HTLV in the Americas: challenges and perspectives

The first description of the human T-lymphotropic virus type 1 (HTLV-1) was made in 1980 followed closely by the discovery of HTLV-2, in 1982. Since then, the main characteristics of these viruses, commonly referred to as HTLV-1/2, have been thoroughly studied. Central and South America and the Caribbean are areas of high prevalence of HTLV-1 and HTLV-2 and have clusters of infected people. The major modes of transmission have been through sexual contact, blood, and mother to child via breast-feeding. HTLV-1 is associated with adult T-cell leukemia/lymphoma (ATL), HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and HTLV-associated uveitis as well as infectious dermatitis of children. More clarification is needed in the possible role of HTLV in rheumatological, psychiatric and infectious diseases. Since cures for ATL and HAM/TSP are lacking and no vaccine is available to prevent HTLV-1 and HTLV-2 transmission, these illnesses impose enormous social and financial cost on infected individuals, their families, and health care systems. For this reason, public health interventions aimed at counseling and educating high-risk individuals and populations are of vital importance. In the Americas this is especially important in the areas of high prevalence(AU)

Curriculum development in Community Health: drift or shift?

The curriculum in community health is best described as eclectic and dynamic. Its relevance is maintained by its response to the macro-environment; this response, whether innovative or otherwise, may be incremental on the one hand or feature wholesale change consequent on radical rethinking on the other. This paper reviews the content of the emerging curriculum in community health and the University of the West Indies, Jamaica, and attempts to discern the process of change and the factors which have informed these developements.(AU)

Forty years: an introduction to the development of a Caribbean public health

The development of public health and primary care in Jamaica is examined with particular reference to the historical events which paved the way for their development: notably, the collaborative work undertaken by the Rockefeller Foundation (Commissions on hookworm, tuberculosis, malaria, yams); recommendations of the Moyne Commission (leading to the establishment of the West Indies School of Public Health); and the Irvine Commission which recommended the establishment of the University College of the West Indies. A confluence of political, social and international activity in the 1970s proved catalytic in the development of the current ethos of primary health care, and the Department of Social and Preventive Medicine was instrumental in the training of the most innovative addition to the primary care health team, the community health aide. Undergraduate and postgraduate training programmes of the Department are highlighted as it celebrates its fortieth anniversary.(AU)

Is preventive medicine a component of the primary care service for diabetes in Barbados? - abstract

Diabetes mellitus is a chronic illness that requires continued medical care and education to prevent acute complications and to reduce the risk of long-term complications. Diabetics should receive care and treatment from a health team with interest and expertise in the management of diabetes. This study aimed to evaluate the quality of care offered to diabetics in three different clinic settings in Barbados. The case notes of 690 diabetic patients attending private practitioner offices, polyclinic general clinics and polyclinic diabetic clinics, were identified during a six-week index period, and a questionnaire was completed for each patient. Although the average number of visits annually was similar in each of the three settings (5-6 visits/year), private practitioners had the lowest percentage of patients (30.7 percent) with poor glycaemic control (defined here as a fasting blood sugar >/=8 mmol/l, or any other blood sugar >/=10 mmol/l. Overall, the glycaemic control was poor in 44.9 percent of patients. Screening for potential long-term complications such as cardiovascular complications, foot problems, eye problems and kidney problems was recorded as being done in a minority of patients, while the concomitant menace of poorly controlled hypertension, which is known to accelerate the progression of diabetic complications, was present in a significant number of patients. While recognising the limitations of the technique of case note review, these results indicate a need for clear concise guidelines for diabetic primary care, with emphasis on prevention and early detection (AU)

The selling of preventive medicine: ethical, fiscal and political imperatives - abstract

After years of paternalistic prescriptions and peer pressure, it is clear that physicians, like most people, act in what they perceive to be their best (financial) interest. The underlying principles whereby physicians can be persuaded to change their professional behaviour are the same as when a patient is convinced first to swallow an initial dose of medicine, and then to carry out the entire treatment plan. Firstly, the patients/physicians have to accept that they have a problem/condition. Secondly, they believe the problem-solver is trustworthy and qualified to solve it. Thirdly, they understand the rationale for the prescription enough to try the first dose. Finally, they get sufficient results or encouragement to finish the course of treatment. One common difficulty of physicians is that they underestimate the importance of the first and second steps: most of the patients we see already acknowledge them, but getting our colleagues to swallow medicine is another matter! It is therefore not surprising that, while we all agree on the importance of preventive medicine, immunization and smoking cessation programmes never get the whole-hearted support of physicians until there is a positive (financial) incentive to do so. The fee-for-service system actually penalizes the early resolution or prevention of health problems, and defensive medicine practices are more costly than malpractice premiums. Thus the major goals of health care reform in the U.S. are to provide positive incentives to reduce visits to the doctor and the hospital, and to reduce fear of lawyers, among providers. At the same time, there need to be safeguards to ensure that quality of care and access by the poor and truly sick are not adversely affected. It is also apparent that preventive medical initiatives are most effective when the responsibility for follow-through is given to Public Health Nursing. There is no shortage of experienced nurses willing to assist consumers to reduce their visits to the doctor, dentist and hospital. We just have to pay what these services are worth in savings to the health care system (AU_

Coverage survey, an evaluation of the immunization programme for infants - abstract

The objective of this study was to obtain information on the coverage rate for DPT, poliomyelitis and MMR/measles and rubella among children in Curacao. A cluster sampling technique was used to select 211 children, aged 15 to 26 months, whose immunization status was evaluated. Data were obtained from the immunization card and by interviewing the parent. The coverage rate ranged from 99.1 percent (first DPT) to 70.6 percent(MMR); 67.8 percent of children were fully immunized. Two children (0.9 percent were not immunized at all. Less than 10 percent of all immunization doses was administered outside the Well Baby Clinics. Some of the recorded doses were given too early (invalid)according to the WHO criteria. Accurate registration was recommended as a possible way to decrease the number of invalid doses. It was found that many of the 3 doses of poliomyelitis vaccine were administered too late and it is recommended that the 3rd oral polio dose should be given earlier. Reasons why children were not fully immunized could be divided into: obstacles to participation in the programme (55.9 percent), lack of motivation (10.3 percent) and lack of information (33.8 percent). Illness of the child was the main obstacle (AU)

Declaration on Health for the Caribbean Community

Presents the resolutions of the Conference of Ministers responsible for health. Outlines the principal issues those related to health status and those related to the health infrastructure. Examines the regions demography, the need for integration of resources, food and nutrition planning, epidemiological surveilance, pharmaceutical policy and research development. Looks at the environment and analyses the changes in structure and orientation of the health service, requisite for primary health care. Outlines priorities of primary health care approach and specific objectives. Concludes that the secretariat should be responsible for taking action at the regional level to stimulate thought and propose new solutions for difficult health problems. (AU)

Public health training programs at the University of the West Indies

The Department of Preventive Medicine of the University of the West Indies was established in 1957 with the idea of improving undergraduate teaching facilities to enable medical students to study patients in their homes and social environment. The authors describe the two public health diploma programs available at the University and cite pertinent enrollment and geographic distribution statistics. Candidates for the Diploma in Public Health are registered medical practitioners who take a series of compulsory and elective subjects and have a period of supervised field training and research during the 12-month course. The Diploma in Community Health trains students in the health and diseases of man in his total environment. Students choose among three program options: the general program, specialization in health education, or specialization in health service administration. The general program is the most popular because it gives the student a rounded education suitable to the needs of small states. The 12-month diploma course features the interdisciplinary approach where students from various fields discuss important issues in community health. Comprehensive courses in these areas include health services administration, social sciences, environmental health, epidemiology and biostatistics, family health, communication science, and community mental health. The authors state that the candidate for the Diploma in Community Health is assessed on the basis of course and field work, a special project report, and a final written and oral examination. (SUMMARY)

Changing perspectives on health care development in Grenada

In this article the writer outlines and describes the programme of health care implemented by the People's Revolutionary Government (PRG), states that the emphasis on health care is now preventative rather than curative and that health care is perceived as a total community effort rather than a package of pre-determined services delivered to a community. (AU)