Accounting for residential and non-residential environments to measure contextual effects on health behavior : the case of recreational walking behavior

Thèse réalisée en cotutelle entre l'Université de Montréal et l'Université Pierre et Marie Curie, Paris 06, Sorbonne Universités.

Clean Cookstoves and Health in Samlout, Cambodia

This paper discusses results from a study of the use of cleaner cooking solutions and general health status of people in rural areas from the Battambang province of Cambodia. Data collection included 372 demographic, health and socio-economic surveys with households living in 6 villages in the Samlout district, general health examinations, and measurements of stove use and household concentrations of PM 2.5. The data reveal that health in this population is a major concern, with a very high prevalence of reported abdominal pain, nausea, chronic cough, chest pains, and fever during examinations.  At the household level, we find that clean stove ownership is significantly correlated with the educational status of household head and socio-economic status of a household. Respondents from households with clean stoves appear less likely (though not statistically significantly so) to report household individuals having health problems such as occasional cough, high blood pressure and tuberculosis. Concentrations of PM2.5 are positively correlated with prevalence of occasional cough, high blood pressure and tuberculosis. Based on these results, we advise field testing and evaluation of targeted health interventions in these villages to address the numerous concerns of the local population, including exploring the potential role of clean stoves.

The impact of user charges on patient choice of healthcare services in Ireland

This research assesses the impact of user charges in the context of consumer choice to ascertain how user charges in healthcare impact on patient behaviour in Ireland. Quantitative data is collected from a subset of the population in walk-in Urgent Care Clinics and General Practitioner surgeries to assess their responses to user charges and whether user charges are a viable source of part-funding healthcare in Ireland. Examining the economic theories of Becker (1965) and Grossman (1972), the research has assessed the impact of user charges on patient choice in terms of affordability and accessibility in healthcare. The research examined a number of private, public and part-publicly funded healthcare services in Ireland for which varying levels of user charges exist depending on patients’ healthcare cover. Firstly, the study identifies the factors affecting patient choice of privately funded walk-in Urgent Care Clinics in Ireland given user charges. Secondly, the study assesses patient response to user charges for a mainly public or part-publicly provided service; prescription drugs. Finally, the study examines patients’ attitudes towards the potential application of user charges for both public and private healthcare services when patient choice is part of a time-money trade-off, convenience choice or preference choice. These services are valued in the context of user charges becoming more prevalent in healthcare systems over time. The results indicate that the impact of user charges on healthcare services vary according to socio-economic status. The study shows that user charges can disproportionately affect lower income groups and consequently lead to affordability and accessibility issues. However, when valuing the potential application of user charges for three healthcare services (MRI scans, blood tests and a branded over a generic prescription drug), this research indicates that lower income individuals are willing to pay for healthcare services, albeit at a lower user charge than higher income earners. Consequently, this study suggests that user charges may be a feasible source of part-financing Irish healthcare, once the user charge is determined from the patients’ perspective, taking into account their ability to pay.

In two minds about screening: an investigation of cervical cancer prevention among Irish women

Cervical cancer is the second most common female cancer worldwide. Cervical screening programmes can reduce the incidence of cervical cancer by up to 80 percent if the invited women participate. Previous Irish research has associated screening attendance with subjective norms, anticipated regret, higher socio-economic status and education. Greater perceived screening barriers and lacking knowledge were associated with avoidance. These findings support a variety of expectancy-value theories of behaviour. They also suggest that expectancy-value theories could benefit from the inclusion of affective predictors of behaviour, like anticipated regret. In 2008 the Republic of Ireland introduced the National Cervical Screening Programme (NCSP). This research seeks to identify the predictors of participation in the NCSP. A systematic review of reviews showed that predictors of screening participation clustered into environmental and psychological influences. There is a gap in the evidence synthesis of associations with personal characteristics and health beliefs. Thematic analysis of focus group interviews confirmed the validity of many screening predictors identified by the systematic review and expectancy-value theories. A survey of these predictors suggested that reduced screening barriers might encourage first-time participation, while regular attendance requires greater endorsement of screening benefits and stronger subjective norm and intention. Positive attitude, rather than knowledge, appeared to be crucial for strong intention, so the final study piloted an experiment comparing the utility of positive attitude in strengthening intention to the utility of information provision. Despite lacking significant differences between conditions, content analysis of participant comments suggested that a full trial would be worthwhile, given purposive sampling and improved sample retention. These findings agree with previous Irish research on the importance of screening intention, although its association with attitude appeared to be stronger in the present research. The findings further indicate that future screening promotion should consider interventions based on patients’ experiences of screening.

