The characterisation of the Danish e-business - Aarstiderne as an alternative food network: A case study

The object of this case study is Aarstiderne, a Danish organic food company delivering 30,000 boxes per week. The study aims to characterise this company within the context of alternative food chains, using specific environmental, economic and social criteria. During the course of the study, 19 interviews were conducted with company members, clients, suppliers, and researchers. In addition, a life cycle analysis and a price comparison for two box types were conducted. The results of the study focus on the environmental, economic, and social impacts of the company on its stakeholders throughout the food network. These results indicate how the company can be characterised in relation to other alternative food chains, with specific attention paid to how this food chain addresses some limitations of supermarket and Community Supported Agriculture food distribution models. Lastly, a comparison of the company’s own ideals to its practices is made and some suggestions for improved coherence between ideals, practices and impacts on sustainability are put forth

Plan d’action québécois en santé mentale : contextes de mise en oeuvre et éléments d’impact sur l’organisation des services de première ligne et les modes de collaboration

Depuis 2005, le Plan d’action en santé mentale oriente le développement et l’organisation des services en santé mentale au Québec. En conjonction avec d’autres réformes modifiant l’économie générale du système de santé, il vise en particulier à favoriser une réponse adéquate aux troubles mentaux courants. Cette préoccupation appelle une transformation de l’offre de services en première ligne. Une analyse de différents contextes dans lesquels opèrent ces changements permet une réflexion sur les principaux facteurs susceptibles d’influencer l’actualisation de certaines propositions du Plan d’action et sur l’évolution des modes de collaboration, un pré requis à la mise en place des réseaux locaux de services.Since 2005, the Mental Health Action Plan maps out development and reorganization of mental health services in Québec. With concurrent reforms affecting the overall layout of the health care system, the Action Plan especially seeks to improve the management of common mental disorders. This particular concern calls for transformations at the primary care level. Contextual analysis of contrasting settings allows the identification of the main determinants in this actual process of change and in the ways collaborative issues are addressed.Desde 2005, el Plan de Acción de Salud Mental orienta el desarrollo y la organización de los servicios de salud mental en Quebec. Junto con otras reformas que modifican la economía general del sistema de salud, el plan busca en particular favorecer una respuesta adecuada a los trastornos mentales comunes. Esta preocupación implica una transformación de la oferta de servicios de primer nivel. Un análisis de diferentes contextos en los que operan estos cambios permite una reflexión acerca de los principales factores susceptibles de influir en la actualización de ciertas proposiciones del Plan de Acción y en la evolución de las formas de colaboración, un prerrequisito para la puesta en marcha de las redes locales de servicios.Desde 2005, o Plano de Ação em Saúde Mental orienta o desenvolvimento e a organização dos serviços em saúde mental no Quebec. Em conjunto com outras reformas que modificam a economia geral do sistema de saúde, ele visa principalmente favorecer uma resposta adequada aos transtornos mentais correntes. Esta preocupação demanda uma transformação da oferta de serviços primários. Uma análise de diferentes contextos nos quais operam estas mudanças permite uma reflexão sobre os principais fatores susceptíveis de influenciar a atualização de algumas propostas do Plano de Ação e sobre a evolução dos modos de colaboração, um pré-requisito para a criação das redes locais de serviços

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

Short-term heart rate variability in a population-based sample of 10-year-old children

Heart rate variability (HRV) is a non-invasive quantitative marker of cardiac autonomic function derived from continuous electrocardiogram (ECG) recordings. Normative HRV values and development factors have not been established in pediatric populations. The objective was to derive referent time- and frequency-domain HRV values for a population-based sample of children. Children aged 9-11 years (N = 1,036) participated in the Québec Longitudinal Study of Child Development cohort cardiovascular health screening. Registered nurses measured anthropometrics (height, weight) and children wore an ambulatory Holter monitor to continuously record an ECG signal. HRV variables included time (SDNN, pNN50, RMSSD, SDANN) and frequency (HF, LF, LF/HF ratio) domain variables. Normative HRV values, stratified by age, sex, and heart rate, are presented. Greater heart rate (β avg = -0.60, R avg (2) = 0.39), pubertal maturation (β avg = -0.11, R avg (2) = 0.01), later ECG recording times (β avg = -0.19, R avg (2) = 0.07), and higher diastolic blood pressure (β avg = -0.11, R avg (2) = 0.01) were significantly associated with reduced HRV in 10-year-old children. The normative HRV values permit clinicians to monitor, describe, and establish pediatric nosologies in primary care and research settings, which may improve treatment of diseases associated with HRV in children. By better understanding existing values, the practical applicability of HRV among clinicians will be enhanced. Lastly, developmental (e.g., puberty) and procedural (e.g., recording time) factors were identified that will improve recording procedures and interpretation of results

A subcutaneous adipose tissue-liver signalling axis controls hepatic gluconeogenesis.

The search for effective treatments for obesity and its comorbidities is of prime importance. We previously identified IKK-ε and TBK1 as promising therapeutic targets for the treatment of obesity and associated insulin resistance. Here we show that acute inhibition of IKK-ε and TBK1 with amlexanox treatment increases cAMP levels in subcutaneous adipose depots of obese mice, promoting the synthesis and secretion of the cytokine IL-6 from adipocytes and preadipocytes, but not from macrophages. IL-6, in turn, stimulates the phosphorylation of hepatic Stat3 to suppress expression of genes involved in gluconeogenesis, in the process improving glucose handling in obese mice. Preliminary data in a small cohort of obese patients show a similar association. These data support an important role for a subcutaneous adipose tissue-liver axis in mediating the acute metabolic benefits of amlexanox on glucose metabolism, and point to a new therapeutic pathway for type 2 diabetes

L’incidence du volet scolaire du projet Ruelle de l’Avenir sur la motivation et la performance d’élèves de milieux défavorisés

L’évolution de la motivation et de la performance d’élèves du primaire ayant profité du volet scolaire du projet Ruelle de l’Avenir (N = 139) a été comparée à celle d’un groupe témoin (N = 164) issu du même milieu défavorisé. Les analyses de variance à mesures répétées (MANOVA) et les analyses complémentaires (ANOVA) indiquent une augmentation significative de la perception de l’utilité de l’école, du français et des mathématiques, de même qu’une amélioration de la performance en écriture et en mathématiques pour le groupe expérimental. L’importance du partenariat et du choix des situations d’apprentissage en milieux défavorisés est discutée

Reduced Cognitive Assessment Scores Among Individuals With Magnetic Resonance Imaging-Detected Vascular Brain Injury

Background and Purpose- Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury. Methods- Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated. Results- The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age