Intervention précoce dans la phase initiale des troubles psychotiques à Lausanne: quels problèmes et quelles solutions [Early intervention for the initial phase of psychotic disorders in Lausanne: what problems and what solutions?]

Schizophrenia has long been considered with pessimism, but the recent interest in the early phase of psychotic disorders has modified this often unjustified perception. Literature has demonstrated the benefit of the development of programs specialised in the treatment of early psychosis, which tend to be developed in many countries. It is however important to match them to local needs as well as to the structure of local health services. This paper reviews elements that justify such a development in Lausanne, Switzerland, and describe its various elements.

Parents living with HIV in a high-income country: do patients need specific support?

The number of HIV-infected persons with children and caregiving duties is likely to increase. From this statement, the present study was designed to establish how HIV infected caregivers organise their parenting routines and to determine their support needs. A further aim was to ascertain caregivers' perception of conspicuous behaviours displayed by their children. Finally, it sought to determine the extent to which the caregivers' assessment of their parenting activity is influenced by the required support and their children's perceived conspicuous behaviours. The study design was observational and cross-sectional. Sampling was based on the 7 HIV Outpatient Clinics associated with the national population-based Swiss HIV Cohort Study. It focused on persons living with HIV who are responsible for raising children below the age of 18. A total of 520 caregivers were approached and 261 participated. An anonymous, standardised, self-administered questionnaire was used for data collection. The data were analysed using descriptive statistical procedures and backward elimination multiple regression analysis. The 261 respondents cared for 406 children and adolescents under 18 years of age; the median age was 10 years. The caregivers' material resources were low. 70% had a net family income in a range below the median of Swiss net family income and 30% were dependent on welfare assistance. 73% were undergoing treatment with 86% reporting no physical impairments. The proportion of single caregivers was 34%. 92% of the children were living with their HIV infected caregivers. 80% of the children attended an institution such as a school or kindergarten during the day. 89% of the caregivers had access to social networks providing support. Nevertheless, caregivers required additional support in performing their parenting duties and indicated a need for assistance on the material level, in connection with legal problems and with participation in the labour market. 46% of the caregivers had observed one or more conspicuous behaviours displayed by their children, which indicates a challenging situation. However, most of these caregivers assessed their parenting activity very favourably. Backward elimination multiple regression analysis indicated that a smaller number of support needs, younger age of the eldest child and fewer physical impairments on the part of the caregiver enhance the caregivers' assessment of their parenting activity. Physicians should speak to caregivers living with HIV about their parenting responsibilities and provide the necessary scope for this subject in their consultation sessions. Physicians are in a position to draw their patients' attention to the services available to them.

Integrating Children with Emotional and Behavioural Disabilities into Community Recreation Programs: A Handbook for Staff

This study examined the process of integrating children with Emotional Behavioural Disorders (EBDs) with their peers into recreation programs. The purpose was to develop a set of recommendations for the development of a handbook to help workers in recreation with the integration process. To this end, a needs assessment was conducted with experienced recreation workers in the form of semistructured interviews. Participants were recruited from two community centers in a large southern Ontario city. Themes were drawn from the analysis of the interview transcripts and combined with findings from the research literature. The results were a set of recommendations on the content and format of a handbook for integrating children with EBDs into recreation programs.

Anxiety in the Primary Classroom: A Handbook for Elementary Educators

This project presents a literature review of pediatric anxiety including the prevalence, etiology, and treatment of anxiety disorders in children, presented along with evidence indicating the short- and long-term effects of anxiety in young children, and the important role of the school in first response regarding the early identification and intervention for these children. A needs assessment was conducted using primary elementary school teachers to identify their level of confidence in their ability to identify and support children suffering with anxiety disorders in their classrooms. Results of the assessment indicated a strong need for a resource that provides both information and support for teachers in their interactions with children with anxiety disorders. The assessment results were used to guide the development of a handbook for elementary educators providing current empirical research detailing information about various forms of anxiety disorders commonly affecting young children in primary grades, as well as a list of available resources, and a series of six sequential lesson plans to be implemented for the entire class. Lesson plans are designed to facilitate increased levels of understanding toward the issues confronted by children suffering from anxiety, and fostering strong peer relations and character-building opportunities. Participants were provided with the handbook for evaluation, which indicated a strong support for the effectiveness and usefulness of the resource.

