Styles de vie, besoins de santé et utilisation des services de soins des adolescents porteurs d'affections chroniques

Résumé Contexte et objectifs Le premier volet a comme objectif d'évaluer la prévalence de l'affection chronique (AC) parmi les adolescents en Suisse, de décrire leurs comportements (loisirs, sexualité, conduites à risque) et de les comparer aux adolescents non porteur d'AC afin d'évaluer l'impact de l'AC sur leur bien-être. Le second volet a comme objectif d'explorer leur réseau de soutien, leur mode d'adaptation et leur perception de la prise en charge dont ils bénéficient par les équipes soignantes. Chacun des objectifs est traité dans un article : - « Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland » Eur J Pediatr (2003) 162: 682-689 - « Adolescents porteurs d'affections chroniques: la parole aux patients » Med Hyg 2004 ; 62 : 2224-9. Méthode Première partie: les données ont été obtenues par analyse secondaire de l'enquête sur la santé des adolescents en Suisse, réalisée en 1993-1994 auprès d'un échantillon de 9268 jeunes de 15 à 20 ans (6% de la population visée), à l'aide d'un questionnaire auto administré de 100 questions environ. Le programme SPSS a été utilisé pour effectuer les analyses bi- et multi-variées. Seconde partie: la commission d'éthique de la Faculté de médecine de l'Université de Lausanne a donné son accord permettant la réalisation d'un focus group (discussion en petit groupe) de 12 jeunes. Ils ont participé à une discussion de 2 heures, conduite par un modérateur entraîné à cette méthode. Résultats Premier volet : 11.4% des filles et 9.6% des garçons se déclarent porteurs d'une AC. 25% des filles porteuses d'une AC (versus 13% de non porteur; p=0.007) et 38% des garçons porteurs d'une AC (versus 25% de non porteur; p=0.002) déclarent ne pas utiliser la ceinture de sécurité quand ils conduisent. 6.3% des filles (versus 2.7% ; p= 0.000) disent avoir conduit en étant ivres. 43% des filles (versus 36% ; p= 0.004) et 47% des garçons (versus 39% ; p=0.001) sent fumeurs de cigarettes. 32% des garçons (versus 27% p=0.02) rapportent avoir consommé du cannabis. 17% des filles (versus 13°h ; p=0.013) et 43% des garçons (versus 36% ; p= 0.002) disent boire de l'alcool. Le fait d'être porteur d'AC a aussi des conséquences psychologiques : 7.7% des filles (versus 3.4% ; p= 0.000) et 4.9% des garçons (versus 2% ; p=0.000) ont effectué un tentamen durant les 12 mois précédents. Deuxième volet: Sur oui peuvent-ils compter ? Avant tout sur eux-mêmes, puis sur leurs parents ou leurs amis. Les pairs, l'équipe soignante, les autres malades et les enseignants ont chacun des rôles à jouer à des moments précis de l'évolution de l'AC. Leurs modes d'adaptation: prendre du recul, faire preuve d'humour et demander de l'aide à leurs proches. Ils s'évadent dans l'écriture, les pensées ou la musique. Demande aux médecins une prise en charge globale qui permette une compréhension de l'ensemble de leurs besoins plutôt que focalisée seulement sur leur AC. Le respect, la possibilité d'un soutien et d'explications précises leur paraissent importants. Conclusions Les conduites dites à risque ne sont pas moins fréquentes chez les adolescents porteurs d'AC que chez leurs pairs Elles peuvent être expliquées par le besoin de tester leurs limites tant sur le plan des consommations que du comportement. Une prévention et une attention spécifiques des équipes soignantes sont nécessaires. Un réseau social diversifié paraît nécessaire aux jeunes souffrant d'AC. Les médecins devraient avoir une vision globale de leur patient, les aider à se situer dans le monde de l'adolescence, leur permettre de nommer leurs émotions et anticiper les questions difficiles à poser. Abstract The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; interval to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey Introduction on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P = 0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P= 0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. Conclusion: Experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

