Étude des propriétés vibrationnelles à basse fréquence des matériaux nanocristallins à l'aide de la dynamique moléculaire

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

Développement d'un questionnaire mesurant la perception du patient atteint de maladies chroniques de l'habilitation par le médecin de famille

Contexte: Les maladies chroniques constituent un fardeau important et impliquent une adaptation souvent majeure à la gestion de la maladie au quotidien. Les professionnels de la santé, dont le médecin de famille, peuvent aider la personne à acquérir davantage de pouvoir sur sa santé (habilitation). Bien qu'il soit utile de mesurer la perception du patient de l'habilitation par le médecin de famille à l'aide d'un questionnaire valide, les questionnaires existants présentent des lacunes importantes. But et objectifs: Cette étude visait le développement d'un questionnaire auto-administré pour mesurer la perception du patient atteint de maladies chroniques de l'habilitation par son médecin de famille. Les objectifs suivants étaient poursuivis: 1) Approfondir la conceptualisation de l'habilitation en médecine de famille en validant le cadre conceptuel proposé auprès de patients atteints de maladies chroniques et préciser l'importance relative des dimensions; 2) Opérationnaliser les dimensions en proposant des indicateurs de ces dimensions (bassin d'items); 3) Vérifier la validité de contenu du questionnaire. Méthodes: Un dispositif de recherche mixte de type séquentiel exploratoire a été retenu. Le volet qualitatif descriptif (objectifs 1 et 2) comportait des entrevues en profondeur auprès de 30 patients âgés de 35 à 75 ans atteints d'au moins une maladie chronique, ayant le même médecin de famille depuis au moins un an et recrutés selon un échantillonnage à variabilité maximale. Les enregistrements étaient transcrits et analysés à l'aide d'une codification mixte selon Miles et Huberman (2003a). Le volet quantitatif (méthode Del phi électronique, objectif 3) comportait trois tours auprès de 15 experts canadiens en médecine de famille aptes à lire le français. Les experts cotaient les items proposés selon une échelle allant de ( 1) inapproprié à (9) très approprié et pouvaient suggérer des reformulations et des ajouts. Les items cotés de sept à neuf par tous les experts étaient considérés consensuels et n'étaient pas présentés au tour suivant. Les items non consensuels après le troisième tour ont fait l'objet d'une décision par l'équipe de chercheurs. Résultats: Le partenariat (au plan de la relation de confiance et des décisions à prendre) qui se développe au fil du temps émerge comme un élément majeur de l'habilitation. Le rôle de soutien à l'habilitation par le médecin déborderait la stricte consultation médicale pour défendre les intérêts et la sécurité du patient dans le système de soins. La relation de confiance alliée à une bonne connaissance de la personne peut permettre au médecin de mieux comprendre et de légitimer les divers sentiments ressentis par celle-ci tout en lui offrant un espoir réaliste. Le médecin de famille occupe une position privilégiée pour aider les patients à développer leur propre expertise. Soixante-six items classés en six dimensions ont été soumis au premier tour du Delphi, complété par 13 experts: 21 items étaient consensuels; 25 items ont été resoumis sans modification; 16 items ont été modifiés et quatre items ont été rejetés. Quarante et un items ont été soumis au deuxième tour, complété par 13 experts: huit items étaient consensuels; 20 items ont été resoumis sans modification; 12 items ont été modifiés et un item a été rejeté. Trente-trois items ont été soumis au troisième tour complété par neuf experts: 29 items ont été conservés intacts; trois items ont été modifiés et un item a été rejeté. Conclusion: Un questionnaire de 61 items est proposé.Abstract: Rationale: Chronic diseases represent an important health burden that often involves major adaptations to manage the disease on a daily basis. Health professionals, such as the family physician, can help a person acquire more power over his or her health (enablement). While it would be useful to measure patient perception of enablement by the family doctor with a valid questionnaire, existing tools present important gaps. Aim and objectives: This study aimed at developing a self-administered questionnaire to measure the perception of patients with chronic diseases of enablement by their family physician. The objectives were: 1) To deepen the conceptualization of enablement by validating the proposed conceptual framework with patients presenting with chronic diseases and to specify the relative importance of its dimensions; 2) To operationalise the dimensions by proposing indicators of these dimensions (pool of items); 3) To verify the content validity of the questionnaire. Methods: An exploratory sequential mixed-method research design was chosen. The descriptive qualitative study (objectives 1 and 2) used in-depth interviews with 30 patients aged 35 to 75 presenting with at least one chronic disease, having the same family doctor for at least one year and recruited through maximum variation sampling. Taped interviews were transcribed and analyzed using Miles and Huberman's mixed coding method (2003a). A three-round e-Delphi study (objective 3) involved 15 Canadian experts in family medicine, able to read in French. The experts scored the items proposed on a 9-point scale (1 = Inappropriate to 9 = Very appropriate) and could suggest rewording and additions. Items scored 7-9 by the experts were considered consensual and were not presented in the following round. Items that were not consensual after the third round were decided upon by the team of researchers. Results: The partnership (the trusting relationship and decisions to be taken) that develops over time was found to be a major component of enablement. The enablement role of the physician goes beyond the medical consultation to defend the interests and safety of the patient's journey through the healthcare system. The trusting relationship combined with a good knowledge of the person may help the family physician better understand and legitimize the various feelings experienced while offering realistic hope . The family physician is in a privileged position to help patients develop their own expertise . Sixty-six items classified into six dimensions were submitted to the experts during the first round of the E-Delphi method. The first round was completed by 13 experts: 21 items were consensual; 25 items were resubmitted without any modification; 16 items were modified and four were rejected. Forty-one items were submitted during the second round, completed by 13 experts: eight items were consensual; 20 items were submitted without any modification; 12 items were modified and one item was rejected. Thirty-three items were submitted during the third round completed by nine experts: 29 items remained intact; three items were modified and one item was rejected. Conclusion: An initial 61-item questionnaire is proposed

