A survey of TB services in hospitals in seven large cities in Asia and North Africa.

SETTING: Hospitals in Bangkok, Cairo, Dhaka, Jakarta, Karachi, Kathmandu and Manila. OBJECTIVES: To evaluate tuberculosis (TB) services provided in public and private hospitals in big cities. DESIGN: A survey on TB services in hospitals was carried out in 2005 by visiting hospitals and face-to-face interviews. Selection criteria were determined for each city. All hospitals were included if feasible. RESULTS: The number of hospitals included in the survey ranged from 52 in Bangkok to 106 in Jakarta. The proportion of private hospitals with access to a National Tuberculosis Programme (NTP) manual ranged from 8% in Jakarta to 89% in Bangkok. Private hospitals rarely functioned as a basic management unit (BMU) of the NTP, except in Bangkok. TB treatment was not always free of charge in BMU hospitals. The proportion of non-BMU hospitals that never referred/reported TB patients to the NTP was substantial in Bangkok, Dhaka, Jakarta, Karachi and Manila. Non-BMU hospitals did not routinely use standard NTP regimens, especially in Jakarta, Karachi and Manila. In non-BMU hospitals, patient tracing mechanisms were generally lacking and treatment outcome was not known. CONCLUSION: TB services provided in non-BMU hospitals were not satisfactory. NTPs need to involve non-BMU hospitals in TB control.

Cranial electrostimulation (CES) use in the detoxification of opiate-dependent patients.

This paper reviews the scientific literature on cranial electrostimulation (CES) as a non-chemical means to alleviate opiate withdrawal symptoms. CES involves applying small amounts of electrical stimulation through electrodes applied to the skin surface over the cranium. The paper summarizes major theories (gate, endorphin, and Chinese acupuncture) which attempt to explain how CES may help alleviate drug withdrawal and craving. Two of the studies reviewed show that CES patients experienced more severe withdrawal during the early part of treatment than comparison groups of methadone patients. Other studies show that CES patients did better than methadone patients. The findings from all studies reviewed, however, were limited because of low participation rates, high dropout rates, difficulties in blinding subjects and evaluators, and the absence of standardized procedures and equipment. The evidence reviewed suggests that CES is a promising line of inquiry for continued efforts to develop nonchemical ways to detoxify opiate-dependent individuals. Improved research designs, larger sample sizes, more integrity in data collection, and improved data analysis are needed in the future.