Global health education program: experience of a multidisciplinary curriculum at the school of medicine in Rouen, France

Rouen University Hospital, Rouen, FranceIntroduction. The One Health (OH) approach is based on the notion that human, animal, and environmental health are intimately connected and mutually dependent. Consequently, advocates of this movement describe the need for transdisciplinary approach when tackling complex global health (GH) issues with high societal values. The interest in GH as an academic discipline has increased in the last decade. Global health, including OH, are increasingly taught in health training institutions. The Rouen School of Medicine is one of the first to offer a GH curriculum in France. The objective was to identify the characteristics and profile of students involved in GH curriculum. Material and methods. In 2019 and 2019, a cross-sectional study was conducted, including enrolled in the GH course: 3rd and 4th year in medicine, midwifes studies and pharmacy. Based on self-questionnaire, data collected were gender, age, motivations for health studies, investment in humanitarian actions and associations, opinions about the themes proposed for HG/OH teaching content and their future professional career. Results. A total of 422 students were included. In the group attended to GH cursus (GH+) and the control group (GH-), the sex ratio M: F was respectively 0.4 and 0.7, p=0.02. The students of the GH+ group were more likely to get involved in a humanitarian association (22.3% versus 6.7%, p<0.001) and to have already taken part in a humanitarian action (20.5% vs 9.3%, p=0.002). GH+ students were more likely to engage in professional practice abroad or in humanitarian medicine (67% versus 38%, p=0.001). Work in vulnerable populations, as well as in low and middle-incomes countries, the impacts of climate change on health and OH are more frequent in GH+ group. Conclusions. This study is innovative in France, through its sociological aspect and the identification of the profile and expectations of students in GH/OH. The principles of GH/OH are widely found in the group of GH+ students. To overcome the recent threats posed by infectious disease and emerging zoonotic diseases as COVID-19 and early warning system, it is becoming clear that the entire health system must address the OH concept. Given its importance for mitigating the public health threat from emerging infectious diseases the implementation of the GH and OH approach through multi-sectoral cooperative initiatives should be re-enforced. Therefore, integrated training of future health professionals is a promising avenue for a better management of effect of sanitary crisis (i.e. pandemic, climate change and health effects, global surveillance-response system)

Instruirea mediciniștilor în Sănătatea Globală: experiența învățământului multidisciplinar la Unitatea de Formare și de Cercetare în sănătate din Rouen, Franța

Introduction. The interest in Global Health (HG) as an academic discipline has increased in the last decade. The Rouen School of Medicine is one of the first to offer a GH curriculum in France. The objective was to identify the characteristics and profile of students involved in a GH curriculum. Material and methods. In 2016 and 2017, a cross-sectional study was conducted, including enrolled in the GH course: 3rd and 4th year in medicine, midwifes studies and pharmacy. Based on self-questionnaire, data collected were motivations for health studies, investment in humanitarian associations, opinions about the GH topics. Results. A total of 422 students were included; 122 students attended to GH cursus (GH+) and 300 in control group (GH-). The students of the GH+ group were more likely to get involved in a humanitarian association (22.3% versus 6.7%, p<0.001) and to have already taken part in a humanitarian action (20.5% vs 9.3%, p=0.002). GH+ students were more likely to engage in professional practice abroad or in humanitarian medicine (67% versus 38%, p=0.001). Work in vulnerable populations, the impacts of climate change on health are frequent topics in GH+ group. Conclusions. Students enrolled in GH cursus presented a particular profile: predominantly female, open to The World, involved in caritative associations and aware of the importance of interculturality in the care relationship. Integrated training of future health workers is a promising avenue for a better management of effect of sanitary crisis (i.e. pandemic, climate change and health effects, etc.).Introducere. Interesul pentru Sănătatea Globală (SG) ca disciplină academică a crescut în ultimul deceniu. Unitatea de Formare și de Cercetare din Rouen este una dintre primele care oferă în Franța un curriculum în SG. Obiectivul a fost de a identifica caracteristicile și profilul studenților implicați într-un curriculum în SG.Material și metode. În 2016 și 2017, a fost realizat un studiu transversal, pe studenții anului 3 și 4 de la Facultățile Medicină, Moașe și Farmacie, înscriși la cursul de SG. Rezultatele chestionării au servit drept bază pentru lansarea studiilor în sănătate, investiții în asociații umanitare, opinii despre subiectele SG.Rezultate. În studiu au fost incluși 422 de studenți; 122 au participat la cursul SG (SG+), iar 300 de studenți au intrat în grupul de control, neparticipând la cursul SG (SG-). Studenții grupului SG+ au fost mai predispuși să se implice într-o asociație umanitară (22,3% față de 6,7%, p<0,001) sau au luat deja parte la o acțiune umanitară (20,5% față de 9,3%, p=0,002). Studenții SG+ au fost mai predispuși să se angajeze în domeniul activității practice profesionale în străinătate sau în medicina umanitară (67% față de 38%, p=0,001). Munca în populații vulnerabile, impactul schimbărilor climatice asupra sănătății sunt subiecte frecvente în grupul SG+.Concluzii. Studenții înscriși la cursul SG au prezentat un profil special: predominant feminin, deschis către lume, implicați în asociații de caritate și conștienți de importanța interculturalității în relația de îngrijire. Pregătirea integrată a viitorilor lucrători din domeniul sănătății este o cale promițătoare pentru o mai bună gestionare a efectului crizei sanitare (de exemplu: pandemie, schimbări climatice și efecte asupra sănătății etc.)

Assessment of eight HPV vaccination programs implemented in lowest income countries

BACKGROUND: Cervix cancer, preventable, continues to be the third most common cancer in women worldwide, especially in lowest income countries. Prophylactic HPV vaccination should help to reduce the morbidity and mortality associated with cervical cancer. The purpose of the study was to describe the results of and key concerns in eight HPV vaccination programs conducted in seven lowest income countries through the Gardasil Access Program (GAP). METHODS: The GAP provides free HPV vaccine to organizations and institutions in lowest income countries. The HPV vaccination programs were entirely developed, implemented and managed by local institutions. Institutions submitted application forms with institution characteristics, target population, communication delivery strategies. After completion of the vaccination campaign (3 doses), institutions provided a final project report with data on doses administered and vaccination models. Two indicators were calculated, the program vaccination coverage and adherence. Qualitative data were also collected in the following areas: government and community involvement; communication, and sensitization; training and logistics resources, and challenges. RESULTS: A total of eight programs were implemented in seven countries. The eight programs initially targeted a total of 87,580 girls, of which 76,983 received the full 3-dose vaccine course, with mean program vaccination coverage of 87.8%; the mean adherence between the first and third doses of vaccine was 90.9%. Three programs used school-based delivery models, 2 used health facility-based models, and 3 used mixed models that included schools and health facilities. Models that included school-based vaccination were most effective at reaching girls aged 9-13 years. Mixed models comprising school and health facility-based vaccination had better overall performance compared with models using just one of the methods. Increased rates of program coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year limit the number of girls lost to follow-up. CONCLUSION: Mixed models that incorporate both schools and health facilities appear to be the most effective at delivering HPV vaccine. This study provides lessons for development of public health programs and policies as countries go forward in national decision-making for HPV vaccination

Phenomena Conflict, Anxiety, and Depression for Cancer Survivor One Year and After Have Therapy in General Hospital

Introduction. Psychosocial distress emerges in cancer disease. This research explores experience of conflict, anxiety, and depression in one year cancer survivor. Methods. Data were collected through in-depth semi structured interviews with fifteen participants when seeking treatment at a public hospital in Bandung. Result. There nine themes emerge: anxiety about cancer\u27s spread and recurrence, changing relationships with a partner, \u27labeling\u27 from oneself and others, physical discomfort along treatment, psychological discomfort along treatment, self-concept, religious/spiritual, hiding diagnose and complain, and deficit information about cancer. But, four themes among were not characterized with conflict, anxiety, and depression. Conflict, anxiety, and depression impact condition of the client cancer. Discussion. Experience of conflict, anxiety, and depression became the basis for the development of management system service and provision of facilities for integrated mental health nursing therapy

Activitatea fizică la studenți: un studiu epidemiologic transversal în Republica Moldova și Franța

Université d’État de Médecine et de Pharmacie „Nicolae Testemițanu”, République de Moldavie, Unisversité de Rouen, FranceIntroduction. Physical activity is the key component of a student's healthy lifestyle, which is a fundamental factor contributing to academic success. The importance of physical activities during the study period is determined particularly by the student's working regime, which is often characterized by sedentary lifestyle, reduced mobility and constant working position. Material and methods. A cross-sectional epidemiological study (2017-2018) was carried out. The study sample consisted of 783 students, including 430 students from the Republic of Moldova and 353 students from France. The data collection was performed by using a questionnaire that was completed by each study participant online, in electronic form. Results. The mean body mass index (kg/m2) of students from Chisinau was 21.5±0.10 (ranging between 16.16 and 34.72) and of students from Rouen - 22.65±0.22 (15.75-43.76) (p<0.001). 43.9% students from Chisinau and 56.4% students from Rouen practice sport (p<0.001). Both men (98.5%) and women (98.4%) from Chisinau practice same-intensity physical activities, until sweating. A slightly more different situation was reported in students from Rouen, where only 88.8% of women exercise until sweating, compared to men – 93.1%. Conclusions. The results of the research showed a slightly significant difference among students from both countries, as well as in their gender distribution.Introducere. Activitatea fizică reprezintă una din componentele de bază ale unui stil de viață sănătos al unui student – un factor primordial, care contribuie la succesul academic. Importanța activităților fizice în perioada studiilor este determinată, în special, de faptul că regimul de lucru al studentului se caracterizează adesea prin sedentarism, mobilitate redusă sau poziţie de lucru invariabilă. Material și metode. A fost proiectat un studiu epidemiologic transversal (2017-2018), eșantionul de studiu fiind constituit din 783 studenți, dintre care 430 de respondenți din Republica Moldova și 353 - din Franța. Datele au fost colectate în baza unui formular cu întrebări, care a fost completat de către fiecare participant la studiu, în format electronic, în regim online. Rezultate. Valoarea medie a indicelui masei corporale (kg/m2) pentru studenții din Chișinău a constituit 21,5±0,10 (limitele cuprinse între 16,16 și 34,72), iar pentru studenții din Rouen - 22,65±0,22 (15,75-43,76) (p<0,001). Astfel, practică sportul: 43,9% studenți din Chișinău și 56,4% studenți din Rouen (p<0,001). Atât bărbații (98,5%), cât și femeile (98,4%) din Chișinău practică activitățile fizice cu aceeași intensitate, până la transpirație. O situație puțin mai deosebită atestându-se la studenții din Rouen, unde femeile fac exerciții fizice până la transpirație doar în 88,8% cazuri, în comparație cu bărbații – 93,1%. Concluzii. Rezultatele cercetării au arătat că diferențele au fost puțin semnificative atât după criteriul de gen, cât și la nivel de țări

Experiences and lessons learned from 29 HPV vaccination programs implemented in 19 low and middle-income countries, 2009-2014

BACKGROUND: Cervical cancer is the greatest cause of age-weighted years of life lost in the developing world. Human papillomavirus (HPV) infection is associated with a high proportion of cervical cancers, and HPV vaccination may help to reduce the incidence of cancer. The aim of the study was to identify barriers, obstacles, and strategies and to analyze key concerns and lessons learned with respect to the implementation of HPV vaccination program in low- and middle-income countries. METHODS: The Gardasil Access Program (GAP) is a donation program established to enable organizations and institutions in eligible low-resource countries to gain operational experience designing and implementing HPV vaccination programs. This study used an online survey to capture the experiences and insights of program managers participating in the GAP. Different factors related to HPV vaccination program management were collected. A mixed-method approach enabled the presentation of both quantitative measurements and qualitative insights. RESULTS: Twenty-nine programs implemented by 23 institutions in 19 low- and middle-income countries were included. Twenty programs managers (97.7 %) reported that their institution implemented sensitization strategies about vaccination prior to the launch of vaccination campaign. The most frequently reported obstacles to HPV vaccination by the program managers were erroneous perceptions of population related to the vaccine’s safety and efficacy. Reaching and maintaining follow-up with target populations were identified as challenges. Insufficient infrastructure and human resources financing and the vaccine delivery method were identified as significant health system barriers. Coupling HPV vaccination with other health interventions for mothers of targeted girls helped to increase vaccination and cervical cancer screening. The majority of program managers reported that their programs had a positive impact on national HPV vaccination policy. The majority of institutions had national and international partners that provided support for human resources, technical assistance, and training and financial support for health professionals. CONCLUSION: Local organizations and institutions can implement successful HPV vaccination campaigns. Adequate and adapted planning and resources that support information sharing, sensitization, and mobilization are essential for such success. These results can inform the development of programs and policies related to HPV vaccination in low- and middle-income countries

La pandémie Covid-19 : une opportunité pour développer la formation en santé mondiale

Contexte et problématique : La pandémie de Covid-19 a déclenché des mesures urgentes sans précédent dans le monde et entraîné le confinement de plus de la moitié de la planète. Des populations ont été et restent fragiles et vulnérables. Les facultés de médecine gèrent au mieux cette période inédite et doivent anticiper et préparer l’avenir en tenant compte de cette nouvelle réalité, et se préparer à la gestion de nouvelles crises sanitaires. Exégèse : La santé mondiale, discipline émergente, est fondée sur une approche transnationale des problèmes de santé, une caractéristique de la pandémie Covid-19, tout en prenant en compte l’ensemble des déterminants environnementaux et sociaux de la santé (au-delà du système de soins). L’enseignement de la santé mondiale, intégré à la formation médicale, contribuera à mieux préparer les professionnels de santé à répondre aux besoins des populations confrontées aux crises sanitaires. Conclusion : Un des premiers enseignements de la pandémie Covid-19 est la nécessité de développer rapidement des filières de formation structurées, multidisciplinaires en santé mondiale pour les étudiants en santé

Facteurs de risque de troubles du comportement alimentaire et addictions associées chez les étudiants en Haute-Normandie

Introduction et objectif : Les étudiants constituent une population à risque de troubles des conduites. Le transition du statut de lycéen à celui d'étudiant représente une phase charnière de développement des jeunes. Cette nouvelle autonomie est propice aux excès (tabac, alcool, cannabis, internet). Il est également clairement établi que les jeunes sont les plus à risque de développer des Troubles du Comportement Alimentaire (TCA). Devant ce constat, le projet Ta Santé en Un Clic a vu le jour dans le but d'étudier la prévalence des conduites addictives chez les étudiants, et de mettre en évidence certains facteurs de risque de TCA. Matériel et méthode : Le recueil de données a été effectué à l'aide d'un questionnaire anonyme, auto-administré et multithématique permettant d'évaluer le statut socio-économique, les modes de consommation de substances psycho-actives telles que le tabac et l'alcool (questionnaire ADOSPA), l'utilisation d'internet (test d'ORMAN), le stress perçu (échelle de COHEN), le risque de TCA (test SCOFF) des étudiants. Pour chacune des conduites addictives, une analyse descriptive puis une analyse univariée a été réalisée. Dans le but d'identifier les facteurs de risque de TCA, une régression logistique a ensuite été effectuée. Résultats : Au total, 1945 étudiants ont été inclus dans cette étude avec une prédominance féminine (sexe-ratio H/F = 0,5). Près d'un quart des étudiants étaient fumeurs, plus de 30% présentaient des difficultés avec l'alcool (ADOSPA >= 2) et plus d'un étudiant sur quatre était à risque de développer une cyberaddiction. La prévalence du risque de développer un TCA était de 22,4% avec un risque accru chez les femmes, les étudiants ayant déjà suivi un régime, à risque avec l'alcool ou internet (p < 0,001). Conclusion : Cette étude a permis d'identifier certains facteurs de risque de TCA et conforte l'idée de comportement addictif très présent dans la population étudiante particulièrement fragile. Des programmes de prévention ciblés devront voir le jour dans le but de lutter contre ces dépendances et leurs complications.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF