NCube/papyrus huggingface dataset:
Intervention d’échange de connaissances pour faciliter l’intégration d’interventions systémiques familiales sur une unité de soins intensifs

In the health team, nurses are in the best position to provide holistic care (Leon & Knapp, 2008) to families dealing with health problems. Holistic care aims to explore and respond to family needs in order to minimize development of adverse psychological sequelae and optimize their adaptation to the health situation (Davidson, Daly, Agan, Brady, & Higgins, 2010). It is well known that the integration of the family into the practice of adult critical nursing care remains suboptimal (Nelms & Eggenberger, 2010). This project aimed to facilitate the integration of Family Systems Nursing (FSN) into clinical practice and thus, improve family care in a context of an adult intensive care. FSN (Wright & Leahey, 2014) and the Knowledge-to-Action framework by Graham et al. (2006) guided the planning of this project. A pre-intervention questionnaire and discussion with nurses participants allowed to identify nurses’ learning needs regarding family care in an adult intensive care unit, as well as barriers and facilitators related to family care practice.   An educational training session on FSN and its application in a context of an adult critical care, as well as FSN coaching provided by the author of this project, that is the trainee nurse, have served as knowledge translation (KT) strategies to facilitate FSN integration into practice. These KT strategies were co-developed in collaboration with the participant nurses to enable them to learn, experiment and adapt FSN knowledge to their clinical practice. A total of 22 nurses participated in the project and several of them have incorporated FSN skills into their practice. The coaching provided by the trainee nurse was perceived by these nurses as particularly useful to facilitate the integration of FSN into practice. Other strategies have been suggested by nurses, nursing educators, clinical nurse specialist and the trainee nurse to ensure the sustainability of changes in family care practice in this intensive care setting.

Keyphrases: Knowledge translation, Family nursing, Family System Nursing, Adult critical care, Intensive care units
Perceptions des résidents en médecine d'urgence suite à l'obtention d'une rétroaction multisources: de l'information différente, pertinente et utile

In a world where residents are continuously assessed by physicians, this present study explored residents’ perceptions of multisource feedback provided by their teaching physicians, nurses with whom they have worked, and patients they have treated. In the emergency department of a tertiary-care university hospital, ten emergency medicine residents participated in a multisource feedback intervention. Three months later, they participated in semi-structured group and individual interviews on their perception of the intervention. The qualitative analysis of these interviews shows the evident potential of using multisource feedback in resident formation. While physicians focused primarily on medical expertise, nurses and patients addressed many others competencies (management, communication, collaboration, professionalism). Residents concluded that obtaining feedback from nurses and patients was acceptable and useful in their training. Residents received information they found helpful, and the great majority of them reported having modified certain behaviours after obtaining this feedback. Multisource feedback appeared as an acceptable, credible and useful option for the assessment of medical competencies other than medical expertise in emergency residents.

Keyphrases: Multisource Feedback, Emergency medicine, Interprofessional feedback, Competencies, Emergency, Resident
L’insertion professionnelle des enseignants en éducation physique et à la santé au primaire et au secondaire au Québec

In this research, we are interested in the process of professional induction of new physical education teachers. More precisely, we seek to identify the main factors influencing their professional induction as well as their perception on the knowledge acquired during their initial training and mobilized during this crucial stage. Thus, for several years, Quebec has undergone various economic and political changes. They affected the world of education and brought educational reforms, resulting in many transformations in education (Lessard and Tardif, 2004). Many writers expose these new challenges that teachers face, including the complexity of the teaching task, which has led several researchers to want to deepen the process of induction and the difficulties associated (De Stercke , 2014, Mukamurera, 2011, Mukamurera, Bourque and Gingras, 2008). Several find that the situation is marked, among other things, by burnout and dropping out of teachers, but also its transposition in other countries (Karsenti, et al., 2008; Cattonar, 2008). However, few studies focus on professional induction within the singular context of physical education and health (Grenier et al., 2014, Spallanzani et al., 2012, Blankenship and Coleman, 2009). It therefore seems appropriate to look at the situation and draw a representative portrait of Quebec. To achieve this, our theoretical framework is designed around the multidimensional model of Mukamurera (2013). The dimensions of this model will be related to the perception and the experience of each participant as to their induction as well as the knowledge resulting from their initial training. We hope that this will allow us to describe the conditions of professional induction of elementary and high school teachers in Quebec, to identify and analyze the factors influencing their professional induction experience and the knowledge mobilized during this stage. As part of this interpretative research, we have adopted a qualitative approach in order to better understand the reality of these teachers at the beginning of their careers. The fourteen participants in the sample were selected on a voluntary basis and were subjected to a semi-structured interview whose questions were developed according to the dimensions of the Mukamurera model (2013). The processing of the data took place in an inductive logic, and their analysis, by thematic content with the QDA-Miner software. It can be established that the perception of initial training is mixed. Teachers seem to have enjoyed the moments on the ground, but found several courses too theoretical and unrealistic. The results obtained also gave an overall picture of the induction process and to identify the structures that may influence the induction and the programs that offer support the new teachers.