Extending the Theory of Planned Behavior in the Exercise Domain: A Study of Community College Students in an Urban Multicultural Setting

The purpose of this study was to assess the intention to exercise among ethnically and racially diverse community college students using the Theory of Planned Behavior (TPB). In addition to identifying the variables associated with motivation or intention of college students to engage in physical activity, this study tested the model of the Theory of Planned Behavior, asking: Does the TPB model explain intention to exercise among a racially/ethnically diverse group of college students? The relevant variables were the TPB constructs (behavioral beliefs, normative beliefs, and control beliefs), which combined to form a measure of intention to exercise. Structural Equation Modeling was used to test the predictive power of the TPB constructs for predicting intention to exercise. Following procedures described by Ajzen (2002), the researcher developed a questionnaire encompassing the external variables of student demographics (age, gender, work status, student status, socio-economic status, access to exercise facilities, and past behavior), major constructs of the TPB, and two questions from the Godin Leisure Time Questionnaire (GLTQ; Godin & Shephard, 1985). Participants were students (N = 255) who enrolled in an on-campus wellness course at an urban community college. The demographic profile of the sample revealed a racially/ethnically diverse study population. The original model that was used to reflect the TPB as developed by Ajzen was not supported by the data analyzed using SEM; however, a revised model that the researcher thought was theoretically a more accurate reflection of the causal relations between the TPB constructs was supported. The GLTQ questions were problematic for some students; those data could not be used in the modeling efforts. The GLTQ measure, however, revealed a significant correlation with intention to exercise (r = .27, p = .001). Post-hoc comparisons revealed significant differences in normative beliefs and attitude toward exercising behavior between Black students and Hispanic students. Compared to Black students, Hispanic students were more likely to (a) perceive “friends” as approving of them being physically active and (b) rate being physically active for 30 minutes per day as “beneficial”. No statistically significant difference was found among groups on overall intention to exercise.

Alcoholic Beverage Preference and Dietary Habits in Elderly across Europe: Analyses within the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) Project

INTRODUCTION: The differential associations of beer, wine, and spirit consumption on cardiovascular risk found in observational studies may be confounded by diet. We described and compared dietary intake and diet quality according to alcoholic beverage preference in European elderly.

METHODS: From the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES), seven European cohorts were included, i.e. four sub-cohorts from EPIC-Elderly, the SENECA Study, the Zutphen Elderly Study, and the Rotterdam Study. Harmonized data of 29,423 elderly participants from 14 European countries were analyzed. Baseline data on consumption of beer, wine, and spirits, and dietary intake were collected with questionnaires. Diet quality was assessed using the Healthy Diet Indicator (HDI). Intakes and scores across categories of alcoholic beverage preference (beer, wine, spirit, no preference, non-consumers) were adjusted for age, sex, socio-economic status, self-reported prevalent diseases, and lifestyle factors. Cohort-specific mean intakes and scores were calculated as well as weighted means combining all cohorts.

RESULTS: In 5 of 7 cohorts, persons with a wine preference formed the largest group. After multivariate adjustment, persons with a wine preference tended to have a higher HDI score and intake of healthy foods in most cohorts, but differences were small. The weighted estimates of all cohorts combined revealed that non-consumers had the highest fruit and vegetable intake, followed by wine consumers. Non-consumers and persons with no specific preference had a higher HDI score, spirit consumers the lowest. However, overall diet quality as measured by HDI did not differ greatly across alcoholic beverage preference categories.

