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1.
Rev Epidemiol Sante Publique ; 61(1): 21-7, 2013 Feb.
Artigo em Francês | MEDLINE | ID: mdl-23337841

RESUMO

BACKGROUND: Although HIV testing is offered during antenatal care, the proportion of women giving birth without knowing their HIV status is still important in DR Congo. The objective of this study was to determine the acceptability of rapid HIV testing among parturients in labor room, and to identify factors that are associated with the acceptability of HIV testing. METHODS: Intervention including rapid HIV testing among pregnant women in labor rooms in Lubumbashi for 5 months, from September 2010 to February 2011. Pregnant women who tested HIV positive were attended by prevention of mother-to-child transmission service. Descriptive statistical analysis and logistic regression were performed. RESULTS: Among 474 pregnant women who enter the labor room, 433 (91.4%; confidence interval [CI]: 95%: 88.4-93.7%) had voluntary testing for HIV in the labor room after counseling. The acceptance of rapid testing for HIV was significantly higher when the duration of counseling was less or equal to 5 minutes (adjusted Odds ratio [aOR]=5.8; [CI] 95%: 2.6-13); among those who did not report having this screening test during antenatal care (aOR=3.8; [CI] 95%: 2-7.8), among those who were in early labor (aOR=2.3; [CI] 95%: 1.2-4.7) and lower in adolescents than in adults (aOR=0.1; [CI] 95%: 0.0-0.7). CONCLUSION: Counseling and voluntary HIV testing are accepted in our labor rooms. Consistently offering this service in the labor room could be a catch-up strategy to be combined with antenatal care testing.


Assuntos
Sorodiagnóstico da AIDS , Salas de Parto , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Sorodiagnóstico da AIDS/métodos , Adolescente , Adulto , Aconselhamento , República Democrática do Congo/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Recém-Nascido , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Diagnóstico Pré-Natal , Prevalência , Fatores de Risco
2.
Trans R Soc Trop Med Hyg ; 101(1): 79-84, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16962622

RESUMO

A study was carried in a rural district in Malawi among HIV-positive individuals placed on antiretroviral treatment (ART) in order to verify if community support influences ART outcomes. Standardized ART outcomes in areas of the district with and without community support were compared. Between April 2003 (when ART was started) and December 2004 a total of 1634 individuals had been placed on ART. Eight hundred and ninety-five (55%) individuals were offered community support, while 739 received no such support. For all patients placed on ART with and without community support, those who were alive and continuing ART were 96 and 76%, respectively (P<0.001); death was 3.5 and 15.5% (P<0.001); loss to follow-up was 0.1 and 5.2% (P<0.001); and stopped ART was 0.8 and 3.3% (P<0.001). The relative risks (with 95% CI) for alive and on ART [1.26 (1.21-1.32)], death [0.22 (0.15-0.33)], loss to follow-up [0.02 (0-0.12)] and stopped ART [0.23 (0.08-0.54)] were all significantly better in those offered community support (P<0.001). Community support is associated with a considerably lower death rate and better overall ART outcomes. The community might be an unrecognized and largely 'unexploited resource' that could play an important contributory role in countries desperately trying to scale up ART with limited resources.


Assuntos
Terapia Antirretroviral de Alta Atividade , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/tratamento farmacológico , Adulto , Feminino , Humanos , Malaui/epidemiologia , Masculino , Saúde da População Rural , Apoio Social , Resultado do Tratamento
3.
Trans R Soc Trop Med Hyg ; 100(2): 167-75, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16214192

RESUMO

This paper describes (a) the experience of initiating community involvement in HIV/AIDS and tuberculosis (TB) activities in a rural district in Malawi and (b) some of the different ways in which the community is contributing in the fight against these two diseases and the outcomes of their involvement. During a 2-year period, a total of 21,358 (41%) of 52,510 HIV tests performed at voluntary counselling and HIV testing (VCT) sites in the district were conducted by lay community counsellors. A team of 465 community volunteers, 1,362 trained family caregivers and 9 community nurses provided care and support to 5,106 HIV-positive individuals, of whom 2,006 (39%) were in WHO stage III or IV. All those in WHO stage III or IV were on co-trimoxazole prophylaxis and 895 (45%) of these were also on antiretroviral treatment. A total of 2,714 TB patients, of whom 1627 (60%) were HIV-positive, also received care and support. A total of 1,694 orphans were trained in vocational skills. Twelve vegetable gardens and three maize farms were set up, and pre-school activities were organised for 900 orphans. Communities can play an important contributory role in reducing the burden of HIV/AIDS and TB and in mitigating its impact. Despite this, community resources in most settings are often under-exploited and their role remains undefined.


Assuntos
Redes Comunitárias/organização & administração , Infecções por HIV/prevenção & controle , Saúde da População Rural , Tuberculose/prevenção & controle , Atitude Frente a Saúde , Aconselhamento , Humanos , Malaui , Apoio Social , Programas Voluntários
4.
Trans R Soc Trop Med Hyg ; 100(1): 24-31, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16202436

RESUMO

Malawi offers antiretroviral treatment (ART) to all HIV-positive adults who are clinically classified as being in WHO clinical stage III or IV without 'universal' CD4 testing. This study was conducted among such adults attending a rural district hospital HIV/AIDS clinic (a) to determine the proportion who have CD4 counts >or=350 cells/microl, (b) to identify risk factors associated with such CD4 counts and (c) to assess the validity and predictive values of possible clinical markers for CD4 counts >or=350 cells/microl. A CD4 count >or=350 cells/microl was found in 36 (9%) of 401 individuals who are thus at risk of being placed prematurely on ART. A body mass index (BMI) >22 kg/m(2), the absence of an active WHO indicator disease at the time of presentation for ART, and a total lymphocyte count >1,200 cells/microl were significantly associated with such a CD4 count. The first two of these variables could serve as clinical markers for selecting subgroups of patients who should undergo CD4 testing. In a resource-limited district setting, assessing the BMI and checking for active opportunistic infections are routine clinical procedures that could be used to target CD4 measurements, thereby minimising unnecessary CD4 measurements, unnecessary (too early) treatment and costs.


Assuntos
Antirretrovirais/administração & dosagem , Antígenos CD4/imunologia , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/imunologia , Adolescente , Adulto , Antirretrovirais/economia , Índice de Massa Corporal , Contagem de Linfócito CD4 , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Soropositividade para HIV/economia , Mau Uso de Serviços de Saúde , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco
5.
Trop Med Int Health ; 10(12): 1242-50, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16359404

RESUMO

SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT registers. RESULTS: Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. CONCLUSIONS: In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.


Assuntos
Aconselhamento , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações Infecciosas na Gravidez , Adulto , Estudos de Coortes , Parto Obstétrico , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/transmissão , Humanos , Malaui/epidemiologia , Cuidado Pós-Natal/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/psicologia , Saúde da População Rural
6.
Int J Tuberc Lung Dis ; 9(3): 238-47, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15786885

RESUMO

The World Health Organization (WHO) has set a target of treating 3 million people with antiretroviral treatment (ART) by 2005. In sub-Saharan Africa, HIV-positive tuberculosis (TB) patients could significantly contribute to this target. ART (stavudine/lamivudine/nevirapine) was initiated in Thyolo district, Malawi, in April 2003, and all HIV-positive TB patients were considered eligible and offered ART. Despite this, only 44 (13%) of 352 TB patients were eventually started on ART by the end of November 2003. Most TB patients leave hospital after 2 weeks to complete the initial phase of anti-tuberculosis treatment (rifampicin-based) in the community, and ART is offered to HIV-positive TB patients after they have started the continuation phase of treatment (isoniazid/ ethambutol). ART is only offered at hospital, while the majority of TB patients take their continuation phase of anti-tuberculosis treatment from health centres. HIV-positive TB patients therefore find it difficult to access ART. In this paper, we discuss a series of options to increase the uptake of ART among HIV-positive TB patients. The main options are: 1) to hospitalise HIV-positive TB patients with a view to starting ART in the continuation phase in hospital; 2) to decentralise ART delivery so ART can be delivered at health centres; 3) to replace nevirapine with efavirenz so ART can be started earlier in the initial phase of anti-tuberculosis treatment. Decentralisation of ART from hospitals to health centres would greatly improve ART access.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Soropositividade para HIV/tratamento farmacológico , População Rural , Tuberculose/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/métodos , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Uso de Medicamentos , Soropositividade para HIV/complicações , Soropositividade para HIV/epidemiologia , Humanos , Lamivudina/uso terapêutico , Malaui/epidemiologia , Programas Nacionais de Saúde/tendências , Nevirapina/uso terapêutico , Prevalência , Estavudina/uso terapêutico , Tuberculose/complicações , Tuberculose/epidemiologia , Organização Mundial da Saúde
7.
Int J Tuberc Lung Dis ; 9(3): 258-62, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15786887

RESUMO

SETTING: Thyolo district, Malawi. OBJECTIVES: To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). DESIGN: Cross-sectional study. METHODS: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. RESULTS: A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. CONCLUSIONS: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Definição da Elegibilidade/métodos , Infecções por HIV/imunologia , Tuberculose/imunologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Anticorpos Anti-HIV/imunologia , Infecções por HIV/classificação , Infecções por HIV/tratamento farmacológico , HIV-1/imunologia , HIV-2/imunologia , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Tuberculose/tratamento farmacológico , Organização Mundial da Saúde
8.
Int J Tuberc Lung Dis ; 8(9): 1058-64, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15455589

RESUMO

In a rural district in Malawi, poorly motivated health personnel, shortages of human and financial resources, weak dialogue between existing tuberculosis (TB) and human immunodeficiency virus (HIV) programmes and poor community involvement are constraints to establishing joint TB-HIV interventions. The presence of a non-governmental organisation (NGO), Médecins Sans Frontières (MSF), in the health care delivery system provided an opportunity to bridge some of these gaps. The main inputs provided by MSF included additional staff, supplementary drugs including antiretroviral drugs, technical assistance and infrastructure development. The introduction of a scheme of monthly performance-linked incentives for health personnel proved successful in improving their performance, as judged by attendance rates as well as the quality and quantity of activities. This initiative also provided the district management with a tool for exerting pressure on health staff to improve their performance. The availability of independent NGO funds and a logistics team for construction of new infrastructure allowed the rapid initiation of new interventions at the district level without having to wait for disbursements of funds from the central level. This introduced a new dynamic of decentralised operational flexibility at the district level which improved access to care and support for people with TB-HIV.


Assuntos
Atenção à Saúde/organização & administração , Infecções por HIV/prevenção & controle , Cooperação Internacional , Setor Privado , Tuberculose Pulmonar/prevenção & controle , Antivirais/economia , Antivirais/uso terapêutico , Pessoal de Saúde/normas , Humanos , Malaui , Indicadores de Qualidade em Assistência à Saúde , População Rural
9.
Int J Tuberc Lung Dis ; 7(11): 1033-9, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14598961

RESUMO

SETTING: Thyolo district, rural Malawi. OBJECTIVES: To compare passive with active case finding among household contacts of smear-positive pulmonary tuberculosis (TB) patients for 1) TB case detection and 2) the proportion of child contacts aged under 6 years who are placed on isoniazid (INH) preventive therapy. DESIGN: Cross-sectional study. METHODS: Passive and active case finding was conducted among household contacts, and the uptake of INH preventive therapy in children was assessed. RESULTS: There were 189 index TB cases and 985 household contacts. Human immunodeficiency virus (HIV) prevalence among index cases was 69%. Prevalence of TB by passive case finding among 524 household contacts was 0.19% (191/100000), which was significantly lower than with active finding among 461 contacts (1.74%, 1735/100000, P = 0.01). Of 126 children in the passive cohort, 22 (17%) received INH, while in the active cohort 25 (22%) of 113 children received the drug. Transport costs associated with chest X-ray (CXR) screening were the major reason for low INH uptake. CONCLUSIONS: Where the majority of TB patients are HIV-positive, active case finding among household contacts yields nine times more TB cases and is an opportunity for reducing TB morbidity and mortality. The need for a CXR is an obstacle to the uptake of INH prophylaxis.


Assuntos
Busca de Comunicante/métodos , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/prevenção & controle , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Isoniazida/uso terapêutico , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Radiografia , População Rural , Tuberculose Pulmonar/diagnóstico por imagem
10.
Rev Epidemiol Sante Publique ; 50(4): 371-82, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12442054

RESUMO

BACKGROUND: Socio-economic differentials in health are a reality in adults but their postulated persistence throughout the life-course is a subject of discussion. METHODS: Given the real socio-economic inequalities in the health of the adult population in Belgium, we used the 1997 national health survey data to measure these inequalities in the population between the ages of 15 and 24 years, inclusive. Concentration indices were calculated for three health-related variables, namely, subjective health, smoking, and drinking, in connection with various socio-economic indicators specific to the individual and/or the household (occupation, education, income, poverty, socio-economic insecurity). RESULTS: These concentration indices confirmed the existence of socio-economic differentials in the health of these 15-to-24-year-olds in Belgium. The data showed that a "poor health" status for subjective health and smoking was more frequent in the most disadvantaged socio-economic groups and for daily drinking more frequent in the better-off socio-economic groups. CONCLUSIONS: We found a relative diversity in the magnitudes of the inequalities measured depending on the parameters used for their quantification. However, there was an overlapping convergence and reproducibility of the patterns in the general directions of the inequality measurements, as follows: the results for a given indicator were remarkably consistent, regardless of the socio-economic variable studied. This consistency argues in favour of the confirmation of socio-economic class differentials in health in 15- to 24-year-olds in Belgium.


Assuntos
Comportamentos Relacionados com a Saúde , Nível de Saúde , Classe Social , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Bélgica , Feminino , Humanos , Masculino , Ocupações , Pobreza , Curva ROC , Fumar , Fatores Socioeconômicos
11.
J Epidemiol Community Health ; 56(7): 510-6, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12080158

RESUMO

STUDY OBJECTIVE: There is an increasing body of evidence about socioeconomic inequality in preventive use, mostly for cancer screening. But as far as needs of prevention are unequally distributed, even equal use may not be fair. Moreover, prevention might be unequally used in the same way as health care in general. The objective of the paper is to assess inequity in prevention and to compare socioeconomic inequity in preventive medicine with that in health care. DESIGN: A cross sectional Health Interview Survey was carried out in 1997 by face to face interview and self administered questionnaire. Two types of health care utilisation were considered (contacts with GPs and with specialists) and four preventive care mostly delivered in a GP setting (flu vaccination, cholesterol screening) or in a specialty setting (mammography and pap smear). SETTING: Belgium. PARTICIPANTS: A representative sample of 7378 residents aged 25 years and over (participation rate: 61%). OUTCOME MEASURE: Socioeconomic inequity was measured by the HI(wvp) index, which is the difference between use inequality and needs inequality. Needs was computed as the expected use by the risk factors or target groups. MAIN RESULTS: There was significant inequity for all medical contacts and preventive medicine. Medical contacts showed inequity favouring the rich for specialist visits and inequity favouring the poor for contacts with GPs. Regarding preventive medicine, inequity was high and favoured the rich for mammography and cervical screening; inequity was lower for flu immunisation and cholesterol screening but still favoured the higher socioeconomic groups. In the general practice setting, inequity in prevention was higher than inequity in health care; in the specialty setting, inequity in prevention was not statistically different from inequity in health care, although it was higher than in the general practice setting. CONCLUSIONS: If inequity in preventive medicine is to be lowered, the role of the GP must be fostered and access to specialty medicine increased, especially for cancer screening.


Assuntos
Neoplasias da Mama/prevenção & controle , Hipercolesterolemia/prevenção & controle , Influenza Humana/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Idoso , Bélgica , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Imunização/estatística & dados numéricos , Masculino , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Teste de Papanicolaou , Fatores Socioeconômicos , Esfregaço Vaginal/estatística & dados numéricos
12.
Rev Med Brux ; 22(2): 67-72, 2001 Apr.
Artigo em Francês | MEDLINE | ID: mdl-11388025

RESUMO

The haemoglobin disorders are frequent genetic diseases in tropical regions and in the mediterranean basin. They include thalassaemia and sickle cell disease. Because of important migrations of populations after the Second World War many big cities are confronted with the disease in West Europe nowadays. In Brussels where a neonatal screening has been organised in the majority of the maternity's, 45% of newborns have at least one parent originating from a region at risk for an haemoglobin disorder. One neonate among 2.000 is diagnosed with a major haemoglobinopathy at the screening. This rate is important and it appeared essential to evaluate the knowledge and need for complementary information among the doctors confronted with the disease. A survey was done in January 1999 and a questionnaire was sent to all gynaecologists, paediatricians and general practitioners in Brussels. The main results were a general self-evaluation of poor knowledge and a great need for complementary information. This survey was important to obtain adequate support of official health authorities in term of screening, prevention and financial aid to information campaigns. A consensus is needed among the different doctors for the best care possible of sick patients.


Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Hemoglobinopatias/diagnóstico , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atitude do Pessoal de Saúde , Bélgica/epidemiologia , Competência Clínica/normas , Medicina de Família e Comunidade/educação , Ginecologia/educação , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Hemoglobinopatias/epidemiologia , Humanos , Recém-Nascido , Auditoria Médica , Pediatria/educação , Fatores de Risco , Autoeficácia , Inquéritos e Questionários , Saúde da População Urbana
13.
Eur J Epidemiol ; 17(9): 841-5, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-12081103

RESUMO

Road traffic injuries are a major public health problem. In this study, we chose Years of Potential Life Lost (YPLL) to analyse the trends during the period 1974-1994 and the relative impact of the traffic injuries death on total mortality and on total avoidable mortality in Belgium. We analysed the geographical trends over a 20-year period at the district level. The YPLL age-adjusted rates were analysed for four successive 5-year periods: 1974-1978, 1980-1984, 1985-1989, 1990-1994 and the ratios of YPLL rates were used to describe changes between 1974 and 1994 at district level. The YPLL rates decrease for 'all causes mortality', 'total avoidable causes' and 'road traffic injuries'. This trend can be observed during the four periods of 5 years. A slowing down of the decrease of the YPLL rates for road traffic injuries, both for men and women is observed: 11.7% between periods 2 and 1, and only 3% between periods 4 and 3 for men (16.2 and 7.5% for women). The geographical analysis shows marked differences between districts. Even though a favourable trend is observed for the traffic injuries deaths in Belgium it is important to highlight the important slowing down of this trend during the most recent years. It is also necessary to underline the importance of geographical disparities in the distribution of YPLL rates within the entire population.


Assuntos
Acidentes de Trânsito/mortalidade , Bélgica/epidemiologia , Feminino , Humanos , Masculino , Mortalidade/tendências
14.
J Epidemiol Community Health ; 54(9): 687-91, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10942448

RESUMO

STUDY OBJECTIVES: To analyse over a 20 year period the level and trends in the "EC avoidable death indicators". DESIGN: The Years of Potential Life Lost (YPLL) method applied to curative and preventive avoidable mortality indicators in Belgium for four successive five year periods, countrywide as well as by district, separately for women and men. Ratios of YPLL rates (age standardised) describe changes between 1974-78 and 1990-94. SETTING: Belgium for the periods 1974-78, 1980-84, 1985-89, 1990-94. PARTICIPANTS: All avoidable death cases aged 1-64. MAIN RESULTS: Ratio of YPLL rates indicated a more favourable development between 1974-78 and 1990-94 in the EC avoidable indicators than in all causes premature mortality. The EC avoidable mortality indicators have been assigned to two categories, curative indicators and preventive indicators. The best ratio of YPLL rates was found in curative indicators for men but the largest gains in YPLL rates over the periods come from the "preventive indicators" in men. For women, malignant neoplasm of the breast rose to the first ranked in 1985-1989 and 1990-1994, where it contributed to more years of YPLL loss than motor vehicle accidents, and malignant neoplasm of the trachea, bronchus and lung had risen to the fifth ranked since 1985-89. The order of the top causes for men did not change between 1974 and 1994, except for cirrhosis of liver, which rose from the fifth to the fourth rank. In the particular case of one "preventive indicator", malignant neoplasm of the trachea, bronchus and lung, the regional analysis of time trend between 1974-78 and 1990-94 showed more districts with a favourable development for both men and women in the Flemish region than in Wallonia. CONCLUSION: The YPLL method combined with the avoidable mortality indicators enabled us to compare the changes of curative and preventive EC avoidable indicators between 1974-78 and 1990-94. In the case of malignant neoplasm of the trachea, bronchus and lung, which is of major concern to the health promotion policies, changes over the periods have widened a "north/south" health contrast.


Assuntos
Causas de Morte/tendências , Prevenção de Acidentes , Adolescente , Adulto , Bélgica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/prevenção & controle , Distribuição por Sexo , Fatores Sexuais
15.
Soc Sci Med ; 31(3): 237-48, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-2218604

RESUMO

This paper presents two different yet complementary on-going studies related to the understanding of the mechanisms leading to social inequalities in health. The first part is devoted to a differential morbidity survey held in southern Belgium. It confirms that striking differences exist in the period around birth between social categories, and between the three districts under study. In a multivariate approach, differences remain between the social categories and between the district samples, which classically studied socio-demographical, behavioural and medical characteristics cannot fully explain. The role of cultural factors is analysed and discussed through the concept of 'health culture' and alternative hypotheses are reviewed in the light of the results. The second part reviews the studies conducted on the so-called avoidable mortality in the EEC and more specifically in Belgium. The concept of avoidable mortality is discussed, as well as its utility from the standpoint of the present concern on social inequalities. Differences between EEC countries are large, and even within Belgium there are important disparities between the districts. The role of health care supply has not been demonstrated yet in these two contexts. For Belgium, it appears that a major part of the unequally distributed mortality is constituted by causes of death considered as avoidable. Moreover, the most discriminating causes of death are overrepresented in socially deprived districts. The two perspectives are confronted in order to delineate perspectives for future research and operational outcomes for policy making and interventions.


Assuntos
Comparação Transcultural , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Bélgica , Criança , Pré-Escolar , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Morbidade , Mortalidade/tendências , Perinatologia , Gravidez , Resultado da Gravidez , Justiça Social , Fatores Socioeconômicos
16.
Biol Neonate ; 55(1): 55-62, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2650746

RESUMO

Prenatal care in Belgium is characterized by regional variations between the Flemish- and French-speaking communities. Generally, care in the former area is provided by a general practitioner or a gynecologist/obstetrician in private practice, and in the latter by a gynecologist/obstetrician on a private or public basis. The level of use of prenatal care observed is, on average, high, but variations do exist according to the socioeconomic and cultural characteristics of the families and the health care services which they frequent.


Assuntos
Cuidado Pré-Natal/organização & administração , Bélgica , Feminino , Humanos , Sistemas de Informação , Gravidez , Cuidado Pré-Natal/normas , Fatores Socioeconômicos
17.
Artigo em Francês | MEDLINE | ID: mdl-3253850

RESUMO

Two cases of irreducibility of recent posterior dislocation of the shoulder due to interposition of the long biceps are reported. The diagnostic procedures, the lesions noted during surgery and the therapeutic approach are described in the light of data found in the relevant literature.


Assuntos
Luxação do Ombro/terapia , Adulto , Artrografia , Humanos , Masculino , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia
18.
Soc Sci Med ; 25(5): 485-93, 1987.
Artigo em Francês | MEDLINE | ID: mdl-3672147

RESUMO

The concept of avoidable mortality leads to an attempt at using specific mortality rates as output measures of health services. The analysis covered 43 Belgian districts between the years 1974 and 1978. Two Belgian areas were compared along a dimension defined by two axes of a correspondence factor analysis: Flanders which is associated with low SMR of avoidable mortality and Wallonia which has high rates. The persistence of high mortality in Wallonia was confirmed. Factorial scores for each district were used as indexes for geographical heterogeneity. Variations in these indices, including patient consultation rates and technical medical procedures, remained even after adjustment for socio-economic differences.


Assuntos
Mortalidade , Adolescente , Adulto , Idoso , Bélgica , Criança , Pré-Escolar , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
19.
Ann Chir Main ; 1(3): 242-6, 1982.
Artigo em Francês | MEDLINE | ID: mdl-9382617

RESUMO

The authors have studied the incidence of lunate necrosis in 110 perilunate dislocations. Twenty-one cases (19%) developed a necrosis. The classification into three types, according to the amount of damage to the perilunar ligaments, is of prognostic value. There is no risk of necrosis in type 1, 17% in type II, and 50% in type III. An associated fracture of the scaphoid does not modify the risk. In neglected lesions, reduction of the lunate dislocation should be attempted, even at a late date, the risk of necrosis then being 50%. Surgical reduction increases the risk of secondary necrosis to a greater extent than does orthopedic treatment, but it is generally use in the most complex cases too. The authors advocate a closed reduction with percutaneous pin fixation.


Assuntos
Fraturas Ósseas/complicações , Luxações Articulares/complicações , Osso Semilunar/lesões , Osteocondrite/etiologia , Osteonecrose/complicações , Adolescente , Adulto , Fixação Interna de Fraturas , Fraturas Ósseas/classificação , Fraturas Ósseas/cirurgia , Humanos , Incidência , Luxações Articulares/classificação , Luxações Articulares/cirurgia , Osteonecrose/classificação , Osteonecrose/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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