Intérêts et limites de l’utilisation d’une méthodologie mixte : à propos d’une recherche en psychologie de la santé

Recently, the health social sciences, like some fields of psychology, have progressively adopted qualitative methods, particularly in English-speaking countries. When they come in addition to quantitative methods, they are called “mixed methodologies”. Among other reasons, these approaches suffer nonetheless of a lack of acknowledgement because of a still topical debate opposing the positivist-objectivist and the constructivist paradigms. Another reason to this lack of acknowledgement is due to the fact that several authors explain the use of a mixed methodology according to pragmatic arguments. The authors of this paper briefly present these debates and their pertinence in health psychology research and try to overcome them by showing that it is possible to make mixed methodologies fall within a constructivist approach. Their proposal is exemplified through a research work about organ donation decision led in Switzerland. Actually, this research embed multiple and complex factors that offer an appropriated ground for the use of a mixed methodology, qualitative and quantitative.     

Le médecin expert confronté aux confidences de la personne expertisée

During an expertise, if the expert “discovers” or is entrusted with information concerning an offence, should he report it to the authorities? Could the expert be sanctioned in the absence of denunciation of a tort or criminal act? The answer will be nuanced on a case-by-case basis. The expert confronted with the revelation of a crime or misdemeanor must decide in good conscience what he reveals in his report, or even report it to the prosecution.     

L’évaluation psychologique en situation transculturelle : une révision de la littérature

Human migration provokes transcultural clinical encounters that may challenge the way clinicians see themselves and how they proceed in their usual practices. In the field of psychology, psychological assessment is an important tool to better understand the patients’ needs and to design psychological interventions. Considering that most diagnostic tests and manuals have been developed in the Western context, the application of these tools with other populations remains controversial. The present literature review aims to describe the state of current knowledge on psychological transcultural assessment. Specifically, we will address: (1) the use of psychological tests in transcultural contexts, (2) the development of the Cultural Formulation Interview (CFI, DSM-5) and (3) the clinical interview: language, therapeutic relationship and participation of interpreters. In the first section, we discuss the international norms for scales and tests translation and adaptation, as well as the cultural issues that may bias the test’ application and interpretation. In the second section, we describe the creation of the CFI, and its use in recent studies. The CFI is composed by four clusters: (1) cultural definition of a problem, (2) cultural perceptions of cause, context, and support, (3) cultural factors affecting self-coping and past help seeking, and (4) cultural factors affecting current help seeking. The revised studies indicated that the CFI has a positive impact on the cultural sensibilization of mental health professionals, also improving the relationship between the patients and professionals. The cultural formulation may also prevent misdiagnosis. Beyond the use of tests and structured interviews, the clinician also faces other challenges during a transcultural assessment. We discuss in the third section the transferential and countertransferential relationship in a transcultural situation. Several elements may influence this relationship, at an individual, institutional and societal level. The evaluation of these elements may allow the clinician to better understand results of the psychological assessment. We also describe the current guidelines for the use of interpreters during health consultations in France. In conclusion, several advances have been made in the field of transcultural psychological assessment, among other things the development of guides for good translation and cultural adaptation of tools, as well as the integration of cultural issues into the DSM. However, research and changes in clinical practice are still needed, as the evaluation of cultural biases in cognitive tests and the expansion of cultural competences training among clinicians.     

Le contrôle judiciaire des hospitalisations sans consentement et épidémie de Covid : la fin d’une procédure en trompe l’oeil ?

Since 2011, the judge of freedoms and detention (JLD) is competent to control care measures without consent. This control, although essential in order to avoid abusive deprivation of liberty, is incomplete. Faced with the health crisis, the shortcomings of this control are more noticeable in a context of violation of the rights of people hospitalized without detriment.     

Intelligence artificielle et médecine : quelles règles éthiques et juridiques pour une IA responsable ?

Combining AI and medicine means talking about the medicine of the future, but even more about improving the quality of care. Its fields of application: predictive medicine, precision medicine, decision support, prevention, computer-assisted surgery, robotic support for the elderly, etc. are all related concerns: the possibility of maintaining human contact with the patient, the explicability of the algorithm - the collection of health data - and the improvement of the health care system. AI applications are already improving the quality of care. Its deployment at the heart of the medicine of the future is in constant evolution. To be acceptable and legitimate, the decisions of any algorithm must be understood and therefore explained. Only a good understanding of the diagnoses and therapies proposed by the AI application will allow doctors to discuss with their patients and to explain the possible alternatives. In the opposite case, the doctor risks to dismiss the use of algorithms because he will not be able to justify the decisions which will pose problems in terms of liability research in particular.     

Comment réagir face à une situation de harcèlement à l’école ? Une synthèse de la littérature

Bullying affects a significant number of students and can have serious negative consequences in terms of physical and mental health. It is, therefore, necessary for education staff to know how to respond effectively to stop it. However, this does not always seem to be the case at present. The purpose of this article is to describe six commonly used reactive approach (direct sanctions, restorative practices, reinforcement of the victim, mediation, the support group method, and the shared concerns method), as well as to synthesize the scientific knowledge regarding the effectiveness of each of these approaches. It emerges that no approach appears to be particularly effective in all cases and that it is therefore necessary for professionals to be trained to be able to choose the appropriate approach according to the situation.     

Analyse narrative du récit de la maladie : intérêts méthodologiques et réflexion sur la prise en charge thérapeutique des patients en oncologie

The narrative approach is an emerging disciplinary field, which considers the narrative to be a therapeutic, a methodological and an object of study in its own right. The objective of our contribution is twofold: (a) to present the context of emergence of the narrative approach and the notion of narrative in the field of psychology, and (b) to question the theoretical-methodological relevance of this approach in order to explore the expression of social knowledge with regard to the lived experience of cancer. After presenting some methods of collection and analysis of the narrative, we will suggest an application of this approach by analyzing narrative interviews of people with cancer. We will build on the results obtained to develop a reflection on the applied perspectives of the narrative approach, particularly with regard to the psychological therapy of cancer patients.     

Le droit à la protection de la santé dans l’alinéa 11 du Préambule de 1946 : les impacts en termes de solidarité

The right to health protection is recognized as a constitutional objective. This includes guaranteeing an equal access to health care without any discrimination. The implementation of this right is a difficult task due to geographical and socioeconomic inequalities. In many situations, the public health sector is experiencing financial crises. The problems concerning health access seem to be mounting and could jeopardise the principle of solidarity which is the foundation of the health system.     

Spécificité des stratégies de coping des patients en rémission de la maladie de Crohn : une étude qualitative

IntroductionCrohn's disease (CD), a chronic inflammatory bowel disease, has strong psychological and social repercussions related to the specificity of the symptomatology. To better understand how patients cope with the disease, coping strategies have been studied but without taking into account the specificity of the CD experience.ObjectiveOur objective is to identify the perceived coping strategies used by patients in relation to their illness experience.MethodUsing a qualitative approach, semi-structured interviews and thematic content analysis with 33 CD patients in remission were conducted.ResultsOur results highlight that some of the coping strategies used are not taken into account by the coping scales frequently used in the literature. Indeed, the illness experience appears to be fundamental in the establishment of new strategies based on the experiential knowledge patients use to reduce the stress induced by a potential relapse. Moreover, coping strategies based on positive emotions are also implemented, and they enable patients to make sense of the disease.ConclusionThe coping strategies, i.e., “experiential knowledge” and “positive emotions”, may shed more light on the complexity of the illness experience of CD patients and allow us to make recommendations concerning the psychological support of patients.     

De la prévention à la promotion de la santé : intérêt de l’approche communautaire

Psychological research and practice shows increasing interest for prevention and health promotion in France. Current-scientific literature recommends the implementation of targeted actions, directed towards populations expressing specific needs. The community-based approach offers a framework corresponding to the flexibility, which is necessary to the effectiveness of this type of intervention. It includes the mobilization and the participation of the citizens in the development of each unique project, in the renewal of the project according to the needs, in finding possible solutions, and in assessing the actions carried out. This article aims at presenting the importance of a community-based approach in the field of health promotion; a field which would benefit from being better known in France in order to develop intervention programs adapted to each population.     

