Caring for the carer: home design and modification for carers of young people with disability

This HMinfo Occasional Research Paper focuses on carers, that is those who deliver informal (unpaid) care to young people with disability, and particularly those carers who share their home with the person they are caring for, as well as the housing design considerations that may support carers in their caring role. In this report, paid carers are referred to as support workers, and their role is clearly differentiated from that of carers, who are unpaid. It should also be noted that many people with disability are themselves the carer for a partner or family member. Both carers, who are usually family members or partners, and support workers, who are paid to provide care to a person with disability, need supportive and safe environments in which to care for people with disability. The definition of a carer is: “A person of any age who provides any informal assistance, in terms of help or supervision, to persons with disabilities or long-term conditions, or older persons (i.e. aged 60 years and over). This assistance has to be ongoing, or likely to be ongoing, for at least six months.”. This research adopts a definition of disability that understands it as the product of interaction between an individual and their environment. Whether or not a particular physical condition is experienced as disabling depends on the natural and built environment, social, political and cultural structures, and interpersonal processes of the individual concerned. In addition, Eley et al highlight that both people with intellectual disability and their carers are ageing, and the concurrent ageing of these groups poses specific challenges in providing suitable housing. For the purpose of this research, the concept of ‘care’ is defined as the provision of assistance to a person with disability or chronic health condition or frail older person, to ensure their health, safety and wellbeing. Care is generally triaged into: • formal care delivered by waged staff or trained volunteers • informal care delivered by unpaid carers, usually family members; or • self-care, a newly evolving conceptual category that will be referenced in this report insofar as it impacts on the degree of care provided by carers. The ABS describes self-care as the capacity to undertake tasks associated with: showering or bathing; dressing; eating; toileting; and bladder or bowel control. This HMinfo Occasional Research Paper will focus on the unpaid (informal) carers of young people with disability (<65 years) only, and from the following perspectives: 1. What tensions, if any, may exist between a carer’s needs and the needs of the person with disability in home design? 2. What design features of the physical home environment would enable carers t

Knowledge, attitude and practice about cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of Congo

Background: Cervical cancer is the most frequent cancer of women in the Democratic Republic of Congo (DRC). Nevertheless, the level of women's awareness about cervical cancer is unknown. Knowledge, attitude and practice (KAP) are important elements for designing and monitoring screening programs. The study purpose was to estimate KAP on cervical cancer and to identify associated factors. Methods: A cross-sectional study was conducted in Kinshasa, DRC, including 524 women aged 16-78 years (median age 28; interquartile range 22-35). The women were interviewed at home by trained field workers using a standardized questionnaire. The women's score on knowledge, attitude and practice were dichotomized as sufficient or insufficient. We used binary and multiple logistic regression to assess associations between obtaining sufficient scores and a series of socio-demographic factors: age, residence, marital status, education, occupation, religion, and parity. Results: The women's score on knowledge was not significantly correlated with their score on practice (Spearman's rho = 0.08; P > 0.05). Obtaining a sufficient score on knowledge was positively associated with higher education (adjusted odds ratio (OR) 7.65; 95% confidence interval (95% CI) 3.31-17.66) and formal employment (adjusted OR 3.35; 95% CI 1.85-6.09); it was negatively associated with being single (adjusted OR 0.44; 95% CI 0.24-0.81) and living in the eastern, western and northern zone of Kinshasa compared to the city centre. The attitude score was associated with place of residence (adjusted OR for east Kinshasa: 0.49; 95% CI 0.27-0.86 and for south Kinshasa: 0.48; 95% CI 0.27-0.85) and with religion (adjusted OR 0.55; 95% CI 0.35-0.86 for women with a religion other than Catholicism or Protestantism compared to Catholics). Regarding practice, there were negative associations between a sufficient score on practice and being single (adjusted OR 0.24; 95% CI 0.13-0.41) and living in the eastern zone of the city (adjusted OR 0.39; 95% CI 0.22-0.70). Although 84% of women had heard about cervical cancer, only 9% had ever had a Papanicolaou (Pap) smear test. Conclusions: This study shows a low level of knowledge, attitude and practice on cervical cancer among women in Kinshasa. Increasing women's awareness would be a first step in the long chain of conditions to attain a lower incidence and mortality

Micromechanics Contribution to Coupled Transport and Mechanical Properties of Fractured Geomaterials

International audienceThis article is devoted to the modelling of interdependent mechanical and hydraulic behaviours of geomaterials in presence of a single through-wall fracture by means of micromechanics arguments. Experimental results of fractured concrete samples show non-linear evolutions for both mechanical and hydraulic behaviours with respect to confinement intensity. These non-linear responses are interpreted by the progressive closure of crack-like pores defining the pore volume of the fracture interfacial domain. Disregarding tortuosity effects, we adopt a 2D representation for these cracks. The key role of the fracture initial porosity is also emphasized. It allows to discuss the shape of the distribution of the local apertures distribution function classically used, intercepted here in terms of the distribution of initial crack–aspect ratio within the fracture domain. Application on fractured concrete samples shows the capability of the theoretical model to accurately reproduce the experimental results

Prevalence and risk factors for cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of the Congo : a cross-sectional study

Background: Cancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce. The study objectives were to: 1/assess prevalence of (pre) cancerous cervical lesions in adult women in Kinshasa, 2/identify associated socio-demographic and behavioural factors and 3/describe human papillomavirus (HPV) types in cervical lesions. Methods: A cross-sectional study was conducted in Kinshasa. Between 2006 and 2013, four groups of women were recruited. The first two groups were included at HIV screening centres. Group 1 consisted of HIV-positive and group 2 of HIV-negative women. Group 3 was included in large hospitals and group 4 in primary health centres. Pap smears were studied by monolayer technique (Bethesda classification). Low-or high-grade squamous intraepithelial lesions or carcinoma were classified as LSIL+. HPV types were determined by INNO-LiPA (R). Bivariate and multivariable analyses (logistic regression and generalised estimating equations (GEE)) were used to assess associations between explanatory variables and LSIL+. Results: LSIL+ lesions were found in 76 out of 1018 participants. The prevalence was 31.3 % in group 1 (n = 131 HIV-positive women), 3.9 % in group 2 (n = 128 HIV-negative women), 3.9 % in group 3 (n = 539) and 4.1 % in group 4 (n = 220). The following variables were included in the GEE model but did not reach statistical significance: history of abortion, = 3 sexual partners and use of chemical products for vaginal care. In groups 3 and 4 where this information was available, the use of plants for vaginal care was associated with LSIL+ (adjusted OR 2.70 (95 % confidence interval 1.04 - 7.01). The most common HPV types among HIV-positive women with ASCUS+ cytology (ASCUS or worse) were HPV68 (12 out of 50 samples tested), HPV35 (12/50), HPV52 (12/50) and HPV16 (10/50). Among women with negative/unknown HIV status, the most common types were HPV52 (10/40), HPV35, (6/40) and HPV18 (5/40). Conclusion: LSIL+ lesions are frequent among women in Kinshasa. The use of plants for vaginal care deserves attention as a possible risk factor for LSIL+. In this setting, HPV16 is not the most frequent genotype in samples of LSIL+ lesions

Etanchéité de l'interface argilite-bentonite re-saturée et soumise à une pression de gaz, dans le contexte du stockage profond de déchets radioactifs

En France, le système de stockage profond de déchets radioactifs envisagé est constitué d une barrière naturelle (roche hôte argileuse, argilite) et de barrières artificielles, comprenant des bouchons d argile gonflante (bentonite)-sable pour son scellement. L'objectif de cette thèse est d étudier l efficacité du gonflement et du scellement des bouchons placés dans l argilite, sous l effet, à la fois, d une pression d eau et d une pression de gaz (tel que formé dans le tunnel). Pour évaluer la capacité de scellement du bouchon bentonite/sable partiellement saturé en eau, on a évalué sa perméabilité au gaz Kgaz sous pression de confinement variable (jusqu à 12MPa). L'étanchéité au gaz (Kgaz =9MPa si la saturation est d au moins 86-91%. Par ailleurs, nous avons évalué le gonflement et l'étanchéité du bouchon de bentonite-sable imbibé d eau dans un tube d argilite ou de Plexiglas-aluminium lisse ou rugueux. La présence de gaz diminue la pression effective de gonflement (et la pression de percée de gaz) à partir d une pression Pgaz= 4 MPa. Après saturation complète en eau, l écoulement continu de gaz au travers du bouchon seul se fait à Pgaz=7-8MPa s il dispose d une interface lisse avec un autre matériau (tube métallique), alors que celui au travers de l ensemble bouchon/argilite a lieu à Pgaz=7-7,5MPa. Le passage à travers le bouchon gonflé au contact d une interface rugueuse se fait à une pression de gaz bien supérieure à la pression de gonflement du bouchon. Les essais de percée de gaz montrent que l'interface et l'argilite sont deux voies possibles de migration de gaz lorsque l ensemble bouchon/roche hôte est complètement saturéIn France, the deep underground nuclear waste repository consists of a natural barrier (in an argillaceous rock named argillite), associated to artificial barriers, including plugs of swelling clay (bentonite)-sand for tunnel sealing purposes. The main objective of this thesis is to assess the sealing efficiency of the bentonite-sand plug in contact with argillite, in presence of both water and gas pressures. To assess the sealing ability of partially water-saturated bentonite/sand plugs, their gas permeability is measured under varying confining pressure (up to 12MPa). It is observed that tightness to gas is achieved under confinement greater than 9MPafor saturation levels of at least 86-91%. We than assess the sealing efficiency of the bentonite-sand plug placed in a tube of argillite or of Plexiglas-aluminium (with a smooth or a rough interface). The presence of pressurized gas affects the effective swelling pressure at values Pgas from 4MPa. Continuous gas breakthrough of fully water-saturated bentonite-sand plugs is obtained for gas pressures on the order of full swelling pressure (7-8MPa), whenever the plug is applied along a smooth interface. Whenever a rough interface is used in contact with the bentonite-sand plug, a gas pressure significantly greater than its swelling pressure is needed for gas to pass continuously. Gas breakthrough tests show that the interface between plug/argillite or the argillite itself are two preferential pathways for gas migration, when the assembly is fully saturatedVILLENEUVE D'ASCQ-ECLI (590092307) / SudocSudocFranceF

Report of a small feasibility study involving group analysts and groupwork practitioners in facilitating self-practice/self-reflection groups in the training of cognitive behaviour therapists

This article provides a narrative account of a small research study run with a grant from the Institute of Group Analysis (IGA) Legacy Fund. It discusses the challenges and opportunities of engaging in research involving interdisciplinary collaboration between trainee cognitive behaviour therapists working in the NHS and group analysts/groupwork practitioners. It makes the case for building on the results of this study by developing a protocol for a pre-post pilot study using a mixed methods approach to explore whether IGA-led groupwork in CBT training has any effect on patient outcomes and service key performance indicators

Germline mutation in the RAD51B gene confers predisposition to breast cancer.

International audienceBACKGROUND: Most currently known breast cancer predisposition genes play a role in DNA repair by homologous recombination. Recent studies conducted on RAD51 paralogs, involved in the same DNA repair pathway, have identified rare germline mutations conferring breast and/or ovarian cancer predisposition in the RAD51C, RAD51D and XRCC2 genes. The present study analysed the five RAD51 paralogs (RAD51B, RAD51C, RAD51D, XRCC2, XRCC3) to estimate their contribution to breast and ovarian cancer predisposition. METHODS: The study was conducted on 142 unrelated patients with breast and/or ovarian cancer either with early onset or with a breast/ovarian cancer family history. Patients were referred to a French family cancer clinic and had been previously tested negative for a BRCA1/2 mutation. Coding sequences of the five genes were analysed by EMMA (Enhanced Mismatch Mutation Analysis). Detected variants were characterized by Sanger sequencing analysis. RESULTS: Three splicing mutations and two likely deleterious missense variants were identified: RAD51B c.452 + 3A > G, RAD51C c.706-2A > G, RAD51C c.1026 + 5_1026 + 7del, RAD51B c.475C > T/p.Arg159Cys and XRCC3 c.448C > T/p.Arg150Cys. No RAD51D and XRCC2 gene mutations were detected. These mutations and variants were detected in families with both breast and ovarian cancers, except for the RAD51B c.475C > T/p.Arg159Cys variant that occurred in a family with 3 breast cancer cases. CONCLUSIONS: This study identified the first RAD51B mutation in a breast and ovarian cancer family and is the first report of XRCC3 mutation analysis in breast and ovarian cancer. It confirms that RAD51 paralog mutations confer breast and ovarian cancer predisposition and are rare events. In view of the low frequency of RAD51 paralog mutations, international collaboration of family cancer clinics will be required to more accurately estimate their penetrance and establish clinical guidelines in carrier individuals

Association of leisure-time sedentary behavior with fast food and carbonated soft drink consumption among 133,555 adolescents aged 12-15 years in 44 low- and middle-income countries

Background: Rates of sedentary behavior (SB), fast food and carbonated soft drink consumption are increasing worldwide, with steeper increases being observed in low- and middle-income countries (LMICs) in recent years. Given that these behaviors have been linked to adverse health outcomes among adolescents, this presents a new but rapidly growing challenge to human health in these under-resourced nations. However, very little is known about the associations between SB and fast food or soft drink consumption among adolescents in LMICs. Methods: Thus, data from the Global school-based Student Health Survey (GSHS) were cross-sectionally analyzed in 133,555 adolescents aged 12-15 years from 44 LMICs [mean (SD) age 13.8 (1.0) years; 49% females]. The data were collected in the form of self-report questionnaires. Associations were assessed with multivariable logistic regression analysis and meta-analysis. Results: The overall prevalence of fast food consumption (at least once in previous 7 days) and carbonated soft drink consumption (at least once per day during past 30 days) were 49.3% and 43.8%, respectively. The overall pooled estimates based on a meta-analysis with random effects for the association of ≥3 hours/day of SB with fast food consumption and soft drink consumption using country-wise estimates were OR=1.35 (95%CI=1.27-1.43, I2=62.1%).) and OR=1.26 (95%CI=1.19-1.34; I2=54.3%), respectively. Spending >8 hours/day of SB compared to <1 hour/day in females was associated with significantly higher odds for fast food (OR=1.61, 95% CI= 1.38-1.88) and soft drink consumption (OR=1.91, 95% CI= 1.60-2.28). Conclusions: Future interventions to address unhealthy behaviors in adolescents should take into account the interrelated nature of SB and unhealthy dietary habits, and seek to further understand the mechanisms linking these behaviors in the LMIC context

Etude physico-chimique et minéralogique comparative des attapulgites de Mbodiène (Sénégal) et de Mormoiron (France)

La valorisation des ressources locales constitue un impératif afin d’atteindre des objectifs de développement durable. Cette étude a consisté à évaluer les caractéristiques physiques, chimiques et minéralogiques d’une argile provenant de Mbodiène (Sénégal), l’attapulgite, comparativement avec un médicament antidiarrhéique, constitué d’attapulgite, dénommé Actapulgite®. L’échantillon d’attapulgite brute a été purifié avec une solution de HNO3 1M. Une étude morphologique effectuée par visualisation à la Microscopie Electronique à Balayage a montré pour les deux argiles étudiées, une structure fibreuse caractéristique de la palygorskite, représentant le minéral dominant. L’analyse chimique par la spectrométrie à fluorescence X a donné pour l’attapulgite purifiée : 65,69% Si, 7,89% Al, 5,92% Fe, 17,90% Mg, 0,43% Ca et 0,93% K contre respectivement 63,98 % Si, 12,92% Al, 10,32% Fe, 6,20% Mg, 2,48% Ca et 2,25% K pour l’Actapulgite®. La diffraction aux rayons X a montré une présence de palygorskite, quartz et carbonates dans les échantillons étudiés. L’étude des isothermes d’adsorption a montré une surface spécifique nettement plus élevée pour l’attapulgite purifiée, 138,96 m2.g-1 contre 98,72 m2.g-1 pour l’Actapulgite®. Ces résultats ont montré que l’attapulgite de Mbodiène pourrait être utilisée comme antidiarrhéique orale après lavage à l’eau et séchage.© 2016 International Formulae Group. All rights reservedMots clés: Argile, attapulgite, antidiarrhéique, SénégalEnglish Title: Physico-chemical and mineralogical comparative study of attapulgites Mbodiène (Senegal) and Mormoiron (France)English AbstractThe development of local resources is imperative to achieve sustainable development goals. This study was to assess physical, chemical and mineralogical characteristics of a clay from Mbodiène (Senegal), named attapulgite, compared with Actapulgite® (antidiarrheal drug), composed of attapulgite. A sample of attapulgite from Mbodiène was purified with a 1M HNO3 solution to remove impurities including carbonates. A morphological study using Scanning Electron Microscopy showed for both types of clay studied, a fibrous structure characteristic of palygorskite which represent major mineral. Chemical analysis by XRF spectrometry gave for purified attapulgite: 65.69% Si, 7.89% Al, 5.92% Fe, 17.90% Mg, 0.43% Ca and 0.93% K against respectively 63.98% Si, 12.92% Al, 10.32% Fe, 6.20% Mg, 2.48% Ca and 2.25% K for Actapulgite®. X-ray diffraction showed the presence of palygorskite, quartz and carbonates for both samples studied. The study of adsorption isotherms showed a significantly higher surface area for purified attapulgite, 138.96 m2.g-1 versus 98.72 m2.g-1 for Actapulgite®. These results have shown that Mbodiène attapulgite compared to Actapulgite®, could be used as an oral antidiarrheal after washing with water and drying.© 2016 International Formulae Group. All rights reserved.Keywords: Clay, attapulgite, antidiarrheal, Senega