Comparison of techniques of detecting immunoglobulin-binding protein reactivity to immunoglobulin produced by different avian and mammalian species.

The rationale of this study was to use several immunological assays to investigate the reactivity of immunoglobulin binding protein (IBP) to immunoglobulins from various avian and mammalian species. The IBP studied were Staphylococcal protein A (SpA), Streptococcal protein G (SpG), Peptostreptococcal protein L (SpL) and recombinant protein LA (SpLA). The various immunological techniques used were double immunodiffusion (Ouchterlony technique) that tested positive high protein reactivities, direct and competitive enzyme-linked immunosorbent assays (ELISAs) that tested moderate and low positive protein binding capacities, respectively. In addition to sandwich ELISAs, immunoblot analyses and Ig-purification by SpA-affinity chromatography, which were sensitive tests and helpful in the screening and confirmatory tests were also used. The Ouchterlony technique showed that compared to the other proteins, SpLA had the highest range of reactivity with animal sera and purified immunoglobulins while SpL was least reactive. With the direct ELISA, SpL reacted with the raccoon sera, rabbit IgG and with IgY from bantam hens and pigeons. While with the direct ELISA, SpA reacted with sera from skunk, coyote, raccoon, mule, donkey and human. The sandwich ELISA revealed high reactivity of both SpG and SpLA with mammalian sera titres ranging from 1:32 (raccoon serum) to 1:1024 (mule and donkey sera). These results suggest that IBP can be used for the detection of immunoglobulin using various immunological assays and this is important for the diagnosis of infectious diseases in animal and bird populations studied and in the purification of immunoglobulins.

Toll-like receptor-associated sequence variants and prostate cancer risk among men of African descent.

Recent advances demonstrate a relationship between chronic/recurrent inflammation and prostate cancer (PCA). Among inflammatory regulators, toll-like receptors (TLRs) have a critical role in innate immune responses. However, it remains unclear whether variant TLR genes influence PCA risk among men of African descent. Therefore, we evaluated the impact of 32 TLR-associated single-nucleotide polymorphisms (SNPs) on PCA risk among African Americans and Jamaicans. SNP profiles of 814 subjects were evaluated using Illumina's Veracode genotyping platform. Single and combined effects of SNPs in relation to PCA risk were assessed using age-adjusted logistic regression and entropy-based multifactor dimensionality reduction (MDR) models. Seven sequence variants detected in TLR6, TOLLIP (Toll-interacting protein), IRAK4 (interleukin-1 receptor-associated kinase 4) and IRF3 (interferon regulatory factor 3) were marginally related to PCA. However, none of these effects remained significant after adjusting for multiple hypothesis testing. Nevertheless, MDR modeling revealed a complex interaction between IRAK4 rs4251545 and TLR2 rs1898830 as a significant predictor of PCA risk among US men (permutation testing P-value=0.001). However, these findings require further assessment and validation.

Comparison of techniques of detecting immunoglobulin-binding protein reactivity to immunoglobulin produced by different avian and mammalian species / Comparación de las técnicas de detección de la reactividad de la proteína de unión de la inmunoglobulina frente a la inmunoglobulina producida por diferentes especies aviarias y mamíferas

The rationale of this study was to use several immunological assays to investigate the reactivity of immunoglobulin binding protein (IBP) to immunoglobulins from various avian and mammalian species. The IBP studied were Staphylococcal protein A (SpA), Streptococcal protein G (SpG), Peptostreptococcal protein L (SpL) and recombinant protein LA (SpLA). The various immunological techniques used were double immunodiffusion (Ouchterlony technique) that tested positive high protein reactivities, direct and competitive enzyme-linked immunosorbent assays (ELISAs) that tested moderate and low positive protein binding capacities, respectively. In addition to sandwich ELISAs, immunoblot analyses and Ig-purification by SpA-affinity chromatography, which were sensitive tests and helpful in the screening and confirmatory tests were also used. The Ouchterlony technique showed that compared to the other proteins, SpLA had the highest range of reactivity with animal sera and purified immunoglobulins while SpL was least reactive. With the direct ELISA, SpL reacted with the raccoon sera, rabbit IgG and with IgY from bantam hens and pigeons. While with the direct ELISA, SpA reacted with sera from skunk, coyote, raccoon, mule, donkey and human. The sandwich ELISA revealed high reactivity of both SpG and SpLA with mammalian sera titres ranging from 1:32 (raccoon serum) to 1:1024 (mule and donkey sera).These results suggest that IBP can be used for the detection of immunoglobulin using various immunological assays and this is important for the diagnosis of infectious diseases in animal and bird populations studied and in the purification of immunoglobulins.

