Il s'agit d'une étude ayant pour but d'examiner les besoins perçus et le niveau de détresse mentale d'aidants naturels primaires (ANP) de patients en attente de pontages aortocoronariens (PAC). Le devis de recherche consiste en un pré-post-test auprès d'un échantillon aléatoire de 19 ANP. L'Inventaire des Besoins des Familles (IBF) et le Brief Symptom Inventory (BSI) ont servi à mesurer respectivement les besoins et la détresse mentale auprès de la clientèle cible, les ANP, avant (T1 ) et suivant (T2 ) une session d'information. Les résultats révèlent qu'il existe une différence significative (p = 0,015) à la dimension besoins physiques entre les deux intervalles de temps visés. La corrélation entre les besoins et la santé mentale s'accroît avec le temps. L'âge est corrélée positivement (r = 0,51) avec l'indice de détresse mentale au T1 . Les ANP ayant une scolarité post-secondaire présentent un score plus élevé (p = 0,02) au nombre total de besoins comparativement aux autres.

Caregiver burden has been studied at length in caregivers of many populations of chronically ill people. The other side of the informal caregiving relationship is the recipient's response to aid, especially their perceptions of the burden they pose to their caregiver. This is referred to as self-perceived burden, and has rarely been studied from the patient's point of view. Strong feelings of being a burden may be an important emotional factor influencing adjustment to illness, compliance with physician's orders, utilization of health-care resources and end-of-life decision-making. The current study advances the current understanding of self-perceived burden through the development and preliminary validation of the Self-Perceived Burden Scale. Through the course of this study, we have developed a valuable screening instrument for feelings of being a burden. It is brief, easily self-administered, and reliably identifies individuals in emotional distress due to feelings of being a burden on others. (Abstract shortened by UMI.)

Overweight and obesity are important public health concerns associated with a variety of negative physiological and psychological consequences in children, youth as well as in adults. The objective of this study was to evaluate the increase in childhood overweight and obesity in a Canadian sample of 7 to 12 year olds between 1979 and 1998 using the BMI as the indicator of obesity. Analyses of variance were performed on the data between the different study cohorts. The 85$\rm\sp{th}$ and 95$\rm\sp{th}$ age and gender specific percentile of BMI of the 1979 CAHPERD study respectively defined overweight and obesity cut-off points. Results support previous studies and clearly show a significant increase in the prevalence of overweight and obesity in today's children. They also show a higher increase of overweight and obesity in girls than in boys. Since childhood obesity is an increasingly important predictor of adult obesity and obesity in adults is associated with a number of health consequences, regular screening of children for overweight and obesity should be put in place and preventive measures taken when children are at risk. (Abstract shortened by UMI.)

Les études sur le fardeau des aidants de personnes atteintes de troubles mentaux ont à ce jour été réalisées principalement dans des contextes d'hospitalisation ou de services externes. On connaît très peu la situation des aidants dans le contexte de l'hôpital de jour, une modalité de services ambulatoires utilisée davantage aujourd'hui comme alternative à l'hospitalisation. Cette étude avait pour but de décrire le fardeau des aidants primaires (N 25) de personnes admises à un hôpital de jour psychiatrique, dans une perspective d'examen de l'évolution du fardeau entre le moment de l'admission (T 1 ) et cinq semaines après le congé (T 2 ). Les hypothèses étaient: (1) que le fardeau des aidants serait plus important à l'admission qu'à la période post-traitement, (2) qu'à l'admission, les variables liées à l'état actuel du malade auraient une contribution plus importante sur le fardeau que les variables liées aux caractéristiques sociodémographiques, du malade, à l'histoire et à l'évolution de la maladie, (3) qu'à l'admission, les comportements symptomatiques auraient un contribution plus importante sur le fardeau que les dysfonctions sociales et les effets indésirables sur l'entourage et (4) qu'au T 2 , les variables liées aux effets indésirables sur l'entourage auraient une contribution plus importante sur le fardeau que les variables liées aux symptômes et aux dysfonctions sociales du malade. (Abstract shortened by UMI.)

Fifty-five adolescents with Type 1 diabetes, who were receiving secondary care services from diabetes clinics and pediatricians, were followed for three months in this exploratory community study. Measures of parental depression, marital distress, general family functioning, and diabetes-specific family functioning were obtained during an assessment of both parents and adolescent. The 24-hour recall adherence interviews were conducted separately with both the parent and adolescent on six occasions over the three months, and metabolic control was measured by HbA1c levels at the onset and end of the study. Multiple regression analyses showed that adherence was not associated with control. Adolescents who had been diagnosed longer were in worse metabolic control. Family relations were not linked with glycemic control and their influence varied on the five dimensions of adherence. The family relations variables, as a model, was significant in predicting diet amount adherence, accounting for 32.8% of the variance, with parental depression and general family conflict accounting for most of it. The family relations model was significant in predicting exercise adherence, with diabetes-specific guidance-control, accounting for 37.2% of the variance. Controlling for chronological age and gender, adolescent depression, as a measure of child adaptation, was not a significant predictor of glycemic control or adherence. However, both gender and chronological age accounted for 39.2% of exercise adherence. Glycemic control was consistent, with 75% of the adolescents displaying stable controlled and non-controlled metabolic control throughout the study. Metabolic control, treatment adherence and frequency of insulin omissions were similar for those receiving treatment from a diabetes clinic versus a pediatrician, Using an insulin sliding scale improved metabolic control, whereas adherence was similar for the groups. Males and females omitted insulin injections equally across the three adolescent age groupings and metabolic control was worse for those who missed insulin injections. Neither adherence nor family relations differentiated between the adolescents who missed or did not miss insulin injections. Parental involvement in the diabetes regime differed by gender, with parents remaining involved with females for longer. Results were discussed in the context of adolescent development and the systems social/ecological model of adaptation and coping developed by Kazak (1989).

