L'identité européenne: du déterminisme historique à une objectivité culturelle

Comme d'autres avant elle dans l'histoire, l'Union européenne, en même temps qu'elle se dote des institutions nécessaires à son fonctionnement est en quête d'une identité. Identité à trouver ? À re-trouver ? À construire ? Mythologie à ré-écrire ? La question n'est pas si simple. En effet, s'il est bon de dénouer l'écheveau des racines, s'il est bon de faire référence à un héritage commun, encore faut-il s'interroger sur les raisons qui motivent une telle démarche, sur la problématique mise en oeuvre pour aboutir, sur l'usage fondamental qui en sera fait. Les exemples ne sont pas rares de ces identités devenues meurtrières à force de se contempler dans leur propre reflet alors qu'elles renvoient fondamentalement à l'Autre.As many others in the history, the European Union, while building its institutional tools is in search of its own identity. Identity to be found ? Mythology to be written ? The question is far from simple for people. For it is certainly commendable to want to untangle the complexity of our roots and to refer to a common heritage, but not without trying to explain the reasons for such an approach, the methods used to achieve such a goal and the fundamental way in which these findings will be used. Examples abound of such identities becoming fatal through too much self-contemplation whilst they should fundamentally reflect towards the Other

Navigating multiple sources of healing in the context of HIV/AIDS and wide availability of antiretroviral treatment: a qualitative study of community participants’ perceptions and experiences in rural South Africa

Background: South Africa introduced the world’s largest antiretroviral treatment (ART) program in 2004 and since 2016 the Department of Health implemented a universal Treatment as Prevention (TasP) strategy. However, some studies have shown that increasing the availability of ART is insufficient for the comprehensive treatment of HIV, since many people still use traditional health practitioners (THPs) to avoid being identified as HIV positive, and for reasons unrelated to HIV/AIDS. This qualitative study explored the factors influencing how both HIV-negative and HIV-positive people choose amongst multiple sources of healing and how they engage with them, in the context of HIV/AIDS and wide availability of ART. Methods: Data were collected as part of a larger TasP trial at the Africa Health Research Institute, KwaZulu-Natal. Repeat in-depth individual interviews were conducted with 10 participants. Repeat group discussions were conducted with 42 participants. Group discussion data were triangulated using community walks and photo-voice techniques to give more insight into the perceptions of community members. All data were collected over 18 months. Thematic analysis was used to analyze participants’ narratives from both individual interviews and group discussions. Findings: In the context of HIV/AIDS and wide availability of ART, use of biomedical and traditional healing systems seemed to be common in this locality. People used THPs to meet family expectations, particularly those of authoritative heads of households such as parents or grandparents. Most participants believed that THPs could address specific types of illnesses, especially those understood to be spiritually caused and which could not be addressed or cured by biomedical practitioners. However, it was not easy for participants to separate some spiritually caused illnesses from biological illnesses in the context of HIV/AIDS. These data demonstrate that in this context, the use of THPs continues regardless of the wide availability of ART. To meet the health care needs of those patients requiring a health care system which combines biomedical and traditional approaches, collaboration and integration of biomedical and traditional health care should be considered

Traditional health practitioners’ management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy

Background: Traditional health practitioners (THPs) have been identified as a key local resource in the fight against HIV/AIDS in South Africa. However, their approaches to the treatment of people living with HIV (PLHIV) have been met with skepticism by some biomedical practitioners amidst increasing access to antiretroviral treatment (ART). In light of this ambivalence, this study aims to document and identify treatment approaches of THPs to the management of illness among PLHIV in the current era of widespread access to ART. Methods: The study was conducted as part of a larger trial of treatment as prevention (TasP) in rural northern Kwa-Zulu Natal, intended to treat PLHIV regardless of CD4 count. Nine THPs were enrolled using purposive and snowballing techniques. Repeat group discussions, triangulated with community walks and photo-voice techniques were conducted. A thematic analysis approach was used to analyse the data. Results: Eight of the nine THPs had received training in biomedical aspects of HIV. THPs showed a multilayered decision-making process in managing illness among PLHIV, influenced by attributes and choices of the THPs. THPs assessed and managed illness among PLHIV based on THP training in HIV/AIDS, THP type, as well as knowledge and experience in the traditional healing practice. Management of illness depended on the patients’ report of their HIV status or willingness to test for HIV. Conclusions: THPs’ approaches to illness in PLHIV appear to be shifting in light of increasing exposure to HIV/AIDS-related information. Importantly, disclosure of HIV status plays a major role in THPs’ management of illness among PLHIV, as well as linkage to HIV testing and care for their patients. Therefore, THPs can potentially enhance further success of antiretroviral therapy for PLHIV when HIV status is known

Taking HIV testing to families: designing a family-based intervention to facilitate HIV testing, disclosure and intergenerational communication

Introduction: Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents and adults who are not accessing health facilities. While home based counseling and testing has been succesfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated. Methods: The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention. Results: The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed and older families). There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored. Conclusion: This paper maps the process for adapting a novel and largely successful home-based counseling and testing intervention for use with families. Expanding the successful home-based counseling and testing model to capture children, adolescents and men could have significant impact if the pilot is successful and scaled-up

The role of traditional health practitioners in rural KwaZulu-Natal, South Africa: generic or mode specific?

Background Traditional health practitioners (THPs) play a vital role in the health care of the majority of the South African population and elsewhere on the African continent. However, many studies have challenged the role of THPs in health care. Concerns raised in the literature include the rationale, safety and effectiveness of traditional health practices and methods, as well as what informs them. This paper explores the processes followed in becoming a traditional healer and how these processes are related to THP roles. Methods A qualitative research design was adopted, using four repeat group discussions with nine THPs, as part of a larger qualitative study conducted within the HIV Treatment as Prevention trial in rural South Africa. THPs were sampled through the local THP association and snowballing techniques. Data collection approaches included photo-voice and community walks. The role identity theory and content analysis were used to explore the data following transcription and translation. Results In the context of rural Northern KwaZulu-Natal, three types of THPs were identified: 1) Isangoma (diviner); 2) Inyanga (one who focuses on traditional medical remedies) and 3) Umthandazi (faith healer). Findings revealed that THPs are called by ancestors to become healers and/or go through an intensive process of learning about traditional medicines including plant, animal or mineral substances to provide health care. Some THPs identified themselves primarily as one type of healer, while most occupied multiple healing categories, that is, they practiced across different healing types. Our study also demonstrates that THPs fulfil roles that are not specific to the type of healer they are, these include services that go beyond the uses of herbs for physical illnesses or divination. Conclusions THPs serve roles which include, but are not limited to, being custodians of traditional African religion and customs, educators about culture, counsellors, mediators and spiritual protectors. THPs’ mode specific roles are influenced by the processes by which they become healers. However, whichever type of healer they identified as, most THPs used similar, generic methods and practices to focus on the physical, spiritual, cultural, psychological, emotional and social elements of illness

Effect of a prebiotic mixture on intestinal comfort and general wellbeing in health

Specific carbohydrates, i.e. prebiotics such as fructo-oligosaccharide (FOS), are not digested in the small intestine but fermented in the colon. Besides beneficial health effects of an enhanced bifidobacteria population, intestinal gas production resulting from fermentation can induce abdominal symptoms. Partial replacement with slowly fermented acacia gum may attenuate side effects. The aim was to compare the effects of FOS with those of a prebiotic mixture (50% FOS and 50% acacia gum; BLEND) and a rapidly absorbed carbohydrate (maltodextrin) on general intestinal wellbeing, abdominal comfort and anorectal sensory function. Twenty volunteers (eight male and twelve female; age 20-37 years) completed this double-blind, randomised study with two cycles of a 2-week run-in phase (10g maltodextrin) followed by 5 weeks of 10g FOS or BLEND once daily, separated by a 4-week wash-out interval. Abdominal symptoms and general wellbeing were documented by telephone interview or Internet twice weekly. Rectal sensations were assessed by a visual analogue scale during a rectal barostat test after FOS and BLEND treatment. Both FOS and BLEND induced more side effects than maltodextrin. Belching was more pronounced under FOS compared with BLEND (P=0·09 for females; P=0·01 for males), and for self-reported general wellbeing strong sex differences were reported (P=0·002). Urgency scores during rectal barostat were higher with FOS than BLEND (P=0·01). Faced with a growing range of supplemented food products, consumers may benefit from prebiotic mixtures which cause fewer abdominal side effects. Sex differences must be taken in consideration when food supplements are use

Respiratory symptoms do not reflect functional impairment in early CF lung disease.

BACKGROUND Lung disease can develop within the first year of life in infants with cystic fibrosis (CF). However, the frequency and severity of respiratory symptoms in infancy are not known. METHODS We assessed respiratory symptoms in 50 infants with CF and 50 healthy matched controls from two prospective birth cohort studies. Respiratory symptoms and respiratory rate were documented by standardized weekly interviews throughout the first year. Infants performed multiple breath washout in the first weeks of life. RESULTS We analyzed 4552 data points (2217 in CF). Respiratory symptoms (either mild or severe) were not more frequent in infants with CF (OR:1.1;95% CI:[0.76, 1.59]; p=0.6). Higher lung clearance index and higher respiratory rate in infants with CF were not associated with respiratory symptoms. CONCLUSIONS We found no difference in respiratory symptoms between healthy and CF infants. These data indicate that early CF lung disease may not be captured by clinical presentation alone

Biodiversity dynamics and the effect of urban environment on the distribution of genetic variation in the Geneva cross-border area

Population growth, urbanization and agriculture lead to degradation and loss of natural environment. This has an adverse effect on the diversity of habitats, species and genes and might cause decline in the quality of life of the resident population. In this context and in the densely populated Geneva cross-border area, we study biodiversity dynamics and the effect of the environment on the distribution of genetic variation (URBANGENE project). We use genetic information of three model species (a plant, an insect and an amphibian) in combination with environmental and landscape data to evaluate their potential to disperse and adapt to urban environments. Based on a representative population survey, we further investigate how urban residents perceive their quality of life with a local biodiversity perspective, compared with health data measured in the same areas. Using genome-wide SNP data, we assessed genome-environment associations for Plantago major, a synanthropic plant, in order to obtain information on its ability to disperse among habitats and to adapt to the urban environment. Butterfly (Pieris rapae) and amphibian model species (Bufo bufo) will be sampled in 2015. As regards the amphibians, we developed a WebGIS participatory platform, making it possible for Geneva residents to indicate the geographic location of amphibian habitats on an interactive map, and to transmit information on the species they observed in this area. The integration of results from this interdisciplinary project should allow for a more sustainable urban development and a better conservation and management of biodiversity in urban areas

Relationship between land cover type and Body Mass Index in Geneva

Past studies conducted in urban areas analyzed the impact of the presence of green spaces on public health, and highlighted in particular the psychological benefits of interacting with nature. To investigate a supposed relationship between overweight and dense built environment, we focused on the State of Geneva, Switzerland, and calculated the correlation between Body Mass Index (BMI) in a representative sample of 6663 adults and the percentage of natural areas at the locations where these individuals were living. To this end, we used populationbased health data from the “Bus Sante” study (Geneva University Hospitals) and multi-scale land cover maps obtained by means of satellite images and LiDAR data classification. We found little correlation between BMI (as a proxy for health) and land cover data and were not able to verify the working hypothesis at local and regional scales. However, an important phenomenon highlighted here is the difference in the results obtained between the city center and the whole State