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Leclerc B.-S.,University of Montreal | Leclerc B.-S.,Ecole Of Sante Publique Of Luniversite Of Montreal | Lessard S.,University of Montreal | Bechennec C.,University of Southern Brittany | And 3 more authors.
Journal of the American Medical Directors Association

Background: Besides personal and professional experiences, long term care providers' own attitudes toward death may affect the care given to dying residents. Objectives: To assess beliefs, values, and attitudes toward death, dying, palliative, and interdisciplinary care in long term care workers and identify any differences between different job categories and places of work. Design: Descriptive cross-sectional survey study. Setting: Five public long term care facilities. Participants: One thousand one hundred seventy volunteers, clinical managers, and all categories of residential long term care workers. Measurements and Methods: An anonymous paper or electronic self-administered survey questionnaire consisting of 24 items, answered on a 4-point bipolar Likert scale. Between-group differences were compared with the analysis of variance test after adjustment for the multiple post-hoc comparisons. Results: Healthcare workers had a relatively positive attitude toward more than one-half of the selected aspects of interdisciplinary practice and end-of-life palliative care for long-term residents. However, attitudes were more mixed about 10 other aspects and a higher percentage of respondents indicated negative attitudes toward them. Overall, there are significant differences between upper-level professionals and managers (registered nurses, physicians, rehabilitation staff, and clinical managers) vs the hands-on caregivers (nursing assistants, patient assistants, and volunteers) with regard to some aspects of the care of the dying. Conclusions: The results suggest that healthcare workers' attitudes need to be taken into account in long term care facilities. Patient assistants, volunteers, and nursing assistants seem most likely to above all benefit from training and support programs. © 2014 American Medical Directors Association, Inc. Source

Levesque M.C.,Ecole Of Sante Publique Of Luniversite Of Montreal | Levesque M.C.,McGill University | Levine A.,McGill University | Bedos C.,McGill University | Bedos C.,Institute Of Recherche En Sante Publique Of Luniversite Of Montreal Irspum
International Journal for Equity in Health

Background: Front line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients' health. Developing and evaluating approaches to raising health professional awareness and capacity to respond to social determinants is a crucial step in addressing this issue. McGill University, in partnership with Université de Montréal, Québec dental regulatory authorities, and the Québec anti-poverty coalition, co-developed a continuing education (CE) intervention that aims to transfer knowledge and improve the practices of oral health professionals with people living on welfare. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching. Methods: A qualitative case study was conducted, in Montreal Canada, among members of a dental team who participated in this innovative CE course over a period of four months. Data collection consisted in a series of semi-structured individual interviews conducted with 15 members of the dental team throughout the training, digitally recorded group discussions linked to the CE activities, clinic administrative documents and researcher-trainer field notes and journal. In line with adult transformative learning theory, interpretive analysis aimed to reveal learning processes, perceived outcomes and collective perspectives that constrain individual and organizational change. Results: The findings presented in this article consist in four interactive themes, reflective of clinic culture and context, that act as barriers to humanizing patient care: 1) belief in the "ineluctable" commoditization of dentistry; 2) "equal treatment", a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into "deserving" vs. "non-deserving" poor. We discuss implications for oral health policy, orientations for dental education, as well as the role dental regulatory authorities should play in addressing discrimination and prejudice. Conclusion: Humanizing care and developing oral health practitioners' capacity to respond to social determinants of health, are challenged by significant ideological roadblocks. These require multi-level and multi-sectorial action if gains in social equity in oral health are to be made. © 2015 Lévesque et al.; licensee BioMed Central. Source

There is still a major need for health programme evaluation training in French-speaking West Africa. Based on a ten-year experience of this type of training in a number of countries, this review article describes and discusses the content of proposed training programmes. These short vocational and participative training programmes concern the essential themes of evaluation practice: general introduction to the concepts and the evaluation approach, the preevaluation phase and intervention theory/logic, the various approaches to (participative, directive, etc.) and types of evaluation (needs, implantation, process, efficacy, etc.), data collection methods and tools, communication and use of the results, professional practice standards. Reflective analysis shows that a non-directive, participative educational approach, based on case studies is highly appreciated by participants. Several essential elements of professional evaluation practice are perceived as very novel by participants: the pre-evaluation phase, the rigorous approach, the primary concern for the usefulness of the results, practice standards. Quantitative analyses are well known, but not well utilized and qualitative analyses are poorly known and poorly understood. The deployment of health promotion evaluation programme training has become essential. It is consubstantial with rigorous professional practice, which must be useful to decision-makers in Africa. © S.F.S.P.. Tous droits réservés pour tous pays. Source

