Family social environment in childhood and self-rated health in young adulthood.

BACKGROUND: Family social support, as a form of social capital, contributes to social health disparities at different age of life. In a life-course epidemiological perspective, the aims of our study were to examine the association between self-reported family social environment during childhood and self-reported health in young adulthood and to assess the role of family functioning during childhood as a potential mediating factor in explaining the association between family breakup in childhood and self-reported health in young adulthood. METHODS: We analyzed data from the first wave of the Health, Inequalities and Social Ruptures Survey (SIRS), a longitudinal health and socio-epidemiological survey of a random sample of 3000 households initiated in the Paris metropolitan area in 2005. Sample-weighted logistic regression analyses were performed to determine the association between the quality of family social environment in childhood and self-rated health (overall health, physical health and psychological well-being) in young adults (n = 1006). We used structural equation model to explore the mediating role of the quality of family functioning in childhood in the association between family breakup in childhood and self-rated health in young adulthood. RESULTS: The multivariate results support an association between a negative family social environment in childhood and poor self-perceived health in adulthood. The association found between parental separation or divorce in childhood and poor self-perceived health in adulthood was mediated by parent-child relationships and by having witnessed interparental violence during childhood. CONCLUSION: These results argue for interventions that enhance family cohesion, particularly after family disruptions during childhood, to promote health in young adulthood.

Exploring mediating factors in the association between parental psychological distress and psychosocial maladjustment in adolescence.

Parental psychopathology is associated with increased psychosocial maladjustment in adolescents. We examined, from a psychosocial perspective, the association between parental psychological distress and psychosocial maladjustment in adolescents and assessed the mediating role of psychosocial covariates. This is a cross-sectional survey and the setting include representative sample of Quebec adolescents in 1999. The participants of the study include 13- and 16-year-old children (N = 2,346) in the Social and Health Survey of Quebec Children and Adolescents. The main outcome measures are internalizing disorders, externalizing disorders, substance use, and alcohol consumption. For statistical analysis, we used structural equation modeling to test for mediation. Internalizing and externalizing disorders were significantly associated with parental psychological distress, but not substance use or alcohol consumption. The higher the parental distress, the higher the risk of adolescent mental health disorders. The association between parental psychological distress and internalizing disorders was mediated by adolescent self-esteem, parental emotional support and extrafamilial social support. As for externalizing disorders, these variables only had an independent effect. In conclusion, A family's well being is a necessary condition for psychosocial adjustment in adolescence. Beyond the psychiatric approach, psychosocial considerations need to be taken into consideration to prevent negative mental health outcomes in children living in homes with distressed parents.

Evaluation of the unified model of information systems continuance (UMISC) in two hospital environments.

CONTEXT: The deployment and long-term acceptance of clinical information systems (CISs) are faced with multiple difficulties. They include insufficient quality of the systems in place and resistance to the multiple changes they induce in care processes. Permanent evaluation of deployed solutions is a prerequisite to their continuous improvement. OBJECTIVE: The purpose of this study was twofold: (1) To validate the post-adoption unified model of information systems continuance (UMISC) progressively developed at the Georges Pompidou University Hospital (HEGP) in Paris (internal validation); and (2) To compare, using the same evaluation model, the results observed at HEGP with those of the Saint-Joseph Hospital Group (HPSJ), another Paris acute care institution (external validation). METHODS: The UMISC post-adoption model is built around nine dimensions: end-user characteristics, social norm (SN), IS quality (ISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), profession-adjusted use (PAU), satisfaction (SAT), and continuance intention (CI). Two semi-quantitative evaluation surveys were performed at HEGP in 2014 and 2015, and one at HPSJ in 2015. Statistical analysis included multiple regression analysis and structural equation modeling (SEM). RESULTS: The analysis concerned 459 responders, 264 at HEGP and 195 at HPSJ. UMISC indicators, with the exception of SN, are superior at HEGP than at HPSJ, which had a shorter CIS anteriority than HEGP. In SEM analysis, the UMISC model explained 25% and 40% of the CIS use, 92% and 93% of health professionals' satisfaction, and 72% and 71% of continuance intention at HEGP and HPSJ, respectively. Seventeen of the 21 tested UMISC hypotheses were supported in at least one of the two sites. CONCLUSION: The UMISC evaluation model can be used as a comparison and explanatory model of CIS use, satisfaction and continuance intention in post-CIS adoption situations that become prevalent in current electronic hospitals.

14 Years longitudinal evaluation of clinical information systems acceptance: The HEGP case.

CONTEXT: Meaningful use and end-user satisfaction are two major components of the success of a clinical information system (CIS). The purpose of this study was to longitudinally measure and analyze the CIS use and satisfaction determinants in a multi-professional group at the Georges Pompidou university hospital (HEGP) in Paris. METHODS: From the different evaluation surveys performed at HEGP, three periods were considered corresponding to 4, 8 and over 10 years after the first CIS deployment in 2000, respectively. Six acceptance dimensions were considered: CIS quality (CISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), use, and global satisfaction (GS). Relationships between these constructs were tested through multiple regressions analysis and structural equation modeling (SEM). RESULTS: Responses were obtained from 298, 332, and 448 users for the three periods considered. CIS acceptance dimensions progressively and significantly increased over time. Significant differences between professions were observed with an initial low PU among medical staff. In the early deployment phase, GS appeared to be determined by CIS use, CISQ and PU (R(2)=.53 in SEM). In the very late post-adoption phase, GS was strongly determined by CISQ, CE, and PU (R(2)=.86 in SEM) and was no longer associated with CIS use. CONCLUSION: Acceptance models should be adapted to the phase of deployment of a CIS and integrate end-users' individual characteristics. Progressive reduction over time of the positive relationships between CIS use and satisfaction could possibly be considered as a maturity indicator of CIS deployment. These observations validate the introduction in post-adoption models of a continuance intention dimension.