Massimiliano Orri

Qualitative studies among obese children and adolescents: a systematic review of the literature

Childhood obesity is a complex condition involving medical, social, moral and cultural issues. Qualitative approaches are of great value in understanding this complexity. This meta‐synthesis of 45 qualitative studies deals specifically with the issue of obesity in children and adolescents from different perspectives – those of obese children and adolescents, of parents, and of health professionals providing support to the family. Our aim was to obtain a coherent view of child and adolescent obesity, focused on clinical and personal experience. The themes derived from the synthesis process fall under three main axes: ‘Seeing others, seeing oneself’, ‘Understanding others, understanding oneself’, and ‘Treating others, treating oneself’. It emerges that participants in all three groups had equal difficulty in perceiving and labelling obesity, mainly because of their lack of any real common ground. The insufficiency of shared representations destabilizes the therapeutic relationship and its construction: an important issue in the doctor–child–parent relationship in this context is the need to exchange their viewpoints of obesity. Health workers may also expand their understanding of obesity by incorporating the personal experiences of obese children and their parents in order to match treatment plans to their needs and expectations.

Metasynthesis of Youth Suicidal Behaviours: Perspectives of Youth, Parents, and Health Care Professionals

Background Youth suicide is a major public health issue throughout the world. Numerous theoretical models have been proposed to improve our understanding of suicidal behaviours, but medical science has struggled to integrate all the complex aspects of this question. The aim of this review is to synthesise the views of suicidal adolescents and young adults, their parents, and their healthcare professionals on the topics of suicidal behaviour and management of those who have attempted suicide, in order to propose new pathways of care, closer to the issues and expectations of each group. Methods and Findings This systematic review of qualitative studies — Medline, PsycInfo, Embase, CINAHL, and SSCI from 1990 to 2014 — concerning suicide attempts by young people used thematic synthesis to develop categories inductively from the themes identified in the studies. The synthesis included 44 studies from 16 countries: 31 interviewed the youth, 7 their parents, and 6 the healthcare professionals. The results are organised around three superordinate themes: the individual experience, that is, the individual burden and suffering related to suicide attempts in all three groups; the relational experience, which describes the importance of relationships with others at all stages of the process of suicidal behaviour; and the social and cultural experience, or how the group and society accept or reject young people in distress and their families and how that affects the suicidal process and its management. Conclusion The violence of the message of a suicidal act and the fears associated with death lead to incomprehension and interfere with the capacity for empathy of both family members and professionals. The issue in treatment is to be able to witness this violence so that the patient feels understood and heard, and thus to limit recurrences.

Surgeons’ Emotional Experience of Their Everyday Practice - A Qualitative Study

Background Physicians’ emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice. Methods and Findings 27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women) participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon). 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons’ emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital)—surgeons’ own emotions, their perception of patients’ emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues), the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon), as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability). Conclusions Emotions are ubiquitous in surgeons’ experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done) is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

Background Anorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment. Methods We performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program. Results We included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool—a relationship, specifically the core concept of the therapeutic relationship. Conclusion Our results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.

Qualitative approach to patient-reported outcomes in oncology: protocol of a French study

Introduction The past decade has been characterised by movement from a doctor-centred to a patient-centred approach to treatment outcomes, in which doctors try to see the illness through their patients’ eyes. Patients, family members and doctors are the three participants in cancer care, but their perspectives about what have been helpful during cancer treatment have never simultaneously and explicitly compared in the same qualitative study. The aim of this study project is to explore patients’ perspectives about the care they receive, as well as families’ and doctors’ perspectives about what have been helpful for the patient. These three points of view will be compared and contrasted in order to analyse the convergences and divergences in these perspectives. Methods and analysis This is a national multicentre qualitative study. Participants will be constituted by three different subsamples: (1) patients with cancer (skin, breast, urological and lung cancers), (2) their relatives, and (3) their referring physicians. Recruitment will follow the purposive sample technique, and the final sample size will be determined by data saturation. Data will be collected through open-ended semistructured interviews and independently analysed with NVivo V.10 software by three researchers according to the principles of Interpretative Phenomenological Analysis. Ethics and dissemination The research protocol received approval from the University Paris Descartes review board (IRB number: 20140600001072), and participants will provide written consent. To the best of our knowledge, this is the first study to focus on the simultaneous exploration of the separate points of view of patients, families and doctors about the care received during the cancer care journey. We expect that our findings will help to improve communication and relationships between doctors, patients and families. Comparison of these three points of view will provide information about the convergences and divergences of these perspectives and how to address the needs of all three groups.