Van Hulst A.,Ecole Of Sante Publique Of Luniversite Of Montreal | Van Hulst A.,University of Quebec at Montreal | Roy-Gagnon M.-H.,University of Ottawa | Gauvin L.,Ecole Of Sante Publique Of Luniversite Of Montreal | And 5 more authors.
International Journal of Behavioral Nutrition and Physical Activity

Background: Few studies consider how risk factors within multiple levels of influence operate synergistically to determine childhood obesity. We used recursive partitioning analysis to identify unique combinations of individual, familial, and neighborhood factors that best predict obesity in children, and tested whether these predict 2-year changes in body mass index (BMI). Methods: Data were collected in 2005-2008 and in 2008-2011 for 512 Quebec youth (8-10 years at baseline) with a history of parental obesity (QUALITY study). CDC age- and sex-specific BMI percentiles were computed and children were considered obese if their BMI was ≥95th percentile. Individual (physical activity and sugar-sweetened beverage intake), familial (household socioeconomic status and measures of parental obesity including both BMI and waist circumference), and neighborhood (disadvantage, prestige, and presence of parks, convenience stores, and fast food restaurants) factors were examined. Recursive partitioning, a method that generates a classification tree predicting obesity based on combined exposure to a series of variables, was used. Associations between resulting varying risk group membership and BMI percentile at baseline and 2-year follow up were examined using linear regression. Results: Recursive partitioning yielded 7 subgroups with a prevalence of obesity equal to 8%, 11%, 26%, 28%, 41%, 60%, and 63%, respectively. The 2 highest risk subgroups comprised i) children not meeting physical activity guidelines, with at least one BMI-defined obese parent and 2 abdominally obese parents, living in disadvantaged neighborhoods without parks and, ii) children with these characteristics, except with access to ≥1 park and with access to ≥1 convenience store. Group membership was strongly associated with BMI at baseline, but did not systematically predict change in BMI. Conclusion: Findings support the notion that obesity is predicted by multiple factors in different settings and provide some indications of potentially obesogenic environments. Alternate group definitions as well as longer duration of follow up should be investigated to predict change in obesity. © 2015 Van Hulst et al.; licensee BioMed Central. Source

Janvier F.,Ecole Of Sante Publique Of Luniversite Of Montreal | Tuduri L.,Institute Of Recherche Robert Sauve En Sante Et En Securite Du Travail | Cossement D.,University of Quebec at Trois - Rivieres | Drolet D.,Institute Of Recherche Robert Sauve En Sante Et En Securite Du Travail | Lara J.,Ecole Of Sante Publique Of Luniversite Of Montreal

Activated carbon is the preferred adsorbent to remove organic vapor (OV) because of its micropore structure. For ten activated carbons of commercially available respirator cartridges, the microstructure were characterized using argon at 87.3 K, carbon dioxide at 273 K, and five organic vapors having different vapor pressures (dichloromethane, n-hexane, methyl isobutyl ketone (MIBK), m-xylene, and toluene) at 500 ppm, 294 K, and 40% relative humidity. The corresponding OV adsorption isotherm at relative vapor pressures ranging from 9 × 10-4 to 0.1 exhibited the characteristic Type I isotherm as verified by the Langmuir model. The Dubinin Radushkevish (DR) equation was applied to the argon and OV data to extrapolate the micropore volumes and the specific relative structural constants, B. The micropore volumes obtained with the OV experimental data were within 0-19% from the values of the argon data. Comparison between the DR predicted and experimental adsorption capacities showed that the OV approach could successfully predict the adsorption capacity for the tested OV. The complementary characterization with carbon dioxide showed that narrow micropores might play an important role in the adsorption. © 2015 Elsevier Ltd. Source

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