Le maintien en emploi de personnes souffrant d’une maladie mentale

L’insertion au travail de personnes souffrant d’une maladie mentale s’avère complexe et difficile. Pour celles qui travaillent, le maintien en emploi est de courte durée. Cet article vise à identifier des déterminants personnels du maintien en emploi de personnes souffrant d’une maladie mentale et inscrites dans un programme de réinsertion au travail. Des 105 personnes qui travaillent durant le suivi de 9 mois après leur inscription à un programme, près de 50 % maintiennent leur première activité de travail. Les résultats d’analyses de survie révèlent que selon l’indicateur de maintien en emploi observé (premier ou dernier emploi obtenu), les variables qui apparaissent comme significatives peuvent être reliées aux aspects sociodémographiques (aide financière reçue), travail (la durée d’absence du marché du travail, le type d’emploi obtenu), cognitif (fonctions exécutives) et clinique (symptômes paranoïdes). En conclusion, les auteurs suggèrent non seulement de considérer les variables inhérentes à la personne souffrant d’une maladie mentale pour prédire le maintien en emploi, mais aussi d’évaluer de façon plus systématique son milieu de travail.Work integration for people with mental illness is complex and difficult. For those who obtain employment, job tenure is typically brief. The purpose of this article is to identify the personal determinants of job tenure of people with severe mental illness registered in prevocational programs. Out of 105 people with mental illness who are employed during the nine month follow-up after their registration in a prevocational program, close to 50 % kept their first job. According to the job tenure indicators (first or last job obtained), the results from survival analyses show that the significant variables are related to background characteristics (financial aid), work-related characteristics (length of absence from the workplace, type of job), cognitive (executive functions), and clinical aspects (paranoid symptoms). In conclusion, the authors propose not only to assess personal variables to better understand the work integration process for people with mental illness, but also to conduct a systematic evaluation of the job site.La inserción al trabajo de personas que sufren de una enfermedad mental resulta compleja y difícil. Para aquellas que trabajan, mantenerse en un empleo dura poco tiempo. Este artículo busca identificar las variables personales de las personas que sufren de una enfermedad mental y que están inscritas a un programa de reinserción al trabajo para mantenerse en un empleo. De las 105 personas que trabajan durante el seguimiento de 9 meses después de su inscripción a un programa, cerca del 50% conservan su primera actividad de trabajo. Los resultados de los análisis de sobrevivencia revelan que según el índice de mantenimiento en empleo observado (primer o último empleo obtenido), las variables que aparecen como significativas pueden estar relacionadas con aspectos sociodemográficos (ayuda financiera recibida), trabajo (la duración de la ausencia en el mercado de trabajo, el tipo de empleo obtenido), cognitivos (funciones ejecutivas) y clínicos (síntomas paranoides). En conclusión, los autores no solamente sugieren considerar las variables inherentes a la persona que sufre de una enfermedad mental para predecir el mantenimiento del empleo, sino también evaluar de manera más sistemática su medio de trabajo.A inserção no trabalho, para pessoas que sofrem de uma doença mental, mostra-se complexa e difícil. Para as que trabalham, a continuação no emprego é de curta duração. Este artigo visa identificar determinantes pessoais da continuação no trabalho para pessoas que sofrem de uma doença mental e inscritas em um programa de reinserção no trabalho. Das 105 pessoas que trabalham, durante o acompanhamento de nove meses após a inscrição em um programa, cerca de 50% mantêm sua primeira atividade de trabalho. Os resultados de análises de sobrevivência revelam que, segundo o indicador de continuação no emprego observado (primeiro ou último emprego obtido), as variáveis que aparecem como significativas podem estar ligadas aos aspectos sócio-demográficos (auxílio financeiro recebido), ao trabalho (duração da ausência no mercado de trabalho, tipo de emprego obtido), aos aspectos cognitivos (funções executivas) e clínicos (sintomas paranóides). Concluindo, os autores sugerem, não apenas considerar as variáveis inerentes à pessoa que sofre de uma doença mental para predizer a continuação no emprego, mas também avaliar, de maneira mais sistemática, seu meio de trabalho

Obstacles à l’insertion socioprofessionnelle de personnes ayant des problèmes graves de santé mentale : données empiriques et repères théoriques

