Challenges to the implementation of behavioural survellance for HIV/STI in Europe

Background: Well-conducted behavioural surveillance (BS) is essential for policy planning and evaluation. Data should be comparable across countries. In 2008, the European Centre for Disease Prevention and Control (ECDC) began a programme to support Member States in the implementation of BS for Second Generation Surveillance. Methods: Data from a mapping exercise on current BS activities in EU/EFTA countries led to recommendations for establishing national BS systems and international coordination, and the definition of a set of core and transversal (UNGASS-Dublin compatible) indicators for BS in the general and eight specific populations. A toolkit for establishing BS has been developed and a BS needs-assessment survey has been launched in 30 countries. Tools for BS self-assessment and planning are currently being tested during interactive workshops with country representatives. Results: The mapping exercise revealed extreme diversity between countries. Around half had established a BS system, but this did not always correspond to the epidemiological situation. Challenges to implementation and harmonisation at all levels emerged from survey findings and workshop feedback. These include: absence of synergy between biological and behavioural surveillance and of actors having an overall view of all system elements; lack of awareness of the relevance of BS and of coordination between agencies; insufficient use of available data; financial constraints; poor sustainability, data quality and access to certain key populations; unfavourable legislative environments. Conclusions: There is widespread need in the region not only for technical support but also for BS advocacy: BS remains the neglected partner of second generation surveillance and requires increased political support and capacity-building in order to become effective. Dissemination of validated tools for BS, developed in interaction with country experts, proves feasible and acceptable.

From protein sequences to 3D-structures and beyond: the example of the UniProt knowledgebase.

With the dramatic increase in the volume of experimental results in every domain of life sciences, assembling pertinent data and combining information from different fields has become a challenge. Information is dispersed over numerous specialized databases and is presented in many different formats. Rapid access to experiment-based information about well-characterized proteins helps predict the function of uncharacterized proteins identified by large-scale sequencing. In this context, universal knowledgebases play essential roles in providing access to data from complementary types of experiments and serving as hubs with cross-references to many specialized databases. This review outlines how the value of experimental data is optimized by combining high-quality protein sequences with complementary experimental results, including information derived from protein 3D-structures, using as an example the UniProt knowledgebase (UniProtKB) and the tools and links provided on its website ( http://www.uniprot.org/ ). It also evokes precautions that are necessary for successful predictions and extrapolations.

Public-health and individual approaches to antiretroviral therapy: township South Africa and Switzerland compared.

BACKGROUND: The provision of highly active antiretroviral therapy (HAART) in resource-limited settings follows a public health approach, which is characterised by a limited number of regimens and the standardisation of clinical and laboratory monitoring. In industrialized countries doctors prescribe from the full range of available antiretroviral drugs, supported by resistance testing and frequent laboratory monitoring. We compared virologic response, changes to first-line regimens, and mortality in HIV-infected patients starting HAART in South Africa and Switzerland. METHODS AND FINDINGS: We analysed data from the Swiss HIV Cohort Study and two HAART programmes in townships of Cape Town, South Africa. We included treatment-naïve patients aged 16 y or older who had started treatment with at least three drugs since 2001, and excluded intravenous drug users. Data from a total of 2,348 patients from South Africa and 1,016 patients from the Swiss HIV Cohort Study were analysed. Median baseline CD4+ T cell counts were 80 cells/mul in South Africa and 204 cells/mul in Switzerland. In South Africa, patients started with one of four first-line regimens, which was subsequently changed in 514 patients (22%). In Switzerland, 36 first-line regimens were used initially, and these were changed in 539 patients (53%). In most patients HIV-1 RNA was suppressed to 500 copies/ml or less within one year: 96% (95% confidence interval [CI] 95%-97%) in South Africa and 96% (94%-97%) in Switzerland, and 26% (22%-29%) and 27% (24%-31%), respectively, developed viral rebound within two years. Mortality was higher in South Africa than in Switzerland during the first months of HAART: adjusted hazard ratios were 5.90 (95% CI 1.81-19.2) during months 1-3 and 1.77 (0.90-3.50) during months 4-24. CONCLUSIONS: Compared to the highly individualised approach in Switzerland, programmatic HAART in South Africa resulted in similar virologic outcomes, with relatively few changes to initial regimens. Further innovation and resources are required in South Africa to both achieve more timely access to HAART and improve the prognosis of patients who start HAART with advanced disease.

Information retention during competitive interactions : siblings need to constantly repeat vocal displays

Memory is essential to adjust behaviour according to past experience. In societies where animals interact on numerous occasions, memory of previous social interactions may help optimise investment in competition. How long information about the resource holding potential and motivation to compete of conspecifics is retained depends on how fast the value of this information fades, but also on the cost and benefit of retaining information. Information retention has never been investigated in the context of interactions prevailing within the family and more specifically sibling competition. In the absence of parents, barn owl (Tyto alba) nestlings vocally compete for priority of access to the next indivisible food item brought by a parent. The finding that owlets eavesdrop on vocal interactions between siblings to adjust investment in vocalization once competing with them suggests that they memorize siblings' vocal interactions. Playback experiments showed that owlets take into account the past siblings' vocal performance that signals hunger for at least 15 min, but only if the performance was witnessed during a sufficiently long period of time (30 min). Moreover, using natural vocal exchanges in another set of individuals, we showed that sibling signalling was no more taken into account after a few minutes. This suggests that young barn owls need to continuously display their motivation to trigger siblings' withdrawal from the current competition. Repeating a vocal display may ensure its honesty. Studying the extent to which individuals retain past information is important to understand how individuals adjust their competitive investment over resources.

Mephedrone pharmacokinetics after intravenous and oral administration in rats: relation to pharmacodynamics

Rationale Mephedrone (4-methylmethcathinone) is a still poorly known drug of abuse, alternative to ecstasy or cocaine. Objective The major aims were to investigate the pharmacokineticsa and locomotor activity of mephedrone in rats and provide a pharmacokinetic/pharmacodynamic model. Methods Mephedrone was administered to male SpragueDawley rats intravenously (10 mg/kg) and orally (30 and 60 mg/kg). Plasma concentrations and metabolites were characterized using LC/MS and LC-MS/MS fragmentation patterns. Locomotor activity was monitored for 180240 min. Results Mephedrone plasma concentrations after i.v. administration fit a two-compartment model (α=10.23 h−1, β=1.86 h−1). After oral administration, peak mephedrone concentrations were achieved between 0.5 and 1 h and declined to undetectable levels at 9 h. The absolute bioavailability of mephedrone was about 10 % and the percentage of mephedrone protein binding was 21.59±3.67%. We have identified five phase I metabolites in rat blood after oral administration. The relationship between brain levels and free plasma concentration was 1.85±0.08. Mephedrone induced a dose-dependent increase in locomotor activity, which lasted up to 2 h. The pharmacokineticpharmacodynamic model successfully describes the relationship between mephedrone plasma concentrations and its psychostimulant effect. Conclusions We suggest a very important first-pass effect for mephedrone after oral administration and an easy access to the central nervous system. The model described might be useful in the estimation and prediction of the onset, magnitude,and time course of mephedrone pharmacodynamics as well as to design new animal models of mephedrone addiction and toxicity.

Database Rights in Safe European Home: The Path to More Rigorous Protection of Information

