Strengthening surveillance, disease detection, and outbreak response through Guinea-Bissau's Frontline Field Epidemiology Training Program: a cross-sectional descriptive study.

Introduction: the goal of the Field Epidemiology Training Program (FETP) - Frontline is to strengthen the country's surveillance capacity at the district level to prepare and respond to health emergencies, including outbreaks, by training a skilled frontline public health workforce. We describe the FETP - Frontline program, including implementation, structure, achievements, impact, and its role in improving the epidemiological workforce capacity of Guinea-Bissau. Methods: this cross-sectional descriptive study uses 2015-2019 program data collected through record reviews and historical narratives from FETP students and graduates. We generated descriptive summary statistics using the Guinea-Bissau's FETP-Frontline program database, student assignments, and investigation reports, after reviewing the FETP standardized curriculum and program guidelines. Results: since its inception in 2016, FETP Frontline has implemented 14 cohorts and trained 198 frontline surveillance officers. Program participants improved surveillance data quality, investigated 51 outbreaks at national and regional levels, and contributed to disease research and surveillance in 227 separate field investigations. Participants frequently responded to priority health emergencies, including clusters or outbreaks of Zika, microencephalies, dengue, yellow fever, anthrax, malaria, and tuberculosis. Conclusion: Guinea-Bissau's FETP - Frontline program provides a practical example of an effective strategy to strengthen health systems through a well-prepared workforce trained to quickly detect and respond to health threats.

Zika Virus IgG in Infants with Microcephaly, Guinea-Bissau, 2016.

We analyzed blood samples from infants born with microcephaly and their mothers in Guinea-Bissau in 2016 for pathogens associated with birth defects. No Zika virus RNA was detected, but Zika virus IgG was highly prevalent. We recommend implementing pathogen screening of infants with congenital defects in Guinea-Bissau.

Surveillance Training for Ebola Preparedness in Côte d'Ivoire, Guinea-Bissau, Senegal, and Mali.

The 2014-2015 epidemic of Ebola virus disease in West Africa primarily affected Guinea, Liberia, and Sierra Leone. Several countries, including Mali, Nigeria, and Senegal, experienced Ebola importations. Realizing the importance of a trained field epidemiology workforce in neighboring countries to respond to Ebola importations, the Centers for Disease Control and Prevention Field Epidemiology Training Program unit implemented the Surveillance Training for Ebola Preparedness (STEP) initiative. STEP was a mentored, competency-based initiative to rapidly build up surveillance capacity along the borders of the at-risk neighboring countries Côte d'Ivoire, Mali, Senegal, and Guinea-Bissau. The target audience was district surveillance officers. STEP was delivered to 185 participants from 72 health units (districts or regions). Timeliness of reporting and the quality of surveillance analyses improved 3 months after training. STEP demonstrated that mentored, competency-based training, where learners attain competencies while delivering essential public health services, can be successfully implemented in an emergency response setting.

Contextual and psychosocial factors predicting Ebola prevention behaviours using the RANAS approach to behaviour change in Guinea-Bissau.

BACKGROUND: The outbreak of the Ebola virus disease (EVD) in West Africa in December 2013 was the largest Ebola outbreak in history. This study aimed to measure the underlying contextual and psychosocial factors of intentions to perform Ebola prevention behaviours (not touching people who might be suffering from Ebola, reporting suspected cases to the National Ebola Hotline, NEH) in Guinea-Bissau. Geographical location, cross-border market activities, poor water, sanitation and hygiene (WASH) conditions, and burial practices in some communities pose a serious risk in terms of potential EVD outbreak and seriously hamper its prevention in Guinea-Bissau. METHODS: In July and August 2015, quantitative data from 1369 respondents were gathered by structured face-to-face interviews. The questionnaire was based on the psychosocial factors of the RANAS (risks, attitudes, norms, abilities, and self-regulation) model. Data were analyzed by multiple linear regression analyses. RESULTS: The most important predictors for the intention to call the NEH were believing that calling the Hotline would help the infected person, perceiving that important members from the household approve of calling the Hotline, thinking that calling the Hotline is something they should do, and believing that it is important to call the Hotline to report a suspected case. For the intention not to touch someone who might be suffering from Ebola, the most important predictors were health knowledge, the perception of risk with regard to touching a person who might be suffering from Ebola, and the belief that they were able not to touch a possibly infected person. Age in years was the only significant contextual predictor for one of the two behavioural intentions, the intention to call the Hotline. It seems that younger people are more likely to use a service like the NEH than older people. CONCLUSIONS: Strengths and gaps were identified in the study population in relation to the intention to perform prevention behaviours. These call for innovative ways of aligning existing hygiene programs with relevant psychosocial factors. This research is relevant to further outbreaks of contagious diseases as it sheds light on important aspects of the impact of public health interventions during emergencies and epidemics.

A clínica psicanalítica com adolescentes: especificidades de um encontro analítico / The psychoanalytical clinic with adolescents: specificities of an analytical encounter / La clínica psicoanalítica con adolescentes: especificidades de un encuentro analítico

As contínuas transformações experienciadas pelos adolescentes têm sido objeto de estudo em função da importância que adquirem no contexto da saúde psíquica. Este artigo retrata um estudo de cunho qualitativo, que objetivou conhecer e compreender as características e as peculiaridades da clínica contemporânea da adolescência considerando o exercício da escuta psicanalítica. Foram entrevistados dez psicanalistas com atuação de, no mínimo, dez anos no atendimento a pacientes dessa faixa etária. Por meio da técnica de análise de conteúdo, foram identificadas três categorias finais: a família e a escola como campos fundamentais da experiência intersubjetiva do adolescente, a necessidade de recursos psíquicos: exigências para o enfrentamento do processo de ressignificação de si mesmo, e, por último, os desafios e as inquietações no campo analítico: especificidades teóricas e técnicas a partir da escuta de adolescentes. Para a discussão dos achados, lançou-se mão do referencial psicanalítico. O estudo realizado permitiu não só conhecer melhor a articulação das demandas da cultura atual com as modalidades psicopatológicas presentes na clínica psicanalítica da adolescência assim como identificar as transformações que ocorrem na técnica psicanalítica. O espaço da análise evidenciou-se como uma relevante possibilidade de construção e de atribuição de significado aos padecimentos psíquicos da adolescência, de modo a viabilizar desdobramentos saudáveis às suas vivências....(AU)

The continuous transformations adolescents experience have been object of study because of its importance in the context of psychic health. This paper portrays a qualitative study that aimed to know and to comprehend the characteristics and peculiarities of the contemporary adolescence clinic, considering the practice of the psychoanalytical listening. Ten psychoanalysts who had been at least ten years attending adolescents patients were interviewed. Through the technique of content analysis, three final categories were identified: the family and the school as fundamental fields of the inter-subjective experience of the adolescent, the necessity of psychic resources: demands to cope with the re-signification of oneself, and, finally, the challenges and concerns in the analytical field: theoretical and technical specificities from the adolescence’s listening. For the discussion of the findings, it was used the psychoanalytical referential. The study accomplished allowed a better knowledge about the articulations of the current culture demands with the pathological modalities present in the adolescent’s psychoanalytical clinic, as well as identify the transformations that occur in the psychoanalytical technique. The analysis has been highlighted as a relevant possibility to construct and assign meanings to the psychic suffering of adolescents in order to provide healthy developments for their experiences....(AU)

las continuadas transformaciones experimentadas por los adolescentes han sido objeto de estudio en función de la importancia que adquieren en el contexto de la salud psíquica. Este artículo retracta un estudio de naturaleza cualitativa, que ha tenido como objetivo conocer y comprender características y peculiaridades de la clínica contemporánea de la adolescencia, considerando el ejercicio de la escucha psicoanalítica. Han sido entrevistados diez psicoanalistas, con una actuación de por lo menos diez años en la atención a pacientes adolescentes. A través de la técnica de Análisis de Contenido, se han identificado tres categorías finales: la familia y la escuela como campos fundamentales de la experiencia intersubjetiva del adolescente; la necesidad de recursos psíquicos: exigencias para el enfrentamiento del proceso de resignificación del sí mismo; y, por último, desafíos e inquietudes en el campo analítico: especificidades teóricas y técnicas a partir de la escucha de adolescentes. Para la discusión de los resultados encontrados, se ha llevado a cabo el referencial psicoanalítico. El estudio llevado a cabo ha permitido un mejor conocimiento acerca de la articulación de las demandas de la cultura actual con las modalidades psicopatológicas presentes en la clínica psicoanalítica de la adolescencia, así como identificar transformaciones que ocurren en la técnica psicoanalítica. El espacio del análisis se ha evidenciado como una relevante posibilidad de construcción y atribución de significado a los padecimientos psíquicos de la adolescencia, de forma a tornar viables despliegues saludables a sus vivencias....(AU)

A clínica psicanalítica com adolescentes: especificidades de um encontro analítico / The psychoanalytical clinic with adolescents: specificities of an analytical encounter / La clínica psicoanalítica con adolescentes: especificidades de un encuentro analítico

As contínuas transformações experienciadas pelos adolescentes têm sido objeto de estudo em função da importância que adquirem no contexto da saúde psíquica. Este artigo retrata um estudo de cunho qualitativo, que objetivou conhecer e compreender as características e as peculiaridades da clínica contemporânea da adolescência considerando o exercício da escuta psicanalítica. Foram entrevistados dez psicanalistas com atuação de, no mínimo, dez anos no atendimento a pacientes dessa faixa etária. Por meio da técnica de análise de conteúdo, foram identificadas três categorias finais: a família e a escola como campos fundamentais da experiência intersubjetiva do adolescente, a necessidade de recursos psíquicos: exigências para o enfrentamento do processo de ressignificação de si mesmo, e, por último, os desafios e as inquietações no campo analítico: especificidades teóricas e técnicas a partir da escuta de adolescentes. Para a discussão dos achados, lançou-se mão do referencial psicanalítico. O estudo realizado permitiu não só conhecer melhor a articulação das demandas da cultura atual com as modalidades psicopatológicas presentes na clínica psicanalítica da adolescência assim como identificar as transformações que ocorrem na técnica psicanalítica. O espaço da análise evidenciou-se como uma relevante possibilidade de construção e de atribuição de significado aos padecimentos psíquicos da adolescência, de modo a viabilizar desdobramentos saudáveis às suas vivências.(AU)

The continuous transformations adolescents experience have been object of study because of its importance in the context of psychic health. This paper portrays a qualitative study that aimed to know and to comprehend the characteristics and peculiarities of the contemporary adolescence clinic, considering the practice of the psychoanalytical listening. Ten psychoanalysts who had been at least ten years attending adolescents patients were interviewed. Through the technique of content analysis, three final categories were identified: the family and the school as fundamental fields of the inter-subjective experience of the adolescent, the necessity of psychic resources: demands to cope with the re-signification of oneself, and, finally, the challenges and concerns in the analytical field: theoretical and technical specificities from the adolescence’s listening. For the discussion of the findings, it was used the psychoanalytical referential. The study accomplished allowed a better knowledge about the articulations of the current culture demands with the pathological modalities present in the adolescent’s psychoanalytical clinic, as well as identify the transformations that occur in the psychoanalytical technique. The analysis has been highlighted as a relevant possibility to construct and assign meanings to the psychic suffering of adolescents in order to provide healthy developments for their experiences.(AU)

las continuadas transformaciones experimentadas por los adolescentes han sido objeto de estudio en función de la importancia que adquieren en el contexto de la salud psíquica. Este artículo retracta un estudio de naturaleza cualitativa, que ha tenido como objetivo conocer y comprender características y peculiaridades de la clínica contemporánea de la adolescencia, considerando el ejercicio de la escucha psicoanalítica. Han sido entrevistados diez psicoanalistas, con una actuación de por lo menos diez años en la atención a pacientes adolescentes. A través de la técnica de Análisis de Contenido, se han identificado tres categorías finales: la familia y la escuela como campos fundamentales de la experiencia intersubjetiva del adolescente; la necesidad de recursos psíquicos: exigencias para el enfrentamiento del proceso de resignificación del sí mismo; y, por último, desafíos e inquietudes en el campo analítico: especificidades teóricas y técnicas a partir de la escucha de adolescentes. Para la discusión de los resultados encontrados, se ha llevado a cabo el referencial psicoanalítico. El estudio llevado a cabo ha permitido un mejor conocimiento acerca de la articulación de las demandas de la cultura actual con las modalidades psicopatológicas presentes en la clínica psicoanalítica de la adolescencia, así como identificar transformaciones que ocurren en la técnica psicoanalítica. El espacio del análisis se ha evidenciado como una relevante posibilidad de construcción y atribución de significado a los padecimientos psíquicos de la adolescencia, de forma a tornar viables despliegues saludables a sus vivencias.(AU)

[Reduced post-partum bleeding after treatment with sublingual misoprostol: a randomized double-blind clinical study in a developing country--secondary publication)]. / Reduceret post partum-blødning efter sublingval misoprostol: et randomiseret dobbeltblindt klinisk studie i et udviklingsland--sekundaerpublikation.

Post-partum haemorrhage is the most common cause of maternal death in third-world countries. The objective of this study was to evaluate whether routine administration of sublingual misoprostol, 600 g, reduces post-partum haemorrhage. Significantly fewer women in the misoprostol group experienced a loss of > or = 1,000 ml (11% vs. 17%; 0.66 (0.45-0.98)) or > or = 1,500 ml (2% vs. 8%; 0.28 (0.12-0.64)) of blood. We conclude that sublingual misoprostol reduces the frequency of severe post-partum haemorrhage.

Effect of sublingual misoprostol on severe postpartum haemorrhage in a primary health centre in Guinea-Bissau: randomised double blind clinical trial.

OBJECTIVE: To evaluate whether routine administration of sublingual misoprostol 600 microg after delivery reduces postpartum haemorrhage. DESIGN: Randomised double blind placebo controlled trial. SETTING: Primary health centre in Bissau, Guinea-Bissau, West Africa. PARTICIPANTS: 661 women undergoing vaginal delivery. INTERVENTION: Misoprostol 600 mug or placebo administered sublingually immediately after delivery. MAIN OUTCOME MEASURES: Postpartum haemorrhage, defined as a loss of > or = 500 ml and decrease in haemoglobin concentration after delivery. RESULTS: The incidence of postpartum haemorrhage was not significantly different between the two groups, the relative risk being 0.89 (95% confidence interval 0.76 to 1.04) in the misoprostol group compared with the placebo group. Mean blood loss was 10.5% (-0.5% to 20.4%) lower in the misoprostol group than in the control group. Severe postpartum haemorrhage of > or = 1000 ml or > or = 1500 ml occurred in 17% (56) and 8% (25) in the placebo group and 11% (37) and 2% (7) in the misoprostol group. Significantly fewer women in the misoprostol group experienced a loss of > or = 1000 ml (0.66, 0.45 to 0.98) or > or = 1500 ml (0.28, 0.12 to 0.64). The decrease in haemoglobin concentration tended to be less in the misoprostol group, the mean difference between the two groups being 0.16 mmol/l (-0.01 mmol/l to 0.32 mmol/l). CONCLUSION: Sublingual misoprostol reduces the frequency of severe postpartum haemorrhage.