The Ability of Family Physicians in the Caribbean to Promote Planetary Health Concepts and the Challenges of Implementing Changes in Practice

The global environment is rapidly changing and the subsequent effects on human health are devastating. Planetary Health is a field focused on characterizing the human health impacts of human-caused disruptions of Earth's natural systems. It has been determined that Family Physicians (FPs) are the best suited to advocate and raise awareness of Planetary Health. The purpose of this research is to assess FPs in the Caribbean, their knowledge of planetary health, their ability to implement planetary health concepts in their practice, and the challenges that may impede implementation.

Ministry of Health and Environment Jamaica Annual Report 2008-2009

This document looks at the performance of the public health sector for the year 2008-2009. It details mission, vision and strategic objectives. Gives a feature report on communicable diseases, public population health programmes, healthcare clinical programmes, diagnostic services, control of chronic diseases, abolition of user fee, performance of the environment sector and also financial statements.

Ministry of Health and Environment Jamaica Annual Report 2007-2008

This document looks at the performance of the public health sector the year 2007-2008. Includes feature report on communicable diseases, public population health programmes, salaries and allowances, health service status and utilization and also financial statements.

Dogs and goats as sentinels for environmental lead burden in Caribbean basin islands: Jamaica West Indies

Ingested/inhaled environmental lead (Pb) continues to pose a health risk to humans (children in particular) and animals. Automobile emissions from leaded gasoline combustion (less of a problem today with the phasing out of leaded gasoline), lead contaminated foods, soil and water, lead-based paints, ceramics, batteries (more frequently encountered today), and possible electronic waste, remain major sources of environmental lead. In a study carried out in Jamaica, West Indies, blood samples from dogs (n=63 at 5 locations) and goats (n=46 at 4 locations) were collected in lead-free (EDTA) tubes and analyzed by graphite furnace atomic absorption spectrometry (GFAAS) for lead. The analytical method detection limit was 0.24 μg/dl. Overall (blood lead) PbB concentrations were 2.83 ñ 2.96 μg/dl (dogs), and 1.02 ñ 0:10 μg/dl (goats). There were significant differences among locations, and. in a location of high automobile and plant foliage/grass forage density, PbB levels were 7.03 ñ 2.96 μg/dl (n=8) and 1.91 ñ 0.83 μg/d1 (n=10) in dogs and goats respectively. Although sample sizes are small the results suggest the use of dogs and goats as sentinels for evaluating environmental lead in developing countries.

Genetic and environmental influences on skeletal muscle phenotypes as a function of age and sex in large, multigenerational families of African heritage

The aim of this study was to estimate the heritability of and environmental contributions to skeletal muscle phenotypes (appendicular lean mass and calf muscle cross-sectional area) in subjects of African descent and to determine whether heritability estimates are impacted by sex or age. Body composition was measured by dual-energy X-ray absorptiometry and computed tomography in 444 men and women aged 18 yr and older (mean: 43 yr) from eight large, multigenerational Afro-Caribbean families (family size range: 21-112). Using quantitative genetic methods, we estimated heritability and the association of anthropometric, lifestyle, and medical variables with skeletal muscle phenotypes. In the overall group, we estimated the heritability of lean mass and calf muscle cross-sectional area (h(2) = 0.18-0.23, P < 0.01) and contribution of environmental factors to these phenotypes (r(2) = 0.27-0.55, P < 0.05). In our age-specific analysis, the heritability of leg lean mass was lower in older vs. younger individuals (h(2) = 0.05 vs. 0.23, respectively, P = 0.1). Sex was a significant covariate in our models (P < 0.001), although sex-specific differences in heritability varied depending on the lean mass phenotype analyzed. High genetic correlations (rho(G) = 0.69-0.81; P < 0.01) between different lean mass measures suggest these traits share a large proportion of genetic components. Our results demonstrate the heritability of skeletal muscle traits in individuals of African heritage and that heritability may differ as a function of sex and age. As the loss of skeletal muscle mass is related to metabolic abnormalities, disability, and mortality in older individuals, further research is warranted to identify specific genetic loci that contribute to these traits in general and in a sex- and age-specific manner.

Urban environment and schizophrenia

Selten et al (2005) cite two reasons for the increased risk of schizophrenia in Surinamese immigrants to The Netherlands. These are an increased base rate in the Surinamese population and exposure to an urban competitive Dutch society. These findings are of particular interest to researchers in Trinidad and Tobago because both countries share a similar mix of African and East Indian population and historically were simultaneously but independently developed by British and Dutch colonisers.

Morphological and enzymatic correlates of aerobic and burst performance in different populations of Trinidadian guppies Poecilia reticulata

We examined the mechanistic basis for two whole-animal performance traits, aerobic capacity and burst speed, in six laboratory-reared Trinidadian guppy populations from different native drainages with contrasting levels of predation. Using within- and between-population variation, we tested whether variation in organs and organ systems (heart, gill and swimming motor mass) and the activities of several enzymes that support locomotion (citrate synthetase, lactate dehydrogenase and myofibrillar ATPase) are correlated with aerobic performance (maximum rates of oxygen consumption, (O(2)max)) or burst performance (maximum swim speed during escape responses). We also tested for associations between physiological traits and habitat type (different drainages and predation levels). Organ size and enzyme activities showed substantial size-independent variation, and both performance measures were strongly correlated to body size. After accounting for size effects, neither burst nor aerobic performance was strongly correlated to any organ size or enzymatic variable, or to each other. Two principal components (PCI, PC2) in both males and females accounted for most of the variance in the organ size and enzymatic variables. In both sexes, heart and gill mass tended to covary and were negatively associated with citrate synthetase and lactate dehydrogenase activity. In males (but not females), variation in aerobic performance was weakly but significantly correlated to variation in PC1, suggesting that heart and gill mass scale positively with (O(2)max). Neither of the component variables and no single morphological or enzymatic trait was correlated to burst speed in either sex. Evolutionary changes in important life history traits occur rapidly in guppy populations subjected to different predation intensities (high mortality in downstream sites inhabited by large predatory fish; low mortality in upstream sites lacking large predators). We found significant differences between stream drainages in all morphological variables and most enzymatic variables, but only the mass of the swimming motor and LDH activity were significantly affected by predation regime. Overall, our data show that microevolution has occurred in the physiological foundations of locomotor performance in guppies, but evolutionary changes in physiology do not closely correspond to the predation-induced changes in life history parameters.

Food saftey: an examination of the potential impact on the economies of countries of the Caribbean Community [abstract]

Food safety pertains to the prevention, reduction or elimination of the risk of ill-health as a result of the consumption of foods whether fresh or processed, obtained through the domestic market or by international trade. Food saftey issues therefore impact on agricultural production and trade, as well as on the manufacture of processed foods and on the preparation and service of meals, whether these be in a hotel/restaurant environment or by itinerant street vendors. Agricultural production, trade and tourism are together significant contributors to the output of the open economies of the countries of the Caribbean Community. The discussion examines the findings of a recent assessment of the food safety status of Caribbean Community (CARICOM) Member States, which focussed on food safety in respect of plant, animal and human health systems in the various countries. The economic structure of selected countries is highlighted together with an indication of the trends in trade. The findings of the food safety assessment are then reviewed in the context of their possible impact on the economic output of the countries. The analysis showed that agricultural production and trade play a critical role in the economic output of many CARICOM States, Through their contribution to export earnings as well as employment. Tourism is also important in this regard. Inadequate attention to food safety issues can result in loss of market share either through a shift in purchasing patterns as experienced by other countries, or through detention by the regulatory agency of the importing country. Weak food safety policies could also jeopardize the tourism sector. Improvements in the food safety system and its infrastructure would serve to enhance the earning potential of the agricultural and tourism sectors and this should lead to greater economic output from those sectors. (AU)

The assessment of empathy and the quality of interpersonal communication by standardized patients in an OSCE: an exploratory study [abstract]

Emphatic communication is a critical aspect of medical interviewing. While there are a number of theoretical perspectives on empathy, in the medical context Feignhny (1995) describes, empathy as, "a physician's cognitive capacity to understand a patient's needs, an affective sensitivity to a patient's feelings, and a behavioural ability to convey empathy to a patient". From this definition, the most direct and valid assessment of empathetic concern is likely to come from the patients own perspective. The development of empathy in students is critical in the provision of quality undergraduate medical attention. At the St. Augustine Campus of the Faculty of Medical Sciences, the skills laboratory programme has the responsibility for developing basic clinical competencies in medical students in years 1 to 3, including empathetic concern. However, as yet, there are no formal intervention programmes. A standardized patient (SP) programme is maintained in which a core of volunteers is trained to work with the students and to perform in the role of patient at the annual OSCE at the end of year 3. In the 1999 OSCE, the SPs were asked to assess the quality of the interpersonal communication of students. These ratings were compared with those of experts raters at key stations. In the 2000 OSCE, the study was expanded to include an assessment of empathy using the Adjective Check List. The key research questions for the study focused on the relationship between empathy and student individual characteristics and performance in traditional assessments. It was found that empathetic communication as practised in the OSCE and as assessed by the SPs was related to gender but unrelated to performance in traditional assessments in the Phase examinations and admission scores. There was evidence that students with high admission scores were likely to score lower in some aspects of empathy as perceived by the SPs. Recommendations for the development and assessment of attitudes are provided. Issues centring on design intervention programmes for developing empathetic concern in students are discussed. (AU)

The grass is not always greener on the other side [abstract]

Too often one hears the comment that `you in the first world live a better life and make a lot more than us who live in the third world'. This statement is unfortunate, as I believe it is not true. I will try to discuss the pros and the cons of living in the `first world' and at the end suggest to you that you could be better off in most respects by staying where you are. Do not be in too much of a hurry to trade places with me because `the grass is not always greener on the other side'. (AU)

Managing the environment for health and safety

Reviews the major issues of environmental management of concern in the Caribbean. Examines the types of environmental problems facing the region and their effects on health and safety. Factors suggested as contributing to degradation of the natural resources include unsustainable land use practices; inadequate legislation and lack of enforcement of legislation; inadequate waste management and poverty. (AU)

Development of a questionnaire for assessing the school environment

This article describes the development of a school environment questionnaire to assess student's perception of their school environment. The dimensions and internal consistency reliability were examined ulitlzing various statistical methods - factor analysis and alpha coefficient. The sample consisted of 705 students from two high schools with ages ranging from ten to nineteen years. Results showed that the students perceived their school as having various aspects, rather than a global point of view. Factor analysis identified seven dimensions in the school environment: external characteristics of the environment, aesthetic and functional elements of the classroom, students' bathroom, the canteen and staffroom, the aesthetic and functional elements of the school as a whole and sanitation. Overall the internal reliability of the factors was high. Implications for school health programs are addressed. (au)

Association between social and environmental factors and perinatal mortality in Jamaica

Social and environmental factors in Jamaica were compared between 9919 mothers delivering in a 2-month period a singleton who survived the early neonatal period and 1847 mothers who were delivered of a singleton perinatal death in a continuous 12-month period. Logistic regression showed independent positive statistically significant increased odds of having a perinatal death among mothers who lived in rural parishes, older mothers (aged 30+), single parents, no other children in the household, large number of adults in the household, mother unemployed, the major wage earner of the household not being in a managerial, professional or skilled non-manual occupation, the household not having sole use of toilet facilities, smaller mothers and those classified as obese or undernourished. Variations were found for different categories of death. Intrapartum asphyxia deaths were not related to union (marital) status, occupation of major wage earner, number of adults nor to the use of the toilet. Antepartum fetal deaths did not vary significantly with occupation of major wage earner or maternal height, but did show a relationship with maternal education, mothers with lowest levels having reduced risk. Deaths from immaturity were significantly related only to occupation of major wage earner, number of children in the household, number of social amenities available (negative relationships) and maternal age (<17 at highest risk). In conclusion there was little to indicate that social deprivation per se was related to perinatal death, although specific features of the environment showed strong relationships (AU)

Analysis of investment processes in health and the environment in Guyana

Reviews the evolution of the macroeconomic scenario in Guyana and its implications for the health sector. Deals with the institutional structure of the health sector and the allocation of responsibility for service delivery. Describes and analyzes the processes and procedures associated with national budgeting and capital investment. Provides an inventory of health sector projects. Looks at the participation of agencies and institutions in the investment process and presents conclusions and recommendations. (AU)

Ecotourism and health tourism in the Caribbean

Sees the region as having a great potential for ecotourism, however the environment must be preserved and concept of sustainable development must be central to the success of such ventures. Acknowledges that the region has particular advantages in health and tourism and this should be part of the ecotourism investment package. (AU)