Coexistence des charges professionnelle, familiale et domestique, et d'aide à un aîné fragilisé part son vieillissement chez des membres de la "génération sandwich", relations avec la santé perçue et identification de facteurs protecteurs de la santé : pistes pour développer des interventions infirmières préventives en santé au travail

Les membres de la Génération Sandwich (GS) jouent un rôle pivot dans la société : tout en ayant un emploi, ils s'occupent de leurs enfants ou petits-enfants et offrent de l'aide à leurs parents ou beaux-parents (P/BP) fragilisés par leur vieillissement. Les charges de travail coexistantes générées par ces activités représentent pour leur santé un risque potentiel qui pourrait augmenter. Les connaissances sur la GS et sa santé perçue sont cependant insuffisantes pour que les infirmières de santé au travail développent des interventions préventives basées sur des preuves. La majorité des recherches existantes ont considéré la coexistence des charges comme a priori pathogénique. La plupart des études n'ont examiné l'association que d'une ou de deux de ces trois activités avec la santé. Très peu ont utilisé un cadre théorique infirmier. La présente thèse visait à développer les connaissances sur les membres de la GS et leur santé perçue. Aussi, nous avons adopté une des stratégies existantes pour développer des théories en science infirmière - donc pour développer des connaissances infirmières pour intervenir - décrites par Meleis (2012) : la stratégie « de la Théorie à la Recherche à la Théorie ». Premièrement, un cadre de référence infirmier salutogénique a été construit. Il s'est basé sur le modèle de soins Neuman Systems Model, des concepts issus de la théorie Déséquilibre entre Effort et Récompense de Siegrist et d'une recension intégrative des écrits. Il relie les charges de la GS avec la santé perçue et suggère l'existence de facteurs protégeant la santé. Deuxièmement, un dispositif de recherche descriptif corrélationnel exploratoire a été mis en place pour confronter les deux propositions relationnelles du cadre théorique au monde empirique. Des données ont été récoltées au moyen d'un questionnaire électronique rempli par 826 employés d'une administration publique (âge 45-65 ans). Après examen, 23.5% de l'échantillon appartenait à la GS. La probabilité d'appartenir à la GS augmentait avec l'avancement en âge des P/BP, la co-résidence et la présence d'un enfant dans le ménage ; cependant le sexe n'influençait pas cette probabilité. Les analyses n'ont révélé aucune relation entre la charge totale et la santé physique ou mentale des femmes. Néanmoins, il y avait une relation négative entre cette charge et la santé physique des hommes et une relation négative proche du seuil de significativité, sans toutefois l'atteindre, entre cette charge et leur santé mentale. La nature de ces deux dernières relations était principalement le fait de la charge de travail domestique et familiale. Cinq facteurs identifiés théoriquement ont effectivement protégé la santé de la GS de leurs charges coexistantes : l'absence de sur-engagement dans l'activité professionnelle et une grande latitude décisionnelle dans l'aide aux P/BP ont protégé la santé mentale des femmes ; une grande latitude décisionnelle dans l'activité domestique et familiale a protégé la santé mentale des hommes ; l'absence de sur-engagement dans l'aide aux P/BP et des relations de bonne qualité dans l'activité professionnelle ont protégé la santé physique des hommes. S'appuyant sur ces facteur protecteurs de la santé, cette thèse a proposé des pistes afin de développer des interventions pour la prévention primaire en santé au travail qui soient soucieuses de faire évoluer favorablement les inégalités de genre (gender-transformative). Elles ne concernent pas seulement les membres de la GS et les P/BP, mais aussi les employeurs. Troisièmement, comme les deux propositions relationnelles ont plutôt bien supporté la confrontation avec le monde empirique, cette thèse offre des suggestions pour poursuivre le développement de son cadre théorique et tendre vers la création d'une théorie de moyenne portée en science infirmière.

Developing a theoretical framework using a nursing perspective to investigate perceived health in the "Sandwich Generation" group

Coexisting workloads from professional, household and family, and caregiving activities for frail parents expose middle-aged individuals, the so-called "Sandwich Generation", to potential health risks. Current trends suggest that this situation will continue or increase. Thus SG health promotion has become a nursing concern. Most existing research considers coexisting workloads a priori pathogenic. Most studies have examined the association of one, versus two, of these three activities with health. Few studies have used a nursing perspective. This article presents the development of a framework based on a nursing model. We integrated Siegrist's Effort-Reward Imbalance middle-range theory into "Neuman Systems Model". The latter was chosen for its salutogenic orientation, its attention to preventive nursing interventions and the opportunity it provides to simultaneously consider positive and negative perceptions of SG health and SG coexisting workloads. Finally, it facilitated a theoretical identification of health protective factors.

