Les facteurs socioéconomiques associés à la décision d'avoir un troisième enfant : Québec, 2001

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

L’acquisition du vocabulaire chez les jeunes enfants au Québec : le rôle de l’environnement familial et économique

Cette étude s’intéresse aux facteurs associés à l’acquisition du vocabulaire réceptif des enfants d’âge préscolaire en examinant plus spécifiquement la relation entre diverses caractéristiques de l’environnement familial et économique dans lequel les enfants grandissent. Les analyses de cette étude reposent sur les données de l’Étude longitudinale du développement des enfants du Québec (ÉLDEQ), dont 1 782 enfants âgés d’environ 3 1/2 ans ont répondu à l’Échelle de vocabulaire en images Peabody (ÉVIP). Cette étude met d’abord en évidence le rôle de la précarité économique et des activités de stimulation des parents sur l’acquisition du vocabulaire réceptif chez les jeunes enfants. Elle fait également ressortir l’importance des données longitudinales prospectives pour mieux cerner ce qui, dans l’environnement familial et économique des enfants, peut contribuer à favoriser le développement des habiletés cognitives des enfants.This study addresses the factors associated with receptive vocabulary acquisition in children of preschool age. It specifically examines the link between various characteristics of the family and the economic environment in which children are growing up. The analyses in this study are based on data from the Québec Longitudinal Study of Child Development (QLSCD), in which 1 782 children approximately 3½ years old were administered the Peabody Picture Vocabulary Test (PPVT). The study reveals the role of economic insecurity and parental stimulation activities in receptive vocabulary acquisition of toddlers. It also indicates the importance of prospective longitudinal data in gaining a better understanding of the family and economic factors that can help foster the development of cognitive skills in children

Patient–ventilator asynchrony during conventional mechanical ventilation in children

Abstract Background We aimed (1) to describe the characteristics of patient–ventilator asynchrony in a population of critically ill children, (2) to describe the risk factors associated with patient–ventilator asynchrony, and (3) to evaluate the association between patient–ventilator asynchrony and ventilator-free days at day 28. Methods In this single-center prospective study, consecutive children admitted to the PICU and mechanically ventilated for at least 24 h were included. Patient–ventilator asynchrony was analyzed by comparing the ventilator pressure curve and the electrical activity of the diaphragm (Edi) signal with (1) a manual analysis and (2) using a standardized fully automated method. Results Fifty-two patients (median age 6 months) were included in the analysis. Eighteen patients had a very low ventilatory drive (i.e., peak Edi < 2 µV on average), which prevented the calculation of patient–ventilator asynchrony. Children spent 27% (interquartile 22–39%) of the time in conflict with the ventilator. Cycling-off errors and trigger delays contributed to most of this asynchronous time. The automatic algorithm provided a NeuroSync index of 45%, confirming the high prevalence of asynchrony. No association between the severity of asynchrony and ventilator-free days at day 28 or any other clinical secondary outcomes was observed, but the proportion of children with good synchrony was very low. Conclusion Patient–ventilator interaction is poor in children supported by conventional ventilation, with a high frequency of depressed ventilatory drive and a large proportion of time spent in asynchrony. The clinical benefit of strategies to improve patient–ventilator interactions should be evaluated in pediatric critical care

Association between asthma control trajectories in preschoolers and disease remission

INTRODUCTION: Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remission. METHODS: We conducted a multicentre population-based retrospective cohort study consisting of 48 687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in four Canadian provinces who had prolonged disease activity post-diagnosis. Prolonged disease activity was defined as one or more medical visits or medications for asthma every 6-month period for at least four of the six periods post-diagnosis. Follow-up began at 3 years post-diagnosis (at cohort entry). Remission was defined as 2 consecutive years without drug claims or medical visits for asthma or asthma-like conditions following cohort entry. Asthma control trajectories, ascertained over four 6-month periods following diagnosis using a validated index, were classified as: "controlled throughout", "improving control", "worsening control", "out of control throughout" and "fluctuating control". Adjusted Cox models estimated associations between asthma control trajectories and time to remission. A random effects meta-analysis summarised province-specific hazard ratios (HRs). RESULTS: The pooled remission rate was 8.91 (95% CI 8.80-9.02) per 100 person-years. Compared with children controlled throughout, poorer asthma control was associated with incrementally lower hazard ratios of remission in four other trajectories: improving control (HR 0.89, 95% CI 0.82-0.96), fluctuating control (HR 0.78, 95% CI 0.71-0.85), worsening control (HR 0.68, 95% CI 0.62-0.75) and out of control throughout (HR 0.52, 95% CI 0.45-0.59). CONCLUSIONS: Asthma control trajectories 2 years following a diagnosis in preschoolers were associated with remission, highlighting the clinical relevance of documenting control trajectories in early life