Psychosocial work and home stressors predict sickness absence from work

info:eu-repo/semantics/nonPublishe

Rethinking the anti-FGM zero-tolerance policy: From intellectual concerns to empirical challenges

Abstract Purpose of Review Based on the discussions of a symposium co-organized by the Université Libre de Bruxelles (ULB) and the University of Lausanne (UNIL) in Brussels in 2019, this paper critically reflects upon the zero-tolerance strategy on “Female Genital Mutilation” (FGM) and its socio-political, legal and moral repercussions. We ask whether the strategy is effective given the empirical challenges highlighted during the symposium, and also whether it is credible. Recent Findings The anti-FGM zero-tolerance policy, first launched in 2003, aims to eliminate all types of “female genital mutilation” worldwide. The FGM definition of the World Health Organization condemns all forms of genital cutting (FGC) on the basis that they are harmful and degrading to women and infringe upon their rights to physical integrity. Yet, the zero-tolerance policy only applies to traditional and customary forms of genital cutting and not to cosmetic alterations of the female genitalia. Recent publications have shown that various popular forms of cosmetic genital surgery remove the same tissue as some forms of “FGM”. In response to the zero-tolerance policy, national laws banning traditional forms of FGC are enforced and increasingly scrutinize the performance of FGC as well as non-invasive rituals that are culturally meaningful to migrants. At the same time, cosmetic procedures such as labiaplasty have become more popular than ever before and are increasingly performed on adolescents. Summary This review shows that the socio-legal and ethical inconsistencies between “FGM” and cosmetic genital modification pose concrete dilemmas for professionals in the field that need to be addressed and researched

Gene transfer to pre-hematopoietic and committed hematopoietic precursors in the early mouse Yolk Sac: a comparative study between in situ electroporation and retroviral transduction

<p>Abstract</p> <p>Background</p> <p>Hematopoietic development in vertebrate embryos results from the sequential contribution of two pools of precursors independently generated. While intra-embryonic precursors harbour the features of hematopoietic stem cells (HSC), precursors formed earlier in the yolk sac (YS) display limited differentiation and self-renewal potentials. The mechanisms leading to the generation of the precursors in both sites are still largely unknown, as are the molecular basis underlying their different potential. A possible approach to assess the role of candidate genes is to transfer or modulate their expression/activity in both sites. We thus designed and compared transduction protocols to target either native extra-embryonic precursors, or hematopoietic precursors.</p> <p>Results</p> <p>One transduction protocol involves transient modification of gene expression through <it>in situ </it>electroporation of the prospective blood islands, which allows the evolution of transfected mesodermal cells in their "normal" environment, upon organ culture. Following <it>in situ </it>electroporation of a GFP reporter construct into the YS cavity of embryos at post-streak (mesodermal/pre-hematopoietic precursors) or early somite (hematopoietic precursors) stages, high GFP expression levels as well as a good preservation of cell viability is observed in YS explants. Moreover, the erythro-myeloid progeny typical of the YS arises from GFP⁺mesodermal cells or hematopoietic precursors, even if the number of targeted precursors is low. The second approach, based on retroviral transduction allows a very efficient transduction of large precursor numbers, but may only be used to target 8 dpc YS hematopoietic precursors. Again, transduced cells generate a progeny quantitatively and qualitatively similar to that of control YS.</p> <p>Conclusion</p> <p>We thus provide two protocols whose combination may allow a thorough study of both early and late events of hematopoietic development in the murine YS. <it>In situ </it>electroporation constitutes the only possible gene transfer method to transduce mesodermal/pre-hematopoietic precursors and analyze the earliest steps of hematopoietic development. Both <it>in situ </it>electroporation and retroviral transduction may be used to target early hematopoietic precursors, but the latter appears more convenient if a large pool of stably transduced cells is required. We discuss the assets and limitation of both methods, which may be alternatively chosen depending on scientific constraints.</p

Analyse de l’implantation de la sélection communautaire à large échelle des indigents en Afrique Sub-saharienne: cas du Burkina Faso

