Études fonctionnelles de la section -135 à -27 du promoteur du gène PR-10a de la pomme de terre

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Les parcours d'émancipation et les espaces de participation en santé mentale : un tremplin vers la citoyenneté

Au Québec, comme ailleurs en Occident, de plus en plus de personnes sont confrontées à une expérience de souffrance et d’exclusion qui les renvoie à la marge de la société. Cette thèse permet de saisir comment des personnes qui ont vécu une importante situation d'exclusion, entre autres, en raison de leur problème de santé mentale, en arrivent à se reconnaître comme des citoyennes en s'engageant dans leur communauté. Elle amène aussi à comprendre par quel cheminement ou parcours elles sont passées pour en arriver à s'émanciper des limites et contraintes qui pesaient sur elles. Enfin, elle éclaire le rôle joué par la participation à l'intérieur de leur parcours. Menée dans une perspective interdisciplinaire, cette recherche s’alimente de plusieurs courants théoriques tels que la sociologie, la psychanalyse, la science politique et le travail social. La notion de parcours d’émancipation permet de « s’émanciper » du modèle biomédical dominant en santé mentale en présentant une vision sociopolitique intégrant les dimensions individuelle et collective du changement. Elle amène à comprendre la constitution du « sujet-acteur » aux plans personnel et politique, c’est-à-dire le sujet qui advient par le travail de l’individu sur lui-même lui permettant de faire rupture avec son histoire passée et de la reconfigurer de manière à lui donner un nouveau sens, et l’acteur qui vient concrétiser la manifestation du sujet en actes, donc, la façon dont il s’actualise. La recherche met en évidence l’apport des organismes communautaires en santé mentale à ces parcours d’émancipation en identifiant les valeurs qui les animent et les dispositifs mis en place pour soutenir la transformation des personnes dans l’ensemble des dimensions de leur être : rapport à la « maladie », à soi, aux autres et au monde. En s’inspirant de Winnicott, on constate qu’ils constituent des espaces potentiels ou transitionnels qui donnent un ancrage sécuritaire et profond et qui jouent le rôle de « passeur d’être » permettant au sujet de s’actualiser et de devenir autonome. Ils apportent aussi une importante contribution à la réalisation des valeurs démocratiques et offrent des occasions aux personnes de se manifester en tant que « sujets-citoyens ».In Quebec, as elsewhere in the Western world, an increasing number of people are confronted to experiences of suffering and exclusion that confine them to the margins of society. This doctoral thesis aims at understanding how people who have lived through an important experience of exclusion – because of their mental health status among other reasons – can come to recognize themselves as full citizens by getting involved in their community. It also allows us to understand the course of action or journey they went through in order to become emancipated from the limits and constraints that weighed them down. Finally, this research underscores the role that participation can play in this journey. This thesis was undertaken in an interdisciplinary perspective, and borrows from various theoretical literatures, such as sociology, psychoanalysis, political science and social work. The concept of “emancipation journey” (parcours d’émancipation) that is central to our work allows us to distance ourselves from the biomedical model which remains dominant in mental health by putting forth a socio-political vision integrating the individual and collective dimensions of change. This concept helps us understand how “acting subjects” come to constitute on personal and political levels: both as “subjects” that arise when individuals break free from their past and work at giving it new sense, and as “actors” who materialize the manifestation of the subjects in actions, that is, the ways they self-actualize. This research underscores the contribution of community organizations working in the mental health arena to these journeys of emancipation by identifying their values and the content of devices developed to support the transformation of the persons in various dimensions of their being: relation to “illness”, to oneself, to others and to the world. Borrowing from Winnicott, we consider these organizations as potential or transitional spaces, in as much as they offer a secure and profound anchor and can be seen as “ferryman of beings” allowing the subject to self-actualize and to become autonomous. They also contribute to the realization of democratic values and offer opportunities for people presenting a mental health problem to engage as “subjects-citizens”

La pratique dans un contexte pluriethnique : Démarche en vue de la création d’une approche de négociation entre le personnel des services de soutien à domicile et les proches-aidantes d’un parent âgé

