Despite the developmental and clinical importance of body image during the pre-adolescent and adolescent years, there remains a dearth of information on the body image experiences of immigrant children and adolescents. This thesis represents a purposeful attempt to examine body image experiences among immigrant and ethnic minority children and adolescents in Canada and the United States (US). Specifically, the thesis integrates multiple methods (scoping reviews, qualitative interpretive description, quantitative multi-level modeling) and samples (clinical and population-based samples) to systematically contribute to the academic literature focusing on body image experiences among immigrant and ethnic minority children and adolescents in Canada and the US. Consisting of four conceptually related studies, this thesis makes the following methodological and conceptual contributions to epidemiological and clinical research and practice. First, the results from all four studies point to the need to develop standardized approaches for identifying and classifying immigrant and ethnic-minority children and adolescents. This will substantially increase the field’s ability to systematically characterize the nature and magnitude of body image dissatisfaction, body image distortion, and their associated outcomes among immigrant and ethnic minority children and adolescents. In addition, this systematic classification has the potential to inform the development or adaptation of universal and targeted preventative intervention strategies. Second, Study’s 1 and 2 demonstrate a clear need to further examine the constructs and experiences of acculturation and acculturative stress in relation to the body image experiences of immigrant and ethnic minority children and adolescents. The literature is unclear with respect to whether or not immigrant adolescents’ adoption of the values, behaviours and ideals of the Canadian or US culture increases their risk for body image concerns. On the other hand, we are also unclear as to whether or not immigrant adolescents’ retaining of the values, behaviours and ideals of their culture of origin may offer protection from poor body image experiences. Similarly, we are unclear about whether—and to what extent—stress as a result of adolescents’ acculturative experiences (i.e. acculturative stress) influence the onset or pervasiveness of body image concerns. Greater understanding about these constructs and processes and the extent to which they are implicated in the body image experiences among immigrant children and adolescents has the potential to inform culturally competent and targeted intervention approaches. Results from Study 3 indicate that immigrant adolescents have body image and appearance-related concerns that extend beyond what has typically been found among non-immigrant adolescents. More specifically, immigrant adolescents are concerned about the appearance of their skin (texture, complexion), their hair, their teeth, as well as other bodily features. It would be prudent for future researchers and clinicians to consider this information in relation to measuring, classifying and addressing body image dissatisfaction among immigrant adolescents. Finally, Study 4 demonstrates that females and first generation immigrants with body image dissatisfaction are at significantly elevated risk for body image distortion. This suggests that the assessment and intervention for body image dissatisfaction—particularly among females—soon after the migratory experience may play an important role in reducing body image distortion experiences. Taken together, the findings of this thesis strengthen the body image field by demonstrating that there are several unique aspects about being an immigrant that can influence adolescents’ body image experiences; and therefore, should be considered from a conceptual and methodological standpoint in future research and implementation of body image interventions. / Dissertation / Doctor of Philosophy (PhD) / Body image dissatisfaction and body image distortion have been linked to serious psychological outcomes, including depression and eating disorders. Yet, we know very little about the nature of these experiences among immigrant and ethnic minority children and adolescents. This thesis uses qualitative and quantitative methods, as well as general population and clinical samples to investigate body image dissatisfaction and body image distortion among immigrant and ethnic minority children and adolescents in Canada and the United States. Results provide important information that can inform the development of preventative interventions targeting body image dissatisfaction and body image distortion among immigrant and non-immigrant children and adolescents.