Measuring Intermediary Determinants of Early Childhood Health: A Composite Index Comparing Colombian Departments

In recent years there has been growing interest in composite indicators as an efficient tool of analysis and a method of prioritizing policies. This paper presents a composite index of intermediary determinants of child health using a multivariate statistical approach. The index shows how specific determinants of child health vary across Colombian departments (administrative subdivisions). We used data collected from the 2010 Colombian Demographic and Health Survey (DHS) for 32 departments and the capital city, Bogotá. Adapting the conceptual framework of Commission on Social Determinants of Health (CSDH), five dimensions related to child health are represented in the index: material circumstances, behavioural factors, psychosocial factors, biological factors and the health system. In order to generate the weight of the variables, and taking into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations was employed in constructing the index. From this method five principal components were selected. The index was estimated using a weighted average of the retained components. A hierarchical cluster analysis was also carried out. The results show that the biggest differences in intermediary determinants of child health are associated with health care before and during delivery.

Fiber-reinforced Composite as Oral Implant Material. Experimental studies of glass fiber and bioactive glass in vitro and in vivo

Fiber-reinforced composite as oral implant material: Experimental studies of glass fiber and bioactive glass in vitro and in vivo Department of Prosthetic Dentistry and Biomaterials Science, Institute of Dentistry, University of Turku, Turku, Finland 2008. Biocompatibility and mechanical properties are important variables that need to be determined when new materials are considered for medical implants. Special emphasis was placed on these characteristics in the present work, which aimed to investigate the potential of fiber-reinforced composite (FRC) material as an oral implant. Furthermore, the purpose of this study was to explore the effect of bioactive glass (BAG) on osseointegration of FRC implants. The biocompatibility and mechanical properties of FRC implants were studied both in vitro and in vivo. The mechanical properties of the bulk FRC implant were tested with a cantilever bending test, torsional test and push-out test. The biocompatibility was first evaluated with osteoblast cells cultured on FRC substrates. Bone bonding was determined with the mechanical push-out test and histological as well as histomorplanimetric evaluation. Implant surface was characterized with SEM and EDS analysis. The results of these studies showed that FRC implants can withstand the static load values comparably to titanium. Threaded FRC implants had significantly higher push-out strength than the threaded titanium implants. Cell culture study revealed no cytotoxic effect of FRC materials on the osteoblast-like-cells. Addition of BAG particles enhanced cell proliferation and mineralization of the FRC substrates The in vivo study showed that FRC implants can withstand static loading until failure without fracture. The results also suggest that the FRC implant is biocompatible in bone. The biological behavior of FRC was comparable to that of titanium after 4 and 12 weeks of implantation. Furthermore, addition of BAG to FRC implant increases peri-implant osteogenesis and bone maturation.

Measuring early childhood health : a composite index comparing Colombian departments

This paper presents a composite index of early childhood health using a multivariate statistical approach. The index shows how child health varies across Colombian departments, -administrative subdivisions-. In recent years there has been growing interest in composite indicators as an efficient analysis tool and a way of prioritizing policies. These indicators not only enable multi-dimensional phenomena to be simplified but also make it easier to measure, visualize, monitor and compare a country’s performance in particular issues. We used data collected from the Colombian Demographic and Health Survey, DHS, for 32 departments and the capital city, Bogotá, in 2005 and 2010. The variables included in the index provide a measure of three dimensions related to child health: health status, health determinants and the health system. In order to generate the weight of the variables and take into account the discrete nature of the data, we employed a principal component analysis, PCA, using polychoric correlation. From this method, five principal components were selected. The index was estimated using a weighted average of the components retained. A hierarchical cluster analysis was also carried out. We observed that the departments ranking in the lowest positions are located on the Colombian periphery. They are departments with low per capita incomes and they present critical social indicators. The results suggest that the regional disparities in child health may be associated with differences in parental characteristics, household conditions and economic development levels, which makes clear the importance of context in the study of child health in Colombia.

Charges de travail et santé perçue de la "génération sandwich"