A Home Literacy Handbook for Parents With Preschool Children

The purpose of this project was to provide parents with an awareness of the role that they play in their preschool children's literacy and reading development and to create a practical handbook that parents can use to teach early literacy and reading skills to their preschool children in their home environment. The handbook was created in response to the literature that confirmed that the children benefit from developing emergent literacy skills before they enter school in kindergarten or grade 1. In addition to the information gathered from the academic literature, needs assessments were conducted in order to hear perspectives from multiple stakeholders involved in the context of this project. The needs assessment questionnaires were conducted with 4 Ontario certified grade 1 and 2 teachers, and 4 parents with preschool children or children in kindergarten or grade 1. Data collected from these participants highlighted the needs of parents and were used to create a comprehensive handbook that will hopefully be accessible and useful to a wide parent audience. The results of the research project indicated that parents would, in fact, benefit from having access to a resource such as this handbook to assist in teaching the 4 components of emergent literacy to their preschool children––oral language, alphabet knowledge, phonological awareness, and print awareness––to their preschool children.

Conduct Disorder: A Handbook for Elementary School Educators

This research project examined the behavioural, social, and emotional issues affecting children and youth with conduct disorder. Based on the literature review, the deconstruction of theoretical and empirical studies, and findings from the needs assessment, Conduct Disorder: A Handbook for Elementary School Educators was created. This handbook was developed based on the evidence that conduct problems can most effectively be improved when multiple systems are included in the prevention and intervention of the disorder. Educators, related service providers, and the child all play an important role in designing and implementing effective interventions. Therefore, it is imperative to provide educators with the information necessary to begin this emerging collaborative process. The handbook was created as a tool for educators intending to enhance their knowledge when working with students with conduct disorder. A Needs Assessment was conducted to determine what educators wanted the handbook to contain to assist them in working with students displaying conduct problems. The educators evaluated the handbook, providing constructive feedback and confirming the potential value and practicality of this handbook for elementary school educators. The educators reported an increase in their understanding of conduct disorder, as well as a heightened awareness of the causal factors that contribute to the disorder. The list of community resources and agencies was thought to be a good starting point for educators looking for supplementary aids. The educators indicated that the handbook is a good reference tool to use when teaching students with conduct problems. The educators concluded with the hope that this handbook will be shared with others.

Working Memory in the Junior/Intermediate Classroom

This research project explored the connection between working memory and children’s learning. The project created a resource titled Working Memory Strategies for the Junior/ Intermediate Educator: A Handbook based on a literature review, the deconstruction of theoretical and empirical studies, teacher resources, and findings from a needs assessment completed by teachers that together show there is insufficient support for teachers working with students who have deficits in working memory along with other common classroom learning disabilities. As learning disabilities become more common in the classroom that increasingly affect working memory in a majority of cases, teachers must be prepared not only to address specific symptoms of the conditions, but also to help students learn how to navigate and become aware of their working memory ability. The handbook thus was developed as a useful resource for teachers looking to expand their knowledge about how learning occurs. A needs assessment completed by junior and intermediate division teachers in Ontario helped determine what educators found most important for inclusion in the handbook, and the same teachers were offered the opportunity to review the completed handbook. Teacher participants provided constructive feedback and indicated that the handbook would be a valuable resource for them and their colleagues when working with students who have working memory issues. It was suggested that the handbook would be useful when creating students’ Individual Education Plans and that the assessment checklist included in the handbook would be an excellent resource for teachers collecting data regarding students’ working memory and ability to learn.

Supporting social-cognitive development in the elementary years: The role of executive function and self-regulation

Every day we make decisions that have repercussions. Sometimes the effects are immediate and intended; other times the effects might be unintended or might not be apparent for years. As parents or educators, part of our role is to support the development of children’s decision-making skills, helping them to develop patterns of adaptive decision-making that will serve them well in their current lives and into the future. Part of successful decision-making involves self-control, a system served by the brain’s executive functions (EF). This involves the ability to put aside immediate reactions and base decisions on a variety of important considerations. Social-cognitive development, the ongoing improvement of the ability to get along with others and to understand others’ emotions, expressions, motivations, and intents, relies, to a large degree, on the same EF systems. The current paper explores the interaction of these two factors (the role of EF in social-cognitive development), explores the research to determine the most effective approaches to improving both factors, and develops a handbook providing activities for educators to use while supporting the growth of both EF and social-cognitive skills. Results of a needs assessment reveal that the majority (59%) of educators surveyed had never used a social skills improvement program in their classrooms, while a full 95% believed that social skills are important or very important for a student’s academic success.

L’élaboration d’un programme d’Enseignement à distance par radio (EADR) pour l’amélioration des résultats d’examens officiels du baccalauréat 1ère partie en Haïti

Ce mémoire de maîtrise porte sur la contribution que pourrait apporter l’Enseignement à distance par radio (EADR) dans la réduction du taux d’échec aux examens du baccalauréat 1ère partie en Haïti. De manière spécifique, nous souhaitions élaborer un programme d’ « Enseignement à distance par radio » (EADR) afin d’aider l’ensemble des candidats bacheliers des classes de Rhéto à préparer les examens du bac 1ère partie. En Haïti, l’Enseignement à distance (EAD) est pratiquement absent. De nombreux pays ayant eu des situations similaires à Haïti ont mis en place des programmes de « Formations ouvertes et à distance » (FOAD) en complémentarité avec le mode d’enseignement classique ou en mode présentiel. La complexité de la situation exige d’envisager diverses pistes pour sortir le système éducatif haïtien de cette léthargie. Si l’on ne peut considérer l’EAD comme l’unique perspective, il est par contre pertinent et souhaitable de l’envisager comme une alternative non négligeable (Lubérisse, 2003). En nous appuyant sur les principales conditions d’efficacité des FOAD définies par Karsenti (2003), les principes théoriques de type R & D (Van der Maren, 2003?), le cadre théorique de la méthodologie de l’évaluation des besoins de Chagnon et Paquette (Institut universitaire des Centres Jeunesses de Montréal, 2005) et de Roegiers, Wouters & Gerard (1992), nous avons élaboré les grandes lignes générales de ce programme d’EADR et les avons soumises à douze (12) acteurs clés du système éducatif haïtien (4 élèves, 3 parents, 2 enseignants et 3 spécialistes de la radio ou de l’EADR). Cette ébauche de programme comportait principalement les objectifs du programme d’EADR, la méthode pédagogique, le contenu et les conditions de mise en œuvre. Des données recueillies par le biais d’entrevues individuelles il ressort que l’implantation d’un programme d’EADR peut être bénéfique au système éducatif haïtien, particulièrement sur les résultats d’examens officiels du baccalauréat 1ère partie. Les douze participants à notre recherche, croient que l’objectif poursuivi par le programme d’EADR est tout à fait réalisable et important pour le public cible. Tout en notant l’aspect positif du programme d’EADR proposé, les participants réclament certaines modifications quant à la méthode pédagogique, au contenu et aux conditions de mise en œuvre. Ainsi, les recommandations faites par les douze acteurs clés du système éducatif, jointes à notre recension nous ont permis d’élaborer un nouveau programme d’EADR revu et corrigé qui pourra servir de base à une évaluation plus large.

Développer le soutien aux besoins psychologiques des employés : évaluation des effets affectifs, comportementaux et motivationnels d’une formation destinée aux gestionnaires