Problématique : Les milieux cliniques ont généralement recours à des critères afin d’assurer l’éligibilité et la sécurité de la mobilisation précoce chez les patients mécaniquement ventilés à l’unité des soins intensifs (USI). Considérant que les protocoles de mobilisation et les critères neurologiques qui y sont associés sont peu définis malgré le fait que les altérations neurologiques soient courantes chez le patient ventilé, ce mémoire avait pour but d’investiguer les protocoles et les critères neurologiques qui peuvent être utilisés pour guider la mobilisation précoce à l’USI. Méthode : Les bases de données CINAHL, MEDLINE (OVID), PubMed, EMBASE, PsycINFO et Web of Science ont été explorées en septembre 2022 et 32 articles ont été retenus. La méthodologie d’une revue de la portée décrite par Arksey et O’Malley (2005) a été suivie en tenant pour compte des recommandations supplémentaires formulées par Levac et collaborateurs (2010). Le cadre de référence Knowledge to Action, pertinent à la génération et au transfert d’évidences en sciences infirmières, a permis de structurer la formulation des recommandations pour la pratique. Critères de sélection : adultes (> 18ans) sous ventilation mécanique, intervention de mobilisation précoce initiée dans les deux à cinq jours suivant l’admission à l’USI, énoncer clairement les critères neurologiques. Résultats : Concernant la mobilisation précoce, 24 écrits (75%) ont décrit un protocole progressif d’exercices pouvant s’adapter aux fluctuations de l’état neurologique du patient à l’USI, alors que huit autres (25%) se sont intéressés par une intervention unique pour assurer la mobilité de leurs patients. En regard des critères neurologiques recensés, ils ont été rassemblés sous deux catégories : 1) l’état de sédation-agitation et 2) l’état de conscience. La majorité des écrits (n=20, 63%) ont eu recours à une échelle validée afin de structurer l’évaluation de ces critères, notamment par le biais du Richmond Agitation-Sedation Scale (RASS) (n=16, 50%), de l’Échelle de coma de Glasgow (n=2, 6%) et du Ramsey Sedation Scale (RSS) (n=1, 3%). En revanche, 12 écrits (38%) n’ont pas eu recours à une échelle pour l’évaluation de ces critères. Conclusion : L’utilisation de protocoles pouvant s’adapter à l’état neurologique des patients ventilés mécaniquement en combinaison à des critères neurologiques pouvant être mesurés à l’aide d’échelle validée est recommandée pour encadrer la pratique de mobilisation précoce ainsi que pour promouvoir cette intervention à l’USI. Des études supplémentaires sont nécessaires pour comprendre l’impact de la mobilisation sur la récupération neurologique à l’USI. / Background. Clinical settings typically use criteria to ensure the eligibility and safety of early mobilization in mechanically ventilated patients in the intensive care unit (ICU). Considering that mobilization protocols and associated neurological criteria are poorly defined despite the prevalence of neurological impairments in ventilated patients, this study aimed to investigate the protocols and neurological criteria that can be used to guide early mobilization in the ICU. Methods. In September 2022, CINAHL, MEDLINE (OVID), PubMed, EMBASE, PsycINFO and Web of Science databases were explored, and the selection processes resulted in a final number of 32 articles. The methodology of a scoping review described by Arskey and O’Malley (2005) was followed, and the recommendations by Levac and al., (2010) were also taken into account. The Knowledge to Action framework, relevant to the transfer of evidence in nursing sciences, was used to formulate recommendations for the practice. Selection criteria. adults (>18 years old) under mechanical ventilation, early mobilization intervention initiated within 2-5 days following admission to the ICU, neurological criteria stated by authors Results. Regarding early mobilization, 24 authors (75%) suggested a progressive exercises protocol, while eight (25%) focused on the use of a device or single type of exercises. The neurological criteria are represented under two categories, the level of sedation-agitation and the level of consciousness. Among the reviewed articles, evaluation was structured with a validated scale for the majority (n=20, 63%), as the Richmond Agitation Sedation Scale (RASS) (n=16, 50%), the Glasgow Coma Scale (n=2, 6%) and the Ramsey Sedation Scale (RSS) (n=1, 3%) were used. Conclusion. The use of protocols adapted to the neurological status of mechanically ventilated patients, with the combinaison of neurological criteria defined by validated scale is recommended to guide practice and promote this intervention. Additional studies could be conducted to better understand the impact of mobilization in the neurological recovery in the ICU.

