Journey Through the Fractalization of Multilevel Governance: Levers for Adapt Healthcare Organizations Toward Migrant Populations in Canada.

This article focuses on multilevel governance applied to health organizations in Québec (Canada). The objective is to understand the action levers that facilitate the adaptation of the services toward migrant populations. This type of population establishes itself as an excellent tracer case to analyze the adaptation process, its fractalization and its involvement with the Environment. The dynamics between the actors and their self-organization takes part in the development of a multilevel governance. Interactions with the Environment-both internal and external-highlight the development of networks that emerge from the field and are then implemented at strategic levels in the organizations. The presence of connectivity actors within the organization and the Environment is established. The context, the bonds of trust between the actors and the credibility of the policymakers are reflected as important factors. However, connectivity actors cannot be successful without the support and contribution of the more "hierarchical" actors. Eight action levers are revealed by the analysis. We categorized them in 3 functions: administrative, enabling, and emerging. The levers of the administrative and emerging functions require that the levers of the enabling function be credible and legitimate and be able to support them for the adaptation to spread throughout the healthcare organization, regardless of the scope or policymaking level. The fractal function facilitates this process, by combining connectivity actors with the implementation of connectivity structures.

Empowering Nurses to Provide Humanized Care in Canadian Hospital Care Units: A Qualitative Study.

Previous studies have reported a conflict between nurses' motivation to provide humanized care and practical requirements impeding them from doing so. This exploratory descriptive qualitative study aimed to explore nurses' perspectives on humanized care, the challenges they face, and, most importantly, their recommendations to overcome these barriers. Semistructured individual interviews were conducted with 17 auxiliary and registered nurses working in various health care units in a Canadian hospital. Participants demonstrated a good understanding of what humanized care covers and entails. They also described it as the very core of their profession and main source of job satisfaction. However, nurses reported that they are confronted with organizational barriers, mainly a lack of staff, the burden of administrative tasks, unsuitable physical environments or equipment, and little managerial support. Nurses stressed the need for a cultural change in managerial practices in order to be able to improve their provision of humanized care. Based on the findings, 4 structuring recommendations were identified: adopting an institutional policy promoting the implementation of humanized care, incorporating humanized care in nurses' tasks and procedures, improving participatory management, and ensuring adequate staffing.

Dietary Milk Phospholipids Attenuate Chronic Stress-Induced Changes in Behavior and Endocrine Responses across the Lifespan.

SCOPE: Increasing scientific evidence is validating the use of dietary strategies to support and improve brain health throughout the lifespan, with tailored nutritional interventions catering for specific life stages. Dietary phospholipid supplementations in early life and adulthood are shown to alleviate some of the behavioral consequences associated with chronic stress. This study aims to explore the protective effects of a tailored phospholipid-enriched buttermilk on behavioral and endocrine responses induced by chronic psychosocial stress in adulthood, and to compare these effects according to the life stage at which the supplementation is started. METHODS AND RESULTS: A novel developed phospholipid-enriched dairy product is assessed for its effects on social, anxiety- and depressive-like behaviors, as well as the stress response and cognitive performance following chronic psychosocial stress in C57BL/6J mice, with supplementation beginning in adulthood or early life. Milk phospholipid supplementation from birth protects adult mice against chronic stress-induced changes in endocrine response to a subsequent acute stressor and reduces innate anxiety-like behavior in non-stressed animals. When starting in adulthood, the dietary intervention reverses the anxiety-like phenotype caused by chronic stress exposure. CONCLUSION: Dairy-derived phospholipids exert differential protective effects against chronic psychosocial stress depending on the targeted life stage and duration of the dietary supplementation.

Implementation of an intersectoral outreach and community nursing care intervention with refugees in Quebec: A protocol study.

AIM: To establish and assess an intersectoral local network focused on the roles of registered nurses and primary healthcare nurse practitioners to ensure the continuity of care and service pathways for refugees in Quebec. DESIGN: Developmental evaluation with a mixed methodology. METHODS: The qualitative component will include: (1) a document review; (2) observations of participants during meetings of different governance structures; (3) semi-structured interviews with key actors (n = 40; 20/neighbourhood interventions); and (4) focus groups with end users of the services (refugees) (n = 4; 6 to 8 participants per group). The quantitative component will be based on: (1) a data sheet on health and social interventions for refugees users filled in by registered nurses, primary healthcare nurse practitioners and physicians and (2) data analysis of the clinical-administrative database since 2012. This study received funding in June 2019 and Research Ethics Committee approval was granted in July 2020. DISCUSSION: In Quebec, refugee vulnerability is exacerbated by the lack of integration of existing resources and the lack of access to care and continuity of services. To address these issues, an integrated local network for refugees must be developed. Additionally, we will explore the role of registered nurses and their collaboration with primary healthcare nurse practitioners. IMPACT: This study will provide recommendations on how to optimize the scopes of practice of registered nurses and primary healthcare nurse practitioners, adapt care and services and develop a local intersectoral network to better meet the complex needs of refugees. It will evaluate the use and the appreciation of new services for targeted populations (neighbourhoods and refugees) and aim to improve the accessibility, continuity and user experience of all health services for those populations.

