Tracking Medical Graduates in Jamaica and The Bahamas / Tras los graduados de medicina en Jamaica y las Bahamas

ABSTRACT Objective: To determine the availability of employment and retention for the increased number of medical graduates in Jamaica and The Bahamas. Methods: The availability of internships and junior medical posts for graduates of The University of the West Indies in Jamaica and The Bahamas over the five-year period of 2012 to 2016 was reviewed. Results: There were 947 medical graduates between 2012 and 2016 in Jamaica; 69.4% of them were female. The number of graduates increased annually. The majority of graduates were Jamaicans; non-Jamaicans comprised 18.2%. All Jamaican graduates obtained internship posts in the public hospitals and at the University Hospital of the West Indies, Jamaica, with a phased increase of approximately 20% in the posts available over the period. The public hospitals employed 75% of the graduates. There were 172 non-Jamaican graduates, the majority of whom were from Trinidad and Tobago, who did not seek employment in Jamaica. In The Bahamas, there were 132 graduates, all of whom obtained internship posts in public hospitals. Of the 2259 applicants, 664 were accepted to postgraduate programmes in Jamaica and The Bahamas between 2012 and 2016. Seventy per cent of all graduates were working in the English-speaking Caribbean, with the majority in Jamaica. Conclusion: The number of medical graduates trained increased, with a predominance of females. All graduates obtained employment in Jamaica and The Bahamas, mainly in public institutions. Although there was 70% retention of graduates, there is an urgent need to increase the number of postgraduate posts and accredited training institutions in the Caribbean.

RESUMEN Objetivo: Determinar la disponibilidad de empleo y la retención para el número creciente de graduados de medicina en Jamaica y las Bahamas. Métodos: Se revisó la disponibilidad de pasantías y puestos médicos para recién graduados de la Universidad de West Indies en Jamaica y las Bahamas durante el período de cinco años de 2012 a 2016. Resultados: Hubo 947 graduados de medicina entre 2012 y 2016 en Jamaica, de los cuales el 69.4% eran mujeres. El número de graduados aumentó anualmente. La mayoría de los graduados eran jamaicanos; los no jamaicanos comprendían el 18.2%. Todos los graduados jamaicanos obtuvieron puestos de pasantía en los hospitales públicos y en el Hospital Universitario de UWI, Jamaica, con un aumento gradual de aproximadamente 20% de los puestos disponibles durante el período. Los hospitales públicos emplearon el 75% de los graduados. Hubo 172 graduados no jamaicanos, la mayoría de los cuales eran de Trinidad y Tobago, y no buscaban empleo en Jamaica. En las Bahamas, hubo 132 graduados, todos los cuales obtuvieron puestos de pasantía en hospitales públicos. De los 2259 solicitantes, 664 fueron aceptados en los programas de postgrado en Jamaica y las Bahamas entre 2012 y 2016. El setenta por ciento de todos los graduados trabajaban en el Caribe de habla inglesa, mayormente en Jamaica. Conclusión: El número de graduados médicos entrenados aumentó, con predominio de las mujeres. Todos los graduados obtuvieron empleo en Jamaica y las Bahamas, principalmente en instituciones públicas. Aunque hubo 70% de retención de graduados, hay una necesidad urgente de aumentar el número de puestos de posgrado y formación acreditada en las instituciones del Caribe.

HIV/AIDS knowledge and sexual behaviour among junior high school students in New Providence, Bahamas / El conocimiento acerca del VIH/SIDA y el comportamiento sexual entre los estudiantes de escuela secundaria en Nueva Providencia, Bahamas

OBJECTIVE: To determine accuracy of knowledge and sexual behaviour patterns of junior high school students in New Providence towards HIV/AIDS and identify gender variations. METHODS: A cross-sectional study with cluster sampling of classrooms was undertaken at two schools utilizing a questionnaire. SPSS was used for statistical analysis. RESULTS: Three hundred and fifty-four students participated in the study; the mean age was 12.25 years, 55.1% males and 44.9% females. Most (88%) students identified sexual intercourse as a mode of HIV transmission, 62.5% were accurate regarding anal sex and 32.9% were accurate about sexual intercourse in the water, as modes of HIV transmission. Abstinence was identified as a method of HIV prevention by 54.1% of students although 85.2% of students knew that condoms were a method of prevention. On beliefs regarding transmission, 21.2% believed mosquito bites and 13.1% believed toilet seats were routes for disease spread. Only 16.9% of participants reported a history of sexual intercourse; of those, 57.6% indicated that they were age < 10 years when they first had intercourse. Concerning use of birth control, 64.5% of sexually experienced respondents reported never using any method. CONCLUSION: Junior high school students have fairly accurate knowledge of HIV/AIDS but misconceptions regarding transmission are still prevalent; patterns in gender variation are few.

OBJETIVO: Determinar la exactitud del conocimiento y los patrones de comportamiento sexual hacia el VIH/SIDA, así como identificar las variaciones de género, entre los estudiantes de escuela secundaria básica en Nueva Providencia. MÉTODOS: Se realizó un estudio transversal con muestreo por conglomerados de aulas en dos escuelas utilizando un cuestionario. Se utilizó el programa SPSS para el análisis estadístico. RESULTADOS: Trescientos cincuenta y cuatro estudiantes participaron en el estudio, de los cuales 55.1% fueron varones y 44.9% hembras. La edad promedio fue 12.25 años. La mayoría (88%) de los estudiantes identificaron las relaciones sexuales como un modo de transmisión del VIH, 62,5% fueron precisos con respecto a la transmisión por sexo anal, y 32,9% fueron precisos acerca de las relaciones sexuales en el agua, como modos de transmisión del VIH. La abstinencia fue identificada como método de prevención del VIH por 54,1% de los estudiantes, aunque 85,2% de ellos sabían que los condones son un método de prevención. Sobre las creencias con respecto a la transmisión, 21.2% creía que las picaduras de mosquitos constituían vías de propagación, en tanto que 13.1% consideraba los asientos de inodoro como rutas para la enfermedad. Sólo 16.9% de los participantes reportaron una historia de las relaciones sexuales. De ellos, 57.6% indicó que tenían < 10 años de edad cuando tuvieron su primera relación sexual. Sobre el uso del control de la natalidad, 64.5% de los encuestados con experiencia sexual, reportaron no haber usado nunca ningún método. CONCLUSIÓN: Los estudiantes de escuela secundaria tienen un conocimiento bastante preciso del VIH/SIDA, pero los conceptos erróneos acerca de la transmisión son aún frecuentes. Los patrones de variación de género son pocos.

Factors associated with depression symptoms in high school students in São Paulo, Brazil

OBJECTIVE: To assess factors associated with depression symptoms in high school students. METHODS: A cross-sectional study involving high school students was conducted in the city of São Paulo, Brazil, 2001. A total of 724 students aged 14-18 years answered questionnaires on life and health conditions. Another questionnaire was applied to working (44.8 percent) and unemployed (22.9 percent) students to collect information on working conditions. Factors associated to depressive disorders were analyzed using multiple logistic regression controlled for occupational status. RESULTS: Overall prevalence rate of depression was 7.5 percent. Rates according to gender were 39 (10.3 percent) in females and 15 (4.3 percent) in males. The multiple logistic regression analysis showed that factors associated with depressive disorders were: poor self-perception of health (OR=5.78), being female (OR = 2.45), and alcohol consumption (OR=2.35). CONCLUSIONS: The study results showed that sociodemographic, lifestyle and health variables were associated with symptoms of depression in this population. These ndings suggest that it is important to have mental health professionals available in high schools for early detection of mental conditions and student counseling.

OBJETIVO: Investigar os fatores associados a sintomas depressivos em estudantes do ensino médio. MÉTODOS: Foi realizado estudo transversal com estudantes residentes no Município de São Paulo, Brasil, em 2001. O total de 724 estudantes com idades entre 14 e 18 anos preencheram questionários de condições de vida e saúde. Dentre eles, os estudantes trabalhadores (44,8 por cento) e desempregados (22,9 por cento) também responderam a um outro questionário de condições de trabalho. A regressão logística foi utilizada para determinar os fatores associados para apresentar distúrbios depressivos, utilizando-se a "situação ocupacional" para ajustar o modelo. RESULTADOS: A prevalência dos sintomas depressivos na população estudada foi de 7,5 por cento; as taxas de acordo com o sexo foram de 39 (10,3 por cento) e 15 (4,3 por cento) nos adolescentes dos sexos feminino e masculino, respectivamente. A regressão logística mostrou que os fatores associados aos distúrbios depressivos são: baixo escore na auto-avaliação da saúde (OR=5,78), ser do sexo feminino (OR=2,45) e consumo de bebidas alcoólicas (OR=2,35). CONCLUSÕES: Os resultados mostraram que variáveis sociodemográficas, de estilo de vida e de saúde estavam associadas aos distúrbios depressivos. Esses achados sugerem a importância de que profissionais de saúde mental em escolas de ensino médio efetuem rastreio para reconhecer precocemente problemas mentais e fornecer aconselhamento aos estudantes.

Partnered care in the Bahamas: A model of advanced healthcare delivery for developing countries / Cuidados mediante asociación en las bahamas: un modelo avanzado de prestación de servicios de salud Para los países en vías de desarrollo

OBJECTIVE: To assess the delivery of advanced specialized medical care using The Partnered Care Model as a means of providing affordable access to all, irrespective of ability to pay. DESIGN AND METHODS: A retrospective analysis of all persons presenting to a specialized, private, cardiac unit, The Bahamas Interventional Cardiology Center (BICC), over an 8.5-year period from March 1996 to September 2004 was conducted. The Bahamas Heart Center's Discounted Service System had been applied since inception to all patients in three groups including insured patients billed at 100of the fee schedule of The Medical Association of the Bahamas for the procedures performed, private self-pay and government patients billed at 75and 50respectively. Their respective distribution and contributions to total revenue was analyzed. A series of financial models were constructed taking into consideration variables that could influence the percentages of revenues collected from each sector and the number of individuals served RESULTS: One thousand five-hundred and forty-two patients received services in BICC over the 8.5 year period (56males and 44females age range: 0.25 - 96 years, with mean age of 55.7 years). One thousand eight-hundred and eighty-eight patient-procedures were performed, with 51insured generating 69total revenue, 18Private producing 16Revenue, and 31Government patients generating 15. Financial models were created to predict revenue behaviour in various scenarios. CONCLUSION: Partnered Care is a viable alternative for Governments (Ministries of Health) of developing countries to provide costly specialized healthcare to their populations at minimal expense and capital outlay. Partnered Care reduces the otherwise overwhelming burden of healthcare cost to governments, particularly in developing countries, by sharing the burden of care between the private, user and government sectors.

OBJETIVO: Evaluar la prestación de servicios médicos especializados avanzados, usando el modelo de cuidados mediante asociación, como medio de proporcionar acceso económico a todos, con independencia de su capacidad de pago. DISEÑO Y MÉTODOS: Se llevó a cabo un análisis retrospectivo de todas las personas que acudieron a una unidad privada de cardiología – The Bahamas Interventional Cardiology Center (BICC) – por un periodo del 8.5 años, a saber, de marzo de 1996 a septiembre de 2004. El sistema de servicio de descuentos del Centro Cardiológico de Bahamas, había sido aplicado desde el principio a todos los pacientes en tres grupos. Los mismos comprendían: los pacientes con seguro – quienes pagaban el 100% de la suma estipulada por la Asociación Médica de Bahamas para los procedimientos realizados, los pacientes privados auto-financiados, y los pacientes con asistencia gubernamental, que abonaban 75% y 50% respectivamente. Se analizó su distribución respectiva y sus contribuciones al ingreso total. Se construyó una serie de modelos financieros tomando en consideración las variables que podrían influir en los porcentajes de ingresos percibidos por cada sector así como el número de individuos atendidos. RESULTADOS: Mil quinientos cuarenta y dos pacientes recibieron servicios en el BICC por espacio de 8.5 años (56% hombres y 44% mujeres). El rango de edad: 0.25–96 años, con una edad media de 55.7 años). Se realizaron mil ochocientos ochenta y ocho procedimientos por los cuales el 51% constituido por los asegurados generó un ingreso total del 69%; el 18% formado por los privados produjo un ingreso del 17%; y el 31% representado por los pacientes gubernamentales generó una entrada del 15%. Se crearon modelos financieros a fin de predecir el comportamiento de los ingresos en diversos escenarios. CONCLUSIÓN: El cuidado mediante asociación es una alternativa viable, mediante la cual los gobiernos (los ministerios de salud) de los países en vías de desarrollo pueden brindar a sus respectivas poblaciones, servicios de salud especializados – que de otra forma serían costosos – con costos y desembolso de capital mínimos. Los cuidados mediante asociación reducen la carga del costo de la atención a la salud para los gobiernos – carga que de otra forma resultaría realmente abrumadora, especialmente en los países en vías de desarrollo. Esto se logra mediante el procedimiento de compartir la carga de los cuidados médicos entre los tres sectores referidos – el de los usuarios, el privado, y el gubernamental.

A role for cytokines in early pregnancy.

Cytokines are expressed in a variety of cell types of the reproductive system, although in most instances their functions are not understood. There are, however, a few instances where a role in early pregnancy has been established. First, preimplantation conceptuses of ruminant ungulate species, such as cattle, sheep and goat, secrete a unique Type I interferon (IFN-tau). By mechanisms that are still unclear, IFN-tau prevents the destruction of the corpus luteum and hence ensures the continued production of progesterone which is essential for continuation of pregnancy. Most like the IFN-tau prevent lutcolysis by modulating the output of a luteolytic hormone, prostaglandin F2 alpha, from the uterus. Depsite this involvement in pregnancy, the IFN-tau possess similar antiproliferative and antiviral activities to other Type I IFN, 1 lambda e.g. IFN-alpha. There are 4-5 genes for IFN-tau in sheep and cattle whose promotor regions are highly conserved and distinct from those of other Type I IFN. These genens are not virally inducible and are expressed only in the trophectoderm (outer epithelium of the developing placenta) from the time of blastocyst hatching to implantation. Leukemia inhibitory factor (LIF) is a multi-functional cytokine which is expressed by uterine endometrium of pregnant mice around day 4 of pregnancy. Female mice lacking a functional LIF gene are fertile but their blastocysts fail to implant, strongly implicating the cytokine in maternal control of implantation. Colony stimulating factors (CSF) are a family of proteins (GM-CSF, CSF-1, G-CSF, and IL-3) that stimulate the cellular proliferation and induction of terminal differentiation of hemopoietic progenitor cells. CSF-1 is expressed in the uterine endometrium of the mouse and human during early pregnancy and its receptor, fms, is present on trophoblast. The osteopetrotic mouse, which represents a natural "knockout" of the CSF-1 gene, exhibits a low rate of fetal implantation and poor fetal viability. It seems likely that CSF-1 expression by the uterus influences growth and differentiation of the placenta. Although different species may utilize different strategies for ensuring developmental and endocrinological coordination between the embryo and the mother, these three examples illustrate that cytokines are likely to be major participants as autocrine factors that direct the events of early pregnancy and not simply as modulators of the maternal immune system.

Biochemical interactions between blastocyst and endometrium in the large domestic animals.

In pigs, the blastocyst begins to elongate from a sphere to a long filamentous thread around day 10.5 of pregnancy. At about this time the endometrium secretes large quantities of protein into the uterine lumen. The synthesis of this material which is believed to be required for nutritional support of the conceptus is under the control of progesterone. The release of secretory protein appears to be triggered by the production of estrogens by the elongating blastocyst. Blastocyst estrogens are also involved in the phenomenon of maternal recognition of pregnancy in swine, and their interaction with the maternal system, by a mechanism as yet unknown, prevents a return to reproductive cyclicity. Maternal recognition of pregnancy in the sheep and cow occurs at around the time of blastocyst elongation. Here estrogens do not appear to be involved, and protein products secreted by the conceptus have been implicated. One product of the sheep, ovine trophoblast protein-1, which is produced only during a brief period (days 13–21) of pregnancy, has been purified. It appears to be a hormone whose target tissue is the uterine endometrium.