Philippe Delmas

Factors Related to Quality of Life in Treatment-Adherent, Successfully Treated HIV Patients in France

The objectives of this study were to document the psychosocial characteristics of treatment-adherent, successfully treated HIV patients and to examine the relationships between psychosocial variables. The sample was composed of 133 persons living with HIV, with optimal adherence to antiretroviral therapy and with no detectable viral load. The psychosocial profile of the cohort showed that participants had moderate levels of stress, used a wide range of strategies to adjust to their situation and perceived their social support to be good. As well, they evaluated their quality of life (Medical Outcome Study-HIV) as moderate. Quality of life in psychological domain is largely explained by perceived stress (53%). Quality of life in physical domain is largely dependent on discomfort reported arising from HIV-associated symptoms and treatment (39%). Findings suggest that treatment-adherent, successfully treated patients with HIV are still a fragile population, and that it is essential to provide interventions that reinforce their ways of coping.

Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV

ABSTRACT This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13–20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other’s love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.

L’hypothermie accidentelle, plus qu’un signe clinique, une alerte sociale

Accidental hypothermia, even slight, affects the physiological functioning of the body. It requires all the attention of the caregivers, both in terms of prevention among vulnerable people as well as its treatment. Two types of rewarming therapy, one external and passive, the other internal and active, can be envisaged depending on the seriousness of the hypothermia to be treated.

Évidence d’un manque de concordance entre les patients hémodialysés et les infirmières sur la présence et la sévérité des symptômes

Les patients hemodialyses representent une population fragile experimentant de nombreux symptomes (par exemple douleurs, fatigue) qui impactent leur qualite de vie. La presence et la severite de ces symptomes sont sous-estimees de facon importante par les professionnels de la sante. Le but de cette etude est de decrire et comparer les symptomes percus par les patients hemodialyses versus ceux detectes par les infirmieres et de discuter les possibles causes de disparite observees. Au total, 123 patients et 70 infirmieres œuvrant dans six centres d’hemodialyse ont ete inclus dans cette etude. Les resultats montrent que les infirmieres participantes ont detecte moins de 50 % des symptomes percus par les patients. La concordance entre les reponses des patients hemodialyses et celles des infirmieres sur la presence et la severite de tous les symptomes est tres faible (Kappa<0.4). Par consequent, l’amelioration des connaissances et competences des infirmieres d’hemodialyse dans la detection des symptomes des patients hemodialyses qu’elles soignent apparait etre un des axes centraux pour intervenir de maniere efficiente et ameliorer la qualite de soins.Hemodialysis patients constitute a vulnerable population whose quality of life is affected by the many symptoms (e.g., pain, fatigue) they experience. The presence and severity of these symptoms are significantly under-assessed by health professionals. The purpose of this study was to describe and compare the symptoms perceived by hemodialysis patients versus those detected by nurses. A total of 123 patients and 70 nurses working in six hemodialysis centers were included in the study. The results show that participating nurses detected less than 50% of the symptoms perceived by patients. Agreement between hemodialysis patients and nurses regarding symptom presence and severity was slight to fair at best (kappa < 0.47). This suggests that improving the knowledge and skills of hemodialysis nurses for detecting the symptoms of the patients in their care could go a long way toward intervening more efficiently and improving the quality of the care they offer.