Distinctive Coordination of CO vs N2 to Rhodium Cations: An Infrared and Computational Study.

Carbonyl and nitrogen complexes with Rh+ are produced in a molecular beam using laser ablation and a pulsed-nozzle source. Mass-selected ions of the form Rh(CO)n+ and Rh(N2)n+ are investigated via infrared laser photodissociation spectroscopy. The fragmentation patterns and infrared spectra provide information on the coordination and geometries of these complexes. The shifts in vibrational frequencies relative to the uncoordinated ligands give insight into the nature of the bonding interactions involved. Experimental band positions and intensities are compared to those predicted by density functional theory (DFT). Rh+ coordinates only four nitrogen molecules, whereas it can accommodate five carbonyl ligands. The fifth CO ligand resides in an axial site with bonding intermediate between coordination and solvation. The carbonyl stretch in Rh(CO)4+ (2160 cm-1) is blue-shifted with respect to the molecular CO vibration (2143 cm-1). Conversely, the N-N stretch in Rh(N2)4+ (2297 cm-1) is red-shifted with respect to the free N2 vibration (2330 cm-1). The opposite directions of these frequency shifts is explained by a combination of σ donation and electrostatic ligand polarization.

Infrared photodissociation spectroscopy of vanadium oxide-carbonyl cations.

Mass selected vanadium oxide-carbonyl cations of the form VO(m)(CO)(n)(+) (m = 0-3 and n = 3-6) are studied via infrared laser photodissociation spectroscopy in the 600-2300 cm(-1) region. Insight into the structure and bonding of these complexes is obtained from the number of infrared active bands, their relative intensities and their frequency positions. Density functional theory calculations are carried out in support of the experimental data. The effect of oxidation on the carbonyl stretching frequencies of VO(CO)(n)(+), VO2(CO)(n)(+), and VO3(CO)(n)(+) complexes is investigated. All of these oxide-carbonyl species have C-O stretch vibrations blue-shifted from those of the pure vanadium ion carbonyls. The V-O stretches of these complexes are also investigated, revealing the effects of CO coordination on these vibrations. The oxide-carbonyls all have a hexacoordinate core analogous to that of V(CO)6(+). The fully coordinated vanadium monoxide-carbonyl species is VO(CO)5(+), and those of the dioxide and trioxide are VO2(CO)4(+) and VO3(CO)3(+), respectively.

Infrared photodissociation spectroscopy of saturated group IV (Ti, Zr, Hf) metal carbonyl cations.

Group IV metal carbonyl cations of the form M(CO)n(+) (M = Ti, Zr, Hf; n = 6-8) are produced in a supersonic molecular beam via laser vaporization in a pulsed nozzle source. The ions are mass selected in a reflectron time-of-flight spectrometer and studied with infrared laser photodissociation spectroscopy in the carbonyl stretching region. The number of infrared active bands, their relative intensities, and their frequency positions provide insight into the structure and bonding of these complexes. Density functional theory calculations are employed to aid in the analysis of the experimental spectra. The n = 6 species is found to be the fully coordinated complex for each metal, and all analogues have a D3d structure. This symmetric structure and the resulting simple spectra facilitate the investigation of trends in the bonding and infrared band positions of these complexes. The carbonyl stretching frequencies of the M(CO)6(+) species are all red-shifted with respect to the gas phase CO vibration at 2143 cm(-1), occurring at 2110, 2094, and 2075 cm(-1) for titanium, zirconium and hafnium. The magnitude of the red shift increases systematically going from titanium to hafnium.

The socio-economic determinants of obesity in adults in the Bahamas.