Le vaccin,un médicament devenu l’arme absolue promise contre la COVID-19 : une réglementation adaptée ?

As the first vaccines against COVID-19 arrive on the market, the question of the safety of these products arises in the public debate. The major concern is about the possible occurrence of adverse effects, particularly in the context of the use of novel pharmaceutical technologies such as mRNA. It is important to remind both patients and professionals that a vaccine is not only a medicinal product in its own right, but also a special medicinal product: biological and immunological. As a result, its supervision is draconian, and despite the urgency, no requirements have been lowered. The speed of marketing is the result both of adapted clinical trials and optimized evaluation procedures.     

La responsabilité médicale des accidents de la circoncision en Tunisie : à propos de trois affaires judiciaires

Circumcision is the most frequently performed surgical procedure worldwide, mainly as part of religious rituals. It may lead to serious complications. Although there is no specific law relative to circumcision accidents in Tunisia, the occurrence of complications of this act is likely to engage the penal, civil and disciplinary liability of the doctor. Prevention involves respecting the principles of the Medical Deontology Code, raising awareness about the need to practice circumcision in a medical environment and the promulgation of specific legislation regulating this act. The new Tunisian law on medical liability seems to offer a solution to solve the legal complaints concerning circumcision accidents by providing more opportunities for amicable settlement and at the same time guaranteeing adequate and rapid compensation of the prejudice. In this article, we discuss the medical liability of circumcision accidents through three medicolegal cases carried out at the Department of Legal Medicine of Ibn El Jazzar University Hospital, Kairouan, Tunisia.     

2004–2009 : révision de la loi de bioéthique en France,quels enjeux,quels débats ? Assistance médicale à la procréation,gestation pour autrui,transplantation

The bioethics law, adopted for the first time in 1994 and revised in 2004, is under revision again. This process has raised numerous debates at various institutional, professional and social levels. The government also organised a unique type of citizens’ consultation: the General Estates in Bioethics (GEB). Several panels of citizens had the opportunity to express their informed opinion on a selected set of topics concerning the law revision, after having received a special training by an expert committee. We have analysed the contributions of six public bodies – the Parliament Office for Scientific and Technological Choices Evaluation (OPECST), the National Consultative Ethics Committee, (CCNE), the State Council, (CE), the Biomedical Agency, (ABM), the Senate and the Parliamentary Information Mission for this bioethics law revision – as well as the final GEB's report. In this article, we present and compare their proposals on three themes: Medically assisted procreation (MAP), surrogacy and transplantation. Whereas a consensus emerged from the debates on certain issues – apart from the Senate, all institutions seem to be in favour of maintaining the current banning of surrogacy – other points are still under debate – how to open the access to MAP technologies, under what conditions should we grant access to selected data concerning gamete donors, how is death defined in the difficult conditions of a potential non heart beating donor, should the presumed consent regime for post mortem donation be revised, and if so how, – The parliament should discuss the law during 2010's first semester, and will have the difficult responsibility to take measures on issues raising medical, scientific, social, philosophical and moral questions.     

L’anxiété liée à la COVID-19 : une analyse de ses effets en milieu de travail

The anxiety engendered by the sanitary crisis of the COVID-19 is a novel emotional phenomenon. Due to its recency and novelty, this form of anxiety and its effects are largely unknown. To explore this issue, we conducted a study among 650 civil agents of the Quebec government during the first wave of the pandemic that examined the effects of COVID-19-triggered anxiety on four indicators of work adjustment: job engagement, organizational commitment, psychological empowerment, and ego depletion. While controlling for the effect of relevant contextual factors, our analyses indicate that COVID-19-triggered anxiety is positively related to organizational commitment and ego depletion and negatively related to psychological empowerment. In contrast, COVID-19-triggered anxiety was not significantly related to job engagement.