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Background: in Benin, the misknowledge of the reality of epilepsy and its consequencescould cause difficulties encountered by people with epilepsy (PWE) when searching for a jobbut also in the course of their professional career.Purpose: to study the employability and retention in employment of people with epilepsy inBenin.Methods: a first cross-sectional study (study 1) was conducted between 1st september and 30november 2012 with 300 people belonging to three categories of actors that can promote theemployability of the PWE (caregivers, employers and political decision-makers) and assesstheir knowledge, attitudes and practices against this disease and the PWE. A second crosssectionalstudy (study 2) was conducted between 1st july and 1st november 2013 in order tostudy the impact of epilepsy on employment and professional integration. A first comparisonwas made between a group of 51 PWE employees and a group of 51 PWE without work and asecond comparison was conducted between the same group of 51 PWE employed and a groupof 51 free employees of epilepsy in the same companies.Results: study 1 allowed to highlight that 93.0% of respondents had information on thedisease and 82.0% felt that a PSE could work. For nearly three quarters of respondents,epilepsy was a disease of natural origin, curable by antiepileptic treatments effective and noncontagious.Study 2 helped to highlight that 90.2% of the PSE to labour were active,inadequately controlled seizures with tonic-clonic predominating and that the age of onset ofthe first seizure was significantly later compared the PWE without employment. Analysis ofworkstations were 10 PWE exposed to routine professional tasks at risk (driving, working atheight or assignment to security positions requiring a weapon port). There was a certaininsecurity of the PWE with a larger proportion of term contract and a shorter workplaceseniority position with equal skills. Accidents at work, even if they were not more frequent,were more severe and longer off periods training. The PWE to work ...

Background: in Benin, the misknowledge of the reality of epilepsy and its consequencescould cause difficulties encountered by people with epilepsy (PWE) when searching for a jobbut also in the course of their professional career.Purpose: to study the employability and retention in employment of people with epilepsy inBenin.Methods: a first cross-sectional study (study 1) was conducted between 1st september and 30november 2012 with 300 people belonging to three categories of actors that can promote theemployability of the PWE (caregivers, employers and political decision-makers) and assesstheir knowledge, attitudes and practices against this disease and the PWE. A second crosssectionalstudy (study 2) was conducted between 1st july and 1st november 2013 in order tostudy the impact of epilepsy on employment and professional integration. A first comparisonwas made between a group of 51 PWE employees and a group of 51 PWE without work and asecond comparison was conducted between the same group of 51 PWE employed and a groupof 51 free employees of epilepsy in the same companies.Results: study 1 allowed to highlight that 93.0% of respondents had information on thedisease and 82.0% felt that a PSE could work. For nearly three quarters of respondents,epilepsy was a disease of natural origin, curable by antiepileptic treatments effective and noncontagious.Study 2 helped to highlight that 90.2% of the PSE to labour were active,inadequately controlled seizures with tonic-clonic predominating and that the age of onset ofthe first seizure was significantly later compared the PWE without employment. Analysis ofworkstations were 10 PWE exposed to routine professional tasks at risk (driving, working atheight or assignment to security positions requiring a weapon port). There was a certaininsecurity of the PWE with a larger proportion of term contract and a shorter workplaceseniority position with equal skills. Accidents at work, even if they were not more frequent,were more severe and longer off periods training. The PWE to work ...

Abstract Background Lower socioeconomic populations live and die in contexts that render them vulnerable to poorer health and wellbeing. Contexts of care at the end of life are overwhelmingly determined by the capacity and nature of formal and informal networks and relations to support care. To date, studies exploring the nature of networks and relations of support in lower socioeconomic populations at the end of life are absent. This qualitative study sought to identify the nature of individual, community and civic networks and relations that defined the contexts of care for this group. Methods Semi-structured qualitative interviews were conducted with 16 patients and 6 informal carers who identified that they had social and economic needs and were from a lower socioeconomic area. A social capital questionnaire identifying individual, community and civic networks and relations formed the interview guide. Interviews were audio-taped, transcribed and analysed using framework analysis. Results Participants identified that individual and community networks and relations of support were mainly inadequate to meet care needs. Specifically, data revealed: (1) individual (informal caregivers) networks and relations were small and fragile due to the nature of conflict and crisis; (2) community trust and engagement was limited and shifted by illness and caregiving; (3) and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government engagement and support were overall positive and enabled access to welfare resources. Conclusion Networks and relations of support are essential for ensuring quality end of life care is achieved. Lower socioeconomic groups are at a distinct disadvantage where these networks and relations are limited, as they lack the resources necessary to augment these gaps. Understanding of the nature of assets and limitations, in networks and relations of support, is necessary to inform interventions to improve end of life care for lower socioeconomic populations.

Abstract Background The rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions. Methods Study methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites. Results A series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition. Conclusion The reorientation of Zambia's health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.

AIMS: To systematically identify global research gaps and resource priorities for integrated community case management (iCCM). METHODS: An iCCM Child Health and Nutrition Research Initiative (CHNRI) Advisory Group, in collaboration with the Community Case Management Operational Research Group (CCM ORG) identified experts to participate in a CHNRI research priority setting exercise. These experts generated and systematically ranked research questions for iCCM. Research questions were ranked using a "Research Priority Score" (RPS) and the "Average Expert Agreement" (AEA) was calculated for every question. Our groups of experts were comprised of both individuals working in Ministries of Health or Non Governmental Organizations (NGOs) in low- and middle-income countries (LMICs) and individuals working in high-income countries (HICs) in academia or NGO headquarters. A Spearman's Rho was calculated to determine the correlation between the two groups' research questions' ranks. RESULTS: The overall RPS ranged from 64.58 to 89.31, with a median score of 81.43. AEA scores ranged from 0.54 to 0.86. Research questions involving increasing the uptake of iCCM services, research questions concerning the motivation, retention, training and supervision of Community Health Workers (CHWs) and concerning adding additional responsibilities including counselling for infant and young child feeding (IYCF) and treatment of severe acute malnutrition (SAM) ranked highly. There was weak to moderate, statistically significant, correlation between scores by representatives of high-income countries and those working in-country or regionally (Spearman's ρ = 0.35034, P < 0.01). CONCLUSIONS: Operational research to determine optimal training, supervision and modes of motivation and retention for the CHW is vital for improving iCCM, globally, as is research to motivate caregivers to take advantage of iCCM services. Experts working in-country or regionally in LMICs prioritized different research questions than those working in organization headquarters in HICs. Further exploration is needed to determine the nature of this divergence.

Hungarians have helped to the Red Crescent Association during the First World War as being during the Balkans War. The Ottoman Red Crescent Association had bought the health and medical stuffs (gaseous hydrophilic, cotton hydrophilic, stretcher, dressing packages, gauze bandage, antipyretic) from Hungary many times during the First World War. During the War, the health care teams, consisting of the Hungarian physicians, nurses and caregivers had served to the Ottoman Red Crescent Association in Istanbul and other Ottoman cities. In addition, since Turks and Hungarians were traditional and historical friends, and the Hungarians were allies during the First World War, in order that Hungarians presented their appreciation, they had passed the hat in many Hungarian cities and had donated it to the Ottoman Red Crescent Association. The Hungarian Prime Minister, Count István Tisza, had provided the significant encouragement and support for passing the hat. The municipal committees of the Hungarian cities (Esztergom, Fejer, Nagy Varad and Györ) presented their sincere greetings to the Ottoman nation that was the loyal ally of Hungarian nation, and the greetings from Istanbul city was also presented to the Hungarian brothers. The aids from Hungarians to the Ottoman Red Crescent were encouraged through the announcements in the Hungarian newspapers. Furthermore, the aids to the Ottoman Red Crescent were increased gradually through the concerts and exhibitions that were organized by the Hungarians. The Hungarians stated especially that these aids were provided by the Hungarian people, the Austria should have been exempted due to the dual monarchy and it should have been stated in the announcements for appreciating in the newspapers that the aids were provided by Hungarians only. During the War, the Hungarians helped to the Turks as if competing with Austria. In this case, the Ottoman Government thanked the Hungarians who helped to the Red Crescent Association by awarding the medals.

Transnational mothers working in foreign countries face the challenges of providing "intensive" mothering to their children from a distance, and risk being subject to the "deviancy" discourse of mothering. This paper investigates the role of mobile phone usage, via voice, text messages, and social networking sites, in dealing with the tensions and ambivalence arising from transnational mothering as a dialectical process. We surveyed 42 Filipina and Indonesian foreign domestic workers (FDWs) in Singapore using a mixture of quantitative and qualitative methods. FDWs addressed tensions arising out of societal expectations of motherhood and their own anxieties about children's well-being. The reluctant obsessive struggled to maintain a balance between an intensive nurturing style and a deviant mode of mothering that respected the growing independence of the children. The diverted professional had to balance the financial empowerment of being the primary breadwinner with the risk of surrogate motherhood for the employer's children subsuming the care provided to her own. The remote-control parent shared mothering responsibilities with caregivers, usually relatives, who acted as a contradictory proxy presence for intensive mothering. The incomplete union of stressed marital parenting put further pressure on the romantic and sexual identities of migrant women. Transnational mothers utilized mobile phones actively as a tool to negotiate and redefine identities and relationships that created fissures in their sense of self. These included the management of third-party relationships, withholding of emotions or information, and engaging in counterintuitive phenomenon such as restricting, or actively dis-engaging from, mobile phone usage as a communication strategy. The paper calls for future research into the multiple, and interacting, social identities assumed and managed by transnational mothers, and the complex role played by mobile phones in the constant process of negotiation by agentic, self-relective and multifaceted women.

Because most research on military families has focused on children who are old enough to go to school, we know the least about the youngest and perhaps most vulnerable children in these families. Some of what we do know, however, is worrisome—for example, multiple deployments, which many families have experienced during the wars in Iraq and Afghanistan, may increase the risk that young children will be maltreated.

Where the research on young military children is thin, Joy Osofsky and Lieutenant Colonel Molinda Chartrand extrapolate from theories and research in other contexts—especially attachment theory and research on families who have experienced disasters. They describe the circumstances that are most likely to put young children in military families at risk, and they point to ways that families, communities, the military, and policy makers can help these children overcome such risks and thrive. They also review a number of promising programs to build resilience in young military children.

Deployment, Osofsky and Chartrand write, is particularly stressful for the youngest children, who depend on their parents for nearly everything. Not only does deployment separate young children from one of the central figures in their lives, it can also take a psychological toll on the parent who remains at home, potentially weakening the parenting relationship. Thus one fundamental way to help young military children become resilient is to help their parents cope with the stress of deployment. Parents and caregivers themselves, Osofsky and Chartrand write, can be taught ways to support their young children's resilience during deployment, for example, by keeping routines consistent and predictable and by finding innovative ways to help the child connect with the absent parent. The authors conclude by presenting 10 themes, grounded in research and theory, that can guide policies and programs designed to help young military children.

We present in this thesis the results of a qualitative study based on two programs (Hopital Manager and CURSUS 3),located at the clinic La Sagesse of Rennes; this study aims to emphasize the communicative challenges posed by thesetools in clinical practice.Those tools are now considered as devices for modernization, rationalization, change of practices, and interactions between the patient, the doctor and caregivers. Thus, our goal is to show that in addition to technical issues, managerial, political and economic factors that are identified by many researchers, they are also challenges in terms of communication.The questions we will raise, from the point of view of research in Information Sciences and Communication, deal with rationalization process, and will be part of an issue related to organizational change, information traffic or standardization practices. Considering these concerns, technology deduces any reasoning from one premise, the one of performativity in organizations. What we choose to select in Orlikowski's work has to do with the fact that what matters, in order to evaluate the effectiveness and performance of technology, is not technological artifact, but technologies in practice (Orlikowski, 2000). Thus, our goal is to show that the integrative medical discourse is a performative utterance based on communication patterns ; Nous présenterons dans le cadre de cette thèse les résultats d'une étude qualitative basée sur deux logiciels (HôpitalManager et CURSUS 3), implantés à la clinique La Sagesse de Rennes ; étude qui a pour objectif, de souligner les enjeuxcommunicationnels que pose ces outils dans les pratiques cliniques. Ces outils sont considérés aujourd'hui comme des dispositifs de modernisation, de rationalisation, de changementdes pratiques, et des interactions entre le patient, le médecin et les dispensateurs de soins. Ainsi, notre objectif est donc demontrer qu'en plus des enjeux techniques, managériaux, politiques et économiques qui sont identifiés par de nombreuxchercheurs, il existe ...

Background: Heroin-assisted treatment (HAT) can improve the condition of heroin addicts resistant to other treatment. A new trial compared HAT and methadone treatment with HAT limited to 12 months in order to assess its feasibility and efficacy in Belgium. Methods: TADAM (Treatment Assisted by Diacetylmorphine) was an open label randomised controlled trial. The experimental treatment was based upon the Swiss model of HAT developed in 1994. The primary efficacy criterion was determined by an improvement in street heroin use or in (physical or mental) health or a decrease in criminal involvement. Participants were assessed every 3 months. Self-reported data were complemented with toxicological analyses and criminal proceedings. Findings: 74 participants were randomised in the trial: 36 in the experimental group and 38 in the control group. The experimental group counted 30% of responders more than the control group at 3 months (p<0.05), 6 months (p<0.05), and 9 months (p<0.01). At 12 months, the number of responders was still higher in the experimental group (11%) but the difference was no longer significant (p=0.35). Street heroin use increased in the experimental group at the 12-month assessment just before the end of HAT. Conclusion: HAT is feasible and effective. However, HAT should not have a predetermined duration for heroin users for which heroin addiction became a chronic relapsing disease. Other data: In addition to the outcomes of the randomised controlled trial, the report contains other exploratory data and analysis: satisfaction of in treatment, criminological data, opinion of heroin users not included in the trial, opinion of caregivers and field workers (in the HAT centre, in the partner centres, and in other centres in the addiction field), impact of the HAT centre on its neighbourhood and a socio-economic evaluation. Funding: The TADAM trial was funded at 80% by the Federal Minister of Social Affairs and Public Health. It was also funded the City and the University of Liège. ; Een vertaling in het Nederlands van het document met de samenvattingen is hieronder beschikbaar.

International audience ; Observing artifacts' agency inside interactions to study organizational change The present proposal is part of a wider research pro gram to analyze and understand rationalization pro cesses at work in medical activities. the approach to observing these processes concerns those technolo gical devices that equip them in a communicational approach of the organization within a work group. The purpose of this proposal is to describe and analyze how rationalization processes appear as emerging practices of professional nursing activity, strengthe ning the focus on the mobilization of artifactsof va rious kinds. emphasis will be placed on professional practices involved in the performance of the organi zation emerging from the introduction of information technology tools in the care activities performed by nurses. We will discuss the recourse to these artifacts in the activities, in order to describe social transforma tion processes operating. our team collected data from ethnographical observation sessions in different departments of the same hospital, and from inter views with health care professionals. From this data, we will show how the reconstruction of the organiza tion through interactions can question the negotiation of norms by observing socio-technical mediations. Communication approach of organizations to think organizational change To study the processes of ra tionalization of productive activity in the health sector and, more particularly, in public hospitals, is to ques tion the translation of economic policy - including the development based on political decisions to scale of a country - in procedures and practices in the lives of the caregivers. Such a project involves a theoretical apparatus to analyze organizational restructuring, es pecially by determining access points to observation. Communication approach of organizations (Bouillon et al., 2008) propose to study organizational dyna mics by linking three perspectives, three levels wich intersect, and allow the organization ...

International audience ; Observing artifacts' agency inside interactions to study organizational change The present proposal is part of a wider research pro gram to analyze and understand rationalization pro cesses at work in medical activities. the approach to observing these processes concerns those technolo gical devices that equip them in a communicational approach of the organization within a work group. The purpose of this proposal is to describe and analyze how rationalization processes appear as emerging practices of professional nursing activity, strengthe ning the focus on the mobilization of artifactsof va rious kinds. emphasis will be placed on professional practices involved in the performance of the organi zation emerging from the introduction of information technology tools in the care activities performed by nurses. We will discuss the recourse to these artifacts in the activities, in order to describe social transforma tion processes operating. our team collected data from ethnographical observation sessions in different departments of the same hospital, and from inter views with health care professionals. From this data, we will show how the reconstruction of the organiza tion through interactions can question the negotiation of norms by observing socio-technical mediations. Communication approach of organizations to think organizational change To study the processes of ra tionalization of productive activity in the health sector and, more particularly, in public hospitals, is to ques tion the translation of economic policy - including the development based on political decisions to scale of a country - in procedures and practices in the lives of the caregivers. Such a project involves a theoretical apparatus to analyze organizational restructuring, es pecially by determining access points to observation. Communication approach of organizations (Bouillon et al., 2008) propose to study organizational dyna mics by linking three perspectives, three levels wich intersect, and allow the organization ...