OBJECTIVE: To determine the socio-economic determinants of obesity in adults in The Bahamas. DESIGN AND METHODS: A subpopulation of adults 21 to 60 years was analysed for socio-economic differences in obesity levels. Data from the 2001 Bahamas Living Conditions Survey, a nationwide comprehensive household survey which included anthropometric measurements, were used. Bivariate and binary logistic regression methods for complex samples were employed. FINDINGS: Overall obesity prevalence was 32% (38% female, 25% male, p = < 0.0001). An inverse relationship by education appeared to be the strongest predictor for all persons (OR = 0.78, CI 0.67, 0.90; p < 0.0001). This relationship was also evident for females (OR = 0.71, CI 0.59, 0.85; p < 0.0001) while a positive relationship existed by economic level for males (OR = 1.23, CI 1.07, 1.41; p = 0.005). There was a difference in food group expenditure for starchy vegetables only (p = 0.049). Other food group household expenditure, urban residence and female headed households showed no significant differences by obesity. CONCLUSIONS: In line with international trends, obesity rates are high in The Bahamas, and especially affect females of lower socio-economic status. Public policy that targets this group is necessary to address this health concern.

Poverty, folate deficiency, human immunodeficiency virus and ulcerated vulval sexually transmitted diseases in Jamaica.

Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s-1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Closer review seems to suggest that the peaks were associated firstly with poverty in the 1960s and 1970s and to the HIV epidemic in the 1980s and early 1990s. There are also smaller spikes which appear to be associated with periods of environmental disasters, with a possible association with folate deficiency. This is apparent for the bacterial and chlamydial conditions as well as viral conditions such as Herpes simplex.

Infrared photodissociation spectroscopy of copper carbonyl cations.

Copper carbonyl cations of the form Cu(CO)(n)(+) (n = 1-8) are produced in a molecular beam via laser vaporization in a pulsed nozzle source. Mass-selected infrared photodissociation spectroscopy in the carbonyl stretching region is used to study these ions and their argon "tagged" analogues. The geometries and electronic states of these complexes are determined by the number of infrared-active bands, their frequency positions, and their relative intensities compared to the predictions of theory. Cu(CO)(4)(+) has a completed coordination sphere, consistent with its expected 18-electron stability. It also has a tetrahedral structure similar to that of its neutral isoelectronic analog Ni(CO)(4). The carbonyl stretch in Cu(CO)(4)(+) (2198 cm(-1)) is blue-shifted with respect to the free CO vibration (2143 cm(-1)), providing evidence that this is a "non-classical" metal carbonyl.

The socio-economic determinants of obesity in adults in the Bahamas / Las determinantes socioeconómicas de la obesidad en los adultos de Bahamas

OBJECTIVE: To determine the socio-economic determinants of obesity in adults in The Bahamas. DESIGN AND METHODS: A subpopulation of adults 21 to 60 years was analysed for socio-economic differences in obesity levels. Data from the 2001 Bahamas Living Conditions Survey, a nationwide comprehensive household survey which included anthropometric measurements, were used. Bivariate and binary logistic regression methods for complex samples were employed. FINDINGS: Overall obesity prevalence was 32% (38% female, 25% male, p = < 0.0001). An inverse relationship by education appeared to be the strongest predictor for all persons (OR = 0.78, CI 0.67, 0.90; p < 0.0001). This relationship was also evident for females (OR = 0.71, CI 0.59, 0.85; p< 0.0001) while a positive relationship existed by economic level for males (OR = 1.23, CI 1.07, 1.41; p = 0 .005). There was a difference in food group expenditure for starchy vegetables only (p = 0.049). Other food group household expenditure, urban residence and female headed households showed no significant differences by obesity. CONCLUSIONS: In line with international trends, obesity rates are high in The Bahamas, and especially affect females of lower socio-economic status. Public policy that targets this group is necessary to address this health concern.

