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Treatment and rehabilitation of youth with substance use disorder

Case Study Dr. Tabitha Ndungu presented to
their 2nd
Conference in
Nairobi, Kenya

Date; 10th - 14th JUNE 2013
Venue: Moi Sports Centre

Kasarani Gymnasium
Theme: " The
Youth and
Drugs: A Call to
 In spite of the damage done by alcohol/drug abuse or addiction, only four cents of every spent by the 50 states is devoted to prevention and treatment of substance use problems.(Grinfield 2001)  Nor are the various state governments alone in not addressing the issue of substance abuse. Introduction (CONT.)  Nationally, less than one-fifth of the physicians/medical personnel surveyed considered themselves prepared to deal with alcohol-dependent patients, while less than 17 thought they had the skills necessary to deal with prescription drug abusers (National Center on Addiction and Substance Abuse at Columbia University, 2000).  Indeed, at the end of training , most physicians have a more negative attitude toward patients with substance use disorders than they did at the beginning of their graduate training (Renner Introduction (CONT.)  As a result of this professional pessimism, physicians tend to "resist being involved in negotiating a referral and brokering a consultative recommendation when alcoholism is the diagnosis". (Westermeyer  An example of the outcome of this neglect is that fewer than 50% of patients who go to physicians for alcohol-related problems are actually asked about their alcohol use.(Pagano, Graham, Frost-Pineda, & Gold Introduction (CONT.)  Although the benefits of professional treatment of alcohol abuse/addiction have been demonstrated time and again, many physicians continue to consider alcohol and illicit drug use problems to virtually untreatable, and they ignore research findings suggesting otherwise. (Renner 2004b).  Indeed, "more often than, the physician will view the addicted patient as challenging at best and not worthy of customary compassion" (R. Brown 2006). Introduction (CONT.)  While postgraduate training programs for physicians and medical personnel have devoted instructional time to the treatment of substance use disorders, the average amount of time devoted to this training is about 8 hours.( (Renner 2004b). most medical personnel are ill-prepared to work with patients with SUD. Introduction (CONT.)  Marriage/family therapists also share this lack or preparation in recognizing and dealing with SUD. When a substance use problem within a marriage or family is not uncovered, therapy proceeds in a haphazard fashion.  Vital clues to a very real illness within the family are missed, and the attempt at family or marital therapy is ineffective unless the addictive disorder is identified and Introduction (CONT.)  In spite of the obvious relationship between substance abuse and the various forms of psychopathology , most clinical psychologists are not wel prepared to deal with issues involving substance use or abuse. (Sobel & Sobel 2007, p2). Fully 74% of the psychologists surveyed admitted that they had no formal education in the identification or treatment of the addictions and rate their graduate school training in the area of drug addiction as inadequate ( Aanavi, Taube, Ja & Duran 2000). In a very real sense, mental health professions have responded to the problem of SUD with a marked lack of attention or professional TYPES OF THERAPY  Brief Psychotherapy  Core assessment areas  Pharmacotherapy
Brief Psychotherapy

Core assessment areas
 Before proceeding with brief therapy for substance abuse disorders, a number of areas should be assessed;  Current use patterns  History of substance abuse  Consequences of substance abuse (especially external pressures that are bringing the client into treatment at this time, such as family or legal pressures) Brief Psychotherapy
Core assessment areas (cont.)
 Coexisting psychiatric disorders  Information about major medical problems and health status  Information about education and  Support mechanisms  Client strengths and situational advantages  Previous treatment  Family history of substance abuse disorders and psychological disorders
Pharmacotherapy for

Substance Use Disorders
 Medication-Assisted Treatment (MAT) is a form of pharmacotherapy and refers to any treatment for a substance use disorder that includes a pharmacologic intervention as part of a comprehensive substance abuse treatment plan with an ultimate goal of patient recovery with full social function.
Nicotine Replacement

 NRT works by making it easier to abstain from tobacco by partially replacing the nicotine previously obtained from tobacco.[29] There are at least 3 mechanisms by which NRT could be effective, as follows:  Reducing general withdrawal symptoms, thus allowing people to learn to get by without  Reducing the reinforcing effects of tobacco- delivered nicotine
Nicotine Replacement

 Exerting some psychological effects on mood and attention states  Nicotine replacement medications should not be viewed as standalone medications that make people stop smoking; reassurance and guidance from health professionals are still critical for helping patients achieve and sustain abstinence. Types of NRT
 Transdermal nicotine patch  Nicotine nasal spray  Nicotine gum  Nicotine lozenge  Sublingual nicotine tablet  Nicotine inhaler Nicotine Replacement
(NRT) cont.
 The first type is intended for longer-term use, whereas the other 5 types are used for acute dosing. With the acute-dosing products, the amount and timing of nicotine delivery can be titrated by the user, allowing the use of these products as rescue medication for cravings.
Nicotine Replacement

 Ongoing craving in a quitter is associated with acute episodes of more intense craving (ie, breakthrough craving).  Provoked by situational stimuli, such as seeing someone smoke or experiencing emotional upset, such episodes are associated with a very high risk of relapse. Nicotine Replacement
(NRT) cont.
 Acute NRT approaches may also be used when a situation is expected to produce a craving (eg, a demanding meeting, rush-hour traffic, a long commute, or a social situation where cigarette smokers will be present).  Common adverse events that are common to all NRT products include dizziness, nausea, and headache. Research of efficacy of NRT  Piper et al conducted a randomized, placebo-controlled, double-blind trial of 5 smoking cessation pharmacotherapies.[36]  The study population included 1504 adults who smoked at least 10 cigarettes daily for the previous 6 months and were motivated to quit smoking. Research of efficacy of  Patients were randomly assigned to 1 of the following groups: nicotine lozenge, nicotine patch, sustained-release bupropion, nicotine patch plus nicotine lozenge, bupropion plus nicotine lozenge, Research of efficacy of  All treatment groups had smoking cessation rates differing from those of the placebo group, but only the nicotine patch–plus– nicotine lozenge group showed significantly higher abstinence rates at 6 months after quitting in comparison with the placebo  The effects of the nicotine lozenge, bupropion, and bupropion plus lozenge were comparable with those reported in previous
Case Study; Work in Progress

The following client consulted me after his
very close cousin died of alcoholism. Mr.
X is a young man of 35 years who still live
with the mother. He has a degree in
engineering from one of the universities in
Kenya. He was devastated after his cousin
died from alcoholism. However, he was
not able to go for rehabilitation due to
lack of finances.
Brief Psychotherapy  We had six sessions trying to see the way
1st session; Forming a therapeutic alliance
2nd session. Assessment of the level of
3rd Session; introduction to NICOTINE
Brief Psychotherapy &  In this case we used chewing gums for 28
4th Session; planning of homework
assignments as well as alternative
activities to replace time he spent
drinking and smoking.
Brief Psychotherapy &  5th Session; addressing any fears he had
and meeting with the family members to
look for ways to offer support.
6th Session; we terminated the counseling
session but left it open that the client can
always call in case of a problem.

 Transtheoretical model ; for brief psychotherapy , the client MUST be in the action stage. Mr X was in the action  This is the 7th Month that he has stayed
He left chewing the nicotine gum and has
no craving for tobacco as well as alcohol.
I call it a work in progress as the client is
not two years clean which is the
recommended period to say the client is
clean. He has also gone back to work
and is intending to get married.


The case study is still undergoing and other
factors have to be addressed to confirm
whether it is the brief psychotherapy and the
NRT or other factors like employer support,
family support or the guilt of his cousin's
death. It will be good to go beyond and try to
see the benefits combined brief
psychotherapy & pharmacotherapy in drug
addiction management and may be employ
it in our health care system.
No single treatment has been found
adequate but individualized treatment
has been found to benefit more clients.


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Reducing Maternal Mortality in Tanzania: Health Facility Assessment in Kigoma Summary Health Facility Assessment of Emergency Obstetric & Neonatal Care Services (EmONC) in Kigoma Region, Tanzania: Selected Findings Tanzania has the fourth highest number of maternal deaths in Sub-Saharan Africa and the sixth highest in the world (World Health Organization, 2014). The