Le double fardeau de la malnutrition à l’âge scolaire en milieu urbain : une étude au Burkina Faso

Ce travail financé par l'ACDI a été réalisé au Laboratoire TRANSNUT de l'Université de Montréal (Canada)en collaboration avec le Laboratoire National de Santé Publique (Burkina Faso) et HKI-Burkina Faso.

La transition des soins du milieu pédiatrique au milieu hospitalier adulte chez des adolescents transplantés rénaux et chez des adolescents diabétiques : évaluation de l’identité et de l’autodétermination

Résumé Le pourcentage d’enfants et d’adolescents vivant avec une condition chronique qui atteint l’âge adulte a augmenté de façon significative au cours des dernières décennies grâce, notamment, aux avancées en médecine, donnant lieu à la question de transition du milieu hospitalier pédiatrique au milieu hospitalier adulte. Cette transition est décrite par plusieurs chercheurs et cliniciens comme étant un processus complexe pouvant être associé à des difficultés importantes, tel qu’un manque d’adhérence au suivi médical. Malgré les nombreux écrits sur cette problématique, peu d’études longitudinales ancrées dans un contexte théorique ont été réalisées. Le but de cette thèse est d’identifier des facteurs susceptibles de faciliter l’expérience de transition de patients atteints de diabète et de patients greffés rénaux en utilisant une méthodologie longitudinale ainsi qu’en se basant sur un contexte théorique défini et pertinent à la transition de l’adolescence à la vie adulte ainsi qu’à la prise en charge médicale. La thèse est présentée sous forme de trois articles scientifiques. Le premier article examine le développement identitaire, une tâche centrale pendant la période de l’adolescence. Selon la théorie de l’identité d’Erikson (1963) et de Marcia (1966), une identité achevée, caractérisée par un sentiment de soi cohérent établi suite à une exploration, peut aider l’individu à naviguer les obstacles de l’âge adulte. La transition des soins du milieu hospitalier pédiatrique au milieu hospitalier adulte coïncidant avec le passage à l’âge adulte, il est important d’acquérir une bonne compréhension du développement identitaire d’adolescents atteints d’une condition chronique ainsi que du contexte dans lequel leur identité se développe. Dans le cadre de cet article, le développement identitaire et la qualité de vie de 85 adolescents atteints de diabète de type 1 ou ayant reçu une greffe rénale ont été comparé à ceux de 90 adolescents en santé. Au plan identitaire, des analyses de variance ont démontré des différences significatives dans le développement de l’identité idéologique. Précisément, les résultats démontrent un niveau plus élevé de diffusion chez les patients ainsi qu’un niveau plus élevé de forclusion dans le groupe contrôle. En revanche, aucune différence entre les deux groupes n’a été détectée au niveau de l’identité interpersonnelle. De façon similaire, le groupe des patients et le groupe contrôle ont démontré des résultats comparables aux plans de la qualité de vie, de la perception de contrôle sur celle-ci, ainsi qu’au plan de la perception des opportunités à croître et se développer. Les résultats du développement identitaire sont discutés et mis en lien avec la qualité de vie rapportée par le groupe de patients. Le deuxième article consiste en une recension de la littérature ayant pour buts de résumer systématiquement les études en transition basées sur la perspective des patients et d’identifier les facteurs pouvant faciliter l’expérience de transition au milieu hospitalier adulte. À l’aide de la méthodologie du méta-résumé, nous avons procédé à l’extraction, au regroupement et à l’abstraction de résultats provenant de 46 études qualitatives ou de nature descriptive portant sur la transition de patients. Les résultats ont été divisés en quatre catégories, notamment (1) les sentiments et les préoccupations des patients, (2) les recommandations apportées par les patients, (3) les résultats suite au transfert en milieu adulte et (4) l’impact des différents modes de transfert utilisés. Enfin, les résultats de l’article sont discutés dans un cadre théorique de transition qui met l’emphase sur des conditions précises pouvant assurer une transition réussie. Le troisième article a pour objectif d’utiliser une théorie pour étudier l’expérience de transition d’adolescents atteints d’une condition chronique. Étant donné l’importance accordée à l’environnement médical par les patients ainsi que les différences importantes qui existent entre le milieu hospitalier pédiatrique et le milieu hospitalier adulte, la théorie de l’auto-détermination a été sélectionnée. Selon cette théorie, la perception de soutien de l’autonomie de la part du personnel médical est intimement liée à une plus grande motivation et un sentiment de compétence chez les patients à l’égard de leur routine de soins, ainsi qu’à une meilleure adhérence au traitement. Guidés par cette théorie, nous avons suivi l’expérience de transition de patients atteints d’un diabète de type 1 ou de patients ayant reçu une greffe de rein 6 mois avant leur transfert (n= 85) ainsi que 6 mois (n= 49) et un an (n= 36) après leur transfert au milieu adulte. Les résultats révèlent que les patients se sentent généralement prêts à transférer. Suite au transfert, une baisse est enregistrée dans la perception du soutien de l’autonomie des patients. En revanche, un an suite au transfert, les patients rapportent un plus grand sentiment de choix ainsi que la perception d’une plus grande adaptation au milieu adulte. Enfin, les résultats démontrent qu’un plus grand sentiment de soutien de l’autonomie est associé à des niveaux plus élevés de satisfaction, de motivation, de compétence, et de perception d’adhérence au traitement. Les implications pratiques de cette étude sont soulignées.

