Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

Hazardous Decibels: Hearing Health of Industrial Workers from Developing Countries

First: Sangita
Last: Bhandary
1st country of focus: Nepal
Additional countries of focus: India, pakistan, Bangladesh , Bhutan, Srilanka, Afganistan and other SAARC and developing countries
Relevant to the conference theme: Vulnerable groups
Summary: Noise-induced hearing loss ranks among the most significant occupational health problems. People wirking in industries  are at risk for noise-induced hearing loss due to exposure to hazardous levels of  noise of the machines an d equipment.  Although irreversible, noise-induced hearing loss is entirely preventable through both engineering controls and personal protective equipment. This article describes occupational noise exposure, hearing loss, and strategies to prevent noise-induced hearing loss among industrial workers of developing countries.
What challenges does your project address and why is it of importance?: Noise exposure of industrial workers results in increased risk of hearing loss. Noise-induced hearing loss (NIHL) can be prevented by the consistent use of hearing protection devices (HPDs). However, little is known about the  perceptiof these vulnerable groups  on NIHL and HPD use. Majority of the  iacknowledged the significance of good hearing in their service but perceived ons and attitudes NIHL was unavoidable on the job and viewed it as a small risk compared with other hazards. HPDs were not used regularly because they believed they interfered with the ability to hear commands during work , interfered with other required safety equipment, and were generally forgotten when gearing up. The workers were not provided with protective devices at the work and were unaware of the  importance of hearing health and the benefit of a hearing conservation program, including screening and promotion conservation of hearing.
How have you addressed these challenges? Do you see a solution?: This was a comparative cross sectional study conducted in a factory located in rural area. Total 445 subjects were enrolled in study out of which 224 were exposed to loud noise and 221 were normal individuals. The intensity of noise of working environment was measured by digital sound level meter (SLM) prior to the study. The workers of factory were assessed on the basis of history, clinical examination, otological examination, and hearing status by pure tone audiometry. Data were analyzed on the basis of duration exposure and intensity of exposed noise and compared with control groups  Results: The frequency of noise induced hearing loss is more among factory population (41.5%) as compared to normal population (18.5%). It has linear relationship with duration of exposure and age of person. The odds ratio of hearing loss among factory workers and normal population was 9.26. Conclusion: Population exposed to loud noise are at high risk of high frequency hearing loss as compared to normal population. This is a preventable deafness hence health education and awareness, encourage the use of protective device and early screening and treatment is important especially among the high risk group.
How do you know whether you have made a difference?: The study revealed that the frequency of noise induced hearing loss is more among factory population (41.5%) as compared to normal population (18.5%). It has linear relationship with duration of exposure and age of person. The odds ratio of hearing loss among factory workers and normal population was 9.26. The results were discussed among teh workers, supervisors of the factory and teh community leaders and health workers. The risk of noise exposure, importance of hearing conservation  was explained and the need for use of protective devices for prevention of deafness was emphasized. The supervisors were requested to take urgent measures towards hearing health o fthier workers.
Have you or the project mobilized others and if so, who, why and how?: Yes, the results of the study was shared with other factory workers and their  eaxhibition program conducted by the institute on its annual day program.The importanc eof health of hearing among these vulnerable group and measures of preventing deafness by use of protective device and lowering noise levels were stressed upon.
When your donor funding runs out how will your idea continue to live?: The program was funded  by BP Koirala Institute of Health Sciences , Dharan. The institute is a community based hospital and encourages such preventive and promotive programs. It has continud to support community screening, promotion and conservation of hearing and prevention of deafness. We are continuing the weekly screening and awareness programs with the continuous support from our own institute.

Youth Friendly Health Services: A Chibombo District Experience

First: Victor
Last: Silumbwe
1st country of focus: Zambia
Relevant to the conference theme: Vulnerable groups
Summary: Chilbombo Child Development Agency is implementing the integrated HIV/AIDS project with a focus on Youth Friendly Health Services. youth friendly services meets young peoples sexual and reproductive health needs, regardless of their sex, religion, ethnicity,religion as well as cultural diversity. This was achieved through capacity building and sensitization meeting on the importance of making health services more youth user friendly
What challenges does your project address and why is it of importance?: low utilisation of health services among youths in three rural health posts of  Chibombo District , central province Zambia, due to judgemental tendancies by health staff, long waiting queues as well as lack of privacy
How have you addressed these challenges? Do you see a solution?: 1. Capacity building training to health staff, community health care providers and youths  in Youth Friendly health services Management 2. Construction of 3 youth friendly corners 3. Community sensitization meetings through participatory mass media 4. monitoring and evaluation
How do you know whether you have made a difference?: There has been a drastic increase in the number of youth accessing health services in rural health centres from 10% to 60% as of June, 2011. Chibombo District Health Office Report
Have you or the project mobilized others and if so, who, why and how?: yes the project has mobilised other relevant stakeholders in Chibombo District, to support youth friendly health services advocacy efforts through district stakeholders meetings
When your donor funding runs out how will your idea continue to live?: youth friendly health services will be integrated into the activities that Chibombo Child development agency is implemeting. Peer counsellors will continue providing the service at the local rural health centres.i

