1
|
Mengesha W, Steege R, Kea AZ, Theobald S, Datiko DG. Can mHealth improve timeliness and quality of health data collected and used by health extension workers in rural Southern Ethiopia? J Public Health (Oxf) 2019; 40:ii74-ii86. [PMID: 30551131 PMCID: PMC6294041 DOI: 10.1093/pubmed/fdy200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background Health extension workers (HEWs) are the key cadre within the Ethiopian Health Extension Programme extending health care to rural communities. National policy guidance supports the use of mHealth to improve data quality and use. We report on a mobile Health Management Information system (HMIS) with HEWs and assess its impact on data use, community health service provision and HEWs' experiences. Methodology We used a mixed methods approach, including an iterative process of intervention development for 2 out of 16 essential packages of health services, quantitative analysis of new registrations, and qualitative research with HEWs and their supervisors. Results The iterative approach supported ownership of the intervention by health staff, and 8833 clients were registered onto the mobile HMIS by 62 trained HEWs. HEWs were positive about using mHealth and its impact on data quality, health service delivery, patient follow-up and skill acquisition. Challenges included tensions over who received a phone; worries about phone loss; poor connectivity and power failures in rural areas; and workload. Discussion Mobile HMIS developed through collaborative and locally embedded processes can support quality data collection, flow and better patient follow-up. Scale-up across other community health service packages and zones is encouraged together with appropriate training, support and distribution of phones to address health needs and avoid exacerbating existing inequalities. Keywords CHWs, equity, ethics, Ethiopia, Health Management Information system, HEP, maternal health, mHealth, TB.
Collapse
Affiliation(s)
| | - R Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - A Z Kea
- REACH Ethiopia, Hawassa, Ethiopia
| | - S Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | | |
Collapse
|
2
|
Baral S, Subedi HN, Paudel P, Chand PB, Shrestha MP, McCullough A, Raven J, Theobald S, Martineau T, Elsey H. Implementation research to assess a health workers performance-based management system in Nepal. Acta Paediatr 2018; 107 Suppl 471:24-34. [PMID: 30570792 DOI: 10.1111/apa.14406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
AIM To test and refine a performance-based management system to improve health worker performance in Nepal. METHODS A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes. RESULTS Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. CONCLUSION The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.
Collapse
Affiliation(s)
- S Baral
- HERD International; Kathmandu Nepal
| | - HN Subedi
- Health Research and Social Development Forum; Kathmandu Nepal
| | - P Paudel
- HERD International; Kathmandu Nepal
| | - PB Chand
- Ministry of Health (Nepal); Kathmandu Nepal
| | | | - A McCullough
- South West Public Health Speciality Training Programme; Bristol UK
| | - J Raven
- Liverpool School of Tropical Medicine; Liverpool UK
| | - S Theobald
- Liverpool School of Tropical Medicine; Liverpool UK
| | - T Martineau
- Liverpool School of Tropical Medicine; Liverpool UK
| | - H Elsey
- Nuffield Centre for International Health and Development; University of Leeds; Leeds UK
| |
Collapse
|
3
|
Dhatt R, Theobald S, Buzuzi S, Ros B, Vong S, Muraya K, Molyneux S, Hawkins K, González-Beiras C, Ronsin K, Lichtenstein D, Wilkins K, Thompson K, Davis K, Jackson C. The role of women's leadership and gender equity in leadership and health system strengthening. Glob Health Epidemiol Genom 2017; 2:e8. [PMID: 29868219 PMCID: PMC5870471 DOI: 10.1017/gheg.2016.22] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/02/2016] [Accepted: 12/02/2016] [Indexed: 12/05/2022] Open
Abstract
Gender equity is imperative to the attainment of healthy lives and wellbeing of all, and promoting gender equity in leadership in the health sector is an important part of this endeavour. This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. We conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity.
Collapse
Affiliation(s)
- R. Dhatt
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| | - S. Theobald
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK
- Institute of Development Studies, Institute of Development Studies, Library Road Brighton BN1 9RE, UK
| | - S. Buzuzi
- Biomedical Training Research Institute, 10 Seagrave Road, Avondale Harare, Zimbabwe
| | - B. Ros
- Cambodia Development Resource Institute, 56 St. 315, Phnom Penh 622, Cambodia
| | - S. Vong
- Cambodia Development Resource Institute, 56 St. 315, Phnom Penh 622, Cambodia
| | - K. Muraya
- Kenya Medical Research Institute – KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya
| | - S. Molyneux
- Kenya Medical Research Institute – KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Global Health and Tropical Medicine, University of Oxford, Oxford, UK
| | - K. Hawkins
- Pamoja Communications, UK Bishopstone, 36 Crescent Road, Worthing BN11 1RL, UK
| | - C. González-Beiras
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
- Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Rua da Junqueira 100, Lisbon, Portugal
| | - K. Ronsin
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| | - D. Lichtenstein
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| | - K. Wilkins
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| | - K. Thompson
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| | - K. Davis
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| | - C. Jackson
- Women in Global Health, 30901 Wiegmen Road, Hayward, CA 94544, USA
| |
Collapse
|
4
|
Nelson F, Masulani‐Mwale C, Richards E, Theobald S, Gladstone M. The meaning of participation for children in Malawi: insights from children and caregivers. Child Care Health Dev 2017; 43:133-143. [PMID: 27807865 PMCID: PMC5215659 DOI: 10.1111/cch.12422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 09/16/2016] [Accepted: 10/02/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Global rates of childhood disability are high and are estimated through tools that focus on impairment, functioning and activity. The International Classification of Functioning, Disability and Health has promoted a framework to define disability more broadly and to include participation. New outcome measures have now been created to assess participation of children with disabilities for use in research and clinical practice. In order to use these in other cultural contexts, the validity of concepts and tools developed should be evaluated prior to use. We aim to create a tool that would be relevant and valid to the cultural context of Malawi, but to do so, we first need to understand what participation means to children in Malawi. AIM The aim of this study is to explore what participation means for children (including those with and without disability) in rural Northern Malawi. METHODS We used semi-structured interviews, focus group discussions, participatory action research and direct observations. Sixty-four participants were involved including children (8-18 years) with (14) and without disabilities (17), carers of children with (8) and without (6) disabilities, community members (14) and professionals/healthcare workers (5). Data analysis was carried out using the 'framework' approach. RESULTS Activities reported by children, carers and community members fell within seven main themes or areas of participation. These include contribution to family life (chores and work), social activities (communicating and being with others), social activities (unstructured play), structured and organized activities, activities of daily living, education and schooling and entertainment (listening to and watching media). CONCLUSIONS This study provides concepts and ideas that may be utilized in developing a suitable measure of participation of children with disabilities for rural African settings. Many of the most important activities for all children relate to family and day-to-day social life.