Desenvolvimento de uma framework de argumentação Para apoio à tomada de decisão ubíqua

Os Sistemas de Apoio à Tomada de Decisão em Grupo (SADG) surgiram com o objetivo de apoiar um conjunto de decisores no processo de tomada de decisão. Uma das abordagens mais comuns na literatura para a implementação dos SADG é a utilização de Sistemas Multi-Agente (SMA). Os SMA permitem refletir com maior transparência o contexto real, tanto na representação que cada agente faz do decisor que representa como no formato de comunicação utilizado. Com o crescimento das organizações, atualmente vive-se uma viragem no conceito de tomada de decisão. Cada vez mais, devido a questões como: o estilo de vida, os mercados globais e o tipo de tecnologias disponíveis, faz sentido falar de decisão ubíqua. Isto significa que o decisor deverá poder utilizar o sistema a partir de qualquer local, a qualquer altura e através dos mais variados tipos de dispositivos eletrónicos tais como tablets, smartphones, etc. Neste trabalho é proposto um novo modelo de argumentação, adaptado ao contexto da tomada de decisão ubíqua para ser utilizado por um SMA na resolução de problemas multi-critério. É assumido que cada agente poderá utilizar um estilo de comportamento que afeta o modo como esse agente interage com outros agentes em situações de conflito. Sendo assim, pretende-se estudar o impacto da utilização de estilos de comportamento ao longo do processo da tomada de decisão e perceber se os agentes modelados com estilos de comportamento conseguem atingir o consenso mais facilmente quando comparados com agentes que não apresentam nenhum estilo de comportamento. Pretende-se ainda estudar se o número de argumentos trocados entre os agentes é proporcional ao nível de consenso final após o processo de tomada de decisão. De forma a poder estudar as hipóteses de investigação desenvolveu-se um protótipo de um SADG, utilizando um SMA. Desenvolveu-se ainda uma framework de argumentação que foi adaptada ao protótipo desenvolvido. Os resultados obtidos permitiram validar as hipóteses definidas neste trabalho tendo-se concluído que os agentes modelados com estilos de comportamento conseguem na maioria das vezes atingir um consenso mais facilmente comparado com agentes que não apresentam nenhum estilo de comportamento e que o número de argumentos trocados entre os agentes durante o processo de tomada de decisão não é proporcional ao nível de consenso final.

Parent and Peer Factors Relating to Adolescent Antisocial Behaviour: Investigating the Moderating Role of Temperament

The purpose of this study was to examine whether certain temperament characteristics (fearfulness, surgency, frustration, and effortful control) moderate the association between authoritative parenting dimensions (psychological autonomy granting, acceptance-involvement, and monitoring knowledge) or friends' antisocial behaviour, and self-reported antisocial behaviour among adolescents. Questionnaires on adolescent temperament and authoritative parenting were completed by 484 mothers and their adolescent children (54.8% female). In addition, the adolescents responded to measures regarding friends' antisocial behavior and their own antisocial behaviour. Adolescent participants ranged between 13 and 17 years of age (M = 14.96 years, SD = 1.39) and lived in a region of southern Ontario. As predicted, the results indicated that effortful control moderated the association between parental monitoring knowledge and adolescent antisocial behaviour. Also, as predicted, effortful control moderated the relation between friends' antisocial behaviour and adolescents' self-reports of antisocial behaviour although the relation was sex-specific to girls. Unexpected results included a significant monitoring knowledge by frustration by sex interaction, and a significant friends' antisocial behaviour by age interaction. In general, the findings were consistent with the expectation that the relation of parenting and peer factors to antisocial behaviour would depend on adolescents' temperamental predispositions. However, effortful control, which contributes to individual differences in self-regulation abilities, served this moderating role to a greater extent than the measures of temperamental reactivity, including fearfulness, surgency and frustration-proneness. Implications of these results are discussed with reference to parenting or classroom-based interventions that may be especially helpful for adolescents with poor self-regulation abilities.

