Travail en réseau, savoirs en partage et processus en jeu en contexte d'innovation : une transition planifiée vers le préscolaire d'enfants ayant des besoins particuliers

La recherche doctorale, qualitative/interprétative, invite des acteurs intersectoriels qui gravitent autour d'enfants ayant des besoins particuliers à planifier en réseau la transition vers le préscolaire, sur une période d'un an. Les acteurs proviennent des milieux scolaires, de la santé et des services sociaux et de garde, ainsi que les parents des trois enfants qui ont vécu cette transition. La démarche de transition planifiée par des acteurs en réseau, telle qu'expérimentée, constitue une innovation. La recherche examine les processus qui sont en jeu au cours de cette innovation avec un regard sur la dynamique relationnelle entre les acteurs sous les angles du travail en réseau et des savoirs en partage. La sociologie de la traduction forme la perspective théorique de la recherche. L'observation participante lors des rencontres en réseau, les groupes de discussion focalisée et les entretiens individuels semi-dirigés sont les modes de saisie de données. L'analyse qualitative du contenu s'est réalisée par catégorisation mixte. La planification de la transition a été l'occasion d'observer une évolution du travail en réseau entre les acteurs des trois réseaux étudiés. Ces acteurs se sont unis autour d'une cause commune, soit celle de faire vivre une transition de qualité aux enfants ayant des besoins particuliers. Ils ont su dépasser leurs controverses. De même, ils ont profité de l'occasion créée par cette innovation pour vivre des savoirs en partage. L'analyse des interfaces entre le travail en réseau et les savoirs en partage met en évidence les processus en jeu lors de l'innovation. Les processus structurels illustrent qu'il faut plus que de la bonne volonté pour que survienne l'innovation. Celle-ci requiert la mise en place de dispositifs appuyant une transition planifiée, dont une démarche structurante, des libérations, une coordination, incluant du temps qui y est dédié. Pour leur part, les processus interactionnels sont imbriqués à la dynamique qui se développe entre les acteurs lors des différentes opérations du travail en réseau et lors des savoirs en partage. Les acteurs ont profité des occasions offertes par les processus structurels pour œuvrer ensemble à un « intérêt supérieur ». Ils ont évolué d'une logique d'action individuelle à une logique d'action collective, ils ont risqué des déplacements de rôle. Le temps planifié a été utilisé avec qualité. Les savoirs en partage ont agi à titre d'intermédiaires de la relation au cours du travail en réseau. Enfin, l'innovation a contribué à une transition de qualité (a) par sa planification, (b) par la mise en place de pratiques transitionnelles variées et ajustées aux besoins des enfants et des milieux, (c) par la continuité éducative qu'elle a favorisée, (d) par la place laissée et prise par les parents et (d) par les relations de collaboration qui se sont développées entre les acteurs tout au long de la démarche. Ce faisant, ces dimensions rejoignent les principes associés à une transition écologique et développementale. \ud ______________________________________________________________________________ \ud MOTS-CLÉS DE L’AUTEUR : transition, préscolaire, travail en réseau, savoirs en partage, innovation

Growing the evidence for nutrition programming: perceptions, implementation, and uptake of a package of lipid-based supplementation and behavior change communication interventions in Malawi

