This study examined the associations between social adversity, barriers-to-care (logistical obstacles, wait-time) and participation in children’s mental health treatment. The theoretical role of child symptoms (impact on the child, family burden) was addressed. Records were obtained for 1,963 parents who had accessed community-based care for their child (3-17 years). Data were collected as part of a provincial (Ontario, Canada) screening and outcome measurement initiative. The data were analyzed using multivariate logistic regression. Children with behavioural problems were at increased risk for attrition from treatment (OR=1.47, p < 0.001). The effect held upon controlling for age, gender, and co-morbid emotional symptoms; however, it was explained by child functional impairment. Similar effects were not found for the impact of symptoms on the family. Dropout was greater for adolescents (OR=1.43, p < 0.01) than younger children. Disadvantaged youth were more likely to drop out than more advantaged clients (OR=1.86, p < 0.001). Perceptions of difficulties in attending treatment were associated with a decreased risk (OR=0.89, p < 0.001). The adversity and service relationships were not mediated by child behavioural symptoms, functioning, or family burden. Waiting for care did not influence parent decisions to participate. Moderation analyses showed effects for adversity, service obstacles, emotional symptoms, functional impairment, and family burden for clients with behavioural problems. These children were more likely to drop out if they were socially disadvantaged, or had functional impairment at intake to services. However, completion was more likely for co-morbid children, and parental reports of burden. Families were also willing to overcome access difficulties in order to continue with treatment. There were few findings for children without behavioural problems. The results suggest a focus on other constructs, such as parent cognitions, that may link adversity and barriers with participation. The effects for symptoms as a moderator, suggests different levels of service provision based on sub-types of children. Efforts to engage “high-risk” clients are necessary. On the other hand, resources for intensive services would be appropriate for clients with more severe problems.

This study examined the associations between social adversity, barriers-to-care (logistical obstacles, wait-time) and participation in children’s mental health treatment. The theoretical role of child symptoms (impact on the child, family burden) was addressed. Records were obtained for 1,963 parents who had accessed community-based care for their child (3-17 years). Data were collected as part of a provincial (Ontario, Canada) screening and outcome measurement initiative. The data were analyzed using multivariate logistic regression. Children with behavioural problems were at increased risk for attrition from treatment (OR=1.47, p < 0.001). The effect held upon controlling for age, gender, and co-morbid emotional symptoms; however, it was explained by child functional impairment. Similar effects were not found for the impact of symptoms on the family. Dropout was greater for adolescents (OR=1.43, p < 0.01) than younger children. Disadvantaged youth were more likely to drop out than more advantaged clients (OR=1.86, p < 0.001). Perceptions of difficulties in attending treatment were associated with a decreased risk (OR=0.89, p < 0.001). The adversity and service relationships were not mediated by child behavioural symptoms, functioning, or family burden. Waiting for care did not influence parent decisions to participate. Moderation analyses showed effects for adversity, service obstacles, emotional symptoms, functional impairment, and family burden for clients with behavioural problems. These children were more likely to drop out if they were socially disadvantaged, or had functional impairment at intake to services. However, completion was more likely for co-morbid children, and parental reports of burden. Families were also willing to overcome access difficulties in order to continue with treatment. There were few findings for children without behavioural problems. The results suggest a focus on other constructs, such as parent cognitions, that may link adversity and barriers with participation. The effects for symptoms as a moderator, suggests different levels of service provision based on sub-types of children. Efforts to engage “high-risk” clients are necessary. On the other hand, resources for intensive services would be appropriate for clients with more severe problems.

The aim of the study was to determine whether there is a relationship between organisational culture and occupational health. The General Health Questionnaire and the South African Culture Instruments were used for this purpose. Structural equation modelling (SEM) was used for this purpose. The study focused on clarifying the two concepts and their impact on the organisation. The effects of general health factors were determined in the organisation under investigation. The existing organisational culture was also investigated. In conclusion, the assumption that occupational health can have an impact on organisational health, or vice versa, was confirmed. / Industrial & Organisational Psychology / MCom (Industrial and Organisational Psychology)

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.

Aggressive hospital discharge policies adopted in the 1990s led to an influx of patients recovering from acute illness accessing post-acute home care services. Performance of the post-acute home care program in the Saskatoon Health Region was examined using formative program evaluation methods. Brief surveys of clients and nurse providers captured: care objectives and service outcomes; patient-centeredness; trust in providers; health improvement/decline; emotional/social functioning; functional status; injury avoidance; and overall quality. For clients, perceptions of quality were significantly affected by patient centeredness and experiencing unexpected health complications, which accounted for 83.0% of the variation. For nurse providers, overall quality of care was significantly related to patient centeredness, service outcomes, team communication and injury avoidance. Analysis revealed for clients with complex needs, the service period could be extended from 60 to 97 days which would cover 50.0% of clients. The research examining administrative data predicted the dependent variable Log of Total Care Hours (TCH) to enable analysis using General Linear Modelling. The results showed post-acute home care clients referred from Emergency Departments received approximately 84.2 % more TCH; post-acute home care clients referred from Surgical wards received approximately 42.1% more TCH; and post-acute home care clients referred from Cardiology received approximately 66.3% more TCH than clients referred from the community. Furthermore, single clients received more TCH than married clients. Nursing chart reviews of post-acute home care clients with wound care also predicted the Log of TCH to enable analysis using General Linear Modelling. Post-admission, 11.3% of post-acute home care clients receiving wound care displayed clinical signs and symptoms of emerging infection, while 19.7% displayed clinical signs and symptoms of acquired infection. Post-acute home care clients receiving wound care experiencing injury, trauma or harm while admitted to home care received approximately 53.3% TCH; and post-acute home care clients who acquired an infection after admission received approximately 70.2% TCH. The implications of this research suggest there is room to improve post-acute home care services to address client re-hospitalisation, unexpected health symptoms/complications, and wound care.

The aim of the study was to determine whether there is a relationship between organisational culture and occupational health. The General Health Questionnaire and the South African Culture Instruments were used for this purpose. Structural equation modelling (SEM) was used for this purpose. The study focused on clarifying the two concepts and their impact on the organisation. The effects of general health factors were determined in the organisation under investigation. The existing organisational culture was also investigated. In conclusion, the assumption that occupational health can have an impact on organisational health, or vice versa, was confirmed. / Industrial and Organisational Psychology / MCom (Industrial and Organisational Psychology)

No description available.