La paralysie cérébrale (PC) est un trouble non progressif causé par une lésion cérébrale. La PC survient tôt dans la vie et présente une atteinte hétérogène et une altération fonctionnelle. Chez les personnes atteintes de PC, les modifications du Contrôle neuronal et des muscles entraînent des modifications permanentes de la fonction motrice, entraînant des déficits de mouvement. L'une des raisons des patrons de marche atypiques chez les enfants atteints de PC est l'altération l'activation musculaire. Un niveau anormal d'activation simultanée des muscles agonistes et antagonistes des muscles agonistes et antagonistes entourant une même articulation la même articulation empêche une performance de marche optimale chez les enfants atteints de PC. Ce phénomène est connu sous le nom de co-contraction musculaire (CoM) ou de co-activation musculaire (CaM) dans toutes les études. L'identification des schémas musculaires les plus détériorés, à savoir CoM/CaM, chez les enfants atteints de PC est essentielle pour une rééducation efficace de la marche. L'objectif de ce projet de maîtrise était donc de distinguer CoM/CaM chez les enfants atteints de PC de leurs pairs en développement typique (DT) pendant la marche. Cet objectif a été atteint en deux étapes ; Premièrement, nous avons décrit la CoM/CaM chez les personnes atteintes de PC via la réalisation d'une revue de littérature ; Ensuite, nous avons appliqué nos résultats de la première étape à une étude transversale pour comparer CoM/CaM pendant la marche entre des enfants atteints de CP et de DT. Une revue de littérature suivant la méthodologie en 6 étapes du Joanna Briggs Institute a été effectué. Les bases de données ont été consultées à l'aide de mots-clés pertinents. Toutes les études publiées sur CoM/CaM chez les personnes atteintes de PC pendant la marche ont été recueillies. Après un examen de la pertinence des titres et des résumés, un deuxième examen des textes intégraux des sources par deux examinateurs a été appliqué. Enfin, les données ont été extraites des articles inclus (n=21). Ensuite, à l'étape suivante, les principales méthodes utilisées pour quantifier la MCa identifiées à l'étape précédente ont été codées dans Matlab (The Mathworks Inc., Natick, États-Unis) et appliquées à nos données de 12 enfants atteints de CP et 23 enfants TD. Nous avons comparé le CaM moyen de deux groupes de muscles de la cuisse et de la jambe (Rectus Femoris (RF)/Semitendinosus (ST) et Tibialis Anterior (TA)/Lateral gastrocnemius (LG), respectivement) via des tests t non appariés (ou son équivalent non paramétrique). La revue de littérature a suggéré une CaM plus élevée chez les personnes atteintes de PC par rapport à leurs pairs en bonne santé dans toutes les études. Bien qu'il y ait eu une terminologie et des approches méthodologiques incohérentes, nous avons pu discriminer les terminologies (c'est-à-dire CoM et CaM) en fonction des méthodologies de calcul (c'est-à-dire moment et EMG) utilisées par les études. En outre, cette étude nous a permis de résumer les modèles de CaM chez les individus atteints de PC et d'identifier la relation entre certains des paramètres de marche avec CaM. Enfin, les résultats de cette étude ont révélé des informations précieuses concernant les lacunes de la recherche dans ce domaine. La deuxième étude a identifié une augmentation de la CaM pendant la marche (la foulée entière, la phase d’appuie et la phase oscillante) chez les enfants atteints de PC par rapport à leurs pairs TD. Cette augmentation n'a été observée que dans les muscles de la jambe (pendant la phase d’appuie et la phase oscillante) et dans les muscles de la cuisse (pendant la phase oscillante) lorsque nous avons normalisé les signaux d'électromyographie. Les groupes CP et DT n'avaient pas de CaM différent en utilisant l'EMG normalisé pour l'ensemble de la foulée. Cette différence met en évidence l'effet de la normalisation EMG sur les valeurs de CaM. De plus, les enfants avec le niveau II du système de classification de la fonction motrice globale (SCFMG) avaient un CaM plus élevé dans les muscles de la cuisse pendant le swing que ceux avec le niveau I. Dans l'ensemble, ce projet de maîtrise révèle de nouvelles preuves soutenant une plus grande CaM chez les enfants atteints de PC par rapport à DT pendant la marche. Néanmoins, il est important d'étudier la CaM dans différentes phases de marche car elle affecte la comparaison entre les groupes. En outre, ce projet justifie l'importance de la méthodologie (par exemple, le traitement EMG et le calcul CaM) dans les études CaM. Plus précisément, il est fort probable que les résultats changent avec différentes approches