BackgroundCannabis dependence in adolescents predicts increased risks of using other illicit drugs, poor academic performance and reporting psychotic symptoms. The prevalence of cannabis use was estimated two decades ago in Zambia among secondary school students. There are no recent estimates of the extent of the problem; further, correlates for its use have not been documented in Zambia. The objective of study was to estimate the current prevalence of cannabis use and its socio-demographic correlates among in-school adolescents.MethodsWe conducted secondary analysis of data that was obtained from the 2004 Zambia Global School-Based Health Survey. Logistic regression analysis was conducted to identify the socio-demographic factors associated with cannabis use.ResultsA total of 2,257 adolescents participated in the survey of which 53.9% were females. The overall prevalence of self reported ever-used cannabis was 37.2% (34.5% among males and 39.5% among females). In multivariate analysis, males were 8% (AOR = 0.92; 95% CI [0.89, 0.95]) less likely to have ever smoked cannabis. Compared to adolescents aged 16 years or older, adolescents aged 14 years were 45% (AOR = 1.45; 95% CI [1.37, 1.55]) more likely, and those aged 15 years were 44% (AOR = 0.56; 95% CI [0.53, 0.60]) less likely to report to have ever smoked cannabis. Other factors that were significantly associated with cannabis use were history of having engaged in sexual intercourse (AOR = 2.55; 95% CI [2.46, 2.64]), alcohol use (AOR = 4.38; 95% CI [4.24, 4.53]), and having been bullied (AOR = 1.77; 95% CI [1.71, 1.83]). Adolescents who reported being supervised by parents during free time were less likely to have smoked cannabis (AOR = 0.92; 95% CI [0.88, 0.95]).ConclusionsThe use of cannabis is prevalent among Zambian in-school adolescents. Efforts to prevent adolescents’ psychoactive drug use in Zambia should be designed considering the significant factors associated with drug use in the current study.

Photodynamic therapy comprises a photosensitising agent, which accumulates in malignant tissue, and a light source, which activates the photosensitiser, causing it to generate highly reactive oxygen species that destroy malignant cells. Temoporfin is a second generation photosensitiser that has a shorter half life than its predecessors and is thought to be more selective towards tumours. These two factors should decrease the incidence of photosensitivity, one of the main side effects of photodynamic therapy. We report on a group of patients who received a single dose of temoporfin (Foscan, Scotia Pharmaceuticals) and developed partial thickness burns after minimal exposure to light.Fourteen healthy men aged between 20 and 26 were given a single dose (0.100-0.129 mg/kg) of temoporfin as part of a pharmacokinetic study. The dosage was a standard therapeutic one.1 After two weeks they were exposed to a test dose of sunlight. Twelve men showed no photosensitivity and were told to avoid prolonged exposure to bright sunlight for three months. Within 48 hours of discharge six of the 12 men had developed partial thickness burns on the left forearm (figure) and more superficial burns on other body areas (about 1% of total body surface area) after transient exposure to daylight. They were referred to the regional burns centre where they were treated conventionally with paraffin dressings and reviewed at five day intervals. Healing was much slower than with conventional thermal injury (28 versus 14 days), with prominent scarring in several men. As the men had signed disclaimers before the trial, they were not automatically entitled to compensation.Photodynamic therapy is used in the treatment of various malignancies, 2 3 and photosensitivity is a recognised complication. There is only one report of a skin burn, 4

Background:Overweight and obesity (overweight/obesity) is associated with hypertension. Low-and middleincome countries are experiencing an obesity epidemic. There is growing evidence that the epidemic is on the increase in urban settings of developing countries. However, there is scanty information on the magnitude of this epidemic and its correlates in rural settings. The objective of the current study was to establish levels of overweight/obesity and its correlates in rural areas of Zambia. Designing interventions based on the correlates for overweight/obesity to reduce its prevalence may in turn lead to a reduction in the prevalence of hypertension. Methods:Cross sectional studies using a modified WHO Stepwise questionnaire were conducted. Logistic regression analyses were used to determine factors that were associated with overweight/obesity. Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) and their 95% confidence intervals are reported.Results: Totals of 895 participants from Kaoma and 1198 from Kasama took part in the study. Altogether, 7.6% of the participants were overweight and 2.5% were obese, with a combined prevalence of overweight/obesity of 10.1%. Factors that were independently associated with overweight/obesity were sex, education, vegetable consumption, smoking and hypertension. Female participants were 78% (AOR=1.78, 95% CI [1.46, 2.17]) more like to be overweight/ obese compared to males. Participants with secondary or higher education level were 2.04 (95% CI [1.56, 2.67]) times more likely to be overweight/obese compared to participants with lower levels of education. Participants who consumed vegetables 5 to 7 days in a week were 35% (AOR=1.35, 95% CI [1.06, 1.72]) more likely to be overweight/ obese compared to participants who ate vegetables less than 5 days in a week. Non smokers were 2.06 (95% CI [1.42, 2.98]) times more likely to be overweight/obese than smokers. Participants who were non hypertensive were 30% (AOR=0.70, 95% CI [0.59, 0.82]) less likely to be overweight/obese compared to participants who were hypertensive. Conclusions:Prevalence of overweight/obesity was low and this is the time to start instituting interventions to control the obesity epidemic in rural districts of Zambia.

Background: Diagnostic error is a significant cause of preventable harm worldwide and diagnostic errors have been identified as a high priority patient safety problem by the World Health Organization. Research shows thatdiagnostic error occurs mainly due to system failures and 'cognitive errors' – that is, failure to synthesise all the available information. There is a worldwide consensus that medical schools and postgraduate training programmes rarely teachthe diagnostic process and related decision making (clinical reasoning) in a way that is explicit, systematic and consistent with what is known from research. Materials and methods: This paper presents a short case report and analyses it from a clinical reasoning perspective – performing a 'cognitive autopsy' of a fatal diagnostic error. Results: Clinicians make cognitive shortcuts through pattern recognition and this is highly accurate most of the time. However, shortcuts sometimes go wrong and these are termed 'cognitive biases'. Cognitive biases are subconscious errors of judgement or perception and common examples include 'anchoring', 'the framing effect', 'search satisficing 'and' confirmation biases. These errors are more likely when clinicians are fatigued or cognitively overloaded, and when systems are not designed to mitigate human errors. Conclusions: There is a vast literature on clinical reasoning, 'human factors', and reflection during decision making that show us how we can reduce diagnostic error in our everyday practice. This paper attempts to highlight some of the key findings in the literature that will hopefully encourage readers to explore the patient safety and clinical reasoning literature for themselves and work together to improve outcomes for patients.

Objectives:  The aim of this evaluation was to identify pitfalls in medical prescriptions of uncomplicated urinary tract infections in government healthcare facilities in Zambia. Design:  The study was a cross sectional study and healthcare facilities were conveniently sampled. Main outcome measures: Rate of compliance to Zambia national prescribing guidelines.  Results:  A total of 42 (75.0%) out of 56 students participated in the survey of whom 66.7% were males. Findings in this study has demonstrated significant drug misuse and over-prescription as participants were healthy individuals. Only 75.6% of prescriptions indicated patient’s name and very small proportions of prescriptions (11.5%)  indicated patients’ address.    In addition, relatively small proportion of prescriptions (68.8%) had generic names and many prescriptions (58.1%) had large blank spaces left.  Furthermore, relatively large proportion of prescriptions were not signed (10.7%) and not dated (12.0%).  Almost half of the prescriptions (47.6%) did not show prescribers’ names and only small proportions of prescriptions had precribers’ identification number (24.%) and address or department (21.5%) indicated.  Conclusions:  Overall, the evaluation has shown poor prescribing practices and not in compliance with national prescribing guidelines among prescribers in government healthcare facilities in Zambia.