Au cours des 30 dernières années, l’embonpoint et l’obésité infantile sont devenus de véritables défis pour la santé publique. Bien que l’obésité soit, à la base, un problème physiologique (i.e. balance calorique positive) une série de facteurs psychosociaux sont reliés à son développement. Dans cette thèse, nous avons étudié le rôle des facteurs périnataux et de la petite enfance dans le développement du surpoids, ainsi que la relation entre le surpoids et les troubles internalisés au cours de l’enfance et au début de l’adolescence. Nous avions trois objectifs généraux: 1) Modéliser le développement de l’indice de masse corporelle (IMC) ou du statut pondéral (le fait d’être en surpoids ou non) durant l’enfance, ainsi qu’estimer l’hétérogénéité dans la population au cours du temps (i.e. identification de trajectoires développementales de l’IMC). 2) Identifier les facteurs périnataux et de la petite enfance pouvant accroitre le risque qu’un enfant suive une trajectoire menant au surpoids adolescente. 3) Tester la possibilité que le surpoids durant l’enfance soit associé avec des problèmes de santé mentale internalisés à l’adolescence, et vérifier la possibilité qu’une telle association soit médiatisée par l’expérience de victimisation par les pairs et l’insatisfaction corporelle. Ce travail est mené dans une perspective de développement au cours de la vie (life span perspective), considérant l’accumulation des facteurs de risques au cours du temps ainsi que les facteurs qui se manifestent durant certaines périodes critiques de développement.1,2 Nous avons utilisé les données provenant de l’Étude Longitudinale du Développement des Enfants du Québec (ELDEQ), une cohorte de naissances de la province de Québec, Canada. L’échantillon initial était composé de 2120 familles avec un bébé de 5 mois nés au Québec en 1997. Ces familles ont été suivies annuellement ou à tous les deux ans jusqu’à ce que les enfants atteignent l’âge de 13 ans. En ce qui concerne le premier objectif de recherche, nous avons utilisé la méthode des trajectoires développementales fondée sur des groupes pour modéliser l’IMC en continu et en catégories (surpoids vs poids normal). Pour notre deuxième objectif, nous avons effectué des modèles de régression multinomiale afin d’identifier les facteurs périnataux et de la petite enfance associés aux différents groupes développementaux du statut pondéral. Les facteurs de risques putatifs ont été choisis parmi les facteurs identifiés dans la littérature et représentent l’environnement périnatal, les caractéristiques de l’enfant, ainsi que l’environnement familial. Ces facteurs ont été analysés longitudinalement dans la mesure du possible, et les facteurs pouvant servir de levier potentiel d’intervention, tels que l’usage de tabac chez la mère durant la grossesse, le sommeil de l’enfant ou le temps d’écoute de télévision, ont été sélectionnés pour l’analyse. Pour notre troisième objectif, nous avons examiné les associations longitudinales (de 6 à 12 ans) entre les scores-z d’IMC (selon la référence CDC 2000) et les problèmes internalisés avec les modèles d’équations structurales de type « cross-lagged ». Nous avons ensuite examiné comment la victimisation par les pairs et l’insatisfaction corporelle durant l’enfance peuvent médiatiser un lien potentiel entre le surpoids et les troubles internalisés au début de l’adolescence. Les contributions scientifiques de la présente thèse incluent l’identification de trajectoires distinctes du statut pondérale durant l’enfance (précoce, tardive, jamais en surpoids), ainsi que les facteurs de risques précoces et les profils de santé mentale pouvant différer selon la trajectoire d’un enfant. De plus, nous avons identifié des mécanismes importants qui expliquent une partie de l’association entre les trajectoires de surpoids et les troubles internalisés: la victimisation par les pairs et l’insatisfaction corporelle. / Child overweight and obesity has challenged the field of public health for several decades. While its direct underpinnings may be physiological, its development and outcome are intertwined with an array of psychosocial factors. This dissertation has sought to answer questions relating to the perinatal and early life risk factors associated with overweight development, as well as its potential psychological correlates during middle childhood and early adolescence. Specifically, this project had three research goals: 1) To model the developmental pattern of BMI or weight status throughout childhood and estimate population heterogeneity. 2) To identify the perinatal and early childhood risk factors that may increase the likelihood that a child follows a path leading to overweight by adolescence. 3) To examine whether being overweight in middle childhood is associated with internalizing mental health symptoms in early adolescence, and whether such an association is mediated by the experience of peer victimization and body dissatisfaction. This work takes a developmental life-course perspective in that it considers both the accumulation of risk factors over time as well as risk factors occurring during critical periods of development.1,2 We examined data drawn from the Quebec Longitudinal Study of Child Development (QLSCD), a population-based birth-cohort study in the province of Quebec, Canada. The initial sample consisted of 2120 families with a 5-month old baby born in Quebec in 1997. These families were monitored yearly or biennially until children were 13 years of age. For our first research goal, we modeled group-based developmental trajectories of child BMI and child weight status (overweight vs. not overweight). For our second goal, multinomial logistic regression analyses were conducted in order to identify the perinatal and early risk factors associated with the different developmental groups of weight status. Putative risk factors were chosen from the literature and represent the perinatal environment, child behavioral characteristics, as well as the family home environment. These were analyzed longitudinally when possible, and factors that could be targeted for intervention, such as maternal smoking during pregnancy, child sleep times or television viewing were selected for analysis. In order to complete our third research goal, we examined the longitudinal associations (from age 6 to 12) between BMI z-score (CDC 2000 reference) and internalizing and externalizing problems by way of cross-lag panel models in the Mplus program. Our results indicating sparse cross-lagged links, we then examined whether peer victimization and body dissatisfaction during childhood mediate the association between early overweight development and self-reported internalizing symptoms in early adolescence. Important scientific contributions stemming from this project include the identification of distinct weight status trajectories during childhood (i.e. early onset, late onset, never overweight) and the identification of perinatal and early life risk factors and mental health outcomes that may differ depending on a child’s developmental trajectory. Additionally, we identified two important mechanisms of the association between overweight and internalizing problems: peer victimization and low body satisfaction.