1. Introduction "The one that has compiled ... a database, the collection, securing the validity or presentation of which has required an essential investment, has the sole right to control the content over the whole work or over either a qualitatively or quantitatively substantial part of the work both by means of reproduction and by making them available to the public", Finnish Copyright Act, section 49.1 These are the laconic words that implemented the much-awaited and hotly debated European Community Directive on the legal protection of databases,2 the EDD, into Finnish Copyright legislation in 1998. Now in the year 2005, after more than half a decade of the domestic implementation it is yet uncertain as to the proper meaning and construction of the convoluted qualitative criteria the current legislation employs as a prerequisite for the database protection both in Finland and within the European Union. Further, this opaque Pan-European instrument has the potential of bringing about a number of far-reaching economic and cultural ramifications, which have remained largely uncharted or unobserved. Thus the task of understanding this particular and currently peculiarly European new intellectual property regime is twofold: first, to understand the mechanics and functioning of the EDD and second, to realise the potential and risks inherent in the new legislation in economic, cultural and societal dimensions. 2. Subject-matter of the study: basic issues The first part of the task mentioned above is straightforward: questions such as what is meant by the key concepts triggering the functioning of the EDD such as presentation of independent information, what constitutes an essential investment in acquiring data and when the reproduction of a given database reaches either qualitatively or quantitatively the threshold of substantiality before the right-holder of a database can avail himself of the remedies provided by the statutory framework remain unclear and call for a careful analysis. As for second task, it is already obvious that the practical importance of the legal protection providedby the database right is in the rapid increase. The accelerating transformationof information into digital form is an existing fact, not merely a reflection of a shape of things to come in the future. To take a simple example, the digitisation of a map, traditionally in paper format and protected by copyright, can provide the consumer a markedly easier and faster access to the wanted material and the price can be, depending on the current state of the marketplace, cheaper than that of the traditional form or even free by means of public lending libraries providing access to the information online. This also renders it possible for authors and publishers to make available and sell their products to markedly larger, international markets while the production and distribution costs can be kept at minimum due to the new electronic production, marketing and distributionmechanisms to mention a few. The troublesome side is for authors and publishers the vastly enhanced potential for illegal copying by electronic means, producing numerous virtually identical copies at speed. The fear of illegal copying canlead to stark technical protection that in turn can dampen down the demand for information goods and services and furthermore, efficiently hamper the right of access to the materials available lawfully in electronic form and thus weaken the possibility of access to information, education and the cultural heritage of anation or nations, a condition precedent for a functioning democracy. 3. Particular issues in Digital Economy and Information Networks All what is said above applies a fortiori to the databases. As a result of the ubiquity of the Internet and the pending breakthrough of Mobile Internet, peer-to-peer Networks, Localand Wide Local Area Networks, a rapidly increasing amount of information not protected by traditional copyright, such as various lists, catalogues and tables,3previously protected partially by the old section 49 of the Finnish Copyright act are available free or for consideration in the Internet, and by the same token importantly, numerous databases are collected in order to enable the marketing, tendering and selling products and services in above mentioned networks. Databases and the information embedded therein constitutes a pivotal element in virtually any commercial operation including product and service development, scientific research and education. A poignant but not instantaneously an obvious example of this is a database consisting of physical coordinates of a certain selected group of customers for marketing purposes through cellular phones, laptops and several handheld or vehicle-based devices connected online. These practical needs call for answer to a plethora of questions already outlined above: Has thecollection and securing the validity of this information required an essential input? What qualifies as a quantitatively or qualitatively significant investment? According to the Directive, the database comprises works, information and other independent materials, which are arranged in systematic or methodical way andare individually accessible by electronic or other means. Under what circumstances then, are the materials regarded as arranged in systematic or methodical way? Only when the protected elements of a database are established, the question concerning the scope of protection becomes acute. In digital context, the traditional notions of reproduction and making available to the public of digital materials seem to fit ill or lead into interpretations that are at variance with analogous domain as regards the lawful and illegal uses of information. This may well interfere with or rework the way in which the commercial and other operators have to establish themselves and function in the existing value networks of information products and services. 4. International sphere After the expiry of the implementation period for the European Community Directive on legal protection of databases, the goals of the Directive must have been consolidated into the domestic legislations of the current twenty-five Member States within the European Union. On one hand, these fundamental questions readily imply that the problemsrelated to correct construction of the Directive underlying the domestic legislation transpire the national boundaries. On the other hand, the disputes arisingon account of the implementation and interpretation of the Directive on the European level attract significance domestically. Consequently, the guidelines on correct interpretation of the Directive importing the practical, business-oriented solutions may well have application on European level. This underlines the exigency for a thorough analysis on the implications of the meaning and potential scope of Database protection in Finland and the European Union. This position hasto be contrasted with the larger, international sphere, which in early 2005 does differ markedly from European Union stance, directly having a negative effect on international trade particularly in digital content. A particular case in point is the USA, a database producer primus inter pares, not at least yet having aSui Generis database regime or its kin, while both the political and academic discourse on the matter abounds. 5. The objectives of the study The above mentioned background with its several open issues calls for the detailed study of thefollowing questions: -What is a database-at-law and when is a database protected by intellectual property rights, particularly by the European database regime?What is the international situation? -How is a database protected and what is its relation with other intellectual property regimes, particularly in the Digital context? -The opportunities and threats provided by current protection to creators, users and the society as a whole, including the commercial and cultural implications? -The difficult question on relation of the Database protection and protection of factual information as such. 6. Dsiposition The Study, in purporting to analyse and cast light on the questions above, is divided into three mainparts. The first part has the purpose of introducing the political and rationalbackground and subsequent legislative evolution path of the European database protection, reflected against the international backdrop on the issue. An introduction to databases, originally a vehicle of modern computing and information andcommunication technology, is also incorporated. The second part sets out the chosen and existing two-tier model of the database protection, reviewing both itscopyright and Sui Generis right facets in detail together with the emergent application of the machinery in real-life societal and particularly commercial context. Furthermore, a general outline of copyright, relevant in context of copyright databases is provided. For purposes of further comparison, a chapter on the precursor of Sui Generi, database right, the Nordic catalogue rule also ensues. The third and final part analyses the positive and negative impact of the database protection system and attempts to scrutinize the implications further in the future with some caveats and tentative recommendations, in particular as regards the convoluted issue concerning the IPR protection of information per se, a new tenet in the domain of copyright and related rights.

