Persistent high-risk behavior and escalating HIV, syphilis and hepatitis B incidences among men who have sex with men living in Bangui, Central African Republic.

INTRODUCTION: HIV in sub-Saharan Africa remains a great concern in men who have sex with men (MSM). Intervention on MSM is a key strategy to control the burden of HIV among this population. Herein we assessed the effect of 2 years of HIV testing and counseling on risk-tacking and HIV and STI incidences among MSM living in Bangui in the Central African Republic. METHODS: The incidences of HIV, syphilis and hepatitis B and the sexual behavior characteristics were assessed at inclusion and after 2 years of follow up in the prospective MSM cohort. RESULTS: 99 MSM were included and followed up during 2 years. The mean age of study MSM was 24 years (range, 14-39); among those, the majority was single (84.8%) and unemployed (33.3%) or students (23.9%). The majority (up to 80%) were living in only 4 (out of 10) neighboring district of Bangui. Insertive anal intercourse showed significant decrease from 54% at inclusion to 46% after 2 years of follow up (P < 0.001). In contrast, we observed slight increase in receptive anal intercourse (60% versus 66%) and oral sex (70% versus 74%), but the difference did not reach statistical significance. Finally, the prevalences of HIV, syphilis and hepatitis B increased significantly from 29% to 41%, 12% to 21% and 14% to 23%, respectively. CONCLUSION: These observations indicate that medical care and counseling on MSM does not provide significant changes in risk-taking, whereas the incidences of HIV, syphilis and hepatitis B remained high. Innovative interventions should be conceived for the MSM population living in Bangui.

[Analysis of interventions designed to improve clinical supervision of student nurses in Benin]. / Analyse d?interventions pour améliorer l?encadrement clinique des étudiants infirmiers au Bénin.

INTRODUCTION: The absence of an explicit and coherent conception of the articulation between theory and practice in the reform of nursing training in Benin has resulted in poor quality clinical supervision of student nurses. The objective of this article is to analyze two interventions designed to improve the quality of supervision. METHODS: A student welcome booklet developed by means of a consultative and provocative participatory approach was tested with twelve student nurses versus a control group. Content analysis of the data collected by individual semi-directed interviews and during two focus groups demonstrated the value of this tool. Student nurses were also taught to use to training diaries inspired by the ?experiential learning? MODEL: Training diaries were analysed using a grid based on the descriptive elements of the five types of Scheepers training diaries (2008). RESULTS: According to the student nurses, the welcome booklet provided them with structured information to be used as a reference during their training and a better understanding of their teachers, and allowed them to situate the resources of the training course with a lower level of stress. Fifty-eight per cent of the training diaries were are mosaics, reflecting the reflective practice and self-regulated learning of student nurses. This activity also promoted metacognitive dialogue with their supervisors. CONCLUSION: The student welcome booklet appeared to facilitate integration of student nurses into the clinical setting and promoted professional and organizational socialization. The training diary improved the quality of clinical learning by repeated reflective observation of student nurses and helped to maintain permanent communication with the supervisors.

SET-bullying: presentation of a collaborative project and discussion of its internal and external validity.

BACKGROUND: Since the early 1980s, several school based anti-bullying interventions (SBABI) have been implemented and evaluated in different countries. Some meta-analyses have also drawn conclusions on the effectiveness of SBABIs. However, the relationship between time and effectiveness of SBABIs has not been fully studied. For this aim, a collaborative project, SET-Bullying, is established by researchers from Greece, Belgium, Norway and United Kingdom. Its primary objective is to further understand and statistically model the relationship between the time and the sustainability of the effectiveness of SBABI. The secondary objective of SET-Bullying is to assess the possibility of predicting the medium-term or long-term effectiveness using as key information the prior measurement and the short-term effectiveness of the intervention. RESULTS: Researchers and owners of potentially eligible databases were asked to participate in this effort. Two studies have contributed data for the purpose of SET-Bullying. This paper summarizes the main characteristics of the participating studies and provides a high level overview of the collaborative project. It also discusses on the extent to which both study and project characteristics may pose threats to the expected internal and external validity of the potential outcomes of the project. DISCUSSION: Despite these threats, this work represents the first effort to understand the impact of time on the observed effectiveness of SBABIs and assess its predictability, which would allow for better planning, implementation and evaluation of SBABIs.

[Proposal of a conceptual method of supportive care for co-active patients]. / Proposition d'une méthode conceptuelle d'accompagnement du patient partenaire de soins.

There is a broad consensus on the importance for health professionals to support co-active patients. However, in practice, very few "patient care partnership" approaches have been developed. We hypothesized that the lack of investment in supporting patient care partnerships is due to the lack of interest in the skills needed by caregivers to provide such support. This paper intends to address thisgap. The patient care partnership method is studied, adapted and developed from existing models. It complements, harmonizes and integrates various schools of thought arising from the need to place the patient at the center of care and life in general. The patient care partnership method includes 7 stages during which the professional accompanies the patient through the process of care. The methodological approach for training professionals is designed to ensure that professionals experience the change as well as its difficulties of the change they expect from the patient in the care relationship. This method now needs to be validated by the experience of other professionals in order define the limits of application and to allow further development.

[Internship supervisors' perception of the management process and the quality of the clinical educational support in nursing and midwifery science in Benin]. / Perception des encadrants de stage du processus de estion et de la qualité de l'encadrement pédagogique clinique en sciences infirmières et obstétricales au Bénin.

BACKGROUND: the reform of nursing education requires to focus on the quality of clinical supervision. OBJECTIVE: to identify the perception of internship supervisors of the management process and the quality of the clinical supervision of students of the National Institute Health Services (INMES). METHOD: a qualitative and quantitative descriptive cross-sectional study was conducted among the supervisors of the National Hospital and University and the Hospital of the Mother and Child Lagoon Benin. Data collected using a self-administered questionnaire was treated with EPI INFO Version 3.5.4 and according to a content analysis. RESULTS: 92 % of supervisors have not received any specific training in coaching. There is no formal and regulatory framework conducive to coaching or mentoring repository. Collaboration between INMES and internship sites is low. The supervision is not integrated in the service missions, but rather related to a contextual occasion. The daily training period is considered short for a real learning. Summative assessment tool whose criteria are non adapted is done in the absence of the student. DISCUSSION: these results demonstrate the low quality of clinical supervision. CONCLUSION: the shortcomings identified will serve as basis for improving the quality of clinical supervision.

[The perceptions of adolescents and young people of sexual and reproductive health in the Democratic Republic of Congo]. / Perception des adolescents et jeunes en matière de santé sexuelle et reproductive, République Démocratique du Congo.

Adolescents and young people have specific concerns about issues related to sexual and reproductive health. The purpose of this study, conducted in an urban setting of the DRC, was to identify the needs and perceptions of adolescents and young people in the area of sexual and reproductive health with a view to informing policy. This paper presents the results of a qualitative study using focus groups conducted in three cities of the DRC (Kinshasa, Goma and Matadi). The study focused on adolescents and young people of both sexes and from different social classes from the following age groups: 10-14, 15-19 and 20-24. Among the female participants, the results highlight the need for information on the menstrual cycle and sexual experiences, while the male participants identified masturbation and sexual performance as their main concern. The study also found that emotional relationships and sexuality can help to solve sentimental and material problems not usually addressed within the family. The participants also emphasized the need for sex education, although they insisted on the importance of confidentiality. The results also suggest that adolescents and young people prefer to communicate with medical personnel, religious leaders, and teachers rather than their parents. The media were found to be the main source of information about sexual and reproductive health. However, there also appears to be a need for interpersonal communication. In addition, the results indicate that health services are considered a secondary option after self-medication and traditional treatments, which are seen as more accessible. In the DRC, programs targeting adolescents and young people have been developed to meet current needs and improve provision.

[Tobacco use in secondary schools in Gabon: Prevalence and associated psychosocial factors]. / Tabagisme en milieu scolaire secondaire du Gabon Prévalence et facteurs psychosociaux associés.

This study aims to measure the prevalence of smoking and identify the psychosocial factors associated with it among students in secondary schools in Gabon. This cross-sectional descriptive study collected information by a self-administered questionnaire, completed by 4833 students aged 14 to 22 years. The results show that 10.9% of these young people are current smokers and that the risk of smoking is highest among males and increases with age. Poor school performance and poor family relationships were both associated with smoking. The risk of smoking was highest among students repeating a year at least 3 times, those with substantial school absenteeism, those from smaller families, and finally among those at a relatively well-to-do socioeconomic level. The youth who "go out regularly" were the group at the highest risk in the study. This study, which focuses on the psychosocial factors associated with smoking, may contribute to the prevention of smoking among young Gabonese. For the first time, it is possible to identify the groups at highest risk of smoking and thus to contribute to developing antismoking strategies appropriate to the cultural and socioeconomic conditions of the country.

Analysis of adequacy levels for human resources improvement within primary health care framework in Africa.

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects:- adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations,- adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations,- adequacy between human resource management within health care system and medical standards,- adequacy between human resource management within education/teaching/training and needs from health care system and education sectors,- adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body,- adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...). This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate.

A model for analysis, systemic planning and strategic synthesis for health science teaching in the Democratic Republic of the Congo: a vision for action.

BACKGROUND: The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. METHODS: Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC). RESULTS: The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health. CONCLUSIONS: The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.

Targeting pupils at risk of occupational asthma.

A cross-sectional study was carried out in pupils attending the last training year from three school sections with high risks of occupational asthma (hairdressing, wood's profession, bakery) and in two groups with lower risks (butcher, salesmen). The analysis concerns a representative sample of 533 pupils in the French-speaking Community of Belgium. Among them, 62.0% in high risk professions of occupational asthma (OA) are conscious of occupational risks related to their work, as were 52.1% of those in professions less at risk (P < 0.05). The difference is also significant when asthma is mentioned as a health problem: 12.6% of the bakers and 14.1% of the hairdressers declared having suffered from asthma and 21.4% of the bakers and 26.7% of the hairdressers reckoned having had wheezing in their chest over the last 12 months. These results report preliminary signs of asthma in pupils before entering in their active life with risk of OA. Primary prevention should include information and redirecting pupils at risk of developing or increasing the disease in their working environment.

Role of physicians in preventing accidents in the home involving children under 15 years in the French-speaking community of Belgium.

OBJECTIVES: To measure GPs' and paediatricians' expectations, attitudes, priorities and demands in the area of promoting safety and preventing accidents in the home involving children under 15 years of age. METHODS: A phone survey of a random sample of GPs and paediatricians in the French-speaking community of Belgium (Wallonia and Brussels) conducted in the course of September and October 2000. RESULTS: Close to two-thirds of the physicians surveyed stated that they had been contacted at least once in the 2 weeks preceding the survey to handle an injury. Of the physicians, 80% mention accident prevention after a childhood injury, but only 46% mention it during a routine consultation (whatever the reason of the latter may be). The main obstacles to mentioning prevention during routine consultation put forward by the interviewees are: 1) reasons for consultations that do not permit such an approach (79%); 2) the fact that injuries are not priorities for them (66%); 3) the lack of interesting materials to provide the subject with documentation (63%); 4) the unsuitability of the place where the contact occurs for such discussion, given the time required (56%); 5) insufficient information on the subject (41%); and 6) the patient's lack of interest (39%). An overwhelming majority (98%) nevertheless feel that they have a role to play in preventing children's accidents in the home, with 72.5% seeing this as informative (recommendation on safety rules). More than two-thirds of the respondents feel that they have enough requisite information to play such a role. Those who declare that they have not enough information (34%) proposed some priority subjects about which they would like to find information or additional information to be more effective in preventing accidents. The information needs mentioned most frequently were a systematic review of the risks, of the effective prevention strategies and epidemiological data. CONCLUSIONS: The present study clearly reveals the interest of physicians for accident prevention and puts forward the current obstacles to offering prevention advice during routine consultation. The obstacles mentioned are fairly comparable to those mentioned in other studies, namely, because the reason for the visit does not give such an opening, the lack of appropriate materials and information, the lack of time, the patient's lack of interest, the fact that the issue is not a priority, etc. The problem of lack of priority for certain practitioners underlines the importance of making accident mortality and morbidity statistics available to doctors in order to improve their perception of the magnitude of the problem. The lack of interesting education materials and useful information seems to be a major reason for their failure to carry out such prevention work successfully. These factors should thus be taken into account when developing any policy and/or programme aimed at 'using' GPs and paediatricians in the prevention strategies that are adopted.

Peer, family integration and other determinants of cannabis use among teenagers.

Cannabis consumption is on the rise in the French-speaking Community of Belgium, especially among teenagers. The physical and mental harms related to that drug prompted us to search for factors associated with cannabis consumption. The aim of this paper is thus to identify a series of potential predictors of teenager's cannabis use and particularly the influence of peer and family integration. The data analyzed were taken from the 1998 data bank "Health Behavior in School-Aged Children", an international quantitative cross-national study, which takes place every four years. The variables investigated were peer and family integration and the habit of drug consumption (tobacco, alcohol or a narcotic other than cannabis) as potential determinants of the experimentation, current usage of cannabis (at least once a month) and regular usage (at least once a week). Apart from the socio-demographic variables, these predictors were investigated by univariate and multivariate analysis (logistic regression). The analyses covered 744 students in Catholic high schools. Results showed that 30.2% of students had tried to smoke cannabis and 50% of them continued to smoke it at least during the previous month. Age, number of income in the family, strong peer group integration [OR 7.7; CI 95% (3.5;17.3)] and drug-consumption habit [for example, tobacco use: OR 7.4; CI 95% (4.8;11.32)] were associated with cannabis experimentation. Age, gender, nationality, average family integration [OR 2.13; CI 95% (1.1;4.1)] and other drugs use as addiction to nicotine [OR 9.5; CI 95% (5.6;16.3)] determined the current consumption of the substance. Preventive action should aim at improving the teenager's integration into the family circle in order to prevent the trial and consumption of cannabis. In addition, prevention should include the consumption of (addictive) substances in general.

[Development and evaluation of the use of an interactive CD-ROM for students at risk of disease related to occupational hazards: the case of asthma]. / Développement et évaluation de l'utilisation d'un CD-ROM interactif destiné aux élèves à risque de maladies professionnelles: le cas de l'asthme professionnel.

Within the framework of an informational programme on the risks of asthma associated with certain occupations (hairdresser, carpenter or baker), an interactive CD-ROM was developed for senior students of these professions. Among the schools who benefited from this information, the programme chose three to evaluate. A total of 113 students between the ages of 17 and 20 filled out a questionnaire and participated in a group discussion after the session. All of the students were able even though only 48% regularly use a computer. More than 95% of the participants were satisfied with the content, the academic approach proposed and the interactive support, which is flexible and contains a self-test. The students found the CD-ROM to be a more efficient means of retaining information than classic lectures. As for the evaluation of the knowledge acquired on asthma and the workplace, half of the students said they had considerably increased their knowledge on the illness, while 47% only saw a minor increase. This statement was confirmed through the correlation of scores obtained in the pre- and post-programme exams, whose results show a statistically significant increase in knowledge. Despite the academic value the students gave to this type of learning, the advantage of this kind of pedagogical tool are also to be considered given that is easy for teachers to learn how to use the technology and teach it. Nowadays it is so simple to produce multimedia support for computers, that this method can be easily developed for a target audience and at low cost.