Use of Health Systems Research for Changing Diabetes Management in Resource Poor Settings


First: David Beran1,2
Last: 1Advisor to the Board, International Insulin Foundation, London, United Kingdom, 2Researcher and Lecturer, University of Geneva, Geneva, Switzerland
1st country of focus: Kyrgyzstan
Additional countries of focus: Mali, Mozambique, Nicaragua, Vietnam and Zambia
Relevant to the conference theme: Non-communicable chronic diseases
Summary: The International Insulin Foundation (IIF) was established to investigate barriers to insulin access in the world's poorest countries. In order to take a standardised approach to this the IIF developed a Rapid Assessment Protocol (RAP) to assess health system barriers to insulin, medicines and diabetes care. This protocol has now been implemented in 6 different countries with different in-country partners resulting in a variety of systemic changes.
What challenges does your project address and why is it of importance?: With Non Communicable Diseases representing the largest burden of mortality worldwide, to address this health systems need to find adapted responses. The RAP tool developed by the IIF allows countries to diagnose problems and in doing so identify ways of developing solutions.
How have you addressed these challenges? Do you see a solution?: The issues identified have been addressed in different ways in each country. In Mozambique a Twinning project was developed between Diabetes UK, the Ministry of Health in Mozambique and the diabetes association in Mozambique. For Kyrgyzstan and Vietnam the results have been more focused on using the results for policy changes.
How do you know whether you have made a difference?: In Mali and Mozambique the changes have been formally assessed. In other settings the findings from the RAP have been included in government strategies and policies.
Have you or the project mobilized others and if so, who, why and how?: The WHO has taken the overall issue of access to insulin as a key problem to address following the UN HLM on NCDs. It has also decided to develop the RAP into a WHO methodology for all NCDs. For this the WHO funded a RAP in the Philippines. In Mozambique the Ministry of Health has also adopted the RAP as a tool for M&E of its national NCD policy and programme.
When your donor funding runs out how will your idea continue to live?: There are two aspects to this. One is the data collected and how it is used by country stakeholders in-country as well as from publications. The second is now that the RAP methodology has been adopted by the WHO and the Ministry of Health in Mozambique it will be used by others even when funding for the IIF ceases.

Sant”e”scalade: Popular Road Running Races as Health Promotion Vectors in Geneva

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Author(s): Bengt Kayser1
Affiliation(s): 1Institute of Movement Sciences and Sports Medicine, Faculty of Medicine, University of Geneva, Switzerland
Name your project or intiative: Sant"e"scalade: popular road running races as health promotion vectors
1st country of focus: Switzerland
Relevant to the conference theme: Non-communicable chronic diseases
Summary: World wide habitual daily physical activity levels are decreasing and contribute to the burden of non-communicable disease. Physical activity has therefore become a central theme of international, national and local health promotion campaigns. Popular running events represent an interesting potential for health promotion. The biggest road running race in Switzerland, the Escalade run in Geneva, with more than 25'000 participants between 6 and > 90 yrs old running between 1.9 and 7.3 km the first Saturday of December, has over the last decade developed several initiatives along a health promotion concept, such as special weekly training sessions for adult beginners, sessions for adults > 60 yrs and since 7 years also training sessions for children between 6 and 12 yrs old. In close collaboration with the Geneva state primary school department the latter project has now grown to include more than 68 schools reaching > 15% of the state wide population of school going children and is still growing. The children receive a personal 'passport' in which they collect stamps for each training session attended to. Every training session comes with a special nutrition theme that is discussed along illustrations and text in the passport, promoting a healthy balanced diet. Eight training sessions preceding the race are proposed. Upon completion of at least 5 training sessions and running the race the children receive a little gift. Half of the fee for the run is covered by the state of Geneva, the other by the parents. The impact of the project was evaluated by questionnaire before, after and 6 months later. Knowledge on nutrition and movement increased and retention was excellent. Behavioural changes could not be evaluated for lack of resources, the whole project is being carried entirely by volunteers.
What challenges does your project address and why is it of importance?: Lack of physical activity levels in the general population represent an important health burden because they increase the risk for all-cause morbidity and mortality. The determinants of habitual physical activity are complex including personal, socio-cultural and environmental (urban design) aspects. The promotion of physical activity should therefore use a variety of strategies to make people move more by their own muscular means.
How have you addressed these challenges? Do you see a solution?: Popular road running races (like the New York marathon) represent interesting means to promote of more physically active and healthier life style. In Switzerland the biggest popular road running event is the Escalade run in Geneva when more than 25000 people between 6 and more than 90 yrs old run through the old city centre over distances varying between 1.9 and 7.3 km depending on the age and sex category. The race organizers have understood the potential for health promotion of their event and have started a special NGO called sant"e"scalade (bringing together the words 'santé' or health in French, and the name of the running event 'Escalade' or climb in French). Sant"e"scalade groups all health promotion activities of the race. Senior runners > 60 yrs start training together from mid September. Beginning adults are accompanied from mid-July onwards. The biggest group concerns children between 6 and 12 yrs old. In close collaboration with the Geneva state primary school department an increasing number of schools participate reaching 68 schools in the seventh year of the project, representing more than 3000 children, > 15% of the state wide population of that age. Furthermore, in the months preceding the race one can clearly see a general increase in the number of people jogging in preparation of their participation to the race. Obviously, all of this is not a solution to the problem of lack of physical activity of the Geneva population. On the other hand it certainly contributes to health promotion, even though modestly.
How do you know whether you have made a difference?: The numbers of age categories participating to the Escalade run and to the training sessions prior to the race are still increasing. State wide epidemiological data show a modest increase in general population physical activity levels. The knowledge on health aspects of regular movement and a health diet of children participating to the project were shown to improve with good retention up to 6 months after their participation.
Have you or the project mobilized others and if so, who, why and how?: The project is run by volunteers who have organized themselves in two associations (NGOs). One for the organization of the Escalade run, the other for all health promotion aspects. The latter has obtained funds from Swiss Health Promotion, private foundations, the State of Geneva and several small sponsors to organize its activities. The concept has been exported successfully elsewhere (other races in Switzerland).
When your donor funding runs out how will your idea continue to live?: Our vision is that the preparation for participation to the Escalade run becomes a cultural heritage for the Geneva population. By closely working with the State department for education responsible for the school going children we aim at bringing the project in to all schools in the state of Geneva. We started with a few schools and some municipalities 7 years ago. We now have 68 schools and 15% of the school children who participate and still no ceiling effect. So far the project has been able to find the resources necessary through volunteers and the help of public and private funds.