Essential surgery: the way forward.

INTRODUCTION: Very little surgical care is performed in low- and middle-income countries (LMICs). An estimated two billion people in the world have no access to essential surgical care, and non-surgeons perform much of the surgery in remote and rural areas. Surgical care is as yet not recognized as an integral aspect of primary health care despite its self-demonstrated cost-effectiveness. We aimed to define the parameters of a public health approach to provide surgical care to areas in most need. METHODS: Consensus meetings were held, field experience was collected via targeted interviews, and a literature review on the current state of essential surgical care provision in Sub-Saharan Africa (SSA) was conducted. Comparisons were made across international recommendations for essential surgical interventions and a consensus-driven list was drawn up according to their relative simplicity, resource requirement, and capacity to provide the highest impact in terms of averted mortality or disability. RESULTS: Essential Surgery consists of basic, low-cost surgical interventions, which save lives and prevent life-long disability or life-threatening complications and may be offered in any district hospital. Fifteen essential surgical interventions were deduced from various recommendations from international surgical bodies. Training in the realm of Essential Surgery is narrow and strict enough to be possible for non-physician clinicians (NPCs). This cadre is already active in many SSA countries in providing the bulk of surgical care. CONCLUSION: A basic package of essential surgical care interventions is imperative to provide structure for scaling up training and building essential health services in remote and rural areas of LMICs. NPCs, a health cadre predominant in SSA, require training, mentoring, and monitoring. The cost of such training is vastly more efficient than the expensive training of a few polyvalent or specialist surgeons, who will not be sufficient in numbers within the next few generations. Moreover, these practitioners are used to working in the districts and are much less prone to gravitate elsewhere. The use of these NPCs performing "Essential Surgery" is a feasible route to deal with the almost total lack of primary surgical care in LMICs.

Mephedrone pharmacokinetics after intravenous and oral administration in rats: relation to pharmacodynamics

Rationale Mephedrone (4-methylmethcathinone) is a still poorly known drug of abuse, alternative to ecstasy or cocaine. Objective The major aims were to investigate the pharmacokineticsa and locomotor activity of mephedrone in rats and provide a pharmacokinetic/pharmacodynamic model. Methods Mephedrone was administered to male Sprague-Dawley rats intravenously (10 mg/kg) and orally (30 and 60 mg/kg). Plasma concentrations and metabolites were characterized using LC/MS and LC-MS/MS fragmentation patterns. Locomotor activity was monitored for 180-240 min. Results Mephedrone plasma concentrations after i.v. administration fit a two-compartment model (α=10.23 h−1, β=1.86 h−1). After oral administration, peak mephedrone concentrations were achieved between 0.5 and 1 h and declined to undetectable levels at 9 h. The absolute bioavailability of mephedrone was about 10 % and the percentage of mephedrone protein binding was 21.59±3.67%. We have identified five phase I metabolites in rat blood after oral administration. The relationship between brain levels and free plasma concentration was 1.85±0.08. Mephedrone induced a dose-dependent increase in locomotor activity, which lasted up to 2 h. The pharmacokinetic-pharmacodynamic model successfully describes the relationship between mephedrone plasma concentrations and its psychostimulant effect. Conclusions We suggest a very important first-pass effect for mephedrone after oral administration and an easy access to the central nervous system. The model described might be useful in the estimation and prediction of the onset, magnitude,and time course of mephedrone pharmacodynamics as well as to design new animal models of mephedrone addiction and toxicity.