Les auteurs décrivent les obstacles à l'insertion socioprofessionnelle des personnes atteintes de troubles mentaux graves selon les perspectives de divers acteurs. Des groupes thématiques (22) ont été formés dans la plupart des régions du Québec et ont réuni 87 personnes utilisatrices de services participant à une démarche d'insertion socioprofessionnelle, 47 non participants et 51 employeurs. Quatre-vingt responsables de programmes de réadaptation au travail ont répondu à un questionnaire structuré. Les obstacles identifiés par ces groupes de répondants sont comparés à ceux décrits dans d'autres études. Il s'avère que les résultats sont semblables : l'obstacle le plus saillant est relatif aux préjugés à l'endroit de la maladie mentale et des personnes qui souffrent de problèmes de santé mentale, quel que soit l'acteur interrogé. Ces obstacles sont revus en fonction des théories du sentiment d'efficacité (Bandura, 1977, 1997), de l'attribution causale (Weiner, 1986) et du comportement planifié (Ajzen, 1991, 1996). Cette analyse des obstacles à l'insertion socioprofessionnelle faite à la lumière de ces trois théories permet de proposer des points d'appui à de nouveaux outils et stratégies d'insertion.Barriers to socio-professional integration of people with severe mental disorders: empirical data and theoretical points of reference The authors describe the barriers related to socio-professional integration of people with severe mental disorders according to different perspectives of various people involved. Focus groups (22) have been conducted in almost every region in Quebec involving 87 participants in vocational rehabilitation programs, 47 non participants and 51 employers. Eighty (80) vocational program administrator completed a questionaire. The barriers identified by these groups are compared with those described in other studies. It seems that the results are similar: the main obstacle is prejudice towards mental illness and people with mental disorders, no matter who is questionned. Barriers to socio-professional integration are reviewed according to the theories of feeling of self-efficiency (Bandura, 1977,1997), causal attribution (Weiner, 1986) and planned behavior (Ajzen, 1991, 1996). Analysis of barriers to socio-professional integration carried out in the light of these three theories, allows to suggest points of reference for new tools and integration strategies.Obstáculos a la inserción socioprofesional de personas con problemas graves de salud mental: datos empíricos y marcos teóricos Los autores describen los obstáculos que se presentan a la inserción socioprofesional de personas con problemas mentales graves según las perspectivas de varios actores. Fueron formados 22 grupos temáticos en la mayoría de las regiones del Quebec y se reunieron a 87 personas usuarias que participan en un program dirigido hacia la inserción socioprofesional, 47 no participantes y 51 empleadores. 80 responsables de programas de readaptación al trabajo respondieron a un cuestionario estructurado. Los obstáculos identificados en las respuestas de estos grupos son comparados con los descritos en otras investigaciones. Se revela que los resultados son similares: el obstáculo más saliente se relaciona con los perjuicios con respecto a la enfermedad mental y de personas que sufren problemas de salud mental, cualquiera que sea el actor entrevistado. Estos obstáculos están, enmarcados en función de la teorías del sentimiento de eficacia (Bandura, 1977, 1997), de la atribución causal (Weiner, 1986) y del comportamiento planificado (Ajzen, 1991, 1996). Este análisis de los obstáculos a la inserción socioprofesional a partir de la luz aportada por estas tres teorías permite proponer ciertos puntos de apoyo a nuevos instrumentos y estrategias de inserción.Obstáculos à inserção sócio-profissional de pessoas que sofrem de problemas graves de saúde mental: dados empíricos e referências teóricas Os autores descrevem os obstáculos à inserção sócio-profissional das pessoas atingidas por problemas mentais graves segundo a perspectiva de vários autores. 22 grupos temáticos foram formados na maior parte das regiões do Quebec e reuniram 87 pacientes que participam de um programa de inserção sócio-profissional, 47 não-participantes e 51 empregadores. 80 responsáveis por programas de readaptação ao trabalho responderam a um questionário estruturado. Os obstáculos identificados por eles foram comparados aos descritos em outros estudos. Provou-se que os resultados foram semelhantes: o obstáculo mais evidente está associado aos preconceitos com a doença mental e as pessoas que sofrem de problemas de saúde mental, pouco importa a pessoa interrogada. Estes obstáculos são examinados segundo as teorias do sentimento de eficácia (Bandura, 1977, 1997), da atribuição causal (Weiner, 1986) e do comportamento planificado (Ajzen, 1991, 1996). Esta análise dos obstáculos à inserção sócio-profissional feita à luz destas três teorias permite propor pontos de apoio a novas ferramentas e estratégias de inserção

Identité ethnique à l’adolescence : perspectives interculturelles

Comme suite à la traduction française et à l'adaptation (Tremblay, Corbière, Perron, & Coallier, 2000) du Multigroup Ethnic Identity Measure (Phinney, 1992), cette étude vise à reproduire, avec des groupes d'élèves québécois du cursus secondaire, les conclusions de travaux réalisés aux États-Unis avec des groupes analogues. Les résultats de trois types d'analyses (développemental, différentiel, corrélationnel) sont la plupart du temps semblables à ceux des études américaines et permettent de conclure que la Mesure d'Identité Ethnique (M.I.E. ; Perron & Coallier, 1992) est valide et pourrait servir à mieux comprendre le processus de la formation de l'identité ethnique d'élèves de divers groupes culturels dans les pays de la francophonie.Following the translation and adaptation (Tremblay, Corbière, Perron, & Coallier, 2000) of the Multigroup Ethnic Identity Measure (M.E.LM. ; Phinney, 1992), this study aimed at replicating, with high school Québécois students, the conclusions of researches petformed in the United States with analogue groups. Results from three types of analyses (developmental, differential, and correlational) were mostly similar to those of the American studies and lent support for the conclusion that the Mesure d'Identité Ethnique (M.LE. ; Perron & Coallier, 1992) is a valid instrument and could help to further understand the process of ethnic identity formation among students of diverse ethnic groups within French-speaking countries

