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Search Results: 1 - 10 of 13240 matches for " Aurélia Souares "
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Measuring self-reported health in low-income countries: piloting three instruments in semi-rural Burkina Faso
Yulia Blomstedt,Aurélia Souares,Louis Niamba,Ali Sie
Global Health Action , 2012, DOI: 10.3402/gha.v5i0.8488
Abstract: Background: National surveys in low-income countries increasingly rely on self-reported measures of health. The ease, speed, and economy of collecting self-reports of health make such collection attractive for rapid appraisals. However, the interpretation of these measures is complicated since different cultures understand and respond to the same question in different ways. Objective: The aim of this pilot study was to develop a culturally sensitive tool to study the self-reported health (SRH) of the local adult population in Burkina Faso. Design: The study was carried out in the 2009 rainy season. The sample included 27 men and 25 women aged 18 or older who live in semi-urban Nouna, Burkina Faso. Three culturally adapted instruments were tested: a SRH question, a wooden visual analogue scale (VAS), and a drawn VAS. Respondents were asked to explain their answers to each instrument. The narratives were analyzed with the content analysis technique, and the prevalence of poor SRH was estimated from the quantitative data by stratification for respondent background variables (sex, age, literacy, education, marital status, ethnicity, chronic diseases). The correlation between the instruments was tested with Spearman's correlation test. Results: The SRH question showed a 38.5% prevalence of poor SRH and 44.2% prevalence with both VAS. The correlation between the VAS was 0.89, whereas the correlation between the VAS and the SRH question was 0.60–0.64. Nevertheless, the question used as the basis of each instrument was culturally sensitive and clear to all respondents. Analysis of the narratives shows that respondents clearly differentiated between the various health statuses. Conclusion: In this pilot, we developed and tested a new version of the SRH question that may be more culturally sensitive than its non-adapted equivalents. Additional insight into this population's understanding and reporting of health was also obtained. A larger sample is needed to further study the validity and reliability of the SRH question and the VAS and understand which instrument is best suited to study SRH in the low-income setting of semi-rural Burkina Faso.
Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies
Divya Parmar, Aurélia Souares, Manuela de Allegri, Germain Savadogo, Rainer Sauerborn
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-181
Abstract: The study area, covering 41 villages and 1 town, was divided into 33 clusters and CBHI was randomly offered to these clusters during 2004–06. In 2007, premium subsidies were offered to the poor households. The data was collected by a household panel survey 2004–2007 from randomly selected households in these 33 clusters (n?=?6795). We applied fixed effect models.We found weak evidence of adverse selection before the implementation of subsidies. Adverse selection significantly increased the next year and targeted subsidies largely explained this increase.Adverse selection is an important concern for any voluntary health insurance scheme. Targeted subsidies are often used as a tool to pursue the vision of universal coverage. At the same time targeted subsidies are also associated with increased adverse selection as found in this study. Therefore, it’s essential that targeted subsidies for poor (or other high-risk groups) must be accompanied with a sound plan to bridge the financial gap due to adverse selection so that these schemes can continue to serve these populations.
Motivational determinants among physicians in Lahore, Pakistan
Ahmad Malik, Shelby Yamamoto, Aurélia Souares, Zeeshan Malik, Rainer Sauerborn
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-201
Abstract: A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural.Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians.Motivational determinants differed across different levels of care, sectors and genders. Nonetheless, the important motivators across setups in this study were mostly intrinsic and socio-cultural, which are difficult to affect while the demotivators were largely organizational. Many can be addressed even at the facility level such as less personal safety and poor working conditions. Thus, in resource limited settings a good strategic starting point could be small scale changes that may markedly improve physicians' motivation and subsequently the quality of health care.The wor
Factors related to compliance to anti-malarial drug combination: example of amodiaquine/sulphadoxine-pyrimethamine among children in rural Senegal
Aurélia Souares, Richard Lalou, Ibra Sene, Diarietou Sow, Jean-Yves Le Hesran
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-118
Abstract: The study was conducted in five rural dispensaries. Children, between two and 10 years of age, who presented mild malaria were recruited at the time of the consultation and were prescribed AQ/SP. The child's primary caretaker was questioned at home on D3 about treatment compliance and factors that could have influenced his or her adherence to treatment. A logistic regression model was used for the analyses.The study sample included 289 children. The adherence rate was 64.7%. Two risks factors for non-adherence were identified: the children's age (8–10 years) (ORa = 3.07 [1.49–6.29]; p = 0.004); and the profession of the head of household (retailer/employee versus farmer) (ORa = 2.71 [1.34–5.48]; p = 0.006). Previously seeking care (ORa = 0.28 [0.105–0.736], p=0.001] satisfaction with received information (ORa = 0.45 [0.24–0.84]; p = 0.013), and the quality of history taking (ORa = 0.38 [0.21–0.69]; p = 0.001) were significantly associated with good compliance.The results of the study show the importance of information and communication between caregivers and health center staff. The experience gained from this therapeutic transition emphasizes the importance of information given to the patients at the time of the consultation and drug delivery in order to improve drug use and thus prevent the emergence of rapid drug resistance.Early treatment with effective anti-malarial drugs is the main life-saving intervention for those at risk of malaria. However, drug treatment is threatened by growing resistance of Plasmodium falciparum to drugs that were once effective against the parasite. Chloroquine resistance has increased around the world, and this single drug treatment has become useless in most malaria-endemic areas. Resistance to sulphadoxine-pyrimethamine (SP) is also widespread and its use must soon be discontinued. Resistance to other anti-malarial drugs, such as amodiaquine, varies, but their useful therapeutic life also appears limited. Consequently, nearly all A
Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment
Paul J Robyn, Till B?rnighausen, Aurélia Souares, Germain Savadogo, Brice Bicaba, Ali Sié, Rainer Sauerborn
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-159
Abstract: A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis.Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p?<?0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p?<?0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p?<?0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p?<?0.001)).Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid.
Self-reported data: a major tool to assess compliance with anti-malarial combination therapy among children in Senegal
Aurélia Souares, Patricia Moulin, Sophie Sarrassat, Marie-Paule Carlotti, Richard Lalou, Jean-Yves Le Hesran
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-257
Abstract: The study was carried out in 2004, in five health centres located in the Thies region (Senegal). Children who had AQ/SP prescribed for three and one day respectively at the health centre were recruited. The day following the theoretical last intake of AQ, venous blood, and urine samples were collected for anti-malarial drugs dosage. Caregivers and children above five years were interviewed concerning children's drug intake.Among the children, 64.7% adhered to 80% of the prescribed dose and only 37.7% were strict full adherent to the prescription. There was 72.7% agreement between self-reported data and blood drug dosage for amodiaquine treatment. Concerning SP, results found that blood dosages were 91.4% concordant with urine tests and 90% with self-reported data based on questionnaires.Self-reported data could provide useful quantitative information on drug intake and administration. Under strict methodological conditions this method, easy to implement, can be used to describe patients' behaviors and their use of new anti-malarial treatment. Self-reported data is a major tool for assessing compliance in resource poor countries. Blood and urine drug dosages provide qualitative results that confirm any drug intake. Urine assays for SP could be useful to obtain public health data, for example on chemoprophylaxis among pregnant women.In the fight against malaria, the emergence of resistance to chloroquine, but also to other drugs, such as mefloquine or sulphadoxine-pyrimethamine, directs our attention to one of the factors of resistance emergence, i.e. drug use [1]. The theoretical effectiveness of a growing number of medical interventions appears to be hindered by patients' and caregivers' behaviors concerning compliance with treatment regimens [2,3]. In order to improve therapeutic strategies, a particular interest is focused on the measurement of compliance with treatment.This is a complex issue since there is no benchmark [4,5]. The selection of available methods--
The Influence of Legal Proceedings on French General Practice: A Qualitative Study  [PDF]
Aurélia Nachbauer, Humbert de Fréminville
Open Journal of Social Sciences (JSS) , 2014, DOI: 10.4236/jss.2014.26045
Abstract: Legal proceedings are becoming increasingly common in our society and especially in medicine. This raises the question as to whether General Practitioners (GPs) are concerned by this phenomenon. This study explores the impact of proceedings on the feelings and behaviors of different doctors. A qualitative semi-structured interview with 13 French GPs based on grounded theory was performed. A thematic analysis with major themes was then performed. This survey shows that lawsuits have little impact on the daily practice of GPs. Defensive medicine is practiced in certain specific situations: the treatment given, a patient known or perceived to be litigious. GPs attach importance to information and communicating to the patient. The primary concern of GPs remains their patients. They are not subject to daily anxiety over the risk of lawsuits.

Mudan as na estrutura demográfica do Espirito Santo ocorridas durante a segunda metade do século XX
Aurélia H. Castiglioni
Geografares , 2009,
Abstract: A ocupa o do território do Espírito Santo desenhou-se de maneira particular e seu processo de desenvolvimento foi marcado, até meados do século XX, por características fortemente rurais e por retardo econ mico e social, comparativamente aos demais estados da regi o Sudeste. Este artigo analisa as mudan- as ocorridas nos comportamentos dos fen -menos demográficos nas décadas da segunda metade do século XX, colocando em evidência a originalidade dos processos da transi o demográfica e da redistribui o da popula o.
Une étape de la mise en carte de la montagne marocaine (1937): le massif du Toubkal au 1/20 000
Aurélia Dusserre
M@ppemonde , 2009,
Abstract: La réalisation, en 1937, de la carte du massif du Toubkal au 1/20 000 est une étape importante de la cartographie de la montagne marocaine. Réalisée sous la direction de Théophile-Jean Delaye, officier topographe également alpiniste et dessinateur, elle marque la fin de la cartographie de reconnaissance, au moment où le Protectorat entend accorder une nouvelle valeur aux montagnes du Maroc.
Repensando la política energética en un momento de crisis. Reflexionesa partir de unas lecturas veraniegas
Aurèlia Ma?é Estrada
Revista de Economía Crítica , 2011,
Abstract:
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