Mise en contexte : Le décès neurologique correspond à la perte permanente des fonctions cérébrales. La validité de son diagnostic repose sur des conditions préalables et l’exclusion des facteurs confondants. L’objectif du mémoire est d’investiguer le rôle potentiellement confondant des médicaments sédatifs et analgésiques (MSA) sur le diagnostic de décès neurologique (DDN). Méthodes : 1) Nous avons réalisé une étude de la portée des recommandations mondiales s’intéressant au rôle des médicaments sédatifs et analgésiques lors du diagnostic de décès neurologique. Nous avons extrait les informations pertinentes à nos questions et les références qui les soutiennent. 2) Nous avons réalisé une étude transversale (étude Pinkie) nichée dans la cohorte INDex « CT-Perfusion for neurological diagnostic evaluation: a prospective Canadian multicenter diagnostic test study ». Nous avons comparé les concentrations plasmatiques de MSA lors du DDN et investigué l’association statistique entre MSA et DDN. Résultats : 1) La revue de la portée a démontré la variabilité des recommandations dans le domaine et le peu de preuves qui les soutiennent. Néanmoins, 67% des recommandations suggéraient de doser les MSA lors du DDN. 2) Nous avons observé dans l’étude Pinkie que les concentrations plasmatiques de MSA sont faibles et qu’elles ne sont pas associées à la probabilité de déclarer un patient en décès neurologique. Conclusion : Dans le cadre d’un diagnostic de décès neurologique effectué selon les guides de pratique au Canada, les médicaments sédatifs et analgésiques ne sont pas associés à la probabilité de diagnostic de décès neurologique. / Background: Neurological death is defined by the permanent loss of cerebral function. The validity of its diagnosis relies on prerequisite conditions and the exclusion of confounding factors. The goal of this work is to investigate the potential confounding role of sedatives and analgesics drugs (SAD) on the neurological death determination (NDD). Methods: 1) We conducted a scoping review of global guidelines addressing the role of sedative and analgesic drugs in the neurological death determination. We have extracted the information relevant to our questions and the references that support them. 2) We conducted a cross-sectional study (Pinkie study) nested in the INDex cohort “CT-Perfusion for neurological diagnostic evaluation: a prospective Canadian multicenter diagnostic test study”. We compared plasma concentrations of SAD during NDD and investigated the statistical association between SAD and NDD. Results: 1) The scoping review demonstrated the variability of recommendations in the field and the limited evidence supporting them. Nevertheless, 67% of recommendations suggested dosing SAD during NDD. 2) We observed in the Pinkie study that the plasma concentrations of SAD are low and that they are not associated with the probability of declaring a patient neurologically dead. Conclusion: In the context of a neurological death determination made according to the Canadian practice guidelines, sedative and analgesic drugs are not associated with the probability of neurological death diagnosis.

Bakgrund: Trauma är en av de mest bidragande orsakerna till skada och död globalt. För att minska lidande och död hos patienter samt kostnader för samhället krävs en välfungerande traumavård. Tiden på dygnet, kön och ålder kan påverka utfallet för patienter som inkommer till sjukhus efter ett trauma. Eftersom forskningen inte är enig är detta ett område som ytterligare måste undersökas. Syftet med studien var att undersöka skillnader mellan traumapatienter vid en traumaenhet beroende på om patienten inkommer dagtid respektive jourtid, kön och ålder. Metod: Studien är en retrospektiv icke-experimentell tvärsnittsstudie där redan insamlade från en traumakoordinator vid ett sjukhus i norra sjukvårdsregionen analyserats. Studiepopulationen bestod av 115 patienter som blivit inskrivna som trauma nivå 1 eller 2 på akutmottagningen under år 2022. Data har analyserats med T-test och Chi-2 test för att undersöka eventuella skillnader och för att undersöka samband har Pearson’s korrelationstest använts. Signifikansgränsen sattes till P<0,05. Resultat: I denna studie kunde inga signifikanta skillnader identifieras mellan de trauman som inkom på dagtid och på jourtid gällande tid till vård eller allvarlighetsgrad av skadan. Kvinnor hade signifikant kortare tid mellan larm och ankomsttid till sjukhus. Det fanns ingen signifikant skillnad i allvarlighetsgrad beroende på tid på dygnet. Det fanns inte heller någon skillnad i allvarlighetsgrad mellan könen men det fanns ett positivt samband mellan hög ålder och allvarlighetsgrad. Slutsats: Vården vid det valda sjukhuset skiljer sig inte signifikant i traumaomhändertagande på dagtid och jourtid eller mellan könen vilket utifrån studerade variabler kan indikera en jämlik vård. Vidare studier skulle vara av intresse för att med andra variabler och infallsvinklar studera eventuella skillnader. Det finns också ett behov av jämförande analyser mellan sjukhus för att undersöka närmare hur jämlik vård som bedrivs i landet. Kunskapen är av vikt för anestesisjuksköterskan för att bedriva jämlik vård.

