Malgré les succès spectaculaires de l’immunisation comme mesure de santé publique, certains parents continuent de refuser de vacciner leurs enfants (Diekema, 2005). C’est pourquoi qu’au cours des dernières décennies, des éclosions de maladies évitables par la vaccination comme la rougeole et la coqueluche ont été observées au Canada, surtout chez la population non vaccinée (Hinman, 2000). Au Québec, depuis l’entrée en vigueur de la loi 90 en 2003, les infirmières peuvent procéder à la vaccination sans ordonnance individuelle ou collective conformément au Protocole d’Immunisation du Québec (PIQ). Les infirmières québécoises peuvent alors influencer positivement la couverture vaccinale (Sauvageau & al, 2005). Le but de cette étude est d’évaluer les retombées de la formation VIP (Vaccination par les Infirmières/Infirmiers-Prévention) sur les pratiques vaccinales rapportées par les infirmières (N=12) de CSSS, auprès des parents d’enfants de 0-5 ans lors d’un refus parental. En premier lieu, nous avons identifié et décrit treize pratiques vaccinales en réponse à un refus parental. Par la suite, nous avons identifié des modifications dans certaines des treize pratiques rapportées tel qu’une augmentation dans la description des pratiques de correction des fausses croyances des parents, une amélioration de la justesse des pratiques d’explication et une personnalisation des pratiques décrites. En conclusion, la formation offerte aux infirmières doit permettre à celles-ci d’identifier les préoccupations parentales et d’y répondre adéquatement en utilisant une information juste et individualisée. / In spite of the success of immunization as a public health measure, some parents refuse to vaccinate their children (Diekema, 2005). Over the last couple of decades, outbreaks of vaccine-prevented diseases like whooping cough and measles have been observed in Canada, particularly among the non-vaccinated population (Hinman, 2000). Since the adoption of law 90, nurses in Quebec can provide vaccination without a medical prescription while adhering to the PIQ (Quebec immunization protocol). Nurses in Quebec can, therefore, have a positive impact on immunization uptake in the province (Sauvageau, Boulianne, Clouâtre, Lavoie, & Duval, 2005). The goal of this study was to evaluate the effect of the VIP (Vaccination par les Infirmières/Infirmiers- Promotion) teaching program on the practices of community nurses (CSSS) when faced with a parent refusing vaccination. We first described the nursing practices of nurses (N=12) when faced with parents who refused vaccination. We identified and described 13 practices used by nurses when faced with parental refusal. Secondly, we identified modifications in some of the nursing practices after the VIP teaching program. Nurses must address the fears or questions of parents with pertinent and individualized information. Teaching programs must provide support for nurses to have and maintain an optimal practice.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-04, page: 2059. Adviser: Ross Shegog. Includes bibliographical references.

INTRODUÇÃO: O sucesso do tratamento de dependentes de álcool e outras drogas numa comunidade terapêutica (CT) depende fundamentalmente da adesão ao tratamento, ou seja, o tempo de permanência na comunidade. Sabe-se que pacientes que permanecem em tratamento por um período de pelo menos três meses têm uma evolução melhor do que aqueles que abandonam o tratamento precocemente. O ambiente emocional familiar tem grande influência na adesão ao tratamento, e pode ser medido por meio da emoção expressa EE). MÉTODOS: Foram avaliados familiares de 31 dependentes de substâncias psicoativas e/ou de álcool, internados involuntariamente, por meio da versão abreviada e traduzida para o português da Entrevista Familiar de Camberwell (EFC). A partir de então, mediu-se a taxa de permanência na CT após seis, 12 e 18 meses. Foram avaliados os aspectos hostilidade, superenvolvimento e calor afetivo. A hostilidade foi abordada como ausente (pontuação igual a zero) ou presente (pontuação igual a 1, 2 ou 3). O superenvolvimento e o calor afetivo foram considerados de forma contínua (pontuação de zero a 5) e categorizada. Todos os possíveis pontos de corte foram estudados na procura de novas relações e significados dos componentes da EE para esta população específica e os achados da amostra. RESULTADOS: Foram considerados com alta EE para hostilidade 41,9% dos familiares entrevistados e 71% para superenvolvimento emocional; 25,8% destes familiares pontua ram para ambos os componentes da EE (hostilidade e superenvolvimento). Dos 31 pacientes, cinco (16,1%) desistiram do tratamento até os seis meses; dois pacientes desistiram entre o 6 o e o 12 o mês (25% de desistência em 12 meses) e quatro abandonaram o tratamento entre o 12 o e o 18 o mês (47,8% de abandono em 18 meses). Houve uma associação significativa entre a presença de hostilidade e o abandono do tratamento antes dos seis meses (p = 0,008, teste exato de Fischer). Houve diferença significativa na frequência de superenvolvimento familiar entre o grupo que permaneceu 18 meses e o grupo que abandonou o tratamento (p = 0,037, teste de Mann-Whitney). Os pacientes que permanceram em tratamento até os 18 meses tiveram uma freqüência maior de familiares com alto nível de superenvolvimento familiar (> 4) (p = 0,012; teste exato de Fisher). Não houve nenhuma associação entre o tempo de permanência e o calor afetivo. CONCLUSÕES: Alta EE tem influência significativa sobre o tempo de permanência do dependente químico ou de álcool na CT. A presença de hostilidade foi mais freqüente no grupo com o abandono prematuro do tratamento, enquanto o alto superenvolvimento do familiar foi mais freqüente no grupo de pacientes que permaneceu em tratamento até os 18 meses. Estudos com uma população maior são necessários para apoiar esses achados. / BACKGROUND: The success of treatment for alcohol and other substance dependence in a therapeutic community (TC) depends greatly on the treatment adherence, i.e., the length of stay at the TC. It is well known that subjects who stay on treatment for ate least three months have a better outcome, compared with those who early withdraw. The family emotional environment can be measured through expressed emotion (EE) and has great influence on treatment adherence. METHODS: 31 key-relatives of alcoholics and other substance dependents, who involuntarily began a treatment in a TC, were assessed through the Camberwell Family Interview (CFI) (shorter translated to Portuguese version). The proportion of subjects who remained on treatment in the TC was then measured after six, 12 and 18 months. Evaluated aspects included hostility, overinvolvement and warmth. Hostility was assessed as absent (score = 0) or present (score = 1, 2 or 3). Overinvolvement and warmth were considered as continuous and categorized values (scores 0 to 5). Every possible cutoff points were studied, in order to find new associations and meanings of EE components of this specific population and the length pf stay in a TC. RESULTS: 41.9% of the relatives were considered as having high EE for hostility and 71% for overinvolvement; among those relatives with high EE, 25.8% had presence for both hostility and overinvolvement. Among the 31 patients, five (16.1%) abandoned treatment up to 6 months; 2 patients abandoned treatment between 6th and 12th month (25% treatment abandon in 12 months) and four abandoned the treatment between 12th and 18th month (47.8% treatment abandon at 18 months). There was a significant higher frequency of presence of hostility in the group that abandoned before six months (p = 0.008, Fischer exact test). A significant difference of familiar overinvolvement was found between the group who remained in the treatment up to 18 months and the group that abandoned treatment earlier (p = 0.037, Mann-Whitney test). Families with score = 4 for overinvolvement were more frequent in the group that remained on treatment up to 18 months (p = 0.0012; Fischer exact test). No correlation was found between warmth and length of stay at TC. CONCLUSIONS: High EE has a significant influence over the length of stay of the alcoholic or other substance dependent in a TC. The presence of hostility is more frequent among families of patients who prematurely abandon treatment, while higher score of overinvolvement was more frequent in the families of the group that completed 18 months of treatment in the TC. Further studies with larger population are needed to support those findings.

D’une juridiction à l’autre, les modèles législatifs encadrant la procréation médicalement assistée (PMA) diffèrent, allant de l’absence de directives nationales à des agences réglementaires supervisant les cliniques de fertilité. De 2010 à 2015, le Québec finançait les services de PMA pour ses résidents sans définir de critères d’accessibilité. Alors que l’adoption de critères d’accessibilité représente un défi éthique complexe, les candidats souhaitant obtenir des services de PMA peuvent être confrontés à un refus par des professionnels sur la base d’une évaluation subjective. Déterminer les critères présentement utilisés par les professionnels en l’absence de directives législatives peut éclaircir les décisions difficiles auxquelles ils font face quotidiennement. Un tel travail peut aussi informer la réflexion éthique quant à l’étude normative de directives dans ce domaine. La présente étude décrit les critères d’accessibilité utilisés par les professionnels travaillant dans des cliniques de fertilité, privées ou publiques, au Québec. Des entrevues semi-dirigées ont été réalisées avec quatre médecins et quatre psychologues. Une recension des écrits a permis de regrouper les critères reportés dans la littérature selon leurs similitudes, puis d’analyser les entrevues selon ces regroupements. De façon générale, les professionnels du Québec utilisent des critères similaires à ceux des professionnels d’autres pays, mais des critères non recensés dans la littérature ont aussi été utilisés par les participants. Les critères utilisés les plus communs étaient la relation conjugale, l’état de santé mentale ainsi que l’âge des candidats. Une découverte importante est que les professionnels n’utilisaient pas un seul critère pour refuser un candidat, mais plutôt une combinaison de facteurs en tenant compte de son contexte de vie. Une autre découverte intéressante est l’utilisation du « rejet temporaire », c’est-à-dire le report des traitements à un meilleur moment pour les candidats selon le professionnel. Les entrevues ont permis de déterminer que les professionnels agissent en tant que gatekeepers et doivent souvent prendre des décisions qui dépassent l’évaluation clinique en se basant sur un jugement personnel. Ce rôle n’est pas facile et les participants ont exprimé des doutes et des remises en question de leurs propres décisions. / 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.