Los horarios laborales y su influencia en la percepción del equilibro trabajo-familia

Conciliar el trabajo y la familia es una lucha cotidiana que cada persona realiza para satisfacer las exigencias de ambas dimensiones de su vida. El no tener consciencia del problema que surge en el empleado para lograr esta conciliación y la ausencia de soluciones eficaces a éste, no sólo afecta a la organización a través de la baja productividad, el absentismo, el aumento del estrés, entre otros efectos; sino también a la vida familiar, social, física y psicológica del trabajador. Es por ello, que este proyecto de grado busca a partir de la revisión de la literatura mostrar cómo la percepción que tienen los trabajadores de su equilibrio trabajo-familia, se ve influenciada por un factor organizativo, como lo son los turnos laborales; además evidenciar las soluciones que se han implementado en las diferentes empresas de manera exitósa, para finalmente plantear estrategias que se puedan aplicar en las organizaciones facilitando el equilibrio trabajo-familia de los trabajadores.

Parents' cognitions and expectations about their pre-school children: the contribution of parental anxiety and child anxiety

This study investigated the relative associations between parent and child anxiety and parents' cognitions about their children. One hundred and four parents of children aged 3-5 years completed questionnaires regarding their own anxiety level, their child's anxiety level and their cognitions about the child, specifically parents' expectations about child distress and avoidance, and parents' perceived control over child mood and behaviour. Both parent anxiety and parent report of child anxiety were significantly associated with parents' cognitions. Specifically, parent report of child anxiety correlated significantly with parent locus of control generally and, more specifically, with parental expectations and perceived control of child anxious mood and behaviour. Parent anxiety correlated significantly with locus of control and parents' expectations of child anxious mood and behaviour. Furthermore, when both child and parent anxiety were taken into account, only parental anxiety remained significantly associated with parental locus of control and perceived control of child anxious behaviour. For parents' perceived control of child anxious mood, only child anxiety remained significantly associated. The results suggest that parents' perceived control over their children's behaviour may primarily reflect parental anxiety, rather than child anxiety. Parental anxiety may, therefore, present an important target for interventions that aim to change parent's cognitions and behaviour.

Worry and problem-solving skills and beliefs in primary school children

Objective. To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children. Method. Children (8–11 years) were screened using the Penn State Worry Questionnaire for Children. High (N ¼ 27) and low (N ¼ 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to problems, planfulness, and effectiveness of solutions) and problem-solving beliefs(confidence and perceived control). Results. High and low worry groups differed significantly on measures of anxiety and problem-solving beliefs (confidence and control) but not on problem-solving skills. Conclusions. Consistent with findings with adults, worry in children was associated with cognitive distortions, not skills deficits. Interventions for worried children may benefit froma focus on increasing positive problem-solving beliefs.

