Breastfeeding support at work: A comparison between career women in the public and private sectors in Trinidad and Tobago

OBJECTIVE: To evaluate knowledge and perceptions toward breastfeeding support at work among women in public and private sectors in Trinidad and Tobago. SUBJECTS AND METHODS: A purposive sampling design was used to select women employees from the public and private sectors. Employees were surveyed using a self administered 16-item structured questionnaire. Data were analysed using SPSS version 21. Independent t-test wasused to compare perceptions held by the public and private sectors. Pearson’s correlation was used to determine the relationship between the variables. The level of significance was set at the 0.05 level. RESULTS: The mean breastfeeding knowledge score for the participants was 2.31 ± 0.83, with the public sector employees having a mean score of 2.42 ± 0.759, which was statistically significant (p = 0.004) when compared to the private score of 2.14 ± 0.914. The mean readiness score 26to utilize breastfeeding support for the public and private sectors employees were 1.08 ± 0.482 and 1.14 ± 0.525, respectively; however, no significant difference was observed between the two groups (p = 0.294). The mean perception scores were 1.75 ± 0.985 for the public sector and 1.90 ± 0.950 for the private sector, with no significant difference between groups (p = 0.184). CONCLUSIONS: Participants had adequate breastfeeding knowledge and a positive attitude and perception toward breastfeeding at work. We recommend that an intervention programme be developed to increase the awareness of breastfeeding support at work so that employees and employers can become more aware of its purpose and benefits.

Each one teach one: training students for diabetes and nutrition peer education in schools

OBJECTIVE: To provide a Diabetes (DM) in-school support system; to enable peer education in a general setting without discrimination. DESIGN AND METHODS: 200 student leaders aged 10-14 were chosen from 18 schools. We used the Novo Nordisk “Changing Diabetes in Children” presentations to teach about DM and Nutrition. 162 questionnaires were given to assess the students’ knowledge of type 1 DM. RESULTS: 22 (13.5%) students said in type 1 DM the body makes insulin but more insulin is needed, while 67 (41.4%) said the body does not make insulin and the treatment is pills and plenty water only. 33 (20.4%) said Diabetes affects only old people, 126 (77.8%) said all children can get DM. 157 (96.9%) said eating a variety of vegetables, legumes and some fruits are important in Diabetes management. 11 (6.8%) and 9 (5.6%) respectively, said if their friend had Diabetes they should not play or talk with them anymore and 142 (87.7%) said they should show love and support. 147 (90.7%) said if they learnt about Diabetes, everyone should learn too, 15 (9.3%) said they should keep it to themselves, share with family or “their secret keepers” only. 96 (59.3%) said children with Diabetes can take part in all activities and 23 (14.2%) said if they have DM they cannot go to school. CONCLUSION: Diabetes and nutrition education is necessary for understanding the illness and to facilitate students with DM. Good teaching aids are needed and the “Changing Diabetes in Children” tools were beneficial.

No-one learns in a quiet classroom

OBJECTIVE: To assess the value of an introductory sailing program, Buoyed Up, as an intervention strategy to improve the well-being of children at risk of isolation due to economic, cultural and social factors. DESIGN AND METHODS: Data was collected using a mixed method approach and involved primary school children (n=89) drawing and writing about their school and sailing experiences and a focus group and interviews with primary school teachers (n= 6). RESULTS: Most children appear to be happy attending school (78.2%) however, most were passive in content (67.3%) and even those who included their friends (21.8%) drew them sitting or standing. All children drew a picture of themselves actively sailing (100%) and most were happy to be involved in the program (83% of boys and 72% of girls). Most children included a sentence expressing their like for sailing (83% of boys and 72% of girls), which was particularly evident in pictures that reflected the technicalities of sailing. Teachers found children who participated in the program developed a sense of identity and belonging with a group, developed confidence and resilience to cope with challenges and were more engaged in the classroom. CONCLUSION: Children at risk of social exclusion due to economic, social and cultural adversity can be supported to stay in school through unique and targeted programs which can be linked to the curriculum.

The impact of domestic violence on children in Trinidad and Tobago

Using document analysis and discourse analysis approaches, this study addresses the impact of domestic violence on children in Trinidad and Tobago. With the growing incidence of domestic violence in the country, much attention has been given to the primary parties involved in the abuse - the abused woman and the perpetrator while very little attention has been given to the children witnessing it. The experience of the authors as clinicians, brought us into contact with children who suffer tremendously in these situations and heightened our awareness of the absence of scholarly inquiry on this phenomenon. This inquiry is intended to highlight the telling impact that domestic violence has on children. In addition, we highlight the perceptions of therapists who work with children and families about the adequacy of the services available to this population in Trinidad and Tobago (AU)

The important concepts in the management of microbial keratitis

Eye practitioners in the Caribbean must be aware of the issues involved in the management of microbial keratitis. A comprehensive literature review is presented in order to outline appropriate management strategies and to identify when referral may be indicated. (AU)

Occupational mental health: a study of work-related depression among nurses in the Caribbean

This study addresses issues of occupational mental health among nurses in the Caribbean. A linear model linking role, work and social factors, stress, burnout, depression, absenteeism and turnover intention guides the research. Data were collected from 119 nurses working for major hospitals located in St. Vincent and Trinidad & Tobago using a field survey. Psychometrically sound instruments with provencross-cultural validity were utilized in the questionnaire. Descriptive statistics, correlations, and path analysis were used to analyze the data. The results indicated fairly strong support for proposed model which is tested for the first time among a Caribbean population. Role conflict, role overload and social support predicted stress, which along with social support predicted burnout. Burnout was the sole predictor of depression which in turn predicted both absenteeism and turnover intention. Implications of these findings for research and practice are discussed.(AU)

Relationship between stressful life events and pain in young adults age 20-34

Pain (including headache, neckache, backache, chest pain, abdominal pain or pain in the limbs) that is not managed properly in young adults results in decreased productivity and poor work attendance. Multiple diagnostic and therapeutic interventions can cost the health care system excessively and can lead to iatrogenic disease. Negative reactions in caregivers can ensue and overall, individuals can be left with a sense of hopelessness for recovery. Mental and physicaal health are inextricably linked. Neglect of the psychosocial components in the sea-i-rch for the etiology and management of physical pain at the primary level may be reducing the opportunity for speedy recovery. This study was done to determine the relationship between recent and remote stressful life events and the development of pain. A case-control study was conducted among adults age 20-34 years attending one private, one government and one university clinic in Kingston, Jamaica. 46 cases with pain and 70 controls who were pain-free were chosen. The findings suggest no relation between the actual number of life events and pain but there is a clear association between the perception of a negative impact of a series of life changes on the development of physical pain. The findings also show that of overriding significance in the development of pain is the perceived lack of social support available to the patient. A significant relationship was also found between the perception of a tumultuous childhood and pain although no relationship was found between specific remote childhood stressors and pain. This study highlights the need for greater attention to the integration of mental health and primary care beginning with the training of health workers and education at policy level, service delivery level and of the public.(Au)

Improving community care for persons with the acquired immunodeficiency syndrome in Jamaica

A brief review of the HIV/AIDS epidemic in Jamaica is presented along with the details of a pilot programme aimed at training lay persons and practical nurses to assist with home care of persons with AIDS. Current (1997) estimates are that 2 to 4/1,000 Jamaican adults are HIV positive. 2,301 AIDS cases have been reported to the Epidemiology Unit of the Ministry of Health, 55 percent of whom have died. Males represent 62 percent of reported cases (1421) and children < 9 years old, 7 percent (170 cases). In 1981 a Family Centre was started at the University Hospital of the West Indies to provide support to persons with AIDS and their families. This initiative identified the need to provide special training to persons who would be responsible for caring the AIDS patient at home, where most patient preferred to be managed. All but three of the 41 persons trained in the pilot programme achieved the required standards of attendance and proficiency. Certificates valid for two years were issued and refresher courses will follow.(AU)

Social issues among patients at the Hope institute and ambulatory patients at Kingston Public Hospital oncology clinic

Cancer of the cervix uteri is a global health problem. It is the most common cancer in women in developing countries and the second most common in women worldwide. An analytical survey was carried out on patients with invasive cervical cancer at the Hope Institute and the ambulatory patients at the Kingston Public Hospital Oncology Clinic. Accidental sampling was the method used to select 86 patients from whom data were collected. The dockets of the patients were checked to verify the diagnosis of invasive cancer of the cervix. A questionnaire containing 35 items was specifically designed for this survey. The purpose of the study was to assess the need for social support systems for patients with cancer of the cervix at the institutions of Kingston Public Hospital and the Hope Institute. The survey showed that the family was the main support system. The church/church group was identified by the respondents as a support group. The majority (85 percent) of the respondents expressed interest in meeting with and having the support of others with the same condition. This was with and having the support of others with the same condition. This was one of the key findings of the study. In relation to social support systems for patients with cancer of the cervix in Jamaica, areas of concern were identified and strategies for improvement were recommended.(AU)

Neighbourhood support of families with a disabled child: observations on a coping strategy of caregivers in a Jamaican community-based rehabilitation programme

In Jamaica, a low degree of practical helpfulness of neighbours of families with a disabled child has been described. This seems to cast doubt on the World Health Organisation's concept of community-based rehabilitation which simply assumes that the community is a source of support. Our study tries to elucidate which reasons, in a Jamaican socio-cultural setting, make neighbours give support to or withhold it from disabled children and their caregivers. A concept of neighbourhood help is identified, according to which help is something to asked for and provided under exceptional circumstance only. Caregivers claim to give and receive support in child rearing within the limits of this definition, generally irrespective of the presence of a disability. The impression that neighbours are unconcerned can arise when the support needed becomes too extensive to fit into the local definition of neighbourhood help which is more likely in the case of disabled children.(AU)

The impact of social support on mental health: results from the Curacao health study

The objective of this study was to describe the relationship between perceived social support and mental health in Curacao. A random sample (n=2248) of the non-institutionalized adult population of Curacao was surveyed through face-to-face interviews, containing items on health, social support and background variables. The prevalence of psychological distress was about 20 percent. The prevalence was higher in women, widowed persons, the chronically ill and persons from the low socio-economic classes. Perceived social support was relatively low in young persons, divorced and single persons, the chronically ill and low education groups. There was a strong inverse relationship between perceived social support and psychological distress: persons who feel they have low social support have more psychological distress. This relationship could be found in almost all subgroups, but is especially strong in young women. Prevention and intervention programmes should acknowledge the great impact of social support on mental health. In terms of prevention of psychological distress, people in stressful situations should be helped by reinforcing their social support (e.g. patient should be helped to improve their social support (e.g. halfway houses for (former) psychiatric patients) (AU)

Level of mental impairment in the Jamaican elderly and the issues of screening levels, caregiving, support systems, carepersons, and female burden

Jamaica, although a developing country, has an aging population and is facing the many issues confronting aging. A community-based study using the Folstein minimental screening tool identified 2.3 percent of the over-60 population as severely impaired and 11.8 percent as questionable. The family was identified as the main source of support, and female relatives the main carepersons. Mentally impaired persons were less likely than physically impaired persons not to have a support syustem or careperson needed (AU).

The health, socio-economic, family situation and lifestyle of older adults in Grenada

This study was carried out on 505 adults ages 60 years and over in Grenada between the period October 1994 to December 1994. Three questions were addressed in this study; 1) What kinds of roles do older persons play in their family unit? 2) What kinds of financial supports do they give to or receive from family members? 3) What kinds of attitudes do they have towards family members? It is often observed that family life of older persons is disintegrating and that they are being marginalized. Although this may be true in some cases the older persons in this survey were clearly able to identify the roles which they played within their family units. They distinguished between the traditional roles such as care giving and domestic support and those of counseling, advising and giving emotional support. The teaching of skills and the instilling of moral values and Christian principles were also indicated. They also reported that relationships with their family members were good, and that they were in contact on a regular basis. Most of the persons in the sample had worked and were now retired. However, incomes from pensions were very low, most of them depending on welfare benefits from Government. Family assistance was good in most cases especially where children or grandchildren were overseas. This assistance was not only financial, but took the form of clothing, household items and vacations. Older persons also offered economic support to family members, mainly children and grandchildren and this was mainly in the form of food and shelter. Attitudes and relationships with family memers were generally good. Most of the respondents were in contact with family members even those who were living overseas on a regular basis. Older persons were able to distinguish the kinds of roles which they played within their family units and were able to identify how they see themselves in relation to their families. (AU)

The health, socio-economic, family situation and life style of older adults in St. Vincent and the Grenadines

This survey was carried out on 319 adults ages 60 years and over in Saint Vincent and the Grenadines, between the period August 1994, to November 1994. Three questions were addressed in this study; 1) What kinds of roles do older persons play in their family unit? 2) What kinds of financial supports do they give to or receive from family members? 3) What kinds of attitudes do they have towards family members? It is often observed that family life of older persons is disintegrating and that they are being marginalized. Although this may be true in some cases the older persons in this survey were clearly able to identify the roles which they played within their family units. They distinguished between the traditional roles such as care giving and domestic support and those of counseling, advising and giving emotional support. The teaching of skills and the instilling of moral values and Christian principles were also indicated. They also reported that relationships with their family members were good, and that they were in contact on a regular basis. Most of the persons in the sample had worked and were now retired. However, incomes from pensions were very low, most of them depending on welfare benefits from Government. Family assistance was good in most cases especially where children or grandchildren were overseas. This assistance was not only financial, but took the form of clothing, household items and vacations. Older persons also offered economic support to family members, mainly children and grandchildren and this was mainly in the form of food and shelter. Attitudes and relationships with family memers were generally good. Most of the respondents were in contact with family members even those who were living overseas on a regular basis. Older persons were able to distinguish the kinds of roles which they played within their family units and were able to identify how they see themselves in relation to their families. (AU)

The influence of family support on compliance in the management of diabetes

Diabetes mellitus is one of the leading causes of death and disability among adults, affecting approximately 12 percent of the adult population 35 years and over. Effective metabolic control through the use of pharmacological and non-pharmacological treatment is essential to ameliorate and/or avoid or delay acute and long term complications. This cross-sectional study was conducted to determine influence of family support on compliance, observing whether there was any variation with certain demographic variables. Information was obtained from a purposive sample of seventy diabetics attending weekly diabetic clinics at the Community Health Centre of the Department of Social and Preventative Medicine and the University Hospital of the West Indies. The survey instrument used was a questionnaire and data was collected from a single interview. Patients were found to be more compliant with medication than with diet or exercise, recording lower levels of family support with exercise than with encouragement to take medication or to observe dietary restrictions. All patients reported some level of family support. No patient with a low score for family support recorded a high level of compliance. No significant statistical association was found between levels of family support and age, sex, income and education, or between family support and compliance. However, there was found to be a significant association between compliance and the state of glycaemic control of patients, indicating that patient compliance is a most important factor in management of the disease. Indications are that family support is an important factor in influencing compliance, however, individual influences such as the patient's attitude, judgement and experience are critical factors which influence compliance. (AU)

Social factors mediating social class differences in blood pressure in a Jamaican community

Research on the factors mediating social class differences in blood pressure was carried out in a Jamaican community. It was found in a previous report that higher social class is related to higher blood pressure. These differences are examined in greater detail here, especially in terms of the historical context of the specific community studies, which is on the fringe of the Kingston urban area, and in terms of the continuing importance of a social class system established under colonial rule. In the current study it is shown that social class differences in blood pressure for males are mediated by perceptions of economic stress. It is suggested that specific patterns of the growth of the city, and the the historically-based social class system, have resulted in the juxtaposition of lower and middle class Jamaican within this community, who in turn are influenced by different factors affecting blood pressure (AU)

Adolescents' self-image: A cross-cultural perspective

The aim of the study was to examine the self-image of Jamaican adolescents using an instrument which employs the multidimensional construct of the self-image. Past research using global measures has reported poor adjustment among these youths. The Offer Self-Image Questionnaire for Adolescents which measures 11 aspects of adjustment, was administered to 233 Jamaican secondary school students representing a cross-section of localities in Jamaia. Jamaican adolescents expressed satisfaction with their adjustment in seven areas, impulse control, emotional tone, body image, social relationships, sexual attitudes, mastery of the external world, and superior adjustment, while expressing dissatisfaction on the other four dimensions: morals, vocational and educational goals, family relationships, and emotional health. The findings support the multifaceted nature of the self. The discussion on the cultural and circumstantial fators affecting Jamaican youth.(AU)