Social change and HIV in the former USSR: the making of a new epidemic.

This paper describes the development of the recent HIV epidemic in countries of the former Soviet Union. It explores the socio-political and economic roots of an injection-drug-driven HIV epidemic associated with a drug culture that facilitates HIV transmission. This review, based on many unpublished reports, studies and field notes, discusses the new social and health context in which the epidemic is developing. The evidence of a growing number of drug users in the region is discussed and drug injection behaviour described. The authors present selected data on the heterosexual transmission of HIV and linkages between the drug-linked HIV epidemic and its further spread into the non-injecting population. The potential overlap with the still uncontrolled syphilis epidemic that began in 1990 is probably a key factor in the future of HIV spread in the region. Until now, HIV infection among STD patients has been extremely low. However, rapid changes in sexual norms and behaviours, the growing commercial sex industry, and increased mobility soon may affect the current situation. The huge economic and socio-political crises currently affecting the region have created a "risk situation" for the spread of HIV. Concerns are raised about the appropriateness and the scope of government and non-governmental approaches to the exploding HIV and STD epidemics.

Reorganization of equilibrium and movement control strategies after total knee arthroplasty.

This work was aimed at identifying changes in posturomotor control strategies in patients with unilateral total knee arthroplasty. Using kinetic and kinematic data, a previous study had revealed that, during a side step, patients with unilateral knee arthritis showed a shortened monopodal phase and a lengthened postural phase when the affected leg was the supporting one. It was expected that these strategies would be modified after undergoing total knee arthroplasty. Postoperatively the durations of the monopodal phase and of the postural phase became similar when the operated limb was supporting and when the sound limb was supporting. Concerning the upper body movements, the same asymmetrical results as before surgery were observed. Hence, patients with total knee arthroplasty exhibit posturomotor strategies which, although they become close to normal, remain asymmetrical. The durations of the monopodal and of the postural phases could be considered to assess the results of total knee arthroplasty.

[Methods of shifting body weight in patients with knee arthroses]. / Modalités de transfert du poids du corps chez le patient gonarthrosique.

INTRODUCTION: The aim of this work was to study movement control strategies in patients with knee arthritis. These strategies were expected to be different from healthy subjects because of deficiencies due to knee arthritis (i.e. pain, altered proprioception). METHOD: A kinetic and kinematic analysis was performed in a population of 10 patients with unilateral knee arthritis and in 11 age-matched control subjects, using an ELITE system and two AMTI force-plates. The different phases of a side step were studied. RESULTS: The timing of the movement was different in the two populations. The postural phase was longer and the monopodal phase was shorter in knee arthritis patients when the affected leg was the supporting one than when the sound leg was supporting. Total step duration and landing-stabilization phase duration were longer in knee arthritis patients than in healthy subjects. CONCLUSION: This movement analysis method enables to determine and to quantify differences between knee arthritis patients and control subjects. Clinical examination cannot identify these differences. Movement analysis methods bring up additional information to usual clinical evaluation scales and could be used for evaluation of the results of total knee arthroplasty.

[Influence of knee replacement arthroplasty on modalities of weight transfer during the lateral step]. / Influence de l'arthroplastie totale de genou sur les modalités de transfert du poids du corps au cours du pas latéral.

INTRODUCTION: The aim of this work was to study the relations between equilibrium and movement in patients after total knee arthroplasty. A previous study, conducted in patients with unilateral knee osteoarthritis, had shown that the timing of the events occurring during a side-step was modified in an asymmetrical way according to the supporting leg with respect to the affected one. METHOD: A kinetic and kinematic analysis was performed in a population of 9 patients before and after total knee arthroplasty and in 11 control subjects, using an ELITE system and two AMTI force-plates. The different phases (i.e. postural, monopodal, landing and stabilization) of a side step were studied. RESULTS AND DISCUSSION: Before surgery, the postural phase was longer and the monopodal phase was shorter in knee arthritis patients when the affected leg was the supporting one than when the sound leg was supporting. Total step duration and landing-stabilization phase duration were longer in patients no matter which leg was supporting than in control subjects. After total knee arthroplasty, the postural phase remained longer when the operated leg was supporting than when the sound leg was supporting. Altered proprioception can provide an explanation for this result. However, the duration of the postural phase decreased significantly when the operated leg was supporting as compared to when the affected leg was supporting before surgery. The duration of the monopodal phase was the same when the operated leg was supporting than when the sound limb was supporting and increased significantly as compared to when the affected leg was supporting before surgery. This result can be related to the decrease of pain which was observed in all patients after surgery. The duration of the landing-stabilization phase and the total movement duration remained longer in patients after surgery no matter which leg was supporting than in control subjects. CONCLUSION: This study shows that relations between equilibrium and movement tend to become symmetrical with respect to the leg used as supporting one in patients after undergoing total knee arthroplasty but remain different from those of control subjects. This movement analysis method enables to determine and to quantify differences in patients before and after undergoing total knee arthroplasty and thus provides additional information for the functional evaluation of patients with total knee prosthesis.

Reorganization of equilibrium and movement control strategies in patients with knee arthritis.

The purpose of this study was to identify changes in equilibrium and movement control strategies in patients with arthritis of the knee. These strategies were expected to be different from those of healthy subjects because of the impairments caused by knee arthritis. The different phases of a side step were studied in patients with severe knee arthritis using a movement analysis system and force-plates. The duration of the postural phase and the intensity of the horizontal ground reaction forces during the postural phase were increased when the pathological limb was the supporting one. The monopodal phase was shortened on the pathological leg. These results show that knee arthritis patients develop new posturomotor strategies mainly aimed at shortening the monopodal phase when the affected leg is the supporting one. This movement analysis method enables quantification of differences that cannot be observed on clinical examination between knee arthritis patients and control subjects, and provides additional information to the usual clinical evaluation scales.

Assistance aux victimes de violences sexuelles dans les camps de refugies. Lecture ethnologique des recommendations des agences internationales de soutien psycho-social

"Une politique d'assistance definit dorenavant l'approche et les pratiques considerees comme legitimes en matiere de ""sante de la reproduction"" dont ses procedures concernent l'assistance psycho-sociale aux victimes de violences sexuelles. D'apres l'analyse de l'auteur; avant meme sa mise en pratique; elle semble vouloir appliquer des techiques therapeutiques contigentes a un contexte socioculturel souvent etranger a la victime refugiee. De plus; bien que voulant prendre en compte les ""conceptions traditionnelles"" dont les victimes refugiees seraient porteuses; elle nie l'aspect dynamique de la construction individuelle et collective du sens."