Alors que la théorie de l’autodétermination (Deci & Ryan, 1985, 2000, 2008) propose un bassin de connaissances pouvant être d’une réelle utilité pour aider les travailleurs et les organisations à croître et à prospérer, peu d’études ont porté, à ce jour, sur l’évaluation d’interventions visant à implanter ces connaissances sur le terrain en milieu organisationnel. En ce sens, la présente thèse a pour but de vérifier l’impact d’une formation visant le développement des habiletés de soutien aux besoins psychologiques des gestionnaires sur les comportements en emploi de ces gestionnaires ainsi que sur la satisfaction des besoins psychologiques, la motivation et la santé psychologique de leurs employés. Pour ce faire, 17 gestionnaires provenant de deux organisations canadiennes du secteur public ont participé à un programme de formation d’une durée de trois journées non consécutives. Ils ont également répondu à des questionnaires un mois avant la formation ainsi que trois à quatre mois après le début de celle-ci afin d’évaluer leurs apprentissages ainsi que leurs comportements de soutien aux besoins psychologiques en emploi. Par ailleurs, 55 de leurs employés ont répondu à des questionnaires préformation et postformation au sujet de leur perception à l’égard des comportements de soutien aux besoins psychologiques de leur supérieur immédiat ainsi que de leur propre niveau de satisfaction des besoins psychologiques, de motivation au travail et de santé psychologique. L’étude a été menée à l’aide d’un devis de recherche de type prétest et post-test à groupes non-équivalents, sans groupe contrôle. Afin de renforcer ce devis, la stratégie de référence interne a été utilisée auprès des employés (Haccoun & Hamtiaux, 1994). Les résultats suggèrent que, dans la mesure où des gains étaient possibles par le biais d’une formation plus traditionnelle (c.-à-d., que le potentiel des gestionnaires à s’améliorer davantage par rapport à leur niveau de base était suffisant et que les habiletés visées se développaient bien par le biais d’une telle formation), les gestionnaires ont développé leurs habiletés de soutien aux besoins psychologiques et, selon leur perspective, transféré leurs apprentissages au travail. Toutefois, les employés de ces gestionnaires n’ont pas perçu de changement statistiquement significatif entre les deux temps de mesure quant aux habiletés de soutien aux besoins psychologiques de leur supérieur immédiat en emploi et les retombées escomptées de la formation chez les employés n’ont pas été observées. À la lumière de ces résultats, le dernier chapitre de la thèse discute de l’importance de l’analyse des besoins, de l’implication de l’environnement organisationnel dans les initiatives de formation ainsi que de l’ajout de méthodes d’apprentissage complémentaires aux formations plus traditionnelles afin d’en assurer l’efficacité. Par ailleurs, les contributions, limites et pistes de recherches futures de la thèse y seront exposées.

Rol del residente de Medicina Interna de la Universidad del Rosario como docente

Antecedentes: Cada vez es mayor la relevancia que se da al papel del residente como docente, no solo por su importancia en la formación de estudiantes, internos y otros miembros del equipo de salud, sino por su deber en la instrucción del paciente y su familia. A pesar de ello, el rol del residente como docente no se encuentra plenamente definido en nuestro medio. Objetivo: Caracterizar el rol de los residentes de Medicina Interna de la Universidad el Rosario en la Fundación Cardioinfantil como docentes. Métodos: Estudio cualitativo a partir de observaciones en escenarios de enseñanza y entrevistas semiestructuradas a 44 participantes distribuidos en grupos focales Resultados: Los residentes asumen un rol docente en diversos escenarios educativos con estudiantes, internos, residentes y docentes. Reconocen que no tienen la preparación necesaria para asumir esta responsabilidad ni funciones establecidas para tal fin. A pesar de esto, utilizan diferentes estrategias para enseñar y se sienten motivados para hacerlo. Conclusiones: El rol del residente como docente en el servicio de Medicina Interna en la Fundación Cardioinfantil es fundamental para la formación de los futuros médicos y especialistas según la percepción que tienen los grupos focales. Los encuentros pedagógicos están enmarcados por la disponibilidad de tiempo y dependen de características personales del residente, conocimiento disciplinar y formación para enseñar. Se considera que se debe apoyar más el entrenamiento en docencia de los residentes, avanzar en la formalización de las funciones docentes de los mismos y generar sistemas de evaluación de este proceso de enseñanza y aprendizaje.