Collapse
Affiliation(s)
- F. Nelson
- Department of Women's and Children's Health, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | | | - E. Richards
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - S. Theobald
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - M. Gladstone
- Department of Women's and Children's Health, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
5
|
Tolhurst R, de Koning K, Price J, Kemp J, Theobald S, Squire S. The Challenge of Infectious Disease: Time to Take Gender into Account. Journal of Health Management 2016. [DOI: 10.1177/097206340200400204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Efforts to address infectious diseases have long been hindered by the failure to take into account the social aspects of these diseases. Gender is a fundamental dimension of these social aspects. There is currently a focus in international health on the import ance of addressing diseases of poverty. Attention to gender is a crucial part of a poverty-focused response to the challenges posed by infectious disease. In this article we provide a framework for analysing gender inequities in infectious disease in developing countries, and briefly draw implications for policy and practice. Gender identities, status, roles and responsibilities influence vulnerability to dis ease, access to health care, and the impact of disease for women, men, girls and boys. Women's and men's roles affect their risk of infection with specific diseases, whilst gender relations influence their ability to protect their own health. Gender differences in access to and control over resources, in decision-making power in the household and in roles and activities can limit women's ability to access health care for them selves and their children. Gendered norms and identities influence both women's and men's willingness and ability to seek care. The social consequences of infectious disease are often more severe for women than for men, and illness imposes a parti cularly heavy labour burden upon women. Health services need to adjust their practices to improve the appropriateness of preventive and curative services for infectious disease control for both women and men amongst the poor and disadvantaged. However, measures to reduce gender inequities in health cannot be limited to the health sector alone.
Collapse
Affiliation(s)
- R. Tolhurst
- Liverpool School of Tropical Medicine, Liverpool, UKE-mails:
| | - K. de Koning
- Royal Tropical Institute (KIT), Health Care Training, PO Box 95001, 1090 HA Amsterdam, the Netherlands
| | - J. Price
- Liverpool School of Tropical Medicine, Liverpool,
| | - J. Kemp
- Liverpool School of Tropical Medicine, Liverpool,
| | - S. Theobald
- Liverpool School of Tropical Medicine, Liverpool,
| | - S.B. Squire
- Liverpool School of Tropical Medicine, Liverpool,
| |
Collapse
|
6
|
Abstract
This paper explores some of the opportunities and challenges that the increasing move towards sector-wide approaches (SWAps) offer gender mainstreaming. SWAps, as a new approach to aid and development, are growing in number, particularly in more aid-dependent country contexts. The paper introduces what is understood by SWAps and then explores the concept of gender mainstreaming, with particular reference to health. At a theoretical level the paper discusses the potential synergies between the goals of SWAps and gender mainstreaming in terms of promoting equity, efficiency and sustainability in health outcomes. However, early discussions of the SWAps process in the health sector in different countries reveal some emerging tensions and dilemmas for gender mainstreaming strategies, which are discussed. These are the relationship between government and donors, the involvement of district and civil society in the SWAp process, and, possibly, an increasingly biomedical approach to health. The paper concludes by laying out questions for further discussion and experience sharing.
Collapse
Affiliation(s)
- S. Theobald
- Liverpool school of Tropical Medicine, Pembroke Place, Liverpool L5 3QA, UK. E-mails:
| | - H. Elsey
- Liverpool school of Tropical Medicine, Pembroke Place, Liverpool L5 3QA, UK
| | - R. Tolhurst
- Liverpool school of Tropical Medicine, Pembroke Place, Liverpool L5 3QA, UK.
