The Burden of High-Energy Musculoskeletal Trauma in High-Income Countries.

INTRODUCTION TO THE PROBLEM: Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this review is to assess: (1) the current epidemiologic data on the surgical burden of high-energy musculoskeletal trauma in HICs; (2) the current data on the economic impact of high-energy musculoskeletal trauma; and (3) potential strategies for addressing gaps in musculoskeletal trauma care for the future. REVIEW OF LITERATURE: In 2016, mortality from road traffic injuries (RTIs) between the ages of 15-49 was reported to be 9.5% (9.0-9.9) in high-income countries, accounting for approximately 255 million DALYs. While RTIs do not fully capture the extent of high-energy musculoskeletal trauma, as the most common mechanism, they serve as a useful indicator of the impact on the surgical and economic burden. In 2009, the global losses related to RTIs were estimated to be 518 billion USD, costing governments between 1 and 3% of their gross domestic product (GDP). In the last decade, both the total direct per-person healthcare cost and the incremental direct per-person costs for those with a musculoskeletal injury in the USA rose 75 and 58%, respectively. FUTURE DIRECTIONS: ADDRESSING THE GAPS: While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD-DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.

Case report classics in otolaryngology - head and neck surgery: citation analysis.

OBJECTIVES: To analyse publication and citations trends of case reports within otolaryngology - head and neck surgery literature, with specific attention to the most-cited reports.Study designDatabase query. METHODS: Web of Science was searched for article type 'case reports' published in the leading otolaryngology - head and neck surgery journals since 1945. Variables including publication dates, citation dates and numbers, author, author number, and others were recorded and analysed for trends. The reports with the most citations (classics) were further studied. RESULTS: Of nearly 67 000 published articles in leading otolaryngology - head and neck surgery journals, the overall number of case reports as a percentage of the total has substantially decreased over time. A total of 110 case report classics were identified for which citations have increased. CONCLUSION: Although the case report may not be worthy of its tarnished record, declining trends in publication suggest a limited future for this valuable research and educational resource.

Dementia among Older Persons in Jamaica: Prevalence and Policy Implications / La demencia entre las personas de edad en Jamaica: prevalencia e implicaciones para la implementación de políticas

ABSTRACT Objective: To determine the prevalence of dementia and dementia types in Jamaica. Methods: An embedded case-control design was used to investigate dementia within the ageing population. Cases (Mini-Mental State Examination [MMSE] scores of < 20) and controls (MMSE scores of > 20) were evaluated using DSM-IVprotocol and magnetic resonance imaging. Prevalences (crude and age-adjusted) were calculated and distribution of dementia by type described. Results: Dementia prevalence was 5.9%. Alzheimer's pattern dementia accounted for 61.8% and vascular dementia 32.4%. However, vascular disease was prominent in 45.5% of the Alzheimer's cases. Female gender and increasing age were associated with higher rates of dementia. Dementia was 38 times more likely in participants with MMSE scores below 20. Conclusion: This first nationally representative study indicated that dementia rates in Jamaica were comparable with regional and global estimates. Regardless of the dementia type, vascular change was pervasive and suggested that synergistic efforts should be made to address underlying contributory factors. Cardiovascular and cerebrovascular risk reduction should be deliberately pursued as integral adjuncts to dementia risk reduction.

RESUMEN Objetivo: Determinar la prevalencia de los tipos de demencia y demencia en Jamaica. Métodos: Se utilizó un diseño de caso-control incrustado para investigar la demencia dentro de la población en proceso de envejecimiento. Los casos (puntuación < 20 en el Mini Examen del Estado Mental [MEEM]) y los controles (puntuación > 20 en el MEEM) fueron evaluados usando el protocolo DSM-IVy la imagen por resonancia magnética. Se calcularon prevalencias (crudas y ajustadas por edad) y se describió la distribución de la demencia por tipo. Resultados: La prevalencia de demencia fue de 5.9%. El Alzheimer representó el 61.8% y la demencia vascular 32.4%. Sin embargo, la enfermedad vascular fue prominente en el 45.5% de los casos de Alzheimer. El género femenino y la edad creciente se asociaron con tasas más altas de demencia. La demencia fue 38 veces más probable en los participantes con puntuaciones de MEEM por debajo de 20. Conclusión: Este primer estudio nacionalmente representativo indicó que las tasas de demencia en Jamaica eran comparables con los estimados regionales y globales. Independientemente del tipo de demencia, el cambio vascular fue generalizado y sugirió que se hicieran esfuerzos sinérgicos para abordar los factores contribuyentes subyacentes. Debe buscarse deliberadamente la reducción del riesgo cardiovascular y cerebrovascular como adjuntos integrantes de la reducción del riesgo de demencia.

