La perspective des médecins, des pharmaciens et des parents face au phénomène de prescription à répétition d'antibiotiques aux enfants de moins de 5 ans souffrant d'otites moyennes aiguës

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Parents’ Perception of Medication Treatments for Preschool Children with or at – risk for ADHD

Introduction: ADHD is a chronic medical condition that affects 3-7% of school-aged children. Over the last few years, there has been increased attention with children in the preschool age range. The American Academy of Pediatrics (AAP) recommends that treatment for ADHD in the preschool age range should take the form of behavior modification first, with medication only considered after behavior modification is not effective alone in treating the symptoms (AAP, 2011). However, little research has been done to examine parent perceptions of evidence-based treatment approaches for children in the preschool age range. Objective: This study sought to examine parent perceptions of psychotropic medication use for preschool age (4-6 years) children with or at-risk of ADHD. Method: Data was collected from 176 families who presented for treatment at a clinic in southeast Florida. Parents completed questionnaires about their family background, their child’s behavior, behavioral functioning, and their perceptions of medication treatment. Results: Preliminary results indicate that 50% of parents were not open to the possibility of medication, 44.6% of parents were open to the possibility of medication, and 5.4% of parents chose against medication when a physician recommended it. Results examining the extent to which severity of child behavior problems impacts parent perceptions of medication will also be presented. Conclusion: These findings demonstrate that parents of preschool children are hesitant to consider medication as a treatment option for their young children. The findings of this study are important as more and more young children are being diagnosed with ADHD each year

Age and Life Course Location as Interpretive Resources for Decisions Regarding Disclosure of HIV to Parents and Children: Findings from the HIV and Later Life Study

Studies of disclosure among older people living with HIV (PLWH) are uninformed by critical social-gerontological approaches that can help us to appreciate how older PLWH see and treat age as relevant to disclosure of their HIV status. These approaches include an ethnomethodologically-informed social constructionism that explores how ‘the’ life course (a cultural framework depicting individuals’ movement through predictable developmental stages from birth to death) is used as an interpretive resource for determining self and others’ characteristics, capacities, and social circumstances: a process Rosenfeld and Gallagher (2002) termed ‘lifecoursing’. Applying this approach to our analysis of 74 life-history interviews and three focus groups with older (aged 50+) people living with HIV in the United Kingdom, we uncover the central role that lifecoursing plays in participants’ decision-making surrounding disclosure of their HIV to their children and/or older parents. Analysis of participants’ accounts uncovered four criteria for disclosure: the relevance of their HIV to the other, the other’s knowledge about HIV, the likelihood of the disclosure causing the other emotional distress, and the other’s ability to keep the disclosed confidential. To determine if these criteria were met in relation to specific children and/or elders, participants engaged in lifecoursing, evaluating the other’s knowledge of HIV, and capacity to appropriately manage the disclosure, by reference to their age. The use of assumptions about age and life-course location in decision-making regarding disclosure of HIV reflects a more nuanced engagement with age in the disclosure decision-making process than has been captured by previous research into HIV disclosure, including on the part of people aging with HIV.

Learning for self-regulation: Improving instructional benefits for pupils, teachers, parents, schools, and society at large

Compulsory education laws oblige primary and secondary schools to give each pupil positive encouragement in, for example, social, emotional, cognitive, creative, and ethical respects. This is a fairly smooth process for most pupils, but it is not as easy to achieve with others. A pattern of pupil, home or family, and school variables turns out to be responsible for a long-term process that may lead to a pupil’s dropping out of education. A systemic approach will do much to introduce more clarity into the diagnosis, potential reduction and possible prevention of some persistent educational problems that express themselves in related phenomena, for example low school motivation and achievement; forced underachievement of high ability pupils; concentration of bullying and violent behaviour in and around some types of classes and schools; and drop-out percentages that are relatively constant across time. Such problems have a negative effect on pupils, teachers, parents, schools, and society alike. In this address, I would therefore like to clarify some of the systemic causes and processes that we have identified between specific educational and pupil characteristics. Both theory and practice can assist in developing, implementing, and checking better learning methods and coaching procedures, particularly for pupils at risk. This development approach will take time and require co-ordination, but it will result in much better processes and outcomes than we are used to. First, I will diagnose some systemic aspects of education that do not seem to optimise the learning processes and school careers of some types of pupils in particular. Second, I will specify cognitive, social, motivational, and self-regulative aspects of learning tasks and relate corresponding learning processes to relevant instructional and wider educational contexts. I will elaborate these theoretical notions into an educational design with systemic instructional guidelines and multilevel procedures that may improve learning processes for different types of pupils. Internet-based Information and Communication Technology, or ICT, also plays a major role here. Third, I will report on concrete developments made in prototype research and trials. The development process concerns ICT-based differentiation of learning materials and procedures, and ICT-based strategies to improve pupil development and learning. Fourth, I will focus on the experience gained in primary and secondary educational practice with respect to implementation. We can learn much from such practical experience, in particular about the conditions for developing and implementing the necessary changes in and around schools. Finally, I will propose future research. As I hope to make clear, theory-based development and implementation research can join forces with systemic innovation and differentiated assessment in educational practice, to pave the way for optimal “learning for self-regulation” for pupils, teachers, parents, schools, and society at large.

