The Development of Culturally Appropriate Tobacco Prevention Videos Targeted Toward Somali Youth.

BACKGROUND: Approximately 18% of Somali youth in Minnesota intend to use tobacco in the next year and youth perceive that 64% of their peers smoke. High perceived prevalence increases tobacco use intentions and initiation, indicating that Somali youth-targeted tobacco prevention efforts are needed. OBJECTIVES: To develop a Somali youth-targeted tobacco prevention intervention using a community-based participatory research (CBPR) approach. METHODS: Three focus groups were conducted to inform the development of a tobacco prevention intervention. Three tobacco prevention videos were developed. Twenty interviews were conducted to evaluate the videos. LESSONS LEARNED: It was essential to partner with Somali youth to develop the videos. Recruitment and development of the videos were facilitated through collaborating with trusted, existing community programs. CONCLUSIONS: A CBPR approach can be used to develop a culturally tailored intervention. It was important to involve academic and community partners in all stages of the research project.

Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials.

BACKGROUND: Polyethylene glycol (PEG) is a commonly used bowel preparation for colonoscopy. Unfortunately, the standard large-volume solution may reduce patient compliance. Split-dosing of PEG has been studied in various randomized, controlled trials (RCTs). However, results have been conflicting. OBJECTIVE: We conducted a meta-analysis to assess the role of split-dose PEG versus full-dose PEG for bowel preparation before colonoscopy. DESIGN: Multiple databases were searched (January 2011). RCTs on adults comparing full-dose and split-dose of PEG for bowel preparation before colonoscopy were included and analyzed by calculating pooled estimates of quality of bowel preparation, preparation compliance, willingness to repeat the same preparation, and side effects by using odds ratio (OR) by fixed and random-effects models. SETTING: Literature search. PATIENTS: Per RCTs. MAIN OUTCOME MEASUREMENTS: Satisfactory bowel preparation, willingness to repeat same bowel preparation, patient compliance, and side effects. RESULTS: Five trials met inclusion criteria (N = 1232). Split-dose PEG significantly increased the number of satisfactory bowel preparations (OR 3.70; 95% CI, 2.79-4.91; P < .01) and willingness to repeat the same preparation (OR 1.76; 95% CI, 1.06-2.91; P = .03) compared with full-dose PEG. Split-dose PEG also significantly decreased the number of preparation discontinuations (OR 0.53; 95% CI, 0.28-0.98; P = .04) and nausea (OR 0.55; 95% CI, 0.38-0.79; P < .01) compared with full-dose PEG. LIMITATIONS: Limited number of studies. CONCLUSIONS: The use of a split-dose PEG for bowel preparation before colonoscopy significantly improved the number of satisfactory bowel preparations, increased patient compliance, and decreased nausea compared with the full-dose PEG.

[Management of malaria in Benin: evaluation of the practices of healthcare professionals following the introduction of artemisinin derivatives]. / Prise en charge du paludisme au Bénin: évaluation des pratiques professionnelles suite à l'introduction des dérives d'artémisinine.

In 2004 the policy for malaria management in Benin changed when the National Malaria Coordination Program (NMCP) introduced artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria. Up to that time, chloroquine had been used for first-line therapy against uncomplicated malaria and sulfadoxine pyrimethamine had been used in case of failure. Artemisinin derivatives have been used for monotherapy in Benin since 2002. The purpose of this transverse study carried out among public and private centers in Cotonou from March 16 to May 17, 2005 was to determine the impact of the switch to ACT on the practices of healthcare professionals. Medical centers were randomly selected from each stratum after identification and stratification of all facilities in the healthcare pyramid. A survey questionnaire was sent to healthcare workers. A total of 690 health workers responded to the questionnaire. Most responders (95.5%) were familiar with artemisinin but a lower percentage (89.6%) prescribed them. Responders were less knowledgable about ACT drugs and Coartem was the best known combination in the minds of prescribers. Biological diagnosis was available for 50% of patients. Artemisinine (derivates) were mainly prescribed as a second choice treatment and as monotherapy whether for severe or uncomplicated malaria. They were prescribed to pregnant women in 34.6% of the cases. Dosage was incorrect in 26.1% of cases in adults and 20.9% of cases in children. These findings indicate that more effort is needed to inform healthcare workers. This is especially urgent since the country is now considering revising its malaria management policy to make ACT available at all levels of the healthcare system. An effective information campaign must be set up to ensure that health workers and drug retailers throughout the country are duly informed of the new malaria treatment policy.

Prise en charge du paludisme au Benin : evaluation des pratiques professionnelles suite a l'introduction des derives d'artemisinine

la politique de prise en charge du paludisme au Benin a change en 2004 par l'introduction des combinaisons therapeutiques a base d'artemisinine (CTA) par le Programme National de Lutte contre le Paludisme (PNLP) pour le traitement du paludisme simple. Avant cette date; la chloroquine etait le medicament de premiere intention de prise en charge du paludisme simple avec la sulfadoxine pyrimethamine en cas d'echec. Par ailleurs; les derives d'artemisinine etaient utilises en monotherapie au Benin depuis 2002. Afin d'etudier l'evolution des comportements therapeutiques de prise en charge du paludisme par les agents de sante; une etude transversale a ete realisee aupres du personnel de sante du secteur public et prive de la ville de Cotonou du 16 mars au 17 mai 2005. Les formations sanitaires ont ete tirees au sort dans chaque strate apres recensement et stratification de toutes les formations sanitaires selon la pyramide sanitaire. L'enquete a utilise un questionnaire adresse aux agents de sante. Au total 690 agents de sante ont ete enquetes. Les derives de l'artemisinine sont connus de 95;5des agents de sante enquetes mais ne sont prescrits que par 89;6d'entre eux. Les CTA sont moins connues et le Coartemr reste la combinaison la mieux connue des prescripteurs. Un diagnostic biologique etait disponible dans la moitie des cas. Les derives de l'Artemisinine sont prescrits surtout en deuxieme intention et en monotherapie que ce soit pour le traitement du paludisme simple ou du paludisme grave. Ils sont prescrits chez la femme enceinte dans 34;6des cas. Les posologies sont incorrectes dans 26;1des cas chez l'adulte et dans 20;9des cas chez l'enfant. Ces resultats justifient l'intensification de la formation des agents de sante; d'autant plus que le pays envisage dans le cadre du changement de sa politique de prise en charge du paludisme; de rendre disponible les CTA a tous les niveaux de la pyramide sanitaire. Un systeme de communication efficace doit etre mis en place en vue d'une large diffusion de la nouvelle politique de traitement

[Epidemiological aspects of human and animal rabies in the urban area of Bamako, Mali]. / Aspects épidémiologiques de la rage humaine et animale en milieu urbain à Bamako, Mali.

The district of Bamako is the political and economical capital city of Mali with 1,800,000 inhabitants. The goal of the present retrospective study was to determine the frequency of animal bites, human and animal rabies on the one hand and to determine the frequency and the nature of mad animals on the other hand from January 2000 to December 2003 (4 years). To achieve this goal, we have analysed registers and documents related to rabies in the department of prevention and fight against diseases, the central veterinary laboratory, and also at the lazaret clinic involved in caring for human rabies cases. Human rabies diagnosis has been brought up based upon the following clinical arguments: agitation and lethal hydrophobia within few days following bites by known or unknown animal. Agitation and aggressiveness followed by the animals' death within an observation period of 15 days maximum, allowed to evoke the diagnosis in animals. In Bamako an average of 1470 persons have been bitten each year. In 97.1% of the cases, the mad animal was a dog; cats (1.6%), donkeys, horses, cattle and rats (1.4%) have also been identified on a total of 5870 cases of notified human bites by animals; 10 cases of notified human rabies have been recorded. The dog has been incriminated in 6 cases of human rabies out of 10, in the 4 other cases, it has not been possible to identify the mad animal. Among the 3924 mad animals in observation at the veterinary clinic, 187 have been clinically mad that is 4.8%. The rabies virus has also been researched by direct immunofluorescence in 121 specimens of dead mad animals brain. This research has been positive in 119 cases among which 116 dogs, 2 sheep and 1 cow. Anyway the vaccinal status of people bitten by mad animals has not been clearly established. According to these results, we recommend the implementation of a national specific program to eradicate rabies in Bamako.

Therapeutic efficacy of chloroquine and sulfadoxine/pyrimethamine against Plasmodium falciparum infection in Somalia.

OBJECTIVE: To assess the efficacy of chloroquine and sulfadoxine/pyrimethamine in the treatment of uncomplicated Plasmodium falciparum infections in Somalia. METHODS: Patients with clinical malaria in Merca, an area of high transmission of the disease, were treated with the standard regimens of chloroquine (25 mg/kg) or sulfadoxine/pyrimethamine (25 mg sulfadoxine and 1.25 mg pyrimethamine per kg). Similar patients in Gabiley, an area of low transmission, received the standard regimen of chloroquine. The clinical and parasitological responses were monitored for 14 days. FINDINGS: Chloroquine treatment resulted in clinical failure in 33% (n = 60) and 51% (n = 49) of the patients in Merca and Gabiley respectively. There were corresponding parasitological failures of 77% RII/RIII and 35% RII/RIII. Patients who experienced clinical failure had significantly higher initial parasitaemia than those in whom there was an adequate clinical response, both in Merca (t = 2.2; P t = 2.8; P n = 50) of the patients achieved an adequate clinical response despite a parasitological failure rate of 76% RII/RIII. CONCLUSION: Chloroquine should no longer be considered adequate for treating clinical falciparum malaria in vulnerable groups in the areas studied. Doubts about the therapeutic life of sulfadoxine/pyrimethamine in relation to malaria are raised by the high levels of resistance in the Merca area and underline the need to identify suitable alternatives.