El fundamento de este estudio radica en el uso de varios ensayos inmunológicos para investigar la reactividad de la proteína de unión de la inmunoglobulina (IBP) frente a las inmunoglobulinas de varias especies aviarias y mamíferas. Las proteínas IBP estudiadas fueron la proteína estafilocócica A (SpA), la proteína estreptocócica G (SpG), la proteína peptoestreptocócica L (SpL), y la proteína recombinante LA (SpLA). Las varias técnicas inmunológicas usadas fueron: la inmunodifusión doble (técnica de Ouchterlony) para examinar las reactividades positivas de la proteína alta; el ensayo por inmunoabsorción ligado a enzimas(ELISA), de tipo directo y competitivo, para examinar la capacidad de realizar uniones positivas de proteína moderada y baja, respectivamente, además del ensayo ELISA 'Sándwich', los análisis inmunoblot, yla purificación de IgG, mediante cromatografía de afinidad, los cuales fueron pruebas sensibles y útiles en el tamizaje y las pruebas de confirmación. La técnica de Ouchterlony mostró que - en comparación con otras proteínas - la SpLA tenía el grado más alto de reactividad con los sueros animales y las inmunoglobulinas purificadas, mientras que la SpL fue la menos reactiva. Con el ELISA directo, la SpL reaccionó con los sueros de mapache, la IgG de conejo, así como con la IgY de palomas y gallinas de Bantam, en tanto con el ELISA directo, la SpA reaccionó con sueros de mofeta, coyote, mapache, mula, asno y seres humanos. ELISA "sándwich" reveló una alta reactividad tanto de SpG como de SpLA, con títulos séricos mamíferos que iban desde 1:32 (suero de mapache) hasta 1:1024 (sueros de mula y de asno). Estos resultados sugieren que la proteína de unión IBP puede usarse en la detección de la inmunoglobulina usando varios ensayos inmunológicos, lo cual es importante para el diagnóstico de enfermedades infecciosas en las poblaciones animales y aviarias bajo estudio, así como para la purificación de inmunoglobulinas.

Booking blood pressures and plasma nitrite in Jamaican women with pre-eclampsia.

Our objective was to assess the levels of nitric oxide (NO) in pre-eclampsia and to investigate its effect on blood pressure (BP) in the Jamaican population. A total of 103 participants (50 pre-eclampsia, 53 controls) were recruited from the University Hospital of the West Indies (UHWI). Blood samples were collected in the fasting state and trimester BP measurements were obtained from their records. A commercially available kit supplied by Oxford Biomedical Research Inc. (MI, USA) was used to measure plasma levels of NO. All measures of booking BP were significantly higher in women who later developed pre-eclampsia compared with those whose pregnancies remained normotensive (p 0.05. We concluded that in the Jamaican population, booking BP measurements may be predictors of pre-eclampsia and NO production increases in pre-eclampsia but is not related to the height of the BP.

Knowledge, motivation and barriers to diabetes control in adults in Jamaica / Conocimientos, motivación, y obstáculos en relación con el control de la diabetes de adultos en Jamaica

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

En este estudio descriptivo, se realizaron entrevistas estructuradas individuales a una muestra aleatoria de 35 hombres y 98 mujeres de una población (n = 510) de pacientes clínicos. Las preguntas abiertas buscaban determinar la extensión de los conocimientos, la motivación, y los obstáculos a los cambios en el estilo de vida para el control de la diabetes mellitus (DM) en adultos jamaicanos. Estas fueron codificadas en forma de temas, y descritas. Otros datos fueron analizados usando el paquete estadístico SPSS. Los hombres (61.8 ±14.8 años) fueron mayores que las mujeres (54.9 ± 13.7 años) y demostraron menos conocimientos (p = 0.006). Los respondientes (71%) indicaron la necesidad de más educación. Los obstáculos a los cambios en el estilo de vida y el control glicémico, incluyeron un bajo nivel educacional (64%), conocimientos inadecuados (80%), falta de percepción de riesgos (80.4%) y falta de auto-monitoreo (93%). Sólo el 23% se mantenían bajo un control de HbA1c # 6.5%. La referencia de los pacientes a los médicos como fuente primaria de información indicó la necesidad de un enfoque colaborativo en equipo, y de la incorporación de la educación para la diabetes como un servicio indispensable en esta clínica.

Self-care, compliance and glycaemic control in Jamaican adults with diabetes mellitus / Autocuidado, cumplimiento y control glicémico en los adultos jamaicanos con diabetes mellitus

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4reported being on a [quot ]special diet[quot ]. Only 16.5reported not taking any sugar. Self-care scores were inversely related to HbA1c(p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23had blood glucose controlled to HbA1c < or = 6.5. In women, HbA1clevels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

Las prácticas apropiadas de autocuidado, incluyendo cumplir con los requerimientos de la nutrición y la medicación, son esenciales para el control satisfactorio de la diabetes mellitus (DM). Este estudio descriptivo evalúa las prácticas de autocuidado, y sus relaciones con el control glicémico en adultos con DM en Jamaica. Una entrevista estructurada, previamente probada, así como mediciones antropométricas, fueron llevadas a cabo en 98 mujeres y 35 hombres, seleccionados aleatoriamente de una población (n = 510) de pacientes de una clínica de adultos. La prueba HbA1c se usó como índice de control glicémico. Las puntuaciones de la práctica de autocontrol indicaron el grado de conformidad con prácticas de estilo de vida apropiadas. Los datos fueron analizados utilizando el denominado Paquete Estadístico para la Ciencias Sociales (SPSS). Los hombres (edad mediana, 62 años) eran significativamente mayores (z = -2.64, p = 0.008) que las mujeres (55 años). La duración mediana de la DM fue como sigue: los hombres, siete años; las mujeres 10.5 años. El sesenta y nueve por ciento fue tratado con insulina. Sólo el 45% reportó cumplimiento total con los medicamentos. El índice de la masa mediana de su cuerpo (BMI) fue 29.1 (16.6–47.4) kg/m. El ochenta y uno por ciento resultaró estar por encima del peso o ser obesos. El cuarenta y seis por ciento describió la dieta y/o la obesidad como factores que contribuían a su diabetes. El ochenta y cinco por ciento había consultado a un dietista, pero sólo el 56.4% reportó estar haciendo una "dieta especial". Sólo el 16.5% reportó no estar ingiriendo azúcar ninguna. Las puntuaciones de autocuidados se hallaron en proporción inversa al por ciento resultante de la prueba HbA1c% (p = 0.008), BMI (p = 0.001), ingestión de azúcar (p = 0.005) y fueron los más bajos en el área de control de peso y ejercicios. Sólo el 23% tenía la glucosa en sangre controlada en correspondencia con HbA1c # 6.5%. En las mujeres, los niveles de...

Anticardiolipin antibodies in Jamaican primiparae.

A prevalence survey of anticardiolipin antibodies (aCL) was done among 924 primiparae. aCL were measured in serum by the standardised anticardiolipin enzyme linked immunosorbent assays (ELISA) and beta(2)-glycoprotein 1 assays to determine the seroprevalence of both beta(2) glycoprotein 1 dependent aCL and beta(2)-glycoprotein 1 independent aCL in Jamaican primiparae, to determine whether aCL are associated with abnormal pregnancy outcomes and if treatment with aspirin had any effect on pregnancy outcome in aCL positive primiparae. The prevalence of aCL was (32/671) 4.8% (95%CI 3.2-6.4) in women who were tested twice. A total of 49 of 924 primiparae or 5.3% (95%CI 3.9-6.7) were positive for aCL on at least one occasion. Only three of the 32 primiparae 3/32 (9.4%) who were positive for aCL on two occasions were positive for beta(2)-glycoprotein 1 dependent aCL. Pregnancy outcome did not differ significantly with respect to aCL status. Aspirin therapy did not influence pregnancy outcome in the 49 aCL positive primiparae studied.

Knowledge, motivation and barriers to diabetes control in adults in Jamaica.

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

Self-care, compliance and glycaemic control in Jamaican adults with diabetes mellitus.

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45% reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4% reported being on a "special diet". Only 16.5% reported not taking any sugar. Self-care scores were inversely related to HbA1c% (p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23% had blood glucose controlled to HbA1c < or = 6.5%. In women, HbA1c% levels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

Dietary intake of choline and plasma choline concentrations in pregnant women in Jamaica / La ingestión de colina en la dieta y las concentraciones de colina en plasma en las mujeres embarazadas en Jamaica

Choline is an essential nutrient for humans and its availability during pregnancy is important for optimal fetal development. The Food and Nutrition Board of the Institute of Medicine in the United States of America has set the adequate choline intake during pregnancy at 450 mg/day. There is limited data available on normal plasma choline concentrations in pregnancy. Moreover, there are neither documented studies of choline intake among pregnant women in the Jamaican population nor of free plasma choline concentrations during pregnancy. Sixteen women presenting to the antenatal clinic of the University Hospital of the West Indies (UHWI) at 10-15 weeks of gestation were selected for this pilot study. A food frequency questionnaire was administered to estimate frequency of consumption of foods rich in choline. Fasting blood samples were collected by venepuncture and plasma assayed for choline using liquid chromatography electrospray ionization isotopic dilution mass spectrometry. Most of the women reported consumption of diets that delivered less than the recommended choline intake (mean +/- SEM, 278.5 +/- 28.9 mg). Mean plasma choline concentration was 8.4 +/- 0.4 micromol/L. This falls below the normal concentration (10 micromol/L) reported for individuals that are not pregnant and pregnant (14.5 micromol/L). The results of this study may be an indication that the choline included in the diet of pregnant women in Jamaica may not be adequate to meet both the needs of the mother and fetus and that further studies are warranted to determine clinical implications.

La colina es un nutriente esencial para los seres humanos y su disponibilidad durante el embarazo es importante para el óptimo desarrollo del feto. La Junta de Alimentos y Nutrición (Food and Nutrition Board) del Instituto de Medicina de los Estados Unidos ha establecido que la ingestión de colina durante el embarazo debe ser 450 mg/día. Los datos disponibles sobre concentraciones de colina en plasma durante el embarazo son limitados. Por otro lado, no existen estudios documentados sobre la ingestión de colina entre las mujeres embarazadas en la población de Jamaica, ni sobre las concentraciones libres de colina en plasma durante el embarazo. Dieciséis mujeres que se presentaron a la clínica de atención prenatal del Hospital Universitario de West Indies entre las 10–15 semanas de gestación, fueron seleccionadas para este estudio piloto. Se aplicó un cuestionario de frecuencia alimentaria a fin de estimar la frecuencia de consumo de alimentos ricos en colina. Se recogieron muestras de sangre en ayunas mediante venopuntura, y se sometió el plasma a análisis en busca de colina, usando la espectrometría de masa de dilución isotópica, ionización por electrospray y cromatografía líquida. La mayoría de las mujeres reportaron consumo de dietas que suministrabanmenos de los niveles de ingestion de colina recomendados (media ± SEM, 278.5 ± 28.9 mg). La concentracion media de colina en plasma fue 8.4 ± 0.4 mmoles/L. Esto se halla por debajo de la concentracion normal (10 mmoles/L) reportado tanto para no embrazadas como para embarazadas (14.5 mmoles/L). Concluimos que los resultados de este estudio pueden ser una indicacion de que los niveles de colina incluidos en la dieta de las mujeres en estado de gestacion en Jamaica no son adecuados para satisfacer las necesidades ni de la madre ni del feto, y que vale la pena la realizacion de estudios ulteriores al objeto de determinar las implicaciones clinicas.

Cold-induced elevation of forearm vascular resistance is inversely related to birth weight.

Fetal growth retardation has been linked to elevated blood pressure in adult life. This association between birth weight and blood pressure is present in childhood and is amplified with age. However, the mechanisms that underlie this association are largely unknown. We examined the relationship between birth weight and forearm vascular resistance and forearm blood flow in children aged 9-12.7 years. A total of 58 children were randomly selected from a cohort of 1610 born at the University Hospital of the West Indies in Jamaica where adequate antenatal and delivery records were available. Blood pressure, heart rate and forearm blood flow (by venous occlusion plethysmography) were measured at rest and after cold pressor and mental arithmetic tests. There was a significant inverse correlation between birth weight and the change in the vascular resistance for the cold pressor test (r=-0.47; P<0.001) and the mental arithmetic stress test (r=-0.26; P=0.05). The log ratio of vascular resistance under stress to resting decreased by 0.289 units per kg of birth weight (95% CI: 0.145-0.434; P=0.0002). Lower birth weight is associated with increased vascular responsiveness. Increased vascular resistance might be one mechanism linking fetal growth to subsequent elevated blood pressure.

Dietary intake of choline and plasma choline concentrations in pregnant women in Jamaica.

Choline is an essential nutrient for humans and its availability during pregnancy is important for optimal fetal development. The Food and Nutrition Board of the Institute of Medicine in the United States of America has set the adequate choline intake during pregnancy at 450 mg/day. There is limited data available on normal plasma choline concentrations in pregnancy. Moreover, there are neither documented studies of choline intake among pregnant women in the Jamaican population nor of free plasma choline concentrations during pregnancy. Sixteen women presenting to the antenatal clinic of the University Hospital of the West Indies (UHWI) at 10-15 weeks of gestation were selected for this pilot study. A food frequency questionnaire was administered to estimate frequency of consumption of foods rich in choline. Fasting blood samples were collected by venepuncture and plasma assayed for choline using liquid chromatography electrospray ionization isotopic dilution mass spectrometry. Most of the women reported consumption of diets that delivered less than the recommended choline intake (mean +/- SEM, 278.5 +/- 28.9 mg). Mean plasma choline concentration was 8.4 +/- 0.4 micromol/L. This falls below the normal concentration (10 micromol/L) reported for individuals that are not pregnant and pregnant (14.5 micromol/L). The results of this study may be an indication that the choline included in the diet of pregnant women in Jamaica may not be adequate to meet both the needs of the mother and fetus and that further studies are warranted to determine clinical implications.

Trans-ethnic fine mapping of a quantitative trait locus for circulating angiotensin I-converting enzyme (ACE).

Circulating angiotensin I-converting enzyme (ACE) levels are influenced by a major quantitative trait locus (QTL) that maps to the ACE gene. Phylogenetic and measured haplotype analyses have suggested that the ACE-linked QTL lies downstream of a putative ancestral breakpoint located near to position 6435. However, strong linkage disequilibrium between markers in the 3' portion of the gene has prevented further resolution of the QTL in Caucasian subjects. We have examined 10 ACE gene polymorphisms in Afro-Caribbean families recruited in JAMAICA: Variance components analyses showed strong evidence of linkage and association to circulating ACE levels. When the linkage results were contrasted with those from a set of British Caucasian families, there was no evidence for heterogeneity between the samples. However, patterns of allelic association between the markers and circulating ACE levels differed significantly in the two data sets. In the British families, three markers [G2215A, Alu insertion/deletion and G2350A] were in complete disequilibrium with the ACE-linked QTL. In the Jamaican families, only marker G2350A showed strong but incomplete disequilibrium with the ACE-linked QTL. These results suggest that additional unobserved polymorphisms have an effect on circulating ACE levels in Jamaican families. Furthermore, our results show that a variance components approach combined with structured, quantitative comparisons between families from different ethnic groups may be a useful strategy for helping to determine which, if any, variants in a small genomic region directly influence a quantitative trait.

Hypertension in four African-origin populations: current 'Rule of Halves', quality of blood pressure control and attributable risk of cardiovascular disease.

OBJECTIVE: To assess the public health burden from high blood pressure and the current status of its detection and management in four African-origin populations at emerging or high cardiovascular risk. DESIGN: Cross-site comparison using standardized measurement and techniques. SETTING: Rural and urban Cameroon; Jamaica; Manchester, Britain. SUBJECTS: Representative population samples in each setting. African-Caribbeans (80% of Jamaican origin) and a local European sample in Manchester. MAIN OUTCOME MEASURES: Cross-site age-adjusted prevalence; population attributable risk. RESULTS: Among 1,587 men and 2,087 women, age-adjusted rates of blood pressure > or =160 or 95 mmHg or its treatment rose from 5% in rural to 17% in urban Cameroon, despite young mean ages, to 21% in Jamaica and 29% in Caribbeans in Britain. Treatment rates reached 34% in urban Cameroon, and 69% in Jamaican- and British-Caribbean-origin women. Sub-optimal blood pressure control (> 140 and 90 mmHg) on treatment reached 88% in European women. Population attributable risks (or fractions) indicated that up to 22% of premature all-cause, and 45% of stroke mortality could be reduced by appropriate detection and treatment. Additional benefit on just strokes occurring on treatment could be up to 47% (e.g. in both urban Cameroon men and European women) from tighter blood pressure control on therapy. Cheap, effective therapy is available. CONCLUSION: With mortality risk now higher from non-communicable than communicable diseases in sub-Saharan Africa and elsewhere, systematic measurement, detection and genuine control of hypertension once treated can go hand-in-hand with other adult health programmes in primary care. Cost implications are not great. The data from this collaborative study suggest that such efforts should be well rewarded.

Sick genes, sick individuals or sick populations with chronic disease? The emergence of diabetes and high blood pressure in African-origin populations.

AIM AND METHODS: To discuss evidence for and against genetic 'causes' of type 2 diabetes, illustrated by standardized study of glucose intolerance and high blood pressure in four representative African origin populations. Comparison of two genetically closer sites: rural (site 1) and urban Cameroon (2); then Jamaica (3) and Caribbean migrants to Britain (80% from Jamaica-4). BACKGROUND: Alternatives to the reductionist search for genetic 'causes' of chronic disease include Rose's concept that populations give rise to 'sick' individuals. Twin studies offer little support to genetic hypotheses because monozygotic twins share more than genes in utero and suffer from ascertainment bias. Non-genetic intergenerational mechanisms include amniotic fluid growth factors and maternal exposures. Type 2 diabetes and hypertension incidence accelerate in low-risk European populations from body mass > or =23 kg/m2, well within 'desirable' limits. Transition from subsistence agriculture in West Africa occurred this century and from western hemisphere slavery only six generations ago, with slow escape from intergenerational poverty since. RESULTS: 'Caseness' increased clearly within and between genetically similar populations: age-adjusted diabetes rates were 0.8, 2.4, 8.5 and 16.4% for sites 1-4, respectively; for 'hypertension', rates were 7, 16, 21 and 34%, with small shifts in risk factors. Body mass index rose similarly. CONCLUSION: Energy imbalance and intergenerational socioeconomic influences are much more likely causes of diabetes (and most chronic disease) than ethnic/genetic variation, which does occur, poorly related to phenotype. The newer method of 'proteomics' holds promise for identifying environmental triggers influencing gene products. Even in lower prevalence 'westernized' societies, genetic screening per se for diabetes/chronic disease is likely to be imprecise and inefficient hence unreliable and expensive.

Anticardiolipin antibodies and risk of thromboembolic disease in young Jamaican women.

BACKGROUND: Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that are associated with arterial and venous thrombosis. We measured aCL in women, aged 15-49 years, to determine if they are an independent risk factor for thromboembolic disease. STUDY DESIGN: Case--control study METHODS: Fifty cases were studied including venous thromboembolism (n=29), stroke and myocardial infarction (n=21), along with 148 age-matched controls. Serum samples were assayed for aCL and anti-beta2 glycoprotein 1 antibodies using the enzyme-linked immunosorbent assay (ELISA). Information on other risk factors was obtained by a standardized questionnaire. RESULTS: aCL were present in 16/50 (32%) of cases compared with 25/148 (17%) of controls (P[?]=[?]0.02). Unadjusted odds ratio (OR) and 95% confidence interval (95% CI) for thromboembolic disease associated with aCL was 2.32 (1.10--4.87). Other risk factors were hypertension, 2.93 (1.20--7.17) and a history of other heart diseases, 12.78 (1.32--123.60). Adjustment for hypertension, diabetes, oral contraceptive use, smoking, alcohol use, varicose veins, a family history of cardiovascular disease and a history of other heart diseases yielded OR (95%CI) 2.99 (1.32--6.80). beta2 glycoprotein 1-dependent aCL were also an independent risk factor, OR 4.56 (1.76--17.83). Subgroup analysis was carried out separately for cases of MI and stroke and for venous thrombosis. Adjusted OR (95% CI) associated with aCL in cases of MI and stroke was 1.76 (0.46--6.73) and 3.32 (1.15--9.54) for venous thromboembolism. CONCLUSION: aCL are a risk factor for thromboembolic disease in young Jamaican women. They confer a strong independent risk for venous thromboembolism.

Early perturbations in keratin and actin gene expression and fibrillar organisation in griseofulvin-fed mouse liver.

BACKGROUND/AIMS: Long-term feeding of mice with a diet containing griseofulvin results in the formation of Mallory bodies, keratin K8 and K18 containing aggregates in hepatocytes. These bodies are biochemically and morphologically identical to the Mallory bodies that emerge in several human liver disorders. The aim of this study was to examine the contribution of K8 and K18 and actin to Mallory body formation. METHODS: Mice were fed griseofulvin over a period ranging from 1 day to 20 months. Hepatocyte morphology was monitored by immunocytochemistry, gene expression by Northern and run-off transcription assays, and protein level by Western blotting. RESULTS: Griseofulvin feeding induced a series of morphological alterations in hepatocytes that could be grouped into 3 phases: appearance of cholestasis during the first week (phase I), partial hepatocyte recovery at 3 months (phase II), and development of typical Mallory bodies after 3 to 5 months (phase III). All these cellular alterations were associated with perturbations in keratin and actin fibrillar status, coupled with increases in K8, K18 and actin mRNA steady-state level and, in K8 and K18 protein content. The transcriptional activity of the genes was not affected. CONCLUSIONS: Perturbations in keratin and actin gene expression and fibrillar organisation constitute early events in the griseofulvin-induced pathological process that in the long-term leads to Mallory body formation. The higher keratin and actin mRNA levels reflect significant increases in mRNA stability taking place at the early phase of griseofulvin intoxication in hepatocytes.

Blood pressure is related to placental volume and birth weight.

The objective of this study was to determine whether maternal nutrition and fetal and placental size program blood pressure. A longitudinal study linking the maternal anthropometric measurements of the first antenatal visit, ultrasound data of placental and fetal size, anthropometry at birth, and childhood growth and blood pressure was performed. The subjects were 428 women who attended the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, and their children, who were subsequently followed up. Systolic blood pressure at ages 1, 2, 2.5, 3, and 3.5 years was the main outcome measure. Pooling the data across ages, systolic blood pressure fell by 1.4 mm Hg for every 1-kg increase in birth weight (95% CI 0.2 to 2.7, P=0.02) and by 1.2 mm Hg for every 100-mL increase in placental volume at 20 weeks of gestation (95% CI 0.4 to 2.0, P=0.004). Blood pressure was also negatively associated with placental volume at 17 weeks and fetal abdominal circumference at 20 weeks. Measures of maternal nutritional status were strongly related to birth weight and placental volume but not directly to childhood blood pressure at these young ages. In conclusion, blood pressure is associated with fetal size in this population, as previously described among Europeans. We found associations between placental volume and abdominal circumference in the second trimester and childhood blood pressure, suggesting that the initiating events of blood pressure programming occur early in pregnancy. Measures of maternal nutritional status were not directly related to childhood blood pressure at these young ages but were strong predictors of both birth weight and placental volume, suggesting an indirect relation.

Diabetes in the Caribbean: results of a population survey from Spanish Town, Jamaica.

AIMS: To characterize the prevalence of diabetes and associated risk attributes in the Jamaican population. METHODS: A random population sample was recruited by door-to-door canvassing (n = 1303). A final participation of 60% was achieved. Oral glucose tolerance testing was conducted after an overnight fast and standard anthropometric and demographic data were collected. RESULTS: The prevalence of Type 2 diabetes mellitus was 9.8% (95% confidence interval (CI) 7.2-12.4) among men and 15.7% (95% CI 13.1-18.3) among women with an overall prevalence of 13.4% (95% CI 11.5-15.2). Impaired glucose tolerance was found among 12.3% of men and 14.7% of women. The sex patterns were consistent with a fourfold excess of obesity in women compared to men. The odds ratios for diabetes, fourth vs. first quartiles were 5.42 (95% CI 2.02-16.88) in men and 3.32 (95% CI 1.73-6.63) in women for body mass index (BMI) and 17.39 (95% CI 3.86-78.27) in men and 5.48 (95% CI 2.84-11.00) in women for WHR in a logistic model controlling for age. The population attributes risk percentage, for diabetes, of being overweight and having waist-to-hip ratio (WHR) greater than the median (0.80) were 66% and 80%, respectively. The contribution of central obesity, as characterized by WHR, was also significant in sex-specific multivariate models that included age and BMI. Prevalent hypertension and family history of diabetes were likewise associated with increased odds of having the disease. CONCLUSIONS: The prevalence of diabetes in Jamaica now exceeds that observed among European-origin populations and reflects the emerging epidemic of obesity. The excess risk for this population could not be attributed entirely to relative weight. The pronounced sexual dimorphism in diabetes prevalence most likely reflects the substantial excess of obesity among women compared to men. Like many other island nations, Caribbean societies now appear to be at substantial risk of diabetes.