Evaluating the integration of chronic disease prevention and management services into primary health care

Background The increasing number of patients with chronic diseases represents a challenge for health care systems. The Chronic Care Model suggests a multi-component remodelling of chronic disease services to improve patient outcomes. To meet the complex and ongoing needs of patients, chronic disease prevention and management (CDPM) has been advocated as a key feature of primary care producing better outcomes, greater effectiveness and improved access to services compared to other sectors. The objective of this study is to evaluate the adaptation and implementation of an intervention involving the integration of chronic disease prevention and management (CDPM) services into primary health care. Methods/Design The implementation of the intervention will be evaluated using descriptive qualitative methods to collect data from various stakeholders (decision-makers, primary care professionals, CDPM professionals and patients) before, during and after the implementation. The evaluation of the effects will be based on a combination of experimental designs: a randomized trial using a delayed intervention arm (n = 326), a before-and-after design with repeated measures (n = 163), and a quasi-experimental design using a comparative cohort (n = 326). This evaluation will utilize self-report questionnaires measuring self-efficacy, empowerment, comorbidity, health behaviour, functional health status, quality of life, psychological well-being, patient characteristics and co-interventions. The study will take place in eight primary care practices of the Saguenay region of Quebec (Canada). To be included, patients will have to be referred by their primary care provider and present at least one of the following conditions (or their risk factors): diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, asthma. Patients presenting serious cognitive problems will be excluded. Discussion In the short-term, improved patient self-efficacy and empowerment are expected. In the mid-term, we expect to observe an improvement in health behaviour, functional health status, quality of life and psychological well-being. At the organizational level, the project should lead to coordinated service delivery, improved patient follow-up mechanisms and enhanced interprofessional collaboration. Integration of CDPM services at the point of care in primary care practices is a promising innovation in care delivery that needs to be thoroughly evaluated

Actinobacillus pleuropneumoniae Possesses an Antiviral Activity against Porcine Reproductive and Respiratory Syndrome Virus

Pigs are often colonized by more than one bacterial and/or viral species during respiratory tract infections. This phenomenon is known as the porcine respiratory disease complex (PRDC). Actinobacillus pleuropneumoniae (App) and porcine reproductive and respiratory syndrome virus (PRRSV) are pathogens that are frequently involved in PRDC. The main objective of this project was to study the in vitro interactions between these two pathogens and the host cells in the context of mixed infections. To fulfill this objective, PRRSV permissive cell lines such as MARC-145, SJPL, and porcine alveolar macrophages (PAM) were used. A pre-infection with PRRSV was performed at 0.5 multiplicity of infection (MOI) followed by an infection with App at 10 MOI. Bacterial adherence and cell death were compared. Results showed that PRRSV preinfection did not affect bacterial adherence to the cells. PRRSV and App co-infection produced an additive cytotoxicity effect. Interestingly, a pre-infection of SJPL and PAM cells with App blocked completely PRRSV infection. Incubation of SJPL and PAM cells with an App cell-free culture supernatant is also sufficient to significantly block PRRSV infection. This antiviral activity is not due to LPS but rather by small molecular weight, heat-resistant App metabolites (,1 kDa). The antiviral activity was also observed in SJPL cells infected with swine influenza virus but to a much lower extent compared to PRRSV. More importantly, the PRRSV antiviral activity of App was also seen with PAM, the cells targeted by the virus in vivo during infection in pigs. The antiviral activity might be due, at least in part, to the production of interferon c. The use of in vitro experimental models to study viral and bacterial co-infections will lead to a better understanding of the interactions between pathogens and their host cells, and could allow the development of novel prophylactic and therapeutic tools

Identification of a new cell line permissive to porcine reproductive and respiratory syndrome virus infection and replication which is phenotypically distinct from MARC-145 cell line

Background Airborne transmitted pathogens, such as porcine reproductive and respiratory syndrome virus (PRRSV), need to interact with host cells of the respiratory tract in order to be able to enter and disseminate in the host organism. Pulmonary alveolar macrophages (PAM) and MA104 derived monkey kidney MARC-145 cells are known to be permissive to PRRSV infection and replication and are the most studied cells in the literature. More recently, new cell lines developed to study PRRSV have been genetically modified to make them permissive to the virus. The SJPL cell line origin was initially reported to be epithelial cells of the respiratory tract of swine. Thus, the goal of this study was to determine if SJPL cells could support PRRSV infection and replication in vitro. Results The SJPL cell growth was significantly slower than MARC-145 cell growth. The SJPL cells were found to express the CD151 protein but not the CD163 and neither the sialoadhesin PRRSV receptors. During the course of the present study, the SJPL cells have been reported to be of monkey origin. Nevertheless, SJPL cells were found to be permissive to PRRSV infection and replication even if the development of the cytopathic effect was delayed compared to PRRSV-infected MARC-145 cells. Following PRRSV replication, the amount of infectious viral particles produced in SJPL and MARC-145 infected cells was similar. The SJPL cells allowed the replication of several PRRSV North American strains and were almost efficient as MARC-145 cells for virus isolation. Interestingly, PRRSV is 8 to 16 times more sensitive to IFNα antiviral effect in SJPL cell in comparison to that in MARC-145 cells. PRRSV induced an increase in IFNβ mRNA and no up regulation of IFNα mRNA in both infected cell types. In addition, PRRSV induced an up regulation of IFNγ and TNF-α mRNAs only in infected MARC-145 cells. Conclusions In conclusion, the SJPL cells are permissive to PRRSV. In addition, they are phenotypically different from MARC-145 cells and are an additional tool that could be used to study PRRSV pathogenesis mechanisms in vitro

Multiple case study of changes in participation of adults with myotonic dystrophy type 1: Importance of redesigning accomplishment and resilience

This study explored and explained changes in participation post-diagnosis with myotonic dystrophy type 1 from the perspective of six adults, their relatives and nurse case managers. A multiple case study was carried out with these triads (n=18) using semi-structured individual interviews, medical charts, and a participation patient-reported outcome measure. The six cases were built around three women and three men (age: 40-56 years; disease duration: 19-39 years). Their “relatives” were mainly family members. Nurse case managers had done annual follow-ups with all the adults for approximately ten years. Changes in participation were characterized generally by: 1) heterogeneity, 2) insidious increase in restrictions, and more specifically by: 3) redesigning accomplishment, 4) progressive social isolation, 5) restrictions in life-space mobility, and 6) increasingly sedentary activities. Important facilitators of participation were the adult’s resilience, highly meaningful activities, social support, living arrangement, and willingness to use technical aids. Barriers were mostly related to symptoms and a precarious social network, and were affected by misfit and potential syndemic interactions between personal (e.g., comorbidities) and environmental (e.g., stigma) factors. This study identified key facilitators and barriers and their underlying processes, which should be integrated in the evaluation and intervention framework to optimize participation over time

Young women's use of a microbicide surrogate: The complex influence of relationship characteristics and perceived male partners' evaluations

This is the post-print version of the article. The official published version can be found at the link below.Currently in clinical trials, vaginal microbicides are proposed as a female-initiated method of sexually transmitted infection prevention. Much of microbicide acceptability research has been conducted outside of the United States and frequently without consideration of the social interaction between sex partners, ignoring the complex gender and power structures often inherent in young women’s (heterosexual) relationships. Accordingly, the purpose of this study was to build on existing microbicide research by exploring the role of male partners and relationship characteristics on young women’s use of a microbicide surrogate, an inert vaginal moisturizer (VM), in a large city in the United States. Individual semi-structured interviews were conducted with 40 young women (18–23 years old; 85% African American; 47.5% mothers) following use of the VM during coital events for a 4 week period. Overall, the results indicated that relationship dynamics and perceptions of male partners influenced VM evaluation. These two factors suggest that relationship context will need to be considered in the promotion of vaginal microbicides. The findings offer insights into how future acceptability and use of microbicides will be influenced by gendered power dynamics. The results also underscore the importance of incorporating men into microbicide promotion efforts while encouraging a dialogue that focuses attention on power inequities that can exist in heterosexual relationships. Detailed understanding of these issues is essential for successful microbicide acceptability, social marketing, education, and use.This study was funded by a grant from National Institutes of Health (NIHU19AI 31494) as well as research awards to the first author: Friends of the Kinsey Institute Research Grant Award, Indiana University’s School of HPER Graduate Student Grant-in-Aid of Research Award, William L. Yarber Sexual Health Fellowship, and the Indiana University Graduate and Professional Student Organization Research Grant

