Associations between early shared music activities in the home and later child outcomes : findings from the Longitudinal Study of Australian Children

The benefits of early shared book reading between parents and children have long been established,yet the same cannot be said for early shared music activities in the home. This study investigated the parent–child home music activities in a sample of 3031 Australian children participating in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) study. Frequency of shared home music activities was reported by parents when children were 2–3 years and a range of social, emotional,and cognitive outcomes were measured by parent and teacher report and direct testing two years later when children were 4–5 years old. A series of regression analyses (controlling for a set of important socio-demographic variables) found frequency of shared home music activities to have a small significant partial association with measures of children’s vocabulary, numeracy, attentional and emotional regulation, and prosocial skills. We then included both book reading and shared home music activities in the same models and found that frequency of shared home music activities maintained small partial associations with measures of prosocial skills, attentional regulation, and numeracy. Our findings suggest there may be a role for parent-child home music activities in supporting children’s development.

Recurrence risk modelling of the genetic susceptibility to ankylosing spondylitis

Objectives - It has long been suspected that susceptibility to ankylosing spondylitis (AS) is influenced by genes lying distant to the major histocompatibility complex. This study compares genetic models of AS to assess the most likely mode of inheritance, using recurrence risk ratios in relatives of affected subjects. Methods - Recurrence risk ratios in different degrees of relatives were determined using published data from studies specifically designed to address the question. The methods of Risch were used to determine the expected recurrence risk ratios in different degrees of relatives, assuming equal first degree relative recurrence risk between models. Goodness of fit was determined by χ2 comparison of the expected number of affected subjects with the observed number, given equal numbers of each type of relative studied. Results - The recurrence risks in different degrees of relatives were: monozygotic (MZ) twins 63% (17/27), first degree relatives 8.2% (441/5390), second degree relatives 1.0% (8/834), and third degree relatives 0.7% (7/997). Parent-child recurrence risk (7.9%, 37/466) was not significantly different from the sibling recurrence risk (8.2%, 404/4924), excluding a significant dominance genetic component to susceptibility. Poor fitting models included single gene, genetic heterogeneity, additive, two locus multiplicative, and one locus and residual polygenes (χ2 > 32 (two degrees of freedom), p < 10-6 for all models). The best fitting model studied was a five locus model with multiplicative interaction between loci (χ2 = 1.4 (two degrees of freedom), p = 0.5). Oligogenic multiplicative models were the best fitting over a range of population prevalences and first degree recurrence risk rates. Conclusions - This study suggests that of the genetic models tested, the most likely model operating in AS is an oligogenic model with predominantly multiplicative interaction between loci.

Parenting practices in Northern Ireland: evidence from the Northern Ireland Household Panel Survey

The impact of parental child-rearing practices on child outcomes has been the subject of much research and debate for many years. Studies carried out within a variety of disciplines and across a number of different countries in the world have indicated that parents tend to use a different pattern of rearing their sons than their daughters, and that child-rearing practices are related to the gender of the parent, as well as to the age and developmental stage of the child. However, there has been little research in Northern Ireland on child-rearing behaviours. In order to address this shortfall, this paper presents an analysis of parents’ perceptions of their interactions with their children. Data from Wave 3 of the Northern Ireland Household Panel Survey were analysed to explore aspects of ‘‘negative’’ parenting practices (arguing, yelling and use of physical punishment) as well as ‘‘positive’’ parenting practices (talking, praising and hugging). The participants were all parents (aged 16 years and over) with children under the age of 16 years living in the same household. Each parent reported his/her interaction with each child (up to a maximum of six children), and in total 1,629 responses were recorded. The results of the research supported previous findings from the United Kingdom and elsewhere, and indicated that the parenting styles of respondents in Northern Ireland were indeed related to the gender and age of the children and to the gender of the parents. The survey found that parents in Northern Ireland tend to have a harsher, more negative style of parenting boys than girls and that children in their teenage years have fewer positive interactions with their parents than younger children. The same parents and children will be followed up in 2007 in order to provide a longitudinal analysis of parent/child relationships in Northern Ireland.