Partnering Strategically with Faith Based Organisations: The Case of Moravian Diploma Nursing School in Mbozi, Tanzania

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Author(s): Alexander Bischoff1, Sunoor Verma1
Affiliation(s): 1Division of International and Humanitarian Medicine, Geneva University Hospital, Geneva, Switerland
1st country of focus: Tanzania
Additional countries of focus: Switzerland
Relevant to the conference theme: Communicable chronic diseases
Summary: To address chronic conditions effectively, investments need to be made training nurses with additional and new skills. This is even more relevant in the rural low-income setting where the trained workforce has a high turnover due to economic migration.  In this presentation we will use the partnership between the University Hospitals of Geneva, "Solidarité internationale" and the Moravian Church of Tanzania which has led to the establishment of the Moravian Diploma Nursing School (MDNS) as a case study. We look at the potential and challenges of partnering with a faith-based organisation especially in the broader context of the global chronic conditions epidemic and the human resources in health crisis.
What challenges does your project address and why is it of importance?: The global epidemic of chronic conditions leads to an acute shortage of health workers. The workforce crisis is particularly serious in low-income countries in sub-Saharan Africa, compounded by the fact that the few health workers that are trained in these countries often migrate to the richer countries in the North. Two main strategies exist to address the human resources crisis: either to put into place retention policies in rural areas or to invest in new capacity building. In Tanzania the projections given by the Ministry of Health and Social Welfare (MOHSW) show the need of nursing officers is 20,008 but only 3,280 are in the market. The gap is therefore 16,728.To fill this gap, 18 new schools would need to be built. In Tanzania, the MOHSW is expanding the health services infrastructure in order to ensure universal access to quality health care. The MOHSW has to increase the training capacity in order to train an adequate number of skilled and competent human resources to provide the much needed health services. Currently, there is a huge discrepancy between available infrastructure and available trained health personnel, in particular nurses. While Tanzania is used as an illustration, this scenario is valid to many other low and middle income countries around the world.
How have you addressed these challenges? Do you see a solution?: The need for more nurses is such, that more nurse training institutions are urgently needed. Therefore, the MOHSW is encouraging private institutions, in particular faith-based organizations (FBO) to start or increase their respective nurse training capacities. It is against this background that the Mbozi Diploma Nursing School project was launched.  The Tanzanian Human Resources for Health strategic plan foresees and encourages Private Public Partnerships and FBO driven initiatives to address the shortfall in health workforce:  In Tanzania, 83 hospitals are run by churches (FBO). Overall FBOs provide more than 50% of the health care services in the country.  The MDNS project is constructed as a PPP between the FBO, i.e. the Mbozi Mission Hospital of MCT-SWP, HUG, Solidarité and the MOHSW. It should be mentioned that the FBO is adhering to all policy and clinical guidelines regarding health care in general and HIV/AIDS in particular, issued by Government and WHO. Also, MDNS nurse graduates will receive governmental (MOHSW) certificates and will be free to seek employment wherever they want (they are in no way bound to stay at the MMH or at another FBO health facility).  This project attempts to address the human resources for health shortage by providing diploma nursing education in a rural area where there are few training opportunities. It is an initiative by the Moravian Church of Tanzania South-West Province (MCT-SWP), via its own Mbozi Mission Hospital (MMH) and the Swiss-based partner organization DIHM in Geneva. The DIHM (Division of International and Humanitarian Medicine) is part of HUG (Hôpitaux Universitaires de Genève, Switzerland).  The establishment of an institutional partnership between the MMH Nursing School and the SMIH/HUG will ensure the provision of clinical, educational, management and evaluation support by a different HUG services. The donor is SSI, “Service de solidarité international”, a governmental (cantonal) international development organization.
How do you know whether you have made a difference?: The project is in the first phase of implementation hence it is premature to gauge impact. However if the community participation can be an indicator to how well a need is being addressed, then this project is certainly making a difference. The community has been enthusiastic in its support of the infrastructure development phase of the project. There is increasing pressure from the community to increase the number of enrolments in the school. The overall goal of the project is: to improve access to quality primary health services for the population in Mbeya Region by training nurses in a new Nursing School, attached to Mbozi Mission Hospital. These are the 6 objectives: (A) Decrease nurse shortage, (B) Improve quality training (nursing skills), (C) Improve quality of care /services,  (D) Balance between Human Resources (HR) and infrastructure, (E) Influence health policy (on Human resources), (F) Guarantee sustainability. A detailed project monitoring plan that lists the deliverables (progress indicators) at 6 points in time, i.e. every six months in the 3-year-duration-project shall measure whether the present project makes a difference.
Have you or the project mobilized others and if so, who, why and how?: The present project has been able to mobilize a number of actors in the region. We obtained support and/or go-aheads by different federal governmental officials at district level by district council authorities, the MCT-SWP (church central level). Also, we obtained agreement for nursing student internships at the following health facilities: Vwawa Hospital, Tunduma Health Centre, Mbeya Referral Hospital, Mbeya Regional Hospital.
When your donor funding runs out how will your idea continue to live?: This is an initiative that addresses well articulated needs and wants of the community in which it is embedded. Partnership arrangements are such that they ensure that once the training facility and program is established, it will be integrated into the national chain of such schools.  With up-to-date infrastructure as well as the investment in HRH in the health sector, the project will have a sustained impact, also beyond the project duration. Accommodation facilities that are well-built, well-run and well-kept, will be seen as a well organized school. FBO programmes have been generally acknowledged for their long-term commitment and sustainability as they are well rooted in the community and the community members have a direct stake and control over the direction of the initiatives. The project setting is unique at this moment because the MOSHW is actively encouraging PPPs and has been a reliable partner in international funding and is seeking pilot-projects which can be replicated elsewhere. There is therefore a pronounced interest by the MOSHW that this project works and is sustainable. In the future, the nursing school will be able to generate funds thanks to the student tuition fees.

Mental Health and Young People: International Perspectives on Growing Challenges

Author(s): Anne Meynard1, Dagmar Haller1, Daliborka Pejic2, Suzanne Ehrensberger3, Patana Mulisanze3, Saskia von Overbeck4
Affiliation(s): 1Hôpitaux universitaires Genève, Departement de l’enfant et de l’adolescent et Dpt de médecine communautaire, de premier recours et des urgences, 2Fondacija fami, Doboj, Bosnia & Herzegovina, 3Association Santé Mentale: Suisse Rwanda, 4Service de psychiatrie de l’enfant et de l’adolescentDepartement de l’enfant et de l’adolescent Hôpitaux Universitaires de Genève
1st country of focus: Bosnia and Herzegovina, Switzerland, Australia
Relevant to the conference theme: Vulnerable groups
Summary (max 100 words): There is urgent need of innovative and multisectoral interventions to address mental health issues in young people. Lack of trained professionals or adapted services, impact of socioeconomic factors on mental health are some of the challenges faced by many countries around the world. Interprofessional collaboration, community programs, International partnerships and web-based interventions can maximize the use and exchange of expertise among professionals, young people and their families.
What challenges does your project address and why is it of importance?: The presentation will present short aspects of two collaboration projects (Rwanda and Bosnia and Herzegovina) and experience in Geneva with vulnerable youth, questioning innovative ways of addressing mental health issues with young people and international collaboration. About Bosnia &Herzegovina: Great societal changes and turmoil, such as postwar trauma, unemployment and poverty, have undoubtedly negative effects on the occurrence of risk behavior and health of youth in BiH. About 50% of the young people have lost some family member or a close relative, and around 16% of people suffer from PTSD. UNPFA data show that around 50% of young people in Sarajevo and around 60% in Banja Luka do not use condom during sexual intercourses. Around 30% of young people are regular smokers, 21% frequently consume alcohol; 5.8% of boys and 6,8 of girls have experienced drugs. UNFPA data show that around 50% of young people in Sarajevo, i.e. around 60% in Banja Luka, do not use condom during sexual intercourses. In spite of significant achievements (psychiatric services and community mental health), existing mental health services are still unable to respond to the multiple and growing needs of the population, and in particular young people. Social stigma, segregation and isolation of people with mental health problems, are main barriers to treatment and reintegration of the people with mental health problems. About Rwanda: In the aftermath of the genocide, a significant number of the Rwandan population is traumatised and needs help. The country has very few psychiatrists to take care of the patients and the task is not easy for them because they have to face a huge demand. Moreover, physicians in general have practically no training in mental health. In view of the current state of affairs that is high demand of patients to take care of alongside scarce human and logistical resources, group therapy is deemed to be a very good way to treat people. This form of care can be used in different age ranges from children to adults. Since there is a shortage of skilled and trained people in psychiatry, it is of paramount importance to train the available health workers in this kind of care. This year we start to teach our colleagues with the Child Psychiatry, again this was very useful.
How have you addressed these challenges? Do you see a solution?: About Bosnia &Herzegovina: An established network of family medicine teams is serving as the base to support the development of new activities in various fields, including mental health. According to the BiH Strategic Health Care Reform plan, Family Medicine has been assigned as the primary health care provider also for adolescents. The projects focus has been, therefore, on strengthening family medicine activities in the field of working with youth. Training provided FM teams with the basic knowledge on developmental issues, epidemiological data, communication skills with young people and their families, use of screening tools (HEADSSS), confidentiality and youth-friendly principles. Improvement of multidisciplinary and multi-sectoral collaboration started by including the participants from other departments/institutions/organizations in the training, thus initiating the creation of a network of health and non-health service providers in the municipality (CBR professionals, youth-friendly center staff, social workers, school pedagogues, young people, NGOs, VCCT center. etc.). The network is to be strengthened through implementation of practical tasks, development of procedure/protocols and actions plans, network meeting, etc. Promotional activities, such as round table public discussion and distribution of network leaflets, aim to better inform the community and young people, about the available help. Development of practical tools, such as translation of the WHO Adolescent Job Aids, will be of valuable assistance in everyday work with youth.

