Acadenic Research Services at the Medical Sciences Library, Faculty of Medical Sciences Library, The University of the West Indies, St. Augustine

To profile academic library services at the Medical Sciences Library, The University of the West Indies, St. Augustine Trinidad and Tobago, highlighting reseources and initiatives that support the Faculty of Medical Sciences curriculum, research, and scholarly communication. To outline the resources and services available at the Medical Sciences Library to support teaching and learning with a focus on research.

Los trastornos mentales en America Latina y el Caribe: asunto prioritario para las salud publica / Mental disorders in Latin America and the Caribbean: a public health priority

OBJECTIVE: The growing burden of mental disorders in Latin America and the Caribbean has become too large to ignore. There is a need to know more about the prevelance of mental disorders and the gap between the number of individuals with psychiatric disorders and the number of those persons who remain untreated even though effective treatments exist. Having that knowledge would make it possible to improve advocacy, adopt better policies, formulate innovative intervention programs, and apportion resources commensurate with needs. METHODS: Data were extracted from the community-based psychiatric epidemiological studies published in Latin America and the Caribbean from 1980 through 2004 that used structured diagnostic instruments and provided prevalance rates. Estimates of the crude rates in Latin America and the Caribbean for the various disorders were determined by calculating the mean and median rates across the studies, by gender. In addition, data on service utilization were reviewed in order to calculate the treatment gap for specific disorders. RESULTS: Non affective psychosis (including schizophrenia) and an estimated mean one-year prevalence rate of 1.0 percent; major depression, 4.9 percent; and alcohol use abuse or dependence, 5.7 percent. Over one-third of individuals with nonaffective psychosis, over half of those with an anxiety disorder, and some three-fourths of those with alcohol use abuse or dependence did not receive mental health care from either specialized or general health services. CONCLUSIONS: The current treatment gap in mental health care in Latin America and the Caribbean remains wide. Further, current data likely greatly underestimate the number of untreated individuals. The epidemiological transition and changes in the population structure will further widen the treatment gap in Latin America and the Caribbean unless mental health policies are formulted or updated and programs and services are expanded (AU)

Gasto y financiamiento en salud: situacion y tendencias / Health spending and financing: the current situation and trends

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in the financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the PAn American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach (AU)

Epilepsy in Latin America and the Caribbean: a survey on needs and resources

A survey was done on the needs and resources available to control epilspsy in the countries of Latin America and the Caribbean. Responses came from ministries of health, prominent neurologists, and epilepsy advocacy organizations. A mailed questionnaire was used, and the response rate was excellent, 89 percent. The survey results showed that the private sector, in terms of both specialized personnel and access to a variety of drugs. Public policies are lacking, and linkages between medical personnel and social workers are almost nonexistent. Primary care doctors and nurses are somewhat able to diagnose some types of epilepsy but do less well with other types of the disorder. There is a strong justification for the new "Out of the Shadows" initiative, in which the International League Against Epilepsy, the International Bureau for Epilepsy, the World Health Organization, and the Pan American Health Organization are working to improve epilepsy health-care services, treatment, and social acceptance (AU)

Medicine and its alternatives: health care priorities in the Caribbean

In the Caribbean as as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.(Au)

The role of the aedes aegypti surveillance and control in relation to the epidemiology, prevention and control of Dengue Fever in Jamaica

The control of dengue fever depends on the level of Aedes aegypti infestation and thus relies heavily on the measures for controlling the vector. Quite recently, despite the implementation of mosquito control measures, the Aedes aegypti population has still escalated. The vector apparently has adapted to or resisted most of the control methods. The failure of Aedes aegypti control programmes has been blamed on the vector's biological features fostering the development of species resistance to chemical control or environmental factors favouring the increase of the Aedes aegypti' population at a faster rate than the control methods can reduce them. Nevertheless, many Aedes aegypti control programmes are improperly planned and implemented or the control measures are often used as reactive methods of controlling dengue fever outbreaks, rather than as continuous proactive strategies preventing disease. Aedes aegypti breeding is basically a problem of domestic sanitation and therefore communities have an essential role to play in source reduction activities. The activities of some governmental departments, non governmental organizations and the private sector may encourage the increase of Aedes aegypti mosquitoes or play a positive role in vector control. Consequently, intra sectoral and intersectoral in vector control are very important. This study examined the control measures applied by the Jamaican Ministry of Health, Vector Control Department and the community for Aedes aegypti surveillance and control, and determined the effectiveness of and obstacles to the mosquito control activities presently being applied. The aim of the study was achieved through the execution of an entomology survey, an environmental survey, an insecticide susceptibility test, key informant interviews with vector control staff from the Ministry of Health and the administration of a Knowledge-Attitude-pracitce survey. The research results showed that the environmental conditions in the study area were conducive to Aedes aegypti breeding and proliferation, especially during the months of July to October. Aedes aegypti mosquitoes were present throughout the study area, with a higher density of Aedes aegypti larvae in Tavern and Gordon Town. Aedes aegypti larvae collected from Mona and Hermitage were highly susceptible to a 1 percent abate larvicide.(Au)