Early pain experience, child and family factors, as precursors of somatization:a prospective study of extremely premature and fullterm children

In a prospective study of 36 children who were extremely low birthweight (ELBW: <1000 g) preterm infants and 36 matched full-term controls, differences were found in somatization at age 4 1/2 years. Only children who had been extremely premature, and thereby experienced prolonged hospitalization and repeated medical intervention in infancy, had clinically high somatization scores on the Personality Inventory for Children. The combination of family relations at age 4 1/2 years, neonatal intensive care experience, poor maternal sensitivity to child cues in mother-child interaction observed at age 3 years, and child avoidance of touch or holding at age 3, predicted somatization scores, prior to school entry. Due to the known higher incidence of actual medical problems among children with a history of extreme prematurity, the high somatization ELBW children were compared with the normal somatization ELBW children. There were no differences in prevalence of actual medical problems between the 2 ELBW groups, and the importance of maternal factors in relation to somatization was confirmed. Child temperament at age 3, but not personality at 4 1/2, was related to somatization. The etiology of recurrent physical complaints of no known medical cause appears to be a multi-dimensional problem. Non-optimal parenting may contribute to the development of inappropriate strategies for coping with common pains of childhood, or of chronic pain patterns, in some children who have experienced prolonged or repeated pain as neonates.

First steps: study protocol for a randomized controlled trial of the effectiveness of the Group Family Nurse Partnership (gFNP) program compared to routine care in improving outcomes for high-risk mothers and their children and preventing abuse

Background: Evidence from the USA suggests that the home-based Family Nurse Partnership program (FNP), extending from early pregnancy until infants are 24 months, can reduce the risk of child abuse and neglect throughout childhood. FNP is now widely available in the UK. A new variant, Group Family Nurse Partnership (gFNP) offers similar content but in a group context and for a shorter time, until infants are 12 months old. Each group comprises 8 to 12 women with similar expected delivery dates and their partners. Its implementation has been established but there is no evidence of its effectiveness.

Methods/Design: The study comprises a multi-site randomized controlled trial designed to identify the benefits of gFNP compared to standard care. Participants (not eligible for FNP) must be either aged <20 years at their last menstrual period (LMP) with one or more previous live births, or aged 20 to 24 at LMP with low educational qualifications and no previous live births. 'Low educational qualifications' is defined as not having both Maths and English Language GCSE at grade C or higher or, if they have both, no more than four in total at grade C or higher. Exclusions are: under 20 years and previously received home-based FNP and, in either age group, severe psychotic mental illness or not able to communicate in English. Consenting women are randomly allocated (minimized by site and maternal age group) when between 10 and 16 weeks pregnant to either to the 44 session gFNP program or to standard care after the collection of baseline information. Researchers are blind to group assignment. The primary outcomes at 12 months are child abuse potential based on the revised Adult-Adolescent Parenting Inventory and parent/infant interaction coded using the CARE Index based on a video-taped interaction. Secondary outcomes are maternal depression, parenting stress, health related quality of life, social support, and use of services.

Discussion: This is the first study of the effectiveness of gFNP in the UK. Results should inform decision-making about its delivery alongside universal services, potentially enabling a wider range of families to benefit from the FNP curriculum and approach to supporting parenting.

Assessing elements of a family approach to reduce adolescent drinking frequency: parent-adolescent relationship, knowledge management, and keeping secrets

AIMS: To estimate 1) the associations between parent-adolescent relationship, parental knowledge and subsequent adolescent drinking frequency and 2) the influence of alcohol use on parental knowledge.

DESIGN: Path analysis of school based cohort study with annual surveys SETTING: Post primary schools from urban and intermediate/rural areas in Northern Ireland PARTICIPANTS: 4,937 post primary school students aged around 11 years in 2000 followed until around age 16 in 2005.

MEASUREMENTS: Pupil reported measures of: frequency of alcohol use; parental-child relationship quality; sub-dimensions of parental monitoring: parental control, parental solicitation, child disclosure and child secrecy.

FINDINGS: Higher levels of parental control (Ordinal logistic OR 0.86 95% CI 0.78, 0.95) and lower levels of child secrecy (OR 0.83 95% CI 0.75 0.92) were associated with less frequent alcohol use subsequently. Parental solicitation and parent-child relationship quality were not associated with drinking frequency. Weekly alcohol drinking was associated with higher subsequent secrecy (Beta -0.42 95% CI -0.53, -0.32) and lower parental control (Beta -0.15 95% CI -0.26, -0.04). Secrecy was more strongly predictive of alcohol use at younger compared with older ages (P=0.02), and alcohol use was less strongly associated with parental control among families with poorer relationships (P=0.04).

