Danielle Piette

Prevalence of dog bites in children: a telephone survey

The prevalence of non-medically attended dog bite accidents in children is unknown. Dog bite frequencies have been estimated between 9 and 18 per 1000 subjects [1, 2,4]. These figures include both adults and children. As children are at least 3 to 5 times more likely to experience dog bites than adults [2,4], it could be expected that the prevalence of dog bites is significantly greater in children. The data could be useful to set goals for local prevention programmes, as child victims of dog bites may suffer physical and emotional complications [1,3]. A telephone survey was conducted between August and November 2002 in the French-speaking community of Belgium. From an initial anonymous list established by the telephone company Belgacom, the telephone numbers of 8000 families were randomly selected. Families entered the study if they included at least one child under 15 years of age and if parents agreed to answer a questionnaire about family characteristics. If a child had been bitten by a dog during the last 12 months preceding the enquiry, additional questions were asked about the circumstances of the accident and type of medical intervention. The questionnaire had been pretested on 20 families and some questions modified or omitted for lack of clarity. The university ethics committee had approved the study. Of the 8000 telephone numbers randomly selected, 1184 families (14.8%) were included in the study. The other families could either not be contacted (16%) or did not meet the selection criteria. A dog was owned by 398 of the 1184 families (33.6%). Of the 1184 families, 26 reported that a child had been bitten by a dog during the preceding 12 months. The annual prevalence of dog bite was thus 2.2% (CI 1.4-–3.0). Among the 26 children bitten by a dog, 10 presented to a general practitioner, 5 to a hospital emergency department and one child was hospitalised. No child had been bitten on a second occasion during the preceding 12 months and no child died following a bite accident. An annual frequency of 22 bites was determined per 1000 children under the age of 15 years. The findings also support previous observations that far less than 50% of dog bites were reported to medical or legal authorities [2]. The actual incidence of dog bites could still be greater than reported in this survey. Younger families with only portable telephones might not have been reached, while bites from family pets could have been underreported [2,3]. It can, however, be concluded that dog bites represent a significant and underreported portion of accidents in children.

Analysis of adequacy levels for human resources improvement within primary health care framework in Africa

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects:- adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations,- adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations,- adequacy between human resource management within health care system and medical standards,- adequacy between human resource management within education/teaching/training and needs from health care system and education sectors,- adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body,- adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...).This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate.

A model for analysis, systemic planning and strategic synthesis for health science teaching in the Democratic Republic of the Congo: a vision for action

BackgroundThe problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care.MethodsTaking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC).ResultsThe results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health.ConclusionsThe analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.

Trends in cannabis use and its determinants among teenagers in the French-speaking community of Belgium.

BACKGROUND Cannabis consumption among teenagers has undergone dramatic changes in Europe since the beginning of the 1990s. A number of behaviors associated with cannabis consumption, such as tobacco smoking, excessive drinking and truancy are developing too, each in their own way. METHODS To assess the evolution over time of the various types of cannabis consumption (both ever and weekly consumption) in relation to these determinants (age, sex, studies chosen, truancy, tobacco smoking and recurrent intoxication), we have analyzed the cross-sectional study on Health Behaviour in School-Aged Children in the French-speaking Belgian Community (12-17 years) since 1994. We used logistic models to analyze the evolution of the various types of cannabis consumption and to identify the associated factors. Finally, in order to demonstrate time trends, we tested for each type of consumption in the interactions between the significant predictive variables in each model and the survey year (1994-1998-2000). RESULTS Rates of ever use, past 30-day use and weekly use among the ever users have been increasing from 1994 to 2002 and reached, respectively, 22.0%, 11.6%, 6.8% and 32.9%. Cannabis ever use rose more noticeably among the general education students (adjusted OR (95%CI)): 3.08 (2.66-3.57) and among the truants: 4.57 (3.39-6.14). Weekly cannabis smoking rose most especially among the truants: 1.92 (1.34-2.78). CONCLUSION Truants should constitute a priority target for the prevention of cannabis consumption, while the phenomenon of truancy must be moreover examined in depth in order to more thoroughly identify the appropriate prevention programs organized both in and outside of the school environment.

SET‑bullying: presentation of a collaborative project and discussion of its internal and external validity

BackgroundSince the early 1980s, several school based anti-bullying interventions (SBABI) have been implemented and evaluated in different countries. Some meta-analyses have also drawn conclusions on the effectiveness of SBABIs. However, the relationship between time and effectiveness of SBABIs has not been fully studied. For this aim, a collaborative project, SET-Bullying, is established by researchers from Greece, Belgium, Norway and United Kingdom. Its primary objective is to further understand and statistically model the relationship between the time and the sustainability of the effectiveness of SBABI. The secondary objective of SET-Bullying is to assess the possibility of predicting the medium-term or long-term effectiveness using as key information the prior measurement and the short-term effectiveness of the intervention.ResultsResearchers and owners of potentially eligible databases were asked to participate in this effort. Two studies have contributed data for the purpose of SET-Bullying. This paper summarizes the main characteristics of the participating studies and provides a high level overview of the collaborative project. It also discusses on the extent to which both study and project characteristics may pose threats to the expected internal and external validity of the potential outcomes of the project.DiscussionDespite these threats, this work represents the first effort to understand the impact of time on the observed effectiveness of SBABIs and assess its predictability, which would allow for better planning, implementation and evaluation of SBABIs.

Analyse d’interventions pour améliorer l’encadrement clinique des étudiants infirmiers au Bénin

INTRODUCTION The absence of an explicit and coherent conception of the articulation between theory and practice in the reform of nursing training in Benin has resulted in poor quality clinical supervision of student nurses. The objective of this article is to analyze two interventions designed to improve the quality of supervision. METHODS A student welcome booklet developed by means of a consultative and provocative participatory approach was tested with twelve student nurses versus a control group. Content analysis of the data collected by individual semi-directed interviews and during two focus groups demonstrated the value of this tool. Student nurses were also taught to use to training diaries inspired by the ?experiential learning? MODEL Training diaries were analysed using a grid based on the descriptive elements of the five types of Scheepers training diaries (2008). RESULTS According to the student nurses, the welcome booklet provided them with structured information to be used as a reference during their training and a better understanding of their teachers, and allowed them to situate the resources of the training course with a lower level of stress. Fifty-eight per cent of the training diaries were are mosaics, reflecting the reflective practice and self-regulated learning of student nurses. This activity also promoted metacognitive dialogue with their supervisors. CONCLUSION The student welcome booklet appeared to facilitate integration of student nurses into the clinical setting and promoted professional and organizational socialization. The training diary improved the quality of clinical learning by repeated reflective observation of student nurses and helped to maintain permanent communication with the supervisors.