Poor Understanding of Health Promotion Related to Underdeployment of Qualified Health Promoters in Uganda

Health promotion is a relatively new field in the health sector. Having been born as a result of observed weaknesses in the implementation of primary health care (PHC) strategies; it has been slow to pick up in many countries. In Uganda; the Faculty of Health Sciences of Uganda Martyrs University (UMU) picked up the challenge of training health workers in the field of health promotion. Over 100 health workers have qualified in health promotion since 2004. This study meant to follow up the graduates of the programme to see what they are actually doing in the field; to see how their current work is related to health promotion; to see how they perceive their work and to identify the challenges they face in executing health promotion duties. It found that most of them are not in health promotion activities because they have been deployed in clinical services. They attributed this to shortage of clinical staff in health services as well as lack of knowledge of the scope and role of health promotion by the other health workers and; especially; the policy makers and those responsible for staff deployment. The work environment of the graduates is not favourable for the expansion of health promotion activities because of the poor understanding of the field. There are no resources allocated for health promotion; apart from health education campaigns; and many positions are vacant at all levels of the health system. The graduates are isolated from each other and do not receive updated information about the field. The paper recommends sensitisation of all stakeholders of health promotion; formation of a professional association and increased facilitation for health promotion activities; among others

Improving the number of mothers breastfeeding in the postpartum period.

The objective of this study was to review an experience at Jackson Memorial Hospital, Miami, Florida that has resulted in an increase in the percentage of mothers breastfeeding at postpartum discharge. Data was obtained from postpartum interviews in 1993, which provided the percentage of mothers breastfeeding at discharge. Staff members and personnel involved in the care of postpartum mothers and babies were educated about breastfeeding, and rounds were made to problem solve and reinforce. Patients who elected to breastfeed from April to September 1994 were followed for a duration of 3 months. These early efforts led to the implementation of a Baby-Friendly initiative and intent in 1996 and the formation of a mother-baby unit in 1997. Ten percent of mothers were breastfeeding at postpartum discharge. After implementing a program in 1994, 41% were breastfeeding at discharge. There was a decline in the number of mothers breastfeeding during the postpartum period from discharge. At 3 days postpartum, 80% of patients were breastfeeding followed by 64%, 37%, and 17% at 2 weeks, 6 weeks, and 3 months from discharge, respectively. The percentage of mothers opting not to breastfeed at 3 days after discharge was 20%, followed by 12% from 3 days to 2 weeks postdischarge, by 21% 2 weeks to 6 weeks postdischarge, and finally by 16% from 6 weeks to 3 months postdischarge. In 1998, 70% of patients were breastfeeding, and in 1999, 71% of patients were breastfeeding upon postpartum discharge. The data show that by implementing programs to promote breastfeeding, through education, encouragement, and reinforcement, one can increase the number of mothers who breastfeed at postpartum discharge. However, there is an inverse relationship between the duration of the postdischarge period and the number of mothers breastfeeding.

Dermatology teleconsultations to Central Prison: experience at East Carolina University.

OBJECTIVE: To review our experience with dermatology teleconsultations between East Carolina University School of Medicine in Greenville and Central Prison in Raleigh, NC. MATERIALS AND METHODS: Consultation forms kept on file in the Department of Internal Medicine served as the source of data. One physician reviewed the forms from the initial 22 months of our dermatology teleconsultation service to Central Prison. Patient demographics and the diagnoses made by the consulting physician were recorded. Recommendations were tabulated as either diagnostic or therapeutic. Diagnoses and recommendations for known HIV-positive individuals were separately recorded. RESULTS: One hundred thirty-eight dermatology teleconsultations were performed over the 22-month period. Seventy two per cent of the patients seen were African-American. The average age was 32 years. One hundred fifty-nine diagnoses were made. The most common problems were eczema and acneiform eruptions. Fifty-nine diagnostic and 252 therapeutic recommendations were made. CONCLUSION: Consultants generally were confident of their diagnoses and management decisions. Dermatologists can assist primary care physicians through telemedicine consultation.

Proliferating trichilemmal tumor: report of a case and review of the literature.

The authors report a case of proliferating trichilemmal tumor and review the related literature. Although considered biologically benign, malignant proliferating trichilemmal tumor have been reported. The authors emphasize the importance of recognizing that the tumors can occur in individuals in their 20s and 30s, and that the tumors should be excised with a margin of normal tissue. Routine follow-up is recommended.

Piezogenic wrist papules: a common and asymptomatic finding.

The first description of piezogenic wrist papules is presented. Twenty-nine persons were examined; 76% had pedal papules and 86% had wrist papules. Piezogenic papules are a common, nonhereditary finding and are not secondary to an inherent connective tissue defect.

Pemphigoid-like bullous eruption related to ibuprofen.

We report two patients who had a bullous eruption limited to the lower extremities when first seen by us. Clinically the eruption resembled limited bullous pemphigoid. In both patients the onset of the eruption was associated with ibuprofen therapy, and lesions promptly resolved after discontinuing the ibuprofen. This type of presentation has not been reported previously as an adverse effect of ibuprofen. Bullous reactions to nonsteroidal anti-inflammatory agents are briefly reviewed.