Comprendre l'expérience de la relation maître-élève(s) selon l'approche phénoménologique : le point de vue d'enfants de cinquième année du primaire

La relation maître-élève(s) est primordiale dans l'expérience scolaire des élèves du primaire. Or, les recherches s'y intéressant sont plus souvent qu'autrement menées du point de vue de l'adulte, qu'il soit chercheur ou enseignant. En effet, très peu d'enquêtes tiennent compte du point de vue des enfants, pourtant eux-mêmes acteurs de cette relation. Alors que cette dernière est habituellement vue et expliquée par les adultes, nous nous sommes attachée au point de vue d'enfants. Par notre recherche exploratoire qualitative/interprétative, nous proposons une compréhension de l'expérience de cette relation à partir de quatre témoignages d'enfants, deux filles et deux garçons âgés d'environ 11 ans et fréquentant la cinquième année du primaire, recueillis lors d'entretiens individuels non-directifs. Nos objectifs de recherche sont, d'abord, de mettre au jour le point de vue d'enfants sur leur vécu scolaire en leur donnant la parole et, ensuite, de comprendre le sens de l'expérience de la relation maître-élève(s) de ce point de vue. Puisque nous explorons l'expérience scolaire des enfants, nous avons opté pour l'approche phénoménologique en recherche, car celle-ci permet, grâce à son ouverture, de non seulement comprendre le vécu des enfants sans cadre théorique préétabli, mais également d'en rendre compte dans toute sa densité. Nos résultats de recherche sont présentés en deux temps. D'abord, nous rendons compte des témoignages des enfants, en présentant de façon condensée l'expérience spécifique de chacun des co-chercheurs, cela en respectant le langage qu'ils utilisent. Puis, nous proposons une seconde compréhension du phénomène de la relation maître-élève(s) par la présentation d'une analyse phénoménologique de la relation maître-élève(s) du point de vue de ces enfants qui permet d'en révéler les éléments « essentiels ». Enfin, nous revenons sur notre expérience de l'approche phénoménologique et de celle d'entretiens non-directifs auprès d'enfants. Puisqu'il s'intéresse au vécu scolaire, notre mémoire a la particularité d'être à la fois destiné aux chercheurs et aux théoriciens en éducation de même qu'aux enseignants, aux praticiens dont nous faisons partie. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Point de vue d’enfants, Élève(s) du primaire, Relation maître-élève(s), Enseignant du primaire, Approche phénoménologique

Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children

Background Long-acting beta2-agonists (LABA) in combination with inhaled corticosteroids (ICS) are increasingly prescribed for children with asthma. Objectives To assess the safety and efficacy of adding a LABA to an ICS in children and adolescents with asthma. To determine whether the benefit of LABA was influenced by baseline severity of airway obstruction, the dose of ICS to which it was added or with which it was compared, the type of LABA used, the number of devices used to deliver combination therapy and trial duration. Search methods We searched the Cochrane Airways Group Asthma Trials Register until January 2015. Selection criteria We included randomised controlled trials testing the combination of LABA and ICS versus the same, or an increased, dose of ICS for at least four weeks in children and adolescents with asthma. The main outcome was the rate of exacerbations requiring rescue oral steroids. Secondary outcomes included markers of exacerbation, pulmonary function, symptoms, quality of life, adverse events and withdrawals. Data collection and analysis Two review authors assessed studies independently for methodological quality and extracted data. We obtained confirmation from trialists when possible. Main results We included in this review a total of 33 trials representing 39 control-intervention comparisons and randomly assigning 6381 children. Most participants were inadequately controlled on their current ICS dose. We assessed the addition of LABA to ICS (1) versus the same dose of ICS, and (2) versus an increased dose of ICS. LABA added to ICS was compared with the same dose of ICS in 28 studies. Mean age of participants was 11 years, and males accounted for 59% of the study population. Mean forced expiratory volume in one second (FEV1) at baseline was ≥ 80% of predicted in 18 studies, 61% to 79% of predicted in six studies and unreported in the remaining studies. Participants were inadequately controlled before randomisation in all but four studies. There was no significant group difference in exacerbations requiring oral steroids (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.28, 12 studies, 1669 children; moderate-quality evidence) with addition of LABA to ICS compared with ICS alone. There was no statistically significant group difference in hospital admissions (RR 1.74, 95% CI 0.90 to 3.36, seven studies, 1292 children; moderate-quality evidence)nor in serious adverse events (RR 1.17, 95% CI 0.75 to 1.85, 17 studies, N = 4021; moderate-quality evidence). Withdrawals occurred significantly less frequently with the addition of LABA (23 studies, 471 children, RR 0.80, 95% CI 0.67 to 0.94; low-quality evidence). Compared with ICS alone, addition of LABA led to significantly greater improvement in FEV1 (nine studies, 1942 children, inverse variance (IV) 0.08 L, 95% CI 0.06 to 0.10; mean difference (MD) 2.99%, 95% CI 0.86 to 5.11, seven studies, 534 children; low-quality evidence), morning peak expiratory flow (PEF) (16 studies, 3934 children, IV 10.20 L/min, 95% CI 8.14 to 12.26), reduction in use of daytime rescue inhalations (MD -0.07 puffs/d, 95% CI -0.11 to -0.02, seven studies; 1798 children) and reduction in use of nighttime rescue inhalations (MD -0.08 puffs/d, 95% CI -0.13 to -0.03, three studies, 672 children). No significant group difference was noted in exercise-induced % fall in FEV1, symptom-free days, asthma symptom score, quality of life, use of reliever medication and adverse events. A total of 11 studies assessed the addition of LABA to ICS therapy versus an increased dose of ICS with random assignment of 1628 children. Mean age of participants was 10 years, and 64% were male. Baseline mean FEV1 was ≥ 80% of predicted. All trials enrolled participants who were inadequately controlled on a baseline inhaled steroid dose equivalent to 400 µg/d of beclomethasone equivalent or less. There was no significant group differences in risk of exacerbation requiring oral steroids with the combination of LABA and ICS versus a double dose of ICS (RR 1.69, 95% CI 0.85 to 3.32, three studies, 581 children; moderate-quality evidence) nor in risk of hospital admission (RR 1.90, 95% CI 0.65 to 5.54, four studies, 1008 children; moderate-quality evidence). No statistical significant group difference was noted in serious adverse events (RR 1.54, 95% CI 0.81 to 2.94, seven studies, N = 1343; moderate-quality evidence) and no statistically significant differences in overall risk of all-cause withdrawals (RR 0.96, 95% CI 0.67 to 1.37, eight studies, 1491 children; moderate-quality evidence). Compared with double the dose of ICS, use of LABA was associated with significantly greater improvement in morning PEF (MD 8.73 L/min, 95% CI 5.15 to 12.31, five studies, 1283 children; moderate-quality evidence), but data were insufficient to aggregate on other markers of asthma symptoms, rescue medication use and nighttime awakening. There was no group difference in risk of overall adverse effects, A significant group difference was observed in linear growth over 12 months, clearly indicating lower growth velocity in the higher ICS dose group (two studies: MD 1.21 cm/y, 95% CI 0.72 to 1.70). Authors' conclusions In children with persistent asthma, the addition of LABA to ICS was not associated with a significant reduction in the rate of exacerbations requiring systemic steroids, but it was superior for improving lung function compared with the same or higher doses of ICS. No differences in adverse effects were apparent, with the exception of greater growth with the use of ICS and LABA compared with a higher ICS dose. The trend towards increased risk of hospital admission with LABA, irrespective of the dose of ICS, is a matter of concern and requires further monitoring