Integrated primary mental health care

Mental health is increasingly being recognised as contributing significantly to the burden of disease, particularly now that the indicators have shifted from measures of mortality to measures of morbidity. Psychiatric morbidity in the community, based on community surveys, is estimated at 20 to 30 percent of the population. Increasingly, patients needing health services prefer to be in a general health care setting than in specialized centres. Internationally and regionally, the general policy has been to move toward the development of comprehensive mental health programmes integrated within primary health care. This integration may be structural (use of shared facilities), administrative (shared administrative resources) or functional (complete integration of clinical services, with staff jointly responsible for patient welfare). This paper examines how this integration can be achieved, and the potential role of the Department of Community Health and Psychiatry, University of the West Indies in advancing this integrative process through research and training.(AU)

Analysis of the investment process in the environment and health in Dominica

Looks at the main variables and their inter-relationship in the allocation of resources for investment in the environment and health in Dominica and identifies the elements that will contribute to the design and development of support for the implementation of PIAS. Examines the macro-economic aspects and the policies on investment in health and the environments: identifies the main components in the process of investment and their inter-relationships; looks at the evolution and composition of investment in health and the environment; considers the compatibility between economic policy and investment in the two sectors; and analyzes the investment process cycle which includes generation of investment initiatives, allocation of resources and implementation of investments. (AU)

Changes in material resource levels in Jamaica's primary health care services between 1984 and 1991/1992

Jamaica's primary health-care services have been in a process of development since the 1970s. In 1984, a large management study collected data on levels of material resources (basic facilities, utilities, furniture, equipment and supplies items). Since 1984, serious staff shortages have affected the services, and there have been economic constraints, as well as a major hurricane. In order to measure changes over subsequent years, data on material resources were again collected in 1991/1992, using the same sample of 65 types 2 and 3 health centres as in 1984. Data were collected by interview with health centre staff. Results, whilst showing various changes item-by-item, showed constancy or minor improvements overall in levels of resources. Type 2 health centres continued to have lower resource levels than type 3s, even though the methodology allowed for their different needs where appropriate. Staff members' opinions of condition and adequacy of resources had become more positive than before. It was concluded that, in terms of material resources, activities within the primary health-care sector have offset the adverse effects of the macro-environmental conditions affecting the health centres. This method of material resource monitoring has implications for quality assessment of health facilities in primary health-care (AU)

Changes in material resource levels in Jamaica's primary health care services between 1984 and 1992 - abstract

Jamaica's primary health care services have been in a process of development since the 1970s. In 1984, a large management study collected data on levels of material resources (basic facilities, utilities, furniture, equipment and supplies items). Since 1984, serious staff shortages have affected the services and there have been economic constraints, as well as a major hurricane. In order to measure changes over subsequent years, data on material resources were again collected in 1991/92, using the same sample of 65 type 2 and 3 health centres as in 1984. Data were collected by interview with health centre staff. Results, whilst showing various changes item-by-item, showed constancy or minor improvements in the global (mean) levels of resources. Type 2 health centres continued to have lower resource levels than type 3s. Staff members' opinions of condition and adequacy of resources had become more positive. It was concluded that, in terms of material resourcs, activities within the primary health care sector have offset the adverse effects of the macro-environmental conditions affecting the health centres (AU)

Whatever happened to public health?

In many rich and poor countries, recent health service developments have led to neglect of the traditional public health functions. For various reasons, however, the need for these functions is increasing rather than diminishing. Developing countries should devote more resources to them, but they should not necessarily folow proposals from developed countries such as those in the Acheson Report, when locating public health in their organizational structure (AU)

Material resources in Jamaica's primary health care centres

A national study of management aspects of the primary health care services in Jamaica provided data on material resources (facilities, utilities, furniture, equipment and supplies) available at health centres. It was postulated that a description of resources and of their relationship to output could be useful, and the study set out to develop composite indices to measure material resource levels. Staff at a sample of 92 health centres, in all parishes, were interviewed to provide objective statements of resources present and subjective assessments of their adequacy and condition. Results showed that certain basic material resource items were present in a relatively high proportion of health centres but others, perhaps less crucial, were scarce. The lower level health centres were less well supplied with resource items than the others, even after standardising for their different needs. The data provided evidence that output by personnel was related to level of material resource inputs. Experimenting with formulation of composite indices of material resources, considerations of sensitivity, simplicity and creditability led to the conclusion that indices based on objective statements were as appropriate as the more complicated ones based on subjective assessments. Use of indices based on objective data showed that the South-Eastern and Western health areas had higher levels of resource than the North-Eastern and Southern areas. It was concluded that composite indices based on simple statements and calculations can be useful in monitoring levels of material resources, and that material resources probably have an effect on output from health centres (AU)

Indices to measure material resources in Jamaica's health centres - abstract

Jamaica's primary health care system was developed and implemented in the 1970's. Many new health centres were built and many equipped according to defined standards. Resources became more scarce in the 1980s. As part of a management study, instruments were devised to measure 'Facilities and Utilities', Equipment and Furniture', 'Condition of Equipment' and 'Drugs and Supplies' proved too complex to handle in practice and had a low completion rate. The other three instruments proved feasible. Indices such as these could be used to monitor changing levels of resources of make comparisons of any kind. The low levels of the indices were in accordance with the low levels of resources known to exists (AU)