L’efficacité contestée du recours aux agents de santé communautaires pour la prise en charge du paludisme : évaluation du programme burkinabé dans les districts de Kaya et de Zorgho

Contexte. Le paludisme provoque annuellement le décès d’environ 25 000 enfants de moins de cinq ans au Burkina Faso. Afin d’améliorer un accès rapide à des traitements efficaces, les autorités burkinabées ont introduit en 2010 la prise en charge du paludisme par les agents de santé communautaires (ASC). Alors que son efficacité a été démontrée dans des études contrôlées, très peu d’études ont évalué cette stratégie implantée dans des conditions naturelles et à l’échelle nationale. Objectif. L’objectif central de cette thèse est d’évaluer, dans des conditions réelles d’implantation, les effets du programme burkinabé de prise en charge communautaire du paludisme sur le recours aux soins des enfants fébriles. Les objectifs spécifiques sont : (1) de sonder les perceptions des ASC à l’égard du programme et explorer les facteurs contextuels susceptibles d’affecter leur performance ; (2) d’estimer le recours aux ASC par les enfants fébriles et identifier ses déterminants ; (3) de mesurer, auprès des enfants fébriles, le changement des pratiques de recours aux soins induit par l’introduction d’une intervention concomitante – la gratuité des soins dans les centres de santé. Méthodes. L’étude a été conduite dans deux districts sanitaires similaires, Kaya et Zorgho. Le devis d’évaluation combine des volets qualitatifs et quantitatifs. Des entrevues ont été menées avec tous les ASC de la zone à l’étude (N=27). Des enquêtes ont été répétées annuellement entre 2011 et 2013 auprès de 3002 ménages sélectionnés aléatoirement. Les pratiques de recours aux soins de tous les enfants de moins de cinq ans ayant connu un récent épisode de maladie ont été étudiées (N2011=707 ; N2012=787 ; N2013=831). Résultats. Les résultats montrent que le recours aux ASC est très modeste en comparaison de précédentes études réalisées dans des milieux contrôlés. Des obstacles liés à l’implantation du programme de prise en charge communautaire du paludisme ont été identifiés ainsi qu’un défaut de faisabilité dans les milieux urbains. Enfin, l’efficacité du programme communautaire a été négativement affectée par l’introduction de la gratuité dans les centres de santé. Conclusion. La prise en charge communautaire du paludisme rencontre au Burkina Faso des obstacles importants de faisabilité et d’implantation qui compromettent son efficacité potentielle pour réduire la mortalité infantile. Le manque de coordination entre le programme et des interventions locales concomitantes peut générer des effets néfastes et inattendus.

Ist der Ernährungsführerschein eine geeignete Primärpräventionsmaßnahme, um die Ernährungssituation zu verbessern?

Das Ernährungsverhalten einer Bevölkerung hat einen wesentlichen Einfluss auf das Wohlbefinden, die Gesundheit und Leistungsfähigkeit der Menschen. Ernährungsbedingte, chronische Erkrankungen weisen in den westlichen Industrienationen eine hohe Inzidenz und Prävalenz auf. Präventionsmaßnahmen im Setting Schule sollen das Ernährungsverhalten der Kinder- und Jugendlichen positiv beeinflussen. Gerade in diesem Setting können Personen mit unterschiedlichem sozioökonomischem Status, sowie Personen aus diversen Lebensbereichen angesprochen werden. Der Ernährungsführerschein (EFS) ist eine schulbasierte Primärpräventions-maßnahme, der in der 3. Jahrgangsstufe/Grundschule durchgeführt wird. In 6 – 7 Unterrichtseinheiten erfolgt eine praxisnahe Vermittlung von Grundkenntnissen über Ernährung, Lebensmittel und deren Zubereitung. Der EFS möchte eine Verhaltensänderung der Schulkinder bewirken. Sie erlernen Kompetenzen, damit sie in der Lage sind, sich selbst eine gesunde Mahlzeit zubereiten zu können. Aber kann dieses Projekt eine nachhaltige Verhaltensänderung bewirken? Die folgende Studie mit Mixed-Methods-Ansatz im Explanatory-Sequential-Design versucht genau dieser Frage nachzugehen. Auf eine quantitative Prä- und Postbefragung in 16 Klassen an 12 Grundschulen im Landkreis Marburg Biedenkopf und insgesamt 992 Befragungen folgte eine qualitative Studie mit neun problemzentrierten, leitfadengestützten Interviews. Der EFS zeigt keinen signifikanten Einfluss auf die Veränderung des Ernährungsverhaltens. Positiv zu bewerten ist, dass durch den EFS Alltagskompetenzen bei der Nahrungszubereitung gefördert wurden. Dieser positive Einfluss muss jedoch differenziert betrachtet werden, denn die qualitativen Studie zeigt, dass der EFS sehr gut in Familien aufgenommen wird, die sich bereits mit Ernährungsfragen auseinandersetzen und darauf achten, einen ernährungsphysiologisch günstigen Ernährungsstil zu leben oder anzustreben. In Familien der Billig- und Fleischesser konnte der EFS die Türen nicht öffnen. Aber gerade in diesem Segment wäre eine Veränderung des Essverhaltens induziert. Die Untersuchung ergab, dass der EFS für sich alleine nicht den Anspruch erheben kann, die Ernährungssituation der Kinder und Familien zu verbessern. Aber er bietet ein methodisch-didaktisch gut ausgearbeitetes Konzept und könnte als Baustein in die Entwicklung eines praxisnahen, erlebnisorientierten und ganzheitlichen Ernährungsbildungskonzepts unter Berücksichtigung diverser Settings und Lebenswelten der Kinder und Familien einfließen.

