Suicide in Jamaica: some socio-demographic findings [abstract]

The objective of this study was to examine trends in suicide in Jamaica from 1974 to 2000; socio-demographic variables for suicide over the past 5 years and specific aspects of in the year 2000 were examined. Figures for suicide in Jamaica over the period 1974-2000, provided by the Police Computing Centre, were examined. The trends in respect of suicide methods used, and socio-demographic factors: age, gender, location (urban/rural), over the period 1996 to date were identified, and additionally, 57 cases (51 males, 6 females) of suicide in 2000, to date, were examined via month/ quarter of occurrence, and possible precipitating factors, including mental disorder, stressful life events, and larger social issues. The ages of the suicide cases ranged from 15 to 78 years with a mean age of 40 years. The data were analyzed at the Department of Administrative Computing. The SPSS package was used. There was a marked increase in suicide from 1992. Linear regression indicated a continued increase in suicide over the following three years unless there was appropriate intervention. Hanging emerged as the most commonly used method of suicide by both men (80.4 percent, (n= 41) and women (66.7 percent, (n= 4). Chi-square analysis showed no significant difference between the genders, both choosing hanging over all other methods. Regarding age and method, 100 percent of cases in age groups 20 to 29 years (n= 13) and 70 to 79 years (n= 6) used hanging, while 80 percent of cases in age group 50 to 59 years (n= 5) chose methods other than hanging, including shooting, setting self on fire, drowning, jumping from a height, throat and wrist slashing, and ingestion of poisonous liquids (levels of significance, p= 0.006). (AU)

A sociodemographic and clinical study of patients admitted to the University Hospital of the West Indies detoxification unit over a three-month period [abstract]

OBJECTIVE: To characterize the patients admitted to the Detoxification Unit for the 3-month period, May 28, 2001 to August 24, 2001, and to identify factors which may influence premature discharge. METHOD: The socio-demographic variables, drug use history, clinical assessment management and clinical of 17 persons admitted during the period under consideration were obtained. Particular attention was paid to group and one-to-one interaction. SPSS was used in data analysis. RESULTS: 94.1 percent (n= 16) were male and 5.9 percent, (n= 1), female. Most were in the 25 to 29-year age group (35.3 percent. n= 6). Most (76.6 percent, n= 13) had Kingston and St. Andrew addresses. Ten (58.8 percent) persons sucessfully completed the 4-week programme; one (5.9 percent) was transferred for medical reasons and 6 (35.3 percent) were discharged prematurely because of infringement of rules. The presence of dual Axis 1 or Axis 2 disorders was not in itself a significant contributory factor in premature discharge, though several of these individuals showed personality deficits; nor was poor schooling with poor literacy skills related. CONCLUSION: Further studies, including case control studies, are required. Patients who may not be suitable for in-patient therapy would be appropriately channelled to close outpatient follow up. (AU)

A study of adult T-cell leukemia/lymphoma incidence in central Brooklyn

Adult T-cell leukemia/lymphoma (ATL), a rare outcome of infection with human T-lymphotropic virus (HTLV-I), is endemic in central Brooklyn, which has a large Caribbean migrant population. Previous studies have suggested that HTLV-I prevalence in central Brooklyn may be similar to that recorded in the Caribbean islands. We established a pilot 1-year surveillance program to identify cases of ATL in 7 of 10 hospitals serving the residents of 18 zip codes of central Brooklyn with a combined population of 1,184,670. Of the 6,198 in-patient beds in the catchment area, approximately 83 percent were covered. Twelve incident cases of ATL were ascertained, all among persons of Afro-Caribbean descent, indicating an annual incidence in African-Americans in this community of approximately 3.2/100,000 person-years. Unexplained hypercalcemia was the most useful screening method, identifying 3 of 5 patients not referred for possible ATL by a local hematologist. The female:male ratio was 3:1. The age pattern was different from that reported in the Caribbean Basin and closer to the pattern seen in Japan. Our study supports evidence that HTLV-I infection and ATL are endemic in central Brooklyn and suggests that a more intensive surveillance program for this disease coupled with intervention efforts to reduce HTLV-I transmission are warranted.(Au)

Stroke in Trinidad and Tobago: Burden of illness and risk factors

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects are admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1,105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9,478 bed days per annum. The hospital admission fatality rate was 29 percent. Among surviving patients, 437 (56 percent) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95 percent CI: 83 to 145) per 100,000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 to 186). Among patients with first strokes, 348/531 (66 percent) reported physician-diagnosed hypertension, but only 226 (65 percent) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.(AU)

TRYPNET: new hemoparasite information network

Although Guyana, Suriname and French Guiana share borders and climatic and geographic similarities, the countries have maintained little contact, due to language, political, and administrative differences. In 1993, two international organizations involved in the improvement of animal health, the Inter-American Institute for Cooperation on Agriculture (IICA) and CIRAD-EMVT (Centre de Cooperation en Recherche Agronomique pour le Developement-Elevage et Medicine Veterinaire des Pays Tropicaux), jointly developed a collaborative project between the veterinary services of the three countries entitled Hemoparsite Network of the Guianas. This project seeks to pool livestock, laboratory, and technical resources between the three countries in order to generate and exchange information on hemoparasites of livestock. A Hemoparasite Reference Laboratory for the Guianas has been created at the CIRAD-EMVT laboratory in Cayenne, French Guiana. Besides processing ruminant serum samples for the three countries, specialists from this organization conduct training in hemoparasite diagnostic techniques for laboratory personnel from Guyana and Suriname. A large-scale epidemiologic study of cattle in the three countries is under way, to determine the prevalence, distribution, and clinical and economic significance of hemoparasites in the three countries, particularly Trypanosoma vivax and T. envansi. Preliminary results are presented and discussed. A hemoparasite information Network (TRYPNET) has been initiated, including a quarterly hemoparasite newsletter (TRYPNEWS), published in English and Spanish and disseminated to researchers in the Americas, Europe, and Africa. In 1995/96, it is proposed to expand the network's scope to include Venezuela and Brazil. (AU)

Clustering of human T lymphotropic virus type 1 seropositive in Montserrat, West Indies: evidence for an environmental factor in transmission of the virus

A community survey of human T cell lymphotropic virus type I (HTLV-I) in Montserrat, West Indies, identified 22 instances in which 2 HTLV-I-seropositive adults lived within 60 m of each other (close pairs), compared with 7.8 expected (P<.001). Five of these close pairs were mother offspring or husband-wife. The remaining 17 pairs were of unrelated members in separate households. The percentages of male-female (41 percent), female-female (41 percent), and male-male (18 percent) types in these 17 pairs were similar to those among the 1377 similarly defined pairs in which neither or only 1 member was seropositive, affording no support for extramarital heterosexual activity as an explanation for the clustering observed. Thus, the demography of HTLV-I was not accounted for completely by sexual and mother-to-offspring tranmission. The predominace of clustering of unrelated HTLV-I-seropositive individuals in locations with high mosquito infestation raised the possibility of sporadic transmission of HTLV-I by hematophagous insects (AU)

Social, economic and cultural factors contributing to adolescents dropping out of school in Grenada, West Indies

Presents results of a study aimed at determining factors that contribute to adolescents dropping out of school. Findings show that the most common reasons are breakdown in family structure; economic factors, barriers within the educational system and custom and culture. The methodology involved the review of available qualitative data, and indepth interviews with a mix of professionals who are involved in providing services to teens, and also with school leavers and drop-outs. Recommendations for meeting the needs of adolescents who drop out and those at risk of dropping out are discussed. Suggests the introduction of family life curricula, review of the school curriculum to cater for the non-academically inclined. Recommends also the provision of education for adolescents mothers and emphasises the role of the church in providing guidance to young people

Methodological issues in the design of survey protocols for substance abuse studies

The paper considers the problems involved in sample surveys of a population using the interviewer/enumerator method. The particular subject matter is substance abuse, covering activities that are defined in many cases as illegal according to Jamaican law. The design of the sample has to conform to the normal standards of rigour required for making inferences about the population as a whole. Beyond the basic design however, given the conditions in which interviews must be conducted, the interviewers must be trained in such a manner that they are able to anticipate problems and be prepared to counter them where feasible. It is well known that the direct interview technique normally used in social science research suffers from problems of validity of responses especially when there are legal and in cases social sanctions attendant upon the behaviours being studied. Additionally respondents recall of their substance abuse patterns may well be incomplete or incorrect. The sample design cannot overcome these problems. It is in a mix of sample design, interviewing techniques and other types of study that these problems may be minimized thus providing a more accurate reflection of the phenomenon(AU)

An investigation of some risk factors for severe leptospirosis on Barbados

Between November 1979 and the end of December 1986 (7.17 years), 248 cases of leptospirosis were confirmed among hospital patients on Barbados (mean 35 per year; range 25-57). Considering the 235 who were greater than or equal to 15 years of age, the annual incidence of leptospirosis was 19.2/100,000 population (14.0 for all age groups). There were 173 males and 62 females, and for cases aged 15-34 leptospirosis was 9.6 times more common in men than women. Among men, incidence increased fairly steadily with age, and an even steadier increase was apparent in women up to age 64, with some decline in later years. The incidence of disease was much higher among agricultural than other workers and the un-employed. Highest case numbers were recorded in the parishes of St Michael (65 or 28 percent) and Christ Church (36 or 15 percent), though the incidence was lowest in these two parishes (13.1/100,000 and 17.4/100,000, respectively). The highest incidence rates were in St Andrew and St Joseph ((50.2 and 36.1/100,000, respectively). The incidence in areas with rainfall greater than or equal to 1600 mm (32.6/100,000) was nearly twice that in areas with rainfall less than 1600 mm (17.3/100,000). There is a clear link between cases of severe disease and recent rainfall. Using 134 patients greater than or equal to 15 years of age with fever due to other illnesses as controls, a higher proportion of cases than controls came from rural areas. The risk of contracting leptospirosis was increased for all categories of manual workers relative to the group at lowest risk (non-manual indoor workers). Sugar-cane workers were five times more likely to contract leptospirosis than were non-manual indoor workers, while those with rodents in their garden/yard were 1.8 times more likely to do so. Other risk factors examined did not show significant associations with the disease. Despite increasing mechanization and the use of more protective clothing, agricultural workers are still at high risk from leptospirosis. The annual range of cases is likely to stay much as it is in the foreseeable future. (AU)

Seasonal incidence and vertical distribution patterns of oviposition by Aedes aegypti in an urban environment in Trinidad, W. I

The oviposition patterns of Aedes aegypti were investigated using modified ovitraps placed along 4 vertical transects and monitored weekly for 52 wk in St. Augustine, Trinidad, W. I. From the 832 ovitraps exposed at ground level, 1.2, 3.0 and 4.6-m elevations, 43 percent(361) were found containing 20,114 Ae.aegpti eggs. During the wet season, 52.7 percent of the eggs were collected whereas during the dry season only 47.3 percent were collected. Egg populations were highest at the 1.2-m elevation. The implications of these results are discussed. (AU)

Selection, change, and discontinuation of contraceptives methods in Trinidad and Tobago

As a result of Trinidad and Tobago migration history, the contemporary population enjoys a large measure of heterogeneity. The two main ethnic groups--persons of Indian and African descent--together account for 82 percent of the population. Diversity of culture, including religion and patterns of family formation remain. The paper explores the extent to which the use of contraceptives generally, the choice of specific methods, and the shifting and/or discontinuation of these methods vary according to the demographic characteristics of the women. Current age had an overwhelming impact on the selection of specific methods, although the contraceptive pill and the condom remain the two most widely used methods in all age groups except the youngest, among whom withdrawal was very popular. Method shifting is also highest among the 15-19 age group. The impact of education on method selection appears minimal. There is also no real difference according to education in the incidence of contraceptive drop-out, but method shifting is higher among the the more educated and younger group. The pill and the rhythm method are more popular among urban women, who are more prone to method shifting than rural women (AU)

Persistence of leptospiral agglutinins in Trinidadian survey subjects

Participants in a survey for leptospiral agglutinating antibodies undertaken in Trinidad, West Indies, in 1977-78, were further monitored for up to 5-and-a-half years. 52 individuals with a titre >1:400 were matched for age, sex and occupation with seronegative subjects. They were re-bled twice (on average 2.38 and 4.84 years leater), and changes of titre were noted. At the first follow-up, 78 percent of negative controls remained negative, and 22 percent, showed titre changes. Among the seropositive subjects, 47 percent showed a fall in titre, 38 percent showed no change, and in 15 percent the titre rose. New exposure rates between the original and fist follow-up samples were 96/1,000 survey population per year in the controls, and 68/1,000 for the subjects with titres >1:400. Between the first and second follow-up, 47 percent ofthe seropositive subjects lost titre, 40 percent showed no change, and 13 percent showed a rise in titre. These data demonstrate that although antibody titre may be maintained for a few years at the same level, or show a loss as is usually expected, about 8.3 percent of individuals in Trinidad may be infected/reinfected per year. The infection/reinfection rate is an important factor in the epidemiology of leptospirosis. (AU)

Breast feeding promotion in an urban and a rural Jamaican hospital

Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n=62) and one rural (n=51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital. Moreover, there was no difference between urban and rural mothers' knowledge about breast feeding despite the input of far greater educational resources to mothers at the urban hospital. This study suggests that merely educating mothers about feeding is insufficient. Efforts to promote breast feeding must emphasize specific health professional practices that support early initiation of breast feeding. The health policy implications of these findings are discussed. (AU)