DISCUSSION: This study using harmonized data from ~30,000 elderly from 14 European countries showed that, after multivariate adjustment, dietary habits and diet quality did not differ greatly according to alcoholic beverage preference.

Influence of Heterogamy by Religion on Risk of Marital Dissolution: A Cohort Study of 20,000 Couples

Heterogamous marriages, in which partners have dissimilar attributes (e.g. by socio-economic status or ethnicity), are often at elevated risk of dissolution. We investigated the influences of heterogamy by religion and area of residence on risk of marital dissolution in Northern Ireland, a country with a history of conflict and residential segregation along Catholic–Protestant lines. We expected Catholic–Protestant marriages to have elevated risks of dissolution, especially in areas with high concentrations of a single religious group where opposition to intermarriage was expected to be high. We estimated risks of marital dissolution from 2001 to 2011 for 19,791 couples drawn from the Northern Ireland Longitudinal Study (a record linkage study), adjusting for a range of compositional and contextual factors using multilevel logistic regression. Dissolution risk decreased with increasing age and higher socio-economic status. Catholic–Protestant marriages were rare (5.9 % of the sample) and were at increased risk of dissolution relative to homogamous marriages. We found no association between local population composition and dissolution risk for Catholic–Protestant couples, indicating that partner and household characteristics may have a greater influence on dissolution risk than the wider community.

Teenage motherhood: where you live is also important. A prospective cohort study of 14,000 women

The United Kingdom has among the highest rates of teenage motherhood (TM) in Western Europe. The relationship to individual social and material disadvantage is well established but the influence of area of residence is unclear. We tested for additional TM risks in deprived areas or in cities. The Northern Ireland Longitudinal Study was used to identify 14,055 nulliparous females (15-18). TM risk was measured using multilevel logistic regression, adjusting for health status, religion, family structure, socio-economic status, rurality and employment-based area deprivation. Most variation in TM was driven by individual, household and socioeconomic factors with the greatest proportion of mothers in low value or social rented accommodation. Living in an area with fewer employment opportunities was associated with elevated TM risk (most vs. least deprived, ORadj = 1.98 [1.49, 2.63]), as was urban dwelling (urban vs. intermediate, ORadj = 1.42 [1.13, 1.78]). We conclude that area of residence is a significant independent risk factor for TM. Interventions should be targeted towards the most deprived and urban areas and to those in the lowest value housing.

Health, ageing migrants and care strategies

This article is the result of a study that seeks to understand the relationship between socio-economic conditions, health and active ageing. Behaviours related to active ageing in relation to health were identified as were the strategies used in active ageing and their determinants. A qualitative methodology was adopted in the form of semi-structured interviews. Data processing consisted of thematic content analysis in interviews. Two socio-economic groups of elderly Cape Verdean men and women composed the study sample. Both groups totalled 22 cases. Findings indicated that the socio-economic status interferes directly in the affairs of active ageing rather than health issues. In the higher socio-economic group, it was found that status determines active ageing rather than health issues.

Sleep and school education

Sleep has emerged in the past decades as a key process for memory consolidation and restructuring. Given the universality of sleep across cultures, the need to reduce educational inequality, the low implementation cost of a sleep-based pedagogy, and its global scalability, it is surprising that the potential of improved sleep as a means of enhancing school education has remained largely unexploited. Students of various socio-economic status often suffer from sleep deficits. In principle, the optimization of sleep schedules both before and after classes should produce large positive benefits for learning. Here we review the biological and psychological phenomena underlying the cognitive role of sleep, present the few published studies on sleep and learning that have been performed in schools, and discuss potential applications of sleep to the school setting. Translational research on sleep and learning has never seemed more appropriate.