Chemical profiling: a tool to decipher the structure and organisation of illicit drugs markets: an 8-year study in Western Switzerland

Illicit drug analyses usually focus on the identification and quantitation of questioned material to support the judicial process. In parallel, more and more laboratories develop physical and chemical profiling methods in a forensic intelligence perspective. The analysis of large databases resulting from this approach enables not only to draw tactical and operational intelligence, but may also contribute to the strategic overview of drugs markets. In Western Switzerland, the chemical analysis of illicit drug seizures is centralised in a laboratory hosted by the University of Lausanne. For over 8 years, this laboratory has analysed 5875 cocaine and 2728 heroin specimens, coming from respectively 1138 and 614 seizures operated by police and border guards or customs. Chemical (major and minor alkaloids, purity, cutting agents, chemical class), physical (packaging and appearance) as well as circumstantial (criminal case number, mass of drug seized, date and place of seizure) information are collated in a dedicated database for each specimen. The study capitalises on this extended database and defines several indicators to characterise the structure of drugs markets, to follow-up on their evolution and to compare cocaine and heroin markets. Relational, spatial, temporal and quantitative analyses of data reveal the emergence and importance of distribution networks. They enable to evaluate the cross-jurisdictional character of drug trafficking and the observation time of drug batches, as well as the quantity of drugs entering the market every year. Results highlight the stable nature of drugs markets over the years despite the very dynamic flows of distribution and consumption. This research work illustrates how the systematic analysis of forensic data may elicit knowledge on criminal activities at a strategic level. In combination with information from other sources, such knowledge can help to devise intelligence-based preventive and repressive measures and to discuss the impact of countermeasures.

A questão da inovação em fármacos no Brasil: proposta de criação do programa nacional de fármacos (Pronfar)

Medicines are essential instruments to the preservation, maintenance and promotion of Health. The access to the medicine represents an important factor of social inclusion, depending on the availability of the pharmaceutical - active principle contained in the medicine that in 85% of the cases has a synthetic origin. In this scenario the importance of knowing how to make pharmaceuticals and medicines plays a significant role for the viability of the autonomous Health politics necessary for the demands of the major Nations. In this context, this work describes concisely the main aspects involved in the interdisciplinary drug discovery process, identifying the possible gorges for the successful development of innovative drugs in Brazil.

Addressing Adherence to Antiretroviral Therapy in Ouagadougou, Burkina Faso: Insights from hospital ethnography