CONCLUSIONS: Adolescent alcohol use appears to increase as parental control decreases and child secrecy increases. Greater parental control is associated with less frequent adolescent drinking subsequently, while parent-child attachment and parental solicitation have little influence on alcohol use. 

TIC e relação pais-filhos : um projecto de formação na Alta de Lisboa

Relatório de estágio de mestrado, Ciências da Educação (Formação de Adultos), Universidade de Lisboa, Instituto de Educação, 2011

Development of a Parent Version of the Manchester-Minneapolis Quality of Life Survey for use by Parents and Crers of UK Children: MMQL-UK (PF).

Background Although it is now widely endorsed that children should as far as possible rate their own health related quality of life (HRQL), there are situations where proxy information on child HRQL may be useful, especially where a child is too ill or young to provide their own HRQL assessment. There is limited availability of generic HRQL scales that have a parallel child and parent version and that are reliable, valid, brief, comprehensible and suitable for use in UK populations. The aims of this study were therefore to develop and validate a parent version of the anglicised Manchester-Minneapolis Quality of Life child form (MMQL-UK (CF)) and to determine the level of association between the child and parent versions of this form. Methods This study was undertaken concurrently with the anglicisation and validation of the MMQL, a measure of HRQL developed for use with children in North America. At that time, no parent version existed, so the MMQL form for children (MMQL-UK (CF)) was used as the basis for the development of the MMQL-UK parent form (PF). The sample included a control group of healthy children and their parents and five exemplar groups; children diagnosed with asthma, diabetes or inflammatory bowel disease and their parents, children in remission from cancer and their parents and children in public care and their carers. Consistency of the MMQL-UK (PF) components were assessed by calculating Cronbach's alpha. Validation of the parent questionnaire was undertaken by comparing MMQL-UK (PF) component scores with comparable components on the proxy PedsQL™ quality of life scales, comparing MMQL-UK (PF) component scores between parents of healthy and chronic disease children and by comparison of component scores from children and their parents or carers. Reproducibility and responsiveness were assessed by retesting parents by follow-up questionnaires. Results A total of 874 children (completing MMQL-UK (CF)) and 572 parents or carers (completing MMQL-UK (PF)) took part in the study. The internal consistency of all the MMQL-UK (PF) components exceeding the accepted criterion of 0.70 and the construct validity was good with moderate correlations being evident between comparable components of the MMQL-UK (PF) and the proxy PedsQL™. Discriminant validity was demonstrated with significant differences being identified between parents of healthy children and those with chronic conditions. Intra-class correlations exceeded 0.65 for all MMQL-UK (PF) components demonstrating good reproducibility. Weak to moderate levels of responsiveness were demonstrated for all but social functioning. The MMQL-UK (PF) showed moderate parent-child correlation with the MMQL-UK (CF) for all components. The best correlations were seen for those components measuring the same construct (Pearson's r ranged from 0.31 to 0.61, p < 0.01 for equivalent components). Conclusion The MMQL-UK (PF) showed moderate to good correlations with the MMQL-UK (CF) component scores. The MMQL-UK (PF) will be of use when comparing child and parent/carer perception of the impact of a child's condition on their HRQL or where the child is too ill or young to provide their own report.

Estudo sobre a qualidade da autorregulação do bebé na situação face-to-face-still-face com o pai

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Ciências da Educação Especialidade Intervenção Precoce

Family relationships and learning experiences in anxious vs. non-anxious families: Are there differences ?

