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Motivation for dental hygiene in adolescents. The aim of this study was to investigate the relation between some 'lifestyle' factors and motivation for tooth brushing in young people. Data from a questionnaire survey of 7770 children aged 14-15 years were analyzed to obtain information about their main reason for tooth brushing, their tooth brushing frequency, smoking behaviours and social efficacy. In those who brushed their teeth less frequently, tooth brushing was performed more for cosmetic reasons, that is, having teeth that look and feel good and breath that smells fresh, in contrast to the avoidance of toothache and false teeth, which are health reasons. The more socially advantaged individuals were more inclined to brush their teeth to avoid toothache, and less for the sake of good appearance, compared with the more disadvantaged. Motivation for tooth brushing varied significantly with smoking behavior, committed smokers were more inclined to brush for cosmetic reasons whereas those who had never smoked were more concerned to avoid dental problems. Similarly, those who had a current friend of opposite sex, and in males, those expressing confidence when meeting members of the opposite sex, brushed more for cosmetic reasons. These findings need to be taken into account when instructing patients in personal dental care and formulating dental health messages. Macgregor ID. Balding JW. Regis D. Motivation for dental hygiene in adolescents. International Journal of Paediatric Dentistry. 7(4):235-41, 1997 Dec.
Leshner AI. Addiction is a brain disease, and it matters [see comments].
Science. 278(5335):45-7, 1997 Oct 3.
Adolescent physical abuse
Liaison psychiatry and psychology in dentistry. Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much in appropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing Journal of Psychosomatic Research. 43(5):467-76, 1997 Nov. Kaplan SJ. Pelcovitz D. Salzinger S. Weiner M. Mandel FS. Lesser ML. Labruna VE. Adolescent physical abuse: risk for adolescent psychiatric disorders.
American Journal of Psychiatry. 155(7):954-9, 1998 Jul.
Breasfeeding & drug exposure
A practical guide for the diagnosis and treatment of acute sinusitis OBJECTIVE: To develop guidelines for the diagnosis and management of acute sinusitis. OPTIONS: Diagnostic clinical criteria and imaging techniques, the role of antimicrobial therapy and duration of treatment, and the role of adjunct therapy, including decongestants, glucocorticosteroids and nasal irrigation. OUTCOMES: Improved accuracy of clinical diagnosis, better utilization of imaging techniques and rational use of antimicrobial therapy. EVIDENCE: A MEDLINE search for relevant articles published from 1980 to 1996 using the MeSH terms "sinusitis," "acute sinusitis," "respiratory infections," "upper respiratory infections," "sinusitis" and "diagnosis," "sinusitis" and "therapy," "sinusitis" and "etiology," and "antimicrobial resistance" and search for additional articles from the reference lists of retrieved articles. Papers referring to chronic sinusitis, sinusitis in compromised patients and documented nonbacterial sinusitis were excluded. The evidence was evaluated by participants at the Canadian Sinusitis Symposium, field in Toronto on April 26-27, 1996. VALUES: A hierarchical evaluation of the strength of evidence modified from the methods of the Canadian Task Force on the Periodic Health Examination was used. Strategies were identified to deal with problems for which no adequate clinical data were available. Recommendations arrived at by consensus of the symposium participants were included. BENEFITS, HARMS AND COSTS: Increased awareness of acute sinusitis, accurate diagnosis and prompt treatment should reduce costs related to unnecessary investigations, time lost from work and complications due to inappropriate treatment. As well, physicians will be better able to decide which patients will not require antimicrobial therapy, thus saving the patient the cost and potential side effects of treatment
Howard CR. Lawrence RA. Breast-feeding and drug exposure.
Obstetrics & Gynecology Clinics of North America. 25(1):195-217, 1998 Mar.
Women & substance abuse
TI: Liaison psychiatry and psychology in dentistry. AU: Feinmann-C; Harrison-S SO: J-Psychosom-Res. 1997 Nov; 43(5): 467-76 ISSN: 0022-3999 LA: ENGLISH AB: Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry. Carrington BW. Loftman PO. Jones K. Williams D. Mitchell JL. The special prenatal clinic: one approach to women and substance abuse.
Journal of Womens Health. 7(2):189-93, 1998 Mar.
Initiation of use of alcohol, cigarettes, etc
TI: Clinical manifestations and diagnostic approach to metastatic cancer of the mandible. AU: Glaser-C; Lang-S; Pruckmayer-M; Millesi-W; Rasse-M; Marosi-C; Leitha-T SO: Int-J-Oral-Maxillofac-Surg. 1997 Oct; 26(5): 365-8 ISSN: 0901-5027 LA: ENGLISH AB: In a 12-month period, metastatic cancer was diagnosed in eight patients. Six of them presented with pain mimicking toothache, temporomandibular joint disorders or trigeminal neuralgia, while two showed osteopenic bone lesions in the panoramic radiography, and perimandibular swelling. Anesthesia of the lower lip was the only common clinical feature. In seven of the eight patients, a whole body bone scintigraphy and single photon emission computed tomography (SPECT) of the skull in combination with a whole body and SPECT anti-granulocyte (Tc-99m MAK 250/183) bone marrow scintigraphy was performed. One patient did not have combined scintigraphy performed secondary to severe systemic illness. In six of the seven, the results were conclusive for a metastatic bone lesion. Biopsies confirmed three patients to have a previously unrecognized primary cancer, one patient to have previously unrecognized recurrent cancer, and three patients to exhibit new metastatic spread of an already diagnosed cancer. Histology revealed breast, lung, renal cancer and a malignancy of inconclusive origin. In the remaining patient, combined scintigraphy suggested osteomyelitis, yet biopsy revealed a prostate cancer metastasis with acute inflammatory cell infiltration. Thus, the scintigraphy pattern of a hot spot in the bone scan and a cold lesion in the bone marrow scintigraphy is highly suggestive of a mandibular metastasis, if accompanied by anesthesia of the lower lip. Frank JB. Weihs K. Minerva E. Lieberman DZ. Women's mental health in primary care. Depression, anxiety, somatization, eating disorders, and substance abuse. [Review] [227 refs]
Medical Clinics of North America. 82(2):359-89, 1998 Mar.
Childhood physical assault as a risk factor in substance abuse
TI: Children's dental health in Europe. An epidemiological investigation of 5- and 12-year-old children from eight EU countries. AU: Bolin-AK SO: Swed-Dent-J-Suppl. 1997; 122: 1-88 ISSN: 0348-6672 LA: ENGLISH AB: This thesis is based on a cross-sectional comparative study of dental health, treatment needs and attitudes to dental care in groups of 5- and 12-year-old children from the following eight cities in respective EU countries: Athens-Greece, Berlin-Germany, Cork-Ireland, Dundee-Scotland, Gent-Belgium, Sassari-Italy, Stockholm-Sweden and Valencia-Spain. A total of 3,200 children, 200 in each age group, were clinically examined by well-calibrated dentists, the parents completing a questionnaire on dental habits, parental and children's attitudes to dental care, smoking habits and parental occupations. The results disclosed pronounced differences in dental health and treatment need among the children from the different countries. The Scottish, Italian and German 5-year-olds exhibited the highest values for decayed, missing and filled teeth (dmft). The m component dominated for the Scottish sample, the d component in the Italian and d and f in the German sample. The highest values for DMFT in the 12-year-olds were found in the German, Greek and Italian samples followed by the Swedish sample. The F component dominated in the German and Swedish samples, while D dominated in the Greek and Italian samples. Analyses of the influence of socio-demographic and behavioural factors on the dental health, expressed as dmft/DMFT, showed that the most important factors explaining differences in caries experience were toothache, social class of the family and dental fear in the children. The frequency of similar attitudes (dental fear) in subjects and parents was 50% or higher in all the samples, and the frequency of similar dental attendance patterns in child and parent was 42% or higher in all the samples. For both age groups the proportion of subjects with regular dental attendance habits was highest in the Swedish, Belgian, German and Scottish samples. These findings, together with the high frequency of regular attenders without treatment need in the Swedish 5-year-olds indicate that organization of dental care must be closely adapted to the population it is set to serve. Separate strategies are necessary to manage the dental needs of healthy respectively diseased children. Reliable epidemiological data are necessary for planning, so that resources can be directed to the individuals with the greatest needs. However, to reach the children before onset of disease, parents, teachers, general health workers, sports coaches etc. must work jointly together with the dental profession. Among the eight countries, there is greater similarity in the organization of dental care for schoolchildren than for pre-school children. Only the Swedish system offers both preventive and restorative treatment irrespective of initiatives from the parents. In the other countries parents are mainly responsible for arranging for restorative treatment, above all for pre-school children. Different policies to promote dental health in the child population can be seen. Fluoridation of domestic water supplies has been implemented in Ireland, and the frequent use of fissure sealants in the Scottish, Irish and also the Belgian 12-year-olds is another example of a cost-effective measure influencing the dental health..
Duncan RD. Saunders BE. Kilpatrick DG. Hanson RF. Resnick HS. Childhood physical assault as a risk factor for PTSD, depression, and substance abuse: findings from a national survey [published erratum appears in Am J Orthopsychiatry 1997 Jan;67(1):161].
American Journal of Orthopsychiatry. 66(3):437-48, 1996 Jul.
Substance abuse & divorce
TI: [A case of pulmonary tuberculosis complicated with gingival lesions] AU: Kobayashi-T; Sato-M; Onoi-Y; Ohshiro-S; Nishii-K; Ishihara-T; Tomino-I; Nisihimoto-M; Tsubura-E; Okazaki-T; Yamanaka-H SO: Kekkaku. 1997 Jun; 72(6): 411-4 ISSN: 0022-9776 LA: JAPANESE; NON-ENGLISH AB: A case of secondary gingival tuberculosis is presented. The case is 51 year-old male who had been suffering from undetected pulmonary tuberculosis visited a dentist because of chronic periodontal inflammation around the gingiva of the right upper and left lower molar teeth lasting for one year. The lesions remained unchanged and painful granulomatous swelling sustained in spite of the conservative treatment. The case was treated with the extraction of six teeth due to continued toothache. By pathohistological examination of gingiva and chest X-ray examination, the case was diagnosed as tuberculosis. Chest roentgenogram showed active pulmonary tuberculosis, and bacteriological examination of sputum showed tubercle bacilli. The administration of INH, RFP and EB was started, and the response to the treatment was good and the pain in the gingiva disappeared within three weeks. Secondary gingival tuberculosis is manifested as local granulomatous lesions with severe pain. The incidence of gingival tuberculosis is very rare, but we have to keep in mind that the oral tuberculosis secondary to pulmonary tuberculosis could occur. AN: 1997391483 Shafik A. Cohen O. Savaya R. "Broken Glass": the divorced woman in Moslem Arab society in Israel.
Family Process. 36(3):225-45, 1997 Sep.
Office approach to drug abuse prevention
TI: Dental health and dental treatment needs among recruits of the Finnish Defence Forces, 1919-91. AU: Ankkuriniemi-O; Ainamo-J SO: Acta-Odontol-Scand. 1997 Jun; 55(3): 192-7 ISSN: 0001-6357 LA: ENGLISH AB: The first two surveys of the dental health of young Finnish men were conducted in 1919 and 1965. The objective of four subsequent surveys (1976, 1981, 1986, and 1991) was to collect both interview and clinical examination data for the monitoring of changes in the oral health status of the recruits. A significant reduction in self-reported toothache, gingival bleeding, and number of decayed teeth was observed from 1976 to 1991. At examination, the numbers of decayed teeth, teeth indicated for extraction, teeth in need of fillings, and missing teeth decreased substantially, as did the teeth with visible plaque, subgingival calculus, and teeth with 4-mm or deeper periodontal pockets. This comprehensive series of successive cross-sectional oral health surveys clearly shows that since 1976 a significant decrease in oral disease and treatment needs has taken place among the Finnish population of young men.
Heyman RB. Adger H Jr. Office approach to drug abuse prevention. [Review] [11 refs]
Pediatric Clinics of North America. 44(6):1447-55, 1997 Dec.
A new approach to substance abuse treatment
TI: Oral disease, impairment, and illness: congruence between clinical and questionnaire findings. AU: Unell-L; Soderfeldt-B; Halling-A; Paulander-J; Birkhed-D SO: Acta-Odontol-Scand. 1997 Apr; 55(2): 127-32 ISSN: 0001-6357 LA: ENGLISH AB: In 1992 a questionnaire was sent to 50-year-olds in two Swedish counties. These self-report data were compared with clinical observations with regard to number of teeth, removable dentures, caries, and periodontitis. Complete information from both data sources was obtained for 1041 persons. The relevant questionnaire item explained 71% of the missing tooth variance. An agreement of 0.91 (Cohen's kappa) was obtained for removable dentures. A question about problems in opening the mouth differentiated clearly with regard to measured mouth opening ability. Toothache and tooth sensitivity were reported with 95% probability when having 22 decayed teeth and with 46% when there were no decayed teeth (58% correctly predicted). Two teeth with pockets > or = 6 mm gave 5% probability and 22 such teeth gave 39% probability of reporting migration of front teeth. The main conclusion from this study is that there is good correspondence between subjective self-reports and clinical findings, especially for those conditions that are relatively easy for the patient to observe, such as the number of teeth and the presence of dentures. Thus questionnaire data can be used for information and screening about some well-defined oral conditions.
Stratton J. Gailfus D. A new approach to substance abuse treatment. Adolescents and adults with ADHD. [Review] [11 refs]
Journal of Substance Abuse Treatment. 15(2):89-94, 1998 Mar-Apr.
Suicidal children
TI: Nonodontogenic toothache. AU: Okeson-JP; Falace-DA SO: Dent-Clin-North-Am. 1997 Apr; 41(2): 367-83 ISSN: 0011-8532 LA: ENGLISH AB: Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to consider that the pain may not be of dental origin. Signs and symptoms suggestive of nonodontogenic toothache are as follows: 1. Inadequate local dental cause for the pain. 2. Stimulating, burning, nonpulsatile toothaches. 3. Constant, unremitting, nonvariable toothaches. 4. Persistent, recurrent toothaches over months or years. 5. Spontaneous multiple toothaches. 6. Local anesthetic blocking of the suspected tooth does not eliminate the pain. 7. Failure to respond to reasonable dental therapy of the tooth.
Pfeffer CR. Normandin L. Kakuma T. Suicidal children grow up: relations between family psychopathology and adolescents' lifetime suicidal behavior.
Journal of Nervous & Mental Disease. 186(5):269-75, 1998 May.
School counselling in substance abuse risk reduction
TI: [Headache and teeth] AU: Palla-S SO: Ther-Umsch. 1997 Feb; 54(2): 87-93 ISSN: 0040-5930 LA: GERMAN; NON-ENGLISH AB: Headache, facial pain and toothache are poorly localized and irradiate in distant areas. Thus, toothache often causes facial pain and headache, but, in turn, it can also be mimicked by several forms of these disorders, in particular by a myoarthropathy of the masticatory system, a migraine, a tension-type headache, a neuropatic pain and a trigeminal neuralgia. The atypical odontalgia is a nonodontogenic form of toothache that is difficult to diagnose; therefore, it leads to a number of invasive dental procedures which normally worsen the pain condition. The atypical odontalgia can often be solely diagnosed by means of a diagnostic block. Headache and facial pain can also be caused by a myoarthropathy of the masticatory system. This disorder is often misdiagnosed, because the signs and symptoms are not pathognomonic, and they are frequently present also in healthy individuals. The disorder has a good prognosis, the therapy is generally simple and follows the treatment principles for chronic musculoskeletal disorders. The burning-mouth syndrome is an other poorly understood form of intraoral pain that occurs primarily in postmenopausal females. Several etiologic factors have been described, but treatment based on one or more of these factors is often ineffective. Spontaneous remission occurs in about half of the patients after several years. McClanahan KK. McLaughlin RJ. Loos VE. Holcomb JD. Gibbins AD. Smith QW. Training school counselors in substance abuse risk reduction techniques for use with children and adolescents. Journal of Drug Education. 28(1):39-51, 1998.
Counselling and care for substance abusers
TI: Importance of dental problems according to 12- to 16-year-old children. AU: Assink-MH; Verhey-JG; Hoogstraten-J; Goedhart-H SO: Pediatr-Dent. 1996 Sep-Oct; 18(5): 391-4 ISSN: 0164-1263 LA: ENGLISH AB: The willingness to take preventive action is partly determined by the perceived importance of the disease. The purpose of this study was to investigate the relationship of age, sex, education, and ethnicity to the importance of dental and other health problems by 12- to 16-year-old children. The children (361 boys, 272 girls) attending Dutch schools were asked a series of questions requiring a choice by students as to the more important problems in a given pair of conditions. Conditions included systemic, dental, and psychological problems. Nervousness was the least important problem and hearing disability the most of the nine ranked. Having full dentures was ranked third, bad teeth fifth, and toothache sixth of the nine from least (first) to most important (ninth). Age, sex, education, and ethnicity showed no relationship to importance of problems alone or in aggregate..
Dorsch NG. Being real and being realistic: chemical abuse prevention, teen counselors, and an ethic of care.
Journal of Drug Education. 27(4):335-48, 1997.
ADHD & substance abuse
TI: [Biological rhythm, inflammation and non-steroidal anti-inflammatory agents] AU: Bureau-JP; Labrecque-G SO: Pathol-Biol-Paris. 1996 Sep; 44(7): 610-7 ISSN: 0369-8114 LA: FRENCH; NON-ENGLISH AB: The inflammation is characterized by a multifrequency time structure described both in the edematous reaction and in the migration of neutrophilic polymorphonuclear (PMN) in the inflammatory site. The circadian rhythm of PMN migration appears to be similar when the migration was induced by BCG, LPS or carrageenan. The corticosteroids play an important role in the mechanisms in the circadian rhythm of PMN, but recent data in intact and castrated mice indicated that testosterone is also involved in these mechanisms. In arthritic patients, the signs and symptoms of the diseases varied as a function of time of day and of the type of arthritic diseases. Human data with indomethacin, ketoprofen and piroxicam indicated that it is possible to find an optimal time of day for the administration of these non-steroidal anti-inflammatory agents (NSAID). Clinicians can use these chronopharmacological data to maximize the analgesic effect and to minimize the side effects of the NSAID. The research on biological rhythms in inflammation and in the effects of NSAID lead to a better understanding of the mechanisms of inflammation and to the rational use of the drugs in arthritic patients.
Levin FR. Kleber HD. Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment. [Review] [78 refs]
Harvard Review of Psychiatry. 2(5):246-58, 1995 Jan-Feb.
Psychopathology in preadolescent children
TI: Barodontalgia among flyers: a review of seven cases. AU: Holowatyj-RE SO: J-Can-Dent-Assoc. 1996 Jul; 62(7): 578-84 ISSN: 0709-8936 LA: ENGLISH AB: Once referred to as "flyer's toothache," barodontalgia is defined as tooth pain occurring with changes in ambient pressure. It usually occurs in people who fly or dive. It can develop in conjunction with sinusitis, and in teeth experiencing pulpitis after restorative treatment, new and recurrent caries, intra-treatment endodontic symptoms, dental and periodontal cysts, or abscesses. Although the causal process of barodontalgia is not well understood, it may be related to pulpal hyperemia, or to gases that are trapped in the teeth following incomplete root canal treatment. Patients who are frequently exposed to changes in ambient pressure should be encouraged to follow good oral health practices, attend regularly-scheduled dental recall examinations and accept the timely completion of restorative treatment to minimize the possibility of developing barodontalgia. By employing a classification system to document cases of barodontalgia, dentists will be better prepared to provide appropriate and successful treatment. Seven case reports of barodontalgia are presented and compared to previously documented cases. The author also reviews the reasons why military flyers are more likely to develop barodontalgia than others, although the passengers and crews of commercial airliners may also suffer from this condition..
Wilens TE. Biederman J. Psychopathology in preadolescent children at high risk for substance abuse: a review of the literature. [Review] [124 refs]
Harvard Review of Psychiatry. 1(4):207-18, 1993 Nov-Dec..
In utero exposure to drugs
TI: Thermographic assessment of neuropathic facial pain. AU: Graff-Radford-SB; Ketelaer-MC; Gratt-BM; Solberg-WK SO: J-Orofac-Pain. 1995 Spring; 9(2): 138-46 ISSN: 1064-6655 LA: ENGLISH AB: Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. The purpose of this study was to determine if electronic thermography was able to differentiate neuropathic facial pains presenting as toothache from pulpal pathology. Electronic thermography was used to compare asymptomatic subjects and subjects with neuropathic facial pains. Asymptomatic subjects and subjects with trigeminal neuralgia, pre-trigeminal neuralgia, and pulpal pain without periapical pathology showed no thermographic difference in the territory of the pain complaint when compared to the opposite nonpainful side. Patients with sympathetically maintained traumatic trigeminal neuralgia (atypical odontalgia) and half of the group with sympathetically independent traumatic trigeminal neuralgia presented with "hot" thermograms. The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.
Kenner C. D'Apolito K. Outcomes for children exposed to drugs in utero. [Review] [46 refs]
Journal of Obstetric, Gynecologic, & Neonatal Nursing. 26(5):595-603,1997 Sep-Oct.
Child abuse & substance abuse
TI: [A case of pulmonary tuberculosis complicated with gingival lesions] AU: Kobayashi-T; Sato-M; Onoi-Y; Ohshiro-S; Nishii-K; Ishihara-T; Tomino-I; Nisihimoto-M; Tsubura-E; Okazaki-T; Yamanaka-H SO: Kekkaku. 1997 Jun; 72(6): 411-4 ISSN: 0022-9776 LA: JAPANESE; NON-ENGLISH AB: A case of secondary gingival tuberculosis is presented. The case is 51 year-old male who had been suffering from undetected pulmonary tuberculosis visited a dentist because of chronic periodontal inflammation around the gingiva of the right upper and left lower molar teeth lasting for one year. The lesions remained unchanged and painful granulomatous swelling sustained in spite of the conservative treatment. The case was treated with the extraction of six teeth due to continued toothache. By pathohistological examination of gingiva and chest X-ray examination, the case was diagnosed as tuberculosis. Chest roentgenogram showed active pulmonary tuberculosis, and bacteriological examination of sputum showed tubercle bacilli. The administration of INH, RFP and EB was started, and the response to the treatment was good and the pain in the gingiva disappeared within three weeks. Secondary gingival tuberculosis is manifested as local granulomatous lesions with severe pain. The incidence of gingival tuberculosis is very rare, but we have to keep in mind that the oral tuberculosis secondary to pulmonary tuberculosis could occur.
Child Abuse & Neglect.ugtoitupn.re Fergusson DM. Lynskey MT. Physical punishment/maltreatment during childhood and adjustment in young adulthood.
Child Abuse & Neglect. 21(7):617-30, 1997 Jul.
Drug addict pregnant women & their children
Children of substance abuse mothers have an increased risk of severe pathological disorders such as perinatal diseases (prematurity, intrauterine growth retardation, infections) with their neurological and respiratory complications and sequelae, and transmission of drug addiction related infections, ie human immunodeficiency virus, hepatitis B and C virus, syphilis. Many of these children present a drug withdrawal syndrome characterized by restlessness and jetteriness during the neonatal period. This is frequently followed by a post withdrawal period of several weeks duration with crying, excitement, sleep and feeding difficulties. Although these drug withdrawal manifestations have no incidence on the vital prognosis, it severely impairs the mother-infant interaction. Despite these disorders it appears that the outcome of these children is mainly related to their familial environment which is exposed to many risk factors: mother-child separation, violence, delinquency, precariousness, unhealthy housing, prostitution, drug dependency, parental death or imprisonment... Early medico-psycho-social intervention starting during pregnancy and a prolonged support for several years are the only way to improve their spontaneously poor outcome.
Lejeune C. Floch-Tudal C. Montamat S. Crenn-Hebert C. Simonpoli AM. [Management of drug addict pregnant women and their children].
Archives de Pediatrie. 4(3):263-70, 1997 Mar.
Family background of drug related deaths
Drug abuse and problems arising from it are increasing all over the world. Most of the research concerning substance abuse has focused on three dimensions: sociocultural influences, personal characteristics, and interpersonal factors. The aim of this descriptive study was to describe family characteristics of drug-related deaths examined at the Viennese Institute of Forensic Medicine in 1993. Furthermore, it was of interest to analyze the onset of substance use as well as traumatic life events during childhood. For this purpose, relatives or partners for life of drug-related deaths, examined from 1 Jan. to 30 June 1993 at the Institute of Forensic Medicine in Vienna, were interviewed using a semistructured technique.Eighty percent of drug users were reported to have experienced a traumatic event during their childhood. In the majority, this was the parents' divorce or the death of a parent. Male drug users were significantly younger at time of this event than females. The first signs of smoking and alcohol drinking of examined drug users, as recognized by the interviewees, occurred at the age of about 15. Those who experienced a traumatic event during their childhood started to smoke at a significantly lower age. In 3/4 of investigated cases, parents also were smokers, and more than one third of families had a problem drinker, mostly the father. In 16% of drug users, a mental disturbance concerning the mother was reported, and in 14%, prescribed psychoactive drugs were regularly used. Physical violence, generally by the father, was a common phenomenon in 20% of investigated families. About 45% of the victims were from families having more than one of these factors present.
Kenner C. D'Apolito K. Risser D. Bonsch A. Schneider B. Family background of drug-related deaths: a descriptive study based on interviews with relatives of deceased drug users.
Journal of Forensic Sciences. 41(6):960-2, 1996 Nov.
Women & managing drug abuse in the family
The abuse of alcohol and other drugs presents a multiplicity of problems for the abuser, family members and the wider community. The psychosocial, as well as the economic, problems can produce an environment of chaos and misery. Women in families in which there is an abuser are challenged in a variety of ways and, depending on the severity of the situation and their capacity to cope, they may confront the problem, seek help of withdraw from it. The present article reviews the impact of drug abuse within the family on Jamaican women from the viewpoint of treatment and rehabilitation specialists and the women themselves and on the basis of case histories and the work experience of the author. Although there have been efforts through demand reduction strategies and culturally relevant treatment and rehabilitation programmes to control the epidemic of drug abuse, the specific needs of women have been left largely unattended.Both men and women are however critical in the fight against drug abuse and women have the skills and experience that can contribute to making such programmes achieve their desired objectives. Addressing their needs would not only help them, but also the family and the wider community. In order to address these needs effectively with the limited resources available, however, a credible basis for action has to be established, which can only be done by research and analysis so that the issues can be clearly defined and a plan of action developed.
Boyce-Reid K. The challenge for women with a drug-abusing family member: the Jamaican perspective. [Review] [11 refs]
Bulletin on Narcotics. 47(1-2):23-30, 1995.
Efforts should be made to design and implement drug abuse assessment programmes to determine the real magnitude and characteristics of the problem and to monitor its trends. A lack of funds and a shortage of adequately trained personnel have made it difficult to implement drug abuse control programmes. In addition to formal drug control involving the implementation of legislation, there is an informal system of drug abuse control operating through the family, church, school, neighbourhood and work environment, as well as healthy recreational activities. It is suggested that efforts in African countries should be directed towards strengthening not only the formal drug control system but also informal control in order to compensate for the insufficient funds and the shortage of personnel trained in implementing formal drug control measures. It is very likely that the drug problems in African countries will worsen in future unless more effective measures are implemented to arrest the current situation.
Introduction:
Drug abuse is defined as "... excessive or inappropriate use of a
(psycho-active) substance by a person; such use being
considered or judged to be illegal (immoral) by the culture and
resulting in harm to the person or society" [1]. In
defining the phenomenon, therefore, the key determinant is the
perception of society of what constitutes drug abuse. It
may be stated in general terms that the socio-cultural values and
standards relating to drug abuse in Africa have been
weakened by the influence of international developments relating to
drug abuse, which have given rise to the change in
what society considers abuse.
Historical Background:
With the exception of North Africa, where cannabis resin (Hashish)
has traditionally been used by members of the Sufi
sect, east Africa, where the use of khat has been institutionalized,
and perhaps southern Africa, where cannabis (dagger)
has been widely used [2], there is no evidence to support the view
that the abuse of drugs has been part of the African
heritage [3,4]. Other psycho-active substances currently being
abused do not have historical antecedents in any part of
Africa. Africans, though deeply religious, have not used drugs as a
medium in religious rituals, and none of the
indigenous herbal psycho-active substances have been used in
ceremonies [2].
The situation in Africa and the life-styles of the Africans have drastically changed over the past years under the influence of industrial and urban developments. These developments have, in turn, changed the way in which the Africans achieve ataraxia; at present, the easiest way to achieve it is to resort to psycho-active substances.
Khat (Catha edulis), a plant grown mainly in southern Arabia and eastern and souther Africa [5], first received international attention in 1935 at the league of Nations [6]. The psycho-active effects of khat chewing, which are derived from cathine and cathionone [7], are similar to the effects produced by using amphetamines. Within the African region, khat has been grown and used in Ethiopia, Kenya, Madagascar, Somalia and the United Republic of Tanzania. The fact that the pleasurable, stimulating and euphoric effects of khat chewing can only be derived from the fresh leaves and shoots of the plant may have contributed to the low popularity of khat as a substance of abuse beyond the local areas of cultivation.
The plant Cannabis sativa, from which cannabis preparations such as marijuana and hashish are derived, grows wild in Africa. Certain evidence suggests that the cultivation of cannabis and its use as a drug of abuse were introduced into Africa from India [8-10] by the Sufi sect and by Asian traders and travellers [9,11]. One study indicated that the cannabis plant and its use could have been spread across the Sahara to west Africa around the sixteenth century [8]. There is also evidence suggesting that soldiers returning from the Second World War were responsible for the increased incidence of cannabis abuse in West Africa, particularly in Nigeria [2,4]. This is supported by the fact that in west Africa there is no known indigenous name for cannabis, nor has it been used there for mystical purposes. This is also supported by research findings indicating that cannabis is an important factor in the occurrence of mental illness in Africa [12,13]; this factor is much less known in cultures where cannabis has for a long time been consumed [14].
Another possible route was across the Indian Ocean. This may have been the route by which travellers from India brought cannabis from India to east, central and south Africa as early as the second century, but there is no evidence to suggest that the use of cannabis spread at that time from there to the west coast of Africa.
Current Drug Abuse Situation in Africa:
Because of the lack of information on the subject, an assessment of
the extent, patterns and trends of drug abuse in all the
countries of Africa is not an easy task. There are no systems for
collecting and retrieving data on drug abuse in African
countries, and drug abuse assessment projects are urgently needed for
all African countries. This article has, to a large extent, been prepared on the basis of data provided by various workshops and seminars held
on the subject in the course of the past 12 years.* The following
paragraphs summarize the drug abuse situation
according to the most commonly abused substances .
Cannabis:
Cannabis grows wild in most parts of Africa but it is also illicitly
cultivated. It is the most widely abused illicit drug in
the region. It appears to be less abused in countries of east
Africa, such as Ethiopia and Somalia, where the abuse of
khat is prevalent. Although cannabis is not indigenous to west
Africa, it is illicitly cultivated and widely abused in the
part of the continent. In Nigeria, cannabis is predominantly abused
by teenagers, who begin using it at the age of 14.
The situation in other west African countries is similar.
Khat:
The chewing of khat has been practised for years and is, to a large
extent, socially accepted in Ethiopia, Kenya,
Madagascar and Somalia; some of these countries are introducing
control measures to discourage the cultivation and use
of the khat. Apart from the habitual use of Khat, Workneh [15]
reports that it is used by students to improve their
academic performance, by truck drivers to keep themselves awake and
by labourers to supply the extra vigour and
energy they need for their work. It is interesting to note that the
same reasons have been reported by cannabis users in
west Africa.
Amphetamines
Amphetamines are imported into Africa, although there is no
significant medical justification for using these substances.
They are often illegally smuggled into African countries, where they
eventually find their way into open markets and
patent medicine stores.
A few countries, such as Somalia, the Sudan and Togo, have not reported any amphetamine-related problems, but there is general consensus that the abuse of amphetamines in Africa is a problem mainly among adolescents and unskilled labourers, such as drivers and farmers.
Opium:
Opium is reported to have been abused, sometimes in combination with
cannabis or alcohol, in Mauritius, mainly among
the Chinese ethnic group.
Cocaine, Heroin and Lysergic Acid Diethylamide:
These drugs are not manufactured in Africa but have been increasingly
present in Nigeria and other west African
countries, as shown by recent seizures and arrests. The evidence
suggests that African, and especially west African
countries, are used by drug traffickers as transit points for heroin
trafficking from South-East Asia to Europe and North
America. It has recently been reported that some Nigerians have been
used as carriers of drugs and some have invested
in the illicit drug trafficking [16]. Cocaine and heroin have
recently been seized for the first time in the Sudan.
An increasing abuse of cocaine and heroin has been reported in
Nigeria [13]. The abuse of these drugs has also been
reported in other African countries such as Kenya, Liberia and
Mauritius.
Sedative-Hypnotics:
For the purpose of this article, sedative-hypnotics include
barbiturates, benzodiazipines and other substances, the abuse
of which presents similar problems. These substances are imported
for legitimate medical purposes, but reports from
various African countries indicate that they have also been abused,
especially by women. A study in Nigeria has shown
that, in order of magnitude, the abuse of these substances is second
in rank following alcohol abuse [13]. Mandrax
(methaqualone and diphenhydramine) was commonly abused in Nigeria in
the early 1970s, but since it was banned, its
abuse has abated [13]. However, some other African countries, such
as Swaziland, have reported an increase in the
trafficking and abuse of Mandrax.
Glue and Petrol Sniffing:
An increase in the abuse of benzine by inhalation has been reported
among Sudanese children [17]. Recent reports from
Kenya, Somalia, Swaziland and Zambia indicate the abuse of glue and
petrol by sniffing, though the extent of such abuse
varies from country to country. Pela and Ebie [13] highlighted the
potential for abuse of volatile solvents in some
occupational groups in Nigeria. Most recent reports from Ethiopia
indicate that the abuse of glue and petrol is prevalent
among juveniles.
Pethidine, Morphine and Demerol:
These drugs have mainly been abused in African countries by
individuals working in the field of health, but such abuse
has not been widespread.
Effects of Drug Abuse in Africa:
The amotivational syndrome has been described as an effect of
cannabis abuse. It leads to a poor school performance
and the adolescent may eventually drop out altogether.
The percentage of cannabis-associated psychosis has been reported to
be between 12 and 40 per cent of all psychosis in
African psychiatric hospitals. These findings leave no doubt that
the abuse of cannabis in African conditions can
contribute to the development of psychosis in susceptible
individuals. Boroffka has observed that two types of psychosis
may develop in association with cannabis abuse: (a) a reaction to the
first exposure to cannabis abuse in a previously
well-integrated personality; and (b) escalation of a psychotic
process in a personality that has already been breaking
down (the resort to cannabis is in this case a symptom of the
incipient psychosis) [18].
The cannabis-associated psychosis is a schizophrenic-like disorder and may be accompanied by a bout of excitement. Certain evidence suggests that cannabis use is one of the important contributory factors in automobile accidents. It has been reported that criminals involved in highway or armed robberies use cannabis before committing such criminal acts. The habitual cannabis user is usually a drifter, unable to maintain a job or establish a continuous relationship with others, especially with members of the opposite sex.
Amphetamine psychosis, which is usually acute, is especially noticeable among students during pre-examination period. As khat chewers spend more time chewing khat than working, khat abuse affects the productivity of the countries involved. Khat users from the lower income group may spend as much as half of their daily earnings on khat. The abuse of cocaine and heroin is a new and increasing phenomenon inmost African countries and there is currently no evidence available to assess its psycho-social effects.
The relationship between crime and drug abuse has not been sufficiently studied in African countries, and this subject merits the attention of future research. There have been reports suggesting that adolescents have stolen money from family members to procure the drugs of their choice. Reports of stealing outside the family and mugging have not been very common. There have been reports that the use of cannabis is associated with serious criminal behaviour, such as armed robbery, reckless driving, assault and homicide, but such reports have not been substantiated.
Treatment and Rehabilitation:
The holistic approach to treatment is favoured, encompassing the
whole of the individual. Treatment is carried out by a
treatment team, which includes a nurse, a clinical psychologist, a
social worker, an occupational therapist and a
psychiatrist who usually leads and co-ordinates the team. In most
African countries, there is a dearth of treatment
personnel. These countries cannot afford the over-specialization and
the rigid division of roles in treatment.
Detoxification is considered an integral part of the whole treatment and is not usually applied as an isolated entity. Rehabilitation goes along with psychiatric treatment, which involves relatives and friends of the addicted person. There is no special treatment set-up for drug-dependent persons in African countries. Treatment usually commences in a general psychiatric hospital, but there is a shortage of such facilities. The patient is hospitalized for detoxification and his close relatives and friends are asked to help in the treatment process. On the basis of observation and information obtained from the patient and his relatives and friends, the treatment programme defines the patient's problems, including those of a personal, familial, economic, social, occupational or marital nature, as well as ways to deal with such problems.
During detoxification the patient may receive social and pharmacological support to avert or reduce withdrawal symptoms, but it is not the practice to administer a substitute drug for maintenance purposes in African countries. It has not been possible to follow up drug abuse cases in any systematic manner after treatment, because patients are difficult to trace when they stop attending treatment facilities. It is believed that some traditional healing practices can enhance and reinforce the effectiveness of treatment. Acupuncture has been used for the treatment of addicts in Mauritius, where it has been found to reduce the severity of withdrawal symptoms [19].
The duration of in-patient treatment varies from patient to patient and from hospital to hospital, but, in general, it exceeds the usual period required for detoxification. The major criterion for discharging the patient from a treatment facility is that the patient, having been weaned from his drug, appears to exhibit no yearning for it and has worked out a practical and realistic plan to keep off drugs. It is of particular importance that strong social and family support is provided for the discharged patient, who as a general rule continues treatment in an out-patient department. The family members, in co-operation with the therapists, monitor the patient's movement and behaviour.
Control Mechanisms:
Psycho-active substances are controlled in Africa either through
formal or informal control measures.
Formal Control:
The formal control measures embody national legislation that
implements the two main international drug control
conventions [20, 21]. Nearly all African countries are already
signatories to these two conventions. Legislation in most
African countries provides heavy penalties for offences involving
very dangerous illicit drugs, such as cocaine and
heroin. For example, in Nigeria, death by firing squad is the
punishment for illegal possession, use, trafficking or
cultivation of such drugs. In formulating policies, no distinction
is made between the drug pusher and the user.
Offences relating to cannabis are treated more leniently in most
African countries. There are some difficulties in enforcing formal control measures,
mainly because of the shortage of funds and trained
personnel required to implement such control.
Informal Control:
In addition to the control system entailing the implantation of drug
control legislation, there is a system of informal
control, which includes the family, church, school, neighbourhood and
work environment, as well as healthy forms of
recreation. Since the implementation of the official control system
is limited by inadequate funding and a shortage of
trained personnel, greater emphasis needs to be placed on the
informal control system.
The most important component of this system resides in the family. One of the reasons often given for drug abuse by young people is peer pressure, but it should be remembered that such pressure succeeds only if it is stronger than family and parental influence on the young. Family and parental influence depends on the level of affection, communication, interaction and cohesion within the family. Very often, young people are left to their own devices with the assumption that they will learn from their own mistakes. Unfortunately, the damage done by some mistakes is irreparable. For instance, in African countries there is a lack of educational facilities, and an adolescent who has dropped out of school may find it impossible to enrol again in an educational institution once he has outgrown the pattern of behaviour that led him to his failure.
In small towns and villages, bringing up children is not the exclusive responsibility of the parents and the family. It is a task that is also shared by neighbours except in the big cities, where the local community spirit is much weaker. Furthermore, respect for tradition, which includes respect for elders and for the family name and status, obliges each family member to consider at all times the impact of his behaviour on the honour and prestige of his family.
There are certain patterns of behaviour, such as drug abuse, that are not socially acceptable and carry a certain degree of opprobrium, an attitude that must be very clearly maintained. Such behaviour should not be condoned or tolerated. It is, for example, a grave mistake to glamorize or praise artists or other successful personalities who are known to abuse drugs, while at the same time playing down the fact that they are dependent on drugs.
The major religions do not approve of the non-medical use of drugs and drug dependence. Participation in religious activities and observance of religious tenets can certainly help in controlling drug abuse. Healthy recreational activities help young people to spend their free time in a constructive manner and to draw their attention away from drug abuse. Youth organization, such as boys' clubs and girls' clubs, the Boy Scouts and Girl Scouts and Guides, are examples of informal programmes that can carry out such activities and thus help to prevent drug abuse.
Future Trends:
It is expected that improved communication, particularly the
completion of the proposed trans-African highway linking
east and west Africa, may lead to an increase in drug trafficking and
other drug-related problems in Africa. Improved
communication may result in a broader distribution of the khat and
cannabis that grow in Africa and of illicitly imported
drugs, such as cocaine and heroin.
While the widespread abuse of drugs such as cannabis had initially been observed among the marginal and lower economic classes of society in West Africa, such abuse has been spreading to the more affluent members of society, and this trend will probably continue. Adolescents and young adults appear to be the main populations at risk of drug abuse. It is very likely that, in future, youth may turn to the use of more potent drugs, with all the predictable health and socio-economic consequences.
T. Asuni & O.A. Pela
United Nations. Bulletin on Narcotics Vol. xxxviii, Nos. 1 & 2
The FDA is considering additional warnings on beer and
alcohol bottles, such as:
Read each question carefully. Answer all questions. Time Limit: Four hours. Begin immediately.
MEDICINE: You have been provided with a razor blade, a piece of gauze and a bottle of Scotch. Remove your appendix. Do not suture until your work has been inspected. You have fifteen minutes.
BIOLOGY: Create life. Estimate the differences in subsequent human culture if this form of life had developed 500 million years earlier with special attention to its probable effect on the English parliamentary system. Prove your thesis.
COMPUTER SCIENCE: Write a program that will end world hunger and homelessness. You may use the computer console next to you, however use of a modem or any other communications device is prohibited, as is the use of electricity.
ENGINEERING: The disassembled parts of a high-powered rifle have been placed in a box on your desk. You will also find an instruction manual, printed in Swahili. In ten minutes a hungry Bengal tiger will be admitted to the room. Take whatever action you feel appropriate. Be prepared to justify your decision.
PHYSICS: Explain the nature of matter. Include in your answer an evaluation of the impact of the development of mathematics on science.
ASTRONOMY: Create a miniature stellar fusion reaction, and describe in detail the effects of close-range stellar radiation on human flesh.
HISTORY: Describe the history of the papacy from its origins to the present day, concentrating especially but not exclusively, on its social, political, economic, religious and philosophical impact on Europe, Asia, America and Africa. Be brief, concise and specific.
GEOGRAPHY: Predict the position of the tectonic plates as they will appear two billion years from now. Be prepared to prove your results.
ECONOMICS: Develop a realistic plan for refinancing the national
debt. Trace the possible effects of your plan in the following areas:
*cubism *the Donatist controversy *the wave theory of light.
Outline a method for preventing these effects. Criticize this method
from all possible points of view. Point out the deficiencies in your point of
view, as demonstrated in your answer to the last question.
PUBLIC SPEAKING: 2500 riot-crazed aborigines are storming the classroom. Calm them. You may use any ancient language except Latin or Greek.
ART: Give an objective analysis of the relative significance and quality of the works of the major artists of the past three millenia. Be specific, and prove your analysis with detailed examples.
MUSIC: Write a piano concerto. Orchestrate and perform it with flute and drum. You will find a piano under your seat.
PSYCHOLOGY: Based on your knowledge of their works, evaluate the
emotional stability, degree of adjustment and repressed frustrations
of each of the following:
*Alexander of Aphrodisias *Ramses II *Gregory of Nicea *Hammurabi
Support your evaluation with quotations from each man's work, making
appropriate references. It is not necessary to translate.
SOCIOLOGY: Estimate the sociological problems which might accompany the end of the world. Construct an experiment to test your theory.
POLITICAL SCIENCE: There is a red telephone on the desk beside you. Start World War III. Report at length on its socio-political effects, if any.
EPISTEMOLOGY: Take a position for or against truth. Prove the validity of your position.
PHILOSOPHY: Sketch the development of human thought; estimate its significance. Compare with the development of any other kind of thought.
RELIGIOUS STUDIES: Prove or disprove the existence of God, without the use of religious texts over ten centuries old. Be specific, and include a discussion on the possible true meanings and uses for the Tetragrammaton.
GENERAL KNOWLEDGE: Describe in detail. Be objective and specific.
Half of all new infections now in 15-24 year olds. Development gains being wiped out Sub-Saharan African countries hardest-hit. Already 34 million infections and almost 12 million deaths Fewer deaths in North America, Western Europe, but no progress in prevention; HIV infection rates unchanged for a decade. According to a report issued today by the Joint United Nations Pro-gramme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) - The AIDS Epidemic Update, December 1998 - during the past year a further 5.8 million people were infected with HIV - approximately 11 men, women and children every minute - and the total number of people living with the virus rose by one-tenth, to 33.4 million world-wide.
Half of all new infections are now occurring among young people aged 15 to 24. This year's World AIDS Campaign "Young People: Force for Change" was prompted in part by the epidemic's threat to those under 25 years old, for as HIV rates rise in the general population, new infections are increasingly concentrated in the younger age group.
The global epicentre of AIDS continues to be sub-Saharan Africa. Since the epidemic began, 34 million Africans have been infected, and almost 12 million of them have already died. In 1998 the region experienced four million new infections and rising AIDS death tolls, seen in an es-timated 5,500 funerals per day. In the southernmost countries of the continent, where HIV spread took on epidemic proportions only recently, infection rates continued to rise dramatically during the past year. Four countries now estimate that 20% to 26% of adults are living with HIV, and South Africa alone accounts for one out of every seven new in-fections on the continent. In contrast a number of countries in West Africa remain relatively less affected, in part as a result of early and sustained prevention efforts.
In the regions of North America and Western Europe, the availability of new more potent anti-HIV drug combinations has helped people with HIV live longer, healthier lives. In the United States, for example, the number of people dying from AIDS dropped by two-thirds between 1995 and 1997, when these anti-retroviral combinations came into wide use. Alongside this undoubted therapeutic success, there is a disturbing lack of progress in prevention. Every year for the past decade, the numbers of new HIV infections have remained stagnant in North America and Western Europe, with close to 75 000 people acquiring the virus in 1998 alone.
"Two decades into the AIDS epidemic, we know better than ever before about prevention --- how to persuade people to protect themselves, make sure they have the necessary skills and back-up services, and remove social and economic barriers to effective prevention," said Dr Peter Piot, Executive Director of UNAIDS. "Yet almost six million people became infected this year. Every one of these new HIV infections represents a prevention failure - our collective failure."
In many Asian and Eastern European countries, where the epidemic started later than in other regions, HIV is rapidly gaining new foot-holds. In India, for example, recent research shows that HIV is now firmly embedded in the general population and is spreading into rural areas that were previously thought to be relatively spared. In the state of Tamil Nadu (population: 25 million), a new survey reveals that almost half a million people are already infected with HIV and that the infection rate is three times higher in villages than in the cities.
In Latin America, while infections are concentrated in men who have sex with men and drug injections, transmission through sex between men and women is on the rise. Development gains being wiped out: In the worst-affected countries the AIDS epidemic is now making significant in roads into precious development gains that have been built up over the past decades.
In nine countries where at least 10% to the adult population is HIV-positive, it has been estimated that AIDS will soon be costing an average of 17 years of life expectancy, compared with what these countries could look forward to in the absence of the epidemic. These dismal declines are not only due to adult deaths. Over half a million children -- most of whom acquired the infection before or at birth, or through breast-feeding - died in 1998 alone. By 2005-2010, the infant mortality rate in, for example, Namibia is expected to reach 72 per 1000 live births as opposed to 45 per 1 000 without AIDS.
The onslaught of AIDS is also denting the prospects for economic development in hard-hit countries. In Zimbabwe, some companies have reported that AIDS costs are now absorbing as much as one-fifth of company earnings and, for instance, in Tanzania and Zambia, other firms estimate that AIDS illness and death cost them more than their total profits for the year.
Says David Heymann, Executive Director, Communicable Diseases Cluster, WHO, "AIDS is a deadly serious public health threat. But as the epidemic continues to spin out of control, countries face more than just a health crisis. They face a growing threat to human development and to economic and social stability."
Forces that fuel the epidemic : Some of the reasons behind HIV's spread remain undetermined. It is not fully understood why, for instance, HIV infection rates take off in some countries while remaining stable in neighbouring countries over many years. What is known is that a number of factors clearly influence the shape and scope of the epidemic in different parts of the world.
Wars and armed conflicts generate fertile conditions for the spread of HIV. The UNAIDS/WHO report notes that in Rwanda, before the political turmoil of the mid-1990s, infection rates were approximately 10% in cities and towns and around 1% in the countryside, where most people lived. Yet by 1997, both urban and rural rates were just over 11%. A revealing fact is that HIV infection rates rose six-fold among the mostly rural people who had fled to refugees camps.
In many places people have no access to voluntary HIV testing and counselling. Yet even when these services are offered, many do not want to know or acknowledge their HIV status because of the blame and shame attached to AIDS. For example, in Cote d'Ivoire, where more than 13,000 pregnant women were offered interventions to increase their chances of having a healthy baby, fewer than half accepted testing and returned for the results.
In Zimbabwe's city of Mutare, surveillance data indicate that close to 40% of pregnant women are HIV-infected and probably 30 000 adults are living with HIV. Yet the sole HIV support group in the city has just 70 members, leaving thousands of others to struggle alone with the implications of their infection, including the dilemma of how to explain the sudden need for condom use with a spouse or other stable partner.
Secrecy can persist even in the face of sickness and death, which in immuno-deficient people is often caused by tuberculosis or other common illnesses. In one study of home-based care schemes in southern Africa, fewer than 1 in 10 people who were caring for HIV-infected relatives at home acknowledged that they were suffering from AIDS, and the patients themselves were barely more open.
"One might think that in a country with a quarter or third of the population infected, people would become more open about the epidemic. Experience teaches us that this doesn't happen automatically," said Dr Piot. "The silence needs to be broken, publicly and courageously, by leaders who encourage their people to face the truth about AIDS."
For more information, please contact:
Anne Winter,
UNAIDS, Geneva,
Mobile phone: +41-79-2194312
Press Office/UNAIDS
You may also visit us on the Internet for more information about the programme at: UNAIDS HOME PAGE
Hundreds of villagers told the member of parliament during a two-day tour of the area that although they knew the pandemic was killing people, they would maintain their tradition of marrying early, with men allowed to marry as many wives as they wished. The villagers, who have a of wealth knowledge of traditional medicine,include sexual prowess enhancing herbs in their everyday diet. Chandengenda said the government need to enact a law which punishes those who use such herbs. He said their excessive use was the main reason why the people of Omay continue to be seriously affected by the scourge.
He said that although the Tonga people had managed to conserve their culture, hundreds of people in the area were dying everyday from the pandemic. Even traditional leaders who were supposed to lead their people by example were also succumbing to the infection. Zimbabwe is rated among countries with high HIV (the virus that causes AIDS) rate. About 700 people are believed to die from the disease every week countrywide.
The Post Newspaper, 3rd November, 1998
When I was asked to come and give the keynote address at the opening of AHILA 6 Congress, I asked the people who invited me in what capacity I should speak. Should I speak as a practising medical practitioner and therefore a consumer of health information? Or should I speak as a person who has over the years been involved in disseminating health information on radio, on TV and in the newspapers? Or should I just speak as a concerned human being to fellow human beings, as a concerned African to fellow Africans. I decided to do a little of each.
So I want first to speak to you as a human being about the extraordinary opportunity that we have at this point in history of man, to make a real difference in the health and lives of millions of our people in Africa-especially the children of Africa. Then I will speak as a fellow health professional- a potential consumer of the services you provided in your various institutions as members of the association for Health Information and Libraries in Africa. And I will remind you that you and I together, as partners, are in some ways responsible for the poor quality of health and for the death of millions of children every year in Africa.
Speaking first in the context of opportunity, I believe that as human beings-but perhaps even more specifically as Africans-in the services of others, you and I are living at an incredibly important and moral moment in history, a most unusually opportunity. We are privileged, honoured and blessed to anticipate - and for those of us who will still be alive at the end of next year - to actually experience the beginning of a new century and a new millennium together. Just pause for a moment and think about it. Not very many humans-let alone Africans have been luck enough to live through the change from one century and one millennium to the next at the same time. A thousand years ago, when the last opportunity presented itself for people to experience the birth of a new century and a new millennium together, what opportunities, what resources, what education and what technology did our ancestors have at their disposal? And now with just about 450 days to go before the dawn of a new century and a new millennium, what opportunities, resources, education, training and dissemination do We have in the area of health information collection, distribution and dissemination? Can you imagine the changes we would be able to bring about in the lives of others if we consciously and deliberately harnessed all the energies, opportunities, resources to make a difference in the lives of others-especially children-though our work?
At the end of next year, are you as an individual, as a parent, going to be able to look your children straight in the eyes and say ro them that you have, with all the resources available to you, been able in this century and this millennium to make true difference in their life and in their health? Will you be able to say with a clear conscience that YOU did your very best to make health-related information available and accessible to those who needed it most? Will you be able to say that your own personal effort helped to save the life of just one African child in a remote part of your country? Believe it or not, at the end of the day it is the sum total of the individual efforts that we put in to our work that end up as national health statistics, and as I will keep saying, the work that you do to help health professionals access health information and literature counts and has a direct bearing on the quality of health that our people receive. So it is up to you how you wish to be remembered when the history of health in Africa in the 20th century is written - as having made a positive or a negative contribution.
Let's me speak to you now as a health professional - a consumer of health related information. I want to suggest some changes in the way that we have been doing things this century and the next millennium. I recently heard a story of a medical librarian - possibly one of you here - who was doing a literature search on a subject on the Internet. He was shocked to find a number of references for articles written in international journals, on the subject he was looking for, by professionals from his own country - from the very hospital where his library is. And his library wasn't even aware of the existence of such work- done in the same hospital. I am sure each one of you can give many examples of when this happened to you.
In my view there are various lessons to be learnt from this simple true story. The major lesson is of course that there is something very seriously wrong with our values and our system, if information from research work done in Africa by Africans, cannot be easily available and accessible in Africa for fellow Africans to refer to. There is something not right the point of view of those doing research and only publishing abroad; and also from the point of view of those like you whose duty is to collect, store and disseminate such work for the benefit of other African health workers.
I note that the theme for this AHILA 6 Congress is HEALTH PROMOTION THOUGH INFORMATION DISSEMINATION:- A STRATEGY FOR THE 21st CENTURY. I think one of the major goals that you should set for yourselves to achieve in the next century is to make health information from Africa more available and more accessible to us Africans. I think it is most unfortunate that workers in Africa must publish their work in journals based outside of the continent - journals which are not available fro Africans health workers working in the field away from major teaching hospitals. The current system is such that workers have published in international journals if they are to be internationally recognised - even by fellow Africans. It is an unfortunate and unnecessary legacy, as well as a challenge, which the health professionals who generate the research and you as custodians if health information, must work together to remove in the 21st century. The onus is on you to devise ways and means of making African research work available for us Africans to see and refer to.
The other challenge that would like to throw at you - also closely to this - is giving wider access to the health information that you hold in custody and that which is available to you in your libraries electronically. The majority of you come from countries like Zambia where the picture of health provision is not a very bright one. Where the health worker that the majority of the people see first they are unwell is not a doctor - but a nurse or a clinical officer or even another level of auxiliary worker. In Zambia our vital statistics are as follows:
Population: 9.8m
Number of doctors: 769
Rural population: 58%
Total health inst's: 1024
Urban pop.:42%
Rural health centres: 734
Growth rate: 3.2%
Urban health centres: 208
Population below 14 yrs: 49%
Total hospitals: 68
Infant mortality rate: 109/1000.(1996)
The rural and urban health centers are manned by nurses, midwives and clinical officers. How much of the literature and health information that you hold as librarians of health institutions is targeted and appropriately levelled at these unsung heroes and heroines of the struggle for better health? Even if you have some information suitable for their consumption, how many of them have access to you and your elevated institutions?
Of the 68 hospital we have in Zambia, only two, the UTH in Lusaka and Ndola Central Hospital which houses the TDRC have any medical libraries to talk of. So how do the majority of health professionals, who cater for the health needs of the vast majority of the population, manage as far as health information is concerned?. The truth is that they do not and that is where the challenge, and it is a very big challenge, comes in for you and for AHILA. You have to develop systems that will give health workers at all levels easy access to appropriate health information and literature. Most of your institutions and libraries now have access to the very latest information technology - allowing you and your direct clients to access the biggest and best medical libraries in the world in just a matter of seconds. The challenge for you is not only to extend that access to reach the health professionals in the remotest part of your countries because that is where it is needed most, but also to put that information into a form and at a level that is appropriate for these consumers.
Therefore, as you plan your strategies for the next century, you have to have a belief that it is possible to make your services available to health workers in the most remote and distant parts of our continent in a form that is most suitable. A few years ago, I was privileged to work closely with Charlie Clements who some of you may have known in his time at Satellife. When Charlie was hired to start Satellife he had very little to start on apart from a dream, a smart idea and a strong belief that it can be made to come true. What he needed to do had never been done before anywhere in the world. Many people told Charlie that it cannot be possible to use personal computers, radio and a small orbiting satelite to communicate from remotest Africa to the rest of the world. Today, I am able to community via HealthNet from my office in Kitwe Zambia with malaria researches at a remote research station at a place called Ifakara in the meddle of the Kilombore Valley in Tanzania. In fact HealthNet is the only reliable means of communication with the people of Ifakara which is in what my friends from there call MASHENZINI. If Charie Clements and others had sat back and listened to the voices that said it cannot be done in Africa - there would be no HealthNet communication with Ifakara and with quite a few of you here today. Your challenge therefore is to first believe that it is possible to make health information available to health workers in remotest Africa. That it can be done, you can make it work, make it such that your invaluable swrvices in disseminating health information and literature are accessible to those of us healthworkers delivering health away from teaching hospitals and capital cities.
Let me leave you with one final challenge for you for the 21st century. Every year 12 million children die in the world before they are five years old, from preventable causes. 12million is a very big number, too big for us to comprehend perhaps. The majority of those deaths happen right here in Africa. In Zambia alone 100,000 children die every year before they reach the age of five years, from malaria, diarrhoea, acute respiratory infections, malnutrition and anaemia. All of them preventable by simple health education and improvements or adjustments in the way our people live. Therein lies your next challenge for this next century and the beginning of the next millennium. All along we have left matters of health education and the prevention of preventable diseases in the hands of health professionals, and speaking as one of them, I think we have not done a very good job. Health education should be the responsibility of every adult who understands its importance. You, as custodians and disseminators of health information and literature area at a privileged position from which you too can take part in health education of the public. I challenge you to take up the theme of CHILD SURVIVAL and work out how it is that you as librarians, as health workers' partners, as Africans and most of all as concerned human beings, can help reduce these unnecessary deaths of our children from preventable causes.
Already, other groups of professionals who have little or nothing to do directly with health are getting involved in Worldwide Child Survival Programmes. As a broadcaster and a health professional, I was invited recently to speak like this at the first International Conference on Broadcasting for Child Survival organised by the Voice of America - VOA. Since that conference, which was mainly for broadcasters, those of you who listen to VOA early morning programmes such as Daybreak Africa will have heard Public Service Announcements during this month of September with Child Survival messages. At the same time, 28 VOA affiliate stations in 25 countries throughout the world are also broadcasting Public Service Announcements related to Child Survival. The aim is to get the whole world talking about Child Survival. To place the responsibility of the survival of our children, the responsibility for preventing their unnecessary deaths from preventable illnesses, back where it should be - with you and I as individual parents. So your colleagues the broadcasters are doing their part for Child Survival, and they are very far removed from issues of health. What are you doing as health institution librarians?? You who are partners to the health professions in the delivery of better health to Africa and Africans? You who have so much power at your disposal? So much ability to influence so much change?
Until recently, I was working with the Dreyfuss Health Foundation in their Problem Solving for Better Health - PSBH - programmes in Zambia and other African countries. I learnt from teaching and practising PSBH that often health problems seem too large and impossible for an individual to solve with locally available resources. I have learnt that in order to tackle a large seemingly insurmountable problem, it may be necessary to break it up into small solvable pieces - solvable with resources that are available locally.
So, soon you will be going back to your countries. Learn from the PSBH process and experience, and begin to use the power that you have, the resources that you have as an individual, to make a difference for the survival of the children in your own country, which is the survival of the children of Africa, and ultimately, for the survival of the children of the world. Something also that learnt in the PSBH process is that even one person can make a whole world of difference. We used to say "Anyone who thinks that they are too small to make a difference has never been alone in a room with a mosquito!" When the work that you are doing as an individual is added to the work that the next person is doing as an individual, and the next and the next and so on, it will make a lot of difference to the lives of a lot of people. As they say in Ethiopia, "When spider webs unite, they can tie up a lion". So go on out there and become mosquitoes making spider webs! Thank you..
Project Title: Specially Designed Counselling for Drug
Abusers
Implementor: Vincent Mbulo
This project is being carried out at Chifubu Secondary School. An
anti-drugs club has been formed at the school with
the support of the school management and local civic clubs. Talks by
different eminent people in Ndola are conducted
every two weeks to speak about the dangers of drug abuse and provide
role models for the students. Former students
of the school who have made a success of their lives are invited to
come and provide a challenge to the students. Young
peer educators have been trained to help in counselling abusers. With
help from the Social Welfare Department at Ndola
Central Hospital, Vincent has managed to help some students who were
thought to be psychiatric cases.
Project Title: Drug and Alcohol abuse among the Youth at
Jacaranda Basic School in Lusaka
Implementor: Doris Sikazwe
Most of the major hotels, clubs and snack places are found in the
central area of Lusaka and this is where Jacaranda
School is situated. The problem of drug abuse among the youths is
increasing mostly because the youths do not
understand the seriousness of the consequences of drug abuse. Doris
has formed an anti-drugs club at the school. With
the help of school management, some students are being are being
trained as peer educators to help friends break the
habit of drugs. The most commonly abused is alcohol. Because of the
proximity of the school to hotels, clubs and snack
places, it is easy for students to sneak out of school and go to
drink. The campaign against drugs and alcohol in particular
has gained in popularity since the project started. Doris hopes to
bring in some people from the Drug Enforcement
Commission to talk to the students about the adverse effects of
drugs.
Project Title: Anti-Drugs Club - Kakoso (Chililabombwe)
Implementor: Steven Samala
There is a high incidence of drug/alcohol abuse in Kakoso Township of
Chililabombwe. Starting an anti-drugs club in
the community is seen as a way of helping to reduce alcohol/drug
abuse as well as related mental illness among
teenagers. Steven intends to use lessons learnt from Neroh's
experience in Nakambala.
Project Title: Knowledge, Attitudes, Practices of
Tuntemba and Store owners selling drugs at their outlets in
Ndola Marke
Implementor: Isaac Ndala
The problem identified is indiscriminate sale of drugs at Masala,
Lubuto & Twapia markets of Ndola. Sensitising
marketeers about the dangers of this practice is seen as a way of
curbing the easy and unguided availability of potentially
harmful drugs on the open market.
Project Title: To help reduce drug abuse among pupils at
Nakambala Basic School
Implementor: Neroh Mwanapabu
The problem identified is that about 15% of pupils aged between 14 &
18 years at Nakambala Basic School are involved
in cases of drug abuse. This amounts to about 60 pupils in the
school. Among the factors contributing to the growth of
the problem is the presence of casual and seasonal employees at the
Estates who are themselves into drug abuse. These have an influence
on the youth who look up to them as role models.
Other factors are peer pressure and broken homes.
EVENTS:
Follow-up Workshop for the Northern region was held at Mukuba
Hotel, Ndola from 30th October to 1st November 1998
Facilitators Workshop took place at Ibis Gardens, Lusaka from 11th to 13th December 1998. New facilitators were taken on board as a step towards broadening further the outreach of PSBH.
Contact Address for Foundation for Better Health - Zambia:
Ruth Mulenga Chikasa
FBH - Zambia
P.O. Box 70721
Ndola, Zambia
Tel/Fax: 260-2-621097
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Last updated January 27, 1999