130 research outputs found

    DECOLONIZATION AND POLITICAL ENGAGEMENT FOR THE HEALTH AND WELLBEING OF THE SELISH, KSANKA AND QLISPE PEOPLE

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    What would a contemporary cultural model for health and wellbeing look like for an Indigenous community and what domains would feature prominent today? How would this model be reflected in governance for the Confederated Salish and Kootenai Tribes (CSKT)? This autoethnographic, interdisciplinary, action research study suggests ten cultural domains for inclusion in a contemporary cultural model for health and wellbeing for the Selish, Ksanka and Qlispe (SKQ), the Indigenous Nations of the CSKT. It then provides a revised, annotated draft of a culture-based constitutional governance structure, which integrates, synthesizes, and incorporates these ten domains. The key purposes of the study were to 1) provide a process whereby cultural models describing values, beliefs, principles and practices at the individual, community and organizational levels may become more clearly articulated and thereby promote increased cultural consonance for promoting health and wellbeing of the SKQ People, and 2) provide a more culturally-aligned, proposed revision of the SKQ Constitution, which better reflects and may serve to promote the health and wellbeing of the People. As action research, the design and methods shifted during the study based on consultations with co-research participants and the focus of attention of the SKQ. The study shifted from presenting the sources of health and wellbeing disparities, and proposed approaches for addressing health and wellbeing issues for the SKQ, to examination of shifting theoretical frameworks from conventional public health to whole systems Indigenous approaches. Study results both described and provided a process for creation of a cultural model for health and wellbeing for the SKQ. Through a systems approach to decolonization and constitutional reform, the study serves as an application and observation of culture-based governance for the SKQ. Cultural constructs from the health and wellbeing model were integrated into a proposed constitutional revision including initial policy direction. An autoethnographic chapter provides a cliff-notes version of the entire study and is addressed primarily to the SKQ community. Key conclusions are: 1) culture is important to and must be reflected in governance, 2) a culturally-articulated governance system has the potential to both produce and reinforce the people it is designed to serve

    L'animation d'une communauté d'apprentissage professionnelle : CAPANIME

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    En raison du fait que le Programme de formation de l’école québécoise (PFÉQ) (2001) est très dense et que le temps pour couvrir l’entièreté des contenus est insuffisant, les enseignantes et les enseignants doivent faire des choix en se basant sur leur jugement professionnel, et ce, trop fréquemment dans une culture d’isolement. Comment le leadership pédagogique de la direction d’une école au primaire peut-il influencer le développement professionnel des enseignantes et des enseignants ? Cette question a guidé les deux projets d’intervention réalisés dans le cadre du doctorat professionnel en éducation. Le premier projet avait pour objectif de poser un diagnostic sur l’état d’avancement de la communauté d’apprentissage professionnelle (CAP) au sein de l’équipe école où la doctorante agissait aussi comme directrice au primaire. Ce dispositif collaboratif vise l’amélioration de la réussite des élèves et contribue aussi au développement professionnel des enseignantes et des enseignants. Trois piliers sous-tendent le travail d’une CAP, soit mettre l’accent sur les apprentissages, développer une culture collaborative avec une responsabilité collective et établir une orientation axée vers les résultats (DuFour, DuFour, Eaker, Many et Mattos, 2019). Plusieurs grilles de Leclerc (2012) ont servi à la collecte de données réalisée auprès du personnel enseignant et à son analyse. Le deuxième projet portait sur l’animation des rencontres de la CAP dont le défi de l’animation, pierre angulaire des rencontres collaboratives, revient à la direction des écoles. Une opportunité pédagogique s’est présentée alors qu’un important mouvement menant à la formation de CAP était en développement au Québec. Comme il existait peu de documentation sur l’animation d’une CAP et que la qualité d’animation devenait un enjeu primordial, « La roue de l’animation de la CAP » a été conçue, inspirée des travaux de Eaker, DuFour et Burnette (2004), de Leclerc (2012) et des travaux de Massé (2019). Pour la collecte de données, plusieurs outils ont été utilisés dont l’enregistrement des échanges lors des six rencontres avec les membres de l’équipe CAP. Les données ont été traitées au moyen de l’analyse de contenu selon L’Écuyer (1987, 1990). Des savoirs professionnels issus des projets rendent compte d’une classe d’actions ayant produit des résultats significatifs pour une famille de situations. Ils ont donc un potentiel de transférabilité pouvant permettre des résultats comparables, soit l’efficacité de la roue et la productivité des rencontres si la direction d’une école primaire, dans une famille de situations semblables, posait des actions d’animation similaires pour animer une CAP. À l’issue de ces deux projets, la roue de l’animation s’est transformée pour les directions d’école au primaire en un outil pour agir en situation, soit CAPANIME, pouvant contribuer à la professionnalisation de cette communauté éducative

