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The sperm-specific CatSper channel controls the intracellular Ca(2+) concentration ([Ca(2+)](i)) and, thereby, the swimming behaviour of sperm. In humans, CatSper is directly activated by progesterone and prostaglandins-female factors that stimulate Ca(2+) influx. Other factors including neurotransmitters, chemokines, and odorants also affect sperm function by changing [Ca(2+)](i). Several ligands, notably odorants, have been proposed to control Ca(2+) entry and motility via G protein-coupled receptors (GPCRs) and cAMP-signalling pathways. Here, we show that odorants directly activate CatSper without involving GPCRs and cAMP. Moreover, membrane-permeable analogues of cyclic nucleotides that have been frequently used to study cAMP-mediated Ca(2+) signalling also activate CatSper directly via an extracellular site. Thus, CatSper or associated protein(s) harbour promiscuous binding sites that can host various ligands. These results contest current concepts of Ca(2+) signalling by GPCR and cAMP in mammalian sperm: ligands thought to activate metabotropic pathways, in fact, act via a common ionotropic mechanism. We propose that the CatSper channel complex serves as a polymodal sensor for multiple chemical cues that assist sperm during their voyage across the female genital tract.

General practitioners (GPs) have a role in improving population health through health promotion and disease prevention (HPDP) activities such as immunisations, screening, and lifestyle advice. However, GPs must also respond to the patient’s agenda in a consultation. With limited time in a consultation, it might be difficult for GPs to prioritise HPDP with their patients. My thesis aimed to offer insights into the behavioural determinants of GPs to deliver HPDP.\ud I considered behaviour theories such as Ajzen’s Theory of Planned Behaviour (TPB) to help understand clinician behaviour and how they could be applied to influence their behaviour to deliver HPDP programmes. I conducted an overview of systematic reviews to examine impact of behavioural interventions, directed at GPs, to improve health of their patients. The overview suggested there is insufficient evidence for any type of intervention to be consistently effective in influencing GPs behaviour.\ud The National Chlamydia Screening Programme aims to detect and treat chlamydia infection in young people. Primary Care Trusts used different behaviour interventions to encourage GPs to deliver screening. I interviewed GPs and practice nurses (PNs) in London about their experiences of delivering chlamydia screening and the behavioural interventions, such as those discussed in systematic reviews, to influence their behaviour to deliver other public health programmes.\ud The interview data suggested the constructs of TPB - behavioural beliefs, normative beliefs, and control beliefs – could be used as a conceptual framework to explain why these primary care clinicians might deliver public health care.\ud Strategies used to implement public health programmes need to consider how primary care clinicians might respond to the different constructs of TPB. In addition, organisational factors such as contracts and financial incentives, and perception of intrusion into the patient’s agenda need to be managed carefully as they could either facilitate or impede delivery of public health programmes.

Objective: As part of the EU-funded Project INTEGRATE, the research sought to develop an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation across varying country contexts and relevant to different chronic and/or long-term conditions. This paper identifies the core dimensions of integrated care based on a review of previous literature on the topic. Methodology: The research reviewed literature evidence from the peer-reviewed and grey literature. It focused on reviewing research articles that had specifically developed frameworks on integrated care and/or set out key elements for successful implementation. The search initially focused on three main scientific journals and was limited to the period from 2006 to 2016. Then, the research snowballed the references from the selected published studies and engaged leading experts in the field to supplement the identification of relevant literature. Two investigators independently reviewed the selected articles using a standard data collection tool to gather the key elements analyzed in each article. Results: A total of 710 articles were screened by title and abstract. Finally, 18 scientific contributions were selected, including studies from grey literature and experts’ suggestions. The analysis identified 175 items grouped in 12 categories. Conclusions: Most of the key factors reported in the literature derive from studies that developed their frameworks in specific contexts and/or for specific types of conditions. The identification and classification of the elements from this literature review provide a basis to develop a comprehensive framework enabling standardized descriptions and benchmarking of integrated care initiatives carried out in different contexts.

International audience; This chapter on case management starts with a case story about Julia, a person with dementia, and her case manager, John (Sect. 4.1). It shows six innovations which are necessary to introduce case managers. Julia and John live in the year 2025, in a rich western country with a health system that supports integrated care by means of adequate financing and digitalization of care. Section 4.2 introduces a definition of the concept of case management and discusses important terms in it. Then (Sect. 4.3), two specific competences of case managers are discussed: (1) the assessments of care and social needs and (2) empowering interviewing of clients. The chapter continues (Sect. 4.4) with the comparison of the “ideal world” in the case story in 2025 with the real world in 2015 by focusing on case management practices in The Netherlands and France. The chapter ends (Sect. 4.5) by offering theories to support the implementation of the case manager. The chapter emphasises that case managers are not only for clients with dementia but are relevant as an approach to support other people with health, educational and financial problems; clients with developmental delays; patients with severe mental illness; patients with cancer and metastases; and persons with more than one chronic condition. In this chapter, the words clients, patients and persons are used as synonyms occurring in different care contexts.