Background: Childhood undernutrition continues to be a problem of public health significance in low and middle-income countries (LMIC), holding consequences for children’s physical and cognitive development that contributes to lower economic earnings and increased morbidity in adulthood. Efficacious interventions to improve child growth during the critical window of opportunity, from conception to 2 years of age, include nutrition education to promote optimal infant and young child feeding (IYCF) practices, and supplementation with fortified foods, such as lipid-based nutrient supplements, among others. The delivery of these interventions in a programmatic context so that they yield improvements in child nutritional status, however, proves to be difficult given the logistical and sociocultural challenges associated with the delivery and uptake of interventions. Understanding how programs work to improve child nutrition and feeding behaviors is critical for scaling up nutrition interventions globally. Objective: To study how a nutrition program in rural Malawi was perceived, accepted, implemented, and taken up, and whether high adherence to program interventions resulted in improved child growth and feeding behaviors after 1 year of implementation. Methods: The nutrition program in Malawi includes: (1) the monthly distribution of a daily, small-quantity (20g) lipid-based nutrient supplement, Nutributter (Nutriset, Malaunay, France) to all children 6-23 months; and (2) a social behavior change communication (SBCC) campaign to promote optimal IYCF and water, sanitation, and hygiene (WASH) practices. The program is monitored by monthly attendance tracking of target beneficiaries, and quarterly post-distribution monitoring (PDM) surveys to assess product utilization and IYCF and WASH knowledge. An independent impact evaluation was led by the Johns Hopkins University’s Center for Human Nutrition (JHU CHN) to measure IYCF and WASH practices, and child nutrition outcomes after 1 and 3 years of implementation in the program (Ntchisi) and a comparison (Dowa) district. A qualitative study employed in-depth interviews (IDI) with mothers (n=34) and household members (fathers, n=11; and grandmothers, n=4), focus group discussions (FGD) with village leaders (1 with n=11) and program staff (3 FGD with n=12, n=10, and n=11), and direct observations of mothers and their children (n=12), to elicit beneficiary and community perceptions of the program’s intervention components. Recorded interviews and FGDs were simultaneously transcribed and translated verbatim, and inductive line-by-line coding was conducted. Results were presented using a hybrid of the Socio Ecological Model and Transactional Theory. A process evaluation study measured the program’s conformity to its original design using various data sources to measure: program recruitment (n=21,456 children tracked through attendance records from the first year of implementation), program fidelity (n=28 direct observations of program activities; n=84 knowledge questionnaires with program staff; 8 PDM surveys with pooled n=2,901 and 2 annual performance review documents); and program reach (n=41,617 children’s attendance records for years 0-3 of implementation). Process indicators were categorized as “working well” (>75%), “needing improvement” (25%-75%), and “not working” (<25%). Impact evaluation data collected at 1 year post-program implementation (midline) (n=2,047) was linked with individual-level program attendance data (n=846) to generate high and low participation for Nutributter distributions (>71.4% and ≤71.4%, respectively) and SBCC messaging (SBCC score≥2 and SBCC score=1, respectively); those who were not exposed served as the referent category for each program component n=1,208 and n=204, respectively). Household, individual, and maternal characteristics were analyzed to examine their association with program exposure, using multinomial logistic regression. Varying levels of program participation were analyzed to examine the association with anthropometric (length-for-age (LAZ), weight-for-age (WAZ), weight-for-length z-scores (WLZ) and stunting, underweight, and wasting, defined as LAZ, WAZ, and WLZ <-2, respectively), IYCF, and WASH outcomes, using multivariable linear and logistic regression for continuous and binary outcomes, respectively. All linear and logistic models adjusted for household, maternal, and individual characteristics. Results: Results from the qualitative study demonstrated that Nutributter was viewed positively by all members of the household and community. Mothers and community members reported perceiving changes in child health and growth, ascribing them to Nutributter. Barriers to the monthly collection of Nutributter were competing household tasks and obligations, such as caring for ill family members or attending funerals. When asked to discuss program messages, a majority of mothers demonstrated limited and superficial knowledge of the IYCF and WASH messages. This, in combination with the described lack of financial and physical access to nutritious foods promoted by those messages were perceived as significant barriers to enacting desired behavioral changes among mothers. The process evaluation indicated that only 20.7% of children were registered into the program at or by 6 months of age. Direct observations of Nutributter distributions demonstrated that most procedures were functioning at 85% or higher, with some areas needing improvement, such as the conduct of multiple counseling sessions throughout distributions to account for latecomers. Despite the relatively high implementation of training activities as planned (73.3%) for frontline staff, the completion of training modules for breastfeeding (22.9%) and complementary feeding (18.6%) was low. Nevertheless, knowledge of key IYCF, WASH, and Nutributter messages among those who were trained on those messages was high, with the exception of being able to list the 6 food groups (22.9%). Over 3 years of implementation, the program reached a mean (SD, range) of 81.0% (8.5, 65.6%-93.5%) of eligible beneficiaries during monthly Nutributter distributions and 92.1% of mothers with group counseling activities, but only 32.9% (8.0, 18.8%-42.0%) of mothers with individual-level SBCC. Using multivariable models, socioeconomic characteristics (land and livestock ownership) and child morbidity (7-day diarrhea and malaria) were positively associated with high vs. no participation in Nutributter distributions (all p<0.05). Maternal age, working in agriculture as a primary occupation, and childhood acute respiratory infection were positively associated with exposure to SBCC (all p<0.05), while food insecurity was associated with lower risk of high exposure to SBCC. The dose-response analysis showed that high and low participation in Nutributter distributions was associated with higher WLZ of 0.21 (95% CI 0.01, 0.31) and 0.17 (95% CI 0.06, 0.36), respectively among children, (both p<0.05) relative to the control children. However, the confidence intervals for each were overlapping, suggesting the lack of a true dose response relationship. Program exposure was not associated with any of the other measures of nutritional status, including LAZ and WAZ, or stunting, wasting and underweight. Low and high exposure to SBCC were associated with increases (p<0.05) in dietary diversity score of 0.22 (95% CI 0.03,0.41) and 0.21 (95% CI 0.01, 0.42), respectively, and higher likelihood of achieving minimum meal frequency (OR=1.62, 95% CI) compared to no exposure. Conclusions: This study demonstrated that the large-scale nutrition program in Ntchisi was well implemented and accepted, and that higher doses of exposure yielded improvements in some anthropometric and IYCF outcomes. The detailed documentation of the perceptions, facilitators and barriers to, implementation, characteristics associated with exposure to program components, and intermediate impact of the large-scale nutrition program generates important lessons for current and future policy, programming, and scale-up of nutrition interventions in this, and other similar contexts in sub-Saharan Africa