This study aimed to provide evidence on knowledge of attitudes toward standard precautions (SPs) and its practice of Healthcare Workers (HCWs) in government and private hospitals in Botswana. It utilised descriptive cross-sectional methodology. A range of significant findings were revealed. Good practice of SPs was noted more amongst the HCWs in government than in private hospitals. Knowledge of SPs amongst HCWs in government hospital was significantly and positively correlated to good practice of SPs. Registered Nurses (RNs) had better knowledge of SPs than HealthcareAssistants (HCAs).There was no significant difference between RNs and HCAs practice of SPS and attitudes toward the same. No significant difference in the knowledge, attitudes and practice of SPs was noted between General Practitioners (GPs) and RNs. No significant difference in the knowledge, attitudes and practice of SPs was observed between GPs and HCAs. The study findings have implications for the application of SPs in practice / Health Studies / M.A. (Public Health)

The objectives of the study were (1) to quantify adherence rate among the study participants in the ART unit and (2) to identify factors that contribute to non-adherence. This cross sectional study was carried out at Nekemete referral clinic. Data was collected using a self-developed structured questionnaire where a total of 338 participants grouped into adherent and non-adherent based on a score derived from an adherence assessment were interviewed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. By using multivariate analysis of variables identified as correlates of adherence, non-adherence was common among those; with age between 18-30 yrs, with no education, who were not married, who had no pipe water supply, those with no electricity in the house, who perceived had no access to assistance from providers, who perceived the health care providers (HCPs) did not keep information confidentially, who had a language barrier with providers, and who were treated with a psychiatric illness. The study concludes that adherence is multi-factorial and varies significantly by individual and care setting. Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Three psychosocial factors were independently associated with poor adherence: the study found that patients perceiving poor access; those perceiving problems in information confidentiality (and possibly experiencing stigmatisation); and having psychiatric morbidity (and possibly with less social support) are more likely to be non-adherent. Furthermore, individuals without electricity and those without piped water supply, implying low income, are at risk for non-adherence / Health Studies / M.A. (Public Health)

À l’instar de plusieurs systèmes de santé, les centres hospitaliers québécois ont amorcé l’informatisation du dossier patient sous forme papier pour la transition vers un dossier clinique informatisé (DCI). Ce changement complexe s’est parfois traduit par des répercussions sur les pratiques de soins, la sécurité et la qualité des soins offerts. L’adoption de la part des utilisateurs de technologies de l’information (TI) est considérée comme un facteur critique de succès pour la réalisation de bénéfices suite au passage à un DCI. Cette étude transversale multicentrique avait pour objectifs d’examiner des facteurs explicatifs de l’adoption, de l’utilisation réelle d’un DCI, de la satisfaction des infirmières et de comparer les résultats au regard du sexe, de l’âge, de l’expérience des infirmières et des stades de déploiement du DCI. Un modèle théorique s’appuyant sur la Théorie unifiée de l’adoption et de l’utilisation de la technologie a été développé et testé auprès d’un échantillon comptant 616 infirmières utilisant un DCI hospitalier dans quatre milieux de soins différents. Plus particulièrement, l’étude a testé 20 hypothèses de recherche s’intéressant aux relations entre huit construits tels la compatibilité du DCI, le sentiment d’auto-efficacité des infirmières, les attentes liées à la performance, celles qui sont liées aux efforts à déployer pour adopter le DCI, l'influence sociale dans l’environnement de travail, les conditions facilitatrices mises de l’avant pour soutenir le changement et ce, relativement à l’utilisation réelle du DCI et la satisfaction des infirmières. Au terme des analyses de modélisation par équations structurelles, 13 hypothèses de recherche ont été confirmées. Les résultats tendent à démontrer qu’un DCI répondant aux attentes des infirmières quant à l’amélioration de leur performance et des efforts à déployer, la présence de conditions facilitatrices dans l’environnement de travail et un DCI compatible avec leur style de travail, leurs pratiques courantes et leurs valeurs sont les facteurs les plus déterminants pour influencer positivement l’utilisation du DCI et leur satisfaction. Les facteurs modélisés ont permis d’expliquer 50,2 % de la variance des attentes liées à la performance, 52,9 % des attentes liées aux efforts, 33,6 % de l’utilisation réelle du DCI et 54,9 % de la satisfaction des infirmières. La forte concordance du modèle testé avec les données de l’échantillon a notamment mis en lumière l’influence des attentes liées à la performance sur l’utilisation réelle du DCI (r = 0,55 p = 0,006) et sur la satisfaction des infirmières (r = 0,27 p = 0,010), des conditions facilitatrices sur les attentes liées aux efforts (r = 0,45 p = 0,009), de la compatibilité du DCI sur les attentes liées à la performance (r = 0,39 p = 0,002) et sur celles qui sont liées aux efforts (r = 0,28 p = 0,009). Les nombreuses hypothèses retenues ont permis de dégager l’importance des effets de médiation captés par le construit des attentes liées à la performance et celui des attentes liées aux efforts requis pour utiliser le DCI. Les comparaisons fondées sur l’âge, l’expérience et le sexe des répondants n’ont décelé aucune différence statistiquement significative quant à l’adoption, l’utilisation réelle du DCI et la satisfaction des infirmières. Par contre, celles qui sont fondées sur les quatre stades de déploiement du DCI ont révélé des différences significatives quant aux relations modélisées. Les résultats indiquent que plus le stade de déploiement du DCI progresse, plus on observe une intensification de certaines relations clés du modèle et une plus forte explication de la variance de la satisfaction des infirmières qui utilisent le DCI. De plus, certains résultats de l’étude divergent des données empiriques produites dans une perspective prédictive de l’adoption des TI. La présente étude tend à démontrer l’applicabilité des modèles et des théories de l’adoption des TI auprès d’infirmières œuvrant en centre hospitalier. Les résultats indiquent qu’un DCI répondant aux attentes liées à la performance des infirmières est le facteur le plus déterminant pour influencer positivement l’utilisation réelle du DCI et leur satisfaction. Pour la gestion du changement, l’étude a relevé des facteurs explicatifs de l’adoption et de l’utilisation d’un DCI. La modélisation a aussi mis en lumière les interrelations qui évoluent en fonction de stades de déploiement différents d’un DCI. Ces résultats pourront orienter les décideurs et les agents de changement quant aux mesures à déployer pour optimiser les bénéfices d’une infostructure entièrement électronique dans les systèmes de santé. / Like many other healthcare systems, healthcare institutions in Quebec are in the process of transitioning from paper-based patient records to Electronic Patient Records (EPRs). For some time now, this considerable and complex transition has had a high failure rate and unexpected consequences on care practices and the quality and safety of the care provided to patients. The acceptance of information technology by users is considered to be a critical success factor in realizing the benefits of EPR implementation. The goal of this multicenter cross-sectional study was to examine the explanatory factors of the adoption and actual use of an EPR by nurses and their satisfaction. It also aimed at comparing the outcomes by gender, age and experience and by EPR adoption stage. To do so, a theoretical model based on the unified theory of acceptance and use of technology (UTAUT) was developed and tested on a sample of 616 nurses who use an EPR in four different acute care facilities. Specifically, the study tested 20 research hypotheses on the relationships among eight different constructs, namely EPR compatibility, self-efficacy, performance expectancy, effort expectancy, social influence, facilitating conditions explaining the actual use of an EPR by nurses and their satisfaction. Fifteen research hypotheses were supported following structural equation modeling analysis. The results revealed that performance expectancy, effort expectancy, facilitating conditions and compatibility of the EPR (with preferred work style, existing work practices and values of nurses) were strong determinants of the actual use of an EPR by nurses and their satisfaction. The variables explained 50.2% of the variance of performance expectancy, 52.9% of effort expectancy, 33.6% of actual use of an EPR by nurses and 54.9% of their satisfaction. The strong fit of the model tested with the sample data showed the influence of performance expectancy on the actual use of the EPR by nurses (r = .55 p = .006) and on their satisfaction (r = .27 p = .010), the influence of the facilitating conditions on effort expectancy (r = .45 p = .009), EPR compatibility on performance expectancy (r = .39 p = .002) and on effort expectancy (r = .28 p = .009). The numerous hypotheses supported highlight the importance of the mediation effects captured by the performance expectancy and effort expectancy constructs. Comparisons based on age, experience and gender of the respondents did not reveal any statistically significant differences in terms of the acceptance and actual use of an EPR by nurses and their satisfaction. However, those based on the four EPR adoption stages revealed significant differences in terms of the relationships modelled. The results suggest that certain key relationships become more intense as the EPR adoption stages