Rapid influenza diagnostic tests: a meta-analysis of 127 studies

BACKGROUND: Timely diagnosis of influenza is important to administer appropriate antiviral therapy, institute proper infection control measures, and decrease ancillary test usage. While viral culture or reverse-transcriptase polymerase chain reaction (RT-PCR) are considered the most accurate diagnostic tests, a vast array of rapid influenza diagnostic tests (RIDTs) is available and could potentially impact patient management at the point-of-care. OBJECTIVE: To summarize, using meta-analysis, available evidence on the diagnostic accuracy of RIDTs compared to a reference standard in adults and children with influenza-like illness and to evaluate patient and test factors associated with higher accuracy.METHODS: Four databases (MEDLINE, EMBASE, Biosis, Web of Science) were searched up to and including September 2010 for studies on RIDTs' accuracy compared to a reference standard of either RT-PCR (first choice) or viral culture. Sensitivity and specificity were pooled using a bivariate random effects regression model and investigation of heterogeneity was done using subgroup analyses and meta-regression using an extension of the summary receiver operating characteristic curve (SROC) model. RESULTS: A total of 100 articles, comprising 127 studies were identified. The pooled sensitivity of all RIDTs was 64.5% (95% CI: 60.6, 68.6), while the pooled specificity was 98.1% (95% CI: 97.3, 98.6). Sensitivity estimates were highly heterogeneous. Some of this heterogeneity was explained by significantly higher sensitivity in children (71.1%, 95% CI: 65.6, 76.1) than in adults (51.6%, 95% CI: 43.9, 59.1). Virus type also accounted for some of the heterogeneity in sensitivity (68.0%, 95% CI: 62.3, 73.1, for influenza A versus 51.8%, 95% CI: 42.8, 60.6, for influenza B) as well as the circulating strain of influenza A (56.9%, 95% CI: 50.9, 62.6, for influenza A/H1N1/2009 versus 72.8%, 95% CI: 65.9-78.8, for other seasonal influenza A strains). Finally, RIDTs performed better when compared against culture as the reference standard (sensitivity of 71.0%, 95% CI: 65.9, 75.6) than when compared against RT-PCR (sensitivity of 56.0%, 95% CI: 49.7, 62.1). Few studies reported duration of symptoms before testing, but studies that did showed a trend toward better accuracy at 24-48h with a rapid decline thereafter. When a meta-regression was conducted including several study-level covariates, only age remained significant with a relative diagnostic odds ratio (RDOR) of 2.67 (95% CI: 1.17, 6.11) for children versus adults.CONCLUSION: RIDTs have modest sensitivity and high specificity, but heterogeneity in sensitivity is a concern. While they are more accurate in children than adults, and for influenza A compared to influenza B, these factors do not completely explain the heterogeneity in sensitivity. Because of their high specificity, RIDTs may be useful to rule in influenza. However, a negative test cannot be used to rule out influenza and should be confirmed by one of the reference standard tests. Further work is needed to summarize the clinical impact of RIDTs on patient management and patient-important outcomes.INTRODUCTION: Poser rapidement le diagnostic d'influenza permet d'administrer une thérapie antivirale appropriée, de débuter en temps opportun des mesures de prévention des infections et de diminuer le recours à d'autres tests diagnostiques. Bien que la culture virale et le RT-PCR demeurent les outils diagnostiques les plus fiables, il existe une vaste gamme de tests de diagnostic rapide de l'influenza (TDRI) pouvant potentiellement avoir un impact sur la prise en charge des patients. OBJECTIFS: Résumer, par le biais d'une méta-analyse, l'ensemble des données disponibles sur la sensibilité et la spécificité des TDRIs comparés à un test de référence, chez les adultes et les enfants souffrant d'un syndrome d'allure grippal, ainsi qu'évaluer les facteurs liés au test ou au patient qui sont associés à une plus grande fiabilité. MÉTHODES: Nous avons cherché à travers quatre bases de données (PubMed, EMBASE, Biosis, Web of Science), jusqu'en septembre 2010, pour des études sur la fiabilité des TDRIs comparés au RT-PCR (1er choix) ou à la culture virale. Nous avons méta-analysé la sensibilité et spécificité des TDRIs au moyen d'un bivariate random effect regression model et tenté d'expliquer l'hétérogénéité des résultats au moyen d'analyses de sous-groupes et d'une méta-régression, via une extension du modèle SROC (summary receiver operating characteristic curve).RÉSULTATS: Nous avons identifiés 100 articles, comprenant 127 études. La sensibilité globale des TDRIs était de 64.5% (95% CI: 60.6, 68.6), alors que leur spécificité globale était de 98.1% (95% CI: 97.3, 98.6). Par contre, on a retrouvé une grande hétérogénéité au niveau de la sensibilité. Une partie de cette hétérogénéité pourrait être expliquée par une sensibilité significativement plus élevée lorsque le test est utilisé chez les enfants (71.1%, 95% CI: 65.6, 76.1) plutôt que chez les adultes (51.6%, 95% CI: 43.9, 59.1). La sensibilité des TDRIs variait également en fonction du type de virus (68.0%, 95% CI: 62.3, 73.1, pour l'influenza A versus 51.8%, 95% CI: 42.8, 60.6, pour l'influenza B) ainsi que de la souche d'influenza A en circulation (56.9%, 95% CI: 50.9, 62.6, pour l'influenza A/H1N1/2009 versus 72.8%, 95% CI: 65.9-78.8, pour les autres souches saisonnières d'influenza A). Finalement, les TDRIs affichaient une meilleure performance lorsque comparés à la culture virale (sensibilité: 71.0%, 95% CI: 65.9, 75.6) plutôt qu'au RT-PCR (sensibilité: 56.0%, 95% CI: 49.7, 62.1). Peu d'études ont évalué l'effet de la durée des symptômes sur la fiabilité des TDRIs, mais les quelques études qui se sont penchées sur le sujet tendaient à démontrer une meilleure sensibilité 24-48h après le début des symptômes suivi d'un déclin rapide. Lorsque plusieurs de ces variables furent analysées en même temps, au moyen d'une méta-régression, seulement l'âge est demeuré significativement associé à la fiabilité des TDRIs, avec un rapport de cotes diagnostiques de 2.67 (95% CI: 1.17, 6.11) pour les enfants versus les adultes.CONCLUSION: Les TDRIs ont une sensibilité modeste et une bonne spécificité, mais une grande hétérogénéité au niveau de la sensibilité demeure une préoccupation. Bien que les TDRIs soient plus fiables chez les enfants que chez les adultes et pour détecter l'influenza A versus l'influenza B, ces facteurs ne suffisent pas à expliquer l'hétérogénéité notée au niveau de la sensibilité. Puisqu'ils sont très spécifiques, les TDRIs sont utiles pour confirmer le diagnostic d'influenza. Cependant, un TDRI négatif n'est pas suffisant pour infirmer le diagnostic d'influenza et devrait être confirmé au moyen d'un des tests de référence. D'autres études sont nécessaires pour résumer l'impact clinique des TDRIs sur la prise en charge des patients

