[Evaluation of a medical teaching programme in public health in Laos]. / Evaluation du programme d'enseignement médical en santé publique 2002-2004 au Laos.

Specialised medical training is progressively being established in Laos at the request of the Ministry of Health. A medical teaching programme in public health has been organised by the Cooperation Committee with Laos (CCL) in collaboration with the National Institute for Public Health (INSP) and has been taking place since 1997 within the framework of Franco-Laos cooperation. At the end of the validation of the second promotion of senior medical management staff (2002-2004) and of the presentation of the first Masters in Public Health in Laos, an evaluation of this training programme was carried out with the aim of completely transferring the project over to the hands of the Laotians. The study consisted of a before and after comparison of the training's procedural criteria and a longitudinal prospective survey over the last seven months of the programme. The results of the evaluation show that the development of the training conforms to the initial project and that the knowledge acquired in public health methodology by the 12 students is satisfactory. The use of the French language was revealed as being a difficult challenge to overcome for most of the students. Moreover, the partners in Laos had a difficult time playing their role in certain organisational and educational aspects of the training programme. It would be desirable, within the perspective of establishing a Masters of Public Health in Laotian, to establish a partnership between the National Institute of Public Health (INSP) and the Faculty of Medical Sciences (FSM) to work together on the organisation of the training programme. Foreign assistance remains necessary to provide essential financial and educational support.

[Nurses and public health: evolution of missions and trainings]. / Les infirmières et la santé publique: évolution des missions et des formations.

Reflection upon the role of nurses in public health is not something new; however, over the past few years, a questioning and similar reports have sprung up pointing to the difficulty perceived by nurses in reconciling their professional practice and public health. Currently, in light of the evolution of public health, where does the practice of nursing fit into public health practice? What are the potential movements and trends in terms of training? The goal of this paper is to present a number of possible avenues for thought on the subject, namely concerning the training and the allocation of competencies. It would be undoubtedly a pity to conceive of public health training today being intended only for nurses. It is rather preferable that post-graduate public health training is aimed at a variety of professional categories, regardless of their initial training or degree course. The development of schools of public health to which nurses could have access in the same way that other health professionals or from the social and educational fields do is critical. Above and beyond what is at stake for specialisation, and even independent of the implication of nurses in public health work, the current trend to re-balance the work and tasks of both nurses and doctors constitutes a significant challenge for public health.

French adolescent attitudes towards informal care for physical and emotional or relational problems.

UNLABELLED: The objective of this study was to determine adolescents' attitudes concerning the use of self-care and traditional medicines. A self-administered anonymous questionnaire with open-ended questions was completed by 543 adolescents aged 15-19 y. The results showed that the most frequent self-care activity for general health problems, in more than three-quarters of them, was self-medication; 14% of them resorted to minor home treatment such as taking care of wounds, bandaging or massages. Instructions for use were mentioned by 69% of adolescents as a way of choosing self-prescribed drugs. Natural medicines were used by 32% of the girls and 23% of the boys, mainly herbal teas or plant-based medicines, followed by homoeopathy. Self-care for emotional and relational problems mainly involved thinking about the problem and questioning themselves about their own behaviour or about the way they are. They also mentioned activities such as sports, going out, listening to music, watching television, and trying to think about something else by keeping themselves occupied. Natural medicines were used by 19% of the girls and 13% of the boys. Plant-based medicines or herbal teas were used most often, followed by drugs or alcohol, with homoeopathy in third place. CONCLUSION: Self-care and alternative medicines were used by adolescents in this study for physical as well as for emotional or relational problems. Their use did not reflect dissatisfaction with physicians and hospital treatment or an objection to formal services, but rather was a choice of these approaches for their own specific characteristics. They were also viewed as being less harmful than conventional treatment.

Growth of preschool children in the Libyan Arab Jamahiriya: regional and sociodemographic differences.

This cross-sectional study was performed in two regions of the Libyan Arab Jamahiriya. The aim was to study the growth and nutritional status of children under 5 years of age and the effect of socioeconomic factors on child development. Anthropometric indices (weight-for-age, height-for-age and weight-for-height) differed in the two regions. The prevalence of stunting was significantly higher among children from mainly rural Al Jabel Al Garby (6.1%) than those from urban Tripoli (2.5%). The z-scores that correlated strongly with under-nutrition included: mother's education, child's age and sex, and region. Stunting was significantly related to age and region and to maternal education level and family size. Wasting was highly correlated with maternal education.

[Attitudes regarding the delivery of formal and informal care: comparison of French and Chilean adolescents]. / Attitudes à l'égard des soins formels et informels: comparaison d'adolescents français et chiliens.

The representations that youth have of health professionals and young people's demands in terms of the operation and administration of services create an original and complex problematic. Clearly, this originality implies the important differences from one culture to another. For this very reason, it seemed that a comparative study relating the representations and attitudes confronted when care is sought by young people from countries with different cultural contexts would assist in comprehending why adolescents have such particular ways of using--or not using--formal and self-administered health services. An original open-ended response questionnaire was jointly designed and validated by a French and Chilean team. A mutually agreed upon sample of 957 school children, adolescents aged from 14 to 19, participated in the study in France and in Chili. The following correlations were found. In the event of a sleeping problem (or other general worry that is physically manifested), the mother is the privileged confidant, and in the specific case of a relationship or emotional problem, it is usually one of the adolescents' friends. The general practitioner is the favoured professional person in the event of a purely physical problem. When confronted with an emotional problem, one-third of adolescents say that they would not consider going to a consultation. The expectations of the French toward health professionals are more often within the "emotional" arena than those of the Chileans which generally concern the "medical/technical" field. The practice of self-administered care is qualitatively similar but the French prefer taking medication whereas the Chileans prefer the "little home remedies". The use of natural medicine is more widespread among young Chileans, but the types of medicine used are similar, namely herbal teas and other plant-based remedies and homeopathy. These results have a variety of implications, especially in terms of the need for training health professionals in the consideration of emotional and relationship problems. It is desirable that the official health care sector considers the care delivered outside of it as being complementary resources, which respond to the adolescents' need for autonomy, and then integrate those contributions into its own area of financial responsibility.

[Health indicators among students from Hô Chi Minh-Ville (Vietnam): comparison with other countries]. / Les représentations de la santé chez les lycéens à Hô Chi Minh-Ville (Vietnam): comparaison avec d'autres pays.

In Vietnam, as in most developing countries, adolescent health is not considered a priority, yet this population faces many health problems. This study aims to describe perceptions of health among high school students in Ho Chi Ming City, Vietnam. The study was carried out with a representative sample of 543 students between the ages of 16 and 19, using a tool adapted from a questionnaire that was created and validated by the Centre for Preventive Medicine in Nancy, France. The adolescents who participated in the study described their perceptions of health in diverse ways: on the one hand they described them in a classic manner (absence of sickness) and on the other hand they described them in a more comprehensive, positive way (fitness, strength, development, happiness). A comparison with other studies in Algeria and France that used the same questionnaire shows certain similarities across cultures with regard to perceptions of health, as well as certain characteristics that are particular to each society and each culture.

[Prognostic factors of pregnancy and delivery complications in Senegalese adolescents and their newborn]. / Facteurs pronostiques des complications de la grossesse et de l'accouchement chez l'adolescente et son nouveau-né au Sénégal.

Developing countries exhibit the highest adolescent fertility rate in the world. Undesirable outcome frequency during adolescents' pregnancy and delivery is debated. The aim of this study is to determine the incidence of these events and the factors predicting their occurrence among pregnant Senegalese adolescents and their newborn. The study was conducted between August 1st, 1999 and July 31st, 2000 in a national sample of 435 women attending prenatal clinics after a 20-week gestation. The data were collected by interviews: sociodemographic characteristics, obstetrical antecedents, current pregnancy history before inclusion in the study; the clinical characteristics were determined at inclusion. Then pregnancy and delivery complication occurrences were observed for mothers and their newborn during follow-up. Logistic regression analyses were performed to determine the factors associated with each complication, controlling the effects of other sociodemographic and clinical factors. The most frequent pregnancy complications were pregnancy-induced hypertension and toxaemia (17.5%). Anemia occurred in 25% of the women. At delivery, at least one of dystocia, eclampsia, or placenta haemorrhage complications occurred in 46% of women. The caesarian rate was 20% and the mortality rate was 71%. When planned, caesarian interventions lowered mortality. Forty percent of the newborns presented a neonatal distress while 17.9% of them weighed less than 2,500 g. The pregnancy-induced hypertension and toxaemia incidence rates were higher when the weight at onset of pregnancy was unknown (OR = 3.7 [1.9-7.5] for hypertension and 3.1 [1.3-7.6] for toxaemia). When a woman with a narrow pelvis was less than 1.50 m tall, the delivery was more frequently assisted by forceps and extracting action in breech delivery. Dystocia, eclampsia, placenta haemorrhage and premature delivery were associated with high mortality. Overall, complications were not more frequent in the youngest (16 years and below), as suggested in previous studies. Those results suggest that undesirable events occur frequently during adolescents' pregnancy and delivery, and in their newborn, while attendance in prenatal clinics is adequate. The prognostic factors of these complications are identified. These complications can be avoided by improving ante- and perinatal care quality.

[Use of formal and informal health services by adolescents: cross-cultural study technics]. / Utilisation des services de santé formels et informels par les adolescents: méthode d'une étude transculturelle.

A cross-cultural study, in Chile and in France, has been held in order to compare care utilisation strategies used by teenagers and youths in two different contexts: self-administered cares, family cares, official or non-official professional cares. It has been decided to use a questionnaire with open-answers for collecting data on views and practices. Tool building and validation process, realised with both French and Chilean teams, has enabled to work with an original questionnaire, with good reproducibility of answers and very good acceptability. This tool can be used in other cultural contexts.

Factor analytic study of two questionnaires measuring oral health-related quality of life among children and adults in New Zealand, Germany and Poland.

A questionnaire designed to measure oral health-related quality of life (OHRQOL) in adults and children was assessed for its factorial structure and reliability using data from the Second International Collaborative Study on Oral Health Outcomes in New Zealand, Poland and Germany. Principal component analysis with orthogonal and oblique rotation was applied. The three-factor structure hypothesized for the children's questionnaire (self-reported oral disease symptoms, perceived oral well-being, social and physical functioning) was confirmed in New Zealand and Poland, and two self-reported oral disease symptom dimensions emerged in Germany. Five factors instead of the three hypothesized were identified for adults: two dimensions of symptoms were identified, and social and physical functioning appeared to be independent dimensions of OHRQOL. Similarity between the factors was demonstrated in all three countries. The reliability of the questionnaire ranged from moderate to excellent depending on the dimension and the country. These findings provide preliminary evidence of the cross-cultural stability of the OHRQOL questionnaire in New Zealand, Poland and Germany, for both children and adults. Further investigations by the present authors of the properties of the instrument in other samples will focus on demonstrating the stability and replicability of the factor structure identified here.

[Lack of communications between general medicine and the mental health sector]. / La non-communication entre la médecine générale et le secteur de santé mentale.

Mental health problems today account for a rising number of visits to general practitioners, which require collaboration between general practitioners and psychiatrists. A KAP study (Knowledge, Attitudes, Practice) was carried out among general practitioners of three towns in the "Meurthe et Moselle" region, in the common territory shared by both a child and an adult psychiatric sector. Twenty-three doctors participated in the study. General practitioners know the different psychiatric structures but they do not know their areas of speciality or how they are organised. All recognise the high frequency of mental health problems among their patients, the most frequent being depressive pathologies. They have a negative image of the sector which is perceived as a complex "world" from which they feel excluded as soon as they refer a patient because of the difficulty they have in communicating with psychiatrists.