Evaluating quality of obstetric care in low-resource settings: Building on the literature to design tailor-made evaluation instruments - an illustration in Burkina Faso

<p>Abstract</p> <p>Background</p> <p>There are many instruments available freely for evaluating obstetric care quality in low-resource settings. However, this profusion can be confusing; moreover, evaluation instruments need to be adapted to local issues. In this article, we present tools we developed to guide the choice of instruments and describe how we used them in Burkina Faso to facilitate the participative development of a locally adapted instrument.</p> <p>Methods</p> <p>Based on a literature review, we developed two tools: a conceptual framework and an analysis grid of existing evaluation instruments. Subsequently, we facilitated several sessions with evaluation stakeholders in Burkina Faso. They used the tools to develop a locally adapted evaluation instrument that was subsequently tested in six healthcare facilities.</p> <p>Results</p> <p>Three outputs emerged from this process:</p> <p>1) A comprehensive conceptual framework for the quality of obstetric care, each component of which is a potential criterion for evaluation.</p> <p>2) A grid analyzing 37 instruments for evaluating the quality of obstetric care in low-resource settings. We highlight their key characteristics and describe how the grid can be used to prepare a new evaluation.</p> <p>3) An evaluation instrument adapted to Burkina Faso. We describe the experience of the Burkinabé stakeholders in developing this instrument using the conceptual framework and the analysis grid, while taking into account local realities.</p> <p>Conclusions</p> <p>This experience demonstrates how drawing upon existing instruments can inspire and rationalize the process of developing a new, tailor-made instrument. Two tools that came out of this experience can be useful to other teams: a conceptual framework for the quality of obstetric care and an analysis grid of existing evaluation instruments. These provide an easily accessible synthesis of the literature and are useful in integrating it with the context-specific knowledge of local actors, resulting in evaluation instruments that have both scientific and local legitimacy.</p

Laddered motivations of external whistleblowers: The truth about attributes, consequences, and values

The purpose of this study was to explore the motivational structures of external whistleblowers involved in the decision to blow the whistle by applying MEC theory and the laddering technique. Using both soft and hard laddering methods, data were collected from 37 Korean external whistleblowers. Results revealed that the means-end chain of external whistleblow-ers was the hierarchical linkage among two concrete attributes (the power of external whistleblowing to make changes and its warning about the seriousness of wrongdoing to the public), two functional consequences (correcting a wrongdoing and making those who violated laws admit their offenses), and one terminal value (the truth). The extant whistleblowing literature has either made assumptions about whistleblowers’ motivations when developing models or has drawn indirect inferences from measures of other variables. Our study is the first with an explicit and empirical focus on whistleblowers’ motivations. The findings provide evidence of the motivational structures of external whistleblowers that consist of a set of complex paths linked by multi-layered motivators. This research will be helpful in designing and reviewing whistleblowing programs for organizations, regulatory agencies, and journalists

Polymorphisme val66met du BDNF, dépression, et réponse aux antidépresseurs

La maladie dépressive sera en 2020 la 2ème cause d incapacité dans le monde. Mieux prédire la réponse aux antidépresseurs (ATD) est donc un enjeu majeur de santé publique. Nous avons étudié, l influence du polymorphisme Val66Met (rs6265) du Brain Derived Neutrophic Factor (BDNF) sur les épisodes dépressifs majeurs (EDM) du trouble dépressif majeur et sur la réponse aux ATD en termes d efficacité et de tolérance métabolique.La revue de la littérature montre que l allèle Met du Val66Met, associé à un défaut de transport axonal de BDNF, est un facteur de risque de dépression, que les taux centraux et périphériques de BDNF sont diminués durant l EDM et augmentent après traitement par ATD. Par ailleurs, le BDNF est impliqué dans la physiopathologie d anomalies métaboliques.Notre étude a pour objectif de déterminer si la présentation clinique de l EDM et la réponse aux ATD diffèrent selon le polymorphisme Val66Met du BDNF. Dans le cadre d une cohorte prospective naturaliste d une durée de 6 mois, 397 patients adultes caucasiens présentant un EDM au cours d un trouble dépressif unipolaire et nécessitant l introduction d un traitement ATD, bénéficient d un génotypage, d une évaluation clinique, de dosages métaboliques avant et après 1, 3 et 6 mois de traitement. Les homozygotes Met/Met ont un EDM d intensité moindre et tendance à une moindre réponse aux ATD après 6 mois de traitement. En termes de tolérance, ils ont tendance à avoir davantage d apparition d HTA et de dyslipidémie après 3 mois de traitement et de diabète après 6 mois de traitement. Nos résultats sont cohérents avec ceux de la littérature et devront être confirmés par d autres étudesPARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

LES DYSFONCTIONNEMENTS URETRAUX AU COURS DES TROUBLES MICTIONNELS DE LA SCLEROSE EN PLAQUES (A PROPOS DE 20 CAS)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hospital room exposure to daylight and clinical improvement in unipolar depressed inpatients