Who Cares? Sociodemographic and Health Characteristics of Carers of Older Persons in Jamaica / ¿Quién cuida? Características Sociodemográficas y de Salud de los Cuidadores de Personas Mayores en Jamaica

ABSTRACT Objective: To describe the sociodemographic and health characteristics and implied needs of caregivers to older persons in Jamaica. Method: This was a community-based, nationally representative study in which a sample of 180 caregivers to older persons was interviewed. Findings: Caregivers were aged between 18 and 88 years (mean 50.5; s = 14.7) and most (77%) were informal compared to 23% who were paid to care. There were no differences between urban and rural caregivers with respect to gender, union status, residing with care recipients and holding a regular job while giving care. Urban caregivers were significantly more likely to report attaining secondary education than those in rural communities (χ2 (2) = 7.40, p < 0.05). Over 90% reported they had not received any formal training in caregiving and those ≤ 45 years were more likely than those in age groups ≥ 46 years to say they want to get caregiver training (χ2 (4) = 27.1, p < 0.001). Male caregivers were significantly more likely to report being the 'child/grandchild/in-law' of care recipients than female caregivers, among whom almost one in four reported their relationship as employee (Fisher's Exact test: p = 0.002). Most caregivers (51.7%) reported being diagnosed with one or more medical condition and 89% of those diagnosed reported being prescribed medications for their illnesses. Forty-five per cent of caregivers reported that they performed one or more activity of daily living (ADL) for their care recipients daily. Conclusion: Carers of older persons in Jamaica are predominantly family members, most have not received caregiving training and most have been diagnosed with a medical condition.

RESUMEN Objetivo: Describir las características sociodemográficas y de salud, así como las necesidades implícitas de los cuidadores de las personas mayores en Jamaica. Método: Se trata de un estudio comunitario representativo a nivel nacional, en el que se entrevista una muestra de 180 cuidadores de personas de edad. Resultados: Los cuidadores tenían entre 18 y 88 años (media 50.5; s.d. = 14.7) y la mayoría (77%) eran informales en comparación con el 23% que recibían pago por el cuidado. No hubo diferencias entre los cuidadores urbanos y rurales con respecto a género, estado civil, residir con las personas objeto del cuidado, y mantener un trabajo regular a la par con la atención a los ancianos. Los cuidadores urbanos presentaban una probabilidad significativamente mayor de haber alcanzado educación secundaria en comparación con aquellos de las comunidades rurales (χ2 (2) = 7.40, p < 0.05). Más del 90% reportó no haber recibido ninguna capacitación formal en cuidados, y aquellos con ≤ 45 años eran más propensos que los de los grupos de edad ≥ 46 años a decir que deseaban recibir entrenamiento como cuidadores (χ2 (4) = 27.1, p < 0.001). Los cuidadores hombres presentaban una probabilidad significativamente mayor de ser "hijo/nieto/yerno" de personas receptoras de cuidados, que las mujeres cuidadoras, entre las cuales casi una de cada cuatro reportó su relación como empleado (Prueba exacta de Fisher: p = 0.002). La mayoría de los cuidadores (51.7%) reportaron estar diagnosticados con una o más condiciones médicas, y el 89% de los diagnosticados reportaron recibir prescripciones de medicamentos para sus enfermedades. Cuarenta y cinco por ciento de los cuidadores informó realizar una o más actividades de la vida diaria (AVD) para las personas bajo su cuidado diariamente. Conclusión: Los cuidadores de personas mayores en Jamaica son en su mayoría miembros de la familia; la mayor parte de ellos no ha recibido capacitación como cuidadores; y la mayoría han sido diagnosticados con alguna condición médica.

Hypertension in Older Adults in Jamaica: Prevalence, Treatment and Control / La Hipertensión en los Adultos Mayores en Jamaica: Prevalencia, Tratamiento y Control

ABSTRACT Objective: To examine the prevalence, treatment and control and associated risk factors for hypertension among older adults in Jamaica. Methods: Four parishes in Jamaica were surveyed using a cross-sectional study design involving 2943 participants. The survey used a cluster sampling methodology with probability-proportional-to-size. A sub sample of 373 persons was randomly selected for assessment with regard to hypertension prevalence, treatment and control. Results: The sample consisted of 373 older adults with the majority (56.6%) being female. The age of the participants ranged from 60 to 100 years, with the median age being 70 (interquartile range = 13) years. Reported prevalence of hypertension was 61.7% and significantly (p < 0.001) more females than males (71.4% vs 49.1%, respectively) reported having hypertension. There was no significant difference in being diagnosed with hypertension by age groups, area of residence, highest level of education and union status. Among older adults who reported having hypertension, the majority (90.0%) were being treated while one in ten (10%) reported not being treated. "Based on the Eighth Joint National Committee (JNC-8) definition of control, among older adults who reported having hypertension, only slightly more than a third (34.8%) were controlled; the majority (65.2%) were uncontrolled. Conclusion: The low level of hypertension control documented is of concern given the availability of medication subsidies and the priority attention being given to chronic disease. Further research is needed regarding facilitators and barriers to hypertension control to identify the best interventions to increase control levels.

RESUMEN Objetivo: Examinar la prevalencia, tratamiento y control, así como los factores de riesgo asociados con la hipertensión entre los adultos mayores en Jamaica. Métodos: Cuatro parroquias en Jamaica fueron encuestadas usando un diseño de estudio transversal que abarcó 2943 participantes. La encuesta utilizó una metodología de muestreo por conglomerados con probabilidad proporcional al tamaño. Una submuestra de 373 personas fue seleccionada aleatoriamente para su evaluación con respecto a la prevalencia, tratamiento y control de la hipertensión. Resultados: La muestra constó de 373 adultos mayores, de los cuales la mayor parte (56. 6%) eran mujeres. La edad de los participantes fluctúo de 60 a 100 años, siendo la edad mediana 70 años (rango intercuartil = 13). La prevalencia de hipertensión reportada fue 61.7%, y significativamente (p < 0.001) más hembras que varones (71.4% vs 49.1%, respectivamente) reportaron tener hipertensión. No hubo diferencia significativa alguna en ser diagnosticado con hipertensión por grupos de edad, área de residencia, nivel más alto de educación, y estado de la unión. Entre los adultos mayores que reportaron tener hipertensión, la mayoría (90.0%) estaban siendo tratados, mientras que uno de cada diez (el 10%) reportaron no tener tratamiento. Basándose en la definición de control ocho del Comité Nacional Conjunto (JNC, siglas en inglés) entre los adultos mayores que reportaron tener hipertensión, sólo poco más de un tercio (34.8%) eran controlados. La mayoría (65.2%) no eran controlados. Conclusión: El bajo nivel de control de la hipertensión documentado es asunto de preocupación, dada la disponibilidad de subsidios para medicamentos y la atención prioritaria que se da a las enfermedades crónicas. Se necesitan investigaciones adicionales sobre facilitadores y barreras al control de la hipertensión para identificar mejores intervenciones para aumentar los niveles de control.

Sinking Teeth into Dental Health of Older Adults in Jamaica / Compromiso Entusiasta con la Salud Dental de los Adultos Mayores en Jamaica

ABSTRACT Objectives: To describe the prevalence of tooth loss, denture use and dental care utilization among older persons by age, gender, union, residence, education, chronic illness and health insurance status and to identify independent predictors of dental service use and tooth loss. Methods: A cross-sectional survey utilizing a nationally representative sample of 2943 older persons in Jamaica was conducted. Data related to tooth loss, dental care use and sociodemographic data were obtained. Relationships between variables were assessed in bivariate analyses and logistic regression models subsequently developed to identify predictors of tooth loss and dental care use. Results: Tooth loss (any) prevalence was 94% and among those who reported tooth loss, 61.1% had dentures: the majority of those with dentures reported using them. Non-use was mainly related to damaged denture or discomfort. Only 35% of persons reported a dental visit within the last 12 months. Age, union status and educational level were significant predictors of both tooth loss and dental visit within the past year. Additionally, gender, residence and having health insurance predicted dental care utilization. Conclusion: Dental health issues are important in the care of older persons and assume increasing relevance given rapid ageing of the population. Jamaica must craft strategies to address emergent needs in its response to the challenges of oral healthcare for older persons.

RESUMEN Objetivos: Describir la prevalencia de la pérdida de dientes, el uso de prótesis dentales, y la utilización de la atención dental entre las personas mayores por edad, género, estado civil, residencia, educación, enfermedad crónica, y posesión de seguro médico, e identificar predictores independientes de la utilización de la atención dental, así como de la pérdida de dientes. Métodos: Se realizó una encuesta transversal utilizando una muestra representativa de 2943 personas de edad a nivel nacional en Jamaica. Se obtuvo datos sobre la pérdida de dientes, el uso de los servicios dentales, y la demografía. Las relaciones entre las variables se evaluaron en análisis bivariados y modelos de regresión logística desarrollados posteriormente para identificar los predictores de la pérdida de dientes y la utilización de la atención dental. Resultados: La prevalencia de la pérdida de dientes (cualesquiera) fue 94%, y entre los que informaron pérdida de dientes, un 61.1% utilizaban prótesis dentales: la mayoría de los que utilizaban prótesis dentales reportaron su uso. El no uso se relacionó principalmente con prótesis dentales dañadas o molestias. Sólo el 35% de las personas reportaron una visita dental en los últimos 12 meses. La edad, el estado civil, y el nivel educacional fueron predictores significativos de la pérdida de dientes y la visita dental el año anterior. Además, el género, la residencia y la posesión del seguro médico fueron predictores de la utilización de la atención dental. Conclusión: Los problemas de salud dental son importantes en el cuidado de las personas de edad y adquieren una relevancia creciente dado el rápido envejecimiento de la población. Jamaica debe elaborar estrategias para abordar las necesidades emergentes en su respuesta a los desafíos de la salud oral de las personas mayores.

Correlates of Pelvic Floor Disorders in Women Fifty years and Over Attending Out-patient Gynaecology and Urology Clinics at a Tertiary Hospital in Kingston and St Andrew, Jamaica / Correlatos de los Trastornos del Suelo Pélvico en Mujeres de Cincuenta años o más que Asisten a las Clínicas Externas de Ginecología y Urología en un Hospital Terciario in Kingston y Saint Andrew, Jamaica

ABSTRACT Objective: To identify correlates of pelvic floor disorders in a clinic-based sample of women fifty years and older. Method: Two hundred and sixty-three randomly selected gynaecology and urology clinic attendees fifty years and older provided information on health, reproductive history, sociodemographics and pelvic floor disorders. Associations between having at least one pelvic floor disorder and the other variables were explored using bivariate and multivariate analyses. Results: Approximately, 52% of women had at least one pelvic floor disorder and each additional vaginal delivery increased these odds by 14%, controlling for important health and sociodemographic variables. Conclusion: Pelvic floor disorders can negatively affect quality of life in older age. Given the increased likelihood of their occurrence with each vaginal delivery, reproductive and post-reproductive health services should prioritise female pelvic medicine, pelvic floor strengthening and physical therapy to improve women's genitourinary health.

RESUMEN Objetivo: Identificar los correlatos de los trastornos del suelo pélvico en una muestra clínica de mujeres de 50 años o más. Método: Doscientos sesenta y seis mujeres de cincuenta años o más, que asisten a la clínica de ginecología y urología, fueron seleccionadas aleatoriamente. Dichas pacientes proporcionaron información sobre salud, historial reproductivo, y trastornos sociodemográficos del suelo pélvico. Las asociaciones entre tener al menos un trastorno del suelo pélvico y las otras variables se exploraron mediante análisis bivariantes y multivariantes. Resultados: Aproximadamente 52% de las mujeres tenían al menos un trastorno del suelo pélvico, y cada parto vaginal adicional aumentó estas probabilidades en un 14%, controlando las variables sanitarias y sociodemográficas importantes. Conclusión: Los trastornos del suelo pélvico pueden afectar negativamente la calidad de vida en la edad avanzada. Dada la mayor probabilidad de que ocurran con cada parto vaginal, los servicios de salud reproductiva y pos reproductiva deben priorizar la medicina pélvica femenina, el fortalecimiento del suelo pélvico y la terapia física para mejorar la salud genitourinaria de las mujeres.

Chronic hepatitis C virus (HCV) burden in Rhode Island: modelling treatment scale-up and elimination.

We utilized a disease progression model to predict the number of viraemic infections, cirrhotic cases, and liver-related deaths in the state of Rhode Island (RI) under four treatment scenarios: (1) current HCV treatment paradigm (about 215 patients treated annually, Medicaid reimbursement criteria fibrosis stage ⩾F3); (2) immediate scale-up of treatment (to 430 annually) and less restrictive Medicaid reimbursement criteria (fibrosis stage ⩾F2); (3) immediate treatment scale-up and no fibrosis stage-specific Medicaid reimbursement criteria (⩾F0); (4) an 'elimination' scenario (i.e. a continued treatment scale-up needed to achieve >90% reduction in viraemic cases by 2030). Under current treatment models, the number of cirrhotic cases and liver-related deaths will plateau and peak by 2030, respectively. Treatment scale-up with ⩾F2 and ⩾F0 fibrosis stage treatment criteria could reduce the number of cirrhotic cases by 21·7% and 10·0%, and the number of liver-related deaths by 19·3% and 7·4%, respectively by 2030. To achieve a >90% reduction in viraemic cases by 2030, over 2000 persons will need to be treated annually by 2020. This strategy could reduce cirrhosis cases and liver-related deaths by 78·9% and 72·4%, respectively by 2030. Increased HCV treatment uptake is needed to substantially reduce the burden of HCV by 2030 in Rhode Island.

Profile of a Malignant Brain Tumour in Jamaica: An Eight-year Review, 2005 to 2012.

OBJECTIVE: Glioblastoma multiforme (GBM) is the most malignant and most common primary brain tumour worldwide. This study was undertaken to investigate the demographics of this tumour in Jamaica as there is to date no such published data. Data from the recently started Intracranial Tumour Registry (ITR) at the University Hospital of the West Indies was used. METHODS: All cases of GBM entered into the ITR between 2005 and 2012 were gathered. Of these, only patients with pathologically proven diagnoses were entered into the study. Demographic data, including age and gender, were recorded. The distribution of the tumours by anatomic location was also documented. RESULTS: Of the 602 patients entered into the ITR up to that time, 42 were found to have histologically proven GBM with a male to female ratio of 2.2:1. There was an age range of 8-92 years with a mean age of diagnosis of 48 years. The majority of the tumours (66.7%) occurred in the left cerebral hemisphere with the most common lobe being the temporal lobe. Two patients (4.8%) had lesions spanning both hemispheres. CONCLUSIONS: This preliminary study reveals that there is a similar gender distribution of GBM within our population compared with the rest of the world. It, however, revealed that the mean age of diagnosis in our population (48 years) is lower than that quoted in the worldwide literature (53 to 64 years). One possible explanation for this is the possibility that many of our GBMs are actually secondary tumours which are thought to arise from less malignant, undiagnosed precursors. The percentage of GBMs occurring in the paediatric population was similar to the rest of the world.

The estimated future disease burden of hepatitis C virus in the Netherlands with different treatment paradigms.

BACKGROUND & AIMS: Prevalence of hepatitis C virus (HCV) infection in the Netherlands is low (anti-HCV prevalence 0.22%). All-oral treatment with direct-acting antivirals (DAAs) is tolerable and effective but expensive. Our analysis projected the future HCV-related disease burden in the Netherlands by applying different treatment scenarios. METHODS: Using a modelling approach, the size of the HCV-viraemic population in the Netherlands in 2014 was estimated using available data and expert consensus. The base scenario (based on the current Dutch situation) and different treatment scenarios (with increased efficacy, treatment uptake, and diagnoses) were modelled and the future HCV disease burden was predicted for each scenario. RESULTS: The estimated number of individuals with viraemic HCV infection in the Netherlands in 2014 was 19,200 (prevalence 0.12%). By 2030, this number is projected to decrease by 4 5% in the base scenario and by 85% if the number of treated patients increases. Furthermore, the number of individuals with hepatocellular carcinoma and liver-related deaths is estimated to decrease by 19% and 27%, respectively, in the base scenario, but may both be further decreased by 68% when focusing on treatment of HCV patients with a fibrosis stage of ≥ F2. CONCLUSIONS: A substantial reduction in HCV-related disease burden is possible with increases in treatment uptake as the efficacy of current therapies is high. Further reduction of HCV-related disease burden may be achieved through increases in diagnosis and preventative measures. These results might inform the further development of effective disease management strategies in the Netherlands.

Non-communicable diseases in an older, aging population: a developing country perspective (Jamaica).

UNLABELLED: Changes in the non-communicable disease (NCD) profile of older adults living in a rapidly-aging, developing country are described. METHODS: Data from a 2012 nationally representative survey of 2,943 older adults were used to determine the burden of NCDs important to elder health. Additionally, the percentage change in NCD prevalence over a 23-year period (1989-2012) was determined. RESULTS: In 2012, approximately 75.3% of the sample reported at least one NCD; 47.5% reported comorbidities. High blood pressure (61%), arthritis (35%) and diabetes (26%) were the most reported conditions, peaking in the 70-79 age group. Females reported higher rates of disease than males. Significant increases in prevalence occurred for all conditions except arthritis; the most significant were in diabetes (157%) and cancer (118%). CONCLUSION: Rapid increases in NCDs are of great public health importance. Strengthening of primary health care and improvements in human resources must occur if the well-being of older adults is to be improved.

Building family medicine postgraduate training in Jamaica: overcoming challenges in a resource-limited setting.

This paper recounts the development of family medicine postgraduate training in Jamaica, the challenges faced and lessons learned. A self-administered questionnaire was completed by past trainees exploring the perceived usefulness, strengths and weaknesses of the programme. The results of this study helped guide the strengthening of family medicine training in a resource-limited setting.

Cardio-Vascular Disease and Cancer: A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country.

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.

Ageing of Jamaica's Population -- What Are the Implications for Healthcare?

The 2011 Census has confirmed the ageing of the Jamaican population. The over-60-year-old population has increased while the under 15-year population has decreased. Other demographic changes of note include the largest increase being in the old-old who are predominantly female. The demographic changes when considered with the increase in chronic disease indicate the need for consideration of healthcare specifically targeting the needs for older persons including increased prevention, continuous medical management, long term care and caregiver support.

A clinical audit of the management of acute asthmatic attacks in adults and children presenting to an emergency department.

OBJECTIVE: To compare the guidelines in the University Hospital of the West Indies (UHWI) acute asthma management protocol with actual practice in the Accident and Emergency Department. METHODS: A prospective docket audit was done of all consecutive medical records of patients, presenting with a diagnosed acute asthmatic attack between June 1 and September 30, 2010, to the emergency department of the UHWI. A convenient sample was used. The audit tool used was created from the UHWI protocol for the emergency management of asthma in adults and children, as well as the British Adult Asthma Audit Tool. The audit tool assessed three main sections: initial assessment, initial management, and discharge considerations. Data were coded and entered in Microsoft Excel 2007 and statistical analyses conducted using Stata version 10. Management patterns were compared to the actual protocol and then discussed. RESULTS: A total of 15 864 patients were seen during the study period. Of these, a total of 293 patients were seen for a presentation of acute asthma. More females (57.3%) than males were seen, with the mean age of 33.53 years. Only 31% of patients were given a severity assessment of mild, moderate, or severe. Peak expiratory flow rate (PEFR) was attempted and recorded in 62%, but only 18.1% of patients had both pre and post PEFR done. Only 4.4% of patients were administered nebulizations within the suggested time frame. Positively, 94.2% of patients were given a prescription for inhaled corticosteroids and bronchodilators to continue post-discharge. CONCLUSIONS: Acute asthma management still remains an area of medical practice that continues to have long-standing difficulties. Failure to assess and document the severity of asthma attacks along with the under-utilization of PEFR was noted.

The compliance of healthcare workers with universal precautions in the emergency room at the university hospital of the west indies.

OBJECTIVES: The study assessed compliance among health workers in the Emergency Room at the University Hospital of the West Indies with universal precautions. This was done by determining the knowledge, practices and perceptions of staff of universal precautions and by assessing compliance. Reported adherence with universal precautions was compared with observed practice. METHODS: This was a cross-sectional study conducted over a one-year period. It was approved by the University Hospital of the West Indies/University of the West Indies/Faculty of Medical Sciences Ethics Committee. Data were analysed using Stata version 11.1. RESULTS: During the study period, 67 persons gave consent for the study, data were obtained for 62 of these participants and 52 of the respondents were observed. All of the participants were aware that universal precautions related to blood. Eighty-six per cent erroneously thought that universal precautions apply to urine. Seventy-nine per cent of the participants reported always washing their hands after performing a procedure and 43.5% reported always washing their hands before a procedure. Just over half of the participants reported always wearing gloves while doing procedures (56.5%). Only 9% reported always using a gown with a trauma patient. However, 31% and 43.3% reported wearing a gown when placing a chest tube and when anticipating splashes, respectively. Of those participants who reported washing their hands often after a procedure, over 30% did not perform hand-washing when observed. Fifty per cent of persons that reported never recapping needles were observed to recap needles by hand. CONCLUSION: The study revealed that compliance among staff in the Emergency Room with universal precautions was unsatisfactory. The need for education in this area was recognized.

Ageing of Jamaica's population - What are the implications for healthcare? / Envejecimiento de la población de Jamaica. ¿Cuáles son las implicaciones para la atención de la salud?

The 2011 Census has confirmed the ageing of the Jamaican population. The over 60-year old population has increased while the under 15-year old population has decreased. Other demographic changes of note include the largest increase being in the old-old who are predominantly female. The demographic changes when considered with the increase in chronic disease indicate the need for consideration of healthcare specifically targeting the needs for older persons including increased prevention, continuous medical management, long term care and caregiver support.

El censo de 2011 ha confirmado el envejecimiento de la población jamaicana. La población de más de 60 años de edad ha aumentado, mientras que la población por debajo de 15 años ha disminuido. Otros cambios demográficos notables incluyen un mayor aumento en el grupo de los ancianos mayores de 85 años, predominantemente femenino. Los cambios demográficos considerados junto con el aumento de las enfermedades crónicas indican la necesidad de tener en cuenta una atención de la salud dirigida específicamente a las necesidades de las personas mayores, que incluya mayor prevención, tratamiento médico continuo, así como apoyo a largo plazo a los cuidados y a los cuidadores de la salud.

Hypertension and Diabetes Prevalence in Older Persons in Jamaica, 2012.

The Jamaican population is experiencing both a demographic and epidemiological transition. This 2012 study of 2943 community dwelling persons over sixty years of age sought to determine the prevalence of hypertension and diabetes and how it has increased since the earlier 1989 study. Hypertension was the most prevalent non-communicable disease with 61.4% and had increased from 41.4% since 1989. It increased with age and was more common in females than males. Diabetes, at 26.3%, was the third most prevalent; it had increased by 157.1% since 1989. While the majority of affected persons were on medication, control of both diseases was less than adequate. Obesity was associated with both diseases. The paper discusses the implications for healthcare systems.

Sociodemographic factors associated with depressive symptoms among elderly persons from two communities in Kingston, Jamaica / Factores sociodemográficos asociados con síntomas depresivos entre personas mayores de dos comunidades en Kingston, Jamaica

OBJECTIVE: To explore possible associations of age, gender, socio-economic status, educational level and level of cognitive functioning with depressive symptoms in a community sample of elderly persons. METHOD: Two hundred elderly persons from two communities in Kingston, Jamaica, were randomly selected for participation in the study. They or their caregivers provided sociodemographic information and participants also completed the Zung Self-rating Depression Scale (ZSDS) and the Mini Mental Status Examination (MMSE). Variables of interest were entered in a multiple variable regression model using ZSDS score as the outcome variable. RESULTS: Predictors of depression were older age (B = 0.26, se = 0.08, p < 0.01), female gender (B = 3.98, se = 1.44, p < 0.01), low socio-economic status (B = 5.14, se = 1.50, p = 0.01) and low level of cognitive function (B = -0.38, se = 0.18, p < 0.05). No statistically significant association was found between educational attainment and depressive symptoms. CONCLUSION: The findings highlight the need for further exploration of the extent to which the associations identified are relevant for the overall population ofelderly persons as well as the potential value of targeted preventive and treatment interventions.

OBJETIVO: Explorar posibles asociaciones de edad, género, estatus socioeconómico, nivel educacional, y nivel de funcionamiento cognitivo con síntomas depresivos en una muestra de la comunidad de personas mayores. MÉTODO: Doscientas personas mayores de dos comunidades en Kingston, Jamaica, fueron seleccionadas al azar para participar en el estudio. Las personas o sus cuidadores proporcionan información sociodemográfica, y los participante stambién completaron la Escalade Autoevaluación para la Depresión de Zung (ZSDS) y el Mini Examen del Estado Mental (siglas MMSE en inglés). Las variables de interés fueron introducidas en un modelo de regresión variable múltiple usando la puntuación de ZSDS como la variable de resultado. RESULTADOS: Los predictores de la depresión fueron mayores (B = 0.26, se = 0.08, p < 0.01), sexo femenino (B = 3.98, se = 1.44, p < 0.01), bajo estatus socio-económico (B = 5.14, se = 1.50, p = 0.01) y bajo nivel de función cognitiva (B = -0.38, se = 0.18, p < 0.05). No se hallaron asociaciones estadísticamente significativas entre el nivel educacional y los síntomas depresivos. CONCLUSIÓN: Los hallazgos resaltan la necesidad de continuar explorando hasta que punto las asociaciones identificadas son pertinentes para la población total de personas de edad avanzada, así como el valor potencial de las intervenciones preventivas y de tratamiento planificadas.

Strength and power predictors of sprinting performance in professional rugby players.

AIM: The ability to accelerate and attain high levels of speed is an essential component of success in team sports; however, the physical qualities that underpin these activities remain unclear. This study aimed to determine some of the key strength and power predictors of speed within professional rugby union players. METHODS: Twenty professional male rugby union players participated in this study. Subjects were tested for speed (0-10 m sprint and a flying 10 m sprint), strength (3 repetition maximum squat), lower body power (countermovement jumps [CMJ] and drop jumps [DJ]), reactive strength and leg spring stiffness. The strength and power variables were expressed as absolute values and relative values for analysis. RESULTS: Both relative strength (r=-0.55, P<0.05) and relative power (-0.82, P<0.01) were negatively correlated with 10 m time. Leg spring stiffness and DJ contact time were also related to the flying 10 m time (r=-0.46 and 0.47, respectively, P<0.05) while reactive strength index was negatively related to both the 10 m and flying 10 m times (r=-0.60 and r=-0.62, P<0.05). CONCLUSION: This study provides an insight into those physical attributes that underpin sprinting performance in professional rugby union players and specifically highlights the importance of relative strength and power in the expression and development of different speed components (e.g. acceleration, maximum velocity).