Estudo das competências pessoais e interpessoais de acordo com as soft skills e hard skills nos empresários das PMEs

Neste percurso sinuoso de longas privações e acontecimentos, esta investigação só foi possível graças à colaboração franca e estreita de várias pessoas, algumas delas ausentes, mas que em muito contribuíram para o sucesso deste estudo, o nosso profundo reconhecimento e sincero agradecimento. Ao Professor Doutor Manuel Jacinto de Ascensão Jardim, que foi uma pessoa sempre disponível e cuja orientação suprema de conhecimento neste estudo, que por vezes se tornou penoso, mas que através da sua sabedoria e experiência, levou-nos a bom porto, por mares claros, lúcidos e objectivos, o nosso muito obrigado. Aos empresários, gestores e aos docentes convidados, que contribuíram decisivamente para a investigação, colaborando na entrevista do estudo, que foram pessoas que pelas suas vivências deram o carácter construtivo e enriquecedor, sem eles, isto não seria o mesmo, a todos eles, o nosso agradecimento muito profundo. Ao ISLA.GAIA e a todos os Docentes que de uma forma directa ou indirecta foram incansáveis na procura de opiniões, sugestões e soluções, que pudessem de alguma forma contribuir para o bom encaminhamento do nosso propósito de estudo, não esquecendo os colaboradores não docentes desta instituição que sempre tiveram uma palavra de encorajamento, o nosso muito obrigado a todos. A Todos os colegas e aos colegas que se tornaram amigos, pela empatia, comunhão, temperança se tornaram pessoas importantes, não só este ano, neste caminho solitário, mas incluindo todos aqueles que pela perseverança e sem dúvida, muita partilha, fazem parte desta meta alcançada, o nosso sincero e sentido obrigado. Aos nossos amigos que nos deram o alento e a força para que nunca perdêssemos o norte, estando sempre atentos aos nossos passos, o nosso muito obrigado a todos. Aos nossos familiares um agradecimento muito especial pelo incansável apoio, disponibilidade e compreensão quando privados da nossa presença, muito particularmente à nossa família nuclear, que sempre nos incentivou e viveu mais de perto todas as nossas dúvidas e angustias estando sempre do nosso lado, o nosso muito particular obrigado.

Oral impacts on the daily performance of Brazilians assessed using a sociodental approach: analyses of national data

The aim of this study was to analyze the relationship between oral diseases and their impact on the daily performance of adult and elderly Brazilians, verify the association of oral diseases with socioeconomic and demographic features, and compare the standard estimate of need with the sociodental assessment of these same needs. The authors evaluated data from 17,398 Brazilians aged between 35-44 years and 65-74 years, taken from the cross-sectional Brazilian Oral Health Survey (Saúde Bucal Brasil - SBBrasil). Regression models were applied to assess associations among impacts on daily performance and income, schooling, gender, region, use of dental services, health perception and dental disease status. McNemar’s test was applied to compare standard versus impact-related estimates of need. The prevalence ratio of these impacts was associated with the sociodemographic versus health perceptions (p < 0.001) of adults and the elderly. Adults also had impacts associated with loss of periodontal attachment (p < 0.001). The prevalence of normative needs was 95.39% for adults and 99.76% for the elderly, whereas the impact-related estimate of need was 50.92% and 43.71%, respectively. The impacted-related approach had a statistically significant association with the normative estimate of need (p < 0.001). This study showed a relationship between oral impact on daily performance of adults and educational level. Sociodemographic features were also related to the impacts on both adults and the elderly, and to health perception. The impacts among the adults were related to the loss of periodontal attachment. In addition, the authors found a sizable difference between the standard versus the sociodental approach, in that the sociodental assessment needs were lower than the needs identified by the standard estimate of need.

Evaluation of the vulnerability of families assisted in Primary Care in Brazil

Objective: to characterize the profiles of families in the area covered by a Primary Health Center and to identify those in a vulnerable situation. Method: this is an epidemiological, observational, cross-sectional and quantitative study. 320 home visits were made, defined by a random sample of the areas covered by the Urban Center 1 in the city of Sao Sebastiao, in Brazil's Federal District. A structured questionnaire was used for data collection, elaborated based on the Family Development Index (FDI). Results: there was a predominance of young families, women, and low levels of schooling. The FDI permitted the identification of families in situations of "high" and "very high" vulnerability. The most critical dimensions were: "access to knowledge" and "access to work". Conclusion: the study indicated the importance of greater investments in the areas of education, work and income, and highlighted the need for the use of a wider concept of vulnerability by the health services.