Fertility care expectations: what do PLHIV and health care providers in Jamaica know about assisted reproduction services for safe conception?

Increased life expectancy among persons living with HIV (PLHIV) has increased the desire for parenthood. It is therefore important that PLHIV and health care providers (HCPs) are aware of the available assisted reproduction services (ARS) for PLHIV facing infertility or unsuppressed viremia. Through secondary data analysis we identified PLHIV who were actively trying to conceive and their knowledge of ARS. As specialized fertility care for PLHIV is managed by Obstetrician/Gynecologists (Ob/Gyns), they were surveyed regarding their attitudes towards working with PLHIV and their awareness and knowledge of ARS with a self-administered questionnaire. In this cross-sectional study, 251 PLHIV and 102 Ob/Gyns were recruited and interviewed using a semi-structured questionnaire. Although most Ob/Gyns (81%) reported being supportive of PLHIV having children, 85% counseled against pregnancy, particularly persons in HIV serodifferent relationships. Significantly more PLHIV under 40 years compared to those over 40 years had heard about ARS (59% vs. 43%, p = .007). Ob/Gyns were more knowledgeable of expensive ARS, while PLHIV's knowledge was more restricted to cheaper more accessible ones. In conclusion Ob/Gyns knowledge gaps and underlying stereotypes may present barriers to PLHIV's uptake of ARS. Additionally, virologically unsuppresed persons in HIV serodifferent relationships may be vulnerable as Ob/Gyns were less supportive of them.

Living with the Threat of Covid-19: Exploring the Psychological Impact of Covid-19 in Those who Conceived Through ART Versus Spontaneously.

OBJECTIVES: To explore and compare anxiety relating to the threat of Covid-19 in pregnancy by women who conceived through assisted reproductive technology (ART) and spontaneously. We also examined the psychological coping strategies used and lived experience for both groups. METHODS: A total of 21 women who conceived through ART at a private university based IVF and a matched sample of women who conceived spontaneously were enrolled from July 2020 to February 2021. This was a mixed methods study. Covid-19-specific anxiety was measured using the coronavirus anxiety scale (CAS) as well as a validating qualitative data model with the use of open-ended questions to expand on quantitative findings. RESULTS: In both groups of women the level of anxiety detected by the CAS was low and mixed coping strategies (emotion-focused and problem-solving) were utilized. The ART group expressed more positive feelings towards pregnancy during the Covid-19 pandemic. CONCLUSION: The vulnerable ART group is no more at risk for negative emotional well-being during the Covid-19 pandemic. Additionally, healthcare providers ought to be knowledgeable of various Covid-19 coping strategies that may provide emotionally protective measures for all women of reproductive age. This is of particular importance as effective coping may ultimately prevent disruptions that could compromise prenatal care during the covid-19 pandemic.

Mental Health Awareness and Counseling Practice of Jamaican Clergy: An Exploratory Study.

Clergy play a vital role in mental health care in Jamaica but little is known about their mental health awareness and practices. Thirty five Anglican and Baptist clergy were compared to 24 helping professionals and 67 community members using purposive sampling. Clergy's awareness exists with spiritualized beliefs about the etiology of mental illness as well as with effective and unethical counseling practices. Findings indicate the need for more training in mental health sensitization and practice.

Reproductive needs of PLHIV in Jamaica: relationship between fertility desire, motives and depression.

Background/objective: Advances in antiretroviral therapy and assisted reproduction technology which allow for longer and healthier lives and safer conception options necessitate a new understanding of the sexual and reproductive needs of persons living with HIV (PLHIV). This study examines fertility desire and motives for having children among PLHIV in Jamaica and explores the association with depressive symptoms.Methods: In a cross-sectional study, 251 PLHIV in their reproductive years voluntarily completed an interviewer-administered questionnaire. SPSS analyses involved bivariate and logistic regression models significant at p < .05.Results: A desire to have children was expressed by 66% (n = 166), mostly males and persons younger than 40 years. Of those in a current relationship (n = 126), not having previous children best predicted fertility desire (p = .001; CI 0.04-0.44) as well as motives to conceive (p = .02; CI 0.01-0.66). PLHIVs in their reproductive years who are at depression risk are those in a sero-discordant relationship (p = .01; CI 1.48-30.22) and who have been diagnosed between 1 and 4 years (p = .05; CI 0.01-1.04).Conclusions: HIV status does not dampen the desire to have future children. There is need to evaluate the sexual, reproductive and mental health needs of PLHIV.

Archival data review of intimate partner homicide-suicide in Jamaica, 2007 - 2017: focus on mental health and community response.

OBJECTIVE: To identify social and behavioral patterns and mental health concerns associated with intimate partner homicide-suicide (IPHS) in Jamaica through an analysis of media and police reports. METHODS: This was an archival data review of police records and print, radio, and television reports of IPHS incidents from January 2007 - June 2017 in Jamaica. The 27 cases found were qualitatively analyzed using pre-identified codes and open coding to generate themes and patterns. RESULTS: A prevalence rate of 0.1 per 100 000 was determined. In all cases, males were the homicide-offender. Sociodemographic patterns associated with IPHS incidents-age, personality traits, choice of weapon, and time of occurrence-were consistent with previous findings. Common triggers were offender obsession, sexual jealousy, and fear of separation. Despite reports of mental health concerns in both male and female partners, neither the couples nor community members sought help prior to the homicide-suicide. CONCLUSION: These findings demand a change in cultural attitudes toward domestic disputes and mental health concerns, and a redefining of the community's responsibility in IPHS. The warning signs associated with IPHS should be part of existing violence and suicide prevention programs.

Archival data review of intimate partner homicide-suicide in Jamaica, 2007 – 2017: focus on mental health and community response

[ABSTRACT]. Objective. To identify social and behavioral patterns and mental health concerns associated with intimate partner homicide-suicide (IPHS) in Jamaica through an analysis of media and police reports. Methods. This was an archival data review of police records and print, radio, and television reports of IPHS incidents from January 2007 – June 2017 in Jamaica. The 27 cases found were qualitatively analyzed using pre-identified codes and open coding to generate themes and patterns. Results. A prevalence rate of 0.1 per 100 000 was determined. In all cases, males were the homicide-offender. Sociodemographic patterns associated with IPHS incidents—age, personality traits, choice of weapon, and time of occurrence—were consistent with previous findings. Common triggers were offender obsession, sexual jealousy, and fear of separation. Despite reports of mental health concerns in both male and female partners, neither the couples nor community members sought help prior to the homicide-suicide. Conclusion. These findings demand a change in cultural attitudes toward domestic disputes and mental health concerns, and a redefining of the community’s responsibility in IPHS. The warning signs associated with IPHS should be part of existing violence and suicide prevention programs.

[RESUMEN]. Objetivo. Identificar los patrones sociales y de comportamiento y los problemas de salud mental asociados con el homicidio de la pareja íntima seguido de suicidio (HPIS) en Jamaica mediante el análisis de los informes de medios de comunicación y policiales. Métodos. Revisión de datos de los archivos policiales y de los informes publicados en la prensa escrita, la radio o la televisión sobre HPIS en Jamaica entre enero de 2007 y junio de 2017. Los 27 casos identificados se analizaron cualitativamente mediante códigos preidentificados y códigos abiertos adicionales a fin de generar temas y patrones. Resultados. Se determinó una tasa de prevalencia de 0,1 por 100 000 habitantes. En todos los casos, los autores del homicidio fueron hombres. Los patrones sociodemográficos asociados con los incidentes –edad, rasgos de personalidad, arma empleada y momento del suceso– coincidieron con los encontrados en incidentes anteriores. Fueron desencadenantes frecuentes la conducta obsesiva del agresor respecto de su pareja, los celos sexuales y el miedo a la separación. A pesar de la presencia de informes sobre problemas de salud mental tanto en los hombres como en las mujeres, ni las propias parejas ni los miembros de la comunidad buscaron ayuda antes del homicidio seguido de suicidio. Conclusión. Estos hallazgos exigen cambiar las actitudes culturales hacia las disputas domésticas y los problemas de salud mental, y redefinir la responsabilidad de la comunidad ante estos incidentes. Las señales de advertencia asociadas con el HPIS deben ser parte de los programas de prevención de la violencia y el suicidio.

[RESUMO]. Objetivo. Identificar os padrões sociais e comportamentais e as questões de saúde mental associados aos homicídios por parceiro íntimo seguidos por suicídio (HPIS) na Jamaica, a partir de análise da mídia e de inquéritos policiais. Métodos. Revisão de inquéritos policiais e de relatos publicados na imprensa escrita, no rádio ou na televisão sobre HPIS na Jamaica de janeiro de 2007 a junho de 2017. Os 27 casos identificados foram analisados qualitativamente utilizando códigos pré-identificados e codificação aberta para gerar temas e padrões. Resultados. Foi detectada uma taxa de prevalência de 0,1 por 100 000 habitantes. Em todos os casos, os autores do homicídio eram homens. Os padrões sociodemográficos associados aos incidentes de HPIS – idade, traços de personalidade, arma utilizada e momento do evento – coincidiram com os encontrados em estudos anteriores. Obsessão por parte do agressor, ciúme sexual e medo da separação foram gatilhos frequentes. Apesar dos relatos de problemas de saúde mental em ambos os parceiros, tanto do sexo feminino quanto do masculino, nem o casal nem os membros da comunidade procuraram ajuda antes do homicídio seguido do suicídio. Conclusão. Estes resultados indicam a necessidade de mudanças culturais na atitude frente a disputas domésticas e problemas de saúde mental e de uma redefinição da responsabilidade da comunidade quanto a HPIS. Os sinais de alerta associados a HPIS devem ser contemplados em programas de prevenção da violência e do suicídio.

Tridimensional acculturation and adaptation among Jamaican adolescent-mother dyads in the United States.

A bidimensional acculturation framework cannot account for multiple destination cultures within contemporary settlement societies. A tridimensional model is proposed and tested among Jamaican adolescent-mother dyads in the United States compared to Jamaican Islander, European American, African American, and other Black and non-Black U.S. immigrant dyads (473 dyads, M adolescent age = 14 years). Jamaican immigrants evidence tridimensional acculturation, orienting toward Jamaican, African American, and European American cultures. Integration is favored (70%), particularly tricultural integration; moreover, Jamaican and other Black U.S. immigrants are more oriented toward African American than European American culture. Jamaican immigrant youth adapt at least as well as nonimmigrant peers in Jamaica and the United States. However, assimilated adolescents, particularly first generation immigrants, have worse sociocultural adaptation than integrated and separated adolescents.

Detecting depression during pregnancy and associated lifestyle practices and concerns among women in a hospital-based obstetric clinic in Jamaica.

OBJECTIVE: Antenatal depression, despite its association with increased maternal morbidity risks, is understudied in the developing world. We determined the rate and predictors of depression throughout pregnancy and the use of medication in women attending an obstetric clinic. METHOD: Prospective longitudinal study of 452 women newly registered at the antenatal clinic at the University Hospital of the West Indies between September 2005 and February 2006. Sociodemographic data, clinical information and self reports of depression using Edinburgh Postnatal Depression Scale (EPDS) were gathered over three trimesters. RESULTS: On average, 25% of women were identified as having a probable depressive disorder over the three trimesters. Independent demographic predictors were youth and unemployment (P<05). Planned pregnancy, exercising, not smoking, being married and support from physician and family were protective factors (P<.05). Using a multivariable model, prior history of depression was the strongest predictor of depression during pregnancy. Of those taking medication for depression prior to pregnancy, only 1.6% remained on medication during the pregnancy. CONCLUSIONS: Poverty-related factors and lifestyle are associated with higher EPDS scores during pregnancy in Jamaican women. A protocol of psychosocial management in obstetric care is discussed along with recommendations for future research.

Children's experience of loss by parental migration in inner-city Jamaica.

Migratory separation, when parents migrate and leave their children behind, was investigated in a case-control sample of 9- to 10-year-olds living in inner-city communities in Kingston and St Andrew, Jamaica (N = 54). Data analyses using descriptive statistics and bivariate correlations showed that children's reactions to their parents' migration were directly related to poor school performance and psychological difficulties. Additionally, being currently exposed to violence in the home and/or community was significantly associated with high scores on a measure of grief intensity. "Protective" factors included having someone to talk to about the migration and living in a supportive family. Migratory separation needs detailed investigation like that devoted to other childhood family disruptions, such as parental divorce or death.

Motivation for and concerns about entering a medical programme: a Caribbean perspective

OBJECTIVE: To determine the motivation for and concerns about studying medicine, and future career plans of students of Faculty of Medical Sciences, University of the West Indies (UWI). DESIGN AND METHODS: A cross-sectional survey that included year 1 medical students at both the Mona and St. Augustine medical schools of the UWI was conducted. A self-administered questionaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences held by students at entrance into the course of study, was used to collect the data. RESULTS: A total of 228 students took part in the study, 103 from Mona and 125 from St. Augustine. Seventy-three percent of the students were between 18 and 22 years of age with 61 percent being females and 39 percent males. The students gave the highest rating to those motives best described as people-oriented. These included interest in relations between health, well-being and society and caring for and working with people. The female students scored significantly higher than the males for most of those motives. However, males rate the social prestige/status motive significantly higher than females. The greatest concern of the students was fear of failure. Surgical specialities (43 percent), family medicine (38 percent) and paediatrics (34 percent) were the top choices of the students for future specialty. However, significantly more males chose surgery while more females chose obstetrics.(AU)

Children's response to hospitalization at the University Hospital of the West Indies

The results of this study indicated that patients aged 3-13 years who had a history of previous hospitalization appeared to be significantly more distressed than patients without such previous history (p<0.05). Previously hospitalized children were more uncooperative and displayed anxious, immature behaviour patterns. Children who were hospitalized for more than a month were also interviewed about their concerns and response to hospitalization. The study highlighted the need for hospitalized children to be better prepared for hospitalization, to have greater parental involvement in the management of their behaviour and to have efficiently run programmes geared at addressing their educational and emotional needs.(Au)

Children's response to hospitalization at the University Hospital of the West Indies

The results of this study indicated that patients aged 3-13 years who had a history of previous hospitalization appeared to be significantly more distressed than patients without such previous history (p<0.05). Previously hospitalized children were more uncooperative and displayed anxious, immature behaviour patterns. Children who were hospitalized for more than a month were also interviewed about their concerns and response to hospitalization. The study highlighted the need for hospitalized children to be better prepared for hospitalization, to have greater parental involvement in the management of their behaviour and to have efficiently run programmes geared at addressing their educational and emotional needs.

Tomorrows doctors - an early profile of our students

In planning for the training of medical personnel in a well ordered health service, it is important to determine the profile of those persons who enter the course of training and what effect, if any, this programme has on their subsequent choice of speciality. Work on this issue elsewhere indicates that the best time to begin gathering information about these factors is at the time of entry to medical school and before students are swayed by the course and by the opinions of their peers and teachers. This study was designed to explore why persons seek to become doctors and what factors influence different sub groups to select different specialities. It sets out to answer the following questions: 1) What are the motivational factors influencing the students to study medicine? 2) What demographic and family background factors are related to these motivational factors? 3) What influence do these motivational factors have on future choice of speciality? A longitudinal study of all medical students from their first year in a 5-year curriculum was begun on the Mona and St. Augustine campuses by administration of a questionnaire at the start of the first year of study. This included structured questions on demographics, the motivation for making the decision to study medicine and the present choice of speciality. Confidentiality of the information collected will be assured by using student's identification numbers. This paper reports the preliminary data from one of the campuses. It focuses on motivational factors, speciality choices and concerns of the students about pursuing the medical programme at the UWI. It is hoped that this information and the results of longitudinal follow-up will help the Faculty to shape decisions about selection criteria for entrants and for designing and implementing the new curriculum (AU)

Autism in Jamaica

This paper reviews childhood autism, a serious psychopathological disorder, with emphasis placed on aetiology and management; and outlines briefly the care of the autistic population in a few well organised programmes existing in Jamaica. There is a need for increased awareness, local research and dissemination of information to appropriate personnel and organizations(AU)

Autism in Jamaica

This paper reviews childhood autism, a serious psychopathological disorder, with emphasis placed on aetiology and management; and outlines briefly the care of the autistic population in a few well organized programmes existing in Jamaica. There is a need for increased awareness, local research and dissemination of information to appropriate personnel and organizations.(Au)

Do relatives of terminally ill patients also benefit from hospice care?

An analysis was carried out on the extent to which staff responded to the relatives of cancer patients who had been admitted to the Consie Walters Hospice Care Centre, and the Pain Centre, both located in Kingston, Jamaica. Although no relationship was found between frequency of intervention and relatives' (caregivers') health, grief reactions were found to be related to a need for staff interaction. The more caregivers reported that they needed staff emotional support and practical assistance, the more intensely the reported grief, and the greater were their reports of anxiety and insomnia. Age was found to influence the relationship between adjustment and receiving intervention (AU)

Relationship between stress and academic achievement in pre-clinical medical undergraduates

The relationship between perceived stress, sex, age, personality, entry qualification and academic grades were examined in a sample of 78 first year medical students at the University of the West Indies. Students were administered a stress questionnaire on which they rated their perception of 33 stress items. Personality was measured using a psycho-neurotic, the Crown-Crisp Experimental Index. The major statistical analyses involved are: (a) Pearson product-moment correlation co-efficient (b) Analysis of variance. A weak, negative relationship was found between stress and grades which was not statistically significant. No significant differences were found between the means of grades with age, sex or entry qualification. However those students who entered medical school with a U.W.I. degree tended to perform consistently better. There were significant differences between low, medium and high grades and somatization and hysteria psycho-neurotic traits. The students who had a tendency to somatic complaints (somatization) obtained low grades and the students with extreme grades, either high or low, were more prone to hysterical behaviour than students with average grades. Biochemistry test grades were found to be negatively related to anxiety psycho-neurotic trait and overall stress score. Also sex was found to be significantly related to community health. The results indicated that students with high anxiety levels and who perceived high levels of stress have low biochemistry grades and that females in the sample performed better than males in community health. These results have implications for selection and prediction of successful and well adjusted physicians. Further research on stress in medical students at U.W.I., using a bio-psycho-social method is necessary and relevant in understanding the effect of stress on the medical student (AU)

HIV/AIDS in women, infants, children and adolescent in Jamaica. A further "call to action"

The UWI/UHWI is playing a major role in the commonwealth Caribbean in developing a coordinated appropriate response from the community for the prevention, treatment and care of HIV/AIDS (AU)