Absence of RNA-binding protein FXR2P prevents prolonged phase of kainate-induced seizures.

Status epilepticus (SE) is a condition in which seizures are not self-terminating and thereby pose a serious threat to the patient's life. The molecular mechanisms underlying SE are likely heterogeneous and not well understood. Here, we reveal a role for the RNA-binding protein Fragile X-Related Protein 2 (FXR2P) in SE. Fxr2 KO mice display reduced sensitivity specifically to kainic acid-induced SE. Immunoprecipitation of FXR2P coupled to next-generation sequencing of associated mRNAs shows that FXR2P targets are enriched in genes that encode glutamatergic post-synaptic components. Of note, the FXR2P target transcriptome has a significant overlap with epilepsy and SE risk genes. In addition, Fxr2 KO mice fail to show sustained ERK1/2 phosphorylation induced by KA and present reduced burst activity in the hippocampus. Taken together, our findings show that the absence of FXR2P decreases the expression of glutamatergic proteins, and this decrease might prevent self-sustained seizures.

The medicalisation of the dying self: The search for life extension in advanced cancer.

Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late-stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day-to-day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms.

Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: a qualitative study.

BACKGROUND: Internationally, women with cervical intraepithelial neoplasia (CIN) lack knowledge about their disease, which limits their ability to take responsibility for self-care and creates negative psychosocial effects, including marital problems. Normally, screening is performed in primary care, and in case of abnormal results, the patient is referred to specialized care for follow-up and treatment. Given the lack of international literature regarding patients' experiences in primary and specialized healthcare, our study aims to: (a) investigate how women with CIN perceive the communication and management of information by healthcare providers at different moments of their healthcare and (b) identify these women's informational needs. METHODS: A qualitative exploratory study was carried out in a gynecology unit of a public hospital of the Galician Health Care Service (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women aged 21 to 52 years old with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed. A thematic analysis was carried out, including triangulation of researchers for analysis verification. RESULTS: Two analytical themes were identified. The first was communication gaps in the diagnosis and management of information in primary and specialized healthcare. These gaps occurred in the following moments of the healthcare process: (a) cervical cancer screening in primary care, (b) waiting time until referral to specialized care, (c) first consultation in specialized care, and (d) after consultation in specialized care. The second theme was participants' unmatched informational needs. The doubts and informational needs of women during their healthcare process related to the following subthemes: (a) HPV transmission, (b) HPV infection symptoms and consequences, and (c) CIN treatment and follow-up. CONCLUSIONS: This study shows that women who have a diagnosis of CIN experience important healthcare informational challenges when accessing primary and specialized care that have several implications for their wellbeing. The information given is limited, which makes it difficult for women to understand and participate in the decision making regarding the prevention and treatment of CIN. Service coordination among different levels of care and the availability of educational materials at any given time would improve the patients' healthcare experience.

Public-private partnership (PPP) development: Toward building a PPP framework for healthy eating.

Public-private partnerships (PPPs) in public health have gained great attention in the global health literature over the last two decades. Evidence suggests that PPPs could contribute to mitigating complex health problems. There is, however, limited knowledge about the process and specific conditions in which PPPs for healthy eating, in particular, can be developed successfully. To address this gap, this article first summarizes the literature, and second, using qualitative content analysis, identifies factors deemed to influence the process of building PPPs for healthy eating. The literature search was undertaken in two stages. The first stage focused on PPPs in public health to understand what constitutes a PPP, and the types and characteristics of PPPs. The second stage sought empirical examples and conceptual papers related to PPPs for healthy eating to identify critical elements that could facilitate or hinder partnerships between the government and the food industry. The search yielded 38 articles on PPPs in public health and 20 on PPPs for healthy eating. The analysis generated 23 individual elements that have the potential to influence a successful process of building PPPs for healthy eating (eg, endorsement from an individual champion, equal representation from partner organizations on board committees). The analysis also yielded five factors that appeared to well-represent the 23 individual elements of PPP formation: motivation, enablers, governance, benefits, and barriers. These results constitute an important step to understand critical factors involved in the formation of PPPs in public health and should inform additional empirical research to validate them.

[Presence of relatives during cardiopulmonary resuscitation: Perspectives of health professionals, patients and family in the Basque Country]. / Presencia de familiares durante la reanimación cardiopulmonar: perspectivas de pacientes, familiares y profesionales de la salud en el País Vasco.

OBJECTIVE: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. DESIGN: A qualitative exploratory study and thematic analysis were developed. SITE: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. PARTICIPANTS: The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians. METHOD: Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used. RESULTS: Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions. CONCLUSIONS: CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives.

The health of workers in the global gig economy.

BACKGROUND: The "gig" economy connects consumers with contractors (or workers) through online platform businesses to perform tasks (or "gigs"). This innovation in technology provides businesses and consumers access to low-cost, on-demand labour, but gig workers' experiences are more complex. They have access to very flexible, potentially autonomous work, but also deal with challenges caused by the nature of the work, its precariousness, and their relationships with the platform businesses. Workers in the Global North and South may also experience these challenges very differently. Based on our report "Towards an Understanding of Canadian Workers in the Global Gig Economy", we present a commentary on the implications of a globalized online platform labour market on the health of gig workers in Canada and globally. MAIN BODY: Based on our scoping review of peer and grey literature, we categorized gig worker vulnerabilities in three ways: 1) occupational vulnerabilities, 2) precarity, and 3) platform-based vulnerabilities. Occupational vulnerabilities are connected to the work being performed (e.g. driving a car or computer work) and are not specific to platform labour. Precarity refers to the short-term, contingent nature of the work, characteristics that may be shared with other forms of work. Some examples of precariousness are lack of health insurance, collective bargaining, or career training and promotion. Finally, platform-based vulnerabilities are particular to the way platform labour is structured. These vulnerabilities include worker misclassification, information asymmetries, and the culture of surveillance. We suggest that, together, these vulnerabilities challenge gig workers' right to health. CONCLUSIONS: We propose that the experience of gig workers around the world must be understood in the context of neoliberalism, which has increased both the globalization and precaritization of work. While gig workers share some vulnerabilities, which have important negative consequences on their health, with other workers, the platform-specific vulnerabilities of workers require further inquiry. In particular, the specific health and overall experience of gig workers in different regions of the world - with different labour policies and sociopolitical contexts for work - must be disentangled as workers in the Global North and South experience this work very differently.

The "Conflicted Dying": The Active Search for Life Extension in Advanced Cancer Through Biomedical Treatment.

Using a poststructural perspective, we examine the subjectivities that are produced when advanced cancer patients seek life extension through biomedical treatments. Seven case studies were developed that included 20 interviews with patients, family, nurses, and physicians recruited from a tertiary hospital in Canada, 30 documents, and 5 hours of participant observation. We identify seven types of subjectivity: (a) the Desperate Subject, (b) the Cancer Expert Subject, (c) the Proactive Subject, (d) the Productive Subject, (e) the Mistrusting Subject, (f) the Model Patient Subject, and (g) the Suffering Subject. We characterize the "conflicted dying," a contemporary figure who holds multiple perspectives about seeking curative treatment despite the acknowledgment of death. Using active strategies to gain access to treatment, this figure resists traditional arrangements of power/knowledge established by health care providers. We suggest that the search for life extension is a process of shaping the self to fit certain aesthetical traits associated with surviving cancer.

Rethinking Case Study Methodology in Poststructural Research.

Little consideration has been given to how case study might be used in poststructural research to explore power relations that constitute a phenomenon. Many case study scholars, most notably Robert Yin, adopt a postpositivist perspective that assumes the "truth" can be accessed through applying prescriptive and rigid research techniques. Using a discussion of Michel Foucault's key theoretical ideas and the insights gained through a Foucauldian case study of people with advanced cancer who continue to receive curative treatment, the authors argue for the expansion of case study in poststructural inquiry. They propose that the use of poststructuralist case study is valuable because of the flexibility and comprehensiveness of the methodology, which allows for the exploration of a deeper understanding of the broader discourses that shape a phenomenon, as well as how power/knowledge relations shape the behaviours and perceptions of people. They also introduce the reflexive implications of poststructural case study research.