About Rwanda: One way to address these challenges is to train the Rwandan colleagues in these methods of treatment. We have been working with them since 1996 and they are currently becoming little by little familiar with the basic notions of psychiatry. After years of collaboration, we can now start to introduce them to different aspects of this specialization. A few weeks ago the Minister of Health talked about launching the training phase of colleagues assisted with partners. We hope to participate to this coming form of collaboration. As long as we do not foresee in the near future any university training in psychiatry, I do not think we there will be any tangible solution to these challenges.
How do you know whether you have made a difference?: About Bosnia &Herzegovina: The training itself showed how important it was for the participants to have the opportunity to “hear each other”, learn more about already available services in the community and together start improving work with and for youth and develop specific services for young people adapted to the local context of each municipality.

About Rwanda:We examined the first sessions we conducted with health workers and noticed that they have started to integrate or internalize some theoretical aspects. In addition, these health workers are more receptive to new concepts. We also observed that our colleagues are becoming more skilled and comfortable in their work. They also are more interested in the training, we have new demands.
Have you or the project mobilized others and if so, who, why and how?: About Rwanda: Since the HUG has stopped their funding, we only have the membership fee from our joint mental health Association (Association Santé Mentale: Suisse Rwanda). The Association “Saturnales 2010” gave us some funds to run and conduct a training in group therapy. As a result, there is a positive feedback from Rwanda and we have begun the process of sensitizing the importance of this project and calling for partners in different kinds of forum such as this congress
When your donor funding runs out how will your idea continue to live?: About Bosnia &Herzegovina: By relying on existing standards and strategies, formalizing mutual collaboration and work with youth with protocols and procedures, improving knowledge and skills with training and practical assistance in their implementation, building a pool of local youth health experts, and creating a network of youth service providers, there are reasonable chances that the changes made will continue to live and grow.

About Rwanda: Since we are training doctors, nurses in the country, our goal is that the latter will take over the work we have started and train others when we complete our training activities.

New Educational Programme for Patients with Epilepsy at Geneva University Hospital: Switzerland