L'épidémie de l'infection au virus de l'immunodéficience humaine (VIH) constitue une crise majeure en santé publique de nos jours. Les efforts de la communauté internationale visent à rendre les traitements antirétroviraux (TARV) plus accessibles aux personnes vivant avec le VIH, particulièrement dans les contextes à ressources limitées. Une observance quasi-parfaite aux TARV est requise pour tirer le maximum de bénéfices thérapeutiques à l'échelle individuelle et à l'échelle populationnelle. Cependant, l’accroissement de la disponibilité des TARV s'effectue dans des pays africains qui disposent de systèmes de santé fragiles et sous-financés. Ceux-ci souffrent également d'une pénurie de personnel de santé, lequel joue un rôle central dans la mise en oeuvre et la pérennité des interventions, notamment celle du soutien à l'observance thérapeutique. La présente étude ethnographique relate l'expérience de personnel de santé dans la fourniture des services de soutien à l'observance dans un contexte de ressources limitées et d'accroissement de l'accès aux TARV. L'étude a été menée dans deux centres hospitaliers de la capitale du Burkina Faso, Ouagadougou. Trois conclusions principales sont mises au jour. Tout d'abord, une bonne organisation – tant logistique que matérielle – dans la provision de services de soutien à l'observance est capitale. L’infrastructure d’observance doit aller au-delà des unités de prise en charge et s’intégrer au sein du système de santé pour assurer un impact durable. De plus, la provision des TARV dans le cadre d'une prise en charge médicale exhaustive est essentielle pour un soutien à l'observance efficace. Ceci implique la présence de professionnelles de santé en nombre suffisant et disposant d‘outils pour soutenir leur pratique clinique (tests de laboratoire, traitements pour infections opportunistes), ainsi que des mécanismes pour leur permettre d’aider les patients à gérer la vie quotidienne (gratuité des services, programmes d’alphabétisation et soutien psychosociale). Enfin, une amélioration de la coordination des programmes VIH au niveau national et international est nécessaire pour assurer une prise en charge cohérente au niveau local. La programmation conçue dans les pays étrangers qui est incomplète et de courte durée a un impact majeur sur la disponibilité de ressources humaines et matérielles à long terme, ainsi que sur les conditions de travail et de prestation de services dans les unités de soins.

Introduction: Working in Development Ethics – a tribute to Denis Goulet

Denis Goulet (1931-2006) was probably the main founder of work on ‘development ethics’ as a self-conscious field that treats the ethical and value questions posed by development theory, planning and practice. This overview of a selection of papers presented at a conference of the International Development Ethics Association (Uganda, 2006) surveys Goulet’s work and compares it with issues and approaches in the selected papers. Ideas raised by Goulet provide a framework for discussing the set of papers, which especially consider corruption, professional ethics and the rights to water and essential drugs. The papers in turn provide a basis for comparing Goulet’s ideas with actual directions of work on development ethics. Rather than as a separate sub-discipline, development ethics takes shape as an interdisciplinary meeting place, aided though by the profile and intellectual space that Goulet strikingly strove to build for it.

