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Dans une perspective de promotion de la santé, qui vise à donner aux personnes la maîtrise de leur propre santé, la proposition théorique et méthodologique que nous présentons s’intéresse à comprendre comment les inégalités sociales basées sur le genre, l’ethnicité, le statut socioéconomique, etc. conditionnent la capacité des jeunes d'agir pour leur santé. Nous focalisant sur les jeunes (18-24 ans), nous mobilisons la notion de « capacités » d’Amartya Sen (1993) pour concevoir le rôle actif des individus par rapport à leur santé, ainsi qu’une approche intersectionnelle qui, au lieu d’analyser les inégalités sociales de façon isolée, met l’accent sur l’imbrication de celles-ci afin de mieux comprendre les mécanismes qui les produisent. Nos objectifs sont (a) cerner les différentes formes de capacité d’agir qu’on les jeunes pour leur santé prend et à (b) analyser comment cette capacité est conditionnée par les inégalités sociales afin d’ (c) identifier des pistes d’action pour améliorer l’empowerment des jeunes. Notre démarche méthodologique s’appuie sur deux volets. Un premier volet, à visée exploratoire, utilisera la méthode d’analyse en groupe afin de réaliser un diagnostic de ressources et de contraintes des jeunes pour agir pour leur santé, ainsi que d’identifier les catégories sociales les plus pertinentes pour l’analyse intersectionnelle. Sur cette base, le deuxième volet, basé sur la technique des récits de vie, a pour objectif de saisir l’interaction des inégalités sociales telle qu’elle est vécue par les jeunes et d’analyser comment cette interaction façonne leur capacité d’agir de façon favorable à leur santé. Ainsi, nous décrivons une démarche méthodologique pour l’étude de la capacité d’agir pour la santé afin de proposer une nouvelle grille de lecture, empiriquement fondée, pour la conceptualisation des programmes en promotion de la santé.

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Background: Building on Honneth’s “Theory of recognition”, we identified strong associations between lack of recognition in the work place and several health indicators. In this study we tested the hypothesis that these associations vary as a function of job uncertainty level which we suppose to modify the recognition processes. Methods: Longitudinal and cross-sectional data from BELSTRESS III study (N=2876) were analyzed by way of logistic regressions. 4 recognition dimensions (social esteem, rights, existential recognition from colleagues, and supervisors) were included as factors. Absenteeism, presenteeism, SPH, back pain and depression were included as outcomes. Stratifications for job insecurity and globalization were applied. Findings: All 4 recognition dimensions were strongly associated with all health indicators (ORs between 1.21 and 3.93) but, contrary to our hypothesis, no variation in associations’ strength was observed for stratified data. Discussion: More research is needed for better grasp the specificities of the link between recognition in the workplace and health when these dynamics are embedded within the novel work forms in the post-taylorist labor market., info:eu-repo/semantics/published, Vol. 16 Supp.http://ehps.net/ehp/index.php/contents/article/view/210/203

While accreditation has been widely used in many countries to improve quality and safety of care, this process is a relatively new concept for healthcare professionals in the French-speaking community of Belgium. And as all new concepts do, it raises many questions about methods, costs and potential benefits. It is worth noticing that these questions vary depending on the group of professionals taken into account.Under the supervision of the Belgian French-Speaking Community’s Ministry of Health, santhea, the largest French speaking association of hospitals, and the School of Public Health of the Université Libre de Bruxelles have been asked to develop a guide for academic hospitals as well as general hospitals describing how hospitals can prepare themselves in order to start an accreditation process. The study began in November 2012 and ended in October 2013. After a short description of the accreditation concept as well as the (many) particularities of the Belgium’s institutional context, three accreditation manuals are compared, in terms of content and philosophy, which leads to the conclusion that while most themes are common, the philosophy can be quite different. Next we test to what extend accreditation norms are in line with everyday work of professionals. We find out that most norms are considered by hospital professionals as being important, which means that the accreditation process could be accepted among them. By evaluating the implementation of a set of accreditation norms in four hospitals, we observed that some of these norms are already quite good implemented, but others are not. The study also proposes a tool which gives hospitals the possibility to evaluate if they are ready to start an accreditation process. It has been developed on the basis of literature references and accreditation manuals customized for French speaking hospitals. The tool is composed of 46 criteria grouped in 16 domains. Once used in a few hospitals, benchmarking will be proposed.Both qualitative and quantitative methods are then used to explore the level of knowledge of accreditation among health professionals and how they feel about it. From the various investigations, it seems that before embarking on this long journey called “accreditation”, it is essential to go through an awareness-raising phase to make sure that the whole staff adhere to accreditation process, participating actively and being deeply involved. Based on advices of accreditation experts, hospital leadership appears to be essential. Therefore, the guide suggests organizing study days for hospital management boards to initiate this awareness-raising phase. The training sessions will begin in 2014 and will be offered to the 91 French speaking hospitals. A methodology will also be suggested to hospitals to raise awareness at the local level. This guide is available free of charge and is distributed by, among others, the "accreditation platform”, whose goal is to help hospitals to improve quality and safety in healthcare. This platform, created in March 2013, brings together many actors of the healthcare sector. It also contributes to the awareness-raising of hospitals and the need of preparation for accreditation The first lessons from the local changes in terms of awareness-raising in hospitals will be obtained as from late 2014.Our work offers concrete proposals to create a friendly environment in hospitals for the accreditation process. We think that accreditation can be accepted by professionals “from the boardroom” as well as those at the bedside. Accreditation could thus serve as a catalyst to lead the whole institution to develop continuous improvement in quality and safety.All findings confirm our belief that both an awareness-raising and a preparation phase are essential before entering in an accreditation process. This is especially true now for French-speaking Belgian hospitals., 0, Autres co-auteurs :Delmotte Nicole, Fima Odile (extérieurs à l'ULB), info:eu-repo/semantics/published

L’etiquetage nutritionnel constitue une aide au suivi des recommandations dietetiques pour les diabetiques de type 2. La comprehension de cet etiquetage a ete comparee entre les diabetiques et d’autres patients. Les determinants sociodemographiques et dietetiques influencant le niveau de comprehension ont ete analyses. L’enquete cas-temoins s’est deroulee a l’hopital Erasme de Bruxelles dans le service d’endocrinologie : 163 patients (dont 71 diabetiques de type 2) ont repondu au questionnaire auto-administre abordant les donnees sociodemographiques et nutritionnelles ainsi que la comprehension (lecture et comparaison). Entre les deux groupes, le score de comprehension (p

Actes de l'Atelier Régional Santé :Rubavu, Rwanda. Du 12 au 15 septembre 2011, info:eu-repo/semantics/published, L'Harmattan, Paris.

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La prévalence importante et en augmentation ainsi que les lourds coûts humains etfinanciers de la naissance prématurée font de l'amélioration des prises en charge et de lalimitation des effets secondaires à l'hospitalisation un enjeu de santé publique. Parmi lestechniques de soins au développement impliquant des stimulations tactiles, l’application dumassage chez les prématurés a été l’objet de plus de 30 ans de littérature qui ont démontrédes bénéfices notamment sur la prise de poids, la sortie anticipée et des moindrescomplications. L’application du massage par les parents apporte en outre une plus-valuetrès intéressante en termes d’attachement. Pourtant cette stratégie reste marginale. Cetteenquête qualitative a eu lieu dans trois unités de soins intensifs néonatals de la régionBruxelles et a pour objectif de comprendre les problèmes de diffusion et de pérennisationde cette technique. Il apparait que beaucoup de difficultés sont communes à l’implantationde tous les soins en lien avec le développement de l’enfant. Le challenge de laréorganisation des services et des soins rend primordial le besoin d’un projet cohérent etcoordonné. Les problèmes de définition créent débats et les manques d’informations etd’échanges entre structures limitent la diffusion des pratiques. Dans le cas du massage, lacomplexité perçue par les acteurs interroge sur la pertinence de cette stratégie qui, enl’absence d’un programme global d’approche par le toucher, a tendance à rester isolée, às’essouffler sans donner lieu à une réflexion plus générale et partagée. Les pistes etsolutions sont du ressort de chaque acteur :des parents aux soignants, des leadershipslocaux et politiques aux chercheurs., info:eu-repo/semantics/nonPublished

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info:eu-repo/semantics/published, 27th Patient Classification Systems International (PCSI) Working Conference, Montreal, Canada, October 2011

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Etats généraux de Bruxelles - Note de synthèse "santé et qualité de vie"., info:eu-repo/semantics/published

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Nous voudrions rapporter ici, l’expérience d’une recherche conduite avec plusieurs « municipios » (unité de gestion périphérique de services de santé du premier échelon public) au Nicaragua, utilisant l’expérience de soins de santé par des patients suspect ou avérés tuberculeux comme porte d’entrée pour une réflexion sur l’organisation de soins de santé ambulatoires (i.e. les soins de santé individuels qui ne nécessitent pas d’hospitalisation).

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Thyroid function and exposure to dietary goitrogenic factors (iodine deficiency and thiocyanate overload) were studied at birth and from birth to 7 years in 200 neonates and 347 children living in the severe endemic goitre area of Ubangi, Northern Zaire. Serum T4 was at the lower limit of normal at birth (104 +/- 4 nmol/l) and stayed at that level during the first year of life (123 +/- 9) (NS), but decreased to 75 +/- 8 (P less than 0.001) at 2-4 years and to 62 +/- 6 (P less than 0.001) at 5-7 years of age. Mean serum FT4 decreased from 10.4 +/- 0.9 pmol/l during the first year to 8.2 +/- 1.0 (NS) at 2-4 years (NS) and to 7.7 +/- 0.9 (P less than 0.05) at 5-7 years. Mean serum TSH was 10.4 (8.4-12.9) mU/l (geometric mean +/- 1 SEM) during the first year, 10.1 (7.5-13.7) (NS) at 2-4 years and 24.3 (18.5-31.9) (P less than 0.05) at 5-7 years. Mean serum T3 was 3.23 +/- 0.12 nmol/l during the first year and remained stable thereafter. The frequencies of low T4 (T4 less than 77 nmol/l), high TSH TSH (TSH greater than 50 mU/l), and low T4 and T3 (T3 less than 1.69 nmol/l) were twice as high at 5-7 years as in the first year (respectively 65%, 42% and 15%). The urinary iodide concentration of the children was stable and low throughout the study period. By contrast, serum thiocyanate concentration which was high at birth (129 +/- 5 mumol/l) decreased to normal values between 3 and 12 months of age and increased again during and after weaning (1 to 3 years of age) to reach a value of 138 mumol/l which was comparable to that observed in adults in the same area. Thiocyanate concentration was high (133 +/- 7 mumol/l) in the mothers' serum but low in the mothers' milk (57 +/- 3 mumol/l) (P less than 0.001). Multivariate analysis showed that both iodine deficiency and thiocyanate overload were explanatory factors of the serum levels of T4, FT4 and TSH in children. In conclusion, our results show that infantile hypothyroidism is much more frequent at 5-7 years of age than at birth or during the first year of life. The deterioration in thyroid function during and after weaning is linked to persistent iodine deficiency accompanied by an increase in thiocyanate overload. The variability in the age of onset, the severity, and the duration of infantile hypothyroidism might explain the wide range of psychomotor and physical abnormalities observed in a large proportion of subjects in this area.Thyroid function and exposure to dietary goitrogenic factors (iodine deficiency and thiocyanate overload) were studied at birth and from birth to 7 years in 200 neonates and 347 children living in the severe endemic goiter area of Ubangi, Northern Zaire. Serum T4 was at the lower limit of normal at birth (104 +or- 4 nmol/1) and stayed at that level during the 1st year of life (123 +or- 9) (NS), but decreased to 75 +or- 8 (P0.001) at 2-4 years and to 62 +or- 6 (P.001) at 5-7 years of age. Mean serum FT4 decreased from 10.4 +or- 0.9 pmol/1 during the 1st year to 8.2 +or- 1.0 (NS) at 2-4 years (NS) and to 7.7 +or- 0.9 (P0.05) at 5-7 years. Mean serum TSH was 10.4 (8.4-12.9) mU/1 (geometric mean +or- 1 SEM) during the 1st year, 10.1 (7.5-13.7) (NS) at 2-4 years, and 24.3 (18.5-31.9) (P0.05) at 5-7 years. Mean serum T3 was 3.23 +or- 0.12 nmol/1 during the 1st year and remained stable thereafter. The frequencies of low T4 (T477 nmol/1), high TSH TSH (TSH50 mU/1), and low T4 and T3 (T31.69 nmol/1) were twice as high at 5-7 years as in the 1st year 65%, 42%, and 15%, respectively). The urinary iodide concentration of the children was stable and low throughout the study period. By contrast, serum thiocyanate concentration which was high at birth (129 +or- 5 cmol/1) decreased to normal values between 3-12 months of age and increased again during and after weaning (1-3 years of age) to reach a value of 138 umol/1 which was comparable to that observed in adults in the same area. Thiocyanate concentration was high (133 +or- 7 umol/1) in the mothers' serum but low in the mothers' milk (57 +or- 3 umol/1) (P0.001). Multivariate analysis showed that both iodine deficiency and thiocyanate overload were explanatory factors of the serum levels of T4, FT4, and TSH in children. The results show that infantile hypothyroidism is more frequent at 5-7 years of age than at birth or during the 1st year of life. The deterioration in thyroid function during and after weaning is linked to persistent iodine deficiency accompanied by an increase in thiocyanate overload. Variability in age at onset, severity, and duration of infantile hypothyroidism might explain the wide range of psychomotor and physical abnormalities observed in a lage proportion of subject, in this area.