OBJETIVO: Establecer cuáles son las determinantes socio-económicas de la obesidad en los adultos en Bahamas. DISEÑO Y MÉTODOS: Se analizó una subpoblación de adultos de 21 a 60 años en busca de las diferencias socio-económicas según los niveles de obesidad. Se usaron los datos de la Encuesta 2001 sobre las condiciones de vida en Bahamas - una encuesta general doméstica nacional que incluyó mediciones antropométricas. Se emplearon métodos de regresión logística bivariados y binarios para las muestras complejas. RESULTADOS: La prevalencia de obesidad global fue de 32% (38% hembras, 25% varones, p =< 0.0001). Una relación inversa para la educación pareció ser el predictor más fuerte para todas las personas (OR = 0.78, CI 0.67[N1], 0.90; p < 0.0001). Esta relación también se hizo evidente en las hembras (OR = 0.71, CI 0.59, 0.85; p < 0.0001) mientras que una relación positiva existió en el nivel económico para los varones (OR = 1.23, CI 1.07, 1.41; p = 0 .005). Hubo una diferencia en el gasto del grupo de alimentos en cuanto a verduras ricas en fécula solamente (p = 0.049). Otro gasto doméstico de grupo de alimentos, residencia urbana, y casas encabezadas por mujeres, no mostraron diferencias significativas en obesidad. CONCLUSIONES: En concordancia con las tendencias internacionales, las tasas de obesidad son altas en Bahamas, y afectan sobre todo a las mujeres de más bajo estatus socio-económico. Se necesitan políticas públicas dirigidas a este grupo, a fin de abordar este problema de salud.

Poverty, folate deficiency, human immunodeficiency virus and ulcerated vulval sexually transmitted diseases in Jamaica / Pobreza, deficiencia de ácido fólico, virus de la inmunodeficiencia humana, y la ulceratión de la vulva por enfermedades de transmisión sexual, en Jamaica

Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s -1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Closer review seems to suggest that the peaks were associated firstly with poverty in the 1960s and 1970s and to the HIV epidemic in the 1980s and early 1990s. There are also smaller spikes which appear to be associated with periods of environmental disasters, with a possible association with folate deficiency. This is apparent for the bacterial and chlamydial conditions as well as viral conditions such as Herpes simplex.

Las condiciones ulcerativas genitales transmitidas sexualmente están disminuyendo en Jamaica. En el presente, los índices son muchos más bajos que los observados en la década de 1950 y 1960 respectivamente. La revisión de los archivos de la llamada Nacional Comprehensive Clinic ha revelado que todas las condiciones principales (sífilis, linfogranuloma venéreo, chancroide, granuloma inguinal, y el herpes simple) han disminuido. No obstante, ha habido tres puntos críticos entre 1958 y 2000. Un examen detallado sugiere que estos picos estaban asociados primeramente con la pobreza en los años 60 y 70, y la epidemia de VIH en la década de los 80 ochenta y principios de los 90. Hay también pequeñas alzas que parecen estar asociados con periodos de desastres medioambientales, así como con una posible asociación con la deficiencia de folato. Esto es evidente en el caso de las condiciones bacterianas y clamidiales, así como las condiciones virales tales como la que representa el herpes simple.

A comprehensive response to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years.

Jamaica has a well-established, comprehensive National Human Immunodeficiency Virus (HIV) programme that has slowed the HIV epidemic and mitigated its impact. Adult HIV prevalence has been stable at approximately 1.5% since 1996. HIV rates are high among those most at risk such as sex-workers (9%) and men who have sex with men [MSM] (31.8%). Risk behaviour among adults with AIDS includes multiple sexual partners (80%), a history of a sexually transmitted infection [STI] (51.1%), commercial sex (23.9%) and crack/cocaine (8.0%). Approximately 20% of all reported AIDS cases, mainly women, give no history of any of the usual risk factors for HIV infection. The national programme is based in the Ministry of Health. Since 1988, Jamaica has had a national plan to guide its HIV response. A National AIDS Committee was established in 1988 to lead the multi-sectoral response. Prevention approaches have included information, education and communication campaigns, condom promotion, sexually transmitted infections (STI) control, targeted interventions, cultural approaches, outreach and peer education, workplace programmes and HIV counselling and testing. Concerted efforts have been made to reduce HIV stigma and discrimination. Antiretroviral therapy (ARV) was introduced for prevention of mother-to-child transmission in 2001 and a public access treatment programme introduced in 2004. A national HIV/AIDS Policy was adopted unanimously in parliament in 2005. The National Strategic plan 2007-2012 commits Jamaica to achieving universal access to HIVprevention, treatment and care. Awareness of HIV and how to prevent it is near universal though belief in myths remains strong. The condom market has increased from approximately 2.5 million in 1985 to 12 million in 2006 while condom use has grown significantly with nearly 75% of men and 65% of women reporting condom use at last sex with a non-regular partner The proportion of women 15-24 years reporting ever having a HIV test increased from 29.8% in 2004 to 48.9% in 2008. HIV transmission from mother-to-child has declined from 25% prior to 2000 to less than 8% in 2007. As of September 2008, 4450 persons or an estimated 68.5% of persons with advanced HIV and AIDS have been placed on ARV treatment resulting in a significant decline in mortality and morbidity due to HIV

