celui de réfugiés, mais est très peu documenté. De 1993 à 2005, le Burundi a plongé dans une crise politico-sociale sans précédent. En 2001, environ 10 % de la population vivaient dans des camps de déplacés. OBJECTIF Documenter l’état de santé des personnes déplacées par la guerre au Burundi et identifier ses déterminants. CADRE CONCEPTUEL Le cadre conceptuel est basé sur la modélisation de l’association entre les événements traumatiques, les facteurs de l’environnement post-traumatique et l’état de santé des déplacés internes burundais. MÉTHODE Une enquête transversale a été menée dans deux camps de déplacés au Burundi. Les données ont été obtenues de façon rétrospective sur l’exposition aux événements traumatiques et de manière transversale pour l’état de santé et les facteurs de l’environnement post-traumatique. Les participants ont été interrogés sur les événements traumatiques vécus personnellement ou par leurs proches selon une courte échelle élaborée à cet effet. De même, les facteurs de l’environnement post-traumatique ont été documentés. Pour la mesure de l’état de santé, un questionnaire comportant certains des 17 items du profil de santé de Duke a été utilisé. Deux traductions ont été réalisées et plusieurs items ont été adaptés. RÉSULTATS Les événements traumatiques vécus par les déplacés internes burundais sont négativement associés à l’état de santé physique, à l’état de santé sociale, à l’état de santé perçu et, positivement, avec l’incapacité. De même, plusieurs facteurs de l’environnement post-traumatique sont associés à l’état de santé. Par contre, certaines associations sont à interpréter selon leurs interactions avec les événements traumatiques. Celles-ci agissent parfois comme modificateurs d’effet, en amortissant ou en amplifiant le lien associatif initial entre certains événements traumatiques et l’état de santé des déplacés. CONCLUSION : Les résultats font ressortir un effet différentiel associé d’une part aux événements traumatiques vécus précédemment et d’autre part, en interaction avec ces derniers, à l’environnement post-traumatique. Notre thèse en arrive à la conclusion que les facteurs de l’environnement post-traumatique constituent des déterminants importants de l’état de santé des déplacés de guerre. / INTRODUCTION Collective violence in the form of civil war and other violent political conflict places a heavy burden on public health. More than half of all deaths caused by conflicts around the globe occur in Africa. One of the consequences of such conflict is the massive displacement of populations seeking refuge either outside their country or, increasingly, within their country’s borders. Those who remain within their country are called internally displaced persons. Although little documented, the health of these people is every bit as vulnerable as that of refugees. From 1993 to 2005, Burundi was plunged into a socio-political crisis of unprecedented proportions. In 2001, approximately 10% of the population was living in displaced person camps. OBJECTIVE To document the health status of persons displaced by the war in Burundi and identify its determinants. CONCEPTUAL FRAMEWORK The conceptual framework is based on a modelling of the association between traumatic events, factors in the post-trauma environment and the health status of internally displaced Burundians. METHOD This cross-sectional study was carried out in two displaced persons camps in Burundi. It uses retrospective data on exposure to traumatic events and cross-sectional data on health status and factors in the post-trauma environment. Using a short scale especially designed for this study, the participants answered questions about the traumatic events that they or those close to them had experienced. Factors in the post-trauma environment were also documented. To measure health status, a questionnaire containing some of the 17 items of the Duke Health Profile was used. Two translations were made, and several of the items were adapted to the particular context. RESULTS The traumatic events experienced by displaced persons in Burundi are negatively associated with physical health, social health and perceived health, and positively associated with disability. A number of factors in the post-trauma environment were also associated with health status. However, some of these associations are difficult to interpret because of their interactions with traumatic events. These interactions sometimes act as effect modifiers by diminishing or amplifying the initial association between certain traumatic events and the health status of displaced persons. CONCLUSION The results reveal a differential response associated with, on the one hand, previously experienced traumatic events and, on the other hand, the post-trauma environment in interaction with these traumatic events. This thesis concludes that factors in the post-trauma environment constitute important determinants of the health of persons displaced by war.

No description available.