Relationship among children’s perception of parental relationship and parental empathy and prosocial behaviour during childhood

The objective of this work is to study if children’s perception of parental relationship and parental empathy can predict prosocial behaviour during childhood. The sample was composed of 934 Argentine children, aged 9 to 12, of middle socio-economical level. The participants completed Argentine scale of Children Perception of Parental relationship (richaud de Minzi, 2007), an Argentine adaptation of scale of Prosocial Behaviour (Caprara and Pastorelli, 1993) and a questionnaire to measure children’s perception of parental empathy (richaud de Minzi, 2006). structural equations modelling (sEM) analyses were conducted to explore our hypotheses. Six theoretical models fit the data very well. The results showed that parental styles of acceptance and pathological control impact on children prosocial behavior. Children’s perception of parental empathy was positively associated with children prosocial behavior. Finally, parental acceptance and pathological control were associated with children’s perception of parental empathy, but negligent parental behaviour did not.  

Sensitivity of OMI SO2 measurements to variable eruptive behaviour at Soufrière Hills Volcano, Montserrat

Since 2004, the satellite-borne Ozone Mapping Instrument (OMI) has observed sulphur dioxide (SO2) plumes during both quiescence and effusive eruptive activity at Soufrière Hills Volcano, Montserrat. On average, OMI detected a SO2 plume 4-6 times more frequently during effusive periods than during quiescence in the 2008-2010 period. The increased ability of OMI to detect SO2 during eruptive periods is mainly due to an increase in plume altitude rather than a higher SO2 emission rate. Three styles of eruptive activity cause thermal lofting of gases (Vulcanian explosions; pyroclastic flows; a hot lava dome) and the resultant plume altitudes are estimated from observations and models. Most lofting plumes from Soufrière Hills are derived from hot domes and pyroclastic flows. Although Vulcanian explosions produced the largest plumes, some produced only negligible SO2 signals detected by OMI. OMI is most valuable for monitoring purposes at this volcano during periods of lava dome growth and during explosive activity.

Ventilation rates indicate stress-coping styles in Nile tilapia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Hunting and social behaviour of leopard seals (Hydrurga leptonyx) at Seal Island, South Shetland Islands, Antarctica

The hunting behavior of leopard seals Hydrurga leptonyx was monitored opportunistically at Seal Island, South Shetland Islands, during the austral summers from 1986/87 to 1994/95. Leopard seals used several methods to catch Antarctic fur seal pups Arctocephalus gazella and chinstrap penguins Pygoscelis antarctica, and individuals showed different hunting styles and hunting success. One to two leopard seals per year were responsible for an average of 60% of observed captures of fur seal pups. Leopard seals preyed on penguins throughout the summer, but preyed on fur seal pups only between late December and mid-February. Hunting behavior differed significantly between different locations on the island; fur seals were hunted only at one colony, and penguins were hunted in several areas. The relative abundance of prey types, size of prey in relation to predator, and specialization of individual leopard seals to hunt fur seal prey probably influence individual prey preferences among leopard seals. On five occasions, two leopard seals were seen together on Seal Island. Possible interpretations of the relationship between the interacting leopard seals included a mother-offspring relationship, a consorting male-female pair, and an adult leopard seal followed by an unrelated juvenile. In two incidents at Seal Island, two leopard seals were observed interacting while hunting: one seal captured fur seal pups and appeared to release them to the other seal. Observations of leopard seals interacting during hunting sessions were difficult to confirm as co-operative hunting, but they strongly implied that the two seals were not agonistic toward one another. The hunting success of individual leopard seals pursuing penguins or fur seals is probably high enough for co-operative hunting not to become a common hunting strategy; however, it may occur infrequently when it increases the hunting productivity of the seals.

