OS BENEFÍCIOS DAS PARCERIAS UNIVERSITÁRIAS INTERNACIONAIS: AS PERSPECTIVAS DE UM MEMBRO DE FACULDADE CANADENSE

Em novembro de 2013, tive o privilégio de visitar a Escola de Enfermagem da Universidade Federal do Rio Grande do Sul (UFRGS), no Brasil. Durante minha visita de nove dias, me reuni com membros da faculdade e estudantes de pós-graduação, conduzi duas aulas de pós-graduação sobre integração de sistemas de saúde e visitei várias instalações de assistência à saúde. Essa visita teve em mim um impacto significativo em termos profissionais e pessoais. Parcerias internacionais na área de saúde entre universidades de vários países têm benefícios distintos. Gostaria de destacar cinco

Developing and Implementing a Community-Based Model of Care for Fibromyalgia: A Feasibility Study

Background. Fibromyalgia (FM) is a complex disease posing challenges for primary care providers and specialists in its management. Aim. To evaluate the development and implementation of a comprehensive, integrated, community-based model of care for FM. Methods. A mixed methods feasibility study was completed in a small urban centre in southern British Columbia, Canada. Eleven adults with FM and a team of seven health care providers (HCPs) participated in a 10-week intervention involving education, exercise, and sleep management. Monthly “team-huddle” sessions with HCPs facilitated the integration of care. Data included health questionnaires, patient interviews, provider focus group/interviews, and provider surveys. Results. Both patients and HCPs valued the interprofessional team approach to care. Other key aspects included the benefits of the group, exercise, and the positive focus of the program. Effectiveness of the model showed promising results: quality of care for chronic illness, quality of life, and sleep showed significant (P<0.05) differences from baseline to follow-up. Conclusions. Our community-based model of care for FM was successfully implemented. Further testing of the model will be required with a larger sample to determine its effectiveness, although promising results were apparent in our feasibility study

Health systems integration: state of the evidence

Introduction: Integrated health systems are considered a solution to the challenge of maintaining the accessibility and integrity of healthcare in numerous jurisdictions worldwide. However, decision makers in a Canadian health region indicated they were challenged to find evidence-based information to assist with the planning and implementation of integrated healthcare systems. <br><br> Methods: A systematic literature review of peer-reviewed literature from health sciences and business databases, and targeted grey literature sources. <br><br> Results: Despite the large number of articles discussing integration, significant gaps in the research literature exist. There was a lack of high quality, empirical studies providing evidence on how health systems can improve service delivery and population health. No universal definition or concept of integration was found and multiple integration models from both the healthcare and business literature were proposed in the literature. The review also revealed a lack of standardized, validated tools that have been systematically used to evaluate integration outcomes. This makes measuring and comparing the impact of integration on system, provider and patient level challenging. <br><br> Discussion and conclusion: Healthcare is likely too complex for a one-size-fits-all integration solution. It is important for decision makers and planners to choose a set of complementary models, structures and processes to create an integrated health system that fits the needs of the population across the continuum of care. However, in order to have evidence available, decision makers and planners should include evaluation for accountability purposes and to ensure a better understanding of the effectiveness and impact of health systems integration

T-Cell Artificial Focal Triggering Tools: Linking Surface Interactions with Cell Response

