Fatherhood in St Kitts: Patterns and predictors of partnership and paternal dynamics in a Caribbean island

OBJECTIVE: To characterize key patterns of paternal behaviour in the Caribbean island of St Kitts. SUBJECTS AND METHODS: A convenience, community-based sample of 102 fathers was recruited. The selection criteria were being a father between 21 and 40 years of age who lives currently in St Kitts and has a biological child, or a step child, or both biological and step children aged 2–10years. Participants were asked to complete one of three versions of a fatherhood questionnaire to provide basic sociodemographic information and enable the testing of three hypotheses concerning variation in partnership and paternal measures. RESULTS: A sample of 102 working fathers who expressed generally favourable attitudes and investments in a relatively low-fertility context participated. Results revealed differences in partnership dynamics and paternal outcomes with respect to relationship status, with married men reporting higher quality partnerships and providing more paternal care than fathers in visiting relationships. Partnership quality predicted a number of paternal outcomes such as supportive paternal attitudes and paternal behaviour. In both between- and within-subject analyses, biological fathers showed evidence of more favourable paternal attitudes and investments compared with stepfathers. CONCLUSIONS: This study of fatherhood in St Kitts providesa portrait of men’s work and family life in a small Caribbean island. Relationship status and quality are associated with key features of paternal attitudes and investment, and some measures of fathers’ attitudes and investments are contingent upon step vs biological status. These data illustrate how key features of Kittitian paternal life can be placed in the social context.

Predicting HIV testing decisions

OBJECTIVE: To evaluate previous HIV testing history among residents of a community in Trinidad so as to identify predictors of HIV testing decisions. DESIGN AND METHODS: A sample of 186 respondents aged 18- 85 years was surveyed using stratified random sampling. Through interviewer administered questionnaire information was acquired on HIV testing history, awareness of HIV testing and treatment information, fear of HV testing, stigma towards persons living with HIV, and perception of risk. A simultaneous logistic regression was used to model respondents’ decision to have an HIV test. RESULTS: There were 185 respondents (M 92, F 93). Respondents with higher levels of awareness are 1.109 times more likely to have had an HIV test; younger respondents were 0.945 times more likely to have had an HIV test than older respondents. Respondents who reported higher levels of perception of risk were 0.924 times less likely to have had an HIV test. CONCLUSION: Younger persons and persons with higher levels of awareness of HIV testing and treatment information were more likely to decide to be HIV tested while persons reporting higher levels of perception of risk were less likely to be tested. Interventions to build awareness of HIV testing and treatment should be designed to encourage HIV testing among older persons. A routinized approach to HIV testing has potential to shift the focus from HIV prevention to health and well-being and dismantle barriers which prevent people from realising the real risks of HIV infection.

Predictors of mortality in patients with left ventricular failure [abstract]

We retrospectively reviewed the clinical presentation and five-year mortality of 64 consecutive adults who underwent echocardiography at the Eric Williams Medical Sciences Complex between January 1992 and December 1994 with a left ventricular ejection fraction < 40 percent. The mean age was 60ñ12 years and 68 percent of patients were male. The prevalence of diabetes mellitus and hypertension was 40 percent and 46 percent, respectively. The mean left ventricle ejection fraction was 30ñ9 percent. The most common primary cost of left ventricular failure was coronary artery disease (CAD) in 47 percent, idiopathic dilated cardiomyopathy (9 percent), hypertensive heart disease (9 percent), alcohol related dilated cardiomyopathy (8 percent) and valvular heart disease (6 percent). Angiotensin converting enzyme inhibitors were prescribed in 85 percent of cases, diuretics (82 percent), digoxin (61 percent), warfarin (18 percent), beta blockers (10 percent), and amiodarone (8 percent). Survival data were available for 84 percent. Mortality was 53 percent at 5 years. Independent predictors of mortality were age, the use of beta blockers and left ventricular internal diameter. In conclusion, CAD was the most common cause of left ventricular failure. Five-year mortality was high, particularly in elderly patients with marked ventricular dilatation. (AU)

Health trends in Jamaica: significant progress and a vision for the 21st century

Health trends in Jamaica have improved considerably during the past century. Life expectancy at birth increased from 38 years in 1900 to 72 years in 2000. The crude death and infant mortality rates declined significantly from 35.7 and 174.3 deaths to 5.1 and 24.4 deaths, respectively in the same period. The seven leading causes of death in 1945 were infectious diseases while the main causes of mortality and morbidity are now the chronic non-communicable lifestyles diseases, and injuries. Over the past few decades, considerable progress has been made in controlling vaccine preventable diseases and eliminating poliomyelitis and measles. Rates of infectious syphilis and gonorrhoea have declined significantly in recent years although chlamydia and herpes are common and the HIV/AIDS epidemic is a growing concern. Over the past few decades health expenditure has grown more rapidly in the private health sector than in the public health sector although services in the public sector are provided at significantly lower cost. Jamaica provides good health at low cost. However, more funds are needed to support the public health system. The current health reform process needs to be informed by a better understanding of the factors that have contributed to Jamaica's achievements in health and needs a clear health focus. The Ministry of Health has articulated a vision of health for the 21st century that requires a significant reorientation of health staff as well as empowering people to take responsibility for adopting healthy lifestyles. (AU)

Iniciativa regional de reforma del sector de la salud en America Latina y el Caribe / Regional initiative on health care reform in Latin America and the Caribbean

Many countries throughout Latin America and the Caribbean are introducing reforms that can profoundly influence how health services are provided and who receives them. Governments in the region identified the need for a network to support health reform by building capacity in analysis and training, both at the summit of the Americas in 1994 and at the Special Meeting on Health Sector Reform, which was convened in 1995 by an interagency committee of the Pan American Health Organization/World Health Organization, the Inter-American Development Bank, the World Bank, and other multilateral agencies. In response, in 1997, the Pan American Health Organization and the United States Agency for the International development launched the Latin America and Caribbean Health Sector Reform Initiative. The Initiative has approximately US$ 10 million in funding through the year 2002 to support activities in Bolivia, Brazil, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Paraquay, and Peru. Now in its third year of implementation, the Initiative supports regional activities seeking to promote more equitable and effective delivery of basic health services. (AU)

Second trimester placental volumes predict birth size

OBJECTIVE: To investigate the ability of second trimester placental volume to predict birth size. DESIGN AND METHODS: Prospective study of women attending the antenatal clinic of the University Hospital of the West Indies. SUBJECTS: 561 women were recruited from the antenatal clinic. Placental volume and foetal biometry at 14, 17 and 20 weeks' gestation were measured. At birth, placental and newborn's weight, lengths and circumferences were measured. MAIN OUTCOME MEASURES: Birth and placental weight, head, chest, abdominal, and mid-upper-arm circumferences, crown-heel and crown-rump length and placental volume. RESULTS: Placental volume in the second trimester showed a positive association to birth measurements. Ponderal index and head: length ratio showed no significant associations with placental volume, but there was a significant relationship between placental volume at 20 weeks' gestation and head: abdominal circumference ratio. The placental volume at 20 week gestation had the greatest effect on birth weight, and when placental volume was compared to foetal biometry in predicting birth outcome, placental volume was superior. CONCLUSION: In this study, second trimester placental volume has been shown to be an independent predictor of birth outcome, at a time when foetal biometry was not. It was not until the third trimester that foetal biometry became important. Identification of the growth retarded foetus is desirable in obstetrics for proper management. Earlier indication of this process is presumably important. It appears that in the second trimester, placental volume may be a more reliable predictor than foetal biometry.(AU)

Ethics, medicine and society: imperatives for the future

Historically, medicine has been a caring profession and social factors have directly and indirectly affected clinical practice, yet the social roots of disease and suffering in patients and the ethics of patient care have often been left out of medical teaching and discussions at medical conferences. As health and social problems are inseparable, ethically, medicine and medical teaching need to respond to social suffering, and should help to solve the economic problems in health care. Further, since all intervention in the lives of human beings carries ethical content through the nature of care, ethical competence involving ethical analysis, critical thinking, and problem-solving should be developed in medical students and doctors simultaneously with clinical judgement and expertise.(AU)

Medicine and its alternatives: health care priorities in the Caribbean

In the Caribbean as as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.(Au)

Alternative medicine: old ideas with new interests?

The use of complementary or alternative medicine has greatly increased in developed countries during th last few years. In such countries, laws have been passed and regulations made to protect both the public and practitioners. There are a growing number of research units in universities, journals, and associations of practitioners of complementary medicine. In Jamaica, too, there is increasing recognition, if not acceptance, of the popular interest in complementary medicine. In preparation for the next century we will need to address some of the legal, educational and scientific issues raised.(AU)

Health expenditures in Latin America and the Caribbean

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average, per capita health expenditure of US$ 162. On average, the countries spent 6.2 percent of their GDP on health, with the expenditure divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.(AU)

Differential patterns of serum biomarkers of immune activation in human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis, and adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATL) and human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are associated with differing patterns of immune dysfunction. Biomarkers of immune activation may correlate with perturbations of immune function associated with these diseases. We conducted a pilot cross-sectionalstudy to assess four candidate biomarkers of immune activation, beta 2-microglobulin, neopterin, tryptophan, and kynurenine levels were assayed in storedsera from asymptomatic, human T-cell leukemia virus type I (HTL V-I) seronegative (HTLV-I-) and HTLV-I-seropositive (HTLV-I+) individuals, and ATL and HAM/TSP patients previously enrolled in seroepidemiological studies in Jamaica. Mean levels of beta 2-microglobulin, neopterin, and kynurenine were significantly elevated among ATL patients compared to the other study groups. Mean tryptophan levels were signigicantly lower among ATL and HAM/TSP patients than HTLV-I- and HTLV-I+ groups. No significant differences in biomarkers were found between HTLV-I- and HTLV-I+ groups. Among HAM/TSP patients, a significant association was found between elevated neopterin levels and symptoms of less than 4 years duration. In Cox proportional hazards regression modeling, neopterin and tryptophan were found to be independent predictors of survival among ATL patients. This study demonstrates a differential pattern of biomarkers of immune activation among ATL and HAM/TSP patients compared to HTLV-I- amd HTLV-I+ individuals. Neopterin and tryptophan may be useful clinical indicators of disease severity and prognosis among HAM/TSP and ATL patients. (AU)

Back-projection of the HIV/AIDs epidemic in the Caribbean - abstract

In this study, we estimated past HIV incidence in 18 English-speaking Caribbean countries and Suriname, and projected the course of the epidemic to the year 2000. Nonlinear optimization methods were used to fit various models to adult (age 15 years or older) AIDS incidence data (not adjusted for bias in reporting) derived from our existing surveillance system. APM, an AIDS projection model, was used to project the future impact. The best feasible fit to the data was obtained by estimating adult HIV incidence as at with a=538.6 and b=0.6313. With this model, in 1992 adult HIV incidence reached 2586 (0.06 percent) and adult HIV prevalence 17272 (0.39 percent). This prevalence estimate is supported by recent blood donor and antenatal clinic data. The model predicts that by the year 2000 adult HIV incidence will reach 3569 (0.0796) and adult HIV prevalence 30,938 (0.61 percent). However, this does not negate the possibility of a recent upswing in incidence, as suggested by data from certain high-risk groups. Further work, including population sampling and additional modelling, is in progress to investigate these trends (AU)

Assessment of risk of perinatal death in Jamaica

Data from the Jamaican Perinatal Mortality Survey had been used to create a statistical model using logistic regression. From this a simple additive scoring system to predict perinatal death was devised and tested on the 2 cohort months of the study. The score had a theoretical range of 0-28 points, with the higher the score, the greater the likelihood of a perinatal death. For a cut-point of 7 sensitivity was 43 percent and specificity 84 percent. A cut-point of 8 resulted in 27 percent sensitivity and 94 percent specificity. Higher cut-points resulted in much reduced sensitivity but enhanced specificity (e.g. cut-point 10: 11 percent sensitivity, 99 percent specificity). However, it is likely that these estimates are optimistically high, and to achieve unbiased estimates of sensitivity and specificity the score needs to be tested on a sample of the population from which it was not derived before implementation takes place. Meanwhile, the cut-off level for implementation will depend on appropriate resources available (Summary)

An economic model for nurse manpower planning in the Caribbean. Part 1: The issues

Below is a noneconomist's view on economic issues impacting on nurse manpower development in the Commonwealth Caribbean. The issues however are of an international nature and are therefore pertinent to all those interested in nurse manpower development. The main objective is to present a model for economic analysis and planning. (AU)