Post-crisis intervention care in situations of danger in the Police of the Czech Republic. The topic of this diploma thesis consists in taking a deeper view into post-crisis intervention care in the Czech Police. The primary goal of the diploma thesis is to verify whether in the Czech Police a functional system of post-crisis intervention care is created that policemen or also their families can use if necessary. Further, we were interested whether there are opinions, attitudes and prejudice among policemen concerning the use of post-crisis intervention care. Therefore, in the theoretical part the diploma thesis deals with basic psychological terms that are closely related to the field of post-traumatic care in the Czech Police and summarizes issues of psychological care in the Czech Police. The entire object of the research is mapping the current situation of providing post-crisis care to policemen, the degree of awareness of this service, attitudes of policemen to using this service and last, but not least, purposefulness and efficiency of this service. An integral part of the goal of the work was an analysis of factors that facilitate or complicate the process of providing post-crisis care and suggestion of possible measures to make its functioning more efficient as well as finding main causes of insufficient utilisation of post-crisis intervention care by policemen. In compliance with the goal of the thesis a quantitative survey was carried out and the most suitable methods were used in such a way that the specified goal could be achieved in the most efficient way. The results of the survey carried out by us have confirmed that in the Czech Police a functioning system of post-crisis intervention care is created that policemen can use if necessary. The survey has also indicated that policemen are sufficiently informed about the system of post-crisis intervention care and that this system corresponds to the needs of police practice. However, the survey has also revealed that negative opinions, attitudes and prejudice concerning the psychological service of the Czech Police persist in policemen's minds. Reducing these negative tendencies would certainly contribute to more efficient utilisation of this service.

Violent cnme is among the most prominent distinguishing characteristics of South African society, it has a severely traumatising effect on the populations concerned. Based on research :findings and existing literature, this study explores traumatic effects of violent crime on the most intimate associate of the victim (the partner). Accordingly, this study deals with the much-neglected topic of secondary trauma, by focusing on the following aspects of or conditions associated with violent crime and the secondary victim: cognitive, emotional and relational effects the experience of trauma, loss, vulnerability, depression and acute stress. It reveals that, depending on the severity of the incident, its consequences for the partner of the victim may range from post-traumatic stress to acute stress or secondary traumatic stress. From the similar results returned for primary and secondary victims, it is apparent that in the future, both victim and supporter should have their needs addressed with equal emphasis. / Educational Studies / M.Ed. (Specialisation in Guidance and Councelling)

The purpose of this study was to analyse the support systems for refugees in Southern Africa with specific reference to the Republic of Botswana. Qualitative framework as described by Lofland and Lofland (1984), Schensus and Schensus (1992) was used to conduct the investigation. Interviews were conducted with thirty refugees who currently living in Botswana as a refugee or asylum seeker. Focus group discussion was also held with twenty-six refugee workers. Interview findings were derived using Glaser and Straus' (1976) and Van Maanen, (1979) constant comparative method of qualitative analysis and were grouped into four major categories. Among the most significant findings were that the subjects agreed that on paper and by design, there are structures for providing the different services to refugees but refugees are not provided with adequate services. The second finding is that the support systems for refugees in Botswana are more focused on the provision of material support with little attention given to the psychosocial needs of the refugees. The third finding is that the Botswana government withheld some of the Articles of the 1951 UN refugee Convention, which deal with the socio-economic rights of refugees in Botswana. The fourth finding is that refugee workers need specialised training to enable them to address a wide rage of psychosocial issues affecting refugees. Last major finding is that there is no established clear system of service delivery in the participating agencies. The researcher concluded that because of trauma and stress experienced by refugees and refugee workers, there is a need to improve on the psychosocial support provided to refugees and refugee workers in Botswana by improving the knowledge and skills of refugee workers and promoting refugee participation. The researcher recommends two urgent actions that should be taken. First, the refugee management in Botswana need to improve on its service quality control mechanism, including evaluating its legal and operational framework. Second, psychosocial components need to be integrated into every aspect of the refugee programmes. This will support recovery for the many traumatised refugees and refugee workers in Botswana. / Social work / DPHIL (SOCIAL WORK)