Conséquences fonctionnelles et sociales de la dystrophie myotonique : impacts des facteurs personnels et environnementaux sur la participation sociale

But : Le but de ce programme était de décrire et d’expliquer la participation sociale des personnes atteintes de dystrophie myotonique de type 1 (DM1). Méthode : Un échantillon aléatoire de 200 patients atteints de DM1 (phénotype léger (42) ou adulte (158)) a été recruté. La participation et la satisfaction dans la réalisation des habitudes de vie a été évaluée avec la Mesure des Habitudes de Vie (MHAVIE). Les facteurs environnementaux ont été évalués avec la Mesure de la Qualité de l’Environnement. Les facteurs personnels incluant la force musculaire, l’équilibre, la dextérité fine, la fatigue et l’hypersomnolence ont été évalués à l’aide d’instruments standardisés. Résultats : Les participants avec le phénotype adulte ont démontré un niveau de participation significativement inférieur à celui des participants avec le phénotype léger dans 8 des 11 catégories de la MHAVIE. Une restriction de la participation a été rapportée dans les catégories Déplacements, Habitation, Soins personnels, Nutrition, Condition corporelle, Travail, Loisirs, Vie communautaire chez les participants avec le phénotype adulte. La réalisation des habitudes de vie dans la catégorie loisirs était la plus affectée avec 57% des items qui démontraient une restriction de la participation chez 22 à 27% des participants. Les catégories Travail et Loisirs ont eu le plus faible taux de satisfaction. Les prédicteurs d’une atteinte de la participation sociale des quatre domaines les plus touchés soit Habitation, Déplacements, Travail et Loisirs ont été déterminés avec une analyse de régression logistique. Pour les facteurs personnels, la diminution de la force musculaire et une fatigue importante étaient significativement associées à la diminution de la participation sociale. Pour les facteurs environnementaux, la présence d’obstacles liée au support de la famille et l’accès et l’utilisation de la technologie est associée à une plus faible participation. Conclusion : Cette étude a permis de dresser un portrait et de mieux comprendre la participation sociale dans la DM1. Les résultats aideront à mieux définir le processus d’évaluation et la mise en place d’interventions en réadaptation et dans le milieu communautaire.Objective: To describe and explain social participation of persons with the adult and mild phenotype of myotonic dystrophy type 1 (DM1). Methods: A random sample of 200 subjects with DM1 (42 mild phenotype, 158 adult phenotype). Level of social participation and satisfaction was assessed with the Assessment of Life Habits (LIFE-H). Environmental factors were assessed with the Measure of the Quality of the Environment. Personal Factors were assessed with standardized instruments including Berg Balance Scale, Krupps Fatigue Severity Scale, and Manual Muscle Testing. Results: Participants with the adult phenotype demonstrated significantly lower participation level than those with the mild phenotype on 8 out of the 11 categories of the LIFE-H. Lower levels of accomplishment were reported in Mobility, Housing, Fitness, Nutrition, Personal Care, Employment, Recreation and Community Life categories among the adult phenotypes. The Recreation category was the most affected category with four out of seven items revealing compromised accomplishment among 22% to 27% of individuals. The lowest satisfaction score was observed in the Employment and Recreation categories. The predictors of the most restricted participation domains being Housing, Mobility, Employment and Recreation were determined with a logistic regression analysis. Participants reported disturbed participation in a large proportion (45-61%) for all domains. Lower extremity strength [OR = 15.4 – 5.5; p < 0.05] and higher fatigue [OR = 6.0 – 2.6; p < 0.05] were significantly present in participants with disturbed participation for all domains. For environmental factors, social support [OR = 3.6 – 2.5; p < 0.05] and public services [OR = 2.8 – 2.4; p < 0.05] were significantly perceived as barriers for participants with disturbed participation for most domains. Conclusion: This doctoral program has permited to better understand social participation in DM1. The results will help to elaborate a more comprehensive evaluation scheme and to develop intervention to promote optimal social participation in this population

Clinical practice guideline in physiotherapy to promote sexuality in adults with a neuromuscular disease (short version)