de normalisation EMG. De plus, les enfants atteints de SCFMG I et II peuvent éprouver différents niveaux de CaM pendant la phase oscillante. Davantage de comparaisons dans des recherches futures, telles qu'entre les SCFMG I, II et III dans la PC hémiplégique et diplégique pendant les sous-phases de la marche (le contact initial, le « mid-stance »), peuvent fournir de meilleures informations sur les modèles de CaM dans cette population. / Cerebral palsy (CP) is a nonprogressive disorder caused by a brain injury. CP occurs early in life, before, during, or after birth, and has heterogeneous involvement and functional impairment. In individuals with CP, changes in neural drive and muscles lead to lifelong changes in motor function, leading to movement deficits. One of the reasons for atypical gait patterns in children with CP is altered muscle activation patterns. An abnormal level of simultaneous activation of agonist and antagonist muscles crossing the same joint prevents optimal gait performance in children with CP. This phenomenon is known as muscle co-contraction (MCo) or muscle co-activation (MCa) across studies. Identification of the most deteriorated muscular patterns, namely, MCo/MCa, in children with CP is vital for effective gait rehabilitation. The objective of this master’s project, therefore, was to distinguish MCo/MCa in children with CP from their typically developing (TD) peers during gait. This objective was achieved through two studies; first, we described MCo/MCa in individuals with CP via the conduction of a scoping review; then, we applied our findings to inform a cross-sectional study to compare MCo/MCa during gait between children with CP and TD. A scoping review following the 6-stage Joanna Briggs Institute methodology was conducted. Databases were searched using relevant keywords. All published studies on MCo/MCa in individuals with CP during gait were collected. After title and abstract relevance screening, a second screening for the full texts of the sources by two reviewers was applied. Finally, data were extracted from the included articles (n=21). Then, leading methods used to quantify MCa identified from the previous study were coded in Matlab (The Mathworks Inc., Natick, USA) and applied to our data from 12 children with CP and 23 TD children. We compared the average MCa of two thigh and shank muscle groups Rectus Femoris (RF)/Semitendinosus (ST) and Tibialis Anterior (TA)/Lateral gastrocnemius (LG), respectively, via unpaired t-tests (or its non-parametric equivalent). According to our scoping review, higher MCa in individuals with CP compared to healthy peers across studies was found. Although there were inconsistent terminology and methodological approaches, we could discriminate terminologies (i.e., MCo and MCa) according to the methodologies in the calculation (i.e., moment and EMG) used by studies. Also, this study enabled us to summarize MCa patterns within individuals with CP and identify the effect of the some of the gait parameters on MCa. Finally, the findings of this study revealed valuable information regarding the research gaps in this area. The second study identified increased MCa around the knee and ankle joints for the following muscles (i.e., RF/ST and TA/LG, respectively) during walking (i.e., entire stride, stance, and swing) in children with CP compared to their TD peers. This increase was seen only in shank muscles (i.e., during stance and swing) and in thigh muscles (i.e., during the swing) when we normalized electromyography (EMG) signals. CP and TD groups did not have different MCa using normalized EMG for the entire stride. This difference highlights the effect of EMG normalization on MCa values. Also, children with Gross Motor Function Classification System (GMFCS) level II had higher MCa around the knee during swing than those with level I. Overall, this master’s project reveals new evidence supporting greater MCa in children with CP compared to TD peers during walking. Nevertheless, it is recommended to investigate MCa within different gait phases as it affects the comparison across groups. Also, this project justifies the importance of methodology (e.g., EMG processing and MCa calculation) in MCa studies. More specifically, it is likely that the results alter with different EMG normalization approaches. Moreover, children with GMFCS I and II can experience various levels of MCa during the swing phase. More comparisons in future research, such as between GMFCS I, II, and III in hemiplegic and diplegic CP during gait sub-phases (i.e., initial stance, mid-stance), can provide better information regarding MCa patterns in this population.