Cette étude qualitative visait à mettre à l’essai une démarche pour la création d’une approche de négociation entre le personnel des services de soutien à domicile et des proches-aidantes d’un parent âgé, en vue de formuler des recommandations pour une offre de services culturellement sensibles. L’approche repose sur un cadre conceptuel de négociation qui tient compte des perspectives paradigmatiques des parties concernées : les utilisateurs et prestataires de services. L’étude a été réalisée auprès d’aidantes d’origine haïtienne, en tant que cas traceurs, et auprès d’intervenants et d’intervenantes des services de soutien à domicile. Les données révèlent que les attentes et solutions concernant les services sont largement convergentes entre ces deux groupes d’acteurs et portent notamment sur les barrières à l’utilisation des services et les relations entre les aidantes et les intervenants ou intervenantes. Les principales recommandations issues des détenteurs d’enjeux concernent la formulation d’une politique de soutien des aidantes, la mise en place d’équipes ethnoculturelles de quartier, l’établissement de liens avec les organismes communautaires et la formation interculturelle des intervenants. Cette démarche fournit des pistes pour une pratique basée sur la négociation dans des contextes culturels divers.The aim of this qualitative study was to test an approach to negotiations between home support service personnel and the family caregivers of an elderly relative, with a view to formulating recommendations for a culturally adjusted service supply. Based on a conceptual model of negotiations, the approach takes into account the paradigmatic perspectives of the stakeholders, namely, service providers and service users. The study was conducted with caregivers of Haitian origin, which served as the tracer condition, and with home support service practitioners. Data indicate that expectations and solutions regarding services are widely convergent between the two groups of actors and have to do in particular with service utilization barriers and caregiver-practitioner relations. The main recommendations concern service supply and coordination, community organization and practitioner training. This approach provides leads for practice in different cultural contexts

Multicentre implementation of a nursing competency framework at a provincial scale : a qualitative description of facilitators and barriers

Rationale : Nurses are responsible for engaging in continuing professional development throughout their careers. This implies that they use tools such as competency frameworks to assess their level of development, identify their learning needs, and plan actions to achieve their learning goals. Although multiple competency frameworks and guidelines for their development have been proposed, the literature on their implementation in clinical settings is sparser. If the complexity of practice creates a need for context-sensitive competency frameworks, their implementation may also be subject to various facilitators and barriers. Aims and Objectives : To document the facilitators and barriers to implementing a nursing competency framework on a provincial scale. Methods : This multicentre study was part of a provincial project to implement a nursing competency framework in Quebec, Canada, using a three-step process based on evidence from implementation science. Nurses’ participation consisted in the self-assessment of their competencies using the framework. For this qualitative descriptive study, 58 stakeholders from 12 organizations involved in the first wave of implementation participated in group interviews to discuss their experience with the implementation process and their perceptions of facilitators and barriers. Data were subjected to thematic analysis. Results : Analysis of the data yielded five themes: finding the ‘right unit’ despite an unfavourable context; taking and protecting time for self-assessment; creating value around competency assessment; bringing the project as close to the nurses as possible; making the framework accessible. Conclusion : This study was one of the first to document the large-scale, multi-site implementation of a nursing competency framework in clinical settings. This project represented a unique challenge because it involved two crucial changes: adopting a competency-based approach focused on educational outcomes and accountability to the public and valorizing a learning culture where nurses become active stakeholders in their continuing professional development

Adaptation of clinical guidelines: literature review and proposition for a framework and procedure

Purpose. The development and updating of high-quality clinical practice guidelines require substantial resources. Many guideline programmes throughout the world are using similar strategies to achieve similar goals, resulting in many guidelines on the same topic. One method of using resources more efficiently and avoiding unnecessary duplication of effort would be to adapt existing guidelines. The aim was to review the literature on adaptation of guidelines and to propose a systematic approach for adaptation of guidelines. Data sources. We selected and reviewed reports describing the methods and results of adaptation of guidelines from those found by searching Medline, Internet, and reference lists of relevant papers. On the basis of this review and our experience in guideline development, we proposed a conceptual framework and procedure for adaptation of guidelines. Results. Adaptation of guidelines is performed either as an alternative to de novo guideline development or to improve guideline implementation through local tailoring of an international or national guideline. However, no validated process for the adaptation of guidelines produced in one cultural and organizational setting for use in another (i.e. trans-contextual adaptation) was found in the literature. The proposed procedure is a stepwise approach to trans-contextual adaptation, including searching for existing guidelines, quality appraisal, detailed analysis of the coherence between the evidence and the recommendations, and adaptation of the recommendations to the target context of use, taking into account the organization of the health care system and cultural context. Conclusions. Trans-contextual adaptation of guidelines is increasingly being considered as an alternative to de novo guideline development. The proposed approach should be validated and evaluated to determine if it can reduce duplication of effort and inefficient use of resources, although guaranteeing a high-quality product, compared with de novo developmen

Transformation of RDX and other energetic compounds by xenobiotic reductases XenA and XenB

The transformation of explosives, including hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), by xenobiotic reductases XenA and XenB (and the bacterial strains harboring these enzymes) under both aerobic and anaerobic conditions was assessed. Under anaerobic conditions, Pseudomonas fluorescens I-C (XenB) degraded RDX faster than Pseudomonas putida II-B (XenA), and transformation occurred when the cells were supplied with sources of both carbon (succinate) and nitrogen (NH\u2084\u207a), but not when only carbon was supplied. Transformation was always faster under anaerobic conditions compared to aerobic conditions, with both enzymes exhibiting a O\u2082 concentration-dependent inhibition of RDX transformation. The primary degradation pathway for RDX was conversion to methylenedinitramine and then to formaldehyde, but a minor pathway that produced 4-nitro-2,4-diazabutanal (NDAB) also appeared to be active during transformation by whole cells of P. putida II-B and purified XenA. Both XenA and XenB also degraded the related nitramine explosives octahydro- 1,3,5,7-tetranitro-1,3,5,7-tetrazocine and 2,4,6,8,10,12- hexanitro-2,4,6,8,10,12-hexaazaisowurtzitane. Purified XenB was found to have a broader substrate range than XenA, degrading more of the explosive compounds examined in this study. The results show that these two xenobiotic reductases (and their respective bacterial strains) have the capacity to transform RDX as well as a wide variety of explosive compounds, especially under low oxygen concentrations.NRC publication: Ye

Sleep and cardiometabolic risk: a cluster analysis of actigraphy-derived sleep profiles in adults and children

Study objectives: Sleep plays an important role in cardiometabolic health. Although the importance of considering sleep as a multidimensional construct is widely appreciated, studies have largely focused on individual sleep characteristics. The association between actigraphy-derived sleep profiles and cardiometabolic health in healthy adults and children has not been examined.Methods: This study used actigraphy-measured sleep data collected between February 2015 and March 2016 in the Child Health CheckPoint study. Participants wore actigraphy monitors (GENEActiv Original, Cambs, UK) on their nondominant wrist for 7 days and sleep characteristics (period, efficiency, timing, and variability) were derived from raw actigraphy data. Actigraphy-derived sleep profiles of 1,043 Australian children aged 11-12 years and 1,337 adults were determined using K-means cluster analysis. The association between cluster membership and biomarkers of cardiometabolic health (blood pressure, body mass index, apolipoproteins, glycoprotein acetyls, composite metabolic syndrome severity score) were assessed using Generalized Estimating Equations, adjusting for geographic clustering, with sex, socioeconomic status, maturity stage (age for adults, pubertal status for children), and season of data collection as covariates.Results: Four actigraphy-derived sleep profiles were identified in both children and adults: short sleepers, late to bed, long sleepers, and overall good sleepers. The overall good sleeper pattern (characterized by adequate sleep period time, high efficiency, early bedtime, and low day-to-day variability) was associated with better cardiometabolic health in the majority of comparisons (80%).Conclusion: Actigraphy-derived sleep profiles are associated with cardiometabolic health in adults and children. The overall good sleeper pattern is associated with more favorable cardiometabolic health.</p

Sleep and cardiometabolic health in children and adults: examining sleep as a component of the 24-h day

Study objectives Sleep, physical activity and sedentary time are all known to play a role in cardiometabolic health. Compositional data analysis (CoDA) enables us to examine associations between 24-h use of time and health outcomes. Methods Data were collected in the Child Health CheckPoint study, a one-off national population-cohort study conducted between February 2015 and March 2016. Wrist-worn actigraphy monitors (GENEActiv Original, Cambs, UK) were used to measure activity behaviours (sleep, physical activity and sedentary time) and sleep characteristics (sleep variability, midsleep, efficiency). CoDA was applied to determine the association between 24-h use of time and cardiometabolic risk markers (blood pressure; body mass index; apolipoprotein B/A1; glycoprotein acetyls; and composite metabolic syndrome score). Substitution modelling (one-for-remaining and one-for-one) examined the associations of reallocating sleep time with other activity behaviours. ResultsData were available for 1073 Australian children aged 11–12 years (50% male) and 1337 adults (13% male). Strong association was found between 24-h use of time and all cardiometabolic health outcomes. Longer sleep was associated with more favourable cardiovascular health. Sleep characteristics other than duration (efficiency, timing, variability) were weakly and inconsistently associated with outcomes. Reallocating time from sleep to moderate-vigorous physical activity (MVPA) had favourable associations with cardiometabolic health, but reallocating from sleep to sedentary time was associated with less favourable cardiometabolic health. Conclusion The 24-h activity composition is strongly associated with cardiometabolic health in children and adults. Days with more sleep and MVPA are associated with improved cardiometabolic health.</p