T-cell activation is a key event in the immune system, involving the interaction of several receptor ligand pairs in a complex intercellular contact that forms between T-cell and antigen-presenting cells. Molecular components implicated in contact formation have been identified, but the mechanism of activation and the link between molecular interactions and cell response remain poorly understood due to the complexity and dynamics exhibited by whole cell-cell conjugates. Here we demonstrate that simplified model colloids grafted so as to target appropriate cell receptors can be efficiently used to explore the relationship of receptor engagement to the T-cell response. Using immortalized Jurkat T cells, we monitored both binding and activation events, as seen by changes in the intracellular calcium concentration. Our experimental strategy used flow cytometry analysis to follow the short time scale cell response in populations of thousands of cells. We targeted both T-cell receptor CD3 (TCR/CD3) and leukocyte-function-associated antigen (LFA-1) alone or in combination. We showed that specific engagement of TCR/CD3 with a single particle induced a transient calcium signal, confirming previous results and validating our approach. By decreasing anti-CD3 particle density, we showed that contact nucleation was the most crucial and determining step in the cell-particle interaction under dynamic conditions, due to shear stress produced by hydrodynamic flow. Introduction of LFA-1 adhesion molecule ligands at the surface of the particle overcame this limitation and elucidated the low TCR/CD3 ligand density regime. Despite their simplicity, model colloids induced relevant biological responses which consistently echoed whole cell behavior. We thus concluded that this biophysical approach provides useful tools for investigating initial events in T-cell activation, and should enable the design of intelligent artificial systems for adoptive immunotherapy

"It is good if everyone knows": an exploration of cervical cancer screening among women in an urban Sikh community

Bibliography: p. 93-11

A participatory case study of primary healthcare for aboriginal peoples in an urban setting

Bibliography: p. 287-330This thesis provides planners with a quantifiable basis for developing design guidelines for pedestrian access to LRT stations. Approximately 1,800 peak hour LRT users were interviewed about their LRT trip. Pedestrians were asked to point out on a map their approximate origin or destination. From this information, walking distance guidelines were developed. Catchment area maps were produced and the relationship between reported walking time and measured walking distance was observed. The research strongly indicates that people walk further to reach an LRT station then they walk to reach a bus stop. Using bus walking standards will underestimate LRT walking distances by about half. The average walking distance to suburban stations is 649 m with a 75th percentile distance of 840 m. At CBD stations the average walking distance is 326 m and the 75th percentile distance is 419 m

Developing and Implementing a Community-Based Model of Care for Fibromyalgia: A Feasibility Study

Background. Fibromyalgia (FM) is a complex disease posing challenges for primary care providers and specialists in its management. Aim. To evaluate the development and implementation of a comprehensive, integrated, community-based model of care for FM. Methods. A mixed methods feasibility study was completed in a small urban centre in southern British Columbia, Canada. Eleven adults with FM and a team of seven health care providers (HCPs) participated in a 10-week intervention involving education, exercise, and sleep management. Monthly “team-huddle” sessions with HCPs facilitated the integration of care. Data included health questionnaires, patient interviews, provider focus group/interviews, and provider surveys. Results. Both patients and HCPs valued the interprofessional team approach to care. Other key aspects included the benefits of the group, exercise, and the positive focus of the program. Effectiveness of the model showed promising results: quality of care for chronic illness, quality of life, and sleep showed significant () differences from baseline to follow-up. Conclusions. Our community-based model of care for FM was successfully implemented. Further testing of the model will be required with a larger sample to determine its effectiveness, although promising results were apparent in our feasibility study.Peer Reviewe

Aboriginal Homelessness: A Framework for Best Practice in the Context of Structural Violence

Homelessness among Indigenous peoples is an important issue in Canada and internationally. Research was conducted in seven metropolitan areas in the four western provinces of Canada to explore current services with the aim of developing a best practices framework to end homelessness for Aboriginal peoples. Sequential mixed methods were used. Key results found agreement that Aboriginal peoples were overrepresented among the homeless and policy determined the approach to and comprehensiveness of services provided. Funding, lack of time, and lack of resources were highlighted as issues. Gaps identified included a lack of partnership, cross-cultural collaboration, cultural safety, and evaluation and research in service provision. Best practices included ensuring cultural safety, fostering partnerships among agencies, implementing Aboriginal governance, ensuring adequate and sustainable funding, equitable employment of Aboriginal staff, incorporating cultural reconnection, and undertaking research and evaluation to guide policy and practices related to homelessness among Aboriginal peoples