Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital

Background: The aims were: 1) to measure the attitudes of learners (and future trainers) before and after a course on WHO-Quality Rights (QR); 2) to evaluate a psychiatric ward, by previously trained staff on QR, comparing it with a previous evaluation and discussing an improvement plan. Methods: 1) Training sample: 19 subjects (8 males), 41.4±10.6 years, including jurists/lawyers, health professionals, and experts. The QR team developed the 26-item tool to assess the knowledge and attitudes of participants. 2) Evaluation of quality of care and respect for human rights in the ward was carried out on 20 staff representatives, 20 family members and 20 users with QRToolkit. Results: 1) Learning in QR has partially changed the knowledge and attitudes of trained people. 2) The evaluation shows significant delays in the implementation of the rights advocated by the United Nations Convention on the Human Rights of Persons with Disabilities (CRPD). In Themes 1, 3, 4 and 5, the evaluation shows no differences compared to 2014, but in Theme 2, the level was lower than four years before. Conclusion: The scarcity of resources due to the economic crisis that Tunisia is going through, cannot be considered the only cause of the delays highlighted. However, it is likely that in a context of uncertainty for the future, scarcity of resources and a decrease in staff (i.e., professionals dedicated to psychosocial intervention) may have demotivated the team towards recovery. The improvement in knowledge and attitudes of many staff members after the training may open future positive scenarios

Etude prospective sur l'agriculture bretonne

Diffusion du document : INRA Unité d'Economie et Sociologie rurales rue Adolphe Bobierre CS 61103 35011 Rennes Cedex (FRA)Cette étude a été conduite à la demande des autorités régionales dans le cadre de la préparation du contrat de plan Etat-Région. La première partie introductive présente l'objectif de l'étude qui est de proposer une vue prospective de l'agriculture bretonne dans un contexte de réexamen de la politique agricole commune (PAC), lié aux contraintes actuelles et anticipées de l'Organisation mondiale du commerce (OMC), à l'élargissement de l'Europe à l'Est, et aux préoccupations environnementales. La deuxième partie dresse un état des lieux de l'agriculture bretonne. On met d'abord l'accent sur l'importance du complexe agro-alimentaire dans l'économie bretonne. On aborde ensuite les structures de production qui ont connu une évolution classique (baisse des effectifs, concentration et gains de productivité) accompagnée de la spécialisation et de la simplification des systèmes de production. Les conséquences de la concentration et de la spécialisation sur l'environnement sont ensuite analysées ainsi que les politiques environnementales mises en oeuvre. Un bilan des industries agro-alimentaires est également fait. La troisième partie fait le point sur les évolutions fondamentales qui vont affecter l'agriculture et celle de la Bretagne en particulier, notamment l'évolution du comportement du consommateur-citoyen, l'intensification des échanges internationaux, les réglementations sanitaires et phytosanitaires ainsi que les politiques environnementales. La quatrième partie tente de cerner les enjeux de la contribution de l'agriculture bretonne à un développement régional durable, face aux risques externes (montée de la concurrence internationale) et internes (forte spécialisation, effets d'image négatifs liés à la dégradation de l'environnement). Elle donne également des principes pour l'action publique. Les aspects prospectifs sont prolongés par des projections d'impact de la future réforme de la PAC (Agenda 2000) sur les résultats économiques du secteur agricole breton. Compte tenu des aides nouvelles, le revenu brut d'exploitation par actif en termes réels devrait augmenter entre 1996 et 2005. Enfin, des initiatives régionales sont proposées visant le maintien du système productif du complexe agroalimentaire breton, la diversification mais aussi la mise au point de produits à vocation universelle rattachés à l'origine régionale, la mise en place d'un système de suivi crédible des pratiques environnementales et d'un zonage complet de l'espace rural pour atténuer les conflits d'usage, la mise en valeur du potentiel de l'espace rural

Cross-national variations in reported discrimination among people treated for major depression worldwide: The ASPEN/INDIGO international study

Background: No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. Aims: To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD. Method: Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. Results: People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. Conclusions: Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD

Wrist osteoarthritis

AbstractPainful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies

Prevalence of neurologic lesions after total shoulder arthroplasty

Clinically evident neurologic injury of the involved limb after total shoulder arthroplasty is not uncommon, but the subclinical prevalence is unknown. The purposes of this prospective study were to determine the subclinical prevalence of neurologic lesions after reverse shoulder arthroplasty and anatomic shoulder arthroplasty, and to evaluate the correlation of neurologic injury to postoperative lengthening of the arm