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Background: Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women. Methods: We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy. Results: Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model. Conclusions: Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.
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From an historical perspective public space has been subjected to the control of the state. It has been used as a means to control those that are considered as needing to be kept in the proper place and, therefore, to maintain social order. However, public space is often used by those who are marginalized in the society who have limited private space for a variety of functions including making a livelihood, private living necessities, and recreation to name a few. With the rise of the COVID-19 pandemic the use of public space was severely restricted in an attempt to curb the pandemic. However, these restrictions on public space have revealed the ways in which spatial inequality is exacerbated in the Caribbean. This chapter addresses the ways in which emergency space management measures adopted by the state to address COVID-19 affect the use of space amongst the poor and marginalized. Using a thematic analysis of newspaper articles from two main daily periodicals in Trinidad and Tobago and Jamaica, the chapter assesses the ways in which restrictions on public space creates spatial inequality. The chapter shows that the COVID-19 policies that have been enacted in Trinidad and Tobago and Jamaica have resulted in a clear disproportionate burden on the poor and marginalized in these countries. It shows that the use of spatial, particularly public space is multi-dimensional in how it is used and control by different stakeholders. The chapter argues that this is not accidental, but rather part of a larger systemic process that is grounded in the history of coloniality. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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This qualitative interpretive phenomenological study focused on teachers lived experiences teaching remotely online during the COVID-19 pandemic. The problem is that primary school teachers in Jamaica had limited resources and were suddenly pushed into a teaching environment that most were unfamiliar with. The teachers also had limited or no internet access to support online teaching. The findings were significant because it sums up the experiences of primary school teachers teaching online during the COVID-19 pandemic. Data were collected via Zoom and Microsoft Teams virtual interviews using semi-structured questions with a purposeful sample of 15 teachers with varying years of teaching experience. The data were transcribed verbatim and analyzed manually using the van Kaams method to help develop themes and uncover the essence of primary school teacher experiences. Five themes emerged from the semi-structured interview of 15 teachers. They were (a) uncertainty and confusion teaching online, (b) challenging/difficult teaching online, (c) lack of computer and limited or no internet access, (d) stressful overall, and (e) long working hours. Based on this study, there were several recommendations for leaders at the Ministry of Education. Two recommendations were to engage school leaders in conversations that inform digital policies and provide professional development on the effective use of digital devices and virtual instruction. Teachers should also integrate digital learning within the curriculum at least once weekly to familiarize students with the educational platform. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Introduction: To examine the use of telehealth for delivery of health care in persons with sickle cell disease in a resource-constrained country during the COVID-19 pandemic. Methods: This study was a retrospective review of patient encounters at the Sickle Cell Unit (SCU), Jamaica during a 3-year period, March 10, 2019 to March 9, 2022 and a comparison of endpoints between 1 year before and 2 years during the pandemic. Primary endpoints of registration numbers, day-care admissions, and study visits were obtained from logbooks and the electronic medical records. Additional endpoints included well visits, hydroxyurea (HU) visits, and bone pain crisis. Results: Patients registered at the clinic on 17,295 occasions, with 7,820 in the pre-pandemic year decreasing by 43.8% and 35% in the 2 subsequent pandemic years. Overall, study visits increased by 4.9% and 1.3% in the pandemic years. They increased in adults by 13.1% and 8.9% but fell by 3.2% and 6.2% in children. Fewer people were seen in the pandemic years, with children showing a 20.7% decline in numbers. Tele-visits accounted for 31.4% of all study visits during the pandemic years and increased by 23.6% between the pandemic years. There were more well-visits and HU visits, but fewer pain visits and day-care admissions in the pandemic years. Conclusions: The SCU maintained health care delivery for a high-risk population during the pandemic, with tele-visits mitigating the short-fall from in-person visits. Tele-visits may be more acceptable to adults with a chronic illness and may be a suitable alternative for delivering health care.
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Introduction: Dysnatremia is common in patients with acute coronavirus disease 2019 (COVID-19). Robust studies looking at the association between sodium imbalance in patients with COVID-19 and clinical outcome remain lacking.This study aimed to identify the prevalence of dysnatremia among patients hospitalized with acute COVID-19 infection. It also sought to determine the association between serum sodium and both mortality and morbidity, as measured by the severity of COVID-19 infection, the need for ventilatory support, intensive care unit (ICU) admission and acute kidney injury (AKI). We sought to evaluate whether sodium levels, a relatively inexpensive and easily accessible lab investigation, may be employed as a predictor of outcome in patients admitted with COVID-19 infection. Method(s): This was a retrospective cohort studyconducted from an electronic medical records review of all hospitalized, adult patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) at the University Hospital of the West Indies between August 1, 2020, and January 31, 2021. The relationship between dysnatremia (serum sodium <135 mmol/l or >145 mmol/l) and in-hospital mortality and morbidity were examined. A total of 374 COVID-19 patients were enrolled. The study was approved by the Mona Campus Research Ethics Committee, an independent body which is housed in the Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica. Result(s): The incidence of hyponatremia and hypernatremia were 29.4% and 6.1% respectively. The mean admission serum sodium was 137.3 +/- 6.0 mmol/l. At the end of the study period, the prevalence of hyponatremia and hypernatremia was 50.3% and 19.8% respectively. Acute kidney injury occurred in 117 patients (31.3%) with 23 patients (6.1%) having an unknown status due to missing data. Hypernatremia was associated with a higher prevalence of AKI (60.9%) than hyponatremia (35.5%) (chi2=13.8, p=0.008). Serum sodium at presentation was higher among the non-survivors (139.3 +/- 7.2 mmol/l), compared to the survivors (136.7 +/- 5.5 mmol/l) (p<0.001). Patients with hypernatremia had a survival rate of 52.2% at a survival average of 18.3 days, significantly lower than patients with hyponatremia (80.9%) or normonatremia (77.6%) (p=0.001). There was statistically significant association between the presence of hypernatremia and in-patient mortality (chi2=9.0, p=0.011) but there was no association with hyponatremia. The majority of the patients (56.1%) had severe COVID-19 infection. Non-severe and critically ill patients accounted for 32.1% and 11.8% respectively.Comparison of serum sodium at presentation to the severity of COVID-19 infection did not show statistical significance(chi2=1.7, p=0.794). There was no statistically significant difference between serum sodium levels and oxygen therapy (chi2=1.4, p=0.502) or the use of mechanical ventilatory support (chi2=4.6, p=0.798). There was no statistical significance in the length of hospital stay across sodium groups (p=0.179). Conclusion(s): Hypernatremia was associated with both a higher risk of acute kidney injury and in-hospital mortality, but not morbidity. Hyponatremia either on admission or developed during the hospitalization was not associated with poor clinical outcomes. Serum sodium can be used in the prognostication and risk stratification of patients with acute COVID-19 infection. No conflict of interestCopyright © 2023
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Introduction: Early in the pandemic various lockdown measures were implemented to decrease spreading of Covid-19. This resulted in many clinics and hospitals observing a decrease in the usual numbers of patients accessing care. Patients have also expressed fears and challenges with accessing care at health clinics and hospitals during this time. Since May 2020, there has been a gradual decrease in the restrictions and stay at home orders for Covid-19 by the government in Jamaica and more persons have begun to access care again at health facilities. The impact of the Covid-19 pandemic in patients with chronic kidney disease especially those who were not admitted with Covid-19 is limited. This study seeks to determine why patients were not accessing care early in the pandemic and the possible longer-term impact of the Covid-19 pandemic on the care and prognosis of patients with chronic kidney disease. Method(s): All patients who attended Renal clinic, Kingston Public Hospital (KPH) from April 20th to July 14th 2021 were eligible for inclusion in the study. Those who consented to participate in the study had an interview with the researcher at the Renal clinic where a questionnaire was administered. Demographic data was collected as well as whether they were a new or follow-up patient and number of appointments missed was noted. Their renal diagnosis and labs were obtained from their dockets by the researchers. The data was analysed using Microsoft excel and Epi info software Results: There were 185 participants. 45.7% of the participants were 51 to 70 years old. 61.1% were females and 38.9% were males. Follow-up patients accounted for 76.2% of the participants whilst 23.8% were new patients. 92.2% of the follow-up patients reported attending clinic in the past year. 15.1% of the participants reported missing at least one appointment in the past year. Most common reasons given for missing appointments were forgot date of appointment, afraid of coming to hospital, was sick at home or admitted to hospital. 2.7% of the participants reported having had Covid-19. Only 7.0% of the study participants were on dialysis. 76.9% of those receiving dialysis were started on haemodialysis since March 2020. 93.0% reported receiving all or most of their medications through the free public health care system during the pandemic. 44.3% of the participants reported working in the past year. Most common reasons given for not working in the past year were medical condition, receiving family support or retired. Only 3.6% reported being sent home by an employer due to the pandemic. The most common renal diagnoses were diabetic nephropathy and hypertensive nephrosclerosis followed by lupus nephritis and sickle cell nephropathy. 49.2% were CKD stage 3b to Stage 5. 14.6% of those who were CKD stage 3 near to March 2020 progressed to CKD stage 4 or 5 by a year later. Conclusion(s): During the pandemic, attendance of patients at Renal clinic, Kingston Public Hospital and their access to medications remained high. Approximately 15% of those with CKD stage 3 near the onset of the pandemic progressed to CKD stage 4 or 5 by a year later. This warrants further study. No conflict of interestCopyright © 2023
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This special issue includes 9 articles that discuss comparative cost of diets for low-income families in the Caribbean;improving dietary diversity in the Caribbean Community;malnutrition in all its forms in Caribbean countries using a food systems approach;sociodemographic and dietary influences on perceptions of eating habits in Jamaica;determinants of unhealthy dietary habits among a sample of survey participants in Jamaica;integrated food systems approaches for healthy diets in the Caribbean;ecological relationships in social resilience;COVID-19 and the social distribution of hunger in three Caribbean Small Island Developing States.
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Transcranial Doppler (TCD) ultrasonography is a non-invasive ultrasound technique that uses high-frequency sound waves to measure blood flow velocities in the cerebral vasculature. This review analyzes TCD research in the Caribbean region using a bibliometric analysis of 29 articles from PubMed. The articles were analyzed using Microsoft Excel 2016 and the VOSviewer software (Van Eck and Waltman, Leiden University, Centre for Science and Technology Studies (CWTS), www.vosviewer.com) and characterized various aspects of TCD research, including countries, research themes, authorship, journals, affiliations, and keywords. The majority of the 29 publications came from Cuba (38%), followed by the French West Indies (22%) and Jamaica (20%). Most TCD research focused on sickle cell disease (SCD), accounting for 45% of the studies, followed by 21% of articles on vasospasm and subarachnoid hemorrhage. The use of TCD in brain death and neuro-intensive care was also explored, constituting 17% of the studies. Alternative TCD-monitored treatment options for SCD, such as stem cell transplantation and hydroxyurea, were also frequently investigated. The most productive institutions were Hospital Clínico-Quirúrgico Hermanos Ameijeiras in Havana, Cuba, the Sickle Cell Unit at the University of West Indies (UWI) Mona in Jamaica, the Medical-Surgical Research Center (CIMEQ) in Havana, Cuba, and the SCD Reference Center in Guadeloupe and Martinique in the French West Indies. TCD has been identified as a cost-effective tool for real-time monitoring of cerebral blood flow in many clinical settings, including stroke and SCD, which are prevalent in the Caribbean. Although there is an increase in the trend of using TCD for neuromonitoring in the Caribbean, gaps still exist. Capacity-building initiatives, such as training programs for healthcare providers and the development of local TCD research networks, can improve access to TCD in resource-constrained settings to treat and neuromonitor patients cost-effectively.
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Despite a high occurrence of acute kidney injury (AKI) with COVID-19 infection, there are no data on its incidence in sickle cell disease (SCD). We performed a single-center retrospective chart review of persons aged >1 year with SCD, COVID-19 infection and no prior dialysis requirement hospitalized from June 1, 2020 to May 31, 2022. Demographics, clinical, laboratory characteristics and outcomes were abstracted. AKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of 38 patients meeting study criteria (60.6% female, mean age ± SD 38.6 ± 15.9 years), 3 (7.9%) were COVID vaccinated. Fifty-five percent (55%) developed AKI with 7.9% (n = 3) requiring dialysis. Participants with AKI were older (44.9 versus 30.8 years, p = 0.005), with a higher proportion having baseline chronic kidney disease (52% versus 0%, p = 0.001). Severe COVID infection [age-adjusted odds ratio (aOR): 8.93, 95%CI: 1.73-45.99, p = 0.033], red cell transfusion (aOR 7.92, 1.47-42.69) and decrease in hemoglobin per unit from baseline (aOR 2.85, 1.24-2.28) were associated with AKI. Five persons died in hospital, with AKI resulting in higher median length of stay (12 versus 5 days, p = 0.007). Targeted COVID-19 preventative measures and multinational longitudinal studies to ascertain the impact of AKI and COVID-19 infection in SCD are needed.
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Purpose: Adolescence (ages 10-19) is a sensitive developmental period for the emergence of mental and behavioral health problems, but there is a lack of multi-country qualitative studies that explore how adolescents themselves understand these critical challenges. As part of UNICEF's 2021 State of the World's Children Report, the Global Early Adolescent Study collaborated with organizations in 13 countries to hold a series of focus group discussions (FGDs) with adolescents focused on mental health. These FGDs aimed to (1) understand adolescents' perspectives on significant mental health challenges in their age group, (2) understand adolescents' perspectives on the key risk and protective factors driving these challenges, and (3) understand the ways in which adolescents cope with these challenges, including barriers and facilitators to help-seeking. Methods: A total of 71 FGDs were conducted across 13 countries between February and June of 2021. Countries were selected to ensure geographic, economic, and cultural diversity, and included: Belgium, Chile, China, the Democratic Republic of Congo, Egypt, Indonesia, Jamaica, Jordan, Kenya, Malawi, Sweden, Switzerland, and the United States. Within each country, FGDs were stratified by sex and age such that there were at least two younger (ages 10-14) and two older (ages 15-19) focus groups. Depending on the COVID-19 restrictions at the time, FGDs were either held in-person or online. All FGDs were held in local languages and lasted between 60 and 90 minutes. FGDs were recorded, transcribed verbatim, and translated into English when necessary. These English translations were then coded and analyzed using an inductive thematic analysis approach. Results: Across diverse cross-cultural settings, a number of consistent findings emerged from the voices of adolescents. In particular, adolescents around the world emphasized the many contexts that drive mental health challenges, including family adversity, community violence, unsupportive school environments, poverty, social media culture, and restrictive gender norms. They also discussed significant barriers to seeking help for mental health challenges, such as community stigma, lack of social support, and fears of invalidation. These barriers frequently resulted in adolescents coping with these challenges without support, often using maladaptive strategies. Importantly, adolescents generally described and understood mental health in terms of distress (e.g., sadness, loneliness, shame, anger) rather than disorder (e.g., depression, anxiety). Conclusions: Above all, it was clear that adolescents around the world need much better formal and informal supports to adequately address mental and behavioral health problems, and that these responses must take into account the many contexts that contribute to these problems. Further, the non-clinical terminology frequently used by adolescents suggests that taking a purely diagnostic approach in addressing mental health challenges may exclude many adolescents in need of assistance. Sources of Support: Wellcome Trust.
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Coronavirus Disease 2019 (COVID-19) has been accompanied by numerous factors which have adversely affected Small Island Develop-ing States (SIDS). Despite several COVID-19 vaccination campaigns and the number of in-dividuals who have been afflicted by, or died from, contracting the virus, many Jamaicans have delayed their vaccination against CO-VID-19. This study investigates the factors that have shaped the attitudes of Jamaicans towards COVID-19 vaccines. Its findings are based on content analysis of Jamaican newspapers (N=200), including columns, editorials, and news stories published in the online editions of two of the country's lead-ing publications (The Jamaica Gleaner and the Jamaica Observer). The study finds that several factors shape the attitudes of Jamaicans towards COVID-19 vaccines. These include the potential side effects of COVID-19 vac-cines, personal choice, perception of the pan-demic, insufficient knowledge regarding the efficacy of the vaccines, religious beliefs, and distrust of the Jamaican government and health authorities. The study highlights that for SIDS, like Jamaica, which are characterised by fragile economies and ailing public health care systems, vaccine hesitancy is a potential barrier to overcoming some of the challenges linked to the current pandemic.The study points to the critical need to improve the COVID-19 vaccination uptake among Jamaicans. Understanding the speci-ficities concerning vaccine hesitancy will al-low the Jamaican government and healthcare providers to better organise public sensitisation campaigns to address the concerns of the un-vaccinated in Jamaica.
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Background. Little is known about the factors which influence COVID-19 vaccine uptake among reproductive-aged women in Jamaica. Methods. We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1- 8, 2022. Participants were recruited from a convenience sample of women (patients, providers and staff) at a tertiary care hospital whose demographic characteristics are shown in Table 1. We assessed self-reported COVID-19 vaccination status, vaccine confidence (defined as confidence in the safety and efficacy of vaccines and the system that delivers them) and medical mistrust beliefs (e.g., "I don't trust the COVID-19 vaccine"). We conducted exploratory factor analysis using principal axis factoring and oblique equamax rotation on 22 survey items. Three factors were extracted which conceptually aligned with three subscales: lack of vaccine confidence, government-related COVID-19 medical mistrust, and race-based COVID-19 medical mistrust;we retained items with factor loadings > 0.40. The final subscale variables and their descriptive statistics are shown in Table 2. In addition, we used multivariable modified Poisson regression to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the association between vaccine uptake and pregnancy status adjusting for education and factors scores. Variables with a p value < 0.1 were retained in the final regression model. Results. Of 192 respondents, 72(38%) were pregnant and 120 (62%) were nonpregnant. Pregnancy was negatively associated with vaccine uptake (aPR=0.70, 95% CI=0.51 - 0.96;p=0.029). Women with higher scores on the lack of vaccine confidence subscale (i.e., less confident in vaccine) were less likely to be vaccinated (aPR=0.72, 95%CI=0.61 - 0.86;p< 0.001). Government-related COVID-19 medical mistrust and race-based COVID-19 medical mistrust were not significantly associated with vaccine uptake (see Table 3). Conclusion. Findings suggest that pregnancy and lack of vaccine confidence are factors associated with lower vaccine uptake among reproductive-aged women in Jamaica. Bolstering vaccine confidence, through the use of evidence-based interventions, may help to increase COVID-19 vaccine uptake in this population.
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Jamaica, an upper-middle-income country, is characterised by high poverty rates, with rural residents, particularly women, being the most impoverished. Despite acknowledgment of various vulnerabilities and deprivations inhibiting development, poverty is narrowly examined as consumption. This unidimensionalperspective leaves a critical gap in the poverty debate in Jamaica. This paper has contributed tofilling this gap. The author reviews consumption poverty, critical analyses changes in the poverty literature and then proposes multidimensionalpoverty as a broader informational base. This is to support evidence-based policy and a more nuanced conceptualisation and evaluation of poverty. Framed by Amartya Sen 's capability approach and situated in the context of women 's development, the study explored the experiences of 84 women from six rural communities in Jamaica. Analysis of qualitative data, collected through interviews, focus groups and observation, provides evidence of the economic, social, psychological and physical dimensions of poverty that permeate the women's lives. Interconnections between poverty dimensions offer insight into the nature of chronic poverty in rural Jamaica. The conclusion includes policy implications and suggestions forfuture research.
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The COVID-19 pandemic has led to a global crisis and has affected the Caribbean islands, leading to significant health and socioeconomic consequences in this region. Efforts to mitigate the burden of this disease have led to an accelerated amount of research in the English-speaking Caribbean (ESC). This bibliometric analysis aimed to evaluate the COVID-19-related scientific literature from the ESC nations. A total of 175 articles were included and analyzed from an initial PubMed search (n = 638) for COVID-19-related scientific literature from the ESC nations published between January 1, 2020, and June 30, 2022. Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) and the VOSviewer (version 1.6.18) were used to characterize countries, authorship, journals, affiliations, and keywords of the COVID-19-related articles. Trinidad and Tobago (38%), Jamaica (22%), Barbados (20%), and Grenada (15%) contributed to the greatest number of publications. The University of the West Indies (UWI) campuses in Trinidad and Tobago, Jamaica and Barbados, and St. George's University in Grenada were the most prolific institutions. Srikanth Umakanthan from the UWI was the most prolific author. Cureus, SN Comprehensive Clinical Medicine, and Frontiers in Public Health were the first three most productive journals; 59% of the 175 articles had either the first or last author affiliated with an institution in the ESC, and 19% of the articles were country-focused: Trinidad and Tobago (16/175), Jamaica (9/175), Barbados (5/175), and Antigua and Barbuda (2/175). Among the top themes of research, 27% were outbreak response and rearrangements, epidemiological studies (23%), clinical management (23%), and medical education (13%). Over the last two years, an interest stimulated by the pandemic has expanded the research in ESC countries. However, gaps in the knowledge exist, especially in the epidemiology of COVID-19 complications in the sub-populations of chronic non-communicable diseases, post-COVID syndrome, and the long-COVID syndrome in the region. Hence, there is enormous scope for more research across the region.
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A cross-sectional SARS-CoV-2 serosurvey was conducted after the Omicron surge in Jamaica using 1,540 samples collected during March - May 2022 from persons attending antenatal, STI and non-communicable diseases clinics in Kingston, Jamaica. SARS-CoV-2 spike receptor binding domain (RBD) and/or nucleocapsid IgG antibodies were detected for 88.4% of the study population, with 77.0% showing evidence of previous SARS-CoV-2 infection. Of persons previously infected with SARS-CoV-2 and/or with COVID-19 vaccination, 9.6% were negative for spike RBD IgG, most of which were unvaccinated previously infected persons. Amongst unvaccinated previously infected people, age was associated with testing spike RBD IgG negative. When considering all samples, median spike RBD IgG levels were 131.6 BAU/mL for unvaccinated persons with serological evidence of past infection, 90.3 BAU/mL for vaccinated persons without serological evidence of past infection, and 896.1 BAU/mL for vaccinated persons with serological evidence of past infection. Our study of the first reported SARS-CoV-2 serosurvey in Jamaica shows extensive SARS-CoV-2 population immunity, identifies a substantial portion of the population lacking spike RBD IgG, and provides additional evidence for increasing COVID-19 vaccine coverage in Jamaica.
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The outbreak of Covid-19 worldwide has presented an unprecedented challenge for the equity-in-education agenda, especially in developing countries of the Global South (e.g., the English-speaking Caribbean). This article examines the impact school closures have had in Jamaica and Barbados, and highlights the emerging disparities the global pandemic has had on education. The central organizing questions are as follows: Who was affected by school closures in Barbados and Jamaica? How did the Ministries of Education (MOEs) support curriculum and instruction during the pandemic? What challenges does Covid-19 present for MOEs? What are the implications for education after Covid-19? School closure data suggest a gender disparity, with more males than females out of school due to Covid-19 from preprimary to secondary school in Barbados and Jamaica. MOEs in the region responded to school closures primarily by increasing access to technology to facilitate remote learning. Some of the challenges with continuing education for students during Covid-19 were due to a lack of infrastructure and amenities to support remote learning. Implications for education post-Covid-19 are considered.
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SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anchoring bias is a cognitive bias where one relies too heavily on initial information early on in the decision making process, affecting subsequent decisions due to future arguments being discussed in relation to the "anchor. Overemphasis on COVID-19 due to the pandemic has impacted the timely diagnosis and treatment of other diseases. CASE PRESENTATION: A 39-year-old man with a past medical history of COVID 19 in 12/2020 presents to the ED with increasing weakness, chest pain, recurrent fevers, diarrhea, and cough. CXR revealed bilateral infiltrates suggestive of pneumonia/pulmonary edema. Patient was empirically started on ceftriaxone. CT chest was suspicious of COVID-19;however repeat testing was negative. Diarrhea did not improve. Patient later admitted to recent travel to Jamaica. Ova and parasite, C-difficile, and stool culture were negative. On hospital day 8, the patient was intubated and placed on mechanical ventilation for worsening hypoxic respiratory failure Infectious disease was consulted for recurrent fevers of unknown origin and diarrhea with recent travel. Testing for typhoid fever, hantavirus, malaria, HIV, zika virus, chikungunya, dengue, and yellow fever were performed. Consent was obtained for HIV testing. HIV antibody tests were positive, CD4 count of 7, and viral load greater than 900k. Since a new diagnosis of AIDS with a CD4 count of 7 was obtained, the patient was subsequently tested for opportunistic infections such as TB. TB sputum PCR testing was positive but AFB smear was negative for TB. Antiretroviral and tuberculosis treatments were initiated. DISCUSSION: Anchoring bias can delay critical diagnoses and impede patient care if it is not recognized. According to Watson et. al, one way physicians circumvent the thought of pretest probability when ordering tests based on patient history and the subsequent list of differential diagnoses is anchoring bias. Bypassing the pretest probability also alters the sensitivity and specificity of testing because results that do not confirm or rule out a top differential diagnosis are thought to be inaccurate and are then repeated attributing the initial result to a bad specimen or an improper collection of the specimen. CONCLUSIONS: The case presented exemplifies clearly the concept of anchoring bias. Upon initial presentation, the patient had nonspecific symptoms such as weakness, chest pain, recurrent fevers, diarrhea, and cough, all of which can be symptoms of COVID 19 in the setting of a global pandemic. It is clear that the initial diagnosis based on these symptoms was COVID 19. When initial testing was negative, anchoring bias still played a role in the decision to test the patient once again, despite the first negative test. Repeat testing still did not support the diagnosis of COVID 19, which expanded the differential diagnosis and ultimately led to the correct diagnosis of AIDS with concomitant TB infection. Reference #1: Saposnik, et. Al. Cognitive Biases Associated with Medical Decisions: A Systematic Review. BMC Med Inform Decis Mak. 2016 Nov. 3. PMID: 27809908 Reference #2: Harada, et. al. COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era. Eur J Case Rep Intern Med. 2020 Oct 23. PMID: 33194872. Reference #3: Singh, et. al. The Global Burden of Diagnostic Errors in Primary Care. BMJ Qual Saf. 2016 Aug 16. PMID: 27530239. DISCLOSURES: No relevant relationships by Sagar Bhula
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Objective: Food insecurity impacts 1 out of 6 patients with celiac disease (CD) in the United States, and rates have increased during the COVID-19 pandemic. This is particularly concerning for vulnerable populations who require specialized medical diets. State and federal resource programs do not account for the increased cost of gluten-free (GF) foods, and food pantries do not address overall health issues that often come with food insecurity. Our project aimed to provide GF food to food insecure families through a hospital-based food pantry and offer dietitian-led cooking classes to improve dietary quality and nutrition knowledge. Method(s): To address barriers to food access, Boston Children's Hospital (BCH) opened a food pantry, the Family Food Connections (FFC), in the Jamaica Plain neighborhood of Boston. FFC offers weekly food supplies to BCH patient families and community members. GF food bags are available for those who request them. Monthly virtual cooking classes led by a registered dietitian are offered free of charge to families with and without CD. All classes are held via Zoom with simultaneous translation services available in Spanish. Classes feature naturally GF recipes, and provide instructions on scratch cooking, nutrition education, and use of ingredients found in the food packages. The recipes are designed to include seasonal ingredients and are used as a platform to teach about nutrition related topics. Classes also serve as an open forum for families to ask nutrition and meal preparation related questions to the dietitian instructor. Metrics on pantry usage and class attendance were collected using Zoom analytics tools and REDCap. Result(s): Utilization of both the food pantry and cooking classes increased monthly. During the first six months of operation, an average of 500 families per week visited the FFC for food packages, totaling over 5,000 unique family visits. Of these families, 122 indicated needing all gluten-free food (64) or some gluten-free food (58). As of May 2022, 34 families attended the live virtual cooking classes, and 628 families viewed the recorded sessions. Survey questionnaire responses were limited to date (N=11) but did indicate that families previously had never attended a cooking class due to a lack of time, or they were not aware that classes were available. Conclusion(s): Initial utilization of the FFC, GF food packages, and accompanying cooking classes revealed a significant demand for the provision of GF food as well as a GF focused cooking and nutrition education program. The classes allow for processing nutrition education through non-intentional learning, and provide an opportunity to improve health and quality of life for all who attend, regardless of dietary restrictions. Future studies will evaluate changes in health outcomes, quality of life, cooking habits, and GF diet knowledge.
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Purpose>This study aims to explore the sustainability of Jamaica’s public debt over a highly volatile period of time.Design/methodology/approach>The authors use a suite of econometric tools, including, unit root testing, cointegration testing and estimating a fiscal reaction function. The authors control for structural breaks in the regression analysis.Findings>The authors find that whilst reschedulings might be indicative of cash-flow problems in Jamaica, fiscal policy has responded effectively to increase the public debt, thereby making the debt sustainable. Notwithstanding the political economy and social demands of the population prior to the impact of the pandemic, the implications of higher debt stocks (higher debt-servicing and lower social expenditures) might make this approach to fiscal policy and debt management infeasible. As a result, the authors recommend that the government will need to take an active approach in managing its debt position to facilitate responses to shocks and provide conditions within which maintaining fiscal discipline is feasible.Originality/value>To the best of the authors’ knowledge, this is the first study to explore fiscal sustainability in Jamaica over this time period whilst taking into consideration structural breaks caused by the global financial crisis and debt restructurings. The authors also take into consideration variables such as exchange rates and the occurrence of elections, which have not been included in previous studies.