Tuberculosis in Suriname: trends in epidemiology, diagnostics and treatment

This thesis describes the epidemiology of tuberculosis in multi-ethnic Suriname, as well as progress in diagnosis and treatment trends of tuberculosis(TB) in Suriname.

Treatment outcomes of substance abusing males who completed a 90-day residential treatment programme in Barbados

OBJECTIVE: To analyse the post-treatment outcomes of male substance abusers who completed a minimum of 90 days at a residential treatment facility in Barbados. SUBJECTS AND METHODS: A sample of 150 male clients who completed 90 days or more of the treatment programme from 2004–2014 was used for the main study. A pilot study was conducted with fifteen subjects to assess the validity and reliability of the Substance Abuse Foundation Evaluation-1 (SAFE-1) questionnaire designed for the study. Correlation coefficients were used to measure the strength of association between variables, and a p-value of0.05 was used to determine statistical significance. RESULTS: To date, data on 37 respondents were used for analysis. Positive significant relationships emerged between number of days in treatment and length of sobriety, and social support, spiritual health and length of sobriety. There was no significant relationship between drug of choice and length of sobriety, nor between trauma and relapse. Self-referred clients reported longer lengths of sobriety and clients who had more than 20 years of drug use prior to treatment were more likely to stay sober longer after treatment. Clients between three and six years post treatment were more likely to request additional support. CONCLUSIONS: There are specific factors that positively impact length of sobriety after treatment. Thus, substance abuse treatment centres should seek to incorporate these factors into their programming so as to better inform their inpatient and after care services.

Rational use of therapeutic drugs in the Caribbean

The concept of "Rational drug use" means the selection of the most appropriate and cost effective drugs, carefully prescribed, with an understanding of patient education needs and compliance problems. Caribbean experience and recent Drug Utilisation Review (DUR) studies indicate that drug use for common problems like hypertension, diabetes and arthritis could be greatly improved. Applying the principles of rational drug use can save money, improve treatment and bring effective drugs to more of our populations. Emphasis must be on education rather that regulation, which leads to other adverse consequences. Skilled professionals and National Drug and Therapeutics Committees are essential, to steer a rational path between the pressures of the drug industry and the realities of economies in crisis (AU)

Rational use of therapeutic drugs in the Caribbean

The concept of "Rational drug use" means the selection of the most appropriate and cost effective drugs, carefully prescribed, with an understanding of patient education needs and compliance problems. Caribbean experience and recent Drug Utilisation Review (DUR) studies indicate that drug use for common problems like hypertension, diabetes and arthritis could be greatly improved. Applying the principles of rational drug use can save money, improve treatment and bring effective drugs to more of our populations. Emphasis must be on education rather than regulation, which leads to other adverse consequences. Skilled professionals and National Drug and Therapeutics Committees are essential, to steer a rational path between the pressures of the drug industry and the realities of economies in crisis (AU)

Metronidazole - a review

Metronidazole (Flagyl) is a 5-nitroimidazole extensively used in many countries in the treatment of several protozoan infections (trichomoniasis, giardiasis, amoebiasis) and obligate anaerobic infections. It is well tolerated orally and parenterally with minimal untoward effects. Metronidazole is rapidly replacing clindamycin in many countries, as resistance to clindamycin has been reported. Metronidazole crosses the blood-brain barrrier readily, difuses well into pus and is therefore very effective in the treatment of brain abscess due to anaerobes. In combination with an aminoglycoside, metronidazole provides good prophylaxis perioperatively in intra-abdominal surgery. Metronidazole is also useful in the managemnent of other disease such as pseudomembranous colitis and rosacea. Metronidazole is inexpensive when compared with other antibotics used to treat anaerobic infections, (for example clindamycin)(AU)

Alternative therapeutic systems in Belize: a semiotic framework

The first part of this paper presents data on the socio-medical system of an ethnically heterogeneous society collected during 16 months of fieldwork. Special attention is given to the Black Caribs (or Garifuna). The focus is on the possible functions of alternative therapeutic systems. The second half of the paper provides a semiotic framework for the analysis of illness episodes. It is concluded that the sign of disorder in this context has no single interpertant. Rather there exist a variety of interpertants from which the therapost and patient may select. There are constraints on this process. But the process is enhanced where the patient (and the social group) are free to negotiate a `diagnosis'. Negotiation implies selecting from among a variety of potential meanings; it implies a dialogue in which one goal is an interpretation which is acceptable in cultural terms and which leads to a therapy which is perceived as `appropriate'. Negotiation may also mean the realignment of signs into new `syndromes' which indicate different etiologies or therapies. The existence of alternative therapeutic systems facilitates this process by providing access to new codes governing interpretation. The confrontation with biomedicine and its largely intractable codes may require that the ensuing interpretation incorporate, account for, or partially assimilate the `diagnosis' or interpretation of biomedical personnel. Nevertheless, a single sign may have multiple referents, each consistent with one of the various interpretations imposed by multiple therapeutic systems. These referents may exist simultaneously without inherent contradiction. But to achieve such a consensus may require the development of new models based on an articulation but not an identification of two or more codes.(AU)