Relationship of social and economic factors to mental disorders among population-based samples of Jamaicans and Guyanese.

BACKGROUND: There have been growing concerns about increasing mental health problems in the Caribbean region. This study explores rates and factors associated with selected mental health disorders within 2 Caribbean countries: Jamaica and Guyana. METHODS: Probability samples of 1218 Jamaicans and 2068 Guyanese participants were used. A modified version of the WHO Composite International Diagnostic Interview (WHO CIDI) defined by the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was administered in order to assess lifetime mental disorders. Descriptive statistics, χ2 and hierarchical regression analytic procedures were used to examine rates and factors associated with mental disorders. RESULTS: Rates of mental health conditions were different across contexts and were generally higher for Guyanese compared with Jamaicans for alcohol abuse (3.6% vs 2.2%), drug abuse (1.4% vs 1.3%), substance abuse (4.7% vs 2.7%) and mania (0.4% vs 0.1%). The rate of depression, however, was higher among Jamaicans than Guyanese (7.4% vs 4.1%). There were also noticeable differences in rates in both countries, due to social and economic factors, with social factors playing a larger contributory role in the mental health status of individuals across countries. CONCLUSIONS: The results of this study suggest the need for more indepth analyses of factors contributing to mental health conditions of peoples within the Caribbean region, including the influence of additional sources of stress, quality of care and help-seeking behaviours of individuals.

Epidemiological Features of violence-related Injuries in Jamaica.

BACKGROUND: Violence-related injuries are common in Caribbean countries such as Jamaica and are a major cause of mortality and morbidity. The study examined the epidemiology of violence-related injuries and ascertained the extent to which the utilization of violence-related injury reports and surveillances inform health policy and programme planning implementation in Jamaica. MATERIALS AND METHODS: Primary data was gathered by the Ministry of Health through its Public Hospital Monthly Statistical Reporting System (HMSR) and the Jamaica Injury Surveillance System (JISS). These data files were collected over a four and five year period respectively. The sample size comprised 187,610 cases (117,615 from HMSR) and (69,995 from JISS) which were seen and treated at the public hospitals in Jamaica because of violence-related injuries. This study employed a descriptive analysis of visits and cases (episodes) relating to violence-relating injuries. Simple random sampling method was used in this study and the data was analysed using both Microsoft Excel and the Statistical Package for Social Scientists 18.0. RESULTS: The highest number of violence-related injuries was in 2007 and assault (stab wounds, gunshot and blunt injury) was the most frequent violence-related injury with human bites, and burns being the least. The highest number of violence-related injuries in males and females was in the age group 20-29 y. More males experienced violence-related injuries compared with females with male to female ratio of 1.35:1 to 1.45:1 in the years considered. CONCLUSION: The findings of this study are consonant with local and international studies and confirm that assault was the most frequent violence-related injury. Males compared with their female counterparts are a stronger demographic risk factor where violence-related injuries are concerned. Violence-related injuries have spurred the charge for effective interventions, policy initiatives, and strategic and programme planning by the Ministry of Health, through multi-sectoral and multi-agency approaches in Jamaica.

Tobacco-related chronic illnesses: a public health concern for Jamaica.

BACKGROUND: Tobacco use is a leading cause of preventable morbidity and mortality from non-communicable diseases. The objectives of the study were to determine the percentage of annual income used to purchase tobacco-related products and treat tobacco-related illnesses, and assess the characteristics of smokers and their awareness of the health-related risks of smoking. METHOD: Stratified and snowball sampling methods were used to obtain information (via a 17-item, close-ended questionnaire) from 85 adult respondents (49 males and 36 females). The instrument comprised of demographic characteristics, smoking behavioural/lifestyle, health, and micro socio-economics. RESULTS: There were no significant differences between individuals who were affected by chronic obstructive pulmonary disorder (COPD) (14.1%) and cardiovascular disease (18.8%). It was found that respondents spend 30-39% of their annual income on tobacco-related products. Forty percent (40.0%) and 41.7% of respondents with lung cancer and COPD respectively spend more than 50% of their annual income to treat these diseases. The majority (80%) of those who continues to consume tobacco-related products were uncertain as to why they were doing it. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. CONCLUSION: The majority of the respondents who had tobacco-related illnesses such as lung cancer and COPD spend a significant amount of their income on their health care. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. This suggests the need for increase public awareness where both smokers and non smokers are being fully or adequately informed about the dangers or health risks of tobacco consumption.

Prostate cancer and metabolic syndrome: is there a link?

Metabolic syndrome has become quite prevalent within our society. Over the past two decades, the prevalence of metabolic syndrome has sharply increased worldwide and it has become a major public health problem in several countries. It is associated with the global epidemic of obesity and diabetes mellitus and imposes numerous cardiovascular risks. Prostate cancer is the second most common cancer among men, surpassed only by non-melanoma skin cancer. A considerable body of evidence exists suggesting that some components of the metabolic syndrome have been associated with the risk of prostate cancer. These components include obesity, an abdominal fat distribution, and hyperinsulinemia. Androgen deprivation therapy (ADT) is the most widely used therapeutic modality in prostate cancer. It changed the body composition and lipid profile of men with prostate cancer. Androgen deficiency is associated with increased levels of total cholesterol, low-density lipoprotein (LDL)- cholesterol, increased production of proinflammatory factors, and increased thickness of the arterial wall and contributes to endothelial dysfunction. The aim of this review is to evaluate the association between metabolic syndrome and prostate cancer and to discuss the implications of androgen deficiency in men with cardiovascular risk factors. A comprehensive literature search was carried out with the use of PubMed from 1980 through 2012, and relevant articles pertinent to metabolic syndrome and prostate cancer are evaluated and discussed.

The church's response to sexual reproductive health issues among youths: Jamaica's experience

This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.

The church's response to sexual reproductive health issues among youths: Jamaica's experience.

This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.

Prevalence of injuries and reporting of accidents among health care workers at the University Hospital of the West Indies.

OBJECTIVES: This study investigated the knowledge, awareness and practices of health care workers towards universal precautions at the University Hospital of the West Indies. The study also examined the prevalence of injuries experienced by health care workers, as well as incidence of accidents and compliance with post-exposure prophylaxis. MATERIALS AND METHODS: A cross sectional survey was conducted in September and October 2007. A 28-item self-administered questionnaire was provided to two hundred health care workers including medical doctors, medical technologists, nurses and porters to assess knowledge and practices regarding universal precautions, prevalence of injuries and incidence of accidents. RESULTS: Almost two-thirds (62.3%) of the respondents were aware of policies and procedures for reporting accidents while one-third (33.2%) were unsure. All nurses were aware of policies and procedures for reporting accidents, followed by medical doctors (88%) and medical technologists (61.2%). The majority (81.5%) of the respondents experienced splashes from bodily fluid. Over three-quarters of medical doctors (78%) and two-thirds of nurses (64%) reported having experienced needle stick injuries, while the incidence among medical technologists was remarkably lower (26%). The majority of the respondents (59%) experienced low accident incidence while just over one-tenth (14%) reported high incidence. Eighty four respondents reported needle stick injuries; just under two-thirds (59.5%) of this group received post-exposure treatment. CONCLUSIONS: The study found that majority of health care workers were aware of policies and procedures for reporting accidents. Splashes from body fluids, needle stick injuries and cuts from other objects were quite prevalent among health care workers. There is a need for monitoring systems which would provide accurate information on the magnitude of needle stick injuries and trends over time, potential risk factors, emerging new problems, and the effectiveness of interventions at The University Hospital of the West Indies and other hospitals in Jamaica.

Health literacy and health seeking behavior among older men in a middle-income nation.

Health literacy is a measure of the patient's ability to read, comprehend and act on medical instructions. This research article examines health literacy and health-seeking behaviors among elderly men in Jamaica, in order to inform health policy. This is a descriptive cross-sectional study. A 133-item questionnaire was administered to a random sample of 2,000 men, 55 years and older, in St Catherine, Jamaica. In this study, 56.9% of urban and 44.5% of rural residents were health literate. Only 34.0% of participants purchased medications prescribed by the medical doctor and 19.8% were currently smoking. Despite the reported good self-related health status (74.4%) and high cognitive functionality (94.1%) of the older men, only 7.9% sought medical care outside of experiencing illnesses. Thirty-seven percent of rural participants sought medical care when they were ill compared with 31.9% of their urban counterparts. Thirty-four percent of the participants took the medication as prescribed by the medical doctor; 43% self-reported being diagnosed with cancers such as prostate and colorectal in the last 6 months, 9.6% with hypertension, 5.3% with heart disease, 5.3% with benign prostatic hyperplasia, 5.3% with diabetes mellitus, and 3.8% with kidney/bladder problems. Approximately 14% and 24% of the participants indicated that they were unaware of the signs and symptoms of hypertension and diabetes mellitus, respectively. The elderly men displayed low health literacy and poor health-seeking behavior. These findings can be used to guide the formulation of health policies and intervention programs for elderly men in Jamaica.

Access to contraception by minors in Jamaica: a public health concern.

BACKGROUND: Access to contraceptive by minors (pre-adolescents and adolescents) has spurred policy and legislative debates, part of which is that in an effort to successfully meet government's objective of a healthy sexual lifestyle among minors. AIMS: THIS STUDY EXAMINED FACTORS AFFECTING SEXUAL REPRODUCTIVE HEALTH IN MINORS, NAMELY: access to contraceptive advice and treatment, pregnancy, number of sexual partners, sexually transmitted infections (STIs) and confidentiality. MATERIALS AND METHODS: This research involved quantitative and qualitative data. Two hundred and thirty eight sexually active cases were investigated in Jamaica by the researchers, during the period 2006-2007. The age group population was 9-11, 12-14, and 15-17. RESULTS: The study showed that access to contraceptive advice and treatment by minors was more favorable to males than females. The difference in access to contraceptive between male and female was statistically significant (x(2) = 20.16, p<0.05). Of the 80 male respondents, who are contraceptive users, 11 encountered challenges in legitimately accessing contraceptive methods, while 38 of the 40 female users also encountered challenges. This resulted in unintended pregnancies and impregnation (33.2%), as well as the contracting of STIs (21%). CONCLUSION: The findings of this study will be important in informing the development of reproductive health services and family life education programs for pre-adolescents and adolescents in Jamaica and other Caribbean countries.

Examining health status of women in rural, peri-urban and urban areas in Jamaica.

BACKGROUND: A comprehensive review of the literature revealed that less information is available in literature on health status of women, and health status of women in 3 geographical zones in Jamaica. AIMS: This study examined data on the health status of women in Jamaica in order to provide some scientific explanation of those factors that account for their health status; and differences based on area of residence. MATERIALS AND METHODS: The sub-sample for the current study was 8,541 women ages of 15 and 100 years extracted from a national survey of 25,018 respondents. Stratified random sampling technique was used to draw the sample. Data were stored, retrieved and analyzed using SPSS 16.0. Descriptive statistics were used to provide background information on the subsample, and logistic regressions were utilized to model health statuses. RESULTS: Rural women had the lowest health status (OR = 0.819, 95% CI = 0.679-0.989) among all women (peri-urban OR = 1.054, 95% CI = 0.842-1.320; urban OR = 1.00) and that they were the least likely to have health insurance coverage. Health insurance was the critical predictor of good health status of women in Jamaica, and this was equally the same across the 3 geographic areas; and that married women were 1.3 times more likely (OR 1.3, 95 CI = 1.036-1.501) to report good health compared to those who were never married. CONCLUSION: This study provides an understanding of women's health status in Jamaica as well as the disparity which correlates based on the different geographical regions.

Response of patients to the introduction of a private Magnetic Resonance Imaging service in Western Jamaica.

BACKGROUND: Magnetic Resonance Imaging (MRI) is one of today's fastest growing imaging modalities, spurred in part by rapid advances in technology and important new applications in patient care. It was introduced in Western Jamaica in March 2005 at a non-hospital-based facility called North Coast Imaging MRI Service. AIMS: The study examined the socio-demographics, accessibility and affordability of the services to patients. MATERIALS AND METHOD: A random sample of 100 patients was used and the research instrument was a questionnaire. The study was conducted between August and November 2008. RESULTS: The findings of the study showed that majority of the respondents lived in rural areas and were within the age group 30 - 59 years. One-half of the respondents resided in St. James, were employed; earned more than US$1,351.00 per month and could afford the cost of the MRI procedure. More than one half of the respondents indicated that it took 15 - 30 minutes to be examined after arrival at the Centre; most (81%) of the respondents indicated that the MRI procedure was adequately explained, and 99% indicated that questions about the procedure were satisfactorily answered. The MRI Scans performed at the North Coast Imaging MRI Service showed an increase of 157.49% in 2006 when compared with 2005, and 70.90% in 2007 when compared with 2006. Our findings suggest that the number of MRI scans done at the North Coast Imaging MRI Service is likely to increase. CONCLUSION: Although most of the respondents were able to afford the procedure there are concerns about persons in the lower socio-economic group who are unable to afford expensive diagnostic imaging tests such as MRI scans. There is an urgent need for government-owned hospital-based MRI Units in Jamaica to offer lower cost MRI scans to the public.

Alternate electrification and non-potable water: A health concern for Jamaicans.

BACKGROUND: Research has shown that the absence of electricity and potable water usually result in negative effects on one's health and is more likely to affect women than men. AIM: To determine the extent to which alternate electrification and limited potable water, impacts on health. MATERIALS AND METHOD: This study is informed by primary and secondary data, representing a sample size of 150 respondents (75 male and 75 female), who were interviewed via a 24-item structured interview schedule during the period 2006-2007, throughout the 14 parishes of Jamaica. In an effort to determine the number of persons to be interviewed, each parish population was divided by the island's population (2,599,334) and then multiplied by 150. Data was analyzed using the statistical package for social scientists 15. RESULTS: The respondents of this study who use kerosene lamp as an alternate means to electricity use firewood for cooking (12% male and 15% female). This sometimes result in obstructive pulmonary disease (female 43%; male 21%). The absence of electricity also results in the consumption of improperly stored meat, thus medical implications: paroxysmal abdominal pain (colic), and diarrhea (male 91%; female, 95%). The transporting of firewood, pans of water and laundry via head-loading, sometimes result in back/spinal injury (male, 75%; female, 48%). CONCLUSION: Alternate access to electricity and potable water result in the use of kerosene lamp, firewood and the consumption of non-potable water (often transported on one's head) - causing medical implications such as back/spinal injury, obstructive pulmonary disease, paroxysmal abdominal pain and gastroenteritis.