La coexistence des charges professionnelles, familiales, et d'aide à des ascendants expose la Génération Sandwich (GS) à des risques potentiels pour sa santé. Toutefois, les connaissances sur la GS sont insuffisantes pour permettre aux infirmières du secteur de la santé au travail de développer des interventions en promotion de la santé basées sur des preuves. Ce manque de clarté est préoccupant au vu de certaines tendances sociodémographiques. La présente étude vise à dresser le portrait des travailleurs de la GS en examinant les liens entre leurs caractéristiques, leurs charges co-existantes et leur santé perçue. Pour ce faire, nous avons développé un cadre de référence salutogénique. puis, nous l'avons utilisé pour conduire une recherche descriptive corrélationnelle transversale. un questionnaire électronique a permis de récolter les données de 826 employés d'une administration publique suisse. L'examen a montré que 23.5 % de l'échantillon appartenait à la GS. Cette appartenance ne dépendait pas du sexe. la charge de travail totale (70.5 h/sem) de la GS différait significativement de celle du reste de l'échantillon (62.8 h/sem). Nous n'avons pas trouvé de relation entre cette charge totale et la santé physique ou mentale des femmes. En revanche, il y avait une relation négative entre cette charge totale et la santé physique des hommes, et cette relation était proche du seuil de significativité pour la santé mentale de ces derniers. Grâce à une analyse soucieuse de faire évoluer favorablement les inégalités de genre (gender-transformative), cette étude fournit des pistes pour fonder des interventions préventives en faveur de la santé des membres de la GS.

Variable-stiffness composite panels: Defect tolerance under in-plane tensile loading

Automated Fiber Placement is being extensively used in the production of major composite components for the aircraft industry. This technology enables the production of tow-steered panels, which have been proven to greatly improve the structural efficiency of composites by means of in-plane stiffness variation and load redistribution. However, traditional straight-fiber architectures are still preferred. One of the reasons behind this is related to the uncertainties, as a result of process-induced defects, in the mechanical performance of the laminates. This experimental work investigates the effect of the fiber angle discontinuities between different tow courses in a ply on the un-notched and open-hole tensile strength of the laminate. The influence of several manufacturing parameters are studied in detail. The results reveal that 'ply staggering' and '0% gap coverage' is an effective combination in reducing the influence of defects in these laminates

Thermoplastic bioactive composite – with special reference to dissolution behaviour and tissue response

Bioactive glasses are surface-active ceramic materials which support and accelerate bone growth in the body. During the healing of a bone fracture or a large bone defect, fixation is often needed. The aim of this thesis was to determine the dissolution behaviour and biocompatibility of a composite consisting of poly(ε-caprolactone-co-DL-lactide) and bioactive glass (S53P4). In addition the applicability as an injectable material straight to a bone defect was assessed. In in vitro tests the dissolution behaviour of plain copolymer and composites containing bioactive glass granules was evaluated, as well as surface reactivity and the material’s capability to form apatite in simulated body fluid (SBF). The human fibroblast proliferation was tested on materials in cell culture. In in vivo experiments, toxicological tests, material degradation and tissue reactions were tested both in subcutaneous space and in experimental bone defects. The composites containing bioactive glass formed a unified layer of apatite on their surface in SBF. The size and amount of glass granules affected the degradation of polymer matrix, as well the material’s surface reactivity. In cell culture on the test materials the human gingival fibroblasts proliferated and matured faster compared with control materials. In in vitro tests a connective tissue capsule was formed around the specimens, and became thinner in the course of time. Foreign body cell reactions in toxicological tests were mild. In experimental bone defects the specimens with a high concentration of small bioactive glass granules (<45 μm) formed a dense apatite surface layer that restricted the bone ingrowth to material. The range of large glass granules (90-315 μm) with high concentrations formed the best bonding with bone, but slow degradation on the copolymer restricted the bone growth only in the superficial layers. In these studies, the handling properties of the material proved to be good and tissue reactions were mild. The reactivity of bioactive glass was retained inside the copolymer matrix, thus enabling bone conductivity with composites. However, the copolymer was noticed to degradate too slowly compared with the bone healing. Therefore, the porosity of the material should be increased in order to improve tissue healing.

Cleaning of ceramic filter plates

In this thesis, cleaning of ceramic filter plates clogged by iron oxides was studied. Oxalic acid is considered as the most effective cleaning agent for the plates fouled by iron oxides, but when using oxalic acid, sparingly soluble calcium oxalate may be formed and it can blind the filter media. Suitability of another chemical for cleaning the plates clogged by iron oxides was studied in this thesis. The literature part was mostly about the properties of the chemical, about its reactions, industrial uses, safety issues etc. In the experimental part, the efficiency of the chemical for cleaning of the ceramic plates clogged by iron oxides was studied. Two kinds of plates were used in the experiments; the others were clogged by hematite and the others by magnetite. Both soaking and flow-through experiments were done. A suitable concentration, pH and temperature were tried to find in the experiments. Also the effect of ultrasound was studied. The efficiency of the cleaning was examined by measuring the permeability of the plates during the experiments. ICP-OES analysis was performed for determining the amount of dissolved iron in the washing solution. Some experiments were also done with oxalic acid. The results from the oxalic acid experiments were compared to the results from the experiments with the other chemical. In the experiments with the other chemical, the permeability increased more and the amounts of dissolved iron were larger. According to the results from the experiments, the method of application of the washing solutions had an impact on the washing results.