[pt] A sociedade tem exigido um desenvolvimento sustentável das organizações com uma postura social e ambiental responsável em sua gestão indo além da tradicional econômica. Entretanto as organizações têm enfrentado dificuldades para implementar a responsabilidade social corporativa (RSC) e adotar uma economia circular (EC) em sua cadeia de suprimentos. A literatura apresenta uma carência de pesquisas de EC com intuito de entender se esse modelo está se tornando parte das estratégias das empresas e também de compreender sua relação com RSC. Visando preencher essa lacuna de pesquisa, o objetivo desta dissertação é desenvolver um framework conceitual para responsabilidade social corporativa visando o desenvolvimento da economia circular sob a perspectiva da gestão de cadeia de suprimentos sustentáveis. O framework foi construído a partir de uma revisão de escopo abrangendo 60 artigos da base Scopus e validado por um painel de especialistas da área de sustentabilidade. Os resultados obtidos contemplam uma análise da literatura acadêmica sobre o tema e apresentam a relação do Tripple Botton Line (TBL) com RSC e EC e os constructos do framework com suas diretrizes e os promotores responsáveis por sua execução. A contribuição prática é um artefato para apoiar empresas na implementação da RSC, como contribuição teórica o próprio framework conceitual e como contribuição social maior conscientização para os stakeholders da necessidade de implementar RSC. / [en] The society has demanded a sustainable development from organizations with a social and environmental responsible attitude in their management going beyond the traditional economic. However, organizations have faced difficulties in implementing corporate social responsibility (CSR) and adopting a circular economy (CE) in their supply chain. The literature shows a lack of research on circular economy in order to understand if this model is becoming part of companies strategies and also to understand its relationship with corporate social responsibility. In order to fill this research gap, the objective of this dissertation is to develop a conceptual framework for corporate social responsibility aiming at the development of circular economy from the perspective of sustainable supply chain management. The framework was built from a scoping review covering 60 articles from the Scopus database and validated by a panel of sustainability experts. The results embrace a bibliometric analysis of the literature on the topic and present the relationship of Tripple Botton Line (TBL) with CSR and CE and the constructs of the framework with its guidelines and the promoters responsible for its implementation. The practical contribution is an artifact to support companies in the implementation of CSR, as a theoretical contribution the conceptual framework itself and as a social contribution greater awareness for stakeholders of the need to implement CSR.

The aim of this thesis is to explore how men in recovery from substance use conceptualize challenges and use their inherent strengths to navigate them. Estimates of substance use prevalence rates in Canada suggest that approximately one-in-five Canadians will meet the diagnostic criteria for substance use disorder throughout their lifetime (Pearson, Janz & Ali, 2013). These prevalence estimates represent a significant cause for concern as addiction is a significant phenomenon in contemporary Canadian society. A scoping literature review was conducted on nineteen research studies to investigate the state of current research. Although there is a wealth of studies on addiction, research frequently utilizes pathologizing approaches. These approaches are commonly focused on addiction in the context of a social or individual issue ripe with problematizing discourses. Six qualitative semi-structured interviews were conducted on men living in recovery-based supportive housing for this research to explore their experiences from the onset of substance use into substance use and recovery efforts. A strength-based perspective was adopted for analysis purposes in order to more accurately reflect on the inherent strengths of the participants. The men provided in-depth accounts of their experiences, conceptualized challenges to their recovery and contrary to many contemporary research discourses, demonstrated an affluence of strengths while articulating challenge navigation. The