COMP6049 Approaching Surveys - Purpose, Paradigms Protocols and Pragmatics

An introduction for students intending to design and conduct a survey. This is the prelude to a practical group activity.

Hypothesis Testing

PowerPoint slides for Hypothesis Testing. Examples are taken from the Medical Literature

Confidence Intervals

PowerPoint slides for Confidence Intervals. Examples are taken from the Medical Literature

Academic Integrity

PowerPoint slides for talk on Academic Integrity. Examples are taken from the Medical Literature. Reference is made to the University's Academic Integrity Statement. A quiz using Zappers is included in the presentation.

Las interacciones organizacionales desde la visión ecológica: el mutualismo

No es requerido en este caso

La educación secundaria y sus dos dimensiones, efectos del barrio y del colegio sobre los resultados saber 11.

Resumen: Este trabajo estudia los resultados en matemáticas y lenguaje de 32000 estudiantes en la prueba saber 11 del 2008, de la ciudad de Bogotá. Este análisis reconoce que los individuos se encuentran contenidos en barrios y colegios, pero no todos los individuos del mismo barrio asisten a la misma escuela y viceversa. Con el fin de modelar esta estructura de datos se utilizan varios modelos econométricos, incluyendo una regresión jerárquica multinivel de efectos cruzados. Nuestro objetivo central es identificar en qué medida y que condiciones del barrio y del colegio se correlacionan con los resultados educacionales de la población objetivo y cuáles características de los barrios y de los colegios están más asociadas al resultado en las pruebas. Usamos datos de la prueba saber 11, del censo de colegios c600, del censo poblacional del 2005 y de la policía metropolitana de Bogotá. Nuestras estimaciones muestran que tanto el barrio como el colegio están correlacionados con los resultados en las pruebas; pero el efecto del colegio parece ser mucho más fuerte que el del barrio. Las características del colegio que están más asociadas con el resultado en las pruebas son la educación de los profesores, la jornada, el valor de la pensión, y el contexto socio económico del colegio. Las características de los barrios más asociadas con el resultado en las pruebas son, la presencia de universitarios en la UPZ, un clúster de altos niveles de educación y nivel de crimen en el barrio que se correlaciona negativamente. Los resultados anteriores fueron hallados teniendo en cuenta controles familiares y personales.

A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample

Background: High rates of co-morbidity between Generalized Social Phobia (GSP) and Generalized Anxiety Disorder (GAD) have been documented. The reason for this is unclear. Family studies are one means of clarifying the nature of co-morbidity between two disorders. Methods: Six models of co-morbidity between GSP and GAD were investigated in a family aggregation study of 403 first-degree relatives of non-clinical probands: 37 with GSP, 22 with GAD, 15 with co-morbid GSP/GAD, and 41 controls with no history of GSP or GAD. Psychiatric data were collected for probands and relatives. Mixed methods (direct and family history interviews) were utilised. Results: Primary contrasts (against controls) found an increased rate of pure GSP in the relatives of both GSP probands and co-morbid GSP/GAD probands, and found relatives of co-morbid GSP/GAD probands to have an increased rate of both pure GAD and comorbid GSP/GAD. Secondary contrasts found (i) increased GSP in the relatives of GSP only probands compared to the relatives of GAD only probands; and (ii) increased GAD in the relatives of co-morbid GSP/GAD probands compared to the relatives of GSP only probands. Limitations: The study did not directly interview all relatives, although the reliability of family history data was assessed. The study was based on an all-female proband sample. The implications of both these limitations are discussed. Conclusions: The results were most consistent with a co-morbidity model indicating independent familial transmission of GSP and GAD. This has clinical implications for the treatment of patients with both disorders. (C) 2006 Elsevier B.V. All fights reserved.

