Perceptions,health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon

Setting:

Lambaréné, Gabon.

Objectives:

To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB.

Design:

Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic.

Results:

Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts.

Conclusion:

There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities.     

Congés-maladie des enseignants : fréquence,durées,raisons et facteurs associés

Background

Absences from work have considerable social and economic impact. In the education sector, the phenomenon is particularly worrying since teacher sick leave has an impact on the overall performance of the education system. Yet, available data are scarce.

Mortality associated with nosocomial infection, occurring in a general hospital of Sumaré-SP, Brazil

This study investigated the socio-demographic profile, clinical procedures and etiology of nosocomial infection associated with deaths in the Hospital Estadual Sumaré, state of S?o Paulo, Brazil, from 2007 to 2008. The retrospective study of medical records (n = 133) revealed an average of 35 days of hospitalization. Most patients (97%) underwent some invasive procedure associated with nosocomial infection (p ≤ 0.05), including: 90 (67.7%) pneumonia, 62 (46.6%), urinary infections and 97 (73%) septicemia. Infection was the leading cause of death in 75 (56.4%) cases, with defined etiology in 110 (82.7%); 34 (30.9%) because of microorganisms that were multidrug-resistant. The most common was Staphylococcus aureus (25%), related to pneumonia and blood stream infection. The monitoring of hospital infection contributed to intervention at risk situation and death.     

Évaluation du handgrip préradiochimiothérapie des patients présentant un cancer des voies aérodigestives supérieures

IntroductionThe updated diagnosis criteria for adult undernutrition introduced assessment of muscle mass and/or muscle function. As undernutrition is a factor in the interruption of radio-chemotherapy treatments for head and neck cancer, we evaluated the association between pre-therapeutic muscle function according to handgrip strength and treatment interruptions.Materials and methodsAncillary study of an observational, mono-centric, prospective cohort evaluating the benefit of systematic, global and early supportive care in patients with head and neck cancer before radio-chemotherapy concomitant. Were included patients for whom radio-chemotherapy concomitant was being considered for radical treatment of head and neck cancer and who had a pre-therapeutic handgrip test.ResultsThirty-nine patients were included from July 2019 to February 2020. Nine patients were undernourished and three had pathological handgrip strength. Handgrip test permitted to reclassify three patients as undernourished. Radiotherapy discontinuation was significantly associated with a pathological pre-therapeutic handgrip strength (P = 0.0359). No association was found for discontinuation of chemotherapy (P = 1).ConclusionPre-therapeutic handgrip test for patients with head and neck cancers is of interest on the oncological treatments choice regarding toxicities risk that may lead to treatment discontinuation.     

Efficacité et tolérance des gastrostomies percutanées radiologiques en cancérologie des voies aérodigestives supérieures

Nutritional care is essential for upper aerodigestive tract cancer patients. In the hospital, percutaneous radiologic gastrostomy is performed using “introducer” method. The objective of this study was to assess the efficacy and tolerability of gastrostomy inserted to patients suffering from upper aerodigestive tract cancer. A retrospective study about data collection has been done on gastrostomy insertions from January 1st, 2018 to December 31st, 2018 to patients suffering of upper aerodigestive tract cancer in the Otorhinolaryngology department. Thirty-seven patients in total received a gastrostomy whose indication was prophylactic in the majority of the cases (78%). Seventeen patients (46%) lost weight (mean [min; max]: ?2,5 kg [?0,1; ?5,7]) and nine (24%) gained weight (3,2 kg [0,5; 6,9]) in the interval between the gastrostomy insertion and two months after the end of treatments. The mean duration of gastrostomy was 146 days [42; 367]. On average, patients resumed eating 42 days [9; 91] after the end of treatments. Complications affected five patients (13%): peristomal leaking, porosity and deflation of the balloon, abdominal contractures and a hemorrhagic shock at the moment of the insertion. Gastrostomy insertion is a major asset to limit weight loss. Furthermore, the tolerability was found to be similar to the one from the literature for any type of gastrostomy (curative and preventive).     

Child health and nutrition in a Teréna indigenous community, Mato Grosso do Sul, Brazil

This paper describes the health and nutritional situation of South American Indian children from a Teréna community, characterizing their nutritional status, food consumption, and socioeconomic and environmental conditions. The sample included 100 children, ranging from 0 to 59 months of age and living in Aldeia Córrego do Meio, Mato Grosso do Sul. Prevailing nutritional deficits were: 8.0% for the weight-for-age index, 16.0% for height-for-age, and 5.0% for weight-for-height. The growth deficit rate was higher than that of the Brazilian population as a whole, probably reflecting the precarious socioeconomic, environmental, and health conditions in this Teréna community. Analysis of the average nutrient sufficiency in the infant diet showed that nutritional recommendations for the different groups were not complied with. New studies, characterized as transdisciplinary and longitudinal, are necessary to better understand this process.     

Activité physique,nutrition et obésité

This review presents the various benefits of physical activity in obese patients and proposes a therapeutic strategy to include this important element in overall obesity management. Physical activity counseling includes structured endurance and resistance exercise training, promotion of lifestyle physical activity as well as limitation of sedentary behavior. The favorable effects of physical activity in obesity management are many but of varying importance. Weight maintenance after weight loss is considered the main benefit but requires higher volume of exercise than recommended for health maintenance in the general population. Other substantial benefits concern maintenance of body composition and improvement of obesity-related comorbidities, especially cardiometabolic complications. Programs and benefits of physical activity in the specific situation of weight loss after bariatric surgery need further research. Following a therapeutic education process aiming at sustained behavior modification, the goals for physical activity counseling need to be tailored to individual situations and barriers (physical/physiological, personal, environmental) should be carefully considered. Specific physical activity programs, when initiated in the health care sector, benefit from the input of physical activity educators. Maintenance of programs over time requires collaboration with stakeholders such as physical activity associations, sports clubs and obese patients organizations.