Analyses stratégiques autour d'enjeux régionaux dans la Grappe des Lacs d'Itasy: SDA-Ausbildung in Madagaskar

Presentation for CDE's Forum E & U on the adaptation of the SDA approach for strategic analyisis of regional development and environment issues in Madagascar

Sustainable Development Appraisal (SDA): A methodological tool for the participatory assessment of sustainability from local to regional planning levels

The term 'sustainable development' is receiving increasing attention in development co-operation and at the global level. However, practical tools which can help local users and multi-disciplinary teams to work together and apply this general concept at the local to regional levels have' emerged only very recently. This paper describes a tool called 'Sustainable Development Appraisal' (SDA), which is based on the principles of sustainable development, and can be applied by small interdisciplinary teams using a transdisciplinary approach, i.e. in participation with local land users and other stakeholders at various levels of intervention. The SDA has been applied in different parts of the globe. It is receiving considerable attention, and may fulfil most requirements contained in the concept of sustainable development, and yet be practically applicable and useful in the local to regional context. Examples from Eritrea and Ethiopia are used in this paper 'to illustrate the practicability of SDA for development planning and implementation.

Vulvovaginal-swab or first-catch urine specimen to detect Chlamydia trachomatis in women in a community setting?

Screening for chlamydia in women is widely recommended. We evaluated the performance of two nucleic acid amplification tests for detecting Chlamydia trachomatis in self-collected vulvovaginal-swab and first-catch urine specimens from women in a community setting and a strategy for optimizing the sensitivity of an amplified enzyme immunoassay on vulvovaginal-swab specimens. We tested 2,745 paired vulvovaginal-swab and urine specimens by PCR (Roche Cobas) or strand displacement amplification (SDA; Becton Dickinson). There were 146 women infected with chlamydia. The assays detected 97.3% (95% confidence interval [CI], 93.1 to 99.2%) of infected patients with vulvovaginal-swab specimens and 91.8% (86.1 to 95.7%) with urine specimens. We tested 2,749 vulvovaginal-swab specimens with both a nucleic acid amplification test and a polymer conjugate-enhanced enzyme immunoassay with negative-gray-zone testing. The relative sensitivities obtained after retesting specimens in the negative gray zone were 74.3% (95% CI, 62.8 to 83.8%) with PCR and 58.3% (95% CI, 46.1 to 69.8%) with SDA. In community settings, both vulvovaginal-swab and first-catch urine specimens from women are suitable substrates for nucleic acid amplification tests, but enzyme immunoassays, even after negative-gray-zone testing, should not be used in screening programs.

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

Die Frühspezialisierung von Juniorennationalspielern im Fussball: Ein Vergleich zweier Generationen

Einleitung: Die Nachwuchsarbeit im Schweizer Fussball ist seit 1995 stark professionalisiert worden, was sich in den letzten 15 Jahren in mehrere internationale Erfolge niedergeschlagen hat. Im Hinblick auf den sportlichen Erfolg hat sich dabei gezeigt, dass sich die Karrieren der erfolgreichsten Schweizer Spieler, deren Förderung in die ersten Jahre dieser Professionalisierung fällt, bereits in der Sampling Phase (Coté, 1999) durch eine frühe Spezialisierung beschreiben lässt (Zibung & Conzelmann, 2013). Die Trainingsumfänge beinhalten v.a. Clubtraining und viel freies Spiel ausserhalb des Clubs oder fussballnahe andere sportliche Aktivitäten. In diesem Beitrag wird der Frage nachgegangen, inwiefern sich die in den folgenden Jahren nochmals akzentuierte Professionalisierung auf die sportlichen Karrieren der aktuellen Generation von talentierten Fussballspielern ausgewirkt hat. Methode: N = 32 Juniorennationalspieler mit mind. 1 Aufgebot in die U15 oder U16 Nationalmannschaft (Jg. 99; Stichprobe A) werden mit n = 151 ehemaligen Juniorennationalspielern (Jg. 81-87; Stichprobe B aus Zibung & Conzelmann, 2013) in Bezug auf relevante Indikatoren zur Frühspezialisierung verglichen. Dafür wurden die beiden Stichproben in Anlehnung an Zibung und Conzelmann (2013) mittels t-Tests (p < .05) bezüglich folgender Indikatoren für Frühspezialisierung verglichen: Alter beim Beginn freies Fussballspiel und beim ersten Clubeintritt, Trainingsstunden im Club, freies Fussballspiel sowie sportliche Aktivitäten neben dem Fussball (jeweils bis 12-jährig). Die Variablen wurden in beiden Studien retrospektiv per Fragebogen erfasst. Resultate: Die Spieler der jüngeren Generation haben bis 12 Jahre weniger Stunden frei Fussball gespielt (MA = 2016.6, SDA = 1107.1) als die Spieler der älteren Generation (MB = 2535.5, SDB = 1277.3) (t(50.1) = 2.34, p = .02, d = .66). Gleichzeitig haben sie neben dem Fussball weniger andere sportliche Aktivitäten aufzuweisen (t(68.0) = 2.53, p = .01, d = .61). In den Variablen Trainingsstunden im Club (MA = 923.0, SDA = 166.6; MB = 967.0, SDB = 287.1), Alter beim Beginn des freien Fussballspiels (MA = 4.08, SDA = 1.5; MB = 4.36, SDB = 1.2) und beim ersten Clubeintritt (MA = 5.75, SDA = 1.0; MB = 6.07, SDB = 1.3) unterscheiden sich die beiden Stichproben nicht. Diskussion: Der Vergleich der beiden Stichproben zeigt, dass es in den letzten 15 Jahren zu einer Veränderung der Trainingsumfänge von Juniorennationalspielern gekommen ist. Die aktuelle Generation von Juniorennationalspielern spielt neben dem Clubtraining weniger frei Fussball und betreibt aber auch weniger andere Sportarten als die Juniorennationalspieler vor 10-15 Jahren. Ob vermehrte schulische Anforderungen diesen Rückgang in der generellen sportlichen Aktivität verschulden, müsste in der Folge weiter untersucht werden. Ebenso bleibt offen, ob die Einschätzung der Stichprobe B, aufgrund des relativ langen Zeitraums, der zwischen der Erhebung und dem zu erfassenden Zeitraum liegt, zu einer Antwortverzerrung und damit einer Erhöhung der geschätzten Trainingsstunden geführt hat. Literatur: Côté, J. (1999). The influence of the family in the development of talent in sport. The Sport Psychologist, 13 (4), 395–417. Zibung, M. & Conzelmann, A. (2013). The role of specialisation in the promotion of young football talents: A person-oriented study. European Journal of Sport Science, 13 (5), 452–460.