International audienceBackground: Light therapy is an effective treatment for unipolar Major Depressive Episodes (MDE). Exposure to daylight, depending on hospital room orientation, could influence clinical improvement. We aim to show greater clinical improvement 1 month after venlafaxine treatment in depressed inpatients staying in South/East facing room compared to inpatients staying in North/West facing rooms. Methods: A nested case-control study was performed within the DEP-ARREST- CLIN, a prospective and monocentric cohort. We analyzed patients with a current MDE in the context of Major Depressive Disorder who stayed at least one month in either South/East or North/West facing hospital rooms. Clinical improvement was assessed with the Hamilton Depressive Rating Scale (HAMD-17) before and after 1 month of venlafaxine treatment. Results: 44 patients were analyzed. The average HAMD-17 score at inclusion was 26.3 (±5.5). Clinical improvement of inpatients staying in South/East facing rooms (56.8% HAMD-17 improvement) did not differ from inpatients staying in North/West facing rooms (65.6% HAMD-17 improvement, p = 0.21) after 1 month of venlafaxine treatment. Subgroup analyses revealed no associations between clinical improvement and East vs West or South vs North facing rooms or winter vs summer inpatients. Limitations: Limited sample size and non-randomized study. Conclusions: In our sample, we observed no association between room exposure to daylight and clinical improvement after treatment in unipolar depressed inpatients

Conflict of interest policies at Belgian medical faculties: Cross-sectional study indicates little oversight.

BackgroundMedical students encounter pharmaceutical promotion from the very start of their training. Medical schools have an important role to play in educating medical students regarding the interactions between healthcare professionals (HCPs) and industry and in protecting them from commercial influence and conflict of interest (COI). In 2019, medical student associations in Belgium and abroad called for more preparation in dealing with COI and for a more independent medical training. As little information is available on the situation in our country, we undertook an assessment of conflict of interest policies at Belgium's medical schools. We relied on a methodology already used in studies from USA, Canada, Australia, France and Germany and adapted it to the Belgian context.MethodsWe identified 10 medical schools in Belgium. We searched the website of each medical school in November 2019 with standardized keywords for COI policies and learning activities on COI in the curriculum. The deans of medicine were invited to participate by sending us information that we could have overlooked during our web-based searches. We also consulted personal contacts within faculties among students and teachers. Based on a list of 15 criteria adapted from North American and French studies, we calculated a total for each faculty of medicine with a maximum score of 30 points.ResultsBy December 2019, we had gathered a set of written documents for four faculties of medicine (40%) containing policies with varying degrees of precision and relevance to our survey. We found elements of the curriculum addressing the COI issue for one faculty (10%). In all cases, these policies consisted of "moderate" initiatives with little or no "restrictive" elements. Only one faculty showed interest in our study by providing us with relevant information (10%). Half of the faculty notified us of their refusal to participate in the study (50%) and the other faculties either did not respond or did not provide us with any information (40%). The maximum score obtained was 3 out of 30 points with six faculties scoring 0 (60%).ConclusionThere is little transparency regarding interactions between medical students and pharmaceutical companies at Belgian medical faculties, which may create COI issues. Initiatives to protect students from pharmaceutical promotion and to train them to manage their future interaction with pharmaceutical companies have a limited scope and are isolated. This is inconsistent with international recommendations from Health Action International, World Health Organization or the American Medical Students' Association. The Belgian government has legislated in favor of more transparency in the relation between HCPs and pharmaceutical industry. Indeed, it made the disclosure of benefits granted by the industry compulsory and limited their value. Our results show that there is still some way to go to ensure an independent medical training for future Belgian physicians

Depressed suicide attempters have smaller hippocampus than depressed patients without suicide attempts

International audienceBACKGROUND:Despite known relationship between hippocampal volumes and major depressive episodes (MDE) and the increased suicidality in MDE, the links between hippocampal volumes and suicidality remain unclear in major depressive disorders (MDD). If the hippocampus could be a biomarker of suicide attempts in depression, it could be useful for prevention matters. This study assessed the association between hippocampal volumes and suicide attempts in MDD.METHODS:Hippocampal volumes assessed with automatic segmentation were compared in 63 patients with MDD, with (n = 24) or without (n = 39) suicide attempts. Acute (one month) suicide attempts were studied.RESULTS:Although not different in terms of socio-demographic, MDD and MDE clinical features, suicide attempters had lower total hippocampus volumes than non-attempters (4.61 (±1.15) cm3 vs 5.22 (±0.99) cm3; w = 625.5; p = 0.03), especially for acute suicide attempts (4.19 (±0.81) cm3 vs 5.22 (±0.99) cm3; w = 334; p = 0.005), even after adjustment on brain volumes, sex, age, Hamilton Depression Rating Scale (HDRS) scores and MDD duration. A ROC analysis showed that a total hippocampal volume threshold of 5.00 cm3 had a 98.2% negative predictive value for acute suicide attempts.CONCLUSION:Depressed suicide attempters have smaller hippocampus than depressed patients without suicide attempts, independently from socio-demographics and MDD characteristics. This difference is related to acute suicide attempts but neither to past suicide attempts nor to duration since the first suicide attempt, suggesting that hippocampal volume could be a suicidal state marker in MDE. Further studies are required to better understand this association