Keyphrases: Professional induction, Physical education and health, Induction process, Induction factors, Initial training, Teacher's knowledge
Risques épigénétiques de la procréation médicalement assistée : enjeux éthiques pour les parents, les futurs enfants et les professionnels de la santé

The use of assisted reproductive technologies (ART) allows many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease (DOHaD) hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, since superovulation, fertilization methods and embryo culture could impair the embryo’s epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals, and society. This thesis focuses on ethical issues raised by the consideration of these risks when using ART. To highlight these issues, we use the principlist approach. We argue that an ethical tension can emerge between respect for the reproductive autonomy of prospective parents and the duty to minimize the risks for potential children. A second ethical tension can emerge between the parents' right to make an informed choice about the use of ART, and the reluctance of health professionals to communicate epigenetic risk given its uncertain validity. We also explore the risks of conflicts of interests for health professionals in ART clinics. We argue that prospective parents and health professionals have a shared responsibility to promote the best interests of the future child. We also argue in favor of further research on the effects of ART on the health of future children, and in favor of clinical guidelines that prioritize the use of techniques that carry less epigenetic risk and that assist health professionals in communicating the epigenetic risks associated with ART. Finally, we suggest that this communication be done within the patient-centered approach. We also explore the contribution of a narrative approach to address the ethical tensions raised by the principlist approach.

Keyphrases: Fécondation in vitro (FIV), DOHaD, Assisted reproductive technologies (ART), In vitro fertilization (IVF), Epigenetic risks, Ethical issues
Le refus de traitement en procréation médicalement assistée au Québec

From 2010 to 2015, Quebec offered comprehensive public funding for assisted reproductive technologies (ART), allowing access to any female resident ‘of reproductive age’ without specifying eligibility criteria. Other jurisdictions have different models ranging from absence of criteria to regulatory agencies overseeing fertility clinics. While establishing eligibility criteria is an ethically daunting task, candidates wishing to access ART may be confronted with professionals who reject them based on subjective criteria. Exploring what criteria are used in practice, in the absence of regulatory guidance, can shed light on the challenges faced by professionals and their decision-making needs. It can also inform our ethical reflection regarding the normative positions required for establishing guidelines in this sensitive area. This qualitative study describes eligibility criteria used by healthcare professionals working in fertility clinics in Quebec, based on semi-structured interviews conducted with four physicians and four psychologists working in both public and private clinics. An extensive literature review on the topic allowed the separation of criteria into groups under overarching themes, which were then used to analyze the interviews. Findings suggests that overall, professionals in Quebec are using similar criteria to those used by professionals in other countries. They also referred to criteria not found in the literature, which required the creation of new groups for analysis. Among the criteria used by interviewees, the researchers found that the relationship status was the most common, followed by candidates’ mental health and their age. A major finding was that professionals never considered one isolated criterion to reject candidates, but rather based their decision on a combination of factors while considering the context of the candidate’s life. Another important element was the repeated phenomenon of “temporary rejection”, i.e. a professional postponing treatment until a later date describing it as a “better time” for candidates who did not seem ready to undergo treatments. Overall, decisions were made by analyzing the context in which candidates were living and in which the prospective child would be raised. The interviews lead to the conclusion that professionals act as gatekeepers and often need to make normative decisions that go beyond a clinical assessment, based on a personal judgement call. These decisions were not easily taken and participants expressed doubts and decisional conflict.

Keyphrases: Assisted reproductive technology, Healthcare regulations, Ethical dilemmas, Healthcare professional, Socio-ethical aspect, Treatment refusal, Eligibility criteria
Exigences dialogiques et enjeux éthiques du travail en collaboration auprès d’enfants présentant des troubles sévères de l’attachement : dix entretiens

This master memoire focuses on the ethical requirements and challenges of work in pluridisciplinarity, interdisciplinary and inter institution interventions with children presenting severe attachement desorders . These memoire presents the results of an investigation for which we used aqualitative/exploratory methodology to perform our research. We have met with ten professionals of diverse backgrounds: social work, psychoeducation, psychology, children psychiatry, rehabilitation and education. We also met with a person that accommodates children with serious disrupted attachment troubles. All these people are working with children living in a very complex situation, which requires a professional intervention coming from diverse fields and different institutions. All the interviews were one hour long and all had three parts. Part 1 gave the participants a chance establish where they see themselves in regards to the children and the situation (The who’s who and who does what). Part 2 let the participant familiarized on a disrupted attachment child’s history case. Finally, part 3 was a series of predetermined questions on the case, with a special attention to clinical and ethical aspects and also with the possible interaction with the other professionals. The results give primary importance to the perception of the other professionals and the notion of self-respect. The reader of the memoire will be discovering the importance of dignity, integrity and also the destructive effects of value judgement on the others and on the difficulty to do well when working with other professionals. It is important to remember that the professionals working in multidisciplinary, interdisciplinary and inter institution situation are first and fore most human being like the troubled children and their parents.

Keyphrases: Ethical, Interdisciplinarity, Pluridisciplinarity, Severe deprivation of attachment, Child vulnerability
Impact de l’organisation des soins en néonatalogie : association entre les heures supplémentaires infirmières, les ressources infirmières, le taux d’occupation et les infections nosocomiales

Background: Healthcare-associated infections (HCAI) are an important issue in neonatal intensive care units (NICUs).1 Few studies have assessed the impact of the structure of care on the risk of infection in the NICU. Objective: To assess the association of nursing overtime, nurse staffing and unit occupancy with healthcare-associated infections in the NICU. Study Design: Two-year retrospective cohort study of 2,236 newborns admitted for more than two days in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database Logibec and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio and the unit occupancy rate over 3-day periods prior to HCAI were compared to days that did not precede infections.  Adjusted Odds Ratios (AOR) that control for the latter factors and unit risk factors were also computed.  Results: A total of 122 infants (5%) developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (AOR, 1.70; 95% Confidence interval [95% CI], 1.05-2.75, Q4 vs Q1). High unit occupancy rates were not associated with increased odds of infection (AOR, 0.85; 95% CI, 0.47-1.51, Q4 vs Q1) nor were higher available/recommended nurse ratios (AOR, 1.16; 95% CI, 0.67-1.99, Q4 vs Q1).  Conclusion: Nursing overtime is associated with higher odds of HCAI in the NICU.

Keyphrases: Infant, Healthcare-associated infection, Nosocomial infection, Neonatal intensive care unit, Nursing overtime, Nurse staffing, Unit occupancy
Identification des trajectoires développementales de fréquence de la consommation d’alcool durant l’adolescence et relation entre ces trajectoires et  la consommation excessive d’alcool épisodique à l’âge jeune adulte

Background: The impetus for this study is that alcohol use among adolescents has increased in recent years and that heavy episodic or binge drinking is increasingly common in young adults. Prevention of problem drinking must begin with appropriate identification of sub-groups of adolescents at higher risk. Objective: This study had three objectives: (i) to identify the developmental trajectories of alcohol consumption among teens; (ii) to examine the influence of sex on trajectories and (iii) to examine the relationship between alcohol consumption trajectories in adolescence and binge drinking in young adulthood. Method: We used data from the NDIT (Nicotine Dependence In Teens) longitudinal study (n=1294; 1999 – 2012) of adolescents ages 12-13 years at inception. The 1245 participants who completed at least three of 22 NDIT cycles were stratified into those who had consumed alcohol at baseline, baseline drinkers (n=497) and those who had never consumed alcohol, baseline nondrinkers (n=748). We identified the developmental trajectories of the frequency of alcohol consumption based on 19 data collection waves after baseline from grade 7 (age 12-13) to grade 11 (age 17-18), using semi-parametric group-based trajectory modeling. Logistic regression was conducted to investigate the association between the alcohol consumption developmental trajectories and binge drinking in young adulthood among baseline drinkers and baseline nondrinkers. Results: Five trajectory were identified for the whole sample (baseline nondrinkers and baseline drinkers, n=1245). Then, four trajectory groups were identified among baseline nondrinkers (low consumers (28.3%, n=211), increasing late consumers (21.5%, n=161), moderate drinkers (29.9%, n=224), and regular users (20.3%, n=152). Among baseline drinkers, trajectory groups included experimenters (15.4%, n=76), increasing (34.1%, n=170), regular (41.7%, n=207) and decreasing consumers (8.8%, n=44). Participants in the higher trajectory groups were more likely to binge drink in young adulthood. Conclusion: This study shows variability among adolescents in alcohol consumption developmental trajectories. The data suggest that multiple approaches may be necessary to prevent problem alcohol consumption among adolescents and that these approaches may need to be sex-sensitive.