Radiation Effects in Pinned Photodiode CMOS Image Sensors: Pixel Performance Degradation Due to Total Ionizing Dose

Several Pinned Photodiode (PPD) CMOS Image Sensors (CIS) are designed, manufactured, characterized and exposed biased to ionizing radiation up to 10 kGy(SiO2 ). In addition to the usually reported dark current increase and quantum efficiency drop at short wavelengths, several original radiation effects are shown: an increase of the pinning voltage, a decrease of the buried photodiode full well capacity, a large change in charge transfer efficiency, the creation of a large number of Total Ionizing Dose (TID) induced Dark Current Random Telegraph Signal (DC-RTS) centers active in the photodiode (even when the Transfer Gate (TG) is accumulated) and the complete depletion of the Pre-Metal Dielectric (PMD) interface at the highest TID leading to a large dark current and the loss of control of the TG on the dark current. The proposed mechanisms at the origin of these degradations are discussed. It is also demonstrated that biasing (i.e., operating) the PPD CIS during irradiation does not enhance the degradations compared to sensors grounded during irradiation

Facteurs déterminants de l’attitude des professionnels en santé mentale envers le rétablissement - une revue de littérature

Objective: The attitudes of mental health professionals towards consumers’ recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. Methods: A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. Results: From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals’ pessimistic attitudes towards recovery. Conclusions: This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers

High Displacement Damage Dose Effects in Radiation Hardened CMOS Image Sensors

CMOS image sensors (CISs) hardened by design against total ionizing dose (TID) are exposed to neutron fluences beyond 1014 n(1 MeV)/cm2. Neutron-irradiated devices show a huge increase in the dark current affecting uniformly the pixel array which leads to Gaussian shape dark current distributions. Moreover, random telegraph signal behavior is hardly detectable at these very high neutron fluences since the fluctuation amplitudes are hidden by the dark current shot noise. It is observed that neutrons induce a change in the depleted volume in impacted photodiodes because of doping profile modifications which are responsible for the decrease in the charge-to-voltage conversion factor and quantum efficiency. Even if neutron-induced degradations affect all the image sensor performances, results show that this technology is still functional after having absorbed 8.1 × 1014 n(1 MeV)/cm2. Image sensors are still able to capture an image without significant degradation compared to nonirradiated devices. Such TID radiation-hardened CISs are thus highly promising for applications where both high TID and high neutron fluence radiation tolerance are required

The Work Disability Prevention CIHR Strategic Training Program: Program Performance After 5 Years of Implementation

Introduction The Work Disability Prevention (WDP) Canadian Institutes of Health Research (CIHR) Strategic Training Program was developed in 2001 and is a unique program in the world. The main objective of this program is to help future researchers develop transdisciplinary knowledge, skills and attitudes regarding WDP. The purpose of this paper is to present a descriptive portrait of the program's performance over the past 5 years, as well as the trainees' and alumni's perspectives on the WDP CIHR Training Program. Methods Data on the program's performance were collected from documents in the program records. The trainees' opinions on the WDP training program were obtained through focus groups and telephone interviews. The data collected were compiled and divided into themes to summarize the qualitative findings pertaining to each question. Results From 2003 to 2007, five successive summer sessions have been offered, involving 44 high-caliber applicants from nine countries, 34 mentors and collaborators, 29 guest speakers and 15 stakeholders. Overall, trainees appreciated the networking, the opportunity to interact with people from different disciplines and countries, the openness, and the international perspective and uniqueness of the program. The least appreciated aspects concerned mainly the e-learning course, evaluations and information on optional courses. The coordination and logistics were judged appropriate and several topics were suggested to improve the program quality. Conclusion In general, the program implementation went well, with good participation from mentors, speakers and stakeholders; the program was appreciated by the trainees and alumni. This paper underscores the importance of the international perspective, the transdisciplinarity and the scientific networking established through the progra

Radiation Hardening of Digital Color CMOS Camera-on-a-Chip Building Blocks for Multi-MGy Total Ionizing Dose Environments

The Total Ionizing Dose (TID) hardness of digital color Camera-on-a-Chip (CoC) building blocks is explored in the Multi-MGy range using 60Co gamma-ray irradiations. The performances of the following CoC subcomponents are studied: radiation hardened (RH) pixel and photodiode designs, RH readout chain, Color Filter Arrays (CFA) and column RH Analog-to-Digital Converters (ADC). Several radiation hardness improvements are reported (on the readout chain and on dark current). CFAs and ADCs degradations appear to be very weak at the maximum TID of 6 MGy(SiO2), 600 Mrad. In the end, this study demonstrates the feasibility of a MGy rad-hard CMOS color digital camera-on-a-chip, illustrated by a color image captured after 6 MGy(SiO2) with no obvious degradation. An original dark current reduction mechanism in irradiated CMOS Image Sensors is also reported and discussed

Practical pathway for the management of depression in the workplace: a Canadian perspective

Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker’s compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues