New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Reuniting philosophy and science to advance cancer research

Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental and clinical) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer

Poverty in Consumer Culture:Towards a Transformative Social Representation

International audienceIn this article, we consider the representations of poverty within consumer culture. We focus on four main themes – social exclusion, vulnerability, pleasure and contentment – that capture some of the associations that contemporary understandings have made with poverty. For each theme, we consider the portrayals of poverty from the perspective of key agents (such as marketers, media, politicians) and then relate this to more emic representations of poverty by drawing on a range of contemporary poverty alleviating projects from around the world. We conclude with a set of guidelines for relevant stakeholders to bear in mind when elaborating their representations of poverty. These guidelines may act as a platform to transform marginalising representations of poverty into more empowering representations

Une exploration de la qualité de vie des étudiants universitaires de l’Ontario qui sont atteints du syndrome chronique d’Ehler-Danlos

Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder that results in negative health events. It also holds potential for periodic or permanent disability and psychosocial stress. While a diagnosis of EDS can occur at any age, the psychosocial effects of an EDS diagnosis can be especially challenging when symptoms present during postsecondary education. This qualitative study examined the psychosocial effects of EDS on the quality of life of Ontario postsecondary students (n=11). After a brief online eligibility survey, one-to-one semi-structured interviews were conducted. Thematic analysis of interview data revealed that emotional factors such as anxiety and depression, faculty and peer attitudes including issues of judgment and stigmatization, and feelings of frustration affect the quality of life of postsecondary students living with EDS.Le syndrome d’Ehlers-Danlos est une maladie qui affecte les tissus conjonctifs et qui cause de gros problèmes de santé. Elle peut également causer des incapacités périodiques ou permanentes et du stress psychologique. Le diagnostic de syndrome d’Ehlers-Danlos peut survenir à n’importe quel âge, toutefois les effets psychosociaux du diagnostic de cette maladie peuvent être particulièrement difficiles quand les symptômes sont présents parmi les étudiants universitaires. Cette étude qualitative a examiné les effets psychosociaux de cette maladie sur la qualité de vie des étudiants universitaires de l’Ontario (n=11). Après une brève enquête d’admissibilité en ligne, des entrevues individuelles semi-structurées ont été menées. Les données de l’analyse thématique des entrevues ont révélé que les facteurs émotionnels tels que l’anxiété et la dépression, les attitudes des professeurs et des autres étudiants, ainsi que les questions de jugement et de stigmatisation et les sentiments de frustration, affectent la qualité de vie des étudiants universitaires qui sont atteints du syndrome d’Ehler-Danlos

Social media as a dissemination and knowledge translation strategy among health professions educators: A scoping review protocol

COVID-19 has arguably affected health professions education. Educators have rapidly transitioned to delivering educational sessions remotely while clinical training opportunities have been canceled, postponed or modified. Recent commentaries and reports have recommended leveraging existing online educational resources like pre-recorded lectures, blogs, and podcasts to facilitate health professions remote learning. However, the feasibility of doing so remains uncertain and the impacts thereof are also a matter for concern. In this work, we present our critical scoping review protocol. We aim to explore whether and how health professions educators have used social media as a mechanism of dissemination and knowledge translation to support evidence informed HPE approaches in the peer-reviewed and grey literature, drawing on Engeström's Activity Theory as a guiding theoretical framework

A qualitative study of patients’ and caregivers’ perspectives on educating healthcare providers

Background: Patients/caregivers can be actively involved in the education of healthcare providers (HCPs). The purpose of this study was to explore patients'/caregivers' perspectives on their involvement and roles in the education of HCPs.Methods: We invited patients/caregivers to participate in one-on-one semi-structured interviews. We analyzed the interview data using conventional content analysis to identify themes.Results: In terms of patient/caregiver involvement in the education of HCPs, we identified that patients/caregivers perceive that it: (a) is challenging because of power-differentials between themselves and HCPs; (b) requires patient training; (c) needs to start early in HCPs’ education processes; (d) can improve patient-HCP partnerships, and (e) requires compensation for patients. With regards to the roles that patients can play in educating HCPs, we found that patients/caregivers want to: (a) teach HCPs about patients’ expectations, experiences and perspectives through case studies, storytelling, and educational research; (b) provide direct feedback to HCPs, and (c) advise on curricula development and admission boards for HCPs.Conclusions: Understanding patients’/caregivers’ perspectives on this topic can help educational leaders and HCPs improve active patient/caregiver involvement in the education of HCPs. We need to listen to patients’/caregivers’ voices in order to make effective changes in current and future health professions education.Contexte : Les patients et les aidants peuvent participer activement à la formation des prestataires de soins de santé (PSS). L’objectif de cette étude était d’explorer le point de vue des patients et des aidants sur leur participation et leur rôle dans la formation des professionnels de la santé.Méthodes : Nous avons invité des patients et des aidants à participer à des entretiens individuels semi-structurés. Nous avons dégagé les thèmes à l’aide d’une analyse de contenu classique des données des entretiens.Résultats : D’après les patients et les aidants, leur implication dans l’éducation des professionnels de la santé : (a) est un défi en raison du déséquilibre de pouvoir entre eux et les professionnels de la santé; (b) nécessite une formation des patients; (c) doit commencer tôt dans le processus de formation des professionnels de la santé; (d) peut améliorer les partenariats entre les patients et les professionnels de la santé; et (e) suppose que les patients soient indemnisés. En ce qui concerne les rôles que les patients peuvent jouer dans l’éducation des professionnels de la santé, nous avons constaté que les patients et les aidants veulent : (a) enseigner aux professionnels de la santé les attentes, les expériences et les points de vue des patients par le biais d’études de cas, de récits et de recherche en éducation; (b) fournir une rétroaction directe aux professionnels de la santé; et (c) donner des conseils pour le développement decursus et les comités d’admission pour les professionnels de la santé.Conclusions : Comprendre le point de vue des patients et des aidants sur ce sujet peut aider les éducateurs en poste de gestion et les professionnels de la santé à mieux intégrer la participation active des patients à la formation des soignants. En écoutant la voix des patients et des aidants, nous serons en mesure d’apporter des changements efficaces à la formation actuelle et future des professions de la santé

Evaluating Health Organization Readiness for Implementing a Learning Health System: Literature Review to Inform Questionnaire Development

Objective: Adopting a learning health system (LHS) is a promising approach to bridging knowledge-to-practice gaps. The aim of this study was to explore how LHS are defined and characterized in the literature, the barriers and facilitators health organizations may face when implementing an LHS, and what tools currently exist to help health organizations assess their readiness to implement an LHS. Methods: A literature review was conducted to identify items relevant for developing the content of an LHS readiness questionnaire. PubMed and the Learning Health Systems journal were searched from inception to December 2023. Publications that addressed the definitions, frameworks, characteristics, barriers, and facilitators of an LHS were included. Results: Of the 28 included articles, 16 provided a definition of LHS–eight of which were based on the Institute of Medicine’s definition (i.e., where science, informatics, incentives, and culture are aligned for continuous improvement and innovation). 16 articles provided domains associated with an LHS framework that informed our questionnaire. These included data to knowledge, knowledge to practice, practice to data, and core values. Barriers to adopting an LHS approach included financial constraints, time, and the complexity of the task; facilitators included financial incentives, government mandates, and consistent implementation across centres. Conclusion: Few specific LHS readiness tools have been outlined in the extant literature. Current readiness tools derived from quality improvement contexts may be helpful but not sufficiently specific for assessing healthcare organizations’ readiness to implement an LHS. A new LHS readiness questionnaire may help meet this need, but further refinement and validation is required