Perceived conflict in the couple and chronic illness management: Preliminary analyses from the Quebec Health Survey

BACKGROUND: The quality of the relationship with the spouse/partner appears crucial among patients with multiple chronic conditions where illness management is complex and multifaceted. This study draws on data from the Quebec Health Survey (QHS) to examine, among patients with one or more chronic conditions, the relation between marital status, the perceived conflict with the spouse/partner, and what the patients do to manage their illness as well as how they perceive their health. METHODS: Data from the QHS 1998 were used. The sample included 7547 coupled adults who had one or more chronic health problems lasting more than 6 months. Independent variables included marital status, perceived conflict with the spouse/partner, and the number of chronic conditions. Illness management was defined broadly as a measure of the patient's efforts at self-care and an illness status indicator, including visits to the generalist and the specialist, the use of telephone health line in the last 12 months, self-rated general health, mental health, and a measure of psychological distress. Linkages between the independent variables and illness management were assessed for males and females separately with logistic regressions, while accounting for the survey sampling design and household clustering. RESULTS: Female patients who did not live with their partner and had never been married were more likely to report a negative perception of their general health and a higher psychological distress than those who were married. Perceived conflict with the partner was linked to a negative perception of mental health and a higher psychological distress among both men and women. Compared to patients with only one chronic condition, males who reported more than one chronic condition were more likely to have consulted a generalist prior to the survey and used the telephone health line, whereas females were more likely to have consulted a specialist. Both males and females with more than one chronic condition were more likely to have a negative perception of their general health and mental health. CONCLUSION: The study provides a useful preliminary measure of the importance of living arrangements and the quality of the couple relationship in chronic illness management broadly conceived as a measure of the patient's efforts at self-care and an illness status indicator. Results of this study prod us to examine more closely, within longitudinal designs, the influence of living arrangements and the presence of conflict in the couple on chronic illness management as well as the modifying effect of gender on these associations

Qualités métrologiques du Cumulative illness rating scale dans un contexte de médecine familiale

Objectif : Aucune échelle de mesure n'est utilisée en médecine familiale pour mesurer le fardeau clinique que représente la présence simultanée de plusieurs problèmes médicaux chez un même patient (multimorbidité). Le but de cette étude était de valider un outil qui permette une évaluation fiable de la multimorbidité. Les objectifs spécifiques étaient de vérifier les fidélités inter juges et intrajuge du Cumulative Illness Rating Scale (CIRS) complété par des infirmières en révisant le dossier médical (CIRS-INF/D) et de comparer la fidélité inter-juges du CIRS-INF/D à celle du CIRS complété par des infirmières lors d'une entrevue clinique (CIRS-INF/C) dans un contexte de médecine familiale ambulatoire ainsi que de documenter la validité concomitante de ces deux formes de CIRS complétées par des infirmières. Conclusion . Cette étude indique que des infirmières formées peuvent coter adéquatement le CIRS en révisant le dossier médical dans un contexte de médecine de famille. En effet, le CIRS-INF/D présente une fidélité inter-juges adéquate et comparable à celle du CIRS-INF/C, ainsi qu'une bonne fidélité intrajuge à 2 mois. La validité concomitante du CIRS complété par des infirmières est adéquate. Le CIRS-INF/D apparaît donc comme un instrument fiable et valide dans un contexte de première ligne.--Résumé abrégé par UMI

Comorbidity and glycemia control among patients with type 2 diabetes in primary care