Considerations for Monitoring School Health and Nutrition Programs.

School health and nutrition (SHN) interventions are among the most ubiquitous public health investments and comprise a key mechanism for reaching populations that are otherwise difficult to reach through the health system. Despite the critical role of monitoring these multisectoral programs to enable data-informed adaptive programming, information to guide program implementers is scant. This manuscript provides an overview of how monitoring indicators can be selected across a SHN program's logical framework, with specific examples across five SHN implementation models. Adaptation of SHN programs in times of school closures, such as those currently being experienced globally due to the emergence of COVID-19, is also addressed. Key aspects of SHN program monitoring are explored, including: (1) why monitor; (2) what to measure; (3) how to measure; and (4) who measures. In situations of school closures, strategies to shift both program activities and corresponding monitoring mechanisms are critical to understanding the rapidly evolving situation and subsequently guiding policy actions to protect vulnerable populations

A nanoparticle ink allowing the high precision visualization of tissue engineered scaffolds by MRI

Hydrogels are widely used as cell scaffolds in several biomedical applications. Once implanted in vivo, cell scaffolds must often be visualized, and monitored overtime. However, cell scaffolds appear poorly contrasted in most biomedical imaging modalities such as magnetic resonance imaging (MRI). MRI is the imaging technique of choice for high-resolution visualization of low-density, water-rich tissues. Attempts to enhance hydrogel contrast in MRI are performed with “negative” contrast agents that produce several image artifacts impeding the delineation of the implant’s contours. In this study, a magnetic ink based on ultra-small iron oxide nanoparticles (USPIONs; <5 nm diameter cores) is developed and integrated into biocompatible alginate hydrogel used in cell scaffolding applications. Relaxometric properties of the magnetic hydrogel are measured, as well as biocompatibility and MR-visibility (T1-weighted mode; in vitro and in vivo). A 2-week MR follow-up study is performed in the mouse model, demonstrating no image artifacts, and the retention of “positive” contrast overtime, which allows very precise delineation of tissue grafts with MRI. Finally, a 3D-contouring procedure developed to facilitate graft delineation and geometrical conformity assessment is applied on an inverted template alginate pore network. This proof-of-concept establishes the possibility to reveal precisely engineered hydrogel structures using this USPIONs ink high-visibility approach

Monitoring and evaluation design of Malawi's Right Foods at the Right Time nutrition program

Abstract Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6–23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation. We describe these and the methodology for an impact evaluation that was conducted for this program. Two monitoring systems using traditional and electronic platforms were established to register and track program delivery and processes including number of eligible beneficiaries, worker performance, program participation, and to monitor input, output, and outcome indicators. The impact evaluation used comparative cross-sectional and longitudinal designs to assess impact on anthropometric and infant and young child feeding outcomes. Three cross-sectional surveys (base-, mid-, and end-line) and two longitudinal cohorts of children followed in 6-month intervals from 6 to 24 months of age, were conducted in sampled households in the program and a neighboring comparison district. Additional M&E included qualitative studies, a process evaluation, and a cost-effectiveness study. The current paper describes lessons from this program's M&E, and demonstrates how multiple implementation research activities can inform course-correction and program scale-up