men were also proactive in their ability to anticipate future challenges and conceive methods of effective challenge navigation. Findings of this study are analyzed and discussed in the context of recognizing the magnitude of the challenges facing the men in recovery and the incredible strengths that they demonstrate in challenge navigation. The implications for current social work practice are outlined and several suggestions are tabled with the goal of improving current practice methods. Finally, suggestions for future strength-based addiction research are offered with the intention of seeking overall improvements to the research field and addressing existing gaps within the literature. / Thesis / Master of Social Work (MSW)

Les thérapies complémentaires et alternatives (TCA), sont largement utilisées par la population pour faire face à différents problèmes de santé. En raison des répercussions tant positives que négatives qu’elles peuvent avoir sur la santé, les infirmières et les infirmiers qui assurent des soins holistiques devraient être bien formés sur les TCA. En vue d’apprécier l’issue de la formation initiale à l’égard des TCA, et procéder à l’appréciation des interventions de formation sur ces thérapies, plusieurs questionnaires axés sur les déterminants d’usage des TCA ont été proposés au cours des dernières années. Cette étude avait comme but de dresser l’inventaire des questionnaires qui ont été proposés à ce jour en lien avec les déterminants d’usage des TCA des étudiantes et étudiants infirmiers notamment les connaissances, les attitudes et/ou les croyances. Pour ce faire, une revue de la portée a été conduite selon la méthodologie d’Arksey et O’Malley (2005). La recherche documentaire a permis d’identifier dix-neuf questionnaires d’études répondant aux critères d’inclusion. Ce travail a permis une meilleure compréhension du contenu général et des particularités des questionnaires sur les TCA destinés aux étudiantes et étudiants infirmiers. L’analyse des questionnaires recensés montre que l’accent été mis sur le concept des connaissances exploré par 95% des études, contrairement aux croyances étudiées dans seulement 16% des cas. La recension des écrits est la stratégie de développement des questionnaires la plus courante, adoptée dans 50% des études, suivie de l’adaptation des questionnaires prédéveloppés dans 37% des cas. Tandis que 53% des études ont pris en compte des considérations contextuelles d’ordre sociopolitique et culturel dans le développement du questionnaire, un pourcentage élevé des études (47%) n’ont pas fourni d’information sur les caractéristiques psychométriques. À la lumière de ces résultats, des recommandations pour les chercheurs en sciences infirmières ont été formulées. / Complementary and alternative therapies, known as CAM, are widely used by the population to deal with various health problems. Due to their potential health impacts, both positive and negative, nurses who provide holistic care should be well trained in CAM. In order to assess the outcome of initial training regarding CAM, as well as evaluating the effectiveness of training interventions on these therapies, several questionnaires focusing on the determinants of CAM use have been proposed in recent years. The aim of this study was to compile an inventory of the questionnaires that have been proposed to date in relation to the knowledge, attitudes and/or beliefs of nursing students about CAM. To this end, a scoping was conducted according to the methodology of Arksey and O'Malley (2005). The literature search identified nineteen questionnaires of studies that met the inclusion criteria. This work provided a better understanding of the general content and specific features of the CAM questionnaires. The analysis of measured concepts showed a focus on the concept of knowledge, explored in 95% of studies, compared to the concept of beliefs studied in only 16% of cases. Literature review emerged as the most common questionnaire development strategy, adopted in 50% of studies, followed by the adaptation of pre-developed questionnaires in 37% of cases. 53% of the studies considered contextual socio-political and cultural factors. A significant percentage (47%) of studies did not provide information on the psychometric characteristics of their scales. In the light of these findings, recommendations were formulated for nursing researchers.