Recruiting faith and non-faith based schools, adolescents and parents to a cluster randomised sexual-health trial: experiences, challenges and lessons from the mixed-methods Jack Feasibility Trial

Background: The move toward evidence-based education has led to increasing numbers of randomised trials in schools. However, the literature on recruitment to non-clinical trials is relatively underdeveloped, when compared to that of clinical trials. Recruitment to school-based randomised trials is, however, challenging; even more so when the focus of the study is a sensitive issue such as sexual health. This article reflects on the challenges of recruiting post-primary schools, adolescent pupils and parents to a cluster randomised feasibility trial of a sexual health intervention, and the strategies employed to address them.
Methods: The Jack Trial was funded by the UK National Institute for Health Research (NIHR). It comprised a feasibility study of an interactive film-based sexual health intervention entitled If I Were Jack, recruiting over 800 adolescents from eight socio-demographically diverse post-primary schools in Northern Ireland. It aimed to determine the facilitators and barriers to recruitment and retention to a school-based sexual health trial and identify optimal multi-level strategies for an effectiveness study. As part of an embedded process evaluation, we conducted semi-structured interviews and focus groups with principals, vice-principals, teachers, pupils and parents recruited to the study as well as classroom observations and a parents’ survey.
Results: With reference to Social Learning Theory, we identified a number of individual, behavioural and environmental level factors which influenced recruitment. Commonly identified facilitators included perceptions of the relevance and potential benefit of the intervention to adolescents, the credibility of the organisation and individuals running the study, support offered by trial staff, and financial incentives. Key barriers were prior commitment to other research, lack of time and resources, and perceptions that the intervention was incompatible with pupil or parent needs or the school ethos.
Conclusions: Reflecting on the methodological challenges of recruiting to a school-based sexual health feasibility trial, this study highlights pertinent general and trial-specific facilitators and barriers to recruitment, which will prove useful for future trials with schools, adolescent pupils and parents.

Multiples in the Newborn Intensive Care Unit: parents' and nurses' perspectives

This paper discusses the issues of parents and nurses when mulitples are admitted to busy NICU's

Psychiatric Nurses’ Practice with Parents who have Mental Illness, their Children and Families, within Adult Mental Health Services in Ireland

Introduction: While it is recommended that mental health professionals engage in family focused practice (FFP), there is limited understanding regarding psychiatric nurses’ practice with parents who have mental illness, their children and families in adult mental health services.

Methods: This study utilized a mixed methods approach to measure the extent of psychiatric nurses’ family focused practice and factors that predicted it. It also sought to explore the nature and scope of high scoring psychiatric nurses’ FFP and factors that affected their capacity to engage in FFP. Three hundred and forty three psychiatric nurses in 12 mental health services throughout Ireland completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Fourteen nurses who achieved high scores on the FFMHPQ also participated in semi-structured interviews.

Results: Whilst the majority of nurses were not family focused a substantial minority were. High scoring nurses’ practice was complex and multifaceted, comprising various family focused activities, principles and processes. Nurses’ capacity to engage in FFP was determined by their knowledge and skills, working in community settings and own parenting experience.

Représentations des pratiques parentales, de la maltraitance et de la protection de la jeunesse : une comparaison entre parents québécois et colombiens

Au Canada, l’immigration est en augmentation depuis les 25 dernières années. À Québec, entre 1999 et 2008, les Colombiens ont été les plus nombreux à s’établir en tant que réfugiés. Cette augmentation de la diversité de la population n’est pas sans conséquences pour les institutions de santé publique. C’est vrai en particulier pour la protection de la jeunesse dans laquelle les familles migrantes et réfugiées sont surreprésentées. Il est par ailleurs reconnu que le processus d’acculturation entraine une transformation des rôles parentaux. De plus, des recherches ont établi un lien entre l’endossement de certaines valeurs, notamment celles axées sur la famille (familismo) et les rôles sexuels (machismo) pour expliquer les pratiques de parents migrants « latinos » et le rapport qu’elles entretiennent avec les institutions. Cette étude comparative a pour objectif d’explorer, à partir de la parole des premiers concernés, c’est-à-dire les parents, les représentations de leurs pratiques parentales, de la maltraitance et de la protection de la jeunesse. Cette exploration a été réalisée auprès de deux populations de parents : des parents québécois et colombiens ayant migrés à Québec. Un devis mixte impliquant des focus groups a été mis en place. Au total, 49 participants (Québécois : 30, 5 focus groups et Colombiens : 19, 4 focus groups) ont été rencontrés et ont rempli trois questionnaires. Ceux-ci mesurent le familismo, le machismo et l’acculturation. Les scores moyens de familismo, de machismo et d’acculturation ont été intégrés à l’analyse thématique. Il apparait que Québécois et Colombiens se différencient peu quant aux pratiques parentales et aux représentations de la maltraitance et de la protection de la jeunesse. Cependant, la question du développement de l’autonomie et de la réussite des enfants sont deux thèmes majeurs pour lesquels il y a des différences. La place qu’occupe l’État québécois, par l’intermédiaire du système de protection de la jeunesse dans la résolution des conflits, suscite également des discours contrastés. La place que ces personnes prennent dans la société devrait avoir un impact sur le fonctionnement des institutions quant à l’intervention et à la diffusion de l’information par rapport au système de la protection de la jeunesse.