    Case 4 : Big Comfy Couch: The Implementation of an LGBTQ2S+ Safe and Positive Space Within a Public Health Unit

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    Samara Lewis is a public health nurse specialist at the North Bay Parry Sound District Health Unit (NBPSDHU). Samara has been tasked with creating a Safe and Positive Spaces workgroup that will aid in the implementation of an LGBTQ2S+ Safe and Positive Space at the health unit. Priority number one in the health unit’s 2014-2018 Strategic Plan aligns directly with the creation of said spaces, as the health unit is committed to provisioning healthy sexuality messaging and to ensuring safe, welcoming, and accessible health services to all sexual and gender diversities. Safe and Positive Spaces act as facilitators in achieving health equity for the LGBTQ2S+ community. In September 2017, Samara will return to the Sexual Health department—her home department. Consequently, the future of the workgroup is unknown. Will a Positive Space champion step up and commit to leading the workgroup? Will the health unit achieve health equity for the LGBTQ2S+ community? Time is of the essence

    Large-scale genome-wide association studies and meta-analyses of longitudinal change in adult lung function.

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    BACKGROUND: Genome-wide association studies (GWAS) have identified numerous loci influencing cross-sectional lung function, but less is known about genes influencing longitudinal change in lung function. METHODS: We performed GWAS of the rate of change in forced expiratory volume in the first second (FEV1) in 14 longitudinal, population-based cohort studies comprising 27,249 adults of European ancestry using linear mixed effects model and combined cohort-specific results using fixed effect meta-analysis to identify novel genetic loci associated with longitudinal change in lung function. Gene expression analyses were subsequently performed for identified genetic loci. As a secondary aim, we estimated the mean rate of decline in FEV1 by smoking pattern, irrespective of genotypes, across these 14 studies using meta-analysis. RESULTS: The overall meta-analysis produced suggestive evidence for association at the novel IL16/STARD5/TMC3 locus on chromosome 15 (P  =  5.71 × 10(-7)). In addition, meta-analysis using the five cohorts with ≥3 FEV1 measurements per participant identified the novel ME3 locus on chromosome 11 (P  =  2.18 × 10(-8)) at genome-wide significance. Neither locus was associated with FEV1 decline in two additional cohort studies. We confirmed gene expression of IL16, STARD5, and ME3 in multiple lung tissues. Publicly available microarray data confirmed differential expression of all three genes in lung samples from COPD patients compared with controls. Irrespective of genotypes, the combined estimate for FEV1 decline was 26.9, 29.2 and 35.7 mL/year in never, former, and persistent smokers, respectively. CONCLUSIONS: In this large-scale GWAS, we identified two novel genetic loci in association with the rate of change in FEV1 that harbor candidate genes with biologically plausible functional links to lung function

    The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology

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    Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men

    Meta-analysis of exome array data identifies six novel genetic loci for lung function [version 1; peer review:1 approved, 1 approved with reservations]

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    Background: Over 90 regions of the genome have been associated with lung function to date, many of which have also been implicated in chronic obstructive pulmonary disease. Methods: We carried out meta-analyses of exome array data and three lung function measures: forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and the ratio of FEV1 to FVC (FEV1/FVC). These analyses by the SpiroMeta and CHARGE consortia included 60,749 individuals of European ancestry from 23 studies, and 7,721 individuals of African Ancestry from 5 studies in the discovery stage, with follow-up in up to 111,556 independent individuals. Results: We identified significant (P&lt;2•8x10 -7 ) associations with six SNPs: a nonsynonymous variant in RPAP1, which is predicted to be damaging, three intronic SNPs (SEC24C, CASC17 and UQCC1) and two intergenic SNPs near to LY86 and FGF10. Expression quantitative trait loci analyses found evidence for regulation of gene expression at three signals and implicated several genes, including TYRO3 and PLAU. Conclusions: Further interrogation of these loci could provide greater understanding of the determinants of lung function and pulmonary disease.</p

    Integrative pathway genomics of lung function and airflow obstruction

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    Chronic respiratory disorders are important contributors to the global burden of disease. Genome-wide association studies (GWASs) of lung function measures have identified several trait-associated loci, but explain only a modest portion of the phenotypic variability. We postulated that integrating pathway-based methods with GWASs of pulmonary function and airflow obstruction would identify a broader repertoire of genes and processes influencing these traits. We performed two independent GWASs of lung function and applied gene set enrichment analysis to one of the studies and validated the results using the second GWAS. We identified 131 significantly enriched gene sets associated with lung function and clustered them into larger biological modules involved in diverse processes including development, immunity, cell signaling, proliferation and arachidonic acid. We found that enrichment of gene sets was not driven by GWAS-significant variants or loci, but instead by those with less stringent association P-values. Next, we applied pathway enrichment analysis to a meta-analyzed GWAS of airflow obstruction. We identified several biologic modules that functionally overlapped with those associated with pulmonary function. However, differences were also noted, including enrichment of extracellular matrix (ECM) processes specifically in the airflow obstruction study. Network analysis of the ECM module implicated a candidate gene, matrix metalloproteinase 10 (MMP10), as a putative disease target. We used a knockout mouse model to functionally validate MMP10's role in influencing lung's susceptibility to cigarette smoke-induced emphysema. By integrating pathway analysis with population-based genomics, we unraveled biologic processes underlying pulmonary function traits and identified a candidate gene for obstructive lung diseas

    Sugar-sweetened beverage intake associations with fasting glucose and insulin concentrations are not modified by selected genetic variants in a ChREBP-FGF21 pathway : a meta-analysis

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    Aims/hypothesis Sugar-sweetened beverages (SSBs) are a major dietary contributor to fructose intake. A molecular pathway involving the carbohydrate responsive element-binding protein (ChREBP) and the metabolic hormone fibroblast growth factor 21 (FGF21) may influence sugar metabolism and, thereby, contribute to fructose-induced metabolic disease. We hypothesise that common variants in 11 genes involved in fructose metabolism and the ChREBP-FGF21 pathway may interact with SSB intake to exacerbate positive associations between higher SSB intake and glycaemic traits. Methods Data from 11 cohorts (six discovery and five replication) in the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium provided association and interaction results from 34,748 adults of European descent. SSB intake (soft drinks, fruit punches, lemonades or other fruit drinks) was derived from food-frequency questionnaires and food diaries. In fixed-effects meta-analyses, we quantified: (1) the associations between SSBs and glycaemic traits (fasting glucose and fasting insulin); and (2) the interactions between SSBs and 18 independent SNPs related to the ChREBP-FGF21 pathway. Results In our combined meta-analyses of discovery and replication cohorts, after adjustment for age, sex, energy intake, BMI and other dietary covariates, each additional serving of SSB intake was associated with higher fasting glucose (beta +/- SE 0.014 +/- 0.004 [mmol/l], p = 1.5 x 10(-3)) and higher fasting insulin (0.030 +/- 0.005 [log(e) pmol/l], p = 2.0 x 10(-10)). No significant interactions on glycaemic traits were observed between SSB intake and selected SNPs. While a suggestive interaction was observed in the discovery cohorts with a SNP (rs1542423) in the beta-Klotho (KLB) locus on fasting insulin (0.030 +/- 0.011 log(e) pmol/l, uncorrected p = 0.006), results in the replication cohorts and combined meta-analyses were non-significant. Conclusions/interpretation In this large meta-analysis, we observed that SSB intake was associated with higher fasting glucose and insulin. Although a suggestive interaction with a genetic variant in the ChREBP-FGF21 pathway was observed in the discovery cohorts, this observation was not confirmed in the replication analysis.Peer reviewe

    Genetic Associations and Architecture of Asthma-COPD Overlap

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    BACKGROUND: Some people have characteristics of both asthma and COPD (asthma-COPD overlap), and evidence suggests they experience worse outcomes than those with either condition alone. RESEARCH QUESTION: What is the genetic architecture of asthma-COPD overlap, and do the determinants of risk for asthma-COPD overlap differ from those for COPD or asthma? STUDY DESIGN AND METHODS: We conducted a genome-wide association study in 8,068 asthma-COPD overlap case subjects and 40,360 control subjects without asthma or COPD of European ancestry in UK Biobank (stage 1). We followed up promising signals (P < 5 x 10(-6)) that remained associated in analyses comparing (1) asthma-COPD overlap vs asthma-only control subjects, and (2) asthma-COPD overlap vs COPD-only control subjects. These variants were analyzed in 12 independent cohorts (stage 2). RESULTS: We selected 31 independent variants for further investigation in stage 2, and discovered eight novel signals (P < 5 x 10(-8)) for asthma-COPD overlap (meta-analysis of stage 1 and 2 studies). These signals suggest a spectrum of shared genetic influences, some predominantly influencing asthma (FAM105A, GLB1, PHB, TSLP), others predominantly influencing fixed airflow obstruction (IL17RD, C5orf56, HLA-DQB1). One intergenic signal on chromosome 5 had not been previously associated with asthma, COPD, or lung function. Subgroup analyses suggested that associations at these eight signals were not driven by smoking or age at asthma diagnosis, and in phenome-wide scans, eosinophil counts, atopy, and asthma traits were prominent. INTERPRETATION: We identified eight signals for asthma-COPD overlap, which may represent loci that predispose to type 2 inflammation, and serious long-term consequences of asthma.Peer reviewe

    Evidence for large-scale gene-by-smoking interaction effects on pulmonary function

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    Background: Smoking is the strongest environmental risk factor for reduced pulmonary function. The genetic component of various pulmonary traits has also been demonstrated, and at least 26 loci have been reproducibly associated with either FEV1 (forced expiratory volume in 1 second) or FEV1/FVC (FEV1/forced vital capacity). Although the main effects of smoking and genetic loci are well established, the question of potential gene-by-smoking interaction effect remains unanswered. The aim of the present study was to assess, using a genetic risk score approach, whether the effect of these 26 loci on pulmonary function is influenced by smoking. Methods: We evaluated the interaction between smoking exposure, considered as either ever vs never or pack-years, and a 26-single nucleotide polymorphisms (SNPs) genetic risk score in relation to FEV1 or FEV1/FVC in 50 047 participants of European ancestry from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) and SpiroMeta consortia. Results: We identified an interaction (beta(int) = -0.036, 95% confidence interval, -0.040 to -0.032, P = 0.00057) between an unweighted 26 SNP genetic risk score and smoking status (ever/never) on the FEV1/FVC ratio. In interpreting this interaction, we showed that the genetic risk of falling below the FEV1/FVC threshold used to diagnose chronic obstructive pulmonary disease is higher among ever smokers than among never smokers. A replication analysis in two independent datasets, although not statistically significant, showed a similar trend in the interaction effect. Conclusions: This study highlights the benefit of using genetic risk scores for identifying interactions missed when studying individual SNPs and shows, for the first time, that persons with the highest genetic risk for low FEV1/FVC may be more susceptible to the deleterious effects of smoking.Peer reviewe
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