Is the Jamaican Population aware of the symptoms of diabetes mellitus? - abstract

OBJECTIVE: This study was conducted to identify the level of awareness of a sample of Jamaicans to symptoms of diabetes mellitus. METHODS: Diabetes mellitus is a common medical condition in the Jamaican population, and early recognition of symptoms and early diagnosis of this disease leads to better prognosis. A questionnaire was administered by way of an interview in public areas in Montego Bay, Buff Bay, Port Antonio, and Spanish Town to determine the mean level of awareness about some of the early and later symptoms of diabetes mellitus. One hundred and twenty persons were selected, 60 diabetics and 60 non-diabetics (49 males and 71 females), 40 persons from each of the three parishes. Correct recognition of early symptoms of diabetes attracted more points than did the recognition of late symptoms of diabetes mellitus. The sources from which this information was acquired were also recorded. RESULTS: There was a significant difference between the mean level of awareness of the symptoms of diabetes mellitus between the diabetic and non-diabetic study population (p = 0.0005); the diabetics were more aware of the symptoms than the non-diabetics (p = 0.001). Female subjects were more aware than the males, (p = 0.002); there was no statistically significant difference in awareness between the younger and older subjects, nor among the samples chosen from the three parishes. CONCLUSION: There is scope for more public health education to improve the level of awareness of the Jamaican Populace to the symptoms of diabetes mellitus.(Au)

Psychosocial realities of schizophrenia: a study in social psychiatry

A retrospective qualitative look at the schizophrenias as seen from a cohort of fifty records (male 53.70 percent and female 46.30 percent) all active in 1996, but ranging up to 30 years. The profile of the disorder is of a life-long relationship with a biophysical substance rather than with a humanistic therapist. For each new admission there ensures a mean of 11 years of continued contact to access the intramuscular panacea called modecate (Fluphenazine decanoate). The decade of "refills" calls for a mean of 46.27 visits per patient (N=33). The clinical nurse emerges as the critical mediator of the technology of this chronic illness. Time budget demands a telescoped dossier. The realities point to unimanginable strains upon individuals and families. The need and demands of schizophrenia will remain the most intractable diagnostic category unless "self-help" and quality care provision by the client for the client are taken aboard. (AU)

The comparative value of various diagnostic tests for malaria - abstract

When 300 blood samples taken from patients attending a fever clinic in Georgetown Public Hospital were examined microscopically, 47.6 percentwere found positive for malaria. IgG antibodies stored in filter paper or liquid serum gave 68 percent and 81 percent positive rate, repsectively. Sixty-one per cent (61 percent) of the patients had positive levels of IgG antibodies. Elevation of the cut-off point of IgG antibody titres from 1:256 to 1:1,024 help to reduced false positives of the indirect flourescent antibody test. Clinical symptoms, visits to endemic areas, occupation and its life styles, as well as age could assist in making a diagnosis. The microscopic method will continue to be the gold standard (AU)

Clinical skills

The author submits that the special training required for clinical skills is no more than the basic medical sciences of anatomy, physiology, and pathology, which provide us with the knowledge of the form, function and malfunction of the human organism. The techniques of clinical skills are twofold: (i) interrogation (ii) physical examination, which has three elements: observation or inspection, palpation and auscultation

HIV infection in children

In this article the author accepts the WHO definition of symptoms to establish a diagnosis of AIDS in children. Risk factors and roster of transmission list parents with Aids Related complex (ARC) or AIDS or at risk for AIDS, receipt of contaminated blood products, infection during treatment of haemophila or coagulation disorders, multiple use of needles in drug abuse and sexual activity or abuse. Age and sex distribution, clinical features, non-specific clinical manifestations of Aids in children and varying clinical manifestations in children versus adults with HIV are examined

Tetanus requiring intensive care in Jamaica: an eleven year review of cases admitted to the Intensive Care Unit, University Hospital of the West Indies

The Intensive Care Unit (ICU) at the University Hospital of the West Indies continues to receive several cases of tetanus each year. An eleven year retrospective study, conducted by examining the medical records of all cases of tetanus admitted to the ICU during the period 1978-1988 inclusive, is presented. Criteria of severity, clinical patterns and management are outlined, discussed and compared to other studies. Of the 97 patients studied, more than two-thirds were males, with peak incidence occurring amongst the very young and the elderly. Trismus was the commonest presenting symptom, the majority of patients manifesting the generalized form of tetanus. Minor wounds were often the source of infection, although disease occurred as a complication of maturity onset diabetes or haemoglobinopathies in 9 percent of patients. Few patients could provide information on their immunization status. Once the disease manifested, it was associated with considerable morbidity and mortality. In a half of the patients, disease was severe enough to require neuromuscular blocade and controlled ventillation. Complications involving the respiratory system were the commonest, primarily due to infection. However, the cardiovascular instability seen in very severe cases, presented the most difficulty in management. Seventeen patients died while in the ICU, representing a mortality rate of 17.5 percent. Sudden cardiac arrest was the commonest cause of death and was attributed to the disease. The average duration of stay in the ICU was 3 weeks. Treatment was thus expensive in terms of limited staff and resources. However, the introduction of intensive care in the management of tetanus, has resulted in a 50 percent decrease in mortality. As Jamaica is a third world country with limited resources, the continued occurrence of this preventable disease reduces optimum utilization of existing resources. Based on the findings, recommendations are made towards improving preventable measures and areas for further research in terms of curative measures are identified. Overall, this study should provide useful information relevant to an understanding of the health problems presented by tetanus in Jamaica (AU)

Antioxidant status of malnourished children

Free radicals, by virtue of their reactive nature, could account for the clinical features of kwashiorkor. These chemical species are produced in excess only after antioxidant defences fall. The possibility of this situation occuring in children with kwashiorkor was therefore investigated. Whole blood glutathione (GSH) levels were significantly decreased in children with kwashiorkor and marasmic-kwashiorkor. This indicates the presence of an overwhelming pro-oxidant stress. At a GSH level of 1.90 moles/Irbc (6.80 æmoles/gHb) oedema could be diagnosed with a sensitivity, specificity and positive accuracy of greater than 90 percent. GSH correlated inversely with the degree of oedema (r = -0.69). In children with maramus GSH was normal. Erythrocyte concentrations of NADPtot were normal in all children. The percentage of this nucleotide in the oxidised form ( percentNADP+/NADPtot) was normal in children with maramus, but abnormally elevated in oedematous children. This means that there is an acute change in the cellular redox in oedematous children, and implies that the cellular environment is oxidising. The activities of erythrocyte glutathione reductase, glutathione S-transferase (GST) and glyoxalase I were either normal or markedly elevated. Riboflavin status was poor. The end products of detoxification by GST, urinary mercapturic acids (UMCA), were between 3 and 5 times higher than normal. There were no intergroup differences. This suggests that the body's burden of toxins is significantly increased. During recovery from malnutrition, children with maramus showed a rapid restoration of normal antioxidant status, whereas those with oedematous malnutrition did so only after loss of oedema. This was followed by progressive, and unexpected, deterioration in antioxidant status: plasma vit. E and GSH levels decreased, and UMCA levels remained elevated. It was reasoned that the high PUFA content (60 percent )of the recovery diet may be a source of oxidative stress. In a second study the recovery diet contained an oil (coconut), rich in saturated fatty acids. On this diet children maintained normal levels of vit.E and GSH, and UMCA decreased significantly. This confirmed the high PUFA diet as a source of oxidative stress. Collectively, these data suggest that free radicals are involved in the aetiology and pathogenesis of kwashiorkor. It is recommended that: (1) whole blood levels of GSH be used in the diagnosis of oedematous malnutrition, and (2) coconut oil and antioxidants be used to treat malnourished children (AU)

Clinical aspects of hypertension in Black Jamaicans

Hypertension is a major contributor to morbidity and mortality in the Caribbean today but data about this disease in the West Indies is scant and this thesis provides some of such much needed research information with particular emphasis on hypertension in blacks. A prospective analysis of admissions to the Medical Wards of the University Hospital of the West Indies during 1980 and 1981 describes the clinical features of black hypertensive patients. Most of these had developed complications within 10 years of the diagnosis of hypertension, and cardiomegaly, renal failure, cardiac failure and stroke were the commonest sequelae. Unlike the situation with white populations today, myocardial infarction was the least common of all the major complications seen in black Jamaicans. The present study was the first to document the renin profile of black Jamaicans and showed that 19 percent of hypertensives had high renin levels, 46 percent had normal levels and 35 percent had low renin levels, a pattern which was similar to that found in white populations. The infleunce of sickle cell anaemia, another common disease of blacks, on blood prressure measurements was assessed. The data showed that subjects with homozygous sickle cell disease may be protected against the development of hypertension since at every age the mean blood pressure was lower than in normal Jamaicans. In an attempt to rationalise drug therapy for hypertensives in the Caribean, earlier conclusions from Jamaica suggesting that beta-blockers may not be effective in blocks were re-examined in a double-blind trial. It was shown that hypertensive Jamaicans were sensitive to small doses of thiazide diuretics and may be less responsive than whites to conventional doses of beta-blockers, and that combination therapy produced a greater fall in blood pressure than either drug used alone. The thesis documented some of the clinical characteristics of the Jamaican hypertensive, provided data helpful for makin recommendations regarding the management of hypertension in the Caribean, and showed that racial factors may modify some of the manifestations of the disease.(AU)

Sources and symptoms of stress among a sample of Jamaican secondary school teachers

This exporatory investigation examined the sources and symptoms of stress experienced by secondary school teachers drawn from a random sample of New Secondary and Traditional High schools throughout Jamaica. The instruments used were a 23-item measure of Teachers' Experience of stress Symptoms (TESS) which comprised the criterion measure: and the independent variable consisted of groupings which emerged from a factor analysis of 60 items tapping sources of stress, as well as selected biographical and demographic variables. The data obtained from 470 respondents (162 males and 308 females) were subjected to the following procedures: 1. ORTHOGONAL FACTOR ANALYSES with varimax rotation grouped the 60 source of stress items into five factors identified as 'Interaction among Staff Members', 'Students' Indiscipline', 'Job Pressures', 'Inadequate Rewards', and 'Poor Working Conditions'. All five factors were significantly related to the criterion measure (TESS). STEPWISE MULTIPLE REGRESSION analysis for the total sample yielded 'Poor Working Conditions', 'Students' Indiscipline', and 'Job Pressures' in that order, as the best predictors of the criterion (TESS). For the male sub-sample, 'Poor Working Conditions', and 'Job Pressures' surfaced as the best predictors of the criterion, while 'Interaction among Staff Members' was the only variable making any significant contribution to the criterion for the female sub-sample. ANALYSIS OF VARIANCE revealed that there were no statistically significantly differences emerging for teachers working in girls', boys' or co-educational schools on the experience of stress symptoms. Teachers at coeducational schools did however experience significantly greater stress from 'Interaction among Staff Members' and 'Inadequate Rewards'. CORRELATION ANALYSIS revealed that the teachers' sex, age, academic speciality and the grade levels of students taught were significantly related to the criterion (TESS). Teachers at New Secondary schools experienced significantly more stress than Traditional High school teachers from certain sources viz: 'Interaction among Staff Members', 'Students' Indiscipline', 'Inadequate Rewards', and 'Poor Working Conditions'. Corporate area teachers also found certain sources, viz: 'Interaction among Staff Members', 'Students' Indiscipline', 'Inadequate Rewards' and 'Poor Working Conditions', more stressful than their non-Corporate Area counterparts. Female teachers not only experienced significantly more symptoms of stress (p<.001) but also found 'Students' Indiscipline', 'Job Pressures', 'Inadequate Rewards' and 'Poor Working Conditions' to be more stressful than male teachers.(AU)

Physical assessment of 30 chronic cannabis users and 30 matched controls

Ganja is used extensively in the working-class population of Jamaica, particularly in certain agricultural and fishing communities. Ganja smoking is illegal but can be accepted as part of the culture in these areas. Sixty male subjects were chosen for assessment, 30 chronic smokers and 30 controls from comparable social, economic, and cultural backgrounds, and were matched for height and age. A chronic smoker had smoked a minimum of three spliffs per day for a minimum of 10 years. The subjects were admitted to the hospital for 1 week for psychologic and physical assessment. The physical assessment included a detailed medical history and examination, heart and lung radiography, electrocardiograms, respiratory, liver, and renal function tests, hematology, treponemal serology and chromosomal studies. No significant physical abnormalities were found, except in two smokers, and there was no reason to suspect that these disabilities were related to ganja. No significant differences between the two groups were demonstrated in the wide range of tests administered (Summary)

Cytogenetic and clinical observations on West Indian patients with primary amenorrhea

Forty-seven patients with primary amenorrhea, oligomenorrhea, and secondary amenorrhea were investigated by chromosome examination, and laparotomy was performed in six. Thirty-six percent of patients with primary amenorrhea showed sex chromosomal abnormality, and two cases showed autosomal anomalities. We feel that undetected mosaicism was present in some of the sexual infantile patients with apparently normal complement; probably, several of this group have gonadal dysgenesis. No abnormality was detected in patients with virilization. However, we now believe that any patient without adrenal hyperplasia should have laparotomy and removal of abnormal gonadal tissue. Laparotomy and gonadal extirpation may be considered for patients with streak gonads without virilization. Patients with normal secondary sexual development deserve full and early investigation of the genital tract, as they may have congenital anomalities associated with normal ovaries (Summary)

A neurological, ophthalmological and audiological survey of a suburban Jamaican community

A neurological, opthalmological and audiological survey was conducted in a suburban Jamaican community aged 35-74 years. One aim was to determine the prevalence of signs found in the Jamaican neuropathy syndrome and their association with sensorineural hearing loss and retrobulbar neuropathy. Mean hearing levels of Jamaicans were better than those reported from a comparable Scottish population. Conductive hearing losses, including otosclerosis, were uncommon. Sensorineural loss was found in 5.0 percent of men and 11.4 percent of women; presbyacusis was a possible cause in older subjects but in many the aetiology was unknown. Noise-induced hearing loss was not an important cause of impaired hearing. Refractive errors in vision were common and many needed proper correction. Pterygia were common (15.9 percent) but less prevalent among those of predominantly African origin, suggesting a racial difference in susceptibility. The prevalence of progressive cataract rose from 3.2 percent at 35-44 years to 71.7 percent at 65-74 years and was greater in diabetics than non-diabetics. Eight cases of chronic simple glaucoma were detected, a prevalence greater than that reported in a Welsh population. Tropical amblyopia (poor visual acuity, temporal pallor and field defects) was found in eight cases. Unexplained neurological signs, possibly representing manifestations of the Jamaican neuropathy syndrome, were found in 25 subjects (4.8 percent of females and 4.0 percent of males). Sensorineural hearing losses and retrobular neuropathy were common in these than in normal subjects but also occurred separately; it is unknown to what extent they are due to the same aetiology (AU)

An outbreak of eastern equine encephalomyelitis in Jamaica, West Indies. 1. Description of human cases

During the outbreak of eastern equine encephalomyelitis (EEE) in Jamaica in November and December 1962, there were 9 deaths among 11 patients clinically diagnosed as having EEE. Five of these cases were confirmed by laboratory tests. Of the two recovered patients, one showed a significant raise in EEE antibody titer and the other showed no demonstratable antibody. The presenting features of illness were mainly fever, headache, neck rigidity, paralysis and drowsiness or coma (Summary)

Neuropathies in Jamaica: a clinical and laboratory study of the aetiology of certain neurological syndromes in Jamaica with particular reference to the role of syphilis in the Jamaican Neuropathies

The characteristics of the neuropathic syndrome seen in Jamaican patients are described, and the relevant literature is reviewed in Section I. This syndrome differs from that seen in prisoners of war in that there is no clinical evidence of vitamin deficiency and spastic syndromes predominate. It differs from similar syndromes described in West Africa because of the high rate of positive tests for treponemal infection and the high incidence of spasticity. The evidence in favour of the various possible aetiological factors is examined critically and it is concluded that malnutrition, syphilis, yaws, viral and bacterial infections, bush teas, arsenical sprays and malaria are all possible causative agents. An attempt was therefore made to assess the relative importance of each. Of the patients examined, 125 fulfilled the criteria for the neuropathic syndrome. These patients were examined at least twice by me and particular attention was paid to features bearing a causal relationship to the aetiological factors mentioned above. The system of examination, the laboratory methods used, and the manner of presentation of results are described in Section II. The results are presented in Section III, and their significance is discussed in Section IV. Little evidence was found to indicate that malnutrition, toxins, and bacterial or parasitic infections were important factors in the aetiology. However, a considerable amount of evidence, direct and indirect, was accumulated to suggest that syphilis is the predominant aetiological factor in the neuropathic syndrome in Jamaican patients. Conclusions concerning the aetiology, course and treatment of this syndrome are summarised in Section V (AU)

Pernicious anaemia in Jamaica

Clinical and laboratory details are given on 10 negro patients with pernicious anaemia admitted to the University College Hospital in Jamaica in the 30 months from January, 1958, to June, 1960. All showed the usual clinical and laboratory features of pernicious anaemia; and in the patients on whom these tests were carried out the Schilling test and gastric biopsy findings were characteristic. Anorexia and loss of weight were conspicuous features. It is thought that the rarity of this disease in the negro has been overemphasized and that hospital statitics may be misleading in this respect. The literature on pernicious anaemia in other parts of the tropics is briefly reviewed. There is evidence that, in addition to the basic gastric lesion, dietary and economic factors may play a part in the genesis of the disease (AU)