Scolarité et séropositivité des femmes au Cameroun : analyse d’un apparent paradoxe

Vécue comme l’une des plus grandes crises qu’a connue notre génération, la propagation du virus du SIDA est une urgence mondiale sans précédent, notamment en Afrique sub-saharienne où vivent la grande majorité des individus séropositifs. Dans un contexte où aucun vaccin n’existe encore et où les traitements sont onéreux et peu accessibles, les campagnes d’information sur le virus et l’acquisition de connaissances sur les méthodes de prévention, notamment à travers les programmes scolaires, sont cruciaux. La scolarisation est souvent vue comme la solution pour enrayer la propagation du virus et plusieurs études effectuées en Afrique sub-saharienne ont effectivement montré que les individus scolarisés étaient souvent les mieux renseignés sur le VIH/SIDA et son mode de propagation. Au Cameroun, pourtant, la partie de la population qui est la plus touchée par la séropositivité est aussi la plus instruite. C’est sur cet apparent paradoxe que se penche la présente étude. Cette recherche explore les différents facteurs qui sous tendent la relation positive entre le niveau d’instruction et la séropositivité au Cameroun en analysant les données de l’Enquête Démographique et de Santé (EDS) de 2004. Les résultats des analyses bivariées montrent que plus le niveau d’instruction des hommes et des femmes camerounais augmente, mieux ces derniers sont informés sur le VIH et ses modes de transmission. Malgré cet avantage au niveau des connaissances, l’analyse confirme un lien positif entre le niveau d’instruction et la séropositivé fort et statistiquement significatif parmi les femmes camerounaises, mais non significatif chez les hommes. Les résultats des analyses logistiques hiérarchiques suggèrent que c’est une combinaison de facteurs qui explique pourquoi les femmes les plus scolarisées sont aussi les plus touchées par le VIH/SIDA. Le fait qu’elles aient un profil sociodémographique différent (qu’elles soient plus jeunes et plus riches notamment), et qu’elles soient plus urbaines que leurs consœurs moins scolarisées, mais surtout qu’elles aient un temps d’exposition au risque hors union plus long et un nombre de partenaires plus élevés exposent davantage les femmes les plus scolarisées au virus.Considered the biggest crisis known to our generation, the propagation of the AIDS virus is an unprecedented worldwide emergency, notably in sub-Saharan Africa where the majority of HIV-positive individuals live. In a context where no vaccine exists and where treatments are expensive and difficult to access, information campaigns about the virus and the acquisition of knowledge on prevention, notably through school programs, are essential. Schooling is often seen as the solution to eradicate the propagation of the virus, and studies held in sub-Saharan Africa have actually shown that highest educated individuals are more informed about HIV/AIDS and about its transmission. However, in Cameroon, the most affected part of the population is also the most educated one. This study investigates this apparent paradox. Using the 2004 data from the Demographic and Health Surveys (DHS), this research explores the multiple factors explaining the positive relation between the education level and seropositivity in Cameroon. Result from the bivariate analysis show that the level of knowledge about HIV and its transmission increases with the education level of men and women. In spite of this knowledge advantage, the analysis show a strong, positive and statistically significant link between the education level and seropositivity of women, but this link is not significant with men. The results of the hierarchical logistical analysis suggest that a combination of factor explains why the most educated women are more affected by HIV/AIDS. The fact that those women have a different sociodemographic profile (they are younger and wealthier), and that they live in more urban areas than their less educated counterparts, and especially the fact that they have a longer exposition time to HIV before engaging in a union, as well as an a higher number of sexual partners, increases their exposure to the virus

Reporting on training developed for pharmacy assistants and pharmacy dispensary technicians working with Medication Assisted Treatment for Opioid Dependence (MATOD) consumers in regional Victoria

A recent study (Patil et al., 2018) analysing lived experiences of Medication Assisted Treatment for Opioid Dependence (MATOD) consumers suggested that some experienced discrimination and stigma in the pharmacy context in regional Victoria, Australia. One of the recommendations was to explore professional training and education opportunities for allied health professionals and in particular, Pharmacy Assistants (PAs) and Pharmacy Dispensary Technicians (PDTs) as they are integral to serving MATOD consumers. Ballarat Community Health commissioned Federation University to develop training modules for PAs and PDTs working in the pharmacy settings in regional Victoria. A survey of the literature identified two key issues, namely, the lack of professional education and training of PAs and PDTs involved in serving the consumers in pharmacy settings either at the national or state level in Australia. The other finding was the varied use of different types of ‘opioid dependence’ treatments in different jurisdictions of Australia which had implications in terms of embedding psychosocial or Social Determinants of Health (SDH) with therapeutic treatments. As a result, this project serves as a significant step in employing SDH based training modules for PAs and PDTs working with MATOD consumers in the pharmacy settings to address stigma and discrimination. The training workshop materials will be evaluated to determine its efficacy in terms of change of attitudes and professional practice. The aim of this study is to: 1. Deliver and evaluate a new professional training module concerning MATOD and; 2. Examine and evaluate the efficacy and impact of the training module on professional practice and changes in attitudes towards stigma and discrimination amongst PAs and PDTs. This project was conducted in two stages. At the first stage, two workshops (each lasting for two hours) were delivered in two different regional locations in the state of Victoria, Australia (referred to as locations A and B in this report). Thirteen participants expressed interest in location A but eleven attended both training workshops. In location B, fourteen attended the first workshop, while twelve attended the second workshop. Participants who attended the training were administered pre-training and post-training surveys. The pre-training surveys included demographic information, professional experience, educational background and professional training, whereas the post-training survey involved questions about the impact and efficacy of the training delivered. The second stage involved conducting in-depth qualitative interviews with participants who attended the training workshops. The main goal was to evaluate the impact on professional practice and change in attitudes amongst PAs and PDTs. Data collected from the surveys and interviews were analysed using quantitative and qualitative content analysis via an inductive process. In addition, an interpretive phenomenological analysis was undertaken to identify and code themes emerging from the interviews. Ethics approval was received through the Federation University’s Human Research Ethics Committee before the commencement of this project

Exploring the feasibility and acceptability of couple-based psychosexual support following prostate cancer surgery: Study protocol for a pilot randomised controlled trial

Background: Men who undergo surgery for prostate cancer frequently experience significant side-effects including urinary and sexual dysfunction. These difficulties can lead to anxiety, depression and reduced quality of life. Many partners also experience psychological distress. An additional impact can be on the couple relationship, with changes to intimacy, and unmet psychosexual supportive needs in relation to sexual recovery and rehabilitation. The aim of this exploratory randomised controlled trial pilot study is to determine the feasibility and acceptability of a novel family-relational-psychosexual intervention to support intimacy and reduce distress among couples following prostate cancer surgery and to estimate the efficacy of this intervention. Methods/Design: The intervention will comprise six sessions of psychosexual and relationship support delivered by experienced couple-support practitioners. Specialist training in delivering the intervention will be provided to practitioners and they will be guided by a detailed treatment manual based on systemic principles. Sixty-eight couples will be randomised to receive either the intervention or standard care (comprising usual follow-up hospital appointments). A pre-test, post-test design will be used to test the feasibility of the intervention (baseline, end of intervention and six-month follow-up) and its acceptability to couples and healthcare professionals (qualitative interviews). Both individual and relational outcome measures will assess sexual functioning, anxiety and depression, couple relationship, use of health services and erectile dysfunction medication/technologies. An economic analysis will estimate population costs of the intervention, compared to usual care, using simple modelling to evaluate the affordability of the intervention. Discussion: Given the increasing incidence and survival of post-operative men with prostate cancer, it is timely and appropriate to determine the feasibility of a definitive trial through a pilot randomised controlled trial of a family-relational-psychosexual intervention for couples. The study will provide evidence about the components of a couple-based intervention, its acceptability to patients and healthcare professionals, and its influence on sexual and relational functioning. Data from this study will be used to calculate sample sizes required for any definitive trial. Trial registration: ClinicalTrials.gov Identifier: NCT01842438. Registration date: 24 April 2013; Randomisation of first patient: 13 May 201

Couple-based psychosexual support following prostate cancer surgery: results of a feasibility pilot randomized control trial

Surgery for prostate cancer can result in distressing side effects such as sexual difficulties, which are associated with lower levels of dyadic functioning. The study developed and tested an intervention to address sexual, relational, and emotional aspects of the relationship after prostate cancer by incorporating elements of family systems theory and sex therapy

Couple-based psychosexual support following prostate cancer surgery: Results of a feasibility pilot randomized control trial

Introduction: Surgery for prostate cancer can result in distressing side effects such as sexual difficulties, which are associated with lower levels of dyadic functioning. The study developed and tested an intervention to address sexual, relational, and emotional aspects of the relationship after prostate cancer by incorporating elements of family systems theory and sex therapy. Aims: To develop and test the feasibility and acceptability of relational psychosexual treatment for couples with prostate cancer, determine whether a relational-psychosexual intervention is feasible and acceptable for couples affected by prostate cancer, and determine the parameters for a full-scale trial. Methods: Forty-three couples were recruited for this pilot randomized controlled trial and received a six-session manual-based psychosexual intervention or usual care. Outcomes were measured before, after, and 6 months after the intervention. Acceptability and feasibility were established from recruitment and retention rates and adherence to the manual. Main Outcome Measures: The primary outcome measurement was the sexual bother subdomain of the Expanded Prostate Cancer Index Composite. The Hospital Anxiety and Depression Scale and the 15-item Systemic Clinical Outcome and Routine Evaluation (SCORE-15) were used to measure emotional and relational functioning, respectively. Results: The intervention was feasible and acceptable. The trial achieved adequate recruitment (38%) and retention (74%) rates. The intervention had a clinically and statistically significant effect on sexual bother immediately after the intervention. Small decreases in anxiety and depression were observed for the intervention couples, although these were not statistically significant. Practitioners reported high levels of adherence to the manual. Conclusion: The clinically significant impact on sexual bother and positive feedback on the study's feasibility and acceptability indicate that the intervention should be tested in a multicenter trial. The SCORE-15 lacked specificity for this intervention, and future trials would benefit from a couple-focused measurement

Stress monitoring using wearable sensors:a pilot study and stress-predict dataset

With the recent advancements in the field of wearable technologies, the opportunity to monitor stress continuously using different physiological variables has gained significant interest. The early detection of stress can help improve healthcare and minimizes the negative impact of long-term stress. This paper reports outcomes of a pilot study and associated stress-monitoring dataset, named the “Stress-Predict Dataset”, created by collecting physiological signals from healthy subjects using wrist-worn watches with a photoplethysmogram (PPG) sensor. While wearing these watches, 35 healthy volunteers underwent a series of tasks (i.e., Stroop color test, Trier Social Stress Test and Hyperventilation Provocation Test), along with a rest period in-between each task. They also answered questionnaires designed to induce stress levels compatible with daily life. The changes in the blood volume pulse (BVP) and heart rate were recorded by the watch and were labelled as occurring during stress-inducing tasks or a rest period (no stress). Additionally, respiratory rate was estimated using the BVP signal. Statistical models and personalised adaptive reference ranges were used to determine the utility of the proposed stressors and the extracted variables (heart rate and respiratory rate). The analysis showed that the interview session was the most significant stress stimulus, causing a significant variation in heart rate of 27 (77%) participants and respiratory rate of 28 (80%) participants out of 35. The outcomes of this study contribute to the understanding the role of stressors and their association with physiological response and provide a dataset to help develop new wearable solutions for more reliable, valid, and sensitive physio-logical stress monitoring

Is it possible to make ‘living’ guidelines? An evaluation of the Australian Living Stroke Guidelines

Background: Keeping best practice guidelines up-to-date with rapidly emerging research evidence is challenging. ‘Living guidelines’ approaches enable continual incorporation of new research, assisting healthcare professionals to apply the latest evidence to their clinical practice. However, information about how living guidelines are developed, maintained and applied is limited. The Stroke Foundation in Australia was one of the first organisations to apply living guideline development methods for their Living Stroke Guidelines (LSGs), presenting a unique opportunity to evaluate the process and impact of this novel approach. Methods: A mixed-methods study was conducted to understand the experience of LSGs developers and end-users. We used thematic analysis of one-on-one semi-structured interview and online survey data to determine the feasibility, acceptability, and facilitators and barriers of the LSGs. Website analytics data were also reviewed to understand usage. Results: Overall, the living guidelines approach was both feasible and acceptable to developers and users. Facilitators to use included collaboration with multidisciplinary clinicians and stroke survivors or carers. Increased workload for developers, workload unpredictability, and limited information sharing, and interoperability of technological platforms were identified as barriers. Users indicated increased trust in the LSGs (69%), likelihood of following the LSGs (66%), and frequency of access (58%), compared with previous static versions. Web analytics data showed individual access by 16,517 users in 2016 rising to 53,154 users in 2020, a threefold increase. There was also a fourfold increase in unique LSG pageviews from 2016 to 2020. Conclusions: This study, the first evaluation of living guidelines, demonstrates that this approach to stroke guideline development is feasible and acceptable, that these approaches may add value to developers and users, and may increase guideline use. Future evaluations should be embedded along with guideline implementation to capture data prospectively

C-STICH2: emergency cervical cerclage to prevent miscarriage and preterm birth—study protocol for a randomised controlled trial

Abstract Background Cervical cerclage is a recognised treatment to prevent late miscarriage and pre-term birth (PTB). Emergency cervical cerclage (ECC) for cervical dilatation with exposed unruptured membranes is less common and the potential benefits of cerclage are less certain. A randomised control trial is needed to accurately assess the effectiveness of ECC in preventing pregnancy loss compared to an expectant approach. Methods C-STICH2 is a multicentre randomised controlled trial in which women presenting with cervical dilatation and unruptured exposed membranes at 16 + 0 to 27 + 6 weeks gestation are randomised to ECC or expectant management. Trial design includes 18 month internal pilot with embedded qualitative process evaluation, minimal data set and a within-trial health economic analysis. Inclusion criteria are ≥16 years, singleton pregnancy, exposed membranes at the external os, gestation 16 + 0–27 + 6 weeks, and informed consent. Exclusion criteria are contraindication to cerclage, cerclage in situ or previous cerclage in this pregnancy. Randomisation occurs via an online service in a 1:1 ratio, using a minimisation algorithm to reduce chance imbalances in key prognostic variables (site, gestation and dilatation). Primary outcome is pregnancy loss; a composite including miscarriage, termination of pregnancy and perinatal mortality defined as stillbirth and neonatal death in the first week of life. Secondary outcomes include all core outcomes for PTB. Two-year development outcomes will be assessed using general health and Parent Report of Children’s Abilities-Revised (PARCA-R) questionnaires. Intended sample size is 260 participants (130 each arm) based on 60% rate of pregnancy loss in the expectant management arm and 40% in the ECC arm, with 90% power and alpha 0.05. Analysis will be by intention-to-treat. Discussion To date there has been one small trial of ECC in 23 participants which included twin and singleton pregnancies. This small trial along with the largest observational study (n = 161) found ECC to prolong pregnancy duration and reduce deliveries before 34 weeks gestation. It is important to generate high quality evidence on the effectiveness of ECC in preventing pregnancy loss, and improve understanding of the prevalence of the condition and frequency of complications associated with ECC. An adequately powered RCT will provide the highest quality evidence regarding optimum care for these women and their babies. Trial registration ISRCTN Registry ISRCTN12981869 . Registered on 13th June 2018