Predicting long-term growth in students' mathematics achievement: the unique contributions of motivation and cognitive strategies

This research examined how motivation (perceived control, intrinsic motivation, and extrinsic motivation), cognitive learning strategies (deep and surface strategies), and intelligence jointly predict long-term growth in students' mathematics achievement over 5 years. Using longitudinal data from six annual waves (Grades 5 through 10; Mage = 11.7 years at baseline; N = 3,530), latent growth curve modeling was employed to analyze growth in achievement. Results showed that the initial level of achievement was strongly related to intelligence, with motivation and cognitive strategies explaining additional variance. In contrast, intelligence had no relation with the growth of achievement over years, whereas motivation and learning strategies were predictors of growth. These findings highlight the importance of motivation and learning strategies in facilitating adolescents' development of mathematical competencies.

Improving child and family outcomes following complicated births requiring admission to neonatal intensive care units

This paper reviews current research regarding the impact of birth complications, such as preterm labour, on parents and the nuclear family system. Specifically, how parents cope with the neonatal intensive care unit (NICU) experience and the associated decision-making tasks required during complicated births will be investigated. Consequences of poor adaptation to prematurity for the parent, family and infant relationships will also be discussed. The importance of informed decision-making, perceived control, self-esteem and the benefits of certain strategies, such as kangaroo care (skin-to-skin contact), in the facilitation of greater levels of attachment and improved relationships, will be highlighted. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Role of internal cognitive processes and external causal attributions in midlife transition

This project was designed to ascertain the defining attributes of midlife that render it distinct from young and older adulthood. Based on the determined salient factors the Midlife Adjustment Scale was developed and the nature of midlife, that of a transitional period, was established. The scale was then used to assess the influence that perceived control and major life events have on one's adjustment during the middle years.

Predicting subjective quality of life

This thesis showed that as samples move from a homeostatic position of high-normal subjective quality of life, to normal, to low-normal subjective quality of life, the contributions of personality (extroversion and neuroticism) and perceived control (approach and avoidant control) to the maintenance of subjective quality of life becomes more complicated

Gatekeeper influence on food acquisition, food preparation and family diet

The problems associated with overweight and obesity has focused attention on obesogenic, or obesity promoting environments. The home environment, in particular the role of the main food gatekeeper, has come under particular scrutiny for its impact on the family diet (Campbell et al, 2007; Coveney, 2004; Crawford et al, 2007). 326 US and 323 Australian gatekeepers are studied to understand relationships between healthy eating capability, food acquisition and food preparation behaviours, and satisfaction with the household diet. The results suggest that gatekeeper attitudes and perceived control over family diet play a significant role in shaping food-related behaviours and diet satisfaction. Impulsiveness, focusing on freshness, meal planning, and vegetable prominence in meals are also important behavioural factors for satisfaction with diet.

Pilot Study of clinician attitudes to insulin pump therapy: international differences and the need for a greater understanding of the patient perspective

OBJECTIVES: To identify and survey health care professionals (HCPs) attitudes to insulin pump therapy (CSII).

METHODS: Eight specialists were interviewed to explore the attitudes and beliefs about CSII. Responses were analysed thematically and used to inform the design of a new 22-item questionnaire: the Attitudes to Pump Therapy (APT) Survey. The APT was pilottested among 95 HCPs (54% male; 75.5% diabetologists/DSNs, 13.8% general practitioners) at the International Diabetes Federation (IDF) conference, 2006. Results were analysed using non-parametric statistics with bonferroni correction.

RESULTS: Analyses of interview data identified 9 themes: biomedical, perceived control of care/diabetes, technology, quality of life, financial resources, training, education & support, suitability, and evidence-base. Items were designed to reflect these themes with responses scored on a 5-point Likert scale (strongly agree—strongly disagree). No statistically significant differences
were found by gender, HCP speciality, country (and continent) of origin or proportion of patients using CSII. Most notable differences were found in relation to gross domestic product (GDP) and the potential for pump therapy to achieve tight blood glucose control (lower GDP = more agreement: p = 0.001), and result in diabetic ketoacidosis (DKA) (lower GDP = less agreement: p < 0.005). Ranked mean scores showed a split between biomedical/clinical items (N = 11) and items concerned with patient experience (N = 11). Attitudes about biomedical/clinical issues were generally clear (i.e. for 7/11 items, the mean score was “agree”) but less decisive about patient experience (i.e. for 8/11 items, the mean score was “neither agree nor disagree”).

CONCLUSION: Few subgroup differences existed, but those that did may be explained by lack of access to treatment (directly corresponding to GDP). Clinicians’ were generally clear in their attitudes regarding biomedical aspects but less so regarding patient experience. Research focusing on patient-reported outcomes is likely to offer clinicians a greater understanding of the patients’ perspective of insulin pump therapy.

Adaptive autobiographical memory in younger and older adults : the indirect association of integrative and instrumental reminiscence with depressive symptoms

Despite the established effectiveness of reminiscence-based interventions for depression, little research exists into the pathways through which specific reminiscence functions are related to depressive symptoms. Drawing on theory of the mechanisms of change in cognitive-reminiscence therapy, the current study tests the hypothesised indirect associations of adaptive integrative and instrumental reminiscence functions with depressive symptoms and whether these relationships might differ among younger and older adults. Questionnaires were completed by a large community sample of the Australian population. Multiple mediation models were tested in two groups: younger adults (n=730, M age=52.24, SD=9.84) and older adults (n=725, M age= 73.59, SD=6.29). Results were consistent across age groups, indicating that there was direct relationship between these reminiscence functions and depressive symptoms, but that integrative reminiscence is indirectly associated with depressive symptoms through meaning in life, self-esteem, and optimism, and that instrumental reminiscence is indirectly associated with depressive symptoms through primary control and self-efficacy. This study provides support for the relationships between constructs underlying the proposed mechanisms of change in cognitive-reminiscence therapy for the treatment of depression, and suggests these relationships are similar for younger and older adults.

Demographic and psychographic associations of consumer intentions to purchase healthier food products

Objective: This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. Methods: A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Results: Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Conclusion: Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.

Food concerns and support for environmental food policies and purchasing.

Consumer support for pro environmental food policies and food purchasing are important for the adoption of successful environmental policies. This paper examines consumers' views of food policy options as their predisposition to purchase pro environmental foods along with their likely demographic, educational and cognitive antecedents including food and environmental concerns and universalism values (relating to care for others and the environment). An online survey to assess these constructs was conducted among 2204 Australian adults in November 2011. The findings showed strong levels of support for both environmental food policies (50%-78% support) and pro environmental food purchasing (51%-69% intending to purchase pro environmental foods). Confirmatory factor analysis and structural equation modelling showed that different cognitive mediators exist along pathways between demographics and the two outcome variables. Support for food policy was positively related to food and environment concerns (std. Beta = 0.25), universalism (0.41), perceived control (0.07), and regulatory issues (0.64 but negatively with food security issues (-0.37). Environment purchasing intentions were positively linked to food and nutrition concerns (0.13), food and environment concerns (0.24), food safety concerns (0.19), food and animal welfare concerns (0.16), universalism (0.25), female gender (0.05), education (0.04), and perceived influence over the food system (0.17). In addition, health study in years 11 and 12 was positively related to the beginning of both of these pathways (0.07 for each). The results are discussed in relation to the opportunities that communications based on the mediating variables offer for the promotion of environmental food policies and purchasing.

Examining customer evaluations across different self-service technologies

Purpose – This study aims to examine the influence of different self-service technologies (SSTs) on customer satisfaction with and continued usage of SSTs. Specifically, it compares an interactive voice response (IVR) SST and an online SST from the same provider to assess how to manage these parallel SSTs.

Design/methodology/approach – A tracking study was used, beginning with a survey of n = 957 SST users to test a model pertaining to SST satisfaction across IVR and online SSTs. These SST users were then tracked over 12 months. The association between customer satisfaction with and continued usage of the SSTs was examined using behavioural data from the service provider.

Findings – While the overall model was found to be valid across both types of SSTs, perceptions of factors including ease of use, perceived control and reliability differed for IVR and online SSTs. Satisfaction with SSTs is linked with users’ continued use of SSTs, but is not a barrier to users’ adoption of newer SST forms.

Research limitations/implications – Highlighting the rapid developments in this field, a new SST was introduced by the provider to respondents during the 12-month tracking period, thus complicating the results. Further studies could include the customer purpose for using SSTs as a variable.

Practical implications – The findings offer support for organisations offering a suite of SSTs, even if they serve the same purpose. Customers evaluate SST types differently, and even satisfied SST users switch to different SSTs when they become available. Allowing customers to choose the SST that best suits them appears to be good practice.

Originality/value – This study develops a comprehensive model of customer SST satisfaction that is used to undertake a comparison of two different types of SSTs, which has been missing from prior research.