Perceptions of European medical staff on the facilitators and barriers to physical closeness between parents and infants in neonatal units

AIM: Studies have provided insights into factors that may facilitate or inhibit parent-infant closeness in neonatal units, but none have specifically focused on the perspectives of senior neonatal staff. The aim of this study was to explore perceptions and experiences of consultant neonatologists and senior nurses in five European countries with regard to these issues. METHODS: Six small group discussions and three one-to-one interviews were conducted with 16 consultant neonatologists and senior nurses representing nine neonatal units from Estonia, Finland, Norway, Spain and Sweden. The interviews explored facilitators and barriers to parent-infant closeness and implications for policy and practice and thematic analysis was undertaken. RESULTS: Participants highlighted how a humanising care agenda that enabled parent-infant closeness was an aspiration, but pointed out that neonatal units were at different stages in achieving this. The facilitators and barriers to physical closeness included socio-economic factors, cultural norms, the designs of neonatal units, resource issues, leadership, staff attitudes and practices and relationships between staff and parents. CONCLUSION: Various factors affected parent-infant closeness in neonatal units in European countries. There needs to be the political motivation, appropriate policy planning, legislation and resource allocation to increase measures that support closeness agendas in neonatal units. This article is protected by copyright. All rights reserved.

Parents’ Preparedness for Their Infants’ Discharge Following First-stage Cardiac Surgery: Development of a Parental Early Warning Tool

Aim The aim of this study was to explore parental preparedness for discharge and their experiences of going home with their infant after the first-stage surgery for a functionally univentricular heart. Background Technological advances worldwide have improved outcomes for infants with a functionally univentricular heart over the last 3 decades; however, concern remains regarding mortality in the period between the first and second stages of surgery. The implementation of home monitoring programmes for this group of infants has improved this initial inter-stage survival; however, little is known about parents’ experiences of going home, their preparedness for discharge, and parents’ recognition of deterioration in their fragile infant. Method This study was conducted in 2011–2013; eight sets of parents were consulted in the research planning stage in September, 2011, and 22 parents with children aged 0–2 years responded to an online survey during November, 2012–March, 2013. Description of categorical data and deductive thematic analysis of the open-ended questions were undertaken. Results Not all parents were taught signs of deterioration or given written information specific to their baby. The following three themes emerged from the qualitative data: mixed emotions about going home, knowledge and preparedness, and support systems. Conclusions Parents are not adequately prepared for discharge and are not well equipped to recognise deterioration in their child. There is a role for greater parental education through development of an early warning tool to address the gap in parents’ understanding of signs of deterioration, enabling appropriate contact and earlier management by clinicians.

La perception de la collaboration école-famille des parents d'élèves victimisés par leurs pairs au primaire

Ce mémoire vise à connaître la perception des parents de la collaboration école-famille principalement lorsque leur enfant est victime de violence à l’école primaire. Un total de 4 394 parents a complété le QSVE/parents (Beaumont Paquet et Leclerc, 2013). Les résultats révèlent que l’ensemble des parents a une perception positive de cette collaboration, mais elle est perçue plus positivement chez ceux ayant des enfants d’âge préscolaire comparativement à ceux de la fin du primaire. Les parents qui croient leur enfant victime de violence montrent cependant une perception plus négative de cette collaboration. Au primaire, c’est près de 20 % des parents qui ont dit avoir rapporté à l’école la victimisation de leur enfant au cours de l’année scolaire. Une relation significative a été observée entre le nombre de fois que les parents ont avisé l’école et leur niveau de satisfaction de l’accueil et de l’aide reçus par les intervenants scolaires. Même si la perception de la collaboration école-famille devient moins positive en fonction du nombre de fois que le parent a signalé cette victimisation, les résultats suggèrent que près de 40 % des parents qui ont signalé quatre fois et plus la victimisation de leur enfant au cours de l’année se sont dits satisfaits de l’aide reçue par l’école. Des pistes de réflexion sont finalement suggérées soulignant l’importance de pousser plus loin la réflexion sur les conditions facilitant la collaboration école-famille dans ce type de situation difficile.