Evaluation of agri-environmental and forestry schemes with multiple objectives

The evaluation of EU policy in the area of rural land use management often encounters problems of multiple and poorly articulated objectives. Agri-environmental policy has a range of aims, including natural resource protection, biodiversity conservation and the protection and enhancement of landscape quality. Forestry policy, in addition to production and environmental objectives, increasingly has social aims, including enhancement of human health and wellbeing, lifelong learning, and the cultural and amenity value of the landscape. Many of these aims are intangible, making them hard to define and quantify. This article describes two approaches for dealing with such situations, both of which rely on substantial participation by stakeholders. The first is the Agri-Environment Footprint Index, a form of multi-criteria participatory approach. The other, applied here to forestry, has been the development of ‘multi-purpose’ approaches to evaluation, which respond to the diverse needs of stakeholders through the use of mixed methods and a broad suite of indicators, selected through a participatory process. Each makes use of case studies and involves stakeholders in the evaluation process, thereby enhancing their commitment to the programmes and increasing their sustainability. Both also demonstrate more ‘holistic’ approaches to evaluation than the formal methods prescribed in the EU Common Monitoring and Evaluation Framework.

Messages about antibiotic resistance in different newspaper genres

Poorer people are more likely to use antibiotics; inappropriate antibiotic use causes resistance, and health campaigns attempt to change behaviour through education. However, fuelled by the media, the public think antibiotic resistance is outside their control. Differences in the attribution of blame for antibiotic resistance in two genres of UK newspapers, targeting distinct socioeconomic groups, were examined using a mixed methods approach. Firstly, depiction of blame was categorised as either external to the lay public (outside their control) or internal (lay person accountable) and subjected to a chi-square test. Secondly, using critical discourse analysis, we examined the portrayal of the main agents through newspaper language. Data from 597 articles (307 broadsheets) analysed revealed a significant association between newspaper genre and attribution of blame for antibiotic resistance. While both newspaper types blamed antibiotic resistance predominantly on factors external to the lay public, broadsheets were more likely to acknowledge internal factors than tabloids. Tabloids provided a more skewed representation, exposing readers to inaccurate explanations about antibiotic resistance. They highlighted ineptitude in health professionals, victimising patients and blaming others, while broadsheets used less emotive language. Pharmacists should take special care to communicate the importance of appropriate antibiotic use against this backdrop of distortion.

Globalisation and MA TESOL programs in the UK

This article reports the results of a mixed-methods approach to investigating the association between globalisation and MATESOL in UK universities. Qualitative and quantitative data collected from academic staff through eight emails, four interviews and 41 questionnaires indicate that the globalised context of higher education have affected these programmes in a number of ways including an increasing interest in recruiting more international students and a growing awareness about the need for curriculum and content modifications. The analysis of the data suggests that although change has been an inherent characteristic of these MAs over the past decade, it has been implemented gradually and conservatively, often relying on a dialectic relationship between academic staff and universities’ policies. The results imply that factors other than globalisation have also been at work. Many of the participants contend that globalisation has not lowered the quality of these MAs or standards of good practice.

Guides of the Falu Mine : Perceptions of Differences and Similarities onDomestic and International Visitors

Industrial heritage tourism has been in focus for many academic studies and tourism is an alternative developmental tool for mines and contributes to their economic success. This thesis is about the Falu Mine in Dalarna, Sweden, which has World Heritage status since 2001 and is one of the biggest attractions in the region. Its history and cultural importance are reasons for the importance of preserving the heritage. The Falu Mine is under the management of the Great Copper Mountain Trust and one of their ambitions is to ensure the continuous popularity among domestic and international visitors. In order to gain a better understanding of the visitors and to find strategies to improve performance, a visitor survey has been conducted in the summer of 2011. It is the authors believe that the guides of the Falu Mine have the best available insight and that their perceptions help to add to the understanding about the visitors. Therefore, this thesis aims to explore the perceptions of the guides about their visitors, to investigate how the perceptions correspond to the statistical results and to study if there are any differences between domestic and international visitors. The mixed methods approach will increase the depth and accuracy of the results, by linking qualitative with quantitative data. The results show that differences between domestic and international visitors exist, both proven by interviews with the guides and the visitor survey. These differences occur in the factors, such as level of education of the visitors, group size and number of children in the group, knowledge of the visitors prior to and after the visit, sources of information and the fulfillment of the visitor expectations. The perceptions emphasize how these differences impact the guided tours. The guides of the Falu Mine have to be aware of those differences in order to adjust the tour accordingly, as well as the management of the Falu Mine can use this knowledge in order to identify strategies for improving performance.

Existential issues in surgical care : Nurses’ experiences and attitudes in caring for patients with cancer

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.