David Dunt,1 Colleen Doyle,1,21Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, The University of Melbourne, Parkville, Victoria, Australia; 2National Ageing Research Institute, Royal Melbourne Hospital, Victoria, AustraliaAbstract: This study aims to describe current trends in Australia regarding chronic obstructive pulmonary disease (COPD) mortality and morbidity rates, and in its treatment and prevention from 2000 to 2010. The study's purpose is to better define future directions in curbing COPD. People with COPD and their caregivers who attend patient support groups (n = 21), pulmonary rehabilitation group coordinators (n = 27) within Victoria, and the Australian Lung Foundation provided informed feedback. COPD was a leading underlying cause of death in both sexes during these years. Nevertheless, mortality rates declined from 1980 to 2007, with rates for males almost halving. Its prevalence has also substantially declined. Smoking rates have declined in age groups over 40 years old in both sexes. The COPD-X Plan provides evidence-based guidelines for the management of COPD. Many government, professional, and community initiatives have been recently implemented to promote the Plan. Two studies—one conducted before and one conducted after the publication of the COPD-X Plan—report some progress, but there are still very considerable departures from evidence-based practice. The Australian Lung Foundation estimates that only 1% of patients who could benefit from pulmonary rehabilitation programs have suitable access to such programs. A common priority for all informants was that there needed to be greater awareness of—and a more positive orientation to—COPD in both the Australian and health professional communities. The study concluded that substantial reductions in COPD and smoking cessation rates contrast with more limited progress toward adopting other aspects of evidence-based practice. The "good news" story concerning reductions in COPD disease with improving smoking cessation rates could form the basis for suitable media campaigns.Keywords: COPD, disease trends, community perceptions, health services planning

International audience ; Observing artifacts' agency inside interactions to study organizational change The present proposal is part of a wider research pro gram to analyze and understand rationalization pro cesses at work in medical activities. the approach to observing these processes concerns those technolo gical devices that equip them in a communicational approach of the organization within a work group. The purpose of this proposal is to describe and analyze how rationalization processes appear as emerging practices of professional nursing activity, strengthe ning the focus on the mobilization of artifactsof va rious kinds. emphasis will be placed on professional practices involved in the performance of the organi zation emerging from the introduction of information technology tools in the care activities performed by nurses. We will discuss the recourse to these artifacts in the activities, in order to describe social transforma tion processes operating. our team collected data from ethnographical observation sessions in different departments of the same hospital, and from inter views with health care professionals. From this data, we will show how the reconstruction of the organiza tion through interactions can question the negotiation of norms by observing socio-technical mediations. Communication approach of organizations to think organizational change To study the processes of ra tionalization of productive activity in the health sector and, more particularly, in public hospitals, is to ques tion the translation of economic policy - including the development based on political decisions to scale of a country - in procedures and practices in the lives of the caregivers. Such a project involves a theoretical apparatus to analyze organizational restructuring, es pecially by determining access points to observation. Communication approach of organizations (Bouillon et al., 2008) propose to study organizational dyna mics by linking three perspectives, three levels wich intersect, and allow the organization ...

International audience ; Observing artifacts' agency inside interactions to study organizational change The present proposal is part of a wider research pro gram to analyze and understand rationalization pro cesses at work in medical activities. the approach to observing these processes concerns those technolo gical devices that equip them in a communicational approach of the organization within a work group. The purpose of this proposal is to describe and analyze how rationalization processes appear as emerging practices of professional nursing activity, strengthe ning the focus on the mobilization of artifactsof va rious kinds. emphasis will be placed on professional practices involved in the performance of the organi zation emerging from the introduction of information technology tools in the care activities performed by nurses. We will discuss the recourse to these artifacts in the activities, in order to describe social transforma tion processes operating. our team collected data from ethnographical observation sessions in different departments of the same hospital, and from inter views with health care professionals. From this data, we will show how the reconstruction of the organiza tion through interactions can question the negotiation of norms by observing socio-technical mediations. Communication approach of organizations to think organizational change To study the processes of ra tionalization of productive activity in the health sector and, more particularly, in public hospitals, is to ques tion the translation of economic policy - including the development based on political decisions to scale of a country - in procedures and practices in the lives of the caregivers. Such a project involves a theoretical apparatus to analyze organizational restructuring, es pecially by determining access points to observation. Communication approach of organizations (Bouillon et al., 2008) propose to study organizational dyna mics by linking three perspectives, three levels wich intersect, and allow the organization ...