Behaviour of displacement piles in sand under cyclic axial loading

Field experiments have demonstrated that piles driven into sand can respond to axial cyclic loading in Stable, Unstable or Meta-Stable ways, depending on the combinations of mean and cyclic loads and the number of cycles. An understanding of the three styles of responses is provided by experiments involving a highly instrumented model displacement pile and an array of soil stress sensors installed in fine sand in a pressurised calibration chamber. The different patterns of effective stress developing on and around the shaft are reported, along with the results of static load tests that track the effects on shaft capacity. The interpretation links these observations to the sand's stress strain behaviour. The interface-shear characteristics, the kinematic yielding, the local densification, the growth of a fractured interface-shear zone and the restrained dilatancy at the pile soil interface are all found to be important. The model tests are shown to be compatible with the full-scale behaviour and to provide key information for improving the modelling and the design rules. (C) 2012 The Japanese Geotechnical Society. Production and hosting by Elsevier B.V. All rights reserved.

Differentiation in Male and Female Speech Styles

From the moment of their birth, a person's life is determined by their sex. Ms. Goroshko wants to know why this difference is so striking, why society is so concerned to sustain it, and how it is able to persist even when certain national or behavioural stereotypes are erased between people. She is convinced of the existence of not only social, but biological differences between men and women, and set herself the task, in a manuscript totalling 126 pages, written in Ukrainian and including extensive illustrations, of analysing these distinctions as they are manifested in language. She points out that, even before 1900, certain stylistic differences between the ways that men and women speak had been noted. Since then it has become possible, for instance in the case of Japanese, to point to examples of male and female sub-languages. In general, one can single out the following characteristics. Males tend to write with less fluency, to refer to events in a verb-phrase, to be time-oriented, to involve themselves more in their references to events, to locate events in their personal sphere of activity, and to refer less to others. Therefore, concludes Ms Goroshko, the male is shown to be more active, more ego-involved in what he does, and less concerned about others. Women, in contrast, were more fluent, referred to events in a noun-phrase, were less time-oriented, tended to be less involved in their event-references, locate events within their interactive community and refer more to others. They spent much more time discussing personal and domestic subjects, relationship problems, family, health and reproductive matters, weight, food and clothing, men, and other women. As regards discourse strategies, Ms Goroshko notes the following. Men more often begin a conversation, they make more utterances, these utterances are longer, they make more assertions, speak less carefully, generally determine the topic of conversation, speak more impersonally, use more vulgar expressions, and use fewer diminutives and more imperatives. Women's speech strategies, apart from being the opposite of those enumerated above, also contain more euphemisms, polite forms, apologies, laughter and crying. All of the above leads Ms. Goroshko to conclude that the differences between male and female speech forms are more striking than the similarities. Furthermore she is convinced that the biological divergence between the sexes is what generates the verbal divergence, and that social factors can only intensify or diminish the differentiation in verbal behaviour established by the sex of a person. Bearing all this in mind, Ms Goroshko set out to construct a grammar of male and female styles of speaking within Russian. One of her most important research tools was a certain type of free association test. She took a list comprising twelve stimuli (to love, to have, to speak, to fuck, a man, a woman, a child, the sky, a prayer, green, beautiful) and gave it to a group of participants specially selected, according to a preliminary psychological testing, for the high levels of masculinity or femininity they displayed. Preliminary responses revealed that the female reactions were more diverse than the male ones, there were more sentences and word combinations in the female reactions, men gave more negative responses to the stimulus and sometimes didn't want to react at all, women reacted more to adjectives and men to nouns, and that, surprisingly, women coloured more negatively their reactions to the words man, to love and a child (Ms. Goroshko is inclined to attribute this to the present economic situation in Russia). Another test performed by Ms. Goroshko was the so-called "defective text" developed by A.A. Brudny. All participants were distributed with packets of complete sentences, which had been taken from a text and then mixed at random. The task was to reconstruct the original text. There were three types of test, the first descriptive, the second narrative, and the third logical. Ms. Goroshko created computer programmes to analyse the results. She found that none of the reconstructed texts was coincident with the original, differing both from the original text and amongst themselves and that there were many more disparities in the male than the female texts. In the descriptive and logical texts the differences manifested themselves more clearly in the male texts, and in the narrative texts in the female texts. The widest dispersal of values was observed at the outset, while the female text ending was practically coincident with the original (in contrast to the male ending). The greatest differences in text reconstruction for both males and females were registered in the middle of the texts. Women, Ms. Goroshko claims, were more sensitive to the semantic structure of the texts, since they assembled the narrative text much more accurately than the other two, while the men assembled more accurately the logical text. Texts written by women were assembled more accurately by women and texts by men by men. On the basis of computer analysis, Ms. Goroshko found that female speech was substantially more emotional. It was expressed by various means, hyperbole, metaphor, comparisons, epithets, ways of enumeration, and with the aid of interjections, rhetorical questions, exclamations. The level of literacy was higher for female speech, and there were fewer mistakes in grammar and spelling in female texts. The last stage of Ms Goroshko's research concerned the social stereotypes of beliefs about men and women in Russian society today. A large number of respondents were asked questions such as "What merits must a woman possess?", "What are male vices and virtues?", etc. After statistical manipulation, an image of modern man and woman, as it exists in the minds of modern Russian men and women, emerged. Ms. Goroshko believes that her findings are significant not only within the field of linguistics. She has already successfully worked on anonymous texts and been able to decide on the sex of the author and consequently believes that in the future her research may even be of benefit to forensic science.

The Role of the Family in Shaping Self-Concept and Cognitive Styles in Hungary

The project studied the perception of parenting styles and their relation to self-development, cognitive styles, and individualisation in adolescence. Typical parenting styles of mothers and fathers were studied in five different maternal and paternal parenting backgrounds: warm authoritarian, warm democratic, cold neglectful, cold authoritarian, and neutral. Perception of different styles of parenting (for fathers: authority, 'maintaining distance' behaviour, reciprocity, enhancing self-reliance; for mothers: authority, unpredictable behaviour, mutual trust, achievement orientation, and enhancing self-reliance) were analysed in each group using the newly developed Hungarian Parenting Questionnaire (Sallay & Munnich, 1999). This questionnaire has a theoretical basis in the ideas of Harvey (1966, 1967), where the socialisation process is combined with self-development. This categorisation of paternal and maternal parenting backgrounds enabled Sallay to explore and describe in detail how diverse parenting styles contribute to self-development, the development of cognitive complexity, and individualisation. The results show that diverse parenting by mothers and fathers produces differing impacts in nuclear and divorced families and for males and females, taking into consideration such self-components as physical, active, psychological (capabilities, personality, emotions, roles, preferences), social and reflective selves. Cognitive self-complexity varied according to parenting styles and genders: maternal and paternal parenting proved to have the most significant impact on self-complexity in a warm, democratic family. With respect to individualistic tendencies, adolescent boys were most individualistic in a cold, neglectful paternal background in nuclear families as compared to other paternal and maternal family backgrounds and to females.

Perception of risk, feelings of vulnerability and effects on driving behaviour in women drivers across the lifespan.