Keyphrases: Adolescents, Group-based trajectory modeling, Alcohol consumption, Developmental trajectories, adolescence
Occupational risk factors for pancreatic cancer in Montreal

Background. Pancreatic cancer is a fatal disease in most cases. Unfortunately, little is known about the etiology of pancreatic cancer and whether modifiable environmental chemical exposures may play an important role. The purpose of this study is to explore whether chemical exposures in the workplace may be risk factors for pancreatic cancer. Methods. A population-based case-control study including 19 types of cancer was conducted in Montreal between 1979 and 1985. Detailed occupational histories were obtained from all subjects as well as information on several socio-demographic and lifestyle variables. Occupational histories were assessed by industrial hygienists and chemists to determine whether exposure had occurred to any of nearly 300 substances from a checklist. For this report, the participating 116 pancreatic cancer cases were compared with other cancer controls and population controls. Preliminary analyses were conducted to identify agents from the checklist showing evidence of an association with pancreatic cancer. These were selected for more in-depth statistical analyses together with agents reported in the literature as being potentially associated with pancreatic cancer. For each agent, “any” and “substantial” exposure metrics were defined. Unconditional logistic regression methods were used to estimate odds ratios between pancreatic cancer and each of the selected exposures while controlling for potential confounders. Similar analyses were conducted for occupation and industry groups. Results. Of all the exposures assessed, the majority did not reveal an association with pancreatic cancer. However, suggestive positive associations were found for several agents including coal combustion products (OR 2.6, 95% CI [1.3-5.3]), soot (OR 3.4, 95% [1.3-8.6]), waxes and polishes (OR 2.7, 95% [1.1-4.1]), cleaning agents (OR 1.9, 95% [1.1-3.2]) and for the occupational category “janitors and cleaners” (OR 2.8, 95% CI [1.5-5.1]). Conclusion. For most of the agents revealing an association with pancreatic cancer in our study, there is a paucity of direct evidence published by other authors to corroborate our findings. However, parallels can be made with previously observed excesses in occupational groups making our findings useful for guiding future research efforts, notably for meta-analyses, to uncover the specific chemical exposures that may account for these excesses.

Keyphrases: Pancreatic cancer, Risk factors, Occupation, Case-control study, Epidemiology
Des fruits et légumes au métro : évaluation d’une intervention visant à améliorer leur accès dans un quartier défavorisé de l’Est de Montréal

Implementation of alternative food sources (AFS) in underserved areas such as local markets offering fresh fruit and vegetable (FV) is a promising strategy to prevent chronic diseases and reduce health inequalities. However, the effectiveness of these interventions remains uncertain. This study aims to assess the use of a new fresh FV market located outside a subway station in a disadvantaged neighbourhood in Montreal with previously limited fresh FV offer. Data were collected on-site among market users (n=218) and by telephone among a random sample of residents living nearby (n=335). Among users surveyed on-site, 23% were low-income, 57% did not consume enough FV and 54% did not have access to a car. After adjusting for the covariables, education and being under the low-income measure were not associated with the FV market usage (n=438). Adequate FV consumption [OR=1.82, 95% CI (1.07-3.10)], living closer to the market [OR for distance home-market = 0.86, 95% CI (0,76-0.97)], having the FV market on the usual travel route [OR=2.57, 95% CI (1.46-4.53)] and not having access to a car [OR=3.16, 95% CI (1.78-5.62)] were associated with the FV market usage. The FV market reached populations who face constraints related to food shopping practices such as low-income populations, those depending on public transportation and single-person households. Interestingly, the transport hub seemed to contribute to democratising access. Implemented in strategic locations, AFS offer a promising strategy to improve FV access and possibly FV consumption.

Keyphrases: Fruit and vegetable, Food access, Farmers’ market, Health disparities, Local food systems, Food environment