Continuity of care in mental health: understanding and measuring a complex phenomenon.

BACKGROUND: Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness. METHOD: A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care. RESULTS: Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model. CONCLUSIONS: We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.

Male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis: observations after a randomised controlled trial for HIV prevention.

OBJECTIVE: To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial. METHODS: We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18-24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression. RESULTS: In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030). CONCLUSIONS: This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.

[Epidemiologic study of hemoglobinopathies in the Congo in 2,257 newborn infants]. / Etude épidémiologique des hémoglobinopathies au Congo chez 2,257 nouveau-nés.

A systematic examination of 2,257 Congolese newborns from Brazzaville for abnormal hemoglobins has been conducted. Gene frequency for HbS was 0.117; no HbC was found. Of the sample 14.4% had detectable amounts of Hb Bart's. Beta-thalassemia trait frequency was approximately estimated to 0.3%, 5 mutations of gamma chain, and 1 mutation for alpha chain were detected.

[Plasmodium falciparum malaria and sickle cell gene in the popular Republic of Congo. I. Relationship between parasitemia and sicke cell trait in Djoumouna (region of Brazzaville) (author's transl)]. / Le paludisme a Plasmodium falciparum et le gène de la drépanocytose en République Populaire du Congo. I. Relation entre la parasitémie et la trait drépanocytaire à Djoumouna (région de Brazzaville).

The relationship between sickle cell trait and falciparum malaria was studied in the village of Djoumouna, twenty kilometers south west of Brazzaville. Malaria is characterized by a stable high intensity of transmission on the average one infective mosquito bite by night and by child contrasting with a relatively low malarial infection rate. The prevalence of carriers of an S gene (AS) does not change with age: 22.2% for children under 5 years, 22.1% for childrern between 5 and 15 years, and 22.9% in adults. Malarial infection rates are 32% in homozygous AA children under five years and 38% in AS children, an insignificant difference. Our data for this region of the Congo fail to confirm the hypothesis that the AS genotype protects the carrier against Plasmodium falciparum infection.