| |
Collapse
|
7
|
Theobald S, Hawkins K, Kok M, Rashid S, Datiko DG, Taegtmeyer M. Close-to-community providers of health care: increasing evidence of how to bridge community and health systems. Hum Resour Health 2016; 14:32. [PMID: 27250338 PMCID: PMC4890328 DOI: 10.1186/s12960-016-0132-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/23/2016] [Indexed: 06/02/2023]
Affiliation(s)
- S Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
| | - K Hawkins
- Pamoja Communications, Brighton, United Kingdom
| | - M Kok
- Royal Tropical Institute, Amsterdam, Netherlands
| | - S Rashid
- James P Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
| | | | - M Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| |
Collapse
|
8
|
Matthews N, Theobald S. Attention-Dependent Hemifield Asymmetries When Judging Numerosity. J Vis 2011. [DOI: 10.1167/11.11.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
9
|
Hamilton C, Okoko D, Tolhurst R, Kilonzo N, Theobald S, Taegtmeyer M. Potential for abuse in the VCT counselling room: service provider's perceptions in Kenya. Health Policy Plan 2008; 23:390-6. [PMID: 18701551 DOI: 10.1093/heapol/czn029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The rapid scale-up of HIV counselling and testing programmes in Kenya has led to quality concerns, including the potential for abuse within the private, confidential setting of client-initiated voluntary counselling and testing (VCT). A qualitative study was conducted in three provinces of Kenya, involving 26 VCT service providers and 13 key informants. First and second hand accounts of emotional, physical and sexual abuse emerged in all three study sites in spite of measures to mitigate such occurrences. Whilst uncommon, abuse was perceived by service providers to be serious and sufficiently widespread to raise significant concerns. Abuse occurred client to counsellor, from counsellor to client and from counsellor to counsellor. In all cases the person suffering the abuse was female. While the potential for abuse was demonstrated in VCT sites, we argue that experiences of abuse are not confined to VCT and are largely shaped by gender and power relations within the Kenyan cultural context. The international impetus for scale-up of HIV services provides an urgent rationale for the need to address and highlight these difficult issues at multiple levels. International guidelines, policy and methods need adapting in recognition of the potential for abuse. Systems for investigating and deregistering counsellors have been developed in Kenya but require formalizing. Institutions providing VCT should consider unlocked doors, semi-opaque windows and the use of 'mystery clients' as a quality assurance measure.
Collapse
Affiliation(s)
- C Hamilton
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | | | | | | | | |
Collapse
|
10
|
Kilonzo N, Taegtmeyer M, Molyneux C, Kibaru J, Kimonji V, Theobald S. Engendering health sector responses to sexual violence and HIV in Kenya: results of a qualitative study. AIDS Care 2008; 20:188-90. [PMID: 18293127 DOI: 10.1080/09540120701473849] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In Kenya many people who have been affected by sexual violence turn to the health sector for clinical treatment and preventive therapies. This interface provides a vital opportunity to impact on the dual epidemics of HIV and sexual violence. Despite this, the uptake of post-rape care services in health facilities is low and health care providers felt ill-prepared to deal with the consequences of sexual violence. A qualitative study was conducted to better understand the reasons for the low uptake of services and to establish perceptions of sexual violence in Kenya. Thirty-four key informants were interviewed and sixteen focus group discussions with women and men were held in three districts in Kenya. Blurred boundaries between forced and consensual sex emerged. Important implications for the delivery of HIV post exposure prophylaxis (PEP) after sexual violence include the need for gender-aware patient-centred training for health providers and for HIV PEP interventions to strengthen on-going HIV-prevention counselling efforts. Further research needs to determine the feasibility of on-going risk reduction measures in the context of PEP delivery.
Collapse
Affiliation(s)
- N Kilonzo
- Liverpool VCT, Treatment and Care, Nairobi, Kenya
| | | | | | | | | | | |
Collapse
|
11
|
Theobald S, Pfeiffer P, Zuber U, König H. Influence of epigallocatechin gallate and phenolic compounds from green tea on the growth of Oenococcus oeni. J Appl Microbiol 2007; 104:566-72. [DOI: 10.1111/j.1365-2672.2007.03584.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Simwaka BN, Nkhonjera P, Sanudi L, Gondwe M, Bello G, Chimzizi R, Theobald S. The Malawi National Tuberculosis Programme: an Equity analysis. Malawi Med J 2007. [DOI: 10.4314/mmj.v18i1.10901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
13
|
Simwaka BN, Theobald S, Mann G, Salaniponi F, Banda H, Nyirenda L, Bongololo G, Sanudi L, Nkonjera P, Sangala W, Makwiza I, Squire SB. Developing research partnerships to bring change: experiences from REACH Trust, Malawi. Malawi Med J 2007. [DOI: 10.4314/mmj.v18i2.10906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
14
|
Theobald S, Makwiza I, Agabu A, Schouten E. From 3 by 5 to universal access: an equity advocacy opportunity for access to antiretroviral therapy in Malawi? Malawi Med J 2007. [DOI: 10.4314/mmj.v18i2.10908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
15
|
Kataika E, Kemp J, Revill P, Simwaka BN, Cardinal I, Theobald S. The Equity and Access Sub Group: current achievements and future challenges in promoting equity in the health sector in Malawi. Malawi Med J 2007. [DOI: 10.4314/mmj.v18i2.10905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
16
|
Phiri F, Simwaka BN, Nkhonjera P, Nhlane B, Nolo M, Masiye C, Chipatala C, Chiumia C, Nanikwa H, Theobald S. Developing partnerships at the community level to promote equity: Community based research in poor urban Lilongwe. Malawi Med J 2007. [DOI: 10.4314/mmj.v18i2.10910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
17
|
|
18
|
Sangala WT, Briggs P, Theobald S, Squire SB, Kemp J. Screening for pulmonary tuberculosis: an acceptable intervention for antenatal care clients and providers? Int J Tuberc Lung Dis 2006; 10:789-94. [PMID: 16848342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
SETTING Five purposively sampled health facilities in Kasungu District, Malawi. OBJECTIVES To explore 1) the acceptability of introducing pulmonary tuberculosis (PTB) screening into antenatal care (ANC) clinics amongst ANC clients and ANC service providers; and 2) the acceptability of tuberculosis (TB) treatment during and after pregnancy among women registered for TB treatment. METHODS Fourteen focus group discussions and 40 in-depth interviews with ANC clients (15), ANC service providers (10) and women registered for TB treatment (15). RESULTS Most clients found the introduction of PTB screening into ANC clinics acceptable. Some expressed concern at submitting a second sputum specimen, citing transportation/distance as the main obstacle. Other concerns were stigma and fear relating to the human immunodeficiency virus and the acquired immune-deficiency syndrome (HIV/AIDS) and taking TB treatment during pregnancy and breast-feeding. All ANC service providers supported the idea, but were concerned about increased workload. CONCLUSION PTB screening in the ANC setting would be an acceptable intervention and could serve to increase PTB case notification in Malawi. However, alternative diagnostic strategies need to be explored. The negative associations with HIV/AIDS and some of the misconceptions surrounding TB treatment need to be addressed to avoid PTB screening becoming a potential barrier to seeking ANC. The main challenge will be whether over-stretched staff will be able to cope with this additional service.
Collapse
Affiliation(s)
- W T Sangala
- Equi-TB Knowledge Programme Malawi (REACH Trust), Lilongwe, Malawi.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Drawing on an international literature review, two international workshops and primary qualitative research in Uganda this paper reviews experiences of mainstreaming HIV/AIDS in development sectors (such as education, health and agriculture) in developing countries. The extent to which HIV/AIDS mainstreaming strategies and associated challenges are similar to or different from those of mainstreaming gender in the health sector is also explored. The paper details the rationale for HIV/AIDS mainstreaming through illustrating the wide reaching effects of the pandemic. Despite the increasing interest in mainstreaming HIV/AIDS there is little clarity on what it actually means in theory or practice. This paper presents a working definition of HIV/AIDS mainstreaming. It is argued that all too often processes of 'mainstreaming' emerge as too narrow and reductionist to be effective. The paper then considers four key challenges for mainstreaming HIV/AIDS and explores how and to what extent they have also been faced in gender mainstreaming and what can be learnt from these experiences. These are: (1) the limited evidence base upon which to build mainstreaming strategies in different country contexts; (2) the role of donors in mainstreaming and implications for sustainability; (3) who should take responsibility for mainstreaming; and (4) how to develop capacity for mainstreaming. The conclusion argues for more joined up thinking and sustainable approaches to mainstreaming both HIV/AIDS and gender.
Collapse
Affiliation(s)
- H Elsey
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | | |
Collapse
|
20
|
Taegtmeyer M, Kilonzo N, Mung'ala L, Morgan G, Theobald S. Using gender analysis to build voluntary counselling and testing responses in Kenya. Trans R Soc Trop Med Hyg 2005; 100:305-11. [PMID: 16214191 DOI: 10.1016/j.trstmh.2005.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 06/08/2005] [Accepted: 06/09/2005] [Indexed: 11/25/2022] Open
Abstract
The rapid expansion of voluntary counselling and testing (VCT) for HIV in sub-Saharan Africa has led to concerns over the quality and equity of the services. Kenya has seen an unprecedented scale-up of VCT, and valuable lessons have been learnt at national as well as at district and community levels. We combined quantitative and qualitative research methodology and showed how the results of gender analysis can be used to develop equity in VCT scale-up. A gender-disaggregated analysis of VCT client data was conducted for the first 8 months of 2003. These quantitative data revealed that despite an increased vulnerability to HIV, women are underrepresented in VCT sites in all settings in Kenya. Our data also showed that women were also less likely to use condoms or to take home condoms after a VCT visit than their male counterparts. Further exploration through in-depth qualitative work with women and men allowed a better understanding of the reasons behind gender differences in Kenyan VCT sites and helped to develop strategies to address gender inequity. We conclude that there is an ongoing need to mainstream gender in monitoring and evaluation strategies to ensure services meet the needs and priorities of all groups.
Collapse
|
21
|
|
22
|
Toussaint S, Roemer-Bécuwe C, Krakowski I, Rakotondranaivo A, Jonveaux T, Torloting G, Verra-de-Ren M, Wagner C, Gauthier A, Bouvier R, Douart P, Hullen C, Walter S, Theobald S, Laurent-Beq A, Lothon C. Évaluation des structures et de l’organisation des soins oncologiques de support en Lorraine. ONCOLOGIE 2005. [DOI: 10.1007/s10269-005-0189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Squire SB, Belaye AK, Kashoti A, Salaniponi FML, Mundy CJF, Theobald S, Kemp J. 'Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them? Int J Tuberc Lung Dis 2005; 9:25-31. [PMID: 15675546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING Ntcheu District, rural Malawi. OBJECTIVES 1) To locate smear-positive pulmonary tuberculosis patients who were identified during the first 6 months of 2000 but did not start treatment ('lost cases'); 2) to describe these patients' pathways to diagnosis, health status and socio-demographic characteristics; and 3) to explore why these patients did not start treatment. METHODS Lost cases were traced from programme registers and interviewed using the qualitative research critical incidents narrative (CIN) interviews technique. Results were triangulated with responses from health care workers through focus group discussions. RESULTS The laboratory registered 157 new smear-positive patients. Twenty three (15%) of these were 'lost' (did not appear in the treatment register). CIN interviews were conducted with five lost patients and 14 carers of lost patients who had died. Long pathways to diagnosis were the norm. Health system structural barriers were the main factors behind these pathways, including requirement for hospital attendance, delays in symptom recognition and receipt of sputum results, and the misconception that negative smears excluded tuberculosis. CONCLUSION Some smear-positive cases experience very long pathways to diagnosis and are lost from this free public health system. The diagnostic process needs to become more responsive to patients' needs.
