Growth curves for normal Jamaican neonates / Curvas de crecimiento en los neonatos jamaicanos normales

The aim of this study was to provide standards for the assessment of birthweight, head circumference and crown-heel length for normal, singleton newborns of predominantly West African descent. Data were collected for 10 482 or 94of all recorded births in Jamaica during the two-month period September 1 to October 31, 1986. After editing procedures, data were available for 6178 (birthweight), 5975 (head circumference), and 5990 (crown-heel length). The data presented in tables and growth curves include birthweight, head circumference and crown-heel length for males and females separately, for gestational ages 30-43 weeks. Data sets from the University Hospital of the West Indies in 1990 and 1999 were used to explore the possibility of secular change over the period 1986-1999. In conclusion, these ethnic and gender-specific growth curves are based on the most extensive dataset currently available in Jamaica for babies of West African descent.

Medical paediatric admission patterns at the University Hospital of the West Indies: issues for future planning / Patrones de ingresos médico-pediátricos en el Hospital Universitario de West Indies: agenda para planes futuros

An understanding of the epidemiological trend in hospital admissions, including morbidity and mortality patterns and the economic impact, is critical for healthcare planning and appropriate resource allocation. Data were collected on all admissions to the paediatric unit of the University Hospital of the West Indies during the period 1999. Each observation included demographic data, admission and discharge data and billed cost of care. There were 1350 admissions (570 female and 715 male, p < 0.001). Admissions [quot ]lows[quot ] were observed in February, April and July; minor peaks in March and June and the major peaks between October and January coincided with admissions due primarily to respiratory conditions. The evening shift was generally the busiest, with the night shift having the lowest average number of admissions in any one-week period Occupancy was uniformly high between November and April, with minor lows in May and August/September. The total cost for a typical patient was J$9708 per admission and the total daily cost for a typical patient was J$1823 (US$1 = J$39 in 1999). The findings could assist with resource allocation and rationalization of health services.

Entender la tendencia epidemiológica en los ingresos al hospital, incluyendo los patrones de morbilidad y mortalidad así como el impacto económico, resulta fundamental a la hora de planificar la atención a la salud y asignar los recursos de forma apropiada. Los datos fueron recopilados en todos los ingresos a la unidad pediátrica del Hospital Universitario de West Indies durante el periodo de 1999. Cada observación incluyó los datos demográficos, los datos de ingreso y alta, y los costos facturados para la atención médica. Hubo un total de 1350 ingresos (570 hembras y 715 varones, p < 0.001). Los periodos “bajos” de ingresos se observaron en febrero, abril, y julio; los picos menores en marzo y junio, y los picos mayores en octubre y enero coincidían con ingresos debidos fundamentalmente a problemas respiratorios. El turno de la tarde-noche era generalmente el más ocupado, teniendo el turno de la noche el número promedio más bajo de ingresos en cualquier período de una semana. La ocupación del hospital se mantuvo uniformemente alta entre noviembre y abril, con bajas en los meses de mayo y agosto/septiembre. El costo total de un paciente típico fue de J$9708 (dólares jamaicanos) por ingreso, y el costo total diario por cada paciente típico fue de J$1823 (US$1 = J$39 en 1999). Los hallazgos podrían ser de utilidad en relación con la asignación de recursos y la racionalización de los servicios de salud.

The prevalence of marijuana smoking in young adults with sickle cell disease: a longitudinal study / Prevalencia del hábito de fumar marihuana en los adultos jóvenes con enfermedad de células falciforme un estudio longitudinal

BACKGROUND: The active ingredients of marijuana may have beneficial properties in the treatment of chronic pain and inflammation and is being used by sufferers of chronic pain and arthritis in some settings. Anecdotally, marijuana is believed by some sickle cell disease (SCD) patients to improve their health. This study aimed to determine the prevalence of marijuana smoking in the Jamaica Sickle Cell Cohort Study (JSCCS) in the years 2000 and 2004. The perception that marijuana use ameliorated the complications of SCD was also investigated. METHODS: All patients in the JSCCS were invited to attend an annual review, and during the 2000 and 2004 reviews, participants with homozygous sickle cell (SS) disease and sickle cell haemoglobin-C (SC) disease were asked whether they smoked marijuana, and if they smoked, whether it was used for medicinal purposes related to SCD. The authors compared smoking prevalence by gender, disease, and year of review. The association of smoking with a measure of pain frequency was also examined. RESULTS: The prevalence of marijuana smoking was higher among men and among SC participants. The proportion of either gender reporting smoking of marijuana increased in 2004 compared to 2000, and this use was not related to a simple measure of clinical severity of SCD. CONCLUSIONS: Marijuana smoking is common in adults with SCD but its usage is unrelated to clinical severity of the disease.

ANTECEDENTES: Los ingredientes de la marihuana pueden tener propiedades beneficiosas para el tratamiento del dolor e inflamación crónicos, y en algunos lugares esta planta está siendo usada por enfermos que sufren de dolor y artritis de manera crónica. De forma anecdótica, se dice que algunos pacientes de la enfermedad de células falciformes (ECF) creen que la marihuana les mejora la salud. Este estudio se propuso determinar la prevalencia del hábito de fumar marihuana en el Estudio de Cohorte Jamaicano de Células Falciformes (ECJCF) en los años 2000 y 2004. Los autores también examinaron la creencia de que el uso de la marihuana guarda relación con la percepción de que la misma mejora los casos con complicaciones por ECF. MÉTODOS: A todos los pacientes en el ECJCF, se les invita a asistir a un examen anual, y durante los exámenes de los años 2000 y 2004, a los participantes con enfermedad de célula falciforme homocigótica (SS) y con la enfermad de célula falciforme hemoglobina C (SC), se les preguntó si fumaban marihuana, y si la usaban con fines medicinales en relación con la ECF. Los autores compararon la prevalencia por género, enfermedad, y año de examen. Asimismo, examinaron la asociación del hábito de fumar marihuana con una medida de frecuencia de dolor. RESULTADOS: La prevalencia del hábito de fumar marihuana fue más alta entre los hombres y entre los participantes SC. La proporción de ambos géneros que reportó hábito de fumar, aumentó en el año 2004 en comparación con el año 2000, y el uso de la marihuana no estuvo relacionado con una simple medida debida a la gravedad de la ECF. CONCLUSIONES: El hábito de fumar marihuana es común en adultos con ECF, pero su uso no guarda relación con la gravedad de la enfermedad.

Skin test reactivity to aeroallergens in Jamaicans: relationship to asthma / Reactividad de la prueba cutánea frente a aeroalérgenos en los jamaicanos: relación con el asma

BACKGROUND: Asthma causes significant morbidity and mortality in the developing world. It is thus important to identify modifiable risk factors. OBJECTIVES: To undertake a cross-sectional study to determine the prevalence of skin test reactivity to aeroallergens in Jamaican children and adults and the relationship of the diagnosis of asthma to the pattern of skin test positivity. METHODS: One hundred and sixty subjects without the sickle cell gene (genotype AA), eighty adults and eighty children, were recruited. Skin testing to seven aeroallergens was undertaken (atopy being diagnosed if there were at least one positive reaction). Asthma status was determined by a questionnaire and/or medical records. RESULTS: Twenty-seven (34) of the children and forty-one (51) of the adults were skin test positive to at least one aeroallergen. The most common positive responses in both age groups were to Dermatophagoides farinae, Dermatophagoides pteronyssinus and cockroach mix-(German and American). All adult asthmatics with current symptoms reacted to cockroach allergen. CONCLUSIONS: Appropriate steps to reduce cockroaches and cockroach sensitization might positively impact on asthma morbidity in Jamaica.

ANTECíENTES: El asma causa morbilidad y mortalidad significativas en el mundo en desarrollo. Por lo tanto, es importante identificar los factores de riesgo modificables. OBJETIVOS: Llevar a cabo un estudio transversal a fin de determinar la prevalencia de la reactividad de la prueba cutánea frente a los aeroalérgenos en niños y adultos jamaicanos, y la relación del diagnóstico del asma con el patrón de positividad de la prueba cutánea. MÉTODOS: Se reclutaron ciento sesenta sujetos AA (sin genes falciformes), ochenta adultos y ochenta niños. Se llevaron a cabo pruebas cutáneas frente a siete aeroalérgenos (diagnosticándose atopia si se producía al menos una reacción positiva). El estatus asmático se determinó mediante encuestas y/o historias clínicas. RESULTADOS: Veintisiete (34%) de los niños y cuarenta y uno (51%) de los adultos, resultaron positivos en la prueba cutánea, al menos a un aeroalérgeno. Las respuestas positivas más comunes en ambos grupos de edad fueron frente a Dermatophagoides farinae, Dermatophagoides pteronyssinus, y mezcla de cucarachas (alemanas y americanas). Todos los asmáticos adultos con síntomas usuales reaccionaron al alérgeno de la cucaracha. CONCLUSIONES: Medidas apropiadas a fin de reducir las cucarachas y la sensibilización a las cucarachas podría tener un impacto positivo en la morbilidad por asma en Jamaica.

Anaesthesia for operative deliveries at the University Hospital of the West Indies: a change of practice / La Anestesia en los Partos Operativos en el Hospital Universitario de West Indies Un Cambio de Práctica

There has been an increasing trend worldwide to use regional anaesthesia for operative deliveries. The Confidential Enquiry into Maternal Deaths in the United Kingdom has demonstrated a steady decline in the anaesthesia-related deaths since the introduction of regional anaesthesia. There are lower morbidity profiles in mothers delivering under regional anaesthesia as well as better infant Apgar scores. In 1997, a decision was taken to have at least 60% of all elective Caesarean sections done at the University Hospital of the West Indies (UHWI) performed under spinal anaesthesia. This is a review of the anaesthetic technique for Caesarean sections at the UHWI since 1996. The Deliveries and Anaesthetic Books on the labour ward were reviewed and the type of anaesthesia for elective and emergency Caesarean sections recorded for the period January 1996 to December 2001. At the beginning of the period under study, more than 90% of the Caesarean sections were being done under general anaesthesia. By the middle of 1998, spinal anaesthesia was more commonly employed than general anaesthesia for Caesarean sections and by December 2001, more than eight out of every ten Caesarean sections were being done under spinal anaesthesia. The main reasons for the successful change of practice were that it was consultant-led, there was good communication between relevant departments, the junior staff were properly trained, there was a consistent supply of appropriate drugs and there was a high level of patient satisfaction

Ha habido una tendencia creciente mundial a usar la anestesia regional en los partos operativos. La Encuesta Confidencial sobre las causas de las muertes maternas en el Reino Unido, ha demostrado un descenso constante de los casos de muertes relacionadas con la anestesia, a partir de la introducción de la anestesia regional. Los perfiles de morbosidad son más bajos en las madres que dan a luz con anestesia regional, en tanto que los infantes presentan una mejor puntuación Apgar. En 1997, se toma la decisión de que al menos el 60% de todas las secciones cesáreas electivas en el Hospital Universitario de West Indies (UHWI) fueran realizadas bajo anestesia espinal. El presente trabajo constituye un resumen que examina la técnica anestésica aplicada en las cesáreas practicadas en el UHWI desde 1996. Se examinaron los Registros de Partos y Anestesia del salón de partos, tomándose nota del tipo de anestesia usado en las cesáreas electivas y de emergencia en el período de enero de 1996 a diciembre de 2001. A principios del periodo bajo estudio, más del 90% de las secciones cesáreas se hacían con anestesia general. A mediados de 1998, la anestesia espinal se empleaba más comúnmente que la anestesia general en las cesáreas. Y para diciembre de 2001 más de ocho de cada diez cesáreas se realizaban con anestesia espinal. Las razones principales para el cambio exitoso de práctica consistieron en que se llevo a cabo bajo la dirección de un consultante, hubo buena comunicación entre los departamentos pertinentes, el personal subalterno estaba debidamente entrenado, hubo un suministro consistente de los medicamentos apropiados, y finalmente un alto nivel de satisfacción de los pacientes.

Triage decisions and outcome among the critically ill at the University Hospital of the West Indies / Decisiones de Triage y Resultados Clínicos en los Pacientes Graves del Hospital Universitario de West Indies

The worldwide scarcity of intensive care therapy leads to the rationing of this expensive resource. This prospective study investigates the rationing of intensive therapy at the University Hospital of the West Indies (UHWI) by recording triage decisions for intensive care unit (ICU) admission and the impact of these decisions on patient outcome. Between June 2001 and May 2002, all patients triaged for admission to a multidisciplinary ICU were studied For each patient, data were collected including APACHE II score, ICU resource availability and patient survival. There were 356 eligible requests, and 285 (80%) were admitted to the ICU, with 73 (26%) of these admitted patients receiving intensive care outside of the ICU due to space limitations. The APACHE II score was the strongest predictor of ICU admission, with admission more likely as the score decreased (odds ratio = 0.94, 95% confidence interval 0.91, 0.98, p = 0.001). Of 311 requests considered suitable for admission, 26 (8%) were refused admission due to resource limitations. Mortality among these eligible refusals was 81%, compared to 34% among admitted patients (p < 0.001). Although triage decisions are based predominantly on a patient's disease severity, the demand for ICU space exceeds supply, and patient care is negatively impacted by this imbalance

La escasez mundial de terapia de cuidados intensivos conduce al racionamiento de este recurso costoso. Este estudio prospectivo investiga el racionamiento de la terapia intensiva en el Hospital Universitario de West Indies (HUWI) a partir del registro de las decisiones de triage respecto a los ingresos en la unidad de cuidados intensivos (UCI), y el impacto de estas decisiones en la evolución clínica de los pacientes. Entre junio 2001 y mayo 2002, se estudiaron todos los pacientes seleccionados tras una clasificación de triage para ingresar en una UCI multidisciplinaria. De cada paciente se recopilaron datos que incluían: puntuación APACHE II, disponibilidad de recursos en términos de UCI, y supervivencia del paciente. Se produjeron 356 solicitudes elegibles, de las cuales 285 (80%) obtuvieron ingreso a la UCI, para lo cual fue necesario ofrecer el cuidado intensivo a 73 (26%) de estos pacientes fuera de la UCI, debido a limitaciones de espacio. La puntuación APACHE II fue el predictor mayor en los ingresos a la UCI, siendo el ingreso tanto más probable cuanto menor se hacía la puntuación (odds ratio = 0.94, 95% intervalo de confianza 0.91, 0.98, p = 0.001). De 311 solicitudes para las cuales era aconsejable el ingreso, a 26 (8%) se les negó a la admisión debido a limitaciones de recursos. La mortalidad entre los rechazados elegibles fue de 81%, en contraste con un 34% entre los pacientes ingresados (p <0.001). Aunque las decisiones del triage se basan predominantemente en la gravedad de la enfermedad del paciente, la demanda de espacio para la UCI se halla muy por encima de la oferta, y la atención al paciente se ve afectada negativamente debido a esta falta de equilibrio.

Antiretroviral drug therapy in HIV-infected Jamaican children

BACKGROUND: The study describes a cohort of HIV-infected Jamaican children receiving antiretroviral therapy (ART) and reports the outcome. METHOD: An observational prospective study was conducted on HIV-infected Jamaican children receiving anti retroviral drug therapy (ART). The outcome measures, weight, height, hospital admissions and length of stay were compared at initiation and within six months of commencing ART. RESULTS: There were 37 (33.6) of 110 HIV-infected children receiving ART during 2001 to 2003. The median age at commencement was six years (age range 1-16 years) with 54.1 (20) males and 48 AIDS orphans. Care was home-based for 68 of all cases with the University Hospital of the West Indies managing 27 (73) and the Bustamante Hospital for Children 10 (27). The distribution by Centers for Disease Control and Prevention (CDC) clinical class was C (severely symptomatic), 22 (59.5); B (moderately symptomatic), 8 (21.6); A (mildly symptomatic), 6 (16.2) and N (asymptomatic), one (2.7). Among 14 (36) children with CD4 counts, 8 (57) were CDC immune class 2 (moderate immunodeficiency) and 6 (43) were class 3 (severe immunodeficiency). After commencing ART the mean difference in admissions was--1.5+/-2.55 admissions (95 CI -2.3, -0.6; p < 0.001) and in length of stay was -12.9+/-21 day (95 CI -19.9, -0.5.9; p < 0.001). Antiretroviral therapy resulted in a mean weight gain of 2.8 kg+/-4.9 kg (95 CI 1.0, 4.5; p < 0.003) and a mean gain in height of 1.7 cm+/-2.6 cm (95 CI 0.6, 2.8; p < 0.003). Five children required second line therapy. CONCLUSION: The introduction of antiretroviral therapy has resulted in improved outcomes and is being initiated in older children cared for mainly at home. Limitations in accessing affordable second line agents underscore the need for compliance with first line therapy

Paravertebral anaesthesia for breast surgery an initial experience at the University Hospital of the West Indies

Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. This retrospective review was undertaken to report the initial experience with this block. We reviewed the notes of all patients who were given a PVB alone, or in combination with general anaesthesia (GA). Twenty-one patients had P VB: twenty females and one male, with age range of 24 to 90 years. Six were attempted with PVB alone, but two of these needed supplementation with a GA. Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods

Patients' desire for peri-operative information: Jamaican attitudes

The desire for peri-operative information has been examined in patients from other countries. This study was undertaken to assess the peri-operative information needs in Jamaican patients and to compare them to those from other populations. A questionnaire examining the desire for information about impending anaesthesia was administered to 93 patients awaiting elective surgery at the University Hospital of the West Indies. Responses were assessed across age and gender, and were compared to results from five industrialized countries. Although Jamaican patients expressed a desire for information concerning anaesthesia and surgery, they did not regard it as their right to get information, and this was the most important factor in the Jamaican sample providing a significantly less positive response than patients from other nations (p < 0.01 versus each country). Information priority was given to practical aspects of anaesthesia and post-operative outcome-mobility, pain, and the consumption of food and drink. Meeting the anesthetist was high on the list of desires. Female patients were 1.9 (Confidence Interval 1.4, 2.5) times more likely to express a positive desire for information. There were no age-related differences.

Psychological distress among younger siblings of patients with homozygous sickle cell disease in the Jamaican cohort study

The presence of a chronically ill family member may adversely affect the psychological health of siblings. This study used the General Health Questionnaire and the Modified Social Adjustment Scale to assess psychological distress in 20 younger siblings (4 AA, 16 AS genotypes), aged 16-19 years, of patients with homozygous sickle cell (SS) disease. The results were compared with those previously obtained in the 20 older siblings with SS disease and in 89 controls with a normal haemoglobin (AA) genotype. High levels of psychological distress occurred among all three groups. Greater psychological distress and poorer social adjustment occurred among siblings compared to AA controls but these differences disappeared after adjusting for the reduced age of sibings. The two measures were similar in SS patients and AA controls. The level of psychological distress among siblings of SS patients did not differ from that in SS patients or AA controls.