Enhancing Employability for Autistic Graduates: Using TRIZ Theory to Design Virtual Reality Solutions for Fostering Inclusive Communications in Workplace Environments

The underemployment of post-secondary graduates with autism AP-PSD is a critical concern This issue often stems from difficulties in workplace integration and communication This research explores the potential of virtual reality VR systems to alleviate these challenges by simulating work environments The methodology rooted in the TRIZ Theory a problem-solving algorithm refines the use of VR systems for enhanced adaptability and efficiency The primary objectives include enhancing employers understanding of AP-PSD-related issues and identifying significant workplace challenges faced by AP-PSDs Through literature reviews surveys and focus groups the study investigates the factors impacting AP-PSDs and identifies key components to develop a more effective VR system to support their workplace integration The research also scrutinizes existing technological adaptations that could improve situation recognition communication and understanding in the workplace Additionally the potential role of human supervision in conjunction with VR technology support for AP-PSD employees is considered The results suggest that regardless of company size supporting AP-PSDs in the workplace is a feasible goal that can enhance their wellbeing Crucially the AP-PSD s active participation in their own integration process which encompasses training human support and environmental adaptations along with the specific involvement of the human resources manager has proven vital With the right accommodations AP-PSDs can demonstrate up to 30 greater productivity than neurotypical employees offsetting accommodation costs This research emphasizes the need to blend human-centered approaches with technological innovations to boost AP-PSDs employability Though industry-specific integration details are beyond the scope of this study the results underline the potential for tailored solutions aligned with each company s unique culture The paper presents a prototype for further co-design phase

Enhancing Employability for Autistic Graduates: Using TRIZ Theory to Design Virtual Reality Solutions for Fostering Inclusive Communications in Workplace Environments

The underemployment of post-secondary graduates with autism (AP-PSD) is a critical concern. This issue often stems from difficulties in workplace integration and communication. This research explores the potential of virtual reality (VR) systems to alleviate these challenges by simulating work environments. The methodology, rooted in the TRIZ Theory, a problem-solving algorithm, refines the use of VR systems for enhanced adaptability and efficiency. The primary objectives include enhancing employers\u27 understanding of AP-PSD-related issues and identifying significant workplace challenges faced by AP-PSDs. Through literature reviews, surveys, and focus groups, the study investigates the factors impacting AP-PSDs and identifies key components to develop a more effective VR system to support their workplace integration

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

La continuité éducative en réponse aux défis de la transition vers le préscolaire d’enfants ayant des besoins particuliers

Durant plusieurs années, les interventions en vue de faciliter la rentrée scolaire ont porté prioritairement sur la préparation des enfants afin de les rendre prêts pour cette première rentrée scolaire. La perspective écologique de la transition invite pour sa part tous les acteurs qui entourent les enfants ayant des besoins particuliers à se mobiliser afin de préparer notamment les milieux scolaires à mieux accueillir les enfants et leurs familles, tout en considérant leur diversité. La continuité éducative s’inscrit dans cet esprit soutenu par la perspective écologique de la transition. Elle favorise les liens entre les différents milieux de vie de l’enfant.Cet article permet d’approfondir la continuité éducative dans ce contexte de la transition vers le préscolaire d’enfants ayant des besoins particuliers. Après avoir défini la continuité éducative et après l’avoir circonscrite dans ce contexte particulier de la première transition scolaire, des pistes d’intervention sont suggérées. Elles soutiennent la poursuite du développement de l’enfant et un partage de la responsabilité de la qualité de la transition.For several years, interventions to facilitate the beginning of the school year focused primarily on preparing children for the start of their first academic school year. An ecological perspective of the transition on the other hand invites all those who surround children with special needs to take action in preparing schools to better accommodate the children and their families, while considering their diversity. Educational continuity is linked to this ecological perspective, supporting home-school-community continuity and school readiness.This article seeks a deeper understanding of educational continuity with regards to children with special needs’ transition to kindergarten needs. After defining educational transition, some strategies are suggested in that regard. These strategies support continuity in the child’s development and a shared responsibility between the community and schools, thereby contributing to the quality of the transition