Collapse
Affiliation(s)
- S B Squire
- Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
24
|
Sanou A, Dembele M, Theobald S, Macq J. Access and adhering to tuberculosis treatment: barriers faced by patients and communities in Burkina Faso. Int J Tuberc Lung Dis 2004; 8:1479-83. [PMID: 15636495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING Three selected districts in Burkina Faso. OBJECTIVES 1) To explore patients' and community members' perceptions and problems associated with accessing formal tuberculosis (TB) treatment; and 2) to identify patients' and community members' perceptions and problems associated with adhering to formal TB treatment. METHODS Twenty-eight focus group discussions and 68 in-depth interviews with TB patients, community representatives, members of the health centre management committee, traditional healers and health professionals. RESULTS Attending the health centre was the last resort for patients with symptoms indicative of TB. When on treatment, patients faced a number of barriers in adhering to care. These related to the centralised nature of direct observation and the problems faced whilst at the treatment unit. CONCLUSION Patients experience three sets of inextricably linked barriers to successfully treating TB: attending the health centre initially, attending the health centre repeatedly and experiences whilst at the health centre. These barriers are further complicated by geography, poverty and gender. The challenge ahead lies in moving beyond documenting barriers from patients' perspectives to addressing them in resource-poor contexts.
Collapse
Affiliation(s)
- A Sanou
- National Tuberculosis Control Programme, Ouagadougou, Burkina Faso
| | | | | | | |
Collapse
|
25
|
Abstract
AIMS To describe the family background of street children in Aracaju, Brazil, their parents' perception of street life, and the reasons for the high prevalence of males observed among street children. METHODS Cross sectional study using semi-structured interviews and qualitative focus group discussions with parents of purposively selected index street children. RESULTS Fifty eight families were enrolled. Most participants were single parent, female headed families living in slums or low cost housing, with high levels of illiteracy, drug use, unemployment, and a history of migration. Most parents reported receiving financial support from their children and were aware of the dangers of the street. Many parents had lived in the street, worked from an early age, and had been adolescent parents themselves. Parents perceived that the street was more dangerous for girls than for boys. Besides economic reasons, parents highlighted the role of peers and drug use in pulling their children to the street. A total of 187 siblings were identified. Siblings had poor school performance with high school drop out rates. Twenty per cent of the adolescent girl siblings were not living at home. Gender determined the type of work undertaken by children and adolescents. Males worked in the streets and females worked as housemaids, shop assistants, and in restaurants and bars. CONCLUSION Family disintegration, poverty, drug use, adolescent pregnancy, peer pressure, and socially constructed gender roles determine the characteristics of children in the street. There is an urgent need for increased social support in this area.
Collapse
Affiliation(s)
- S Abdelgalil
- Department of Paediatrics and Child Health, University of Khartoum, Sudan
| | | | | | | |
Collapse
|
26
|
Krakowski I, Theobald S, Balp L, Bonnefoi MP, Chvetzoff G, Collard O, Collin E, Couturier M, Delorme T, Duclos R, Eschalier A, Fergane B, Larue F, Magnet M, Minello C, Navez ML, Richard A, Richard B, Rostaing-Rigattieri S, Rousselot H, Santolaria N, Torloting G, Toussaint S, Vuillemin N, Wagner JP, Fabre N. Summary version of the Standards, Options and Recommendations for the use of analgesia for the treatment of nociceptive pain in adults with cancer (update 2002). Br J Cancer 2003; 89 Suppl 1:S67-72. [PMID: 12915905 PMCID: PMC2753010 DOI: 10.1038/sj.bjc.6601086] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- I Krakowski
- Centre Alexis Vautrin, Vandoeuvre les Nancy, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Depierre A, Lagrange JL, Theobald S, Astoul P, Baldeyrou P, Bardet E, Bazelly B, Bréchot JM, Breton JL, Douillard JY, Grivaux M, Jacoulet P, Khalil A, Lemarié E, Martinet Y, Massard G, Milleron B, Molina T, Moro-Sibilot D, Paesmans M, Pujol JL, Quoix E, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet PJ, Spaeth D, Stoebner-Delbarre A, Thiberville L, Touboul E, Vaylet F, Vergnon JM, Westeel V. Summary report of the Standards, Options and Recommendations for the management of patients with non-small-cell lung carcinoma (2000). Br J Cancer 2003; 89 Suppl 1:S35-49. [PMID: 12915902 PMCID: PMC2753012 DOI: 10.1038/sj.bjc.6601083] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
28
|
Macq JCM, Theobald S, Dick J, Dembele M. An exploration of the concept of directly observed treatment (DOT) for tuberculosis patients: from a uniform to a customised approach. Int J Tuberc Lung Dis 2003; 7:103-9. [PMID: 12588009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Tuberculosis (TB) management has moved from chaotic systems and low patient adherence with treatment regimens to the directly observed therapy, short course (DOTS) strategy, which has been described as a new paradigm of TB control. Directly observed treatment (DOT) is only one component of the full DOTS strategy. DOT versus self-administered treatment (SAT) has been the subject of extensive debate, particularly about what approach improves treatment adherence. This debate has been complicated by different case-holding rates and cure outcomes in different contexts where DOT is in place. The increasing range of DOT applications in different settings, including the choice of provider, place, target population, and the extent to which DOT is part of a wider approach, has not been sufficiently taken into account. However, the concrete reality of DOT is an important determinant of the overall success or failure of the programme, and has implications in terms of equity and accessibility of care during treatment. This article aims to go beyond the frequently polarised debate of DOT versus SAT and document the diversity of ways in which DOT has been implemented internationally. We also aim to raise key issues for further discussion, including 1) viewing DOT as part of a complex and lengthy set of interventions that are context-specific, 2) incorporating an equity approach that discusses individual patients' needs and the relationship between the patient and provider, and 3) the role of incentives and enablers. It is anticipated that this exchange of opinion and experiences from different parts of the world will be useful for those involved in the policy formulation and practice of TB management.
Collapse
Affiliation(s)
- J C M Macq
- School of Public Health, Université Libre de Bruxelles, Department of Health Systems and Policy, Brussels, Belgium.
| | | | | | | |
Collapse
|
29
|
Theobald S. [Nutrition and cancer prevention. Recommendations for reducing risk of disease]. Med Monatsschr Pharm 2001; 24:407-17. [PMID: 11793823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
30
|
|
31
|
Theobald S. [Cancer diets--significant or dangerous?]. Med Monatsschr Pharm 2001; 24:300-6. [PMID: 11584763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
|
32
|
Affiliation(s)
- S Theobald
- Department of Medicine, Indiana University, and Indiana University Medical School, Indianapolis, IN, USA
| | | | | | | | | |
Collapse
|
33
|
Touboul E, Lagrange JL, Theobald S, Astoul P, Baldeyrou P, Bardet E, Bazelly B, Bréchot J, Breton JL, Douillard JY, Grivaux M, Jacoulet P, Khalil A, Le Chevalier T, Lemarie E, Martinet Y, Massard G, Milleron B, Moro-Sibilot D, Paesmans M, Pujol JL, Quoix AE, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet PJ, Spaeth D, Stoebner-Delbarre A, Thiberville L, Vaylet F, Vergnon JM, Westeel V, Depierre A. [Standards, Options and Recommendations for the management of stage I or II primary bronchial cancers treated exclusively with radiotherapy]. Cancer Radiother 2001; 5:452-63. [PMID: 11521393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
CONTEXT The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French cancer centres and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone. METHODS Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French cancer centres. RESULTS The main recommendations for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone are: 1) The curative external irradiation with a continual course is an alternative to surgery only in the case of medically inoperable tumors or because the patient refuses surgery; 2) The external irradiation of the primary tumor only without the mediastinum could be proposed in peripheral stage IA. In proximal stage IA and IB, external irradiation should be carried out only as part of prospective randomised controlled trials comparing a localised irradiation of the primary tumor with a large irradiation of the mediastinum and the primary tumor. The treated volume must include the macroscopic tumoral volume with or without the microscopic tumoral volume and with a security margin from 1.5 to 2 cm; 3) There is a benefit to delivering a total dose in the primary tumor higher than 60 Gy in so far as the proposed irradiation, taking into account the respiratory function, does not increase the likelihood of severe adverse events due to radiation; and 4) The change in fractionation, the radiochemotherapy combination, the endobronchial brachytherapy with high dose rate alone or with external irradiation could be proposed only as part of prospective controlled trials for tumors classified as stage IB or II.
Collapse
|
34
|
Fervers B, Hardy J, Blanc-Vincent MP, Theobald S, Bataillard A, Farsi F, Gory G, Debuiche S, Guillo S, Renaud-Salis JL, Pinkerton R, Bey P, Philip T. SOR: project methodology. Br J Cancer 2001; 84 Suppl 2:8-16. [PMID: 11355962 PMCID: PMC2408834 DOI: 10.1054/bjoc.2000.1757] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- B Fervers
- Standards Options et Recommandations, Fédération Nationale des Centres de Lutte Contre le Cancer, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Theobald S. [Alternative forms of nutrition. Real alternatives towards the concept of "high quality nutrition" of the German Nutritional Society]. Med Monatsschr Pharm 2001; 24:190-200. [PMID: 11434204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
|
36
|
Bardet E, Moro-Sibilot D, Le Chevalier T, Massard G, Douillard JY, Theobald S, Astoul P, Baldeyrou P, Bazelly B, Bréchot J, Breton JL, Grivaux P, Jacoulet P, Khalil A, Lemarie E, Martinet Y, Milleron B, Paesmans M, Pujol JL, Quoix AE, Ranfaing E, Rivière A, Sancho-Garnier H, Souquet PJ, Spaeth D, Stcebner-Delbarre A, Thiberville L, Touboul E, Vaylet F, Vergnon JM, Westeel V, Depierre A, Lagrange JL. [Standards, options and recommendations for the management of locally advanced non small cell lung carcinoma]. Bull Cancer 2001; 88:369-87. [PMID: 11371371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
CONTEXT The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of locally advanced non small cell lung carcinoma. METHODS Data were identified by searching Medline and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS The main recommendations are: 1) The management of the locally advanced non small cell lung carcinoma has two main goals: firstly to obtain local control of the disease (or to at least delay local progression in order to improve the survival or relapse free survival), and secondly to prevent the development of metastases. 2) There is a consensus that locally advanced non small cell lung carcinoma should be irradiated. External beam radiotherapy should be of optimal quality and delivered at a minimal dose of 60 Gy by standard fractionation. For patients with a poor life expectancy, this can be delivered as a split-course or hypofractionated scheme. 3) Treatment for patients with a performance status of 0-1 should consist of short duration induction chemotherapy (with a least two drugs one of which must be cisplatin), combined sequentially with conventional radiotherapy. 4) Surgery is contraindicated in extensive N3 disease. Combined radio-chemotherapy (adjuvant or neoadjuvant) is not indicated outside clinical trials. Surgery is justified in stage N2 disease as good local control can be achieved. T4-N0 disease should be treated surgically with curative intent.
Collapse
Affiliation(s)
- E Bardet
- Standards, Options, Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Theobald S. [Vegetarian nutrition--ideology or "evidence-based health benefit"?]. Med Monatsschr Pharm 2001; 24:54-60. [PMID: 11255987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
|
38
|
Malgrange VB, Escande MC, Theobald S. Validity of earlier positivity of central venous blood cultures in comparison with peripheral blood cultures for diagnosing catheter-related bacteremia in cancer patients. J Clin Microbiol 2001; 39:274-8. [PMID: 11136783 PMCID: PMC87714 DOI: 10.1128/jcm.39.1.274-278.2001] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We carried out a prospective study in two French Comprehensive Cancer Centers (95 and 184 beds, respectively) to assess the validity of a test based on the earlier positivity of central venous blood cultures in comparison with peripheral blood cultures for predicting catheter-related bacteremia. The differences between the times to positivity for the 21 patients with clinical catheter-related bacteremia and the differences between the times to positivity for the nine patients with bacteremia due to another source were compared by the median test. The difference between the median values was significant (P = 0.0003). A receiver operating characteristic curve was constructed to determine the optimum threshold of the test, which appeared to be at the cutoff point of >/=+3 h, with 100% specificity and 81% sensitivity. The positive and negative predictive values obtained with this cutoff point confirmed the efficacy of the test for predicting the presence or absence of catheter-related bacteremia in cancer patients. The cutoff point was then used to post-classify the 68 episodes of bacteremia from an unknown source. The characteristics and clinical course of both the positive and negative post-classified episodes did not show that the test was clearly useful for a large number of clinical presentations. We therefore suggest restricting it to febrile neutropenic cancer patients for whom clinical signs of infection are slight or absent and when the test is positive.
Collapse
Affiliation(s)
- V B Malgrange
- Laboratoire de Microbiologie Médicale, Institut Jean Godinot, 51056 Rheims Cedex, France.
| | | | | |
Collapse
|
39
|
|
40
|
Theobald S. [Meat, fish and eggs]. Med Monatsschr Pharm 2000; 23:329-35. [PMID: 11084815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
41
|
Theobald S. [New reference values for nutritional requirements]. Med Monatsschr Pharm 2000; 23:232-6. [PMID: 10941254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
42
|
Theobald S. [Milk, milk products and cheese]. Med Monatsschr Pharm 2000; 23:188-98. [PMID: 10885260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
43
|
Theobald S. Child protection: why continuing education for nurses is important. Paediatr Nurs 2000; 12:6-7. [PMID: 11220867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
|
44
|
Theobald S. [Beverages]. Med Monatsschr Pharm 2000; 23:53-61. [PMID: 10701309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
|
45
|
Theobald S. [Fats in nutrition. Fat and oil food groups]. Med Monatsschr Pharm 1999; 22:349-59. [PMID: 10596269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
46
|
Theobald S, Blanc-Vincent M, Farsi F, Bataillard A, Gory-Delabaere G, Demma F, Guillo S, Luporsl E, Fervers B. The development of clinical guidelines for oncology in France. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
47
|
Flamant F, Rodary C, Rey A, Praquin MT, Sommelet D, Quintana E, Theobald S, Brunat-Mentigny M, Otten J, Voûte PA, Habrand JL, Martelli H, Barrett A, Terrier-Lacombe MJ, Oberlin O. Treatment of non-metastatic rhabdomyosarcomas in childhood and adolescence. Results of the second study of the International Society of Paediatric Oncology: MMT84. Eur J Cancer 1998; 34:1050-62. [PMID: 9849454 DOI: 10.1016/s0959-8049(98)00024-0] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The second International Society of Paediatric Oncology (SIOP) study for rhabdomyosarcoma (MMT84) had several goals. The two principal aims were: (1) to improve the survival of children with rhabdomyosarcoma; and (2) to reduce the late effects from therapy by restricting the indications for surgery and/or radiotherapy after good response to initial chemotherapy. A further aim was to investigate the role of high-dose chemotherapy in young patients with parameningeal primary tumours. 186 previously untreated eligible patients entered the study. Patients with completely resected primary tumour received three courses of IVA (ifosfamide, vincristine and actinomycin D). Patients with incompletely resected tumour received six to 10 courses of IVA according to stage. Patients achieving complete remission with chemotherapy alone did not usually receive radiotherapy or undergo extensive surgery, but patients remaining in partial remission received local therapy with surgery and/or radiotherapy. Only patients over 5 years of age with parameningeal disease and patients over 12 years with tumours at any site were given systematic irradiation. Complete remission was achieved in 91% (170/186) of all patients. With a median follow-up of 8 years, the 5-year overall survival was 68% (+/- 3% standard error of the mean (SEM) and the 5-year event-free survival 53% (+/- 4% SEM). These results show an improvement over previous SIOP study (RMS75) in which survival was 52% and event-free survival was 47%. Among the 54 patients who exhibited isolated local relapse, 35% (19/54) survived in further remission longer than 2 years after retreatment, including local therapy (surgery +/- radiotherapy). Analysis of the overall burden of therapy received by all surviving children (including primary treatment and treatment for relapse if required) showed that 24% (28/116) were treated by limited surgery followed by three courses of IVA, 29% (34/116) were treated by chemotherapy alone (after initial biopsy) and 13% (15/116) received chemotherapy plus conservative local treatment (limited surgery or radiotherapy for residual disease). Only 34% (39/116) received intensive local therapy defined as radical wide field radiotherapy or radical surgery or both. Compared with the results obtained in the previous SIOP study, treatment in MMT84 was based on response to initial chemotherapy and, despite an overall reduction of the use of local therapy, significantly improved survival for patients with non-metastatic disease. This trial, also for the first time, provides evidence that retreatment after local relapse can achieve long-term second remissions.