Closing the Gap: Young People's Views on Learning at School

The UK has been criticised for its inequitable education system, as student outcomes are strongly linked to parental socio-economic status. Children and young people experiencing poverty are less likely than their better off peers to leave school with good grades, which can perpetuate disadvantage in later life. The attainment gap between children and young people experiencing poverty and their better off peers in the UK is widening, despite an increasing media and policy focus in this area. Poverty-related educational inequality is a complex area and there is no conclusive evidence in what works to reduce its effects. While there is a plethora of research on the impact of poverty on education, very little of it includes the voice of children and young people and/or the psychological impact of poverty on learning. The importance of hearing the views of children and young people is central to educational psychology, as is social justice and facilitating access to the curriculum for all students. The barriers presented by the experience of poverty to learning are thus vital for educational psychologists to address. This study used qualitative methods to explore the learning journey of Key Stage 3 (age 12-13) young people experiencing poverty in an English coastal borough. Questions from the Little Box of Big Questions 2 were used as a tool in semi-structured interviews, in addition to questions devised by the researcher. Young people discussed aspects of their lives that enabled them to learn at school, and aspects that presented barriers to learning. The research used Positive Psychology, taking a strengths based approach to explore the skills young people thought they brought to education, skills they would like to develop, and how they could be supported in this. The study has highlighted themes that, if addressed, could potentially raise the attainment of children and young people experiencing poverty.

Factibilidad de relanzamiento de la revista de manualidades Costureando

Este es un trabajo de carácter académico que busca identificar la viabilidad del relanzamiento de la revista de manualidades “Costureando”, nacida en la ciudad de Medellín y enfocada a un público específico: mujeres de estratos 4, 5 y 6 de Colombia, amantes a las manualidades y a las actividades de sano entretenimiento. En este documento se presenta el producto mencionado anteriormente y sobre él se hace un análisis enfocado a entender su viabilidad de venta en el mercado actual. Este análisis se logra a través del planteamiento de unos objetivos específicos que orientan la recolección de información, para ser respondidos a través de unas conclusiones y recomendaciones finales; que nacen de los resultados de investigaciones en fuentes secundarias, observaciones en puntos de venta, encuestas a una muestra poblacional y entrevistas con expertos.

Adhésion au traitement de la maladie rénale chronique chez les québécois âgés de 18 ans ou plus

Introduction La progression de la maladie rénale chronique (MRC) augmente le risque des maladies cardiovasculaires. L’hypertension, le diabète et la dyslipidémie sont à la fois des facteurs de risque et des comorbidités de la MRC. Chez les individus souffrant de MRC, la persistance et l’observance du traitement de ces facteurs de risque, i.e. le traitement antihypertenseur (TAH), le traitement hypolipémiant (THL) et le traitement antidiabétique (TAD) contribuent à réduire le risque de mortalité et de morbidité cardiovasculaires. Néanmoins, la persistance et l’observance de ces traitements restent encore peu étudiées chez les individus ayant la MRC. Objectifs: Spécifiquement pour chacun des trois traitements (TAH, THL et TAD), une étude de cohorte a été menée dans le but : 1) d’estimer la persistance à prendre le traitement un an après le début du traitement; 2) d’estimer l’observance du traitement au cours de l’année suivant le début du traitement chez les persistants; 3) d’identifier les facteurs associés à la persistance; et 4) d’identifier les facteurs associés à l’observance. Méthodologie: Nous avons utilisé les banques de données administratives de la Régie de l’assurance maladie du Québec (RAMQ) pour mener trois études de cohorte chez les personnes âgées de 18 ans ou plus. Une étude a été conduite chez les individus qui ont commencé un TAH, l’autre conduite chez les patients ayant commencé un THL et la dernière menée chez les nouveaux utilisateurs de TAD. Les individus qui poursuivaient encore leur traitement un an après son début ont été considérés persistants. Parmi les persistants, les patients qui ont eu une proportion de jours couverts (PJC) ≥ 80 % ont été considérés observants. Les facteurs associés à la persistance et ceux associés à l’observance ont été identifiés à l’aide d’une régression de Poisson modifiée. Résultats: Parmi les 7 119 patients ayant débuté un TAH, 78,8 % ont été persistants et 87,7 % des persistants ont été observants. Les individus qui étaient plus susceptibles d’être persistants se trouvaient dans le groupe des utilisateurs de monothérapie d’inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) (Rapport de prévalences (RP) : 1,20; intervalle de confiance (IC) à 95 % : 1,13-1,27), d’antagonistes du récepteur de l’angiotensine II (ARA) (1,22; 1,14-1,31), de bloquants des canaux calciques (BCC) (1,20; 1,14-1,26), de bêta-bloquants (BB) (1,16; 1,10-1,23) et de multithérapie (1,31; 1,25-1,38) (référence : monothérapie de diurétiques (DIU)). Les individus qui étaient plus susceptibles d’être observants étaient les utilisateurs de monothérapie d’IECA (1,08; 1,03-1,04), de BB (1,10; 1,05-1,15), de BCC (1,10; 1,05-1,15) et de multithérapie. Des 14 607 individus ayant débuté un THL, 80,7 % ont persisté à le prendre; de ces derniers, 88,7 % étaient observants du THL. Les patients qui étaient plus susceptibles d’être persistants étaient ceux ayant un statut socio-économique (SSE) faible (1,03; 1,01-1,06) (référence : SSE élevé) et ceux dont le traitement initial avait été prescrit par un néphrologue (1,06; 1,04-1,09) (référence : omnipraticien). Les individus qui étaient plus susceptibles d’être observants étaient ceux âgés ≥ 66 ans (référence : 18-65) (1,04; 1,01-1,07), ceux ayant un SSE faible (1,08; 1,06-1,10) et ceux qui avaient pris plus de 12 médicaments différents (référence : <7) (1,03; 1.00-1,05). Sur un total de 6 671 individus ayant débuté un TAD, 76,9 % ont persisté à prendre le traitement. Parmi les persistants, 87,9 % étaient observants. Les individus ayant un SSE faible (1,04; 1,01-1,07) (référence : SSE élevé) ou une multithérapie (1,12; 1,08-1,16) (référence : monothérapie de metformine) étaient plus susceptibles d’être persistants, tout comme ceux ayant une comorbidité dont l’hypertension artérielle (1,04; 1,01-1,07), la dyslipidémie (1,06; 1,03-1,10), l’accident vasculaire cérébral (AVC) (1,05; 1,01-1,11) ou la maladie coronarienne (1,03; 1,01-1,06). Les individus plus susceptibles d’être observants étaient ceux ayant un SSE moyen (1,03; 1,01-1,07) ou une multithérapie (1,06; 1,03-1,09). Conclusion: Peu importe le traitement initié par les individus souffrant de MRC, environ 30% des patients ne seraient pas persistants un an après le début du traitement ou observants dans l’année suivant l’initiation. Certains facteurs sont associés de façon consistante à la persistance, par exemple l’AVC, la maladie coronarienne et le nombre de visites médicales, alors que l’âge et le SSE sont associés à l’observance peu importe que le traitement initial soit un TAH, un THL ou un TAD.

Ingvelde Scholz: Das heterogene Klassenzimmer, Differenziert unterrichten. Göttingen: Vandenhoeck & Ruprecht 2012 [Rezension]

Rezension von: Ingvelde Scholz: Das heterogene Klassenzimmer, Differenziert unterrichten, Göttingen: Vandenhoeck & Ruprecht 2012 (144 S.; ISBN 978-3-525-70133-1)

Sleep and school education

Sleep has emerged in the past decades as a key process for memory consolidation and restructuring. Given the universality of sleep across cultures, the need to reduce educational inequality, the low implementation cost of a sleep-based pedagogy, and its global scalability, it is surprising that the potential of improved sleep as a means of enhancing school education has remained largely unexploited. Students of various socio-economic status often suffer from sleep deficits. In principle, the optimization of sleep schedules both before and after classes should produce large positive benefits for learning. Here we review the biological and psychological phenomena underlying the cognitive role of sleep, present the few published studies on sleep and learning that have been performed in schools, and discuss potential applications of sleep to the school setting. Translational research on sleep and learning has never seemed more appropriate.