American cutaneous leishmaniasis in Guyana, South America.

The 185 patients who presented at the dermatology clinic of Georgetown Public Hospital, Guyana, between 1992 and 1998, with skin ulcers indicative of American cutaneous leishmaniasis (ACL) were retrospectively reviewed. The laboratory-confirmed cases of ACL were identified and the corresponding data were analysed for risk factors such as age, gender, areas of residence and of possible exposure to the causative agent (Leishmania braziliensis guyanensis), ethnic origin, longevity of the ulcers, and treatment regimes prior to the definitive diagnosis. Eighty-one (43%) of the 185 subjects were confirmed to be infected with Le. b. guyanensis. Although 53 (66%) of the cases lived in or close to the capital city, Georgetown, most of the cases had travelled to (and probably been infected in) region X in the interior of Guyana (32%) or regions VII (23%), VIII (23%), IX (11%), VI (5%), I (3%) or III (3%), usually because they were involved in the mining (41%) or lumber (21%) industries, the army or hunting. Almost all (95%) of the cases were male and most (58%) were aged 20-39 years. In general, the cases had had their skin lesions for many days before presenting for treatment: 46% for 1-5 weeks and 3% for > 6 months. Prior to presentation at the clinic, many of the cases had attempted to cure themselves, using local herbal remedies (37%), antibiotics and antifungal remedies (39%), other creams (5%), household chemicals (9%) or miscellaneous remedies such as lead salts (especially lead sulphate) and battery acid, all without success. Recommendations are made for an epidemiological study of active ACL among forest workers, eco-tourists and residents of high-risk areas. Diagnostic centres need to be sited in the regions most at-risk, particularly in or near environments in which the main vectors - sandflies such as Lutzomyia umbratilis, Lu. anduzei and Lu. whitmani - are known to be prevalent.

Using the connecting process to meet family caregiver needs.

Individuals who engage in caregiving responsibilities for dependent family members in the home setting face challenges that are little understood by others outside the circle of care. Because a large portion of energy is devoted to caregiving tasks, caregivers potentially fail to devote attention to meeting their own needs. The purpose of this study was to develop a beginning substantive theory describing the needs perceived by caregivers and the processes by which these caregivers are able to get their individual needs met. Grounded theory methodology was used to facilitate the identification of these needs and processes. This study concluded that the needs for help, hope, and happiness are the most crucial needs of family caregivers. The basic social process of connecting was identified as fundamental to meeting caregiver needs. Subprocesses of misconnecting and disconnecting were identified as concurrent processes that existed as functions of connecting and that affected the connecting process. The connecting process was seen as an organizing concept that could both give direction to the practice of nursing care for caregiving families and lay the foundation for continued research and theory development.