Reports on the relationship between comorbidity and glycemia control in diabetic patients are conflicting and the method of measuring comorbidity varies widely among studies. The aim of the present study was to evaluate the relationship between diabetes control and comorbidity, taking into account all comorbidities and their severity, in a primary care setting. We performed a retrospective descriptive study based on chart review of 96 randomly selected type 2 diabetic patients. Comorbidity was measured with the cumulative illness rating scale (CIRS), an exhaustive comorbidity index. Diabetes was considered as controlled if the mean value of two measurements of glycosylated hemoglobin A (HbA1c) was less than 7%. Taking diabetes control as the dependent variable, its relationship with the CIRS score, age, sex, diabetes duration, and diabetes-related complications was explored. Diabetes control was not significantly related with the CIRS score, age, sex or diabetes severity. Diabetes duration was the only variable significantly related to diabetes control. Our study suggests that comorbidity measured with the CIRS in patients with type 2 diabetes is not a factor that prevents the achievement of a good glycemia control

Generic self-reported questionnaires measuring self-management: a scoping review

This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O’Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics

Evaluating complex interventions in real context: Logic analysis of a case management program for frequent users of healthcare services

Case management programs for frequent users of healthcare services are complex interventions which implementation and application are challenging to evaluate. The aim of this article was to conduct a logic analysis to evaluate a case management program for frequent users of healthcare services. The study proceeded in three phases: 1) establishing causal links between the program’s components by the construction of a logic model, 2) developing an integrated framework from a realistic synthesis, and 3) making a new reading of the case management program in regard of the integrated framework. The study demonstrated, on one hand, strengths and weaknesses of the actual case management program, and, on the other hand, how logic analysis can create a constructive dialogue between theory and practice. The evaluative process with decision-makers, clinicians and patients has helped to make connexions between theory, practice, experience and services organization

The experience of pregnant women in contexts of vulnerability of prenatal primary nursing care: a descriptive interpretative qualitative study

Background Prenatal primary nursing care contributes to improving the health outcomes of mothers and unborn babies. Some pregnant women in contexts of vulnerability experience prenatal nursing care in a positive way, while some do not. A better understanding of factors influencing this experience could help improve prenatal nursing care. The aim of this study was to describe factors influencing the prenatal primary nursing care experience of pregnant women in contexts of vulnerability. Methods Thorne’s qualitative interpretative descriptive approach was used. Twenty-four pregnant women in contexts of vulnerability were recruited in local community service centers in Quebec, Canada, using purposive and snowball samplings, to carry out a semi-structured interview. Participants were 16 years old and over, in their second or third trimester, or had given birth in the previous year, and received prenatal nursing care through community health services. Data collection methods included a logbook, sociodemographic questionnaire and semi-structured interview on vulnerable pregnant women’s experience with prenatal primary nursing care. The Qualitative Analysis Guide of Leuven guided the inductive thematic analysis, following a constant comparative iterative process. Results The women’s experience was initially influenced by the fulfillment of their needs and expectations. These stem from their previous or current pregnancy experiences, their motivation to receive prenatal care, their family concerns as well as their contexts of vulnerability. From the pregnant women’s perspective, the main factors that influenced their experience were the nurse’s approach, characteristics and interventions that all impact on their relationship with nurses, as well as the prenatal primary care organization, including the modalities of prenatal care (i.e. schedule, setting, duration, number and frequency of meetings), the continuity and the program’s prenatal care services, such as referral to a nutritionist, social worker or other services. Conclusions A conceptual framework is proposed to describe relationships among the factors distributed in three dimensions that influence the experience of pregnant women in contexts of vulnerability and to guide nurses in the improvement of prenatal primary care. Considering the complexity of this experience, a person-centered approach is mandatory to promote a positive experience, equity and a better use of services

Cell-specific DNA methylation signatures in asthma

Asthma is a complex trait, often associated with atopy. The genetic contribution has been evidenced by familial occurrence. Genome-wide association studies allowed for associating numerous genes with asthma, as well as identifying new loci that have a minor contribution to its phenotype. Considering the role of environmental exposure on asthma development, an increasing amount of literature has been published on epigenetic modifications associated with this pathology and especially on DNA methylation, in an attempt to better understand its missing heritability. These studies have been conducted in different tissues, but mainly in blood or its peripheral mononuclear cells. However, there is growing evidence that epigenetic changes that occur in one cell type cannot be directly translated into another one. In this review, we compare alterations in DNA methylation from different cells of the immune system and of the respiratory tract. The cell types in which data are obtained influences the global status of alteration of DNA methylation in asthmatic individuals compared to control (an increased or a decreased DNA methylation). Given that several genes were cell-type-specific, there is a great need for comparative studies on DNA methylation from different cells, but from the same individuals in order to better understand the role of epigenetics in asthma pathophysiology

Key factors of case management interventions for frequent users of healthcare services : a thematic analysis review

Objective : The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design : Thematic analysis review of CM studies. Methods : We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results : Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions : CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts