A simple method for rapid community assessment of tungiasis

Objective To evaluate a rapid assessment method to estimate the overall prevalence of tungiasis and severity of disease in endemic communities. Methods We analysed data from 10 population‐based surveys on tungiasis, performed in five endemic communities in Brazil and Nigeria between 2001 and 2008. To assess the association between occurrence of tungiasis on six defined topographic areas of the feet and the true prevalence/prevalence of severe disease, linear regression analyses were performed. Estimated prevalences were calculated for each of the 10 surveys and compared to true prevalences. We then selected the most useful topographic localization to define a rapid assessment method, based on the strength of association and operational aspects. Results In total, 7121 individuals of the five communities were examined. Prevalence of tungiasis varied between 21.1% and 54.4%. The presence of periungual lesions on the toes was identified as the most useful rapid assessment to estimate the prevalence of tungiasis (absolute errors: ?4% to +3.6%; R² = 96%; P < 0.0001). Prevalence of severe tungiasis (>20 lesions) was also estimated by the method (absolute errors: ?3.1% to +2.5%; R² = 76%; P = 0.001). Conclusion Prevalence of tungiasis and prevalence of severe disease can be reliably estimated in communities with distinct cultural and geographical characteristics, by applying a simple and rapid epidemiological method. This approach will help to detect high‐risk communities and to monitor control measures aimed at the reduction of tungiasis.     

Change in willingness to pay for normal delivery and caesarean section during pregnancy and after delivery in Kathmandu

Objectives To determine the change in willingness to pay (WTP) measured at pregnancy and at postpartum before and after knowing hospital costs among women who gave birth by normal delivery (NL) and caesarean section (CS) and to identify factors affecting the change in WTP. Methods A prospective study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. WTP for total costs was measured by double‐bound dichotomous contingent valuation and an open‐ended technique. The trend of WTP over time was tested using longitudinal analysis. Associated factors to the positive or negative change in WTP were analysed by logistic regression. Results Of 438 pregnant women followed up both at pregnancy and postpartum, two‐thirds were willing to pay for services at the initial bid of the double‐bound method by $60–$85 for NL and $110–$170 for CS. There were no significant differences in the median WTP measured during pregnancy between NL and CS. The WTP of both groups changed significantly over time (P < 0.001). Caesarean section, perception of good care, information provided on delivery costs and discussion with family about cost were significantly associated with changes from pregnancy to the postpartum period. Conclusions In low‐income countries such as Nepal, where out‐of‐pocket health care expenditures are common, women perceived the health benefit of delivery care in hospital, especially for emergency CS. Their WTP had changed substantially after delivery, and awareness of the associated factors is essential for further policy and planning to improve the services and utilization.     

Rencontre de modèles cliniques et robotiques. Du saut entre les organisations psychiques

Clinical models of the mental system and robotic models of artificial thinking show analogies which enable us to compare them. These encounters facilitate the study of the jumps between the various mental organisations. Actually, these jumps are easily observed in current clinic. It is a matter of commonplace observations (the various organisations), of means reflecting them (ladder and systematical module), of natural jumps in mental disturbances (periods of evolution of mental disturbances, structuring of disturbances, integration of the various levels of organisation), and of internal gaps in the system during the formation of the meaning process. Correspondingly, robotics emphasize the specific principles of a system of artificial thinking: the internal structuring of the system, the relations with the external world and self-control; these principles are directly analogous with clinical facts. Furthermore, their realisation shows an efficient structuring of these jumps allowing a better understanding of them. These comparisons show the interest of modeling in three co-active and indissociable levels (biologic, semantic, and linguistic), of taking account of gaps and regulating factors, of refining means of thinking (particularly of intuition and of the matrices of logic knowledge) and of a better grasp of pathologic phenomena.     

Psychiatrie médico-légale et méthode psychopathologique au cours de la première partie du XX siècle

Epistemological analysis is used for studying forensic psychiatry in xxth century. Clinical analysis with psychodynamical and psychoanalytical approaches have build specifical analysis used for clinical studies. Epistemological analysis is used for studying forensic psychiatry process.