Intégration de l'étude des changements climatiques à l'enseignement au premier cycle du secondaire : l'exemple du Saint-Laurent.

Au Québec, les scénarios de changements climatiques (CC) prévoient un accroissement de la température moyenne annuelle de 1 à 4ºC d'ici 2030 (GIEC, 2001), ayant des effets importants sur le bilan hydrique régional. Malgré ces conséquences anticipées, le phénomène des CC demeure méconnu chez les adolescents (Québec et Nouveau-Brunswick) (Pruneau et al., 2001), soulignant l'importance de les éduquer aux CC. La trousse pédagogique (guide pour l'enseignement et affiche) présentée dans cette étude constitue un exemple concret des effets des CC sur le Saint-Laurent et est destiné aux adolescents du 1er cycle du secondaire. Le guide pour l'enseignement comprend une série de questions destinées aux élèves et une liste de sites électroniques leur permettant d'y répondre. L'affiche décrira les effets du climat sur les composantes de l'écosystème du Saint-Laurent (production en cours). L'approche interdisciplinaire et écosystémique est privilégiée et elle intègre les 5 domaines du programme de formation du Ministère de l'éducation du Québec (MEQ) (Mathématiques, Sciences et Technologie, Univers Social, Langues, Développement Personnel et Arts). Le concept du projet a été présenté avec succès à des classes de niveau secondaire 1 (13 ans), du Collège Notre-Dame à Montréal (Québec) au printemps 2003.In Québec, climatic change scenarios (CC) forecast an increase of 1-4oC in mean annual temperature by 2030 (IPCC, 2001), with important effects on the regional water budgets. In spite of these anticipated consequences, the CC phenomenon remains misunderstood by teenagers (Quebec and New Brunswick) (Pruneau et al., 2001), stressing the necessity to educate them to CC. The teaching kit (teaching guide and poster) we developed for 1st cycle in high school represents a concrete example of the effects of CC on the St. Lawrence River. The teaching guide comprises a series of questions for students and a list of Websites to answer them. The poster will describe the effects of climate on St. Lawrence ecosystem components (production in progress). An interdisciplinary and ecosystemic approach is privileged, which also integrated the 5 domains of Ministère de l'Éducation du Québec (MEQ) training program (Mathématiques, Sciences et Technologie, Univers Social, Langues, Développement Personnel et Arts). The concept was presented with success to high school groups (age 13) from College Notre-Dame in Montreal during spring 2003