Adaptive Behavior of Sheltered Homeless Children in the French ENFAMS Survey

Objectives To describe the adaptive behaviors in a large sample of homeless children and identify factors associated with developmental delay. Methods Data were from a cross-sectional survey of 557 children younger than 6 years randomly sampled among homeless sheltered families in the Paris region, France (January-May 2013). An interviewer and a psychologist conducted face-to-face interviews to collect information on sociodemographic and health characteristics. We assessed adaptive behaviors using the Vineland Adaptive Behavior Scales, second edition (VABS-II). Results The mean VABS-II composite score (SD) was 75.4 (12.0), and most participating children (80.9%) were considered developmentally delayed. Characteristics negatively associated with children’s developmental score were age, birth in a country other than France, low birth weight, and past-year hospitalization. Conclusions There is a high prevalence of developmental delays among children growing up homeless. Public Health Implications Long-term integrated programs improving parenting and children’s opportunities for stimulation and socialization should be developed in daycare centers, schools, shelters, and medical practices to minimize negative effects of early living conditions on children’s development.

L’efficacité des soins perçue chez des adolescents présentant un refus scolaire anxieux

School refusal is a complex disorder which is sometimes difficult to treat and which has potentially significant consequences on the childs schooling and mental health. A qualitative study was carried out in 2014-2015 on the feelings of adolescents and their parents with regard to the efficacy of care. The results show that, while adolescents and parents do not share the same representation of the care objectives, they agree on the therapeutic levers identified as been effective: time and relationships.

The real-life effectiveness of psychosocial therapies on social autonomy in schizophrenia patients: Results from a nationwide cohort study in France

The objectives of the present study were to describe the prescribing patterns for psychosocial therapies in routine clinical practice and to assess the impact of psychoeducation on symptoms and social autonomy of patients with schizophrenia. We used data from the nationwide French ESPASS observational cohort study including 5967 patients with schizophrenia, which provided data on exposure to psychosocial therapies from 4961 (83%) participants. Patients who initiated psychosocial therapy within the first 3 months of study onset (n=143) were compared to patients not subject to psychosocial therapy throughout follow up (n=4268), using parametric tests. Symptom severity and social autonomy at 6 months from baseline were compared between patients undergoing psychoeducation (n=117) and patients not subject to psychosocial therapy, matched (1:1) on propensity scores. Patients who initiated psychosocial therapy were significantly younger, more severely ill and used less often antipsychotic drugs than patients in the reference group. At 6 months, patients who initiated psychoeducation and their matched referents did not differ significantly in terms of symptom severity, but their level of improvement in social autonomy was significantly greater (p=0.005). In routine clinical practice, psychoeducation in addition to antipsychotic drugs provides some benefit among schizophrenia patients, particularly in terms of social autonomy.

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

Purpose Patients, family members, and physicians participate in cancer care, but their perspectives about what is helpful during cancer treatment have rarely been compared. The aim of this study was to compare these three perspectives. Methods Multicenter qualitative study (with previously published protocol) based on 90 semi-structured interviews. Participants (purposively selected until data saturation) came from three different subsamples: (i) patients with cancer (n=30), (ii) their relatives (n=30), and (iii) their referring physicians (n=10, interviewed more than once). Results Our analysis found 3 main axes (perceived positive effects of cancer treatment, perceived negative effects of cancer treatment, doctor-physician relationship), each composed of 2 main themes. The findings showed that patients, families, and physicians shared the long-term objective of increasing survival (while reducing side effects). However, patients and relatives also pointed out the importance of living with cancer each day and thus of factors helping them to live as well as possible in daily life. The physicians difficulty in coping with patients suffering may limit their access to elements that can improve patients capacity to live as well as possible. Conclusions During cancer treatment (and not only at the end of life), attention should be given to enhancing the capacity of patients to live as well as possible (not only as long as possible) to meet the goals of patient-centered care and satisfy this important need of patients and families.

The Adaptative Behavior of Homeless Children in Paris Region, France, in 2013: Results of the Enfams Survey

Introduction Previous studies have revealed developmental problems in children of homeless families. The number of homeless families has increased by 5 in 10 years. Objectives To estimate the adaptative behavior of homeless children aged 0-5 years old in Paris region and to analyze the impact of homelessness on childrens development. Methods In 2013, a random survey was conducted among homeless families housed in emergency centres for asylum-seekers, emergency housing centres, social reinsertion centres and social hotels in the Paris region. A bilingual interviewer and a psychologist conducted the survey in 17 languages. A nurse took the anthropometric measures and collected health data from child health and immunization cards. For children aged 0-5 years old, mothers (or fathers when mothers were absent) were asked about the childrens adaptative behavior using the Vineland Adaptative Behavior Scales, Second Edition (Vineland-II). Results The built random sample consisted in 801 families including 557 in which the selected child was 0-5 years old, which represents 11448 children (95% CI = 10354 – 12541). The estimated mean of the composite score of Vineland-II is 76.98 (95% CI = 74.07 – 76.70) (SD = 12.03) which mean that 9259 children aged 0-5 years old (95% CI = 7684 – 10833) have a developmental delay. The most associated factor with the decrease of the Vineland-II score is the age (p -16 ) in the linear multivariate model. Conclusion ENFAMS survey reveals large developmental problems among homeless children in Paris region . More children are exposed to homelessness more the disorders are important.