Indigent do not have access to health care, and selecting them from a predominantly poor population poses enormous challenges. Little evidence exists on the selection of indigents in relation to the performance of health services. The objective of this study is to analyse the implementation of indigent selection conducted in Burkina Faso, with a view to informing decisions for scaling up with universal health insurance. This is a research on implementation based on a multiple case study coupled with a reflective approach. The cases were the subject of reasoned choice according to the indigent’s selection. A conceptual model adapted from the Consolidated Framework for Implementation Research is used, considering the implementation of community-based selection of indigents as the result of the influence and interaction of the selection process, the steps, the actors, the organisation and the context, and the data collection tools. Data is collected through interviews and document review. Three coordination structures and two implementation structures are set up for the selection. Socio-political unrest and vaccination and drug administration campaigns disrupted the selection process. The selection process was subject to adaptations and power struggles between stakeholders. The desired proportion of indigents is not achieved. Selection is confronted with contextual realities and interactions between actors. A dynamic and adaptive selection process, supported by social communication, should be used in future selection process.Les indigents n’ont pas accès aux soins de santé, et les sélectionner parmi une population majoritairement pauvre pose d’énormes défis. Peu d’évidences existent sur la selection des indigents associés à la performance des services de santé. L’objectif de cette étude est d’analyser l’implantation de la sélection des indigents conduite au Burkina Faso, en vue d’éclairer les décisions pour un passage à l’échelle avec l’assurance maladie universelle. Il s’agit d’une recherche sur l’implantation basée sur une étude de cas multiples couplée à une approche réflexive. Les cas ont fait l’objet de choix raisonné en fonction de l’intervention de la sélection. Un cadre conceptuel adapté du Consolidated Framework for Implementation Research est utilisé en considérant l’implantation de la sélection communautaire des indigents comme le résultat de l’influence et de l’interaction du processus de sélection, des étapes, des acteurs, de l’organisation et du contexte, des outils de collecte de données. Les données sont collectées à travers des entretiens et la revue documentaire. Trois structures de coordination et de deux structures d’exécution sont mises en place pour la sélection. Les troubles socio-politiques et les campagnes de vaccination et d’administration de medicaments ont perturbé le processus de sélection. La sélection a subi des adaptations et des exercices de pouvoir entre parties prenantes. La proportion d’indigents recherchée n’est pas atteinte. La sélection est confrontée aux réalités contextuelles et aux interactions entre acteurs. Il convient d’avoir recours à un processus dynamique et adaptatif de sélection, soutenu par une communication sociale lors des interventions à veni

Analyse de l’implantation de la sélection communautaire à large échelle des indigents en Afrique Sub-saharienne: cas du Burkina Faso

Indigent do not have access to health care, and selecting them from a predominantly poor population poses enormous challenges. Little evidence exists on the selection of indigents in relation to the performance of health services. The objective of this study is to analyse the implementation of indigent selection conducted in Burkina Faso, with a view to informing decisions for scaling up with universal health insurance. This is a research on implementation based on a multiple case study coupled with a reflective approach. The cases were the subject of reasoned choice according to the indigent’s selection. A conceptual model adapted from the Consolidated Framework for Implementation Research is used, considering the implementation of community-based selection of indigents as the result of the influence and interaction of the selection process, the steps, the actors, the organisation and the context, and the data collection tools. Data is collected through interviews and document review. Three coordination structures and two implementation structures are set up for the selection. Socio-political unrest and vaccination and drug administration campaigns disrupted the selection process. The selection process was subject to adaptations and power struggles between stakeholders. The desired proportion of indigents is not achieved. Selection is confronted with contextual realities and interactions between actors. A dynamic and adaptive selection process, supported by social communication, should be used in future selection process.Les indigents n’ont pas accès aux soins de santé, et les sélectionner parmi une population majoritairement pauvre pose d’énormes défis. Peu d’évidences existent sur la selection des indigents associés à la performance des services de santé. L’objectif de cette étude est d’analyser l’implantation de la sélection des indigents conduite au Burkina Faso, en vue d’éclairer les décisions pour un passage à l’échelle avec l’assurance maladie universelle. Il s’agit d’une recherche sur l’implantation basée sur une étude de cas multiples couplée à une approche réflexive. Les cas ont fait l’objet de choix raisonné en fonction de l’intervention de la sélection. Un cadre conceptuel adapté du Consolidated Framework for Implementation Research est utilisé en considérant l’implantation de la sélection communautaire des indigents comme le résultat de l’influence et de l’interaction du processus de sélection, des étapes, des acteurs, de l’organisation et du contexte, des outils de collecte de données. Les données sont collectées à travers des entretiens et la revue documentaire. Trois structures de coordination et de deux structures d’exécution sont mises en place pour la sélection. Les troubles socio-politiques et les campagnes de vaccination et d’administration de medicaments ont perturbé le processus de sélection. La sélection a subi des adaptations et des exercices de pouvoir entre parties prenantes. La proportion d’indigents recherchée n’est pas atteinte. La sélection est confrontée aux réalités contextuelles et aux interactions entre acteurs. Il convient d’avoir recours à un processus dynamique et adaptatif de sélection, soutenu par une communication sociale lors des interventions à veni

A prospective study of cumulative job stress in relation to mental health

BACKGROUND: This study tests associations between psychosocial stress at work measured by the effort-reward imbalance model in a dynamic perspective, and multiple indicators of poor mental health, in a prospective design. METHODS: 1986 male and female employees from four Belgian enterprises were followed-up over one year within the framework of the Somstress study. Based on two consecutive measurements, an index of cumulative job stress was constructed and its associations with five indicators of mental health were studied, excluding caseness at entry (for depression, anxiety, somatisation, chronic fatigue and psychotropic drug consumption respectively). Taking into account the longitudinal design, four categories of job stress are defined: 1) employees free from stress at both measures, 2) job stress present at first measure but not at the second one, 3) recent onset of job stress as evidenced by second measure 4) workers exposed to stress at both measures. Multivariate logistic regression with appropriate adjustments was applied. RESULTS: In bivariate analysis, a clear graded association of cumulative job stress with all five mental health indicators is observed, both in men and women. In multivariate logistic regression analysis, recent onset of stress is strongly associated with poor mental health among men (odds ratios ranging from 1.8 to 4.6), while cumulative stress shows strongest effects on mental health in women (odds ratios ranging from 1.4 to 7.1). CONCLUSION: Cumulative experience and recent onset of job stress in terms of high effort spent and low reward received is associated with elevated risk of all five indicators of poor mental health at follow-up in a large cohort of employees

Bcl-2–Modifying Factor Induces Renal Proximal Tubular Cell Apoptosis in Diabetic Mice

This study investigated the mechanisms underlying tubular apoptosis in diabetes by identifying proapoptotic genes that are differentially upregulated by reactive oxygen species in renal proximal tubular cells (RPTCs) in models of diabetes. Total RNAs isolated from renal proximal tubules (RPTs) of 20-week-old heterozygous db/m+, db/db, and db/db catalase (CAT)-transgenic (Tg) mice were used for DNA chip microarray analysis. Real-time quantitative PCR assays, immunohistochemistry, and mice rendered diabetic with streptozotocin were used to validate the proapoptotic gene expression in RPTs. Cultured rat RPTCs were used to confirm the apoptotic activity and regulation of proapoptotic gene expression. Additionally, studies in kidney tissues from patients with and without diabetes were used to confirm enhanced proapoptotic gene expression in RPTs. Bcl-2–modifying factor (Bmf) was differentially upregulated (P < 0.01) in RPTs of db/db mice compared with db/m+ and db/db CAT-Tg mice and in RPTs of streptozotocin-induced diabetic mice in which insulin reversed this finding. In vitro, Bmf cDNA overexpression in rat RPTCs coimmunoprecipated with Bcl-2, enhanced caspase-3 activity, and promoted apoptosis. High glucose (25 mmol/L) induced Bmf mRNA expression in RPTCs, whereas rotenone, catalase, diphenylene iodinium, and apocynin decreased it. Knockdown of Bmf with small interfering RNA reduced high glucose–induced apoptosis in RPTCs. More important, enhanced Bmf expression was detected in RPTs of kidneys from patients with diabetes. These data demonstrate differential upregulation of Bmf in diabetic RPTs and suggest a potential role for Bmf in regulating RPTC apoptosis and tubular atrophy in diabetes

Experimentação pedagógica - relações CTSA na formação inicial do licenciando em Química

A formação inicial do professor de química é um momento propício a experimentação pedagógica, onde novas metodologias/ enfoques/ teorias podem ser incorporados ao futuro exercício da docência. O presente trabalho visa discutir a experiência de formação de dois licenciandos em química, em seu primeiro estágio supervisionado durante o semestre 2007.1 da Universidade do Estado do Rio Grande do Norte - Brasil. Bem como as propostas de aulas práticas dirigidas por estes com o intuito de desenvolver um enfoque CTSA em seu primeiro contato com a regência de sala. Para a discussão das observações levou-se em conta as impressões de licenciandos para analisar criticamente as contribuições que esta prática efetivamente construíram para a formação dos futuros professores de química, e principalmente sobre as suas visões sobre possibilidades do enfoque CTSA no ensino-aprendizagem

Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs), we conducted a pilot clustered randomized controlled trial (RCT) to evaluate DECISION+, a training program in shared decision making (SDM) for family physicians (FPs). This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician.</p> <p>Methods/design</p> <p>The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs) in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group) or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline) including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700). The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1) physicians and patients' decisional conflict; 2) the agreement between the parties' decisional conflict scores; and 3) perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration.</p> <p>Discussion</p> <p>DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="NCT01116076">NCT01116076</a></p