The short guide is an abbreviated version of “Clinical practice guideline on roles and interventions in physiotherapy to promote sexuality in adults with a neuromuscular disease”. This short version highlights important elements of the long version of the guide and is intended as a practical clinical reference document. The long version of the guide is intended for physiotherapists working with adults with a neuromuscular disease (NMD) who wish to address sexuality with this clientele. The CPG aims to: 1) Propose approaches to address the subject of sexuality with people who have a neuromuscular disease; 2) Provide physiotherapists with tools by identifying and documenting a set of relevant interventions that can be applied in their practice; 3) Highlight issues related to sexuality that can be addressed by all physiotherapists and those requiring expertise in pelvic floor physiotherapy; 4) Support the process of referral to other health professionals involved in providing care. The CPG was developed using the “The Rare Knowledge Mining Methodological Framework”, which includes a literature review, consultation and validation process. It is available in French and in English

Intervenir auprès des jeunes de niveau collégial : que vivent-ils et quels genres d'intervenants et d'interventions veulent-ils?

Ce mémoire traite des jeunes et du monde de l'éducation, plus particulièrement du niveau collégial. Le désir de connaître les diverses situations problématiques de ces étudiants, les ressources mises à leur disposition et le type d'intervention et d'intervenant qu'ils souhaitent est au centre de cette recherche. Une meilleure connaissance de cet agrégat a pour objectif d'apporter de nouvelles informations au corpus littéraire, un renouvellement des pratiques d'intervention et une amélioration des ressources offertes à ce niveau. Cette recherche est une exploration bibliographique et de terrain dans le but de mettre à jour les données existantes et de renouveler les pratiques d'intervention auprès de cette population. Les résultats rapportent les situations problématiques de ces jeunes ainsi que les types de services ou de ressources qu'ils souhaitent avoir afin de vivre adéquatement cette période critique de leur vie. Il a été pris comme postulat que cette population était oubliée et abandonnée des ressources scolaires, ces dernières étant très présentes au niveau secondaire alors qu'au niveau universitaire la maturité acquise des jeunes leur permet de recourir et de trouver plus aisément l'aide nécessaire. Par ailleurs, cette étude s'inscrit dans la perspective théorique de l'interactionnisme symbolique; c'est-à-dire qu'il est attendu que les problèmes vécus par ces jeunes proviennent d'une rupture, d'une absence ou d'une mauvaise interprétation des interactions entre ces jeunes et les divers intervenants professionnels et sociaux présents au niveau collégial. La méthodologie employée a débuté par une revue de littérature visant un recensement des problèmes connus des étudiants du cégep, c'est-à-dire des jeunes entre 17 et 22 ans. Ensuite, huit entrevues, certaines individuelles, d'autres de groupe, avec des étudiants des Cégep de Thetford Mines et de Victoriaville ont été réalisées, pour un total de 19 collégiens ayant participé à cette étude. Les différentes situations problématiques, vécues ou racontées, exprimées par les participants sont présentées et analysées en lien avec l'intervention actuelle et celle souhaitée. Il a été découvert au cours de ce mémoire que la littérature comprenait des lacunes au niveau des connaissances sur la population des collèges. Ainsi, la première partie de ce rapport présente les éléments et/ou les situations problématiques connues dans la littérature. Il s'agit de l'avenir, de l'environnement familial, des ruptures affectives, du suicide et du décrochage scolaire. Toutefois, suite aux entrevues, plusieurs éléments ou situations nouvelles se sont ajoutées. L'analyse du contenu de ces entretiens démontre que les étudiants ont des difficultés ou des commentaires concernant le passage du secondaire au collégial, la gestion du temps, le choix de carrière, les relations familiales, les amours (relation de couple et rupture affective), l'influence des amis, la consommation de drogue et/ou d'alcool, la mort, les rapports avec les professeurs, l'association étudiante, la vie étudiante et culturelle et les services professionnels. De plus, les participants ont illustré leur vision de l'intervention ainsi que l'intervenant idéal. Finalement, il est souhaité que ce mémoire permette aux intervenants de mieux comprendre ces jeunes afin d'intervenir plus efficacement

DSI-ARSACS

Table of contents : 1. Administration -- 2. Scoring sheet -- 3. Items’ description -- 3.1. Speech -- 3.2. Archimedes spiral -- 3.3. Standardized finger-to-nose test -- 3.4. Mobility -- 3.5. Muscle tone -- 3.6. Vibration sense -- 3.7. Circle on the floor with foot -- 3.8. Bladder function -- 4. Items’ origin -- 5. References