Social support, but not perceived food environment, is associated with diet quality in French-speaking Canadians from the PREDISE study

The objectives were to assess whether social support for healthy eating and perceived food environment are associated with diet quality, and to investigate if sociodemographic characteristics moderate these associations. A probability sample of French-speaking adults from the Province of Québec, Canada, was recruited in the context of the PREDISE study. Participants reported their perceptions of supportive and non-supportive actions related to healthy eating from close others at home and outside of home (n = 952), and of the accessibility to healthy foods (n = 1035). The Canadian Healthy Eating Index (C-HEI) was calculated based on three Web-based 24 h food recalls. Multiple linear regression models showed that supportive (B = 1.50 (95% CI 0.46, 2.54)) and non-supportive (B = −3.06 (95% CI −4.94, −1.18)) actions related to healthy eating from close others at home were positively and negatively associated with C-HEI, respectively, whereas actions from close others outside of home were not. The negative association between non-supportive actions occurring at home and C-HEI was stronger among participants with lower (vs. higher) levels of education (p interaction = 0.03). Perceived accessibility to healthy foods was not associated with C-HEI (p > 0.05). These results suggest that the social environment may have a stronger influence on healthy eating than the perceived physical environment. This adds support for healthy eating promotion programs involving entire families, especially for more socioeconomically disadvantaged individuals, whose efforts to eat healthily may be more easily thwarted by non-supportive household

The impact of drinking water, indoor dust and paint on blood lead levels of children aged 1-5 years in Montreal (Quebec, Canada)

Lead is neurotoxic at very low dose and there is a need to better characterize the impact of domestic sources of lead on the biological exposure of young children. A cross-sectional survey evaluated the contribution of drinking water, house dust and paint to blood lead levels (BLLs) of young children living in old boroughs of Montreal (Canada). Three hundred and six children aged 1 to 5 years and currently drinking tap water participated in the study. For each participant, residential lead was measured in kitchen tap water, floor dust, windowsill dust and house paint and a venous blood sample was analyzed. Multivariate logistic regression was used to evaluate the association between elevated BLL in the children (>/= 75th percentile) and indoor lead contamination by means of odds ratios (OR) using 95% confidence intervals (CI). There was an association between BLL >/=75th percentile (1.78 mug/dL) and water lead when the mean water concentration was >3.3 mug/L: adjusted OR=4.7 (95% CI: 2.1-10.2). Windowsill dust loading >14.1 mug/ft(2) was also associated with BLL >/=1.78 mug/dL: adjusted OR=3.2 (95% CI: 1.3-7.8). Despite relatively low BLLs, tap water and house dust lead contribute to an increase of BLLs in exposed young children

Organizational impact of evidence-informed decision making training initiatives : a case study comparison of two approaches

Background The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. Methods We conducted a theory-driven evaluation of the organizational impact of healthcare leaders’ participation in two training programs using a logic model based on Nonaka’s theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. Results We found that the impact of training could primarily be felt in trainees’ immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Conclusions Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence—both positive and negative—of specific organizational factors on extending the impact of training programs

Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician.</p> <p>Methods/design</p> <p>The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline) including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700). The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1) physicians and patients' decisional conflict; 2) the agreement between the parties' decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration.</p> <p>Discussion</p> <p>DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="NCT01116076">NCT01116076</a></p

La maîtrise des modes de décision: le cas de la répartition géographique des effectifs médicaux au Québec

There are three different generations in the formation of policy concerning the geographic distribution of doctors in Quebec. The first one covers the 1974-81 period; the second, the years 1981 to 1985; and the third, the years 1985 to 1991. The policy measures which are characteristic of each of the generations were determined in a large part by some patterns of the decision-making process. During the first generation the governmental authorities and the representatives of the doctors controlled these patterns. During the second generation, the governmental actors were dominating. By the end of the third generation the representatives of the doctors were successful in controlling the decision patterns pertaining to the measures to which they were opposed. Consequently, the governmental authorities have changed these measures to the advantage of doctors.

Analyse des performances du CRAY C98

SIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : 26165 F, issue : a.1995 n.64 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches

Abstract Background The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. Methods We conducted a theory-driven evaluation of the organizational impact of healthcare leaders’ participation in two training programs using a logic model based on Nonaka’s theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. Results We found that the impact of training could primarily be felt in trainees’ immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Conclusions Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence—both positive and negative—of specific organizational factors on extending the impact of training programs

The local insolation signature of air content in Antarctic ice. A new step toward an absolute dating of ice records

International audienceAn accurate chronology of ice cores is still needed for interpreting the paleoclimatic record and to understand the relation between insolation and climate. A new domain of research in this area has been stimulated by the work of M. Bender linking the record of N2/O2 ratio in the air trapped in the ice with the local insolation. Here we investigate the potential of the air content of polar ice, V, as another and complementary ice proxy of local insolation. We propose that the long-term changes in air content recorded in ice from the high Antarctic plateau is dominantly imprinted by the local summer insolation. The V measurements covering the last 440,000 yr and obtained along the EPICA DC (EDC) ice core are presented. 86% of the variance observed in the V record can be explained neither by air pressure nor by temperature changes, and then should reflect properties influencing the porosity at close-off other than temperature. A wavelet analysis indicates a dominant obliquity period (around 41 ka) over the last 440 ka. We propose a mechanism, which can account for the observed anti-correlation between local insolation and V and explain how the local insolation, via the integrated summer insolation, can affect the near-surface snow structure and consequently the porosity at close-off. The V and the integrated summer insolation changes show high coherency over all the record and a variable phase relationship with a maximum phase difference of about 4000 yr around 200 ka ago. The phase difference may reflect the difference between the EDC2 chronology based on an inverse dating method and an accurately dated insolation curve. Our work, by proposing a new and complementary ice proxy for local insolation should eventually contribute to the establishment of an absolute dating of the ice paleo-record