Peu d'attention a été portée à la façon dont la méthode de l'étude de cas peut être utilisée dans le cadre de l'approche post-structuraliste pour étudier les relations de pouvoir qui structurent un phénomène. De nombreuses études de cas universitaires, en particulier celles de Robert Yin, adoptent une perspective postpositiviste qui postule l'existence d'une « vérité ¼ à laquelle il serait possible d'accéder par l'application de techniques de recherche normatives rigoureuses. À partir d'une présentation des principales théories de Michel Foucault et d'une réflexion tirée d'une étude de cas foucaldienne portant sur des personnes atteintes d'un cancer avancé qui ont continué de recevoir un traitement curatif, les auteurs de l'article développent une augmentation pour un plus grand recours aux études de cas réalisées dans un cadre post-structuraliste. Ils font valoir que la méthode post-structuraliste confère une grande valeur aux études de cas en raison de sa souplesse et de son caractère englobant, et qu'elle permet une analyse plus approfondie des discours généraux donnant forme à un phénomène et des relations de pouvoir et de connaissance qui façonnent les comportements et les perceptions. Les auteurs traitent également des implications réflexives de la réalisation d'études de cas dans le cadre de l'approche post-structuraliste.

Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.

This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.

['Sandwich PhD': considerations for a successful experience abroad]. / Doutorado sanduíche: considerações para uma experiência de sucesso no exterior.

International PhD internship, named "Sandwich PhD" in Brazil is an opportunity to improve research abilities, to become known in academic area and to establish and/or increase work opportunities in an international context. In this article, we describe key factors regarding the planning and development of the "Sandwich PhD" as experienced by professors and students involved in the collaboration between the School of Nursing, University of São Paulo and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. We also present the participation of PhD students' network as an alternative to the "Sandwich PhD". An international experience, when well-planned and developed correctly, promotes students' personal and professional development and favors the internationalization of Brazilian graduate programs and research groups.

Cell-type-specific disruption of cortico-striatal circuitry drives repetitive patterns of behavior in fragile X syndrome model mice.

Individuals with fragile X syndrome (FXS) are frequently diagnosed with autism spectrum disorder (ASD), including increased risk for restricted and repetitive behaviors (RRBs). Consistent with observations in humans, FXS model mice display distinct RRBs and hyperactivity that are consistent with dysfunctional cortico-striatal circuits, an area relatively unexplored in FXS. Using a multidisciplinary approach, we dissect the contribution of two populations of striatal medium spiny neurons (SPNs) in the expression of RRBs in FXS model mice. Here, we report that dysregulated protein synthesis at cortico-striatal synapses is a molecular culprit of the synaptic and ASD-associated motor phenotypes displayed by FXS model mice. Cell-type-specific translational profiling of the FXS mouse striatum reveals differentially translated mRNAs, providing critical information concerning potential therapeutic targets. Our findings uncover a cell-type-specific impact of the loss of fragile X messenger ribonucleoprotein (FMRP) on translation and the sequence of neuronal events in the striatum that drive RRBs in FXS.

Altered striatal actin dynamics drives behavioral inflexibility in a mouse model of fragile X syndrome.

The proteome of glutamatergic synapses is diverse across the mammalian brain and involved in neurodevelopmental disorders (NDDs). Among those is fragile X syndrome (FXS), an NDD caused by the absence of the functional RNA-binding protein FMRP. Here, we demonstrate how the brain region-specific composition of postsynaptic density (PSD) contributes to FXS. In the striatum, the FXS mouse model shows an altered association of the PSD with the actin cytoskeleton, reflecting immature dendritic spine morphology and reduced synaptic actin dynamics. Enhancing actin turnover with constitutively active RAC1 ameliorates these deficits. At the behavioral level, the FXS model displays striatal-driven inflexibility, a typical feature of FXS individuals, which is rescued by exogenous RAC1. Striatal ablation of Fmr1 is sufficient to recapitulate behavioral impairments observed in the FXS model. These results indicate that dysregulation of synaptic actin dynamics in the striatum, a region largely unexplored in FXS, contributes to the manifestation of FXS behavioral phenotypes.

Social determinants of health associated with cervical cancer screening among women living in developing countries: a scoping review.

INTRODUCTION: Thousands of women living in many middle and low-income countries are unnecessarily dying from cervical cancer, partly due to limited screening coverage. OBJECTIVES: To identify social determinants of health (SDH) associated with cervical screening for women living in middle and low-income countries, to inform responses to improve SDH and screening coverage, and to identify research gaps. METHODS: A scoping literature review. We located original research articles on SDH associated with cervical cancer screening through bibliographic databases, supplemented by hand searching (n=166+4). Included were those conducted in middle and low-income countries and published in English, Portuguese and Spanish academic journals between January 2000 and June 2011 (n=37). Excluded were those from high-income countries or focusing on screening-diagnostic techniques or HPV vaccine. Narrative synthesis examined the results in relation to a SDH framework. RESULTS: A number of factors influence access along the pathway to cervical cancer screening. Structural (cultural and societal values, socioeconomic position, ethnicity), intermediary (geographic location, health seeking behaviours, psychosocial factors, nature of the health system), and cross-cutting (social cohesion) SDH were all important. No single factor could entirely explain the observed cervical screening patterns. CONCLUSION: Cervical cancer screening among women living in middle and low-income countries are influenced by the interaction among several different SDH. The majority of researchers studying cervical cancer screening focused on exploring single socio-demographic variables, which is typical of positivist, biomedical and epidemiological research. An inter-sectionality approach may provide a richer understanding of the complexities that influence women's pathways to cervical cancer screening and assist design of international programmes and policies from a social justice perspective.

Spanish nursing under Franco: reinvention, modernization and repression (1956-1976).

This article examines Spanish nursing during a critical 20-year period (1956-76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state-run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS-Ayudante Técnico Sanitario (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women's Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid-twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first-year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender-related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women's branch of the ruling Falangist Party in mid-twentieth century Spain.

Immigration Status as the Foundational Determinant of Health for People Without Status in Canada: A Scoping Review.

Migration is increasing at unprecedented rates worldwide, but inadequate mechanisms for granting citizenship or permanent residence have rendered many immigrants without legal status. We study the health of people without immigration status in Canada, building on a 2010 review on being without status and health. We employ an expanded definition of health, guided by the WHO Social Determinants of Health (SDoH) framework. Using a scoping review methodology, we reviewed literature from 2008 to 2018 on the SDoH of people without legal immigration status in Canada, selecting 33 articles for analysis. We found that structural determinants of health, such as stigmatization and criminalization, and intermediary determinants, such as fear of deportation and healthcare avoidance, produce ill health. We show how different social positions are produced by SDoH, finding immigration status to be the foundational determinant of health for people without status in Canada. We argue that lack of immigration status as a SDoH is missing from the WHO framework.

Sex as Boys' Fame, But Girls' Shame: Adversarial Adolescent Gender Roles and Gender-based Violence in Guyana.

Gender-based violence (GBV) is a significant issue for youth in Guyana, particularly among young women. Yet, discussions about sex, dating, and violence rarely occur at the community level. To understand the heightened risk for GBV with youth in Guyana, we utilized a critical qualitative design to explore adolescent dating violence with adolescents (14-16 years old), parents, and school officials in a public secondary school in Guyana. In total, 36 racially and religiously diverse participants from low to middle-income households participated in focus groups (n = 30) and interviews (n = 6). Discussions centered on dating in adolescence; community awareness of dating violence; gender, racialization, and class in relation to dating violence; and dating violence prevention in schools and family settings. Our results revealed that heteronormative, adversarial gender roles in Guyana are enacted in adolescent relationships in ways that contribute to violence. Two important factors emerged in relation to femininity: female respectability related to sexuality; and the relationship between clothing, sexuality, and social class. Masculinity for adolescent boys was centered on reproducing normative assumptions about femininity and explaining the use of violence through pathologizing race. Participants were also asked to identify gender roles that adolescent boys and girls should embody in relationships, which revealed possibilities for overcoming adversarial roles in relationships. We propose that adolescent GBV prevention initiatives consider long-standing and deeply embedded ideas within gender norms that are connected to sexuality, class, and race. Without accounting for these systemic factors, GBV prevention initiatives and programs may inadvertently perpetuate traditional definitions of masculinity and femininity that contribute to violence.

Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues.

A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.

Stress undermines reward-guided cognitive performance through synaptic depression in the lateral habenula.

Weighing alternatives during reward pursuit is a vital cognitive computation that, when disrupted by stress, yields aspects of neuropsychiatric disorders. To examine the neural mechanisms underlying these phenomena, we employed a behavioral task in which mice were confronted by a reward and its omission (i.e., error). The experience of error outcomes engaged neuronal dynamics within the lateral habenula (LHb), a subcortical structure that supports appetitive behaviors and is susceptible to stress. A high incidence of errors predicted low strength of habenular excitatory synapses. Accordingly, stressful experiences increased error choices while decreasing glutamatergic neurotransmission onto LHb neurons. This synaptic adaptation required a reduction in postsynaptic AMPA receptors (AMPARs), irrespective of the anatomical source of glutamate. Bidirectional control of habenular AMPAR transmission recapitulated and averted stress-driven cognitive deficits. Thus, a subcortical synaptic mechanism vulnerable to stress underlies behavioral efficiency during cognitive performance.

A meta-synthesis of post-migration changes in marital relationships in Canada.

OBJECTIVES: Immigration to a new country constitutes a major life change and challenge that can directly and indirectly affect the health of individuals and families. A systematic review was conducted to identify post-migration changes and understand their impact on immigrants' marital relationships in Canada. METHOD: Using Noblit and Hare's meta-ethnography steps and Paterson et al.'s meta-data method, we conducted a meta-synthesis of qualitative articles. SYNTHESIS: Four journal articles and one book chapter met the inclusion criteria. Our synthesis of these studies identified three key themes reflecting the major post-migration changes experienced by couples: changes in gender and sexual relations, loss of social networks and support, and de-skilling and de-professionalization. The importance of communication emerged as a fourth theme that cut across the three key themes. These post-migration changes were common across nine ethnic communities, and affected the couple as a unit as well as individuals within this unit, both negatively and positively. The changes were associated with four outcomes: abuse, separation/divorce, staying with each other, and resilience. The synthesis also showed various pathways that link the post-migration changes and their outcomes. CONCLUSION: Understanding post-migration changes, their outcomes, and the pathways that link them is useful in developing health promotion activities to promote couples' resilience as well as health interventions to reduce the negative impact of the changes on couples and individuals. These activities and interventions must be planned at micro, meso, and macro levels of society.

Intimate male partner violence in the migration process: intersections of gender, race and class.

AIM: This paper is a report of a study of Sri Lankan Tamil Canadian immigrants' perspectives on factors that contribute to intimate male partner violence in the postmigration context. BACKGROUND: Increasing evidence illustrates the extent and nature of intimate male partner violence and its links to a range of physical and mental health problems for women around the world. However, there has been little health sciences research on intimate male partner violence in the postmigration context in Canada. METHODS: Data were collected for this qualitative descriptive study in 2004 and 2005, through individual interviews with community leaders (n = 16), four focus groups with women and four with men from the general community (n = 41), and individual interviews with women who had experienced intimate male partner violence (n = 6). The research was informed by a postcolonial feminist perspective and an ecosystemic framework. FINDINGS: Participants' conceptualization of the production of intimate male partner violence in the postmigration context involved (a) experiences of violence in the premigration context and during border crossing; (b) gender inequity in the marital institution; (c) changes in social networks and supports; and (d) changes in socioeconomic status and privilege. CONCLUSION: Increasing immigration requires that nurses pay attention to and respond appropriately to women's unique needs, based on complex and interrelated factors that produce intimate male partner violence in the postmigration context.