Factorial validation of a French short-form of the Working Alliance Inventory

Evaluation of the therapeutic alliance is crucial for understanding the therapeutic process and its results. However, few instruments are available in French. This article aims to validate a French short form of the Working Alliance Inventory (WAI). Unlike other questionnaires, the WAI is the most widely used in psychotherapy research as well as in social psychiatry. Confirmatory factor analyses were carried out on a sample of 150 client-case manager dyads in order to determine the validity of this short-form instrument. The results of these confirmatory factor analyses allowed us to answer different authors' questions (Horvath and Greenberg, 1989; Tracey and Kokotovic, 1989) regarding the factorial structure of the WAI. The results also indicated a unidimensional solution as being the most valid for the two samples. We suggest that, in future studies, only one score be considered for the evaluation of the WAI. We also suggest modifying two statements in the English and French versions in order to render a faithful comparison between the therapist and client versions.     

Effects of fatiguing isometric and isokinetic ankle exercises on postural control while standing on firm and compliant surfaces

ABSTRACT: BACKGROUND: Fatiguing exercises used across studies to induce alterations in postural control are diverse and may explain the different findings reported. This study aimed to compare the effects of two types of fatiguing plantarflexion exercises on postural control on a firm and a compliant surface. Ten healthy young men (29 +/- 4 years) were asked to stand as steadily as possible for 30 s, blindfolded with feet together, on a firm and a compliant surface before and immediately after an isometric and an isokinetic fatiguing exercise. RESULTS: Maximal force reduction due to fatigue was found significant but similar between exercises. No significant difference was found between the fatiguing exercises on all Center of Pressure (CoP) parameters. Both fatiguing exercises induced increases in CoP excursion area, CoP variability and CoP velocity in both planes (antero-posterior, mediolateral) on the compliant surface. On the firm surface, both fatiguing exercises only induced increases in CoP variability and CoP velocity in the fatigued plane (antero-posterior). CONCLUSIONS: Isometric and isokinetic fatiguing exercises, when producing a similar level of force reduction, induce similar decreases in postural control. The effects of fatigue on postural control in healthy young men are more pronounced when standing on a compliant surface, i.e. when proprioceptive information at the ankle is altered.     

Associations among psychosis,mood, anxiety,and posttraumatic stress symptoms: A network analysis

The associations among psychotic experiences (i.e., hallucinations and delusions), trauma exposure, and posttraumatic stress symptoms are complex and multidirectional. Using network analysis to understand how psychotic experiences and symptoms of posttraumatic stress disorder (PTSD) relate to one another may identify new interventional targets to treat comorbidity and its underlying pathological processes. This study aimed to use network analysis to examine the associations among psychotic experiences; negative symptoms of psychosis; and symptoms of PTSD, anxiety, and depression. In this population-based cohort study, 4,472 participants (36.7% male) were assessed for psychotic experiences, negative symptoms of psychosis, PTSD, anxiety, and depression at age 23 (M = 23.86 years, SD = 0.520) or 24 years (M = 24.03, SD = 0.848). Associations among symptoms were assessed via network analysis. Exploratory graph analysis identified three clusters of densely connected symptoms within the overall network: psychotic experiences; PTSD symptoms; and depressive and anxiety symptoms and negative symptoms of psychosis. Psychotic experiences had the strongest associations with other symptoms in the network, and symptoms of anxiety played a key role in bridging psychotic experiences, symptoms of PTSD, and depressive symptoms. Consistent with the stress reactivity and affective models for psychotic experiences, the results suggest that symptoms of anxiety and emotional distress (e.g., hyperarousal, panic) may have a key role in the development and maintenance of psychotic experiences and symptoms of PTSD. Targeting these symptoms may ameliorate symptom burden transdiagnostically.     

Human sexuality in long-term care.

Sexual expression is a basic human need, a normal part of life that is integral to who we are as human beings. As we age, we continue to be challenged to grow in every area of our lives, including our sexuality. In institutionalized settings, however, human sexuality can be an area in which growth is not fostered, but restrained. Challenges leading to restraint include limited privacy, concerns about the consent of cognitively impaired sexual partners and conflicts with the personal values of institutional staff. Challenges exist in many areas, including inappropriate sexual expression toward a staff member or other residents.     

Editorial Commentary: Rotator Cuff Repair: How Much Tension Can a Tendon Stand? If It Hurts My Finger,It's Probably Hurting the Tendon

Rotator cuff repairs may fail anatomically because of greater-than-needed tension to approximate the tendon to the greater tuberosity during repair. Surgeons should make every effort to minimize the tension when reapproximating a torn rotator cuff.     

In vivo induction of terminal differentiation of malignant myelopoietic progenitor cells by CSF-inducing biological response modifiers

We have investigated the mechanisms by which colony-stimulating factor (CSF)-inducing biological response modifiers (BRM) may have beneficial effects on tumor-bearing hosts undergoing anti-tumor therapy. First, we have documented that treatment of mice with the chemically defined BRM maleic anhydride divinyl ether copolymer (MVE-2), which induces CSF secretion by macrophages (M phi) and bone marrow cells (BMC), significantly increased growth and differentiation of normal myelopoietic cells and counteracted the myelosuppressive effects of cyclophosphamide (CY). Second, we established that MVE-2 may exert CSF- mediated antitumor effects on certain leukemic tumor cells. Serum from mice pretreated in vivo with MVE-2, which contained CSF, induced terminal differentiation of cloned tumor cells from the CSF responsive WEHI-3B D+ subline in vitro, but not from the WEHI-3B D- subline, which is unresponsive to CSF. In vivo experiments showed that treatment of mice bearing the WEHI-3B D+ tumor first with CY and three days later with the CSF inducer MVE-2, significantly increased their survival time and rendered 20% to 50% of the tumor-bearing mice disease free. No such effects were obtained in mice bearing the WEHI-3B D- tumor. Thus, the induction of CSF or other differentiation factors by some BRMs may result in therapeutic effects against certain leukemias based on at least two distinct mechanisms: In addition to their restorative effects on normal bone marrow functions, CSF-inducing BRMs may also prevent further leukemogenesis by induction of terminal differentiation of leukemic cells.     

Ascites and right pleural effusion: demonstration of a peritoneo-pleural communication

A 54-yr-old female with known liver cirrhosis presented with a right transudative pleural effusion and ascites. To find the source of pleural fluid, [99mTc]sulfur colloid was injected intraperitoneally and a serial imaging study revealed its passage to the right pleural space on 2-hr and 24-hr images. Mechanisms proposed in the formation of pleural effusion in liver cirrhosis are (a) lymphatic drainage and (b) diaphragmatic defect. Radioisotope migration speed may be a clue for differentiating these two mechanisms, being more rapid in the presence of a diaphragmatic defect.