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Author(s): Anne-Chantal Héritier Barras1, Anne-Laure Hariel Spinelli1
Affiliation(s): 1Neurology Service, Geneva University Hospitals
Name your project or intiative: New educational programme for patients with epilepsy at Geneva University Hospital
1st country of focus: Switzerland
Relevant to the conference theme: New roles and responsibilities of health personnel
Summary: Even in countries with easy access to medication, patients with epilepsy continue to suffer from psycho-social difficulties often underestimated by health caregivers. An educational programme focused on proper needs of patients is proposed. A comprehensive interview first explores the patients' needs in domains such as comprehension of the disease, emotions and impact on daily social life. Following education sessions a second individual interview with patients was held to evaluate the personal benefit of this approach. Each health caregiver concerned with epileptic patients should be trained in order to systematically include therapeutic education in the care processes.
What challenges does your project address and why is it of importance?: Epilepsy is a chronic neurological condition affecting more than 50 million people worldwide. Medication works well with about 75% of patients. However, the misconceptions, prejudice and subsequent stigma often encountered by patients with epilepsy lead to discrimination, social isolation and personal denial of the disease. Even in developed countries with easy access to antiepileptic drugs and highly technological diagnostic tools, the patients and their families continue to suffer from the physical, psychological, social and economic consequences of epilepsy. The physicians' preoccupation with seizure control and diagnostic processes often overshadows other concerns. A local qualitative study in 2008 explored the educational needs of patients living with epilepsy and how the needs of the patients were perceived by their health caregivers. In comparison with patients, the health caregivers underestimate the difficulties of social adaptations, the direct effect of the seizures and the emotional impact on the patient. In contrast, the concerns of the health professionals reflect their own preoccupations: apprehension in relation to the treatment and comprehension of aetiology. To be effective, a therapeutic educational program must focus on the real needs of the patients and not only on needs perceived by the health caregivers.
How have you addressed these challenges? Do you see a solution?: An educational approach to patients is proposed, focused on their proper needs in order to acquire the necessary competences to live better with epilepsy. The programme is the following. A) An initial comprehensive face-to-face interview between the patient and a health caregiver (nurse or medical doctor) explores the needs of the patient in the four different domains identified in the study mentioned above: 1. Comprehension: “What do I understand about my situation?”2. Emotions: “What do I feel about that?”3. Impact of the disease on the patient: “How does my condition change my daily life?”4. Impact of the disease on the patient’s social life: “How does my condition change my relationship with others?”B) After this first interview, the patient is invited to follow either individual sessions, if the psychological impact predominates, or group sessions, if the social difficulties are prominent. C) In the group sessions, several topics are explored, according to the themes emerging from the study mentioned above:- my seizure: symptoms, localisation in the brain, facilitating factors- management of my seizure: what to do, what to say and to whom- management of my treatment: my advantages and disadvantages to take medication- my specific living conditions: driving licence, applying for a job, pregnancy, travelling, D) Patients benefit from a second individual interview to remind them of the different topics reviewed earlier. The discussion is then continued with the patient's private concerns and difficulties. A personal project is outlined with small objectives in order to become a reality in a near future.
How do you know whether you have made a difference?: An indication of knowing whether we have made a difference is by listening to the patients. During the first face-to-face interview, patients recounted the following:- « If we don’t speak about how we live, the caregivers, the ambulance drivers, the neurologists… they will all never know how we live… So, they won’t understand our daily life. »- « The way a physician learns, the training he received, it is : here is a symptom. Our daily life, our social life: they don’t see them at all. »- « For us, our life isn’t only how many seizures we have and what kind of seizures we have. »And at the second face-to-face interview, we can hear:- « I had the distinct feeling that we could say what we were feeling, that you cared about that, and that it was possible to go further in accordance with how we were living… »- « So, it gave me the impression of being understood, heard. »- « Effectively, I think that to have the opportunity to speak about different concerns, to be able to say things, as well organized as it was : we could express ourselves, listen to each other, unveil our selves, permit to meet each other;  it created a bond, maybe more difficult to create without that. »- « We checked the global situation; I know I have a resource here and that’s great. »- « It helps us in our daily life. »At the moment, we are working on constructing  evaluations, especially auto-evaluations, with an emphasis on patient autonomy. We will evaluate if educational objectives have been reached and if the patient has developed new competences. We also assess the patient’s satisfaction.
Have you or the project mobilized others and if so, who, why and how?: This programme is focused upon those patients who attended educational sessions. The role of patients changed during the process. Passive patients became active partners of health care. The patients’ verbatim (cf. 5.) shows a better comprehension of their own disease, a sharing of life experiences with people in a similar situation and enhanced self-esteem. In parallel, health caregivers are also were affected by the process. They modified their medical practice by considering patients’ preoccupations rather than focusing soley on diagnosis and this was achieved by shared decision-making with the patient and by recognising the patient-health caregiver relationship as a partnership.
When your donor funding runs out how will your idea continue to live?: We do not have specific funding for our educational programme. The awareness and mobilization of the entire medical team taking care of epileptic patients is in progress. Once the medical team is persuaded of the validity of our approach, we hope that education will be included in the health processes and system. If so, the durability of our process will be assured.


Steep Ramp Test: An Efficient Tool to Develop a Pulmonary Rehabilitation Program in the Absence of a Cardio Pulmonary Exercise Test

Project/Initiative Outline:

Author(s): Sandra Da Silva1, Chetna Bhatia1
Affiliation(s) 1Geneva University Hospitals, Geneva, Switzerland
Name your project or intiative Steep Ramp Test: An efficient tool to develop a pulmonary rehabilitation program in the absence of a cardio pulmonary exercise test (CPET)
1st country of focus Switzerland
Relevant to the conference theme Non-communicable chronic diseases;
Summary The Cardio Pulmonary Exercise Testing is a gold standard for the prescription of exercise in a pulmonary rehabilitation program for COPD patients. However, this test is expensive and time consuming and requires sophisticated equipment and the presence of a doctor with elaborate interpretation skills. Exercise prescription for a pulmonary rehabilitation program is essentially done by physiotherapists who do not necessarily have access to the above test. The Steep Ramp Test can be a solution when the CPET is not accessible to the physiotherapists. This was the primary reason for us to develop and create a simple, cost-effective, easily interpretable and reproducible test for our pulmonary rehabilitation program.
Background Meyer & al used the test in 1997 for chronic heart failure patients for the first time followed by De Backer in 2007 and Puhan in 2006 and 2008 for cancer and respiratory insufficiency patients respectively. De Backer demonstrated that the steep ramp test was a valid, practical and secure test when compared with a sub maximal test and CPET to prescribe and elaborate a rehabilitation program for the cancer patients. In our institution all patients inscribed in the pulmonary rehabilitation program do not have a CPET which inspired us to look for a test that can be used to evaluate the maximum short exercise capacity. The test can be performed without the presence of a doctor, can be repeated at regular intervals to adjust the exercise intensity and requires very few means (cycle, oxymeter, Borg scale) making it very cost effective. In our 4 years of experience with this test we found that the COPD patients are able to perform the test without much discomfort as it is of short duration. As numerous COPD patients develop a chronic heart failure, the fact that it was already tested on the cardiac patients makes the test a very safe manner of testing our patients.
Objectives To evaluate if the Steep Ramp Test can be used as an alternatve tool to evaluate exercise intensity in the absence of CPET.
Design: A retrospective study in which the steep ramp test was used to evaluate exercise intensity in a pulmonary rehabilitation program of 3 months. The test was performed along with the six minutes walking test and MRF-28 at the start, at six weeks and end of the program. Participants: 21 patients (8 male, 13 female) suffering from chronic respiratory disease. Mean age +/- 69.19 years, SD (+/-9.5). Setting: University Hospital Geneva Intervention: A 3 month pulmonary rehabilitation program, twice a week including interval training, strength training and patient education, session duration 90 minutes. The patients performed the Steep Ramp Test which was used to evaluate the exercise intensity for the interval training on the ergometer.
Results There was significant improvement in the workload on ergometer (p=0.0001), the distance and the Borg Scale during the 6 minutes walking test (p=0.0001) and in the respiratory health section of the MRF-28 questionnaire,(p=0.001).
Conclusion Steep ramp test is an effective, low cost, practical, easily reproducible test that can be used to construct a pulmonary rehabilitation program in the absence of a CPET. The test needs to be used in conjunction with the six minutes walking test to evaluate the oxygen need.

School Based Intervention to Prevent and Manage Obesity: Tunisia

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Author(s): Jihene Maatoug Maaloul1, Imed Harrabi1, Mylene Belkacem1, Sonia Hmad1, Hassen Ghannem1
Affiliation(s): 1Department of Epidemiology, University Hospital Farhat Hached, Sousse Tunisia
1st country of focus: Tunisia
Relevant to the conference theme: Non-communicable chronic diseases
Summary (max 100 words): This paper presents the results of a pre assessment study aimed at studying the prevalence of obesity and overweight among two randomized samples
of schoolchildren aged 11 to 16 years old who were enrolled in a school based intervention to prevent and manage obesity in the region of Sousse, Tunisia.
Background (max 200 words): The prevalence of childhood obesity has increased worldwide and in Tunisia we are facing an epidemiological transition.
Objectives (max 100 words): The objective of this research was to study the prevalence of obesity and overweight in a population of school children, and to propose a school
based intervention to prevent and manage obesity in the region of Sousse, Tunisia.
Methodology (max 400 words): This was a quasi experimental design with school based intervention. The intervention group was located in Sousse Jawhara and Sousse Riadh and the
control group was located in the region of Msaken. Pre assessment was done with a randomized sample in each group to evaluate the prevalence of obesity in the school year 2009/2010. It concerned schoolchildren aged 11 to 16 years old. The total number of participants was 4003 with 1929 and 2074 respectively in intervention and control groups. The intervention began in the school year 2010/2011 and will last three years. We used a self administered questionnaire to collect data about socio-demographic characteristics, eating and sedentary habits. We also took weight, height and waist circumference of selected schoolchildren. The intervention program began in school year 2010/2011 and will last three years. It consists of educative sessions on healthy diet and physical activity. It also consists of sensitization days animated byschoolchildren leaders formed by the project team.
Results (max 400 words): The proportion of boys was 50.2% and 46.5% respectively in intervention and control groups. The mean age was 13.24 ±1.26 and 13.48 ± 1.30 in each
group. The proportion of schoolchildren who consume vegetables daily was respectively 28.4% and 40.3% in the intervention and control groups. Likewise, the proportion of fruits consumption was 55.8% and 57.6%. The proportion of schoolchildren who do recommended level of physical activity was 14.7% and 9.5% respectively in intervention and control groups. In the intervention group, the proportion of overweight and obesity was respectively 20.6% and 7%. In the control group, the proportion of overweight and obesity was respectively 15.5% and 4.5%.
Conclusion (max 400 words): Intervention in schools is important to prevent and manage obesity among adolescents.

Spatial Distribution and Dependence of Body Mass Index: Geneva, Switzerland

Project/Initiative Outline:

Author(s): Idris Guessous1, Nicola Cantoreggi2, Stéphane Joost3
Affiliation(s) 1Hôpitaux Universitaires de Genève, Geneva, Switzerland.  2University of Geneva, Geneva, Switzerland. 3École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
Name your project or intiative Spatial distribution and dependence of body mass index in the Canton of Geneva, Switzerland
1st country of focus Switzerland
Relevant to the conference theme Non-communicable chronic diseases; Health information and Technologies
Summary The investigators used GIS programs to spatially locate sample participants and assess spatial distribution and dependence of overweight, obesity and body mass index.
Background Urban health (UH) is an emerging field, which explores the effect of urban environment and urbanization on health. Evidence suggests that urban environment can either positively influence health behaviors or be a health stressor. One key approach in UH is the use georeferenced data and geographic information system (GIS). Mapping disease prevalence and trends provide insight into disease mechanisms and etiologies. An important limitation of GIS is that data sets have likely been collected separately by different agencies, often over different time periods. The Canton of Geneva deviates from this limitation as it has been collecting geographic and health-related information continuously since 1998 through the Unit of Population Epidemiology (UEP) of the Geneva University Hospitals and its Bus Santé study.
Objectives Our aims were 1) to explore the spatial distribution of body mass index (BMI) in the Canton of Geneva, 2) to explore the evolution of spatial distribution of BMI between 2001 and 2009 in the Canton of Geneva, and 3) to measure the level of BMI spatial dependence in the Canton of Geneva
We used data from the Bus Santé study. The Bus Santé study is an ongoing, community-based study designed to monitor chronic disease risk factors continuously in the Canton of Geneva, Switzerland. Each randomly selcted participant receives several self-administered, standardized questionnaires covering the risk factors for the major lifestyle chronic diseases, sociodemographic characteristics, educational and occupational histories, as well as reproductive history for women. Participants’ addresses are systematically abstracted, verified, and updated. In addition, participants receive validated questionnaires on Diet (with Energy intake kcal/day calculation) and Physical activity (with MET calulation). Each participant undergoes a physical examination and blood collection in one of the three UEP clinic stations. Spatial information already collected (with the postal address as georeference) or available from GIS databases (communes, parks, roads provided by the Système d’Information du Territoire Genevois (SITG) (e.g. traffic, trees density), the Office Cantonal de la Statistique (OCSTAT), and MicroGIS were considered as chronic cardiovascular exposures or covariates. We used information collected by the “Bus Santé” study, which included >10,000 participants over a 12-year period. We measured the level of spatial dependence of different investigated cardiovascular risk factors, as well as the one of integrated indices like the BMI. Spatial dependence means that we measured how similar were the different values of the different health variables under study for a set of randomly spatially distributed individuals (Bus santé data), and within a rigorously defined neighborhood. Measuring spatial autocorrelation permits a) to quantify the spatial regularity of a given phenomenon on a territory, and b) to determine the range of spatial dependence of this phenomenon on the same area. Autocorrelation can be quantified either globally over a whole territory or locally within the same territory. The opportunity to locally measure spatial dependence is of high interest in our case as it makes it possible to identify specific city districts (“quartiers”) confronted to particular urban configurations, exposed to certain environmental conditions (e.g. air pollution, noise pollution), or meeting precise socio-economic criteria for a specific response in cardiovascular variables. The use of Local Indicators of Spatial Association (LISA) allow for the decomposition of global indicators into the contribution of each observation (an observation being any georeferenced individual participating to the Bus santé action). We used LISA a) as indicators of local pockets of nonstationarity (high/low risk “hot spots” for particular cardiovascular variables) or b) to assess the influence of individual or regional locations on the magnitude of the global statistic to identify outliers
Results Combining health-related data from the Bus Santé study and GIS, the investigators reported the geographic prevalence of overweight and obesity. Map 1 shows the 2001-2009 geographic distribution of overweight (surcharge) or obesity (obésité) prevalences in the Canton of Geneva. Several regions (communes) at high risk appeared clearly on the map with highest prevalences encountered on the right side of Lake of Geneva. Map 2 shows the evolution of the distribution of overweight prevalences in the Canton of Geneva between 2001-2004 and 2005-2009. This map highlights the progression of the burden of overweight and highlights regions that suffer the most from it. The investigators detected significant spatial dependence with respect to BMI (Map not shown). This result clearly indicate that BMI levels are not distributed at random in the Canton of Geneva. Performing preliminary exploratory analyses on blood pressure, investigators have also identified cluster of individuals with higher blood pressure than the average.
Conclusion Our work has both public health and scientific importance. Indeed, this study presents a unique opportunity i) to determine spatial distribution trends of cardiovascular risk factors and ii) to further define the importance of the urban environment on health. Measuring the urban health burden is key since it can guide more effective strategies of housing and urban development (e.g., sidewalks, transportation), which could ultimately promote healthier behaviours. Based on results from similar source of urban health data, movements to promote health in cities have been established (e.g, Healthy Cities, an international project sponsord by the World Health Organization). Outcomes demonstrating associations between urban environment and population’s health status is an important tool to make land planning policies more “health-friendly”. For example, neighborhoods with high walkability mitigate the risk of hypertension at the community level and promotion of neighborhood walkability could play a significant role in improving population health and reducing CVD risk. Currently, little research has been conducted in Switzerland. The main reason is the difficulty to access to robust health data which have a valid link to location. In addition, geographic information on urban environment is generally sub-optimal. An ideal situation is encountered in the Canton of Geneva which has collected more than 12-years of robust population health information, and has extensive public free information on the urban environment. This project translated this ideal situation into a sound scientific research that can offer concrete public health impact.