Un portrait du trafic de drogues fait par les membres de gangs de rue à Montréal

L’image qu’a la population du phénomène des gangs est fortement influencée par les médias. Les informations véhiculées par les journaux et par les canaux de nouvelles mettent généralement l’emphase sur les stéréotypes associés aux gangs et aux comportements de ces derniers. Ceci a pour conséquence de rehausser la crainte que développe la population à l’endroit des gangs de rue. Dans un contexte où le phénomène des gangs paraît devenu omniprésent dans nos quartiers, nos villes et représente une problématique en expansion dans plusieurs grandes villes du Québec et du Canada, une attention particulière portée au trafic de drogues fait par les membres de gangs de rue, reconnu par plusieurs comme la principale activité des gangs de rue, revêt sans nul doute un grand intérêt. Obtenir la description la plus précise possible, faite par des membres ou d’ex-membres de gangs de rue, à partir de leurs connaissances concernant le trafic de drogues étant donné leur appartenance et leur implication dans les activités d’un gang de rue et, le cas échéant, le trafic de drogues effectué par ce dernier, représente l’objectif principal de la présente étude. C’est par le biais d’entrevues avec les principaux concernés que le trafic de drogues fait par les membres de gangs est abordé. Au total, quinze entrevues semi-directives ont été réalisées auprès de membres et ex-membres de gangs de rue, tous – à une exception près - pris en charge au Centre jeunesse de Montréal-Institut universitaire. Globalement, il ressort de cette étude qu’en plus du trafic de stupéfiants, les gangs ou les membres de gangs s’adonneraient à une délinquance polymorphe, le trafic étant rarement l’unique source de revenus du gang ou du membre. De plus, le trafic de stupéfiants ne serait pas une activité exclusive aux gangs de rue auxquels appartiennent les membres interviewés. Ainsi, même si l’on retrouve un certain nombre de membres participant à la vente comme activité structurée d’un gang, il est possible pour un membre d’effectuer de la vente de drogues de façon indépendante, tout en étant affilié à un gang de rue. Il appert que la plupart des interviewés font partie d’une clique, s’identifient à une couleur ou à un quartier, et s’approvisionnent en drogues auprès de membres plus âgés et hauts placés dans la structure des gangs de rue, que les répondants identifient comme étant les vétérans. En ce qui les concerne, les répondants signalent l’importance de gagner la confiance des plus haut placés s’ils souhaitent débuter et évoluer dans la vente de stupéfiants. Lorsque la confiance est présente et que le nouveau vendeur débute ses activités, soit il s’approprie un territoire, généralement à l’intérieur de son quartier, soit on lui fournit un endroit de vente où il peut « travailler ». La présence d’un membre de la famille déjà affilié à un gang paraît faciliter le processus d’accès des nouveaux à l’activité de trafic. Lorsque les interviewés abordent l’aspect du territoire de vente, plusieurs dimensions viennent s’y greffer : la compétition, les conflits, les interactions avec les gangs ennemis et la violence, pour ne nommer que celles-là. Les interviewés indiquent vendre une certaine variété de drogues, le cannabis et le crack représentant les deux drogues les plus couramment citées. La marge de profits varierait, entre autres, en fonction du type de drogue vendue, du quartier et des caractéristiques de la clientèle. Cette dernière, malgré qu’elle soit diversifiée, comporte une constante : les consommateurs dépendants sont, comme plusieurs interviewés l’ont mentionné, prêts à tout pour assurer leur consommation. Les consommateurs sont ordinairement des étudiants, des propriétaires de commerces, des employés de bars, des travailleurs de la construction, des itinérants, des prostitués, des fêtards, des voyageurs de passage à Montréal. Les répondants dénotent également la présence de policiers, agents doubles, pouvant se présenter comme clients. Ceci étant, il leur apparaît essentiel de développer des habiletés permettant de détecter la présence policière et la distinguer des clients réguliers. Côté consommation, les interviewés affirment se limiter presqu’essentiellement à l’alcool et au cannabis. Néanmoins, plusieurs avouent avoir consommé une grande variété d’intoxicants au cours de leur vie. Plusieurs signalent qu’une trop grande consommation nuit à la vente de stupéfiants.

L’exemption de paiement des soins associée à la supervision et à la formation au Burkina Faso : les effets sur la prescription de médicaments

L’accès financier limité aux soins de santé a suscité l’instauration de politiques sanitaires de subvention des soins en Afrique. Au Burkina Faso, une ONG, en complémentarité avec la politique sanitaire nationale subventionne à 100% depuis septembre 2008 les soins et les médicaments pour les enfants de moins de cinq ans dans le district sanitaire de Dori. L’intervention regroupe formation du personnel soignant, supervisions et suppression de paiement des soins et des médicaments. L’objectif de l’étude est d’analyser l’effet de cette intervention sur l’adéquation des prescriptions médicales. Neuf centres de santé ont été pris en compte. Au total 14956 ordonnances d’enfants de moins de cinq ans ciblés par l’intervention ont été sélectionnées par échantillonnage systématique à partir des registres de consultation un an avant et un an après l’instauration de l’intervention. Quatorze prescripteurs ont été interviewés. Les prescriptions ont été analysées par comparaison au référentiel de l’OMS ainsi qu’au référentiel national. Le discours des prescripteurs a été analysé en vue de comprendre leur perception de leur changement de pratiques depuis de début de la subvention. L’intervention a eu pour effet de diminuer l’utilisation des injections (Rapport de cote (RC) =0,28; p<0,005) dans le cas des infections respiratoires aiguës (IRA). Elle a entraîné une diminution de l’utilisation inappropriée des antibiotiques dans les cas de paludisme seul (RC=0,48; p<0,0005). Le nombre moyen de médicaments par ordonnance a également diminué de 14% dans les cas d’IRA (p<0,0005). Les prescripteurs ont affirmé pour la plupart que leurs pratiques se sont soit maintenues soit améliorées. L’intervention a entrainé une amélioration de l’adéquation des prescriptions médicales dans certains cas.

Allergy Refugees: Should They Stay or Should They Go?

Étude de cas / Case study