Objectives. The primary objective of this study is to identify predictors of leisure time physical activity (defined as the reported level of energy expenditure in non-work activities) in the adult population of Ontario. The secondary objective of this study is to compare the predictors in different subgroups of the Ontario population. Subgroups divided by age group, gender and whether the subject lived in a rural or an urban area will be examined specifically. Methods. Two different software packages were used for this thesis. Statistical Analysis Software (SAS) was used for preliminary analyses. Final models were tested using Statistical Analysis for Correlated Data (SUDAAN) software which is designed to adjust for the multi-stage sampling design. Subjects were included in this study if they were over the age of 18. Energy expenditure (NEW), the outcome variable, was calculated by summing the 20 different activity specific scores. Twenty-nine independent variables were considered as potential predictors. Three variables were excluded because they were found to be collinear with other potential predictors. The main statistical method used was multiple linear regression. (Abstract shortened by UMI.)

This research examines the two-year period prevalences and gender-specific correlates for self-reported gonorrhea, chlamydia, genital herpes, and genital warts among 43,192 sexually experienced Canadians aged 15 to 59 years in the 1996--97 National Population Health Survey. Reporting multiple partners in the past year was consistently related to higher prevalences of STD. Regular alcohol consumption was a potential indicator of a higher risk lifestyle that places men and women at increased risk for chlamydia and genital herpes. Canadian-born respondents were significantly more likely to report STD, which may be a result of respondent error. Gender, age, and age at first intercourse were also important correlates, acting as both direct risk factors influencing susceptibility and as markers of higher risk sexual activity. Although the survey relies on self-reports of STD experience, in combination with clinic-based studies and surveillance it can be a useful tool for targeting prevention strategies for the general population.

Since research has implicated a role for serotonin function in smoking abstinence and in smoking behavior, the present study examined the effects of a tryptophan-depleting amino acid mixture and the subsequent smoking of a single cigarette on the nicotine withdrawal syndrome, mood and quantitative electroencephalography (EEG) in chronic smokers acutely deprived of smoking. In a double-blind, placebo-controlled, repeated measures design, eighteen male smokers were tested on two separate occasions, three days apart. On each occasion they: (a) ingested a nutritionally balanced amino acid mixture containing tryptophan or ingested a similar mixture devoid of tryptophan, and (b) sham smoked and smoked a single cigarette. Nicotine withdrawal symptoms, mood states, EEG and expired-breath carbon monoxide (CO) concentrations were measured four times: (a) immediately before smoking deprivation and ingestion of the amino acid mixtures (baseline); (b) 5 hr after smoking abstinence and ingestion of the amino acid mixtures; (c) immediately after sham smoking, and (d) after cigarette smoking. Total plasma tryptophan levels were measured two times: before and 5 hr after amino acid mixture ingestion. A significant reduction of plasma tryptophan (71%) was achieved by the tryptophan-depletion mixture. Smoking deprivation led to clear time-dependent increases in negative mood state and nicotine withdrawal ratings and reduced EEG activation. While acute tryptophan depletion did not exacerbate this withdrawal in abstinent smokers as evidenced by the absence of change in mood and withdrawal ratings, it was associated with altered brain state arousal as indicated by the reduction in alpha2 amplitude. While the smoking of a cigarette reduced and reversed to baseline some of the smoking abstinence-induced effects, these effects were not influenced by the tryptophan depletion mixture. Localized and lateralized EEG effects in abstinent smokers and following tryptophan depletion were also not observed. These findings suggest that in chronic male smokers reduced serotonin neurotransmission is not an important characteristic of acute smoking withdrawal effects. These results do not support previous research that has implicated altered serotonin function in tobacco withdrawal and in smoking behavior.

Driving ability may be adversely affected by many medical conditions and many jurisdictions therefore allow for a restricted license that permits driving under specified conditions. The objective of this retrospective cohort study was to evaluate restricted licensing by comparing "at-fault" crash and traffic violation rates for drivers with a restricted license to the general driving population and also to compare driving pre and post restriction. Following multivariate Poisson regression, the adjusted IRR for "at-fault" crashes and traffic violations for restricted versus non-restricted drivers were 0.92 (95% CI, 0.89 to 0.95) and 0.87 (95% CI, 0.85 to 0.90) respectively. Interventional time series analysis demonstrated a significant decrease in "at-fault" crash and traffic violation rates post imposition of restrictions. Restricted licensing programs are effective and allow persons with decreased driving ability due to medical conditions to continue driving under specific conditions.

Children with chronic illness are confronted with a variety of acute and chronic stressors. As a result, they require coping strategies that can be used successfully during extremely stressful situations. Mental skills training programs teach children stress management and relaxation techniques that may be used during stressful encounters. The primary purpose of this multiple case study was to evaluate the effectiveness of Orlick's Feeling Great Program in teaching children with chronic illness to deal successfully with stress and find highlights. Qualitative research methods were used to explore factors related to the process of learning mental skills, including types of skills used most often, the influence of context, and factors that effect skill development. Four children receiving treatment for cancer between the ages of 7--9 learned techniques such as muscle relaxation, diaphragm breathing and imagery. Data collection included participant observation, field notes, interview data and highlight journals. Program participants perceived the program to be effective in fostering the development of improved coping skills for use within a variety of situations. During acute stressors, such as painful medical procedures, children and parents reported fewer incidents of reactive coping behaviors, such as crying, and described an increased number of proactive coping responses, such as deep breathing. Furthermore, children learned to cope effectively with chronic stressors, such as feelings of anxiety, nausea and treatment side effects.