Sustained driving in older age has implications for quality of life and mental health. Studies have shown that despite the recognised importance of driving in maintaining health and social engagement, many women give up driving prematurely or adopt self-imposed restrictive driving practices. Emotional responses to driving have been implicated in these decisions. This research examined the effect of risk perception and feelings of vulnerability on women’s driving behaviour across the lifespan. It also developed and tested a modified theory of planned behaviour intervention to positively affect driving habits. The first two studies (N=395) used quantitative analysis to model driving behaviours affected by risk perception and feelings of vulnerability, and established that feelings of vulnerability do indeed affect women’s driving behaviour, specifically resulting in increases in driving avoidance and the adoption of maladaptive driving styles. Further, that self-regulation, conceptualised as avoidance, is used by drivers across the lifespan. Qualitative analysis of focus group data (N=48) in the third study provided a deeper understanding of the variations in coping behaviours adopted by sub-groups of drivers and extended the definition of self-regulation to incorporate adaptive coping strategies. The next study (N=64) reported the construction and preliminary validation of the novel self-regulation index (SRI) to measure wider self-regulation behaviours using an objective measure of driving behaviour, a simulated driving task. The understanding gained from the formative research was used in the final study, an extended theory of planned behaviour intervention to promote wider self-regulation behaviour, measured using the previously validated self-regulation index. The intervention achieved moderate success with changes in affective attitude and normative beliefs as well as self-reported behaviour. The results offer promise for self-regulation, incorporating a spectrum of planning and coping behaviours, to be used as a mechanism to assist drivers in achieving their personal mobility goals whilst promoting safe driving.

Behaviour of oligodendrocytes and Schwann cells in an experimental model of toxic demyelination of the central nervous system

Oligodendrocytes and Schwann cells are engaged in myelin production, maintenance and repairing respectively in the central nervous system (CNS) and the peripheral nervous system (PNS). Whereas oligodendrocytes act only within the CNS, Schwann cells are able to invade the CNS in order to make new myelin sheaths around demyelinated axons. Both cells have some limitations in their activities, i.e. oligodendrocytes are post-mitotic cells and Schwann cells only get into the CNS in the absence of astrocytes. Ethidium bromide (EB) is a gliotoxic chemical that when injected locally within the CNS, induce demyelination. In the EB model of demyelination, glial cells are destroyed early after intoxication and Schwann cells are free to approach the naked central axons. In normal Wistar rats, regeneration of lost myelin sheaths can be achieved as early as thirteen days after intoxication; in Wistar rats immunosuppressed with cyclophosphamide the process is delayed and in rats administered cyclosporine it may be accelerated. Aiming the enlightening of those complex processes, all events concerning the myelinating cells in an experimental model are herein presented and discussed.

Behaviour of albino and melanic variants of Biomphalaria glabrata Say, 1818 (Mollusca: Planorbidae) following infection by Schistosoma mansoni Sambon, 1907

The behaviour of the albino and melanic variants of Biomphalaria glabrata of Belo Horizonte (MG. Brazil) was studied comparatively, in terms of their respective susceptibilities to infection by Schistosoma mansoni of the same origin, through observation of the elimination of cercariae for a three-month period and the calculation of mortality and infection rates, in control and in infected snails. The number of amoebocytes, granulocytes and hyalinocytes in the circulating hemolymph during different periods of infection was analyzed. The evolution of the infection in the tissues was observed by means of histological cross-sections. The melanic variant showed greater susceptibility to infection and a higher mortality rate. The albino variant showed a higher number of circulating amoebocytes, both granulocytes and hyalinocytes. A higher number of degenerated sporocysts were seen in the histological cross-sections of the albino variant. The results suggest that the melanic variant of B. glabrata was more susceptible to infection by S. mansoni than was the albino variant.

Food profitability affects intranidal recruitment behaviour in the stingless bee Nannotrigona testaceicornis

Does the food's sugar concentration affect recruitment behaviour in the stingless bee Nan-notrigona testaceicornis? We recorded intranidal forager behaviour while offering sugar water of constant, increasing, or decreasing concentrations. Running speed was not correlated with sugar concentration but the jostling contacts/sec were. Food profitability also affected the recruiter's thorax vibrations: Pulse duration and duty cycle followed both concentration increases and decreases. Sugar concentration also influenced the number of recruited bees. In comparison to the phylogenetically closely related Scaptotrigona, Nan-notrigona's intranidal recruitment behaviour showed a more elaborate association with food profitability. This is likely to reflect differences in ecology and foraging strategies as Nannotrigona - in contrast to Scaptotrigona - does not lay scent trails to guide recruits to a food source.