Understanding venous leg ulcers

Venous leg ulcers are open lesions between the knee and the ankle joint, which occur in the presence of venous insufficiency. There are theories to explain the causes of venous insufficiency, which ultimately leads to venous hypertension and can result in leg ulceration. Although many patients present with evidence of venous hypertension, others do not, except for the manifestation of the ulcer. There are risk factors associated with venous insufficiency and a holistic approach must be taken in order to influence the management approach of venous leg ulceration. This article discusses venous insufficiency as a disease process, and explores the nursing assessment process, when assessing venous leg ulcers related to venous insufficiency

An evaluation of a novel alternating mattress and cushion technology

Pressure ulcer prevention and management remain a challenge across all health-care settings, and the incidence and prevalence of pressure ulcers in nursing homes and residential homes continues to remain unknown. The use of suitable support surfaces has been found to be beneficial in the prevention and management of pressure ulcers. Carrying out a holistic assessment of the patient and recording the patient's at-risk score would help the clinician to determine the most suitable pressure-relieving surface for the patient. The clinician's clinical experience and judgment are also important. The Domus Auto (by APEX) mattress system and Dynamic Seat Cushion (by APEX) are effective dynamic, support surfaces in the prevention and management of pressure ulceration. They meet the recommendations by both national and international guidelines; they also partly fulfil the SSKIN bundle. From a four-week evaluation carried out in a nursing home, it has been demonstrated that, together with regular assessments and repositioning of the patients, these devices are useful tools in preventing patients' risk of tissue damage and improving the patients' quality of life. </jats:p

Slow acceptance of universal antiretroviral therapy (ART) among mothers enrolled in IMPAACT PROMISE studies across the globe

CITATION: Stranix‑Chibanda, L., et al. 2019. Slow acceptance of universal antiretroviral therapy (ART) among mothers enrolled in IMPAACT PROMISE studies across the globe. AIDS and Behavior, 23:2522-2531, doi:10.1007/s10461-019-02624-3.The original publication is available at https://link.springer.comThe PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary reason given for accepting or rejecting the universal ART offer after receiving the START information. One-third of participants did not initiate ART after the initial session, wanting more time to consider. Six sessions were required to attain 95% uptake. The slow uptake of universal ART highlights the need to prepare individuals and sensitize communities regarding the personal and population benefits of the “Treat All” strategy.https://link.springer.com/article/10.1007/s10461-019-02624-3Publisher's versio

Plurilinguisme, politique linguistique et éducation

Mayotte est une petite île française située dans l'océan Indien. Malgré son insularité, elle a toujours été ouverte aux apports étrangers ; sa situation géographique - à l'entrée du canal de Mozambique - l'expose à l'arrivée de tous ceux qui empruntent cette voie maritime sans obstacles. Historiquement, elle a des liens de proximité forts avec les autres îles de l'archipel des Comores et la grande île de Madagascar, ce qui explique la présence, sur son territoire, de deux langues locales, l'une d'origine bantoue, le shimaore, l'autre d'origine malgache, le kibushi. Celles-ci cohabitent avec la langue officielle et de la scolarisation : le français. Française depuis 1841, cette île est aujourd'hui exposée à une démographie galopante, une immigration massive et une mondialisation grandissante. Devenue le 101e département français depuis le 31 mars 2011, en pleine mutation socioculturelle, Mayotte doit faire face à tous ces obstacles. Les articles réunis dans cet ouvrage ne portent pas exclusivement sur Mayotte ; ils rendent compte aussi d'expériences et de travaux qui ont été menés dans d'autres pays ou dans des régions dont les situations linguistiques ressemblent à celle de Mayotte. Par la diversité de leurs regards et la richesse de leurs analyses, ces contributions apportent des éclairages importants sur la situation linguistique mahoraise et contribuent à approfondir le débat sur les rapports entre plurilinguisme, politique linguistique et éducation