Use of ustekinumab for severe refractory atopic dermatitis in a young teenager.

When conventional systemic immunosuppressive treatments fail in the setting of severe eczema, unlike in psoriasis, there are limited treatment options and only anecdotal evidence to help guide clinicians. There is a growing body of evidence for the use of certain biologic agents for moderate to severe eczema. We report the youngest case to date successfully and safely treated with ustekinumab for severe refractory atopic dermatitis.

Establishing a Telephone Medication Order Policy and Protocol for a Small Private Hospital in Jamaica.

OBJECTIVE: To institutionalize an evidence-based policy/protocol adapted from the Agency for Healthcare Research and Quality (AHRQ) national medication standards for managing telephone medication orders (TMO) and to determine the impact of the policy/protocol on the number of telephone medication errors (TME) on two medical units of a small private hospital in Jamaica. METHODS: Kotter's Eight-step Change Model was used to facilitate organizational change among nurses and physicians by teaching and implementing the TMO policy/protocol adapted from AHRQ standards and collecting pre-policy and post-policy frequency of TMEs. A convenience sample of 80 nurses and physicians participated in training about the policy/protocol, took post-instructional tests and participated in the implementation of the policy/protocol. Chart audits over six weeks monitored adherence to the policy/protocol. The annual monthly mean of TMEs for the prior year was compared with the number of TMEs just prior to implementation of policy/protocol and at the end of the first six weeks of implementation. RESULTS: One hundred per cent of the convenience sample of 80 nurses and doctors passed the post-instructional test; the workforce adhered fully to the protocol during six weeks of implementation, and there was a 100% reduction in TMEs between the prior year and six weeks after policy/protocol implementation. CONCLUSIONS: Kotter's eight-step framework of organizational change was a successful strategy in institutionalizing and sustaining adherence to the TMO policy/protocol, reducing the number of TMEs and positively influencing the organizational culture.

Validation of the Jamaican Maternal Sexual Role Modelling Questionnaire.

OBJECTIVE: Urban Jamaican adolescent girls face significant risk for sexually transmitted infections including HIV Studies from the United States ofAmerica have found that parents influence adolescents' sexual risk attitudes and behaviours through parent-child sexual communication and monitoring/supervision. Data from an ongoing mother-daughter HIVrisk reduction intervention study in Kingston, Jamaica identified an additional influence of adolescent girls' sexual risk - maternal sexual role modelling (MSRM). As no reliable and valid questionnaires existed to measure MSRM, one was developed. The objective of the current study was to evaluate the psychometric properties of the Jamaican Maternal Sexual Role Modelling questionnaire. METHOD: Data were collected from 209 Jamaican female adolescents recruited from Kingston, St Andrew and St Catherine parishes. RESULTS: The final 19-item Jamaican MSRM questionnaire was found to have excellent internal reliability (Cronbach's alpha = 0.89). Content validity expert ratings and modified kappa statistics were all 1.0. Principal component analysis identified a three-factor structure that accounted for 53.7% of the variance. Greater MSRM scale scores, indicating more positive and protective maternal sexual role modelling, were associated with less sexual experience, lower intentions to have sex, greater intentions to use condoms if having sex and greater condom use self-efficacy among adolescent girls. CONCLUSION: The MSRM scale was found to be a reliable and valid measure of Jamaican adolescent females'perceptions of their mothers'sexual role modelling. Further research is needed to assess the reliability and validity of the instrument with other populations.

Four-year follow-up of mortality and sleep-related respiratory disturbance in non-demented seniors.

To ascertain whether sleep-disordered breathing (SDB) in the elderly is associated with increased mortality, a prospective cohort study with 4-year follow-up was conducted at a retirement village complex in Sydney, Australia. The subjects were 163 non-demented retirement village residents. Logistic regression was used to assess SDB and co-morbidity as independent predictors of mortality. Respiratory disturbance index (RDI) was measured in the home; those subjects with RDIs > or = 15 were classified as having SDB. Co-morbidity was measured by an index of Burden of Illness based on the medical history obtained at baseline. At 4 years, 27% (4/15) of those subjects with RDIs > or = 15 and 22% (33/148) of those with RDIs < 15 were dead. RDI had an odds ratio (OR) of 1.00 (95% CI: 0.96, 1.04). Burden of Illness had an OR of 1.90 (95% CI: 1.34, 2.71). Adjustment for age and sex did not alter these findings. Significant predictors of mortality from the illness measure were a history of hypertension, Parkinson's disease and other severe illnesses (usually cancer). RDI was not a predictor of mortality in this population of non-demented seniors, where the prevalence of high levels of RDI was low.

Pre-neoplastic lesions of the vulva.

Preneoplastic lesions of the vulva have to be considered lesions "at risk" of facilitating the occurrence of invasive vulvar cancer. The Author examines the two categories of lesions commonly considered at risk for invasive epidermoid carcinoma of the vulva, carcinoma in situ and vulvar dystrophies. Carcinoma in situ of the vulva is characterized by an extreme clinical diversity contrasting with a remarkable uniformity of histologic pattern. The author describes two different clinical patterns, the young female type and the post-menopausal type. According to the new virologic progress, three conclusions may be drawn: 1) Oncogenic HPV is the common aetiology of all the carcinomas in situ of the vulva, whatever the clinical type; 2) Oncogenic HPV may directly induce any type of carcinoma in situ; 3) Oncogenic HPV possesses a very special carcinogenic effect with a long period of ascending trophism. Among the dystrophies, the hyperplastic one is the most at risk. The Author discusses the real autonomy of this entity. He concludes that hyperplastic dystrophy per se does not exist and it is always a mixed dystrophy.

Topical use of papaya in chronic skin ulcer therapy in Jamaica.

The objective of the study was to determine the prevalence of the use of the fruit (papaya) of Carica papaya as topical ulcer dressings by registered nurses in the Spanish Town Hospital (STH), Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI), Jamaica. A ten-item pretested self-administered questionnaire was distributed to 285 randomly selected registered nurses at the UHWI, KPH and STH. There was a 72% response rate. The prevalence of topical papaya use among the respondents was 75%. Comments from the users of papaya suggested that topical application of the unripe fruit promoted desloughing, granulation and healing and reduced odour in chronic skin ulcers. It was cost effective. Papaya was considered to be more effective than other topical applications in the treatment of chronic ulcers. There was some difficulty in preparation of the fruit and occasionally a sensation of burning was reported by the patients. There was concern about the use of a non-sterile, non-standardised procedure but there were no reports of wound infection from its use. Papaya is widely used by nurses as a form of dressing for chronic ulcers and there is need for standardisation of its preparation and application.

Antibacterial effects of Carica papaya fruit on common wound organisms.

The purpose of the study was to investigate antibacterial activity of ripe and unripe Carica papaya on selected micro-organisms. Cultures of micro-organisms were routinely maintained in nutrient agar slants at 4 degrees C. Extracts of immature, mature and ripe Carica papaya fruit were obtained by separately grinding factions of the epicarp, endocarp and seeds and filtering them through gauze. Sensitivity tests were conducted by adding 0.06 ml of extract to agar wells (6 mm diameter) prepared from 20 ml agar seeded with 10(6) cells/ml suspension of one of the eight organisms per plate. The inoculated plates were allowed to equilibrate at 4 degrees C for 1 hour, incubated at 37 degrees C for 24 hours, and zones of inhibition measured in millimetres. Anti-bacterial activity was expressed in terms of the radius of zone of inhibition. Seed extracts from the fruit showed inhibition in the following order: B cereus > E coli > S faecalis > S aureus > P vulgaris > S flexneri. No significant difference was found in bacterial sensitivity between immature, mature and ripe fruits. No inhibition zone was produced by epicarp and endocarp extracts. Carica papaya seeds contain anti-bacterial activity that inhibits growth of gram-positive and gram-negative organisms. Observed activity was independent of stage of fruit maturity. Carica papaya has antibacterial effects that could be useful in treating chronic skin ulcers to promote healing.

Socio-demographic and clinical characteristics of Jamaican adolescents with HIV/AIDS.

BACKGROUND: Clinical symptomatology and socio-demographic factors have not been characterized in Jamaican adolescents with HIV/AIDS. METHODS: We studied these factors in 25 HIV-positive Jamaican adolescents, 10-19 years of age, who were seen at the Centre for HIV/AIDS Research, Education, and Services (CHARES) between the years 1996 and 2002. Data were collected between June 2003 and August 2003 from CHARES social work files and The University Hospital of the West Indies (UHWI) medical records. Microsoft Excel was used to compile descriptive statistics for the data. RESULTS: The mean age of HIV diagnosis was 15.6 (+/-3.09) years, and the mean age of enrollment at CHARES was 16.3 (+/- 2.9) years. Consensual sexual intercourse was the most prominent mode of transmission (56%), followed by vertical transmission (16%), unknown (16%), forced sexual intercourse (8%), and blood transfusion (4%). The predominant clinical presentations among these adolescent patients were generalized dermatitis (77.2%) and lymphadenopathy (50%). Of the patients for whom clinical status could be determined, 70% were "Severely Symptomatic ". Of these patients only 14% were recommended for antiretroviral treatment. CONCLUSIONS: These findings reinforce the need to globally incorporate the goal of the 2002 Joint United Nations Programme on HIV/AIDS (UNAIDS) "to provide reproductive health services, including low-cost or free condoms, voluntary counselling and testing, diagnosis and treatment of sexually transmitted diseases and infections for adolescents in order to effectively prevent HIV infection " (1).

Use of medications by the elderly.

Our study confirms that multiple medications are frequently taken by relatively healthy residents of a retirement village, the more so when they are less socially active during the day, and when they are living in hostel accommodation. There were few drug combinations that caused a potential interaction, suggesting that safe use of medication by the elderly should be an achievable goal.

A life story approach for people with profound learning disabilities.

This article presents an alternative approach to studying issues concerning people with profound learning disabilities. Previous approaches have relied too heavily on quantitative methods, e.g. questionnaires and rating scales, which demand a certain degree of verbal competence. When working with people with profound learning disabilities who can not talk, these techniques are clearly limited. The current research aims to redress this imbalance by presenting an in-depth qualitative analysis of issues concerning the identities of people moving from a long-stay hospital to community care. Life story books were introduced as a resource for presenting biographical information about clients previously undocumented. It is suggested that we should move away from measuring to observing. Life story books take the focus away from viewing the participants as patients or subjects to considering them as people with their own unique life.