Three reasons why parental burnout is more prevalent in individualistic countries: a mediation study in 36 countries

PURPOSE

The prevalence of parental burnout, a condition that has severe consequences for both parents and children, varies dramatically across countries and is highest in Western countries characterized by high individualism.

METHOD

In this study, we examined the mediators of the relationship between individualism measured at the country level and parental burnout measured at the individual level in 36 countries (16,059 parents).

RESULTS

The results revealed three mediating mechanisms, that is, self-discrepancies between socially prescribed and actual parental selves, high agency and self-directed socialization goals, and low parental task sharing, by which individualism leads to an increased risk of burnout among parents.

CONCLUSION

The results confirm that the three mediators under consideration are all involved, and that mediation was higher for self-discrepancies between socially prescribed and actual parental selves, then parental task sharing, and lastly self-directed socialization goals. The results provide some important indications of how to prevent parental burnout at the societal level in Western countries.

A244 PROVIDING THE FODMAP DIET THROUGH AN ONLINE PLATFORM: IMPACT ON THE QUALITY OF LIFE AND THE PHYSICAL AND PSYCHOLOGICAL SYMPTOMS IN IRRITABLE BOWEL SYNDROME

Background

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects approximately 15 % of the worldwide population. It is characterized by recurring abdominal pain and changes in bowel habits. This population is more at risk of suffering from chronic fatigue and psychological distress. Moreover, IBS significantly reduces the quality of life of patients and increases the economic burden on the health system. Many therapies have been developed to try to alleviate the symptoms and improve the lives of people with IBS. Among these is the FODMAP ( Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols) diet which aims to establish a personal tolerance to these nutrients (carbohydrates) that accentuate the symptoms related to IBS. This diet, lasting on average twelve weeks, is separated into three steps: elimination, reintroduction, and personalization. An innovative approach has been developed by the online platform SOSCuisine.com® to allow people with IBS to safely follow the FODMAP diet in a ‘self-service’ way. It consists of using an online service of personalized weekly menus low in FODMAP with tips and instructions for each step of the diet in combination with access to a peer support group, moderated by a specialized registered dietician.

Aims

The aim of this project is to evaluate the impact of this new online service on the quality of life and the control of the physiological and psychological symptoms of people living with IBS. We hypothesized that this online service improve the quality of life and the control of the symptoms.

Methods

The participant has to be at least 18 years old, understand French, have access to Internet and a Facebook account (sufficient familiarity to use them) and have an IBS diagnosis (Rome IV criteria) validated or re-validated by a gastroenterologist within three months. People with eating disorders, mental health problems, other chronic gastrointestinal illnesses (except gastroesophageal reflux disease), diabetes and with a pregnancy are excluded. Validated questionnaires are used to assess the quality of life ( IBS-Quality Of Life), physical symptoms ( IBS-Severity Scoring System), state and trait ( State-Trait Anxiety Inventory, Form Y) whereas food intake is assessed with a online 24-hour dietary recall.

Results

So far, 35 participants have been included in the study (83% female, 45,3±12,8 years old). After the intervention, the severity of symptoms significantly decreased (p<0.001), and quality of life (p=0.041) and state anxiety (p=0.034) significantly improved.

Conclusions

This study should allow the identification of facilitating elements to adhere to the FODMAP diet and possibly improve the quality of life of this population.

Funding Agencies

None

Gender Equality and Maternal Burnout: A 40-Country Study

In Western countries, recent decades have witnessed a revolution toward gender equality. Inequalities have been greatly reduced in areas such as education or employment. Because inequalities lead to distress, this development has largely benefited women. One notable exception is the realm of parenting, which has remained rife with inequalities even in the most egalitarian countries. We hypothesized that experiencing inequality in parenting when one holds egalitarian values and raising a child in a country characterized by a high level of gender equality in other areas, increases mothers’ psychological distress in the specific area of parenting. Multilevel modeling analyses computed among 11,538 mothers from 40 countries confirmed this prediction: high egalitarian values at the individual level and high gender equality at the societal level are associated with higher burnout levels in mothers. The associations hold beyond differences in sociodemographic characteristics at the individual level and beyond economic disparities at the societal level. These findings show the importance of egalitarian values and gender equality and their paradoxical effect when inequalities are still present in specific areas as parenting. This study reveals the crucial need to act not only at the micro level but also at the macro level to promote gender equality in parenting and prevent parental burnout.

How Fast Can Nurses Learn Therapeutic Communication Skills? A Pilot Study on Brief Hypnotic Communication Training Conducted with Oncology Nurses

Objective: This project aimed to train nurses on an oncology unit in hypnotic communication to reduce treatment-related pain and anxiety in their patients. A pilot study was conducted to assess changes in hypnotic communication behaviors associated with the training.

Methods: Nurses were recruited and their interactions during a simulated patient admission for treatment (before and after training) were recorded. Hypnotic communication skills were assessed by independent reviewers using a training checklist listing different hypnotic communication techniques and a validated assessment scale (Sainte-Justine Hypnotic Communication Assessment Scale, SJ-HCAS).

Results: Seven nurses were evaluated. Wilcoxon paired-sample tests (pre–post) reported significant improvement with large effect sizes in the total score of the training grid (P = 0.034, r = 0.832) and significant improvement with large effect sizes in the relational (P = 0.018, r = 0.930) and total (P = 0.021, r = 0.903) scores of the SJ-HCAS.

Conclusion: This pilot study shows promising results regarding the effectiveness of hypnotic communication training for nurses. These acquired skills could translate into improved treatment experience with patients and could be transferred to other professionals and settings in the health care system.

Parental Burnout Around the Globe: a 42-Country Study

High levels of stress in the parenting domain can lead to parental burnout, a condition that has severe consequences for both parents and children. It is not yet clear, however, whether parental burnout varies by culture, and if so, why it might do so. In this study, we examined the prevalence of parental burnout in 42 countries (17,409 parents; 71% mothers; M_age = 39.20) and showed that the prevalence of parental burnout varies dramatically across countries. Analyses of cultural values revealed that individualistic cultures, in particular, displayed a noticeably higher prevalence and mean level of parental burnout. Indeed, individualism plays a larger role in parental burnout than either economic inequalities across countries, or any other individual and family characteristic examined so far, including the number and age of children and the number of hours spent with them. These results suggest that cultural values in Western countries may put parents under heightened levels of stress.

Equality versus equity: Barriers to health care access for Indigenous populations in Canada

Canada's universal and publicly funded health-care system aims to promote universal and equitable access to care based on the needs of individuals, rather than on their capacity to pay for these services. Despite these principles, some groups, such as Indigenous peoples, experience significant and persistent social inequalities in health compared to the general population. This situation results from the continuing impacts of colonialism, which has an undeniable influence on social determinants of health, including access to care. This is surprising for many health professionals because it contradicts the democratic ideals of justice and equality that underlie the health-care system, as well as the rhetoric of their professional practice which asserts that 'everyone is treated the same'.

Based on literature and on research findings, this presentation will demonstrate several ways in which a universal and homogeneous approach to health-care can contribute to creating social inequalities in health for Indigenous populations. First, health professionals tend to favor socially and culturally neutral practice, which can hinder the recognition of the influence of historical and socio-cultural factors on patients' health. This kind of practice may encourage a distorted reading of patients' issues and can lead to inappropriate responses. Second, a homogenous approach to care refers by default to health-care models and practices that are rooted in values and perspectives of the dominant culture, which contributes to the provision of culturally unsafe care for Indigenous patients. Finally, this type of approach overlooks the critical and specific needs of vulnerable groups, who often require more than the general population to achieve the same results. We will conclude by outlining some potential solutions, mainly how cultural safety as a transformative approach to care allows health professionals to better consider the needs and cultural identity of Indigenous patients.

Implementing the clinical standards of the National Institute for Health and Care Excellence (NICE) bipolar clinical guideline

In the UK, the National Institute for Health and Care Excellence (NICE) sets standards for interventions to drive improvement in the quality of services delivered. The actual update of clinical guidelines remains patchy and difficult to ascertain.

NICE most recent guideline on the management of bipolar disorder in adults will be reviewed. A concept tool to facilitate adherence to NICE clinical standards will be presented along with detailed outcomes of its pilot application in a naturalistic treatment setting, which drove the average concordance from 32% for a team providing treatment as usual, to 92% for a team supporting their practice with the tool. This presentation will also address additional impacts of its use including allowing drawing key clinical characteristics of an index population of individuals suffering from bipolar disorder, supporting education and auditing the actual service delivery.

The usefulness of the tool to shape clinical practice according to NICE evidence-based standards will be outlined. Its versatility and limitations will be debated. The discussion of the findings will include epidemiological considerations as well as implications for mental and physical well-being.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Global plant trait relationships extend to the climatic extremes of the tundra biome

The majority of variation in six traits critical to the growth, survival and reproduction of plant species is thought to be organised along just two dimensions, corresponding to strategies of plant size and resource acquisition. However, it is unknown whether global plant trait relationships extend to climatic extremes, and if these interspecific relationships are confounded by trait variation within species. We test whether trait relationships extend to the cold extremes of life on Earth using the largest database of tundra plant traits yet compiled. We show that tundra plants demonstrate remarkably similar resource economic traits, but not size traits, compared to global distributions, and exhibit the same two dimensions of trait variation. Three quarters of trait variation occurs among species, mirroring global estimates of interspecific trait variation. Plant trait relationships are thus generalizable to the edge of global trait-space, informing prediction of plant community change in a warming world.

The β-adrenoceptor blocker propranolol ameliorates compulsive-like gambling behaviour in a rodent slot machine task: implications for iatrogenic gambling disorder

Previous work has shown that chronic administration of the dopamine D_2/3 receptor agonist ropinirole invigorates performance on a rodent slot machine task (rSMT). This behavioural change appears superficially similar to the iatrogenic gambling disorder (GD) observed in a sub-set of patients with Parkinson's disease (PD), and has been associated with increased activation of the intra-cellular signalling proteins GSK3β and CREB in the striatum. Here, we wanted to determine whether this response to ropinirole could be attenuated by targeting these signalling proteins, and if the loss of dopaminergic innervation characteristic of PD would alter ropinirole's effects on the rSMT. Male Long Evans rats were trained on the rSMT. Dopaminergic terminals innervating the dorsolateral striatum were then lesioned bilaterally using the neurotoxin 6-hydroxydopamine hydrochloride (6-OHDA). Subsequently animals were implanted with osmotic mini-pumps delivering ropinirole. Lastly, animals were given dietary lithium (Li⁺ ), to inhibit the activation of GSK3β, or injections of the ß-adrenoceptor antagonist propranolol, which potently inhibits CREB as a secondary mechanism of action, and any changes in ropinirole-induced increases in compulsive-like engagement in the rSMT evaluated. Chronic ropinirole increased the number of trials animals completed, reproducing our original finding. This increase in task engagement was not altered in animals with 6-OHDA lesions, a putative model of early PD. In addition, the effects of ropinirole were not attenuated by administration of Li⁺ , but were ameliorated by propranolol. These data suggest that propranolol may represent a potential pharmacotherapy for the treatment of iatrogenic gambling.

Chronic administration of the dopamine D2/3 agonist ropinirole invigorates performance of a rodent slot machine task, potentially indicative of less distractible or compulsive-like gambling behaviour

RATIONALE

Whilst dopamine agonist therapies can successfully manage the symptoms of diseases such as Parkinson's disease (PD), fibromyalgia and restless leg syndrome, they can also cause impulse control and addiction disorders such as gambling disorder (GD). These compulsive behaviours seriously undermine the utility of such treatments.

OBJECTIVES

The objective of the study was to model this phenomenon using a rodent slot machine task (rSMT) in order to investigate the neurobiological basis underlying such behavioural changes.

METHODS

Male Long Evans rats were trained to perform the rSMT. The D₂-like agonist ropinirole, or saline, was then delivered continuously for 28 days via osmotic mini-pump. The effects of ropinirole on baseline rSMT performance, as well as extinction and reinstatement sessions, were determined during this time. Brain samples from key frontostriatal regions implicated in GD and PD were then harvested immediately or after a 4-week washout period during which behaviour returned to pre-drug baseline.

RESULTS

Ropinirole invigorated task performance, in that drug treatment resulted in a robust and sustained increase in the number of trials completed. Ex vivo analyses revealed that chronic ropinirole treatment led to a pattern of changes indicative of upregulation within the β-arrestin-AKT-GSK3β intracellular cascade, recently theorised to dominate D₂-mediated signalling under hyperdopaminergic conditions, in the dorsal striatum, rather than the canonical PKA-dependent signalling pathway associated with D₂ receptor activation.

CONCLUSIONS

Such findings provide novel insight into the role of dopamine signalling in mediating compulsive-like gambling behaviour and may inform more directed pharmacotherapies for the treatment of both idiopathic and iatrogenic GD.

Continuous daily assessment of multiple sclerosis disability using remote step count monitoring

Disability measures in multiple sclerosis (MS) rely heavily on ambulatory function, and current metrics fail to capture potentially important variability in walking behavior. We sought to determine whether remote step count monitoring using a consumer-friendly accelerometer (Fitbit Flex) can enhance MS disability assessment. 99 adults with relapsing or progressive MS able to walk ≥2-min were prospectively recruited. At 4 weeks, study retention was 97% and median Fitbit use was 97% of days. Substudy validation resulted in high interclass correlations between Fitbit, ActiGraph and manual step count tally during a 2-minute walk test, and between Fitbit and ActiGraph (ICC = 0.76) during 7-day home monitoring. Over 4 weeks of continuous monitoring, daily steps were lower in progressive versus relapsing MS (mean difference 2546 steps, p < 0.01). Lower average daily step count was associated with greater disability on the Expanded Disability Status Scale (EDSS) (p < 0.001). Within each EDSS category, substantial variability in step count was apparent (i.e., EDSS = 6.0 range 1097-7152). Step count demonstrated moderate-strong correlations with other walking measures. Lower average daily step count is associated with greater MS disability and captures important variability in real-world walking activity otherwise masked by standard disability scales, including the EDSS. These results support remote step count monitoring as an exploratory outcome in MS trials.

Chloral hydrate for sedation of children with asthma during dental treatment

AIM

We hypothesised that chloral hydrate is safe and effective for sedation during dental treatments for children with mild asthma. We evaluated the safety and efficacy of chloral hydrate by measuring changes in heart rate (HR), transcutaneous oxygen saturation, (SpO2), asthma score, behaviour, types and frequency of adverse reactions associated with chloral hydrate were assessed throughout treatment.

MATERIALS AND METHODS

Children (<10 years old) with mild asthma undergoing dental treatments received a single 65 mg/kg oral dose of chloral hydrate liquid 1 hour prior to treatment in an open label trial. Heart rate (HR), SpO2, asthma score, behaviour, types and frequency of adverse reactions associated with chloral hydrate were assessed throughout treatment. Asthma score was obtained before and after treatment. Thirty minutes after treatment, SpO2, HR, and level of consciousness was assessed.

RESULTS

Twenty four children were enrolled and 92% (22/24) recovered from sedation without respiratory depression. Two experienced mild respiratory depression related to chloral hydrate. Asthma was not a contributing factor as they did not experience wheezing, cough, tachypnoea, or retractions. Inhaled nitrous oxide supplemented chloral hydrate sedation in 63% (15/24) children to achieve effective cooperation. Three children had a SpO2 <95% (2 during treatment, 1 during recovery).

CONCLUSION

Chloral hydrate 65 mg/kg administered a as single oral dose appears to be safe with respect to disease exacerbation for children with mild asthma undergoing dental treatment. Due to ineffective sedation and mild respiratory depression associated with chloral hydrate, newer, easily titrated medications, such as midazolam, may offer advantages.

Educating, implementing and auditing nice standards for bipolar disorder

Introduction

The National Institute for Health and Care Excellence (NICE) sets standards of clinical practice in the UK. An extensive update on guidance regarding bipolar disorder was released in September 2014. Practitioners face the challenge of translating this guidance into practice. NICE suggests that interventions might be better delivered by bipolar specialist clinics. Updated NICE standards were integrated into a Bipolar Clinical Effective Practice Screen (BICEPS), allowing existing community psychiatric teams to deliver these revised clinical standards in bipolar care.

Purpose

To assess the effectiveness of the BICEPS in delivering interventions aligned with NICE clinical standards.

Method

Three psychiatric community teams were audited; two teams (1 and 2) used the BICEPS to support their interventions whilst a third team provided management as usual. Team 1 was previously familiarized with the concept.

Results

Table 1.

Conclusion

The teams using BICEPS show better concordance to NICE standards. Superior outcomes by the team previously acquainted with the concept suggest longer-term benefits and adaptability. Using BICEPS may offer a cheaper alternative to developing specialist clinics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials

BACKGROUND

Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive.

OBJECTIVE

To conduct a meta-analysis of RCTs examining counselling in pregnant smokers.

SEARCH STRATEGY

We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling.

SELECTION CRITERIA

We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date.

DATA COLLECTION AND ANALYSIS

Overall estimates were derived using random effects meta-analysis models.

MAIN RESULTS

Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type.

CONCLUSIONS

Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.

Brother of CDO (BOC) expression in equine articular cartilage

Brother of CDO (BOC) is a cell surface receptor that derives its name from the structurally related protein, cell adhesion molecule-related/down-regulated by oncogenes (CDO, sometimes CDON). High levels of BOC mRNA and protein expression have been described in embryonic tissues with active cell proliferation and ongoing cellular differentiation(1,2). A microarray-based screen of RNA isolated from 11 different adult equine tissues unexpectedly identified BOC as having an expression pattern restricted to articular cartilage. The objective of this study was to further investigate BOC expression in adult articular cartilage relative to other tissues. Both RT-qPCR and mRNA sequencing confirmed the microarray data. Steady state BOC mRNA levels in articular cartilage were substantially higher than in the other adult tissues tested, neonatal tendon, placenta, and whole embryo. The expression of BOC displayed a pattern of tissue specificity comparable to well established cartilage matrix protein biomarkers. BOC mRNA levels in articular cartilage increased with age, but were rapidly down-regulated when chondrocytes were enzymatically isolated from the cartilage matrix and expanded in monolayer culture. Relative expression patterns of CDO were broadly similar, but displayed lower fold change differences. A functional role in articular cartilage that involves Hedgehog signaling is suggested by the known binding affinity of BOC for all three Hedgehog ligands. These data also extend BOC and CDO biology to a post-mitotic and highly differentiated cell type within a mature tissue.

A semi-automated software tool to study treadmill locomotion in the rat: from experiment videos to statistical gait analysis

A computer-aided method for the tracking of morphological markers in fluoroscopic images of a rat walking on a treadmill is presented and validated. The markers correspond to bone articulations in a hind leg and are used to define the hip, knee, ankle and metatarsophalangeal joints. The method allows a user to identify, using a computer mouse, about 20% of the marker positions in a video and interpolate their trajectories from frame-to-frame. This results in a seven-fold speed improvement in detecting markers. This also eliminates confusion problems due to legs crossing and blurred images. The video images are corrected for geometric distortions from the X-ray camera, wavelet denoised, to preserve the sharpness of minute bone structures, and contrast enhanced. From those images, the marker positions across video frames are extracted, corrected for rat "solid body" motions on the treadmill, and used to compute the positional and angular gait patterns. Robust Bootstrap estimates of those gait patterns and their prediction and confidence bands are finally generated. The gait patterns are invaluable tools to study the locomotion of healthy animals or the complex process of locomotion recovery in animals with injuries. The method could, in principle, be adapted to analyze the locomotion of other animals as long as a fluoroscopic imager and a treadmill are available.

CHARACTERIZATION OF A NEW LCAT MUTATION CAUSING FAMILIAL LCAT DEFICIENCY (FLD) AND THE ROLE OF APOE AS A MODIFIER GENE OF THE FLD PHENOTYPE

Introduction: LCAT (lecithin:cholesterol acyltransferase ) is an enzyme which plays an essential role in cholesterol esterification and reverse cholesterol transport. Familial LCAT deficiency (FLD) is a disease characterized by a defect in LCAT resulting in extremely low HDL-C, premature corneal opacities, anemia as well as proteinuria and renal failure. Method: We have identified two brothers presenting characteristics of familial LCAT deficiency. We sequenced the LCAT gene, measured the lipid profile as well as the LCAT activity in 15 members of this kindred. We also characterized the plasma lipoproteins by agarose gel electrophoresis and size exclusion chromatography and sequenced several candidate genes related to dysbetalipoproteinemia in this family. Results: We have identified the first French Canadian kindred with familial LCAT deficiency. Two brothers affected by FLD, were homozygous for a novel LCAT mutation. This c.102delG mutation occurs at the codon for His35 causing a frameshift that stops transcription at codon 61 abolishing LCAT enzymatic activity both in vivo and in vitro. It has a dramatic effect on the lipoprotein profile, with an important reduction of HDL-C in both heterozygotes (22%) and homozygotes (88%) and a significant decrease in LDL-C in heterozygotes (35%) as well as homozygotes (58%). Furthermore, the lipoprotein profile differed markedly between the two affected brothers who had different APOE genotypes. We propose that APOE could be an important modifier gene explaining heterogeneity in lipoprotein profiles observed among FLD patients. Our results suggest that a LCAT-/- genotype associated with an APOE ?2 allele could be a novel mechanism leading to dysbetalipoproteinemia.

Stress parental, soutien social, comportements de l’enfant et fréquentation des services de garde

Cette étude examine les taux de problèmes de comportement internalisés et externalisés des enfants et des indices de stress parental et du réseau de soutien social rapportés par les parents d’un échantillon d’enfants et de familles en fonction du type de service de garde fréquenté par les enfants. Elle vise aussi à identifier si les mêmes variables diffèrent en fonction de l’utilisation de divers types de services de garde et de la présence de divers facteurs de risques psychosociaux (0, 1, 2, 3) dans la famille, et ce, tout en contrôlant les effets reliés à l’âge et la santé des enfants ainsi qu’au pays d’origine et à l’âge de la mère. À cette fin, nous utilisons les données de trois cueillettes de données transversales de l’évaluation de l’initiative 1,2,3GO!. L’échantillon comporte 1245 enfants et familles provenant de 10 territoires de la grande région de Montréal. Les enfants sont âgés de 20 à 42 mois. Nous mesurons les comportements des enfants à l’aide du Child Behaviour Checklist (CBCL). Nous utilisons aussi la version abrégée du Parenting Stress Index pour mesurer le stress parental et la taille du réseau de soutien social (Barrera). Les parents répondent à un questionnaire sur le type de garde utilisé pour leur enfant. Les résultats indiquent que la fréquentation d’un service de garde est associée à moins de problèmes de comportements internalisés chez les enfants ainsi qu’à un plus grand réseau de soutien social chez les parents. Il n’y a pas de différences significatives pour ce qui est des scores de comportements externalisés chez les enfants et de l’indice de stress parental chez leurs parents. Ce sont les enfants et leurs parents qui utilisent des services structurés (CPE, garderies et services de garde en milieu familial) qui obtiennent les meilleurs scores relativement aux comportements internalisés des enfants et à la taille du réseau de soutien social des parents. Nos résultats soulignent également que les enfants qui ne fréquentent aucun service de garde présentent des taux supérieurs de comportements internalisés problématiques et externalisés limites à ce qu’on retrouve dans la population en général. Il en est de même pour les parents qui ne recourent à aucun service de garde, c’est-à-dire qu’ils présentent des taux plus élevés de stress parental et plus faibles de soutien social que la population en général. La discussion fait le lien entre les résultats de cette étude et d’autres résultats obtenus récemment. La conclusion propose de poursuivre l’accroissement du réseau afin de mieux répondre aux besoins des familles vulnérables.