Background: Mental health (MH) has until recently been a neglected subject which is gradually being recognized from the governments worldwide. Although women are increasingly seeking for emotional support during the pregnancy period and the first year after birth, the main attention and studies remain focused on the medical aspects of those periods. leaving the various health policies and intervention plans addressing perinatal MH, insufficient and/or incomplete. Aim: This Scoping Review aims to present a worldwide Policy Mapping of the latest maternal mental health (MMH) policies from government agencies and major non-governmental organizations (NGOs), and a more in-depth view of recurrent influential factors across a few of the policies that acknowledge the MH of various vulnerable groups of women. Methodology: A Policy Mapping and a Scoping Review were chosen as the appropriate designs to present the percentage of countries that show awareness of MMH issues globally. A deductive Content Analysis identified recurrent categories in seven selected interrelated policies and provided a qualitative description of the findings. Results: The results of the quantitative research identified 103 countries that raise awareness on MMH in their latest policies, and 89 of them were from governmental sources. The study revealed 139 countries that had either no reachable data or did not address the issue in their policies. The Content Analysis of the seven selected policies identified a main category entitled ‘Influential socio-economic factors’ and two generic categories ‘Socio-cultural behaviors’ and ‘Socio-education inequalities’ with subcategories which highlight the family and individualism as both a strength and a burden for MMH. A holistic view of individuals in their specific context and the importance of speaking a common language is essential for appropriate mental healthcare. In low socio-economic groups more stigma and less identification of mental health issues is described. Conclusions: This study provides a global overview of the current awareness on MMH and supports world policy makers in strengthening the plans proposed on MMH issues. It sheds light on the need for contextualization and reflects the common needs and challenges for vulnerable groups of women. / Bakgrund: Psykisk hälsa har varit ett försummat område som kräver beslutsfattarnas uppmärksamhet. Under graviditet och första året postpartum söker kvinnor vård för sin emotionella och mentala status i allt högre grad. Sjudvårdspolitiskt prioriteras den somatiska vården framför den psykiska och hälsopolitiska interventioner för att förbättra den mental hälsan för intrapartum och efter förlossning, har visat sig vara otillräckliga. Syfte: Att presentera åtgärder som görs av beslutsfattare och frivilligorganisationer globalt för att förbättra mental hälsa under graviditet och postpartum. En kvantitativ policy-kartläggning kompletteras med en kvalitativ ansats som vidare beskriver faktorer för att stödja utsatta grupper. Metodologi: Med en kartläggning av policy-dokument presenteras andel länder där beslutsfattarna visar på medvetenhet om mental hälsa under graviditet och post partum. Via en Scoping Review identifieras de mest lämpliga metoderna för att stärka kvinnor mentala hälsa under graviditet och postpartum. Med kvalitativ analys identifierades en huvudkategori, generiska kategorier och sub-kategorier med kvalitativ innehållsanalys relaterat till syftet. Resultat: Resultatet från den kvantitativa undersökningen identifierade 103 länder som nämner mental hälsa under graviditet och post-partum i policy dokument, med 89 av dem var från andra källor. Undersökningen identifierade 139 länder som inte hade tillgängliga uppgifter om mental hälsa under graviditet och post-partum i policydokumenten. Den kvalitativa analysen som på ett djupare plan presenterade problemet mental hälsa under graviditet och post-partum visade i huvudkategorin hur inflytelserika socioekonomiska faktorer är för den mentala hälsan. De två generiska kategorierna beskriver ”Sociokulturella beteenden” och ”Sociala ojämlikheter i utbildningssatsningar”, med subkategorier som beskriver familjen, men även individualismen, som en tillgång och samtidigt en börda, för kvinnans mentala hälsa under graviditet och post partum. Ett holistiskt förhållningsätt till individen i individens specifika kontext och ett gemensamt språk var förslag till åtgärd för att erbjuda kvalitativ vård. I lägre socioekonomiska grupper var stigma och underdiagnostiserad mental hälsa identifierad. Dessa grupper är viktiga grupper att satsa resurser på. Slutsats: Denna studie ger en global översikt av den nuvarande situationen och kunskapsläget kring mental hälsa under graviditet och post-partum. Studien kan utgöra ett stöd för beslutsfattare att planera och ge stöd till interventioner och projekt. Studien belyser vikten av kontextrelaterade strategier och visar på gemensamma behov i utsatta grupper och pekar på utmaningar i olika länder.