Accuracy of Rapid Influenza Diagnostic Tests A Meta-analysis

Background: Timely diagnosis of influenza can help clinical management. Purpose: To examine the accuracy of rapid influenza diagnostic tests (RIDTs) in adults and children with influenza-like illness and evaluate factors associated with higher accuracy. Data Sources: PubMed and EMBASE through December 2011; BIOSIS and Web of Science through March 2010; and citations of articles, guidelines, reviews, and manufacturers. Study Selection: Studies that compared RIDTs with a reference standard of either reverse transcriptase polymerase chain reaction (first choice) or viral culture. Data Extraction: Reviewers abstracted study data by using a standardized form and assessed quality by using Quality Assessment of Diagnostic Accuracy Studies criteria. Data Synthesis: 159 studies evaluated 26 RIDTs, and 35% were conducted during the H1N1 pandemic. Failure to report whether results were assessed in a blinded manner and the basis for patient recruitment were important quality concerns. The pooled sensitivity and specificity were 62.3% (95% CI, 57.9% to 66.6%) and 98.2% (CI, 97.5% to 98.7%), respectively. The positive and negative likelihood ratios were 34.5 (CI, 23.8 to 45.2) and 0.38 (CI, 0.34 to 0.43), respectively. Sensitivity estimates were highly heterogeneous, which was partially explained by lower sensitivity in adults (53.9% [CI, 47.9% to 59.8%]) than in children (66.6% [CI, 61.6% to 71.7%]) and a higher sensitivity for influenza A (64.6% [CI, 59.0% to 70.1%) than for influenza B (52.2% [CI, 45.0% to 59.3%). Limitation: Incomplete reporting limited the ability to assess the effect of important factors, such as specimen type and duration of influenza symptoms, on diagnostic accuracy. Conclusion: Influenza can be ruled in but not ruled out through the use of RIDTs. Sensitivity varies across populations, but it is higher in children than in adults and for influenza A than for influenza

Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family

Objective: To examine the impact of medical complexity among very preterm infants on health care resource use, family, and neurodevelopmental outcomes at 18 months' corrected age. Methods: This observational cohort study of Canadian infants born < 29 weeks' gestational age in 2009-2011 compared infants with and those without medical complexity defined as discharged home with assistive medical technology. Health care resource use and family outcomes were collected. Children were assessed for cerebral palsy, deafness, blindness, and developmental delay at 18 months. Logistic regression analysis was performed for group comparisons. Results: Overall, 466/2,337 infants (20%) needed assistive medical technology at home including oxygen (79%), gavage feeding (21%), gastrostomy or ileostomy (20%), CPAP (5%), and tracheostomy (3%). Children with medical complexity were more likely to be re-hospitalized (OR 3.6, 95% CI 3.0-4.5) and to require ≥2 outpatient services (OR 4.4, 95% CI 3.5-5.6). Employment of both parents at 18 months was also less frequent in those with medical complexity compared to those without medical complexity (52 vs. 60%, p < 0.01). Thirty percent of children with medical complexity had significant neurodevelopmental impairment compared to 13% of those without medical complexity (p < 0.01). Lower gestational age, lower birth weight, bronchopulmonary dysplasia, sepsis, and surgical necrotizing enterocolitis were associated with a risk of medical complexity. Conclusion: Medical complexity is common following very preterm birth and has a significant impact on health care use as well as family employment and is more often associated with neurodevelopmental disabilities. Efforts should be deployed to facilitate care coordination upon hospital discharge and to support families of preterm children with medical complexity.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe