32 research outputs found
Ăvaluation du projet de prĂ©vention du passage Ă l'injection de drogue en Estrie : Ă©valuation, innovation et concertation
La prĂ©valence de lâhĂ©patite C est en constante Ă©volution depuis les dix derniĂšres annĂ©es et constitue un enjeu de santĂ© publique important. La prĂ©valence est particuliĂšrement Ă©levĂ©e chez les utilisateurs de drogue par injection. La nĂ©cessitĂ© dâimplanter des activitĂ©s de prĂ©vention sur le passage Ă lâinjection sâinscrit dans une perspective globale pour tenter dâenrayer le phĂ©nomĂšne. Une formation portant sur la prĂ©vention du passage Ă lâinjection de drogue chez les jeunes a Ă©tĂ© mise en place en Estrie, par lâAgence de santĂ© et des services sociaux. Le prĂ©sent mĂ©moire sâest intĂ©ressĂ© Ă lâĂ©valuation dâimplantation de ce projet en mettant en lumiĂšre les facteurs facilitants et les obstacles Ă la mise en Ćuvre des interventions de prĂ©vention sur le passage Ă lâinjection, effectuĂ©es par les intervenants. Cela a Ă©galement permis de recueillir des donnĂ©es rĂ©gionales sur la clientĂšle desservie, les contextes dâinterventions de mĂȘme que les pistes de solution Ă envisager pour mieux orienter les actions de prĂ©vention et de formation. Le projet visait Ă ce que lâĂ©valuation soit utile et utilisĂ©e par les dĂ©cideurs rĂ©gionaux et les intervenants sur le terrain. Les rĂ©sultats ont dĂ©montrĂ© que la clientĂšle Ă risque est peu rejointe par les intervenants formĂ©s. Les intervenants agissent principalement auprĂšs dâune clientĂšle qui utilise dĂ©jĂ des drogues par injection. Le manque de connaissances et dâaptitudes pour intervenir sur la prĂ©vention du passage Ă lâinjection est parmi les obstacles principaux identifiĂ©s tout comme la rĂ©ticence de certains milieux Ă lâaborder. La clientĂšle jeune et plus vulnĂ©rable est particuliĂšrement difficile Ă rejoindre. Le travail sur le terrain et la concertation ont, entre autres, Ă©tĂ© nommĂ©s comme des facteurs facilitants. Plusieurs amĂ©liorations, visant Ă la fois la formation et les stratĂ©gies dâintervention, sont ainsi nĂ©cessaires pour permettre une amĂ©lioration de la mise en Ćuvre du projet
Enriching health-professional programs in global health: Development and implementation of an interdisciplinary and integrated approach
Background: Globalization results in a rapidly diversifying population, increased inequities, and more complex health problems affecting populations. This forces medical schools to integrate global health (GH) into the training of health-care professionals from curriculum development to practical learning activities, here and abroad.Approach: The approach aims at enriching existing programs in GH competencies in an interdisciplinary context. The goal is to ensure that all health-science students develop a certain level of GH competency. The main actions are the mobilization of key stakeholders, the development of a competency framework (CF) to perform gap analysis, tool formalization, and monitoring and evaluation activities. Subsequent to scoping review and stakeholder consultations, ten principles are identified and used to guide the enrichment process.Results: Actual outputs cover a broad scope, from key decision-makersâ support and endorsement to the formalization of tools and the consolidation and creation of activities such as service-learning activities, rotations among underserved populations, and training for international rotations.Conclusion: While this unique approach is proving to be a major challenge, the preliminary results are well worth the effort. The projectâs tangible impacts on health-sciences teaching, the GH competence of graduates, and care delivery are topics of interest for future investigation
Maternal Environment Influences Cocaine Intake in Adulthood in a Genotype-Dependent Manner
Background: Accumulating epidemiological evidence points to the role of genetic background as a modulator of the capacity of adverse early experiences to give rise to mental illness. However, direct evidence of such gene-environment interaction in the context of substance abuse is scarce. In the present study we investigated whether the impact of early life experiences on cocaine intake in adulthood depends on genetic background. In addition, we studied other behavioral dimensions associated with drug abuse, i.e. anxiety- and depression-related behaviors. Methodology/Principal Findings: For this purpose, we manipulated the maternal environment of two inbred mouse strains, the C57BL/6J and DBA/2J by fostering them with non-related mothers, i.e. the C3H/HeN and AKR strains. These mother strains show respectively high and low pup-oriented behavior. As adults, C57BL/6J and DBA/2J were tested either for cocaine intravenous self-administration or in the elevated plus-maze and forced swim test (FST). We found that the impact of maternal environment on cocaine use and a depression-related behavior depends upon genotype, as cocaine self-administration and behavior in the FST were influenced by maternal environment in DBA/2J, but not in C57BL/6J mice. Anxiety was not influenced by maternal environment in either strain. Conclusions/Significance: Our experimental approach could contribute to the identification of the psychobiological factor
AZASPIRACIDS â Toxicological Evaluation, Test Methods and Identifcation of the Source Organisms (ASTOX II)
Since the Irish monitoring program was set up in 2001 azaspiracids (AZAs) have been detected in shellfish above the regulatory limit every year with the exception of 2004. The south west coast of Ireland is especially prone to the onsets of AZA events. Over this period a number of poisoning incidents associated with this toxin group have occurred, all related to Irish shellfish. In 2003 the Marine Institute was awarded funding for a research project named ASTOX. This project was very successful in producing a range of reference materials (RMs, which are essential for accurate detection and monitoring, and which up to this point were unavailable. The project also examined the toxicity of AZAs, primarily using in vitro cell assays but some in vivo studies were also performed. The overall aims of the ASTOX 2 project were to strengthen knowledge on the causative organism and toxicity of AZAs. The project aims were grouped into three areas: ecology, chemical support and toxicology.Marine Institute Marine Research Sub Programme (NDP 2007 - 2013), co financed under the European Regional Development Fund
Using an evidence-based online module to improve parentsâ ability to manage their child with Developmental Coordination Disorder
Background : Developmental coordination disorder (DCD) is a prevalent neurodevelopmental disorder. Best practices include raising parentsâ awareness and building capacity but few interventions incorporating these best practices are documented.
Objective : To examine whether an evidence-based online module can increase the perceived knowledge and skills of parents of children with DCD, and lead to behavioral changes when managing their childâs health condition.
Methods : A mixed-methods, before-after design guided by the theory of planned behavior was employed. Data about the knowledge, skills and behaviors of parents of children with DCD were collected using questionnaires prior to completing the module, immediately after, and three months later. Paired T-tests, sensitivity analyses and thematic analyses were performed on data as appropriate.
Results: One hundred-sixteen, 81 and 58 participants respectively completed the three questionnaires. For knowledge and skills, post- and follow-up scores were significantly higher than baseline scores (p<0.01). Fifty-two (64%) participants reported an intention to change behavior post-intervention and 29 (50%) participants had tried recommended strategies at follow-up. Three themes emerged to describe parentsâ behavioral change: sharing information, trialing strategies and changing attitudes. Factors influencing parentsâ ability to implement these behavioral changes included clear recommendations, time, and ârightâ attitude. Perceived outcomes associated with the parental behavioral changes involved improvement in well-being for the children at school, at home, and for the family as a whole.
Conclusions : The online module increased parentsâ self-reported knowledge and skills in DCD management. Future research should explore its impacts on childrenâs long-term outcomes
Finishing the euchromatic sequence of the human genome
The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers âŒ99% of the euchromatic genome and is accurate to an error rate of âŒ1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
The experience of accessing rehabilitation services for families of children living with neurodevelopmental disorder through the lens of intersectionality
Introduction : Au Canada, on estime qu'environ 7 % des jeunes prĂ©sentent une incapacitĂ©, une grande partie Ă©tant expliquĂ©e par la prĂ©sence dâun trouble neurodĂ©veloppemental. Ces jeunes et leurs familles sont plus Ă risque de vivre des situations de vulnĂ©rabilitĂ© pouvant compromettre leur dĂ©veloppement et leur participation sociale. Les services de rĂ©adaptation tentent de rĂ©pondre Ă certains de ces besoins. Toutefois, lâaccĂšs aux services de rĂ©adaptation reste problĂ©matique avec un temps dâattente important et un manque de continuitĂ© des services. Lâobjet de ce projet est dâanalyser lâexpĂ©rience dâaccĂšs aux services, selon diffĂ©rentes perspectives et en tenant compte de lâinterdĂ©pendance des facteurs explicatifs et de proposer des pistes de solution. Objectifs : 1) Analyser sous lâangle de lâintersectionnalitĂ© lâexpĂ©rience dâaccĂšs aux services de rĂ©adaptation des familles dâenfants prĂ©sentant un trouble neurodĂ©veloppemental, selon la perspective des familles et selon celle des intervenants; 2) Identifier des leviers permettant dâinfluencer lâexpĂ©rience dâaccĂšs aux services de rĂ©adaptation MĂ©thodologie : Une recherche Ă©valuative intĂ©grant un cadre dâanalyse intersectionnelle a Ă©tĂ© utilisĂ©. Des entrevues individuelles ont Ă©tĂ© menĂ©es auprĂšs de parents (n=21) dâenfants vivant avec un trouble neurodĂ©veloppemental afin de documenter leurs expĂ©riences dâaccĂšs aux services de rĂ©adaptation ainsi que les leviers dâaction pour amĂ©liorer lâaccĂšs Ă ces services. De plus, quatre groupes de discussion ont Ă©tĂ© menĂ©s auprĂšs dâintervenants en rĂ©adaptation (n=18) afin dâidentifier leur perspective quant Ă lâaccĂšs aux services de rĂ©adaptation de mĂȘme que les barriĂšres perçues et leviers possibles. Une recension des Ă©crits de type revue rapide a permis dâidentifier et de catĂ©goriser les leviers dâactions pour amĂ©liorer lâaccĂšs. Finalement, en sâappuyant sur lâun des leviers identifiĂ©s, une dĂ©marche de mobilisation de connaissance a Ă©tĂ© amorcĂ©e. Six participants, incluant une artiste, ont contribuĂ© Ă la crĂ©ation dâune oeuvre reprĂ©sentant lâexpĂ©rience dâaccĂšs des parents. RĂ©sultats : Nos rĂ©sultats indiquent que les intervenants ont une perspective diffĂ©rente de celles des parents concernant lâaccĂšs aux services. LâexpĂ©rience dâaccĂšs des parents est jalonnĂ©e de tensions, de vulnĂ©rabilitĂ©s et de prĂ©jugĂ©s, principalement liĂ©es aux notions de genre, de capacitĂ©s et de classe. Un modĂšle conceptuel dâaccĂšs aux services de rĂ©adaptation a Ă©tĂ© Ă©laborĂ© permettant dâillustrer lâexpĂ©rience dâaccĂšs et sa spĂ©cificitĂ© selon la position des acteurs. Des leviers dâactions ont Ă©tĂ© identifiĂ©s Ă plusieurs niveaux, individuel, interpersonnel, organisationnel et structurel. Cela a permis de soutenir la dĂ©marche de mobilisation de connaissances. Lâoeuvre crĂ©Ă©e permettra un premier pas vers la sensibilisation Ă la rĂ©alitĂ© plurielle et nuancĂ©e quâest lâaccĂšs aux services de rĂ©adaptation.Abstract: In Canada, it is estimated that approximately 7% of youth has a disability, one of the main causes being neurodevelopmental disorders. These young people and their families are at greater risk of experiencing vulnerable situations that can compromise their development and social participation. Rehabilitation services attempt to address some of these needs. However, access to rehabilitation services remains problematic with long waiting times and a lack of continuity of services. The purpose of this project is to analyze the experience of access to services, from different perspectives and considering the interdependence of explanatory factors, and to propose possible solutions. Objectives: 1) To analyze from an intersectional perspective the experience of access to rehabilitation services for families of children with neurodevelopmental disorders from the perspective of families and from the perspective of caregivers. 2) To identify levers that can influence the experience of access to rehabilitation services Methodology: An evaluative research integrating an intersectional analysis framework was used. First, individual interviews were conducted with 21 parents of children living with a neurodevelopmental disorder to document their experiences of accessing rehabilitation services as well as the levers for action to improve access. Second, four focus groups were conducted with 18 rehabilitation workers to identify their perspective on access to rehabilitation services as well as perceived barriers and possible levers of action. A third step was to identify and categorize the levers of action for access through a scoping review. They were compared with those identified by the parents and by the professionals. Finally, based on one of the identified levers, a knowledge transfer process was initiated. Six participants, including an artist, contributed to the creation of an art piece representing the parents' experience of access. Results: Parents identified tensions, vulnerabilities, and biases in the access experience at the intersection of gender, ability, and class. The perspective of access differed between parents and practitioners. A conceptual model of access to rehabilitation services is proposed to better illustrate the experience of access and its specificity according to the position of the different actors. The levers of action were identified at different levels- individual, interpersonal, organizational, and structural. Their identification has allowed to support the knowledge transfer activities. The artwork is a first step for raising awareness on the plural and nuanced reality of access to rehabilitation services. Keywords: neurodevelopmental disorder, intersectionality, access to rehabilitation services, caregiver experience, conceptual framewor
The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland
Abstract Objective: Previous literature has suggested that laws and regulations may impact the use of palliative sedation. Our present study compares the attitudes of French-speaking physicians practicing in the Quebec and Swiss environments, where different laws are in place regarding physician-assisted suicide. Method: Data were drawn from two prior studies, one by Blondeau and colleagues and another by Beauverd and coworkers, employing the same two-by-two experimental design with length of prognosis and type of suffering as independent variables. Both the effect of these variables and the effect of their interaction on Swiss and Quebec physicians' attitudes toward sedation were compared. The written comments of respondents were submitted to a qualitative content analysis and summarized in a comparative perspective. Results: The analysis of variance showed that only the type of suffering had an effect on physicians' attitudes toward sedation. The results of the Wilcoxon test indicated that the attitudes of physicians from Quebec and Switzerland tended to be different for two vignettes: long-term prognosis with existential suffering (p = 0.0577) and short-term prognosis with physical suffering (p = 0.0914). In both cases, the Swiss physicians were less prone to palliative sedation. Significance of results: The attitudes of physicians from Quebec and Switzerland toward palliative sedation, particularly regarding prognosis and type of suffering, seem similar. However, the results suggest that physicians from Quebec could be slightly more open to palliative sedation, even though most were not in favor of this practice as an answer to end-of-life existential sufferin