Child maltreatment and intimate partner violence

Abstract : This study aimed to 1) evaluate the prevalence of intimate partner violence (IPV) and revictimization among a representative sample of 1,001 women living in Quebec, Canada; 2) examine whether IPV was predicted by experiences of child maltreatment; and 3) explore the role of polyvictimization on IPV beyond the effect of any type of exposure. Results indicate the prevalence rates of lifetime IPV (10.5%), IPV over the last year (2.5%), and revictimization (7.2%). All forms of child maltreatment predicted an increased risk of IPV victimization, yet polyvictimization was related to IPV beyond the effects of the specific forms of child maltreatment

Mortalité maternelle et accès aux soins obstétricaux : analyse d'implantation du système de référence-évacuation dans la Région de Kayes (composante Mali); soutien scientifique aux équipes de recherche - rapport technique final

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Vitamin D status, cognitive decline and incident dementia : the Canadian Study of Health and Aging

Objective: Vitamin D could prevent cognitive decline because of its neuroprotective, anti-inflammatory and antioxidant properties. This study aimed to evaluate the associations of plasma 25-hydroxyvitamin D (25(OH)D) concentrations with global cognitive function and incident dementia, including Alzheimer’s disease (AD). Methods: The Canadian Study of Health and Aging is a 10-year cohort study of a representative sample of individuals aged 65years or older. A total of 661 subjects initially without dementia with frozen blood samples and follow-up data were included. Global cognitive function was measured using the validated Modified Mini-Mental State (3MS) examination. A consensus diagnosis of all-cause dementia and AD was made between the physician and the neuropsychologist according to published criteria. Cognitive decline for a 5-year increase in age at specific 25(OH)D concentrations was obtained using linear mixedmodels with repeated measures. Hazard ratios of incident dementia and AD were obtained using semi-parametric proportionalhazards models with age as time scale. Results: Over a mean follow-up of 5.4 years, 141 subjects developed dementia of which 100 were AD. Overall, no significant association was found between 25(OH)D and cognitive decline, dementia or AD. Higher 25(OH)D concentrations were associated with an increased risk of dementia and AD in women, but not in men. Conclusion: This study does not support a protective effect of vitamin D status on cognitive function. Further research is needed toclarify the relation by sex.Objectif : La vitamine D pourrait avoir un effet protecteur sur le déclin cognitif en raison de ses propriétés neuroprotectrices, anti-inflammatoires et antioxydantes. L’objectif de cette étude était d’évaluer les associations entre la concentration plasmatique de 25-hydroxyvitamine D (25(OH)D), la fonction cognitive globale et l’incidence de la démence incluant la maladie d’Alzheimer (MA). Méthodes: L’Étude sur la santé et le vieillissement au Canada est une étude de cohorte de 10 ans réalisée dans un échantillon représentatif des Canadiens âgés de 65 ans et plus. Un total de 661 participants sans démence, pour lesquels un échantillon sanguin congelé et des données au suivi étaient disponibles, ont été inclus dans l’analyse. La fonction cognitive globale a été mesurée à l’aide d’un outil validé, le Modified Mini-Mental State(3MS) Examination. Les diagnostics de démence toutes cause set de MA ont été obtenus par consensus entre un médecin généraliste et un neuropsychologue selon des critères publiés. Le déclin cognitif pour chaque augmentation de 5 ans d’âge à des concentrations spécifiques de 25(OH)D a été mesuré à l’aide de modèles linéaires mixtes avec données répétées. Des rapports de risques de la démence et de la MA ont été obtenus à l’aide de modèles à risques proportionnels semi-paramétriques en utilisant l’âge comme échelle du temps. Résultats : En cours de suivi (moyenne : 5,4 ans), 141 individus ont développé une démence dont 100 étaient la MA. Globalement, aucune association statistiquement significative n’a été observée entre le 25(OH)D et le déclin cognitif, la démence ou la MA. Des concentrations plus élevées de 25(OH)D étaient associées à une augmentation du risque de démence et de MA chez les femmes, mais pas chez les hommes. Conclusion : Cette étude n’appuie pas l’hypothèse d’un effet protecteur de la vitamine D sur la fonction cognitive. D’autres études seraient nécessaires pour clarifier la relation selon le sexe

Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali

Also published in the project's final report as annex AA maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services, and community cost-sharing schemes was implemented in six rural health districts in Kayes region, Mali. Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from hemorrhage, demonstrating that national programmes can be implemented in low-income countries that are able to rapidly improve the coverage of obstetric services and reduce the risk of maternal mortality

Mother and newborn survival according to point of entry and type of human resources in a maternal referral system in Kayes (Mali)

The study assesses maternal and newborn survival in women presenting with an obstetric complication in Kayes (Mali). It compares the effects of the point of entry into the referral system on joint mother-newborn survival, and the effects of the configuration of healthcare teams at the community health centers (CHC). Results show that entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50%. The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less

Improving obstetric care in low-resource settings: implementation of facility-based maternal death reviews in five pilot hospitals in Senegal

<p>Abstract</p> <p>Background</p> <p>In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal.</p> <p>Methods</p> <p>This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches.</p> <p>Results</p> <p>Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1) bad quality of information in medical files; (2) non-participation of the head of department in the audit meetings; (3) lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1) high level of professional qualifications or experience of the data collector; (2) involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3) participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths.</p> <p>Conclusion</p> <p>The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We recommend for future implementation of this method a prior enhancement of the perinatal information system and initial training of the members of the audit committee – particularly the data collector and the head of the maternity unit. Local leadership is essential to promote, initiate and monitor the audit process in the health facilities.</p

Programme evaluation training for health professionals in francophone Africa: process, competence acquisition and use

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18. Une évaluation des processus d’un programme de référence-évacuation au Mali

Ce chapitre traite de l’évaluation d’un programme de référence-évacuation des urgences obstétricales dans un pays à faibles ressources, le Mali. Cette évaluation, qui est toujours en cours, consiste en une analyse de l’implantation et des effets du programme. Elle répond aux besoins d’information des acteurs locaux et régionaux qui ont participé activement à sa définition et à sa mise sur pied, et ce, dans une région précise du Mali. Nous décrirons tout d’abord le programme ainsi que le conte..

Évaluation des processus et des effets d'un programme de référence-évacuation des urgences obstétricales au Mali

Également publié dans le rapport final du projet comme annexe CCe chapitre traitera de l'évaluation d'un programme de référence-évacuation des urgences obstétricales dans un pays à faibles ressources, le Mali. Cette évaluation, qui est toujours en cours, consiste en une analyse de l'implantation et des effets du programme. Elle répond aux besoins d'information des acteurs locaux et régionaux qui ont participé activement à son implantation, et ce, dans une région spécifique du Mali. Nous décrirons tout d'abord le programme ainsi que le contexte dans lequel il s'inscrit. Nous présenterons ensuite succinctement les principales approches utilisées dans l'analyse de l'implantation et le protocole d'évaluation retenu. Enfin, nous détaillerons le processus d'évaluation et présenterons les résultats obtenus et les leçons apprises jusqu'à ce jour