Bifidobacterium longum counters the effects of obesity: Partial successful translation from rodent to human.

BACKGROUND: The human gut microbiota has emerged as a key factor in the development of obesity. Certain probiotic strains have shown anti-obesity effects. The objective of this study was to investigate whether Bifidobacterium longum APC1472 has anti-obesity effects in high-fat diet (HFD)-induced obese mice and whether B. longum APC1472 supplementation reduces body-mass index (BMI) in healthy overweight/obese individuals as the primary outcome. B. longum APC1472 effects on waist-to-hip ratio (W/H ratio) and on obesity-associated plasma biomarkers were analysed as secondary outcomes. METHODS: B. longum APC1472 was administered to HFD-fed C57BL/6 mice in drinking water for 16 weeks. In the human intervention trial, participants received B. longum APC1472 or placebo supplementation for 12 weeks, during which primary and secondary outcomes were measured at the beginning and end of the intervention. FINDINGS: B. longum APC1472 supplementation was associated with decreased bodyweight, fat depots accumulation and increased glucose tolerance in HFD-fed mice. While, in healthy overweight/obese adults, the supplementation of B. longum APC1472 strain did not change primary outcomes of BMI (0.03, 95% CI [-0.4, 0.3]) or W/H ratio (0.003, 95% CI [-0.01, 0.01]), a positive effect on the secondary outcome of fasting blood glucose levels was found (-0.299, 95% CI [-0.44, -0.09]). INTERPRETATION: This study shows a positive translational effect of B. longum APC1472 on fasting blood glucose from a preclinical mouse model of obesity to a human intervention study in otherwise healthy overweight and obese individuals. This highlights the promising potential of B. longum APC1472 to be developed as a valuable supplement in reducing specific markers of obesity. FUNDING: This research was funded in part by Science Foundation Ireland in the form of a Research Centre grant (SFI/12/RC/2273) to APC Microbiome Ireland and by a research grant from Cremo S.A.

Neurobiological effects of phospholipids in vitro: Relevance to stress-related disorders.

Nutrition is a crucial component for maintenance of brain function and mental health. Accumulating evidence suggests that certain molecular compounds derived from diet can exert neuroprotective effects against chronic stress, and moreover improve important neuronal processes vulnerable to the stress response, such as plasticity and neurogenesis. Phospholipids are naturally occurring amphipathic molecules with promising potential to promote brain health. However, it is unclear whether phospholipids are able to modulate neuronal function directly under a stress-related context. In this study, we investigate the neuroprotective effects of phosphatidylcholine (PC), lysophosphatidylcholine (LPC), phosphatidylserine (PS), phosphatidylethanolamine (PE), phosphatidylinositol (PI), phosphatidylglycerol (PG), phosphatidic acid (PA), sphingomyelin (SM) and cardiolipin (CL) against corticosterone (CORT)-induced cytotoxicity in primary cultured rat cortical neurons. In addition, we examine their capacity to modulate proliferation and differentiation of hippocampal neural progenitor cells (NPCs). We show that PS, PG and PE can reverse CORT-induced cytotoxicity and neuronal depletion in cortical cells. On the other hand, phospholipid exposure was unable to prevent the decrease of Bdnf expression produced by CORT. Interestingly, PS was able to increase hippocampal NPCs neurosphere size, and PE elicited a significant increase in astrocytic differentiation in hippocampal NPCs. Together, these results indicate that specific phospholipids protect cortical cells against CORT-induced cytotoxicity and improve proliferation and astrocytic differentiation in hippocampal NPCs, suggesting potential implications on neurodevelopmental and neuroprotective pathways relevant for stress-related disorders.

Dietary phospholipids: Role in cognitive processes across the lifespan.

Chronic stress and ageing are two of the most important factors that negatively affect cognitive processes such as learning and memory across the lifespan. To date, pharmacological agents have been insufficient in reducing the impact of both on brain health, and thus, novel therapeutic strategies are required. Recent research has focused on nutritional interventions to modify behaviour and reduce the deleterious consequences of both stress and ageing. In this context, emerging evidence indicate that phospholipids, a specific type of fat, are capable of improving a variety of cognitive processes in both animals and humans. The mechanisms underlying these positive effects are actively being investigated but as of yet are not fully elucidated. In this review, we summarise the preclinical and clinical studies available on phospholipid-based strategies for improved brain health across the lifespan. Moreover, we summarize the hypothesized direct and indirect mechanisms of action of these lipid-based interventions which may be used to promote resilience to stress and improve age-related cognitive decline in vulnerable populations.

Short-chain fatty acids and microbiota metabolites attenuate ghrelin receptor signaling.

The gastrointestinal microbiota is emerging as a unique and inexhaustible source for metabolites with potential to modulate G-protein coupled receptors (GPCRs). The ghrelin receptor [growth hormone secretagogue receptor (GHSR)-1a] is a GPCR expressed throughout both the gut and the brain and plays a crucial role in maintaining energy balance, metabolism, and the central modulation of food intake, motivation, reward, and mood. To date, few studies have investigated the potential of the gastrointestinal microbiota and its metabolites to modulate GPCR signaling. Here we investigate the ability of short-chain fatty acids (SCFAs), lactate, and different bacterial strains, including Bifidobacterium and Lactobacillus genera, to modulate GHSR-1a signaling. We identify, for what is to our knowledge the first time, a potent effect of microbiota-derived metabolites on GHSR-1a signaling with potential significant consequences for host metabolism and physiology. We show that SCFAs, lactate, and bacterial supernatants are able to attenuate ghrelin-mediated signaling through the GHSR-1a. We suggest a novel route of communication between the gut microbiota and the host via modulation of GHSR-1a receptor signaling. Together, this highlights the emerging therapeutic potential in the exploration of the microbiota metabolome in the specific targeting of key GPCRs, with pleiotropic actions that span both the CNS and periphery.-Torres-Fuentes, C., Golubeva, A. V., Zhdanov, A. V., Wallace, S., Arboleya, S., Papkovsky, D. B., El Aidy, S., Ross, P., Roy, B. L., Stanton, C., Dinan, T. G., Cryan, J. F., Schellekens, H. Short-chain fatty acids and microbiota metabolites attenuate ghrelin receptor signaling.

Health-Promoting Home and Workplace Neighborhoods: Associations With Multiple Facets of Men's Health.

Despite the importance of healthy settings for health promotion, little is known about how neighborhood characteristics affect men's health. The present study aims to explore the associations between perceptions of home and workplace neighborhoods with diverse health outcomes, and to examine mediating mechanisms. A sample of 669 men members of labor unions in Quebec, Canada, completed a questionnaire assessing social and physical aspects of their work and home neighborhoods (the Health-Promoting Neighborhood Questionnaire) as well as subjective and objective health outcomes (perceived health, positive mental health, body mass index) and potential mediators (health behaviors, self-efficacy). Structural equation modeling (path analysis) revealed that the Health-Promoting Neighborhood Questionnaire was associated with all three health outcomes, either directly or indirectly through health behaviors and self-efficacy. Both home and workplace neighborhoods were associated with men's health, home neighborhood being more strongly associated. The findings suggest that physical and social aspects of neighborhood might contribute to men's health. The study highlights positive environmental levers for urban planners, policy makers, and health professionals to promote men's health.

Peer Positive Social Control and Men's Health-Promoting Behaviors.

Men are generally thought to be less inclined to take care of their health. To date, most studies about men's health have focused on deficits in self-care and difficulties in dealing with this sphere of their life. The present study reframes this perspective, using a salutogenic strengths-based approach and seeking to identify variables that influence men to take care of their health, rather than neglect it. This study focuses on the association between peer positive social control and men's health behaviors, while controlling for other important individual and social determinants (sociodemographic characteristics, health self-efficacy, home neighborhood, spousal positive social control, and the restrictive emotionality norm). In a mixed-method study, 669 men answered a self-reported questionnaire, and interviews were conducted with a maximum variation sample of 31 men. Quantitative results indicated that, even after controlling for sociodemographic variables and other important factors, peer positive social control was significantly associated with the six health behaviors measured in the study (health responsibility, nutrition, physical activity, interpersonal relations, stress management, and spirituality). Interview results revealed that peer positive social control influenced men's health behaviors through three different mechanisms: shared activity, being inspired, and serving as a positive role model for others. In summary, friends and coworkers could play a significant role in promoting various health behaviors among adult men in their daily life. Encouraging men to socialize and discuss health, and capitalizing on healthy men as role models appear to be effective ways to influence health behavior adoption among this specific population.

Association between weight status and men's positive mental health: The influence of marital status.

The purpose of this study was to (1) examine the association between weight status and men's positive mental health, defined as the presence of symptoms of emotional, psychological, and social well-being, and (2) evaluate the moderating effect of marital status. A total of 645 men aged between 19 and 71 years self-reported their height and weight and answered a questionnaire measuring their emotional, psychological, and social well-being. Analysis of variance revealed that mean levels of emotional, psychological, and social well-being did not significantly differ according to men's weight status. Moderation analyses indicated that, for men in a relationship (married or living common-law), there were no significant associations between overweight, obesity, and the three components of positive mental health. However, for single men, overweight was marginally associated with higher emotional well-being, while obesity was associated with lower psychological well-being and marginally associated with lower social well-being. Results of the present study suggest that health professionals and researchers should take the characteristics (such as marital status) of men with obesity and overweight into account when working with them. Mental health researchers may need to examine men in each weight category separately (e.g. obesity vs. overweight), since the association with positive mental health can differ from one category to another.

Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper.

INTRODUCTION: The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. METHODS AND ANALYSIS: The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. ETHICS AND DISSEMINATION: The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.

[The qualitative research on social inequalities in health: the life courses]. / La recherche qualitative sur les inégalités sociales de santé : le parcours de vie.

OBJECTIVES: Adopting a lifecourse perspective is more and more frequent in the health inequalities research field. This article describes such an approach, as applied in a study on poverty and social exclusion. METHODS: In this study, life histories were collected through open interviews and focused on the meaning of lived experiences. An original analysis table was used, in which words are grouped within categories identifying the different components of a lifecourse. RESULTS: Whether it refers to experiences lived in childhood or adulthood, the life history enables the placing of these within the individual's lifecourse. The horizontal analysis of different individual stories makes it possible to identify experiences that have harmful, or conversely, beneficial effects. When transferring results, reporting the experiences lived by the populations using the same words they did to describe them can help those responsible for program development or implementation understand the genesis of social health inequities. CONCLUSION: The analysis of life histories, based on the different components of a lifecourse, allows the identification of key moments in the interviewees' life evolution and, in an action perspective, to do so while taking health and social intervention fields into account. Such results make it easier to design actions to counter social health inequities - and above all their chronic nature - that are suited to the realities encountered.

[Contribution to an ethics of care--masculinities and gender in the nursing profession]. / Contribution a une ethique de la sollicitude--masculinités et genre dans la profession infirmière.

Today, the nursing profession is almost exclusively associated to women while men seem to desert this field in which they were, before the nineteenth century, very present. This paper offers a critical look and reflects on the presence of men in nursing. The critical perspective of "genderization" as well as the "ethics of care" constitutes the cornerstone of the reflection developed in this paper. Prejudices against men in the field of nursing are also highlighted, which attest that the future of men in this profession is still not assured. From that point of view, the "degenderization" of nursing and the valorization of men in the history of nursing as well as in the current practice of nursing are presented as potential ways forward.

Drug design, in vitro pharmacology, and structure-activity relationships of 3-acylamino-2-aminopropionic acid derivatives, a novel class of partial agonists at the glycine site on the N-methyl-D-aspartate (NMDA) receptor complex.

Retaining agonistic activity at the glycine coagonist site of the NMDA receptor in molecules derived from glycine or d-serine has proven to be difficult because in the vicinity of the alpha-amino acid group little substitution is tolerated. We have solved this problem by replacing the hydroxy group of d-serine with an amido group, thus keeping the hydrogen donor function and allowing for further substitution and exploration of the adjacent space. Heterocyclic substitutions resulted in a series of 3-acylamino-2-aminopropionic acid derivatives, with high affinities in a binding assay for the glycine site. In a functional assay assessing the activation of the glycine site, these compounds displayed a wide range of intrinsic efficacies, from antagonism to a high degree of partial agonism. Structure-activity relationships reveal that lipophilic substituents, presumably filling an additional hydrophobic pocket, are accepted by the glycine site, provided that they are separated from the alpha-amino acid group by a short linker.

Gamma-lactams--a novel scaffold for highly potent and selective alpha 7 nicotinic acetylcholine receptor agonists.

A novel class of alpha7 nicotinic acetylcholine receptor (nAChR) agonists has been discovered through high-throughput screening. The cis gamma-lactam scaffold has been optimized to reveal highly potent and selective alpha7 nAChR agonists with in vitro activity and selectivity and with good brain penetration in mice.

The use of postcolonialism in the nursing domain: colonial patronage, conversion, and resistance.

The current context in nursing requires radical political analyses to deconstruct the dominant discourses that map both the discipline and the profession. In response to the strong reaction to articles, which critically examined the evidence-based movement in health sciences, we believe that it is essential to offer a perspective that is capable of resisting the progress of such discourses, which currently prevail in nursing and thus shape our profession. We believe that the biomedical model/ideology is a form of colonial patronage that is becoming more and more influential in nursing. Such colonization takes the forms of powerful discourses (eg, evidence-based medicine) and institutional practices that pervade all spheres of nursing: practice, research, education, and administration. In previous articles, we have criticized this trend; consequently, the objective of this article is not to replicate our previous arguments but rather to demonstrate that to what extent a postcolonial approach to nursing constitutes an efficient tool for disrupting the colonizing effects of the biomedical discourse.