Clostridium difficile infection in immunocompromised patients a three health-care facilities in Jamaica

A cross-sectional study was conducted (April 96 to July 97) to investigate the prevalence of Clostridium difficile infection in immunocompromised patients at 3 health care institutions. Standard bacteriological procedure, tissue culture and enzyme immunoassay were used to investigate faecal specimens from immunocompromised inpatients (N = 113) including 21 patients treated with immunosuppressive drugs, 39 patients had received radiotherapy and 53 patients who were not treated with immunosuppressive drugs. The overall prevalence of C. difficile infections was 14.2 percent (16/113). All the C. difficile isolates were identified as toxigenic strains. The prevalence of C. difficile infection in patients who had received immunosuppressive drugs (23.8 percent, 5/21) did not differ significantly from those who had not (20.7 percent, 11/53), but was significantly lower in patients who received radiotherapy (p<0.01). The occurrence of C. difficile was not significantly associated with antibiotics in patients who were on immunosuppressive drugs (2/13, 15.4 percent vs 3/8, 37.5 percent) or patients who were not (7/32, 21.8 percent vs 4/21, 19.0 percent). Eighty percent (4/5) of C. difficile isolates from patients on immunosuppressive drugs were from those whose regimens include cytotoxic drugs. Similarly, anti-tubercolosis drugs were the antibiotics most frequently associated with C. difficile infections (4/8, 50 percent). C. difficile infections are likely to occur in patients treated with cytotoxic drugs and certain antibiotics.(AU)

Primary health care related knowledge attitudes and perceptions of academic staff and medical graduates of the Faculty of Medical Sciences, Mona, University of the West Indies

Primary health care (PHC) is the designated mode to achieve Health For All (HFA) by the Year 2000 (HFA 2000). To this end many organisations and institutions have implemented training programmes to ensure the dissemination of information relating to this concept. In April 1994, a cross-sectional study was conducted on a sample of 81 members of the academic staff of the Faculty of Medical Sciences, Mona, and 81 medical graduates for the years 1982-1992. A self-administered questionnaire was used to ascertain information on knowledge, attitudes and perception. The study revealed that knowledge about HFA and PHC was widely disseminated among both groups although specific knowledge components were far from clear. The graduates scored always marginally better than faculty for knowledge (p < 0.0005). Both groups reported favourable attitudes towards HFA and PHC. However a considerable proportion reported that "HFA is a Utopian ideal". The graduates showed higher attitudinal scores than the faculty (p<0.0004). Seventy seven percent of the academic staff and 85 percent of the graduates perceived PHC to be of practical significance to their job while 43 percent and 58 percent of the academic staff and graduates respectively considered the faculty training programme to be inadequate. These findings suggest that the Faculty of Medical Sciences should have continuing medical education activities giving greater importance to primary health care. Further, periodic and summative evaluation of all programmes be conducted. (AU)