L'objectif principal de ce travail était d'explorer les relations parent-enfant et les processus d'apprentissage familiaux associés aux troubles anxieux. A cet effet, des familles ayant un membre anxieux (la mère ou l'enfant) ont été comparées avec des familles n'ayant aucun membre anxieux. Dans une première étude, l'observation de l'interaction mère-enfant, pendant une situation standardisée de jeu, a révélé que les mères présentant un trouble panique étaient plus susceptibles de se montrer verbalement contrôlantes, critiques et moins sensibles aux besoins de l'enfant, que les mères qui ne présentaient pas de trouble panique. Une deuxième étude a examiné les perceptions des différents membres de la famille quant aux relations au sein de la famille et a indiqué que, par comparaison aux adolescents non-anxieux, les adolescents anxieux étaient plus enclins à éprouver un sentiment d'autonomie individuelle diminué par rapport à leurs parents. Finalement, une troisième étude s'est intéressée à déterminer l'impact d'expériences d'apprentissage moins directes dans l'étiologie de l'anxiété. Les résultats ont indiqué que les mères présentant un trouble panique étaient plus enclines à s'engager dans des comportements qui maintiennent la panique et à impliquer leurs enfants dans ces comportements, que les mères ne présentant pas de trouble panique. En se basant sur des recherches antérieures qui ont établi une relation entre le contrôle parental, la perception de contrôle chez l'enfant et les troubles anxieux, le présent travail non seulement confirme ce lien mais propose également un modèle pour résumer l'état actuel des connaissances concernant les processus familiaux et le développement des troubles anxieux. Deux routes ont été suggérées par lesquelles l'anxiété pourrait être transmise de manière intergénérationnelle. Chacune de ces routes attribue un rôle important à la perception de contrôle chez l'enfant. L'idée est que lorsque les enfants présentent une prédisposition à interpréter le comportement de leurs parents comme hors de leur contrôle, ils seraient plus enclins à développer de l'anxiété. A ce titre, la perception du contrôle représenterait un tampon entre le comportement de contrôle/surprotection des parents et le trouble anxieux chez l'enfant. - The principal objective of the present work was to explore parent-child relationships and family learning processes associated with anxiety disorders. To this purpose, families with and without an anxious family member (mother or child) were compared. In a first study, observation of mother-child interaction, during a standard play situation, revealed that mothers with panic disorder were more likely to display verbal control and criticism, and less likely to display sensitivity toward their children than mothers without panic disorder. A second study examined family members' perceptions of family relationships and indicated that compared to non-anxious adolescents, anxious adolescents were more prone to experience a diminished sense of individual autonomy in relation to their parents. Finally a third study was interested in determining the effect of less direct learning experiences in the aetiology of anxiety. Results indicated that mothers with panic disorder were more likely to engage in panic-maintaining behaviour and to involve their children in this behaviour than mothers without panic disorder. Based on previous research showing a relationship between parental control, children's perception of control, and anxiety disorders, the present work not only further adds evidence to support this link but also proposes a model summarizing the current knowledge concerning family processes and the development of anxiety disorders. Two pathways have been suggested through which anxiety may be intergenerationally transmitted. Both pathways assign an important role to children's perception of control. The idea is that whenever children have a predisposition towards interpreting their parents' behaviour as beyond of their control, they may be more prone to develop anxiety. As such, perceived control may represent a buffer between parental overcontrolling/overprotective behaviours and childhood anxiety disorder.

Parental goals among Italian-Canadian and Anglo-Canadian families : their connection to socialization practices and the quality of parent-young adult relationship /

Parenting goals are the behavioral, cognitive, and affective outcomes that parents implicitly or explicitly strive to achieve during specific interactions with their children. In the present study, intergenerational parenting practices and goals in Italian-Canadian and Anglo-Canadian families were examined. The association between parenting goals, parents' socialization practices, and the quality of relationship between parent and child were investigated. Participants included individuals ranging in age from 1 8-26 years and their mothers from Anglo-Canadian (n= 31) and Italian-Canadian families (n= 50). The young adults and their mothers were asked to imagine how their respective parents would have reacted to five hypothetical vignettes depicting difficult parent-child interactions. Young adults and their mothers were also asked to rate the importance of parenting goals within these parent-child situations. In addition, young adults assessed the perceived quality of their present relationships with each parent. Cultural differences were revealed such that Italian-Canadian parents endorsed more authoritarian parenting strategies and relationship-centered goals than Anglo-Canadian parents. However, Italian-Canadian and Anglo-Canadian parents were not found to differ on their endorsement of parent-centered goals. Italian-Canadian parents' who did use authoritarian strategies were found to have young-adult children who perceived their relationship with their parents as less satisfying, intimate, affectionate and having relatively high levels of conflict than parents who did not use authoritarian strategies. Anglo-Canadian parents' authoritative strategies were correlated with a better perceived relationship quality by young-adult children.

Effects of a preschool parent enrichment programme on children and their parents /

This study evaluated a preschool parent enrichment programme to assess if child and parent involvement in the programme facilitated the children's subsequent school adjustment. Also examined were the programme's effects on parent-child relationships. Participants were 56 Junior-Senior Kindergarten and Grade One students from one elementary school. Parent participants were 12 parents from the preschool parent enrichment programme, 6 parents whose children had attended other preschool programmes, and 6 parents whose children had remained at home prior to school. Five elementary teachers and both nursery school teachers from the parent enrichment programme also participated. Measures used included the Florida Key to assess children's inferred self-concept as learner and four subscales (relating, asserting, coping and investing), and interviews to assess parent and teacher perceptions. Findings indicated that there was little difference between parent and teacher perceptions about children who had attended a preschool programme. Both groups showed improved social, emotional, and behavioural skill development, together with increased self-esteem, and the ability to cope with separation from their parents. This enabled children to make the transition from preschool to primary school more successful. Children from the parent enrichment programme were not readily identifiable in terms of the profile promulgated for disadvantaged children. The Florida Key showed a main effect for the coping subscale, indicating that children from the parent enrichment programme may show more confidence in their abilities, and seek assistance from teachers than children who had no preschool experience. The parent enrichment programme appeared to have the biggest impact on the parents. Parents reported improved relationships with their children, increased confidence and self-esteem, as well as improved parenting and general life skills. The implications for short-term gains for children from this type of programme are better readiness for school, more positive self-esteem, improved social behaviour, and a higher achievement motivation. The long-term gains for children are predicted to be fewer special education placements, less grade retention, and a lower dropout rate from school. The short-term gains for parents are better social support networks," greater self-confidence, better interactions with children, and improved parenting skills. The long-term benefits may be an increased motivation to continue education, gain employment, and less family breakdown and abuse.

Étude exploratoire de la détérioration du lien parent-enfant : contexte d’apparition, caractéristiques et comportements des couples parentaux séparés impliqués dans ces dynamiques

