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Devonshire V.,University of British Columbia | Lapierre Y.,Hopital Neurologique de Montreal | Macdonell R.,Austin Hospital | Ramo-Tello C.,Hospital Universitario Germans Trias jol Servicio Of Neurologia | And 7 more authors.
European Journal of Neurology | Year: 2011

Background: Most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS.Methods: This was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs.Results: Two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment.Conclusion: Identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs. © 2010 The Author(s). European Journal of Neurology © 2010 EFNS.

The role of peritraumatic distress in the genesis of PTSD, although well established and explicit in the DSM criteria, seems to be undervalued by the main theoretical conceptualizations of PTSD. Most models explain the presence of a large variety of emotions other than fear as subsequent to the reinterpretation of the traumatic event. Exposure strategies implemented in the case study illustrate the unexpected appearance of strong feelings of distress in the face of trauma-related sensations and situations and lead us to postulate the primacy of these emotions as well as the role of the avoidance of these same emotions in the genesis of disorders. This hypothesis corroborates the innovations of third generation cognitive and behavioral therapy, which underlines the role of emotions as well as the avoidance of emotions in the development of persistent mood disorders. © 2011 Association française de thérapie comportementale et cognitive.

Analysis purpose: This analysis has allowed to document, in a practical manner, the patients' clinical and sensitization profiles, and to identify the grounds in establishing or not a specific sublingual immunotherapy (SLIT). Patients and methods: National, longitudinal multicenter survey, performed in patients from 5 years old, whose allergy was confirmed by skin test or specific IgE testing. Sociodemographic data, history of allergy and the considered therapeutic approach were gathered in a registry from September 2009 to March 2010, and then analyzed. Results: Amongst 4227 patients registered by 264 physicians, 62% were polysensitized, 80.4% had several symptoms of respiratory allergy, including rhinitis (98.2%) mostly persistent and with moderate to severe intensity; conjunctivitis (65,5%) and asthma (48.1%) intermittent in 69% of cases. About 94.3% of patients had symptomatic treatments, moderate or insufficient effectiveness for 68.5% of them. A SLIT has been initiated in 65% of cases. The presence of conjunctivitis and sensitization to Betulaceae or cypress pollen increased the probability of initiating a SLIT, whereas polysensitization was not a determinant factor. Insufficient symptomatic complain, patient's treatment refusal or predictable poor compliance were the main reasons for not initiating a SLIT. Conclusion: The results of this registry have testified, in practice, the compliance with the ARIA recommendations in the decision establishing a SLIT: treatment was proposed to young patients suffering from moderate to severe rhinitis, with an important discomfort and inadequately relieved by symptomatic treatments. © 2010.

Montes H.,Cabinet Medical
Journal de Therapie Comportementale et Cognitive | Year: 2016

In response to the terrorist attacks of November 2015 in Paris, more than one hundred Cognitive Behavioral psychotherapists, members of the French Association of Cognitive Behavioral Therapy (Association Française de Thérapie Comportementale et Cognitive [AFTCC]), offered immediate, free psychological assistance to victims. This generous action provided therapists with the opportunity to consider the importance of developing creativity and flexibility in their own individual practice. It was also the opportunity for an association the size of the AFTCC to reflect on the assistance and services it provides to its members. © 2015 Association française de thérapie comportementale et cognitive.

A number of questions are raised by the decision of the elderly suffering fromdementia when they accept or reject medical care. When a patient accepts medical care, his assent is considered valid, while when he rejects it, the physician and the health care teams often highlight judgement disorder so as to ask for a legal guardian and then be free from the patient's assent. This behaviour is due to a lack of knowledge of the law: legal incompetence is not the same as being unable to understand and there is no law that exempts the physician from informing the patient and from trying to obtain the patient's consent. There are a lot of legal texts about this subject. Unfortunately, these texts sometimes contradict one another, especially for patients under legal protection, and the 5th March 2007 Act, which specifically deals with adults under legal protection, does not settle the problem. © 2011 Médecine et Hygiène et Springer-Verlag France.

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