Objectifs : 1) résumer et synthétiser des attitudes et croyances des professionnels de la réadaptation envers la douleur chronique; 2) explorer les perceptions de physiothérapeutes envers ces attitudes et croyances et 3) décrire les attitudes et croyances de physiothérapeutes envers la douleur chronique et vérifier si elles différent en fonction de facteurs sociodémographiques. Méthodologie : Pour le premier objectif, nous avons réalisé une revue exploratoire (scoping review) où nous avons effectué une recherche des écrits scientifiques sur divers moteurs de recherche de leur création à juillet 2014. Nous avons effectué une analyse thématique des articles correspondant à nos critères d’inclusion pré-établis. Afin de répondre au deuxième objectif, nous avons réalisé trois groupes de discussion (focus groups), puis analysés les transcriptions par analyse descriptive et thématique. Nous avons sondé 14 physiothérapeutes en utilisant le Questionnaire sur les attitudes et croyances envers la douleur chronique destiné aux professionnel(le)s de la santé (score total, sous-score compétence, engagement émotionnel et empathie). Nous avons utilisé des statistiques descriptives et analyses bivariées pour vérifier si les réponses des participants différaient en fonction de caractéristiques sociodémographiques et expérience. Résultats : La recherche a donné 1538 articles; 26 articles pour révision complète. Nous avons développé sept thèmes post analyse. Les groupes de discussion ont permis d’identifier trois thèmes principaux liés 1) au développement de la douleur chronique; 2) à la légitimité de la douleur chronique et à sa relation avec l’incapacité et 3) à la capacité à gérer les aspects psychologiques liés à la douleur des patients. Les physiothérapeutes ayant plus d’expérience clinique ont démontré plus d’engagement émotionnel (p=0.02) et ceux ayant une expérience de travail antérieur dans une clinique de douleur multidisciplinaire ont démontré plus d’empathie (p=0.02). Conclusion : Les physiothérapeutes ont besoin de plus d’éducation et de formation concernant l’évaluation et le traitement des facteurs psychosociaux liés à la douleur. Les physiothérapeutes avec plus d’expérience clinique ont démontré plus d’engagement émotionnel et ceux ayant une expérience de travail dans une clinique de douleur multidisciplinaire ont démontré plus d’empathie envers les individus vivant avec de la douleur chronique. / Objectives: 1) to summarize and synthesize the literature regarding rehabilitation professionals’ attitudes and beliefs towards chronic pain; 2) to explore physiotherapists’ perceptions of those attitudes and beliefs and 3) to describe physiotherapists’ attitudes and beliefs towards chronic pain and to see if they differ according to socio-demographic factors. Methods: For the first objective, we conducted a scoping review where we searched the literature using various databases from inception until July 2014. We performed thematic analysis on articles that met our pre-established standards for inclusion. To answer objective two, we conducted three focus groups and analyzed transcripts through descriptive and thematic analysis. We also surveyed 14 physiotherapists (objective three) using the Attitudes and Beliefs towards Chronic Pain Questionnaire for Health Professionals (total score, subscores of competence, emotional involvement and empathy). We used descriptive statistics and bivariate analysis to see if participants’ responses differed based on socio-demographic characteristics and experience. Results: The literature search yielded 1538 articles; 26 articles were included for full review. Seven themes evolved post analysis. Focus groups allowed to identify three core themes 1) the development of chronic pain; 2) the legitimacy of chronic pain and its relationship with disability and 3) the ability to manage psychological aspects of patient’s pain. More experienced physiotherapists had higher emotional involvement (p = 0.02) and those with previous experience working in a multidisciplinary pain clinic had greater empathy (p = 0.02). Conclusion: Physiotherapists need to be further educated and trained on how to assess and treat psychosocial factors associated with pain. Physiotherapists with more general clinical experience showed greater emotional involvement and those with specific multidisciplinary pain clinic experience showed more empathy towards individuals living with chronic pain.

A scoping study of the published literature was used to describe the concept and practice of ecosystem approaches to health (ecohealth) in the context of public health. Analysis of commentaries identified 24 themes, expressed in a mind map showing interconnections between themes, with a table of explanations. Most (27 of 29) primary research articles did not explicitly explain how ecohealth was applied in their research, suggesting a need for some standardization in reporting ecohealth. Additionally, a case study approach was undertaken to identify enablers and impediments of ecohealth and how concepts were integrated into a research project of health and environmental sanitation in Vietnam. The project’s conceptual framework was aligned with ecohealth concepts, but in practice, a variety of challenges were identified. In future, ecohealth research teams should include a self-investigation of their ecohealth process to facilitate a comparison of theory-to-practice; this may serve as a best practice for ecohealth. / Public Health Agency of Canada (PHAC), Community of Practice in Ecosystem Approaches to Health - Canada (CoPEH-Can)

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