Collapse
Affiliation(s)
- F Flamant
- Institut Gustave-Roussy, Department of Paediatric Oncology, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Faroux MJ, Theobald S, Pluot M, Patey M, Menzies D. Evaluation of the monoclonal antibody antithyroperoxidase MoAb47 in the diagnostic decision of cold thyroid nodules by fine-needle aspiration. Pathol Res Pract 1998; 193:705-12. [PMID: 9505263 DOI: 10.1016/s0344-0338(97)80030-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fine needle aspiration (FNA) of cold thyroid nodules has become the first line diagnostic decision for electing which patients need surgery. In order to improve FNA accuracy, the monoclonal antithyroperoxidase (TPO) antibody (MoAb47) was tested. A total of 554 patients were included in this study and among them, 208 were referred to surgery. The results of FNA compared to the final histological diagnosis revealed a sensitivity and a specificity of 94 and 55% respectively, while the sensitivity and specificity of TPO immunodetection on the same cases reached 98 and 83% respectively. By combining the two methods, the 3 false-negative of FNA and 60% of suspicious cytology corresponding to histological benign lesions were correctly identified by immunocytochemistry. With better results than FNA alone, TPO immunodetection with MoAb47 represents a useful adjunct to conventional cytology for selecting patients for surgery.
Collapse
Affiliation(s)
- M J Faroux
- Laboratory of Cytology, Institut Jean Godinot, Reims, France
| | | | | | | | | |
Collapse
|
49
|
Patey M, Menzies D, Theobald S, Delisle MJ, Flament JB, Pluot M. [Anatomo-clinical prognostic factors of papillary carcinoma of the thyroid. Multivariate analysis: report of a series of 52 cases]. Ann Pathol 1998; 18:10-5. [PMID: 9551154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective study about 52 cases of papillary thyroid carcinomas was carried out with emphasis on histopathological features. The mean follow up period was 10 years. The survival curves were estimated using the Kaplan-Meier method and compared using the log rank test. The multivariate analysis was performed using the Cox's regression model. In univariate analysis, age, Tp (histopathological extension of the tumor), histological differentiation, VAN score (Vascular invasion nuclear Atypia tumor Necrosis) of Akslen and the LeuM1 expression were significant prognostic factors. In multivariate analysis, the Tp and histological differentiation were associated with high risks of poor outcome.
Collapse
Affiliation(s)
- M Patey
- Laboratoire Central d'Anatomie et Cytologie Pathologiques, CHU Robert-Debré, Reims
| | | | | | | | | | | |
Collapse
|
50
|
Nguyen TD, Theobald S, Rougier P, Ducreux M, Lusinchi A, Bardet E, Eymard JC, Conroy T, Francois E, Seitz JF, Bugat R, Ychou M. Simultaneous high-dose external irradiation and daily cisplatin in unresectable, non-metastatic adenocarcinoma of the pancreas: a phase I-II study. Radiother Oncol 1997; 45:129-32. [PMID: 9424002 DOI: 10.1016/s0167-8140(97)00116-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Clinical trials have demonstrated that high dose radiation therapy and daily cisplatin (CDDP) could increase local control and survival in carcinoma from various sites. The present phase I-II study has combined high dose radiation therapy and daily CDDP at escalating dosages. METHODS From August 1994 to December 1995, 23 patients with non-resectable carcinoma of the pancreas were enrolled in a phase I-II multicentric, pilot study to test the toxicity and the effectiveness of high dose radiotherapy and daily cisplatin (CDDP) at escalating dosages. A dose of 6 mg/sqm/day of CDDP was selected for the phase II step since no grade IV toxicity occurred in any patient in the phase I step. RESULTS Toxicity was considered fairly acceptable. At the time of analysis, the 23 patients who entered the study had clear evidence of evolutive disease either locally or distantly in the liver. It is suggested that high dose radiotherapy (60 Gy continuously) and daily CDDP have little effect on local control of the tumor and survival, and only a moderate effect on pain. CONCLUSIONS In unresectable, apparently non-metastatic cancers of the pancreas, there is an urgent need for new agents or new combinations of agents to be tested.
Collapse
|