Monomer conversion of composite dental resins photoactivated by a halogen lamp and a LED: a FT-Raman spectroscopy study

Eighteen circular blocks of resins cured either by a LED or a halogen lamp (20, 40 and 60 s), had their top (T) and bottom (B) surfaces studied using a FT-Raman spectrometer. Systematic changes in the intensity of the methacrylate C=C stretching mode at 1638 cm-1 as a function of exposure duration were observed. The calculated degree of conversion (DC) ranged from 45.0% (B) to 52.0% (T) and from 49.0% (B) to 55.0% (T) for the LED and halogen lamp, respectively. LED and halogen light produced similar DC values with 40 and 60 s of irradiation.

Hitsatun kerrossihtilevyrakenteen soveltuvuus sellutehtaan laitteiden suodatinpinnaksi

Tässä diplomityössä tutkittiin hitsaamalla valmistettavan kerrossihtilevyn soveltuvuutta eri sellutehtaan laitteisiin mekaanisen kuormituskokeen, korroosiokokeen ja syrjäytyskokeiden avulla. Tutkimusympäristönä käytettiin puukuitupesuria, sillä kerrossihtilevyrakenteen todennäköisimpiä käyttökohteita ovat erilaiset massan pesuun tarkoitetut laitteet. Mekaanisen kuormituksen kokeessa tarkasteltiin kerrossihtilevyn staattista ja dynaamista kuormituksen kestoa painevaihteluiden avulla pesurin koelokerossa ja verrattiin sitä porattuun reikälevyyn. Kokeessa käytetyn kerrossihtilevyversion todettiin olevan huomattavasti porattua saman paksuista reikälevyä heikompi dynaamisen kuormituksen alaisena. Syrjäytyskokeilla määritettiin syrjäytysnopeus erilaisilla reiänhalkaisijoilla ja –jaoilla sekä tutkittiin väriaineen avulla sokeiden tukikannasten vaikutusta syrjäytyspesun homogeenisuuteen levyn pinnassa. Syrjäytysnopeuden todettiin heikentyvän vapaan reikäpinta-alan pienentyessä. Väriaineellisissa kokeissa ei havaittu tukikannasten merkittävästi alentavan syrjäytysnopeutta. Korroosiokokeilla tutkittiin ja vertailtiin laser- ja vastuspistehitsien korroosionkestokykyä kloridipitoisissa olosuhteissa lämpötilan säätelyn mahdollistavan olosuhdekaapin avulla. Laserhitsauksessa parametrien ei havaittu vaikuttavan merkittävästi hitsin herkistymislämpötilaan. Vastuspistehitsaamalla on mahdollista saavuttaa laserhitsien korroosionkesto.

Non-resorbable glass fibre-reinforced composite with porous surface as bone substitute material: Experimental studies in vitro and in vivo focused on bone-implant interface

The development of load-bearing osseous implant with desired mechanical and surface properties in order to promote incorporation with bone and to eliminate risk of bone resorption and implant failure is a very challenging task. Bone formation and resoption processes depend on the mechanical environment. Certain stress/strain conditions are required to promote new bone growth and to prevent bone mass loss. Conventional metallic implants with high stiffness carry most of the load and the surrounding bone becomes virtually unloaded and inactive. Fibre-reinforced composites offer an interesting alternative to metallic implants, because their mechanical properties can be tailored to be equal to those of bone, by the careful selection of matrix polymer, type of fibres, fibre volume fraction, orientation and length. Successful load transfer at bone-implant interface requires proper fixation between the bone and implant. One promising method to promote fixation is to prepare implants with porous surface. Bone ingrowth into porous surface structure stabilises the system and improves clinical success of the implant. The experimental part of this work was focused on polymethyl methacrylate (PMMA) -based composites with dense load-bearing core and porous surface. Three-dimensionally randomly orientated chopped glass fibres were used to reinforce the composite. A method to fabricate those composites was developed by a solvent treatment technique and some characterisations concerning the functionality of the surface structure were made in vitro and in vivo. Scanning electron microscope observations revealed that the pore size and interconnective porous architecture of the surface layer of the fibre-reinforced composite (FRC) could be optimal for bone ingrowth. Microhardness measurements showed that the solvent treatment did not have an effect on the mechanical properties of the load-bearing core. A push-out test, using dental stone as a bone model material, revealed that short glass fibre-reinforced porous surface layer is strong enough to carry load. Unreacted monomers can cause the chemical necrosis of the tissue, but the levels of leachable resisidual monomers were considerably lower than those found in chemically cured fibre-reinforced dentures and in modified acrylic bone cements. Animal experiments proved that surface porous FRC implant can enhance fixation between bone and FRC. New bone ingrowth into the pores was detected and strong interlocking between bone and the implant was achieved.