progress, thereby providing a better explanation of the variance in the satisfaction of nurses. Some results of the study also differ from the empirical data produced in a predictive perspective of information technology adoption. The study shows the applicability of the technology acceptance models and theories for nurses working in hospital centres. The results suggest that an EPR that meets performance expectancies is the most determining factor in positively influencing the actual use of the EPR and the satisfaction of nurses. To manage change, the study identified some explanatory factors of the acceptance and use of an EPR, and the model testing revealed how the relationships evolve based on the various EPR adoption stages. The results could help guide decision makers and change agents in determining the measures to implement in order to maximize the benefits of a fully electronic infostructure in healthcare systems.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries. / Revisión por pares

Cardiovascular diseases are the leading cause of death in most industrialised countries and in developing countries the trend in cardiovascular-related deaths is increasing. World-wide, type 2 diabetes mellitus (T2DM) is an emerging cause of disability and premature death. Both these conditions are closely associated with the consumption of energy-dense foods and food products that are poor in nutrients, as well as with a sedentary lifestyle. Pharmacological and surgical interventions can improve the outcome and delay the progression of the disease, but in terms of population-level prevention there is no substitute for the adoption of a healthy lifestyle. SETTING The underlying studies were conducted in Västerbotten (the VIP study), and in Norrbotten and Västerbotten combined (the MONICA Project). Norrbotten andVästerbotten are the two northernmost counties in Sweden. Since the mid-1980sthe prevalence of cardiovascular disease has decreased and diabetes rates haveremained stable in this region, despite of an unbroken trend of increasing body weight. OBJECTIVE The aim of this thesis is to describe changes in reported dietary habits, estimatetheir relative importance as risk factors for diabetes and cardiovascular disease, and finally to identify lifestyle components as potential targets for intervention. RESULTS The first paper describes changes in self-reported food consumption between 1986 and 1999. During this period, the population in question switched from products with high saturated fatty acid content (e.g. milk containing 3% fat, butter) to foods containing less saturated fat (e.g. milk containing 1.5% fat, vegetable oil, low-fat margarine); pasta and rice were consumed more often, and potatoes were consumed less. Convenience foods (e.g. hamburgers, snacks, sweets) became more popular, whilst traditional dishes (e.g. potato dumplings, black pudding, blöta) decreased in popularity. Fruit and vegetable intake remained low. In paper two we study the effects of these changes in food intake on the risk of developing T2DM using body fat distribution as an early indicator. Increased consumption of convenience foods was associated with unfavourable changes (smaller hip circumference and larger waist circumference), whereas the increased consumption of vegetable oil and pasta was associated with low-risk fat distribution. In the third paper we report studies on the association between fat consumption and T2DM. We used the pattern of fatty acids in the membranes of red blood cells as a marker of fat intake. In addition to confirming earlier findings (markers of the intake of saturated fat are associated with increased risk of T2DM and markers of unsaturated fat are associated with reduced T2DM risk), we also identified associations between two markers of milk-derived saturated fat intake and enterolactone, a biomarker of dietary fibre intake, and the risk of developing myocardial infarction. Our results indicate that moderately high levels of enterolactone intake in men are associated with lower risk of experiencing myocardial infarction. Manuscript 5 ranks education level, physical activity, smoking status, and self-reported intake of dietary fibre and fatty acids according to their effects on body fat distribution. Increased levels of physical activity, a higher education level and a reduced intake of saturated fat from meat were ranked as the most strongly associated factors in both men and women. Increased intake of dietary fibre from grains in women, and increased intake of dietary fibre from fruits and vegetables in men, was also inversely associated with average waist circumference. CONCLUSION Both questionnaire-based and biological markers of the risk of developing diabetes or cardiovascular disease have been identified. Based on available population level measurements, reduced consumption of convenience foods, increased consumption of whole-grain products, fruits and vegetables, vegetable oil and pasta as well as increased physical activity are potential goals for interventions in northern Sweden.

No description available.

The objectives of the study were (1) to quantify adherence rate among the study participants in the ART unit and (2) to identify factors that contribute to non-adherence. This cross sectional study was carried out at Nekemete referral clinic. Data was collected using a self-developed structured questionnaire where a total of 338 participants grouped into adherent and non-adherent based on a score derived from an adherence assessment were interviewed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. By using multivariate analysis of variables identified as correlates of adherence, non-adherence was common among those; with age between 18-30 yrs, with no education, who were not married, who had no pipe water supply, those with no electricity in the house, who perceived had no access to assistance from providers, who perceived the health care providers (HCPs) did not keep information confidentially, who had a language barrier with providers, and who were treated with a psychiatric illness. The study concludes that adherence is multi-factorial and varies significantly by individual and care setting. Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Three psychosocial factors were independently associated with poor adherence: the study found that patients perceiving poor access; those perceiving problems in information confidentiality (and possibly experiencing stigmatisation); and having psychiatric morbidity (and possibly with less social support) are more likely to be non-adherent. Furthermore, individuals without electricity and those without piped water supply, implying low income, are at risk for non-adherence / Health Studies / M.A. (Public Health)

Made available in DSpace on 2011-05-04T12:42:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Introdução: A resiliência pode ser conceituada como um processo dinâmico que leva à adaptação positiva diante de uma adversidade e que envolve a interação entre processos sociais e intrapsíquicos de risco e de proteção. Metodologia: Tese composta por trêsartigos independentes, que apresentam a resiliência como aspecto comum. O primeiro deles apresenta uma revisão sistemática sobre a operacionalização do conceito de resiliência em estudos epidemiológicos sobre o transtorno de estresse pós-traumático (TEPT) seguido a eventos de violência urbana e/ou íntima. O segundo artigo traz uma revisão sistemática sobre as propriedades psicométricas da Escala de Resiliência e de suas diferentes versões. As bases de dados nas duas revisões foram: ISI; MEDLINE; PILOTS e LILACS. O terceiro artigo investigou os fatores associados à resiliência a eventos traumáticos a partir dos dados de um inquérito epidemiológico domiciliar conduzido com uma amostra representativa da população com 15 anos ou mais residente na cidade de São Paulo. A associação foi investigada através de modelos logísticos multivariados hierárquicos, tanto para traumas intensos quanto para aquelesleves/moderados. Resultados: Artigo 1) Estudos epidemiológicos sobre violência íntima e/ou urbana são relativamente recentes e muito heterogêneos no modo como operacionalizam o conceito de resiliência junto ao TEPT. Artigo 2) A literatura apresenta críticas sobre a capacidade de um instrumento único abranger a complexidade do fenômeno de resiliência. No entanto, a Escala de Resiliência vem sendo amplamente aplicada, apresentando boas propriedades psicométricas em suas diferentes versões, e sugerindo ser um instrumento útil para aferir alguns fatores individuais de resiliência. Artigo 3) O estudo seccional conduzido em São Paulo exemplificou a proposta de um método de análise que combina algumas formas de operacionalização da resiliência, demonstrando congruência dos achados (isto é, com maiores escores da Escala de Resiliência predizendo ausência de patologia após um evento traumático e com o grupo classificado como resiliente - através dessa operacionalização de adaptação positiva - apresentando os maiores escores de bem-estar). Conclusão: Apesar da complexidade do fenômeno de resiliência, a congruência dos achados aponta para a possibilidade de uma cada vez melhor apreensão do construto, favorecendo o entendimento sobre o que pode contribuir para a superação de eventos traumáticos pelos indivíduos a eles expostos. / Introduction: The resilience can be conceptualized as a dynamic process that leads to positive adaptation in the face of adversity and involves the interaction between intrapsychic and social processes of risk and protection. Methods: Thesis of three independent articles, which have the resilience as common theme. The first one presents a systematic review on the operationalization of the resilience concept in epidemiological studies on Postttraumatic Stress Disorder (PTSD) following events of urban and/or intimate violence. The second article provides a systematic review on the psychometric properties of the Resilience Scale, and their different versions. The databases in the two revisions were: ISI, MEDLINE, LILACS and PILOTS. The third article investigates the factors associated with resilience to traumatic events from the data of a household survey conducted with a representative sample of the population aged 15 years or more living in the city of São Paulo. The association was investigated using hierarchical multivariate logistic models for both trauma intense as those for light / moderate. Results: Article 1) Epidemiological studies on PTSD followed intimate and/or urban violence are relatively recent and very heterogeneous in how operationalize the resilience concept. 2) The literature presents criticism on the ability of a single instrument to cover the complexity of the resilience phenomenon. However, the Resilience Scale has been widely applied, showing good psychometric properties in different versions, and suggesting to be a useful tool to assess individual factors of resilience. 3) The cross-sectional study conducted in São Paulo illustrated the proposal for a method of analysis that combines some forms of operationalization of resilience, demonstrating consistency of findings (with higher scores of the Resilience Scale predicting absence of disease after a traumatic event and the group classified as resilient - through the operationalization of "positive adjustment" - showing the higher scores of well-being). Conclusion: Despite the complexity of the phenomenon of resilience, the congruence of findings points to the possibility of an even better understanding of the construct, facilitating the comprehension of what can help to overcome traumatic events on individuals exposed to them.