L’objectif principal de cette thèse de doctorat est de déterminer, à l’aide d’une grille d’observation des comportements parentaux après la séparation , si des catégories de la grille permettent de distinguer entre eux les couples parentaux où le risque de Détérioration du Lien Parent-Enfant en contexte de séparation conflictuelle (DLPE) est très élevé des couples parentaux où le risque de DLPE est très faible. De plus, trois objectifs secondaires s’ajoutent à notre objectif principal. Premièrement, nous avons tenté de voir s’il était possible de prédire les cas où les risques de DLPE sont très élevés. Deuxièmement, nous avons exploré comment la DLPE s’inscrit dans les conséquences pouvant découler de la séparation parentale. Et enfin, troisièmement, nous avons brièvement exploré la question des allégations d’agression sexuelle envers l’enfant dans les contextes de DLPE. Cette thèse est composée de deux articles et d’une note de recherche brève. Le premier article s’intitule En quoi et pourquoi les hommes et les femmes sont-ils affectés différemment par la séparation conjugale? Cet article est une recension critique de la littérature traitant des conséquences du divorce chez les adultes ainsi que des conséquences différentielles du divorce pour les hommes et les femmes. Dans cet article, des hypothèses explicatives quant à l’origine de ces diverses conséquences sont discutées et nous proposons de les conceptualiser sous la forme d’un éventail rendant compte des impacts tant positifs que négatifs, notamment à une extrémité du continuum où se retrouvent les dynamiques DLPE. Ce continuum sur lequel s’inscrit la DLPE permet de conceptualiser et de discuter de l’adaptation ou de la mésadaptation des individus face à la séparation. Dans cet article, notre regard sur la DLPE fait ressortir les lacunes de la recherche actuelle sur ce phénomène. Il ressort un manque flagrant de connaissances du contexte d’apparition du phénomène, de connaissances empiriques sur la question des allégations d’abus sexuel se produisant dans le cadre de telles dynamiques ainsi que de connaissances des caractéristiques et des comportements des individus qui y sont impliqués. Conséquemment, notre article met l’emphase sur la nécessité qu’une tradition de recherche se développe dans le domaine de la DLPE afin de clarifier tous ces aspects. Enfin, cet article met en lumière différents facteurs de risque et différents facteurs de protection susceptibles d’expliquer que le divorce ait des conséquences différentes chez les hommes et les femmes. Le deuxième article s’intitule Étude exploratoire des caractéristiques et des comportements de couples parentaux séparés engagés dans une dynamique de Détérioration du Lien Parent-Enfant. Cet article cherchait à déterminer si les couples parentaux séparés hautement à risque d’être engagés dans une dynamique de DLPE se distinguent des couples parentaux séparés dont le risque de DLPE est faible sur certaines variables. Nous avons étudié cette question auprès de notre échantillon de 82 couples parentaux séparés pour lesquels le risque de DLPE est évalué comme étant soit très faible (groupe de comparaison) ou soit très élevé (en tenant compte du fait que la mère ou le père soit le parent dénigrant). À cette fin, nous avons utilisé un instrument de mesure, la Grille d’observation de la Détérioration du Lien Parent-Enfant après la séparation (GODLPE), adapté de celui développé par Johnston, Walters, & Olesen, (2005). Les résultats obtenus à l’aide de tests d’analyse de variance et de khi-deux démontrent que les ex-couples du groupe de comparaison se distinguent des ex-couples du groupe où le risque de DLPE est très élevé par un mariage significativement plus long et un niveau de conflit plus élevé. Également, les résultats démontrent que les parents du groupe de comparaison, les parents dénigrés et les parents dénigrants se distinguent entre eux quant à leurs comportements coparentaux aliénants, à leur relation coparentale supportante, à leur relation coparentale méfiante et à leurs comportements de renversement de rôle. Finalement, notre étude révèle que la durée du mariage et l’intensité des conflits permettent de prédire le risque de DLPE. La note de recherche brève s’intitule Étude exploratoire des allégations d’agression sexuelle envers l’enfant dans un contexte de Détérioration du Lien Parent-Enfant. Cet note de recherche s’intéresse à ce qui a longtemps été considéré comme l’une des caractéristiques déterminantes des dynamiques de DLPE, soit les allégations d’agression sexuelle envers l’enfant professées par un parent à l’endroit de l’autre parent ou d’un membre de son entourage proche. Nous avons étudié cette question chez 82 couples parentaux séparés pour lesquels le risque de DLPE était évalué comme étant très faible ou très élevé. Les résultats indiquent qu’il n’existe aucune différence significative entre les groupes relativement à cette caractéristique. Cependant, les mères auraient davantage tendance à alléguer de tels abus que les pères. Enfin, aucune des allégations professées n’a été jugée suffisamment crédible pour que la Directeur de la protection de la Jeunesse (DPJ) juge nécessaire d’intervenir. Plusieurs hypothèses sont soulevées pour expliquer ces résultats.

Analyse du lien séquentiel entre les comportements d'anxiété et d'évitement lors d'interactions parent-enfant

Les troubles anxieux figurent parmi les psychopathologies les plus fréquentes chez les enfants. Ils peuvent avoir de graves répercussions sur leur développement et, à long terme, ils tendent à persister ainsi qu’à s’aggraver. L’évitement est un moyen souvent utilisé par les personnes anxieuses, adultes ou enfants, afin de tenter d’échapper à l'objet de leur peur et ainsi faire diminuer leur niveau d’anxiété. Les schémas cognitifs dysfonctionnels reliés à l’anxiété, et à l’origine de l’évitement, se développent tôt chez l’enfant et sont en partie reliés aux interactions parent-enfant. La présente recherche vise à examiner, à l’aide d’une analyse séquentielle des interactions, la dépendance entre les comportements d’anxiété et d’évitement chez les membres de 20 dyades parent-enfant, dont les enfants sont âgés entre 4 et 7 ans. La tâche d’interaction, une histoire à compléter par les membres de la dyade, a la capacité de susciter des émotions anxieuses chez les participants. Les résultats de cette étude ne permettent pas de démontrer une dépendance entre les comportements d’anxiété et d’évitement des parents et ceux des enfants. La discussion présente des éléments de réflexion sur des pistes de recherche à explorer.

Intervention éducationnelle de massage auprès de parents de nouveau-nés prématurés dans le but de favoriser leur sensibilité parentale

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option expertise-conseil en soins infirmiers