Comparison of the repercussions of cLBP in four French-speaking countries.

INTRODUCTION: Sociocultural factors may influence the impact of chronic low back pain (cLBP) on patients. The goal of this study was to compare pain and disability levels, and psychobehavioural parameters in four French-speaking countries in patients with cLBP. METHODS: Two hundred and seventy-eight patients were included: 83 in France, 36 in Morocco, 75 in the Ivory Coast and 84 in Tunisia. Demographic data were collected; pain was assessed using a visual analogue scale (VAS), disability with the Quebec scale, psychobehavioural factors by the hospital anxiety depression scale (HAD), the fear and avoidance beliefs questionnaire (FABQ) and the coping strategy questionnaire (CSQ). A Student t-test was used to compare means. Anova (covariance) was used to test for a "Country Effect", i.e. the incidence of country on outcomes. OUTCOMES: There was no difference in disability levels between countries. A "country effect" was found (p<0.001) for pain (F=2.707), anxiety (F=3.467), depression (F=5.137), fear and avoidance beliefs regarding professional activity (F=1.974) and physical activity (F=5.076), strategy of distraction, dramatization, efforts to ignore pain, prayer, seeking social support and reinterpretation (p<0.01). Pain level was higher in Morocco (p<0.05); anxiety, depression, fear and avoidance beliefs about physical activities were higher in Tunisia (p<0.05) and fear and avoidance beliefs about professional activities were higher in the Ivory Coast (p<0.01). Among the coping strategies used, distraction, dramatization, prayer and search for social support were used more in the Ivory Coast; reinterpretation in Tunisia; seeking social support was less common in France. CONCLUSION: In this population of patients with cLBP, despite similar disability levels across the four French-speaking countries, there were considerable variations in pain level and psychobehavioural repercussions.

Organizational and operational capabilities of specialist centres for children with psychomotor disability in Abidjan.

OBJECTIVE: To describe the organizational and operational capabilities of specialized centres for children with psychomotor disability in Abidjan, Republic of Côte d'Ivoire. MATERIALS AND METHODS: This descriptive study was carried out from February to May, 2006 at the various specialized centres for children with psychomotor disability that exist in the district of Abidjan. The procedure comprised a clinical description of the disabled children admitted to these centres and an assessment of the centres' organization and operational capabilities. RESULTS AND COMMENTS: Six specialist centres for children with psychomotor disability were identified, namely the Infant Guidance Centre, the Awakening and Stimulation Centre for disabled Children, the "Sainte-Magdeleine" Centre, the Medical and Training Institute, the "Page Blanche" institute and the "Colombes Notre Dame de la Paix" Centre. Among the children, 97.15% were day patients, 66.37% were mentally challenged, 30.96% had psychomotor impairment and 2.66% had motor impairments. The level of organization varied but the centres nevertheless had operational administrative, medical and paramedical staff, despite the absence of certain specialties. However, the lack of personnel, equipment and infrastructure is hindering the delivery of adequate services to the children. CONCLUSION: In Abidjan District, reception centres for children with psychomotor impairments are essentially privately run. Organizational and operational performances were suboptimal, with a low carer-to-patient ratio. Reinforcement of the centres' operational capabilities appears to be necessary.

Effect of sildenafil on erectile dysfunction in spinal cord injured patients.

BACKGROUND: Erectile dysfunction is a preoccupying issue, just like motor and bladder disability, in spinal cord injured (SCI) patients. This is particularly so because of the increasing prevalence of paraplegic and tetraplegic subjects and the fact that these patients are younger, and sexually active. OBJECTIVE: To determine the effects of Sildenafil (Viagra((R))) on erectile dysfunction in SCI patients. METHODS: After medical ethics committee approval and informed patient consent, we conducted a prospective inquiry between January and March 2007 in 16 SCI patients who were under Sildenafil treatment for erectile dysfunction. An abridged version of the International Index of Erectile Function (IIEF-5) questionnaire was completed the patients. RESULTS: The mean age (range) of the patients was 32.75 yrs (21-53 yrs). The mean duration of their disability was 47.75 months (4 yr). Trauma was the etiology in 87.5% of the cases (44% were road accidents). 12/16 patients were paraplegics (10 above T10) and 4 were tetraplegics (1 above C4 and 3 below C5). The mean duration of sildenafil treatment was 18.75 months (17 days-7 yr). 70% of the patients were satisfied with their erection after treatment. However, 10/16 patients had concomitant treatment with alprostadil. CONCLUSION: Sildenafil is a vasoactive drug which can be used as a simple, discrete and effective treatment for erectile dysfunction in SCI patients. This approach is compatible with the efforts to improve the quality of life and rehabilitation of these patients.

Quality of life assessment of handicapped students integrated into the ordinary higher education system.

OBJECTIVE: To evaluate the quality of life of handicapped students integrated into the ordinary higher education system. MATERIALS AND METHODS: Over a seven-month period in the academic year 2000-2001, we performed a descriptive, cross-sectional, analytical survey of 203 handicapped students registered in universities and high schools in Abidjan, Ivory Coast. The first part of the survey questionnaire concerned the students' social-demographic and clinical characteristics and the second part consisted of a quality of life assessment in terms of building and teaching accessibility and socioeconomic aspects. Quality of life was evaluated on a six-step scale, as per the life satisfaction questionnaire of Bränholm and Fugl-Meyer. RESULTS: A number of the handicapped students (60.6%) received financial support from their families. Several students (89.2 and 10.8%) presented motor and sensory handicaps, respectively. A number of respondents (63.5%) considered that building accessibility was dissatisfactory. A number of the surveyed students (73.89%) were at university. Teaching accessibility was judged to be satisfactory by motor-handicapped subjects and dissatisfactory by sensory handicapped persons. A number of the surveyed students (26.6%) spent between 25 to 50% of their monthly income on handicap-related expenses and 19.7% of the survey population even spent more than 50% of their income in this respect. The surveyed students' considered their overall quality of life to be dissatisfactory. CONCLUSION: Improving handicapped students' quality of life requires an appropriate legislative environment and adequate financial support in order to incite educational institutions to accept these students' needs and their specific characteristics.

[An anthropological approach to how Tchaman people in the Côte-d'Ivoire view hemiplegia]. / Approche anthropologique de l'hémiplégie chez le peuple Tchaman en Côte-d'Ivoire.

OBJECTIVE: Investigate the underlying beliefs, knowledge and therapeutic attitudes toward hemiplegia of the Tchaman people of the Ivory Coast. MATERIAL AND METHODS: A descriptive and cross-sectional study conducted over 10 months in 20 Tchaman village communities in the Ivory Coast. Three groups of people were interviewed: patients with hemiplegia, the circle and close neighbourhood of patients and traditional doctors. The questionnaire asked about epidemiological characteristics; the definition, origin and sociocultural causes of hemiplegia; attitude toward therapy; and developmental aspects of hemiplegia after treatment. RESULTS: The word "awoyo" was most often used (53.3%) to refer to hemiplegia whose origin is most of the time attributed to a curse (57%). For 45% of the people interviewed, hemiplegia is a severe disease that can cause death and is associated with the development of a stationary evolution after treatment. The Tchaman follow modern and traditional methods of treatment for hemiplegia. CONCLUSION: Need to sensitize the Tchaman people to functional rehabilitation for effective assistance to patients with hemiplegia.