Epidemiological profile of cancer for Grand Bahama residents: 1988-2002.

This retrospective and observational study is based on a review of data from the pathology ledgers and clinical records of the Rand Memorial Hospital, of diagnoses and deaths from cancer from 1988 to 2002 (15 years). The aim was to determine the cancer incidence, mortality, survival rates and the trends for the island of Grand Bahama, Bahamas. The records indicated at least 545 (males: 187; females: 358) new cancer diagnoses giving an approximate age-standardized annual incidence rate of 167.7 per 100,000. The most frequent cancers were, in males (except for skin keratinocytic cancers) prostate 21.9%, colon/rectum 12.8% and lung 6.4%; and in females: breast 45.3%, cervix uteri 16.8% and colon/rectum 6.4%. Of these cancers, 443 (81.3%) were diagnosed in the pathology department of the hospital with the median age at diagnosis of all persons being 52 years. This comprised 119 males and 324 females. Whereas the majority of breast and cervical cancers were histologically diagnosed locally, those of prostate and lung were not. During the period, 359 (males: 181; females: 178) persons had died from cancer; an annual age-standardized mortality rate of 114.8 per 100,000, with breast 19.2%, prostate 14.5% and colon/rectum 9.5% being the most frequent. The overall median period of survival was one year (range 0-14 years). The median survival for persons with cervix uteri was five years; for breast cancer, three years; colorectal cancer, 2 years; prostate, one year; and less than a year for lung cancer. The data on cancer were not easily obtained and this may be improved if a cancer registry is established on this second most populated island of The Bahamas.

Epidemiological profile of cancer for Grand Bahama residents: 1988-2002 / Perfil epidemiológico del cáncer en los residentes de gran bahama: 1988 ­ 2002

This retrospective and observational study is based on a review of data from the pathology ledgers and clinical records of the Rand Memorial Hospital, of diagnoses and deaths from cancer from 1988 to 2002 (15 years). The aim was to determine the cancer incidence, mortality, survival rates and the trends for the island of Grand Bahama, Bahamas. The records indicated at least 545 (males: 187; females: 358) new cancer diagnoses giving an approximate age-standardized annual incidence rate of 167.7 per 100,000. The most frequent cancers were, in males (except for skin keratinocytic cancers) prostate 21.9, colon/rectum 12.8and lung 6.4; and in females: breast 45.3, cervix uteri 16.8and colon/rectum 6.4. Of these cancers, 443 (81.3) were diagnosed in the pathology department of the hospital with the median age at diagnosis of all persons being 52 years. This comprised 119 males and 324 females. Whereas the majority of breast and cervical cancers were histologically diagnosed locally, those of prostate and lung were not. During the period, 359 (males: 181; females: 178) persons had died from cancer; an annual age-standardized mortality rate of 114.8 per 100,000, with breast 19.2, prostate 14.5and colon/rectum 9.5being the most frequent. The overall median period of survival was one year (range 0-14 years). The median survival for persons with cervix uteri was five years; for breast cancer, three years; colorectal cancer, 2 years; prostate, one year; and less than a year for lung cancer. The data on cancer were not easily obtained and this may be improved if a cancer registry is established on this second most populated island of The Bahamas.

Este estudio retrospectivo y de observación se basa en una revisión de datos de los libros de registros de patologías y las historias clínicas del Hospital Rand Memorial, en relación con el diagnóstico y las muertes de cáncer desde 1988 hasta el 2002 (15 años). El objetivo fue determinar la incidencia de cáncer, la mortalidad, las tasas de supervivencia y las tendencias, con respecto a la isla de Gran Bahamas, Bahamas. Los registros indicaron al menos 545 (varones: 187; hembras: 358) diagnósticos nuevos de cáncer, para una tasa de incidencia anual estandarizada por edad, de aproximadamente 1677 por 100000. Los tipos más frecuentes de cáncer fueron los siguientes. En los hombres (con excepción de los cánceres queratinocíticos de la piel): próstata, 21.9%; colon/recto 12.8%; y pulmón, 6.4%. En las mujeres: mamas, 45.3%, cervical uterino, 16.8%; y colon/recto 6.4%. De estos tipos de cáncer, el 81.3%, es decir, 443 (varones: 119; hembras: 324), fueron diagnosticados en el departamento de patología del hospital, con una edad mediana de 52 años en relación con todos los pacientes en el momento del diagnóstico. Mientras que la mayoría de los cánceres de cervical y de mamas se diagnosticaron histológicamente de forma local, los de próstata y pulmón no se diagnosticaron de ese modo. Durante ese período, un total de 359 personas (181 varones; 178 hembras) habían muerto de cáncer, para una tasa anual de mortalidad estandarizada por edad, de 114.8 por 100 000, siendo los cánceres de mama (19.2%), próstata (14.5%), y el colorrectal (9.5%) los más frecuentes. La mediana general del período de supervivencia fue de un año (rango 0 ­ 14). Después del diagnóstico, las personas continuaron viviendo con cáncer una mediana de cinco años en el caso del cáncer cervical

Seroprevalence of sexually transmitted infections among accepted and deferred blood donors in Jamaica.

Critical donor selection and testing increases the safety of blood transfusion by excluding donors at risk of transmitting infections. This study investigated the seroprevalence of and risk factors for sexually transmitted infections (STIs) among accepted and deferred blood donors in Jamaica. A total of 1015 blood donors consisting of 794 (78%) accepted donors and 221 (22%) deferred donors presenting at the Central Blood Bank, Jamaica, over a six-month period, were recruited for this study. A standardized questionnaire was administered to each participant and a sample of blood obtained for detection of hepatitis B surface antigen, antibodies to Treponema pallidum, human immunodeficiency virus (HIV) and human T-cell lymphotrophic virus type-1 (HTLV-1). Deferred donors were three times more likely to be seropositive for STI than accepted donors (16.3% vs 5.2%, OR 3.57, 95% CI 2.16 - 5.90, p < 0.0001). Males had significant association between STI seropositivity and having fathered children with two or more women (p = 0.0085), unprotected sexual intercourse with several persons (p = 0.0326), and history of genital herpes (p = 0.0121). Significant risk factors identified among females were unprotected sex with several partners (p = 0.0385); having more than ten lifetime partners (p = 0.0105); and use of depoprovera (p = 0.0028). This study confirms higher rates of STI among deferred blood donors and supports the donor deferral system in Jamaica.

Seroprevalence of sexually transmitted infections among accepted and deferred blood donors in Jamaica / Seroprevalencia de las infecciones transmitidas sexualmente entre los donantes de sangre aceptados y diferidos en Jamaica

Critical donor selection and testing increases the safety of blood transfusion by excluding donors at risk of transmitting infections. This study investigated the seroprevalence of and risk factors for sexually transmitted infections (STIs) among accepted and deferred blood donors in Jamaica. A total of 1015 blood donors consisting of 794 (78) accepted donors and 221 (22) deferred donors presenting at the Central Blood Bank, Jamaica, over a six-month period, were recruited for this study. A standardized questionnaire was administered to each participant and a sample of blood obtained for detection of hepatitis B surface antigen, antibodies to Treponema pallidum, human immunodeficiency virus (HIV) and human T-cell lymphotrophic virus type-1 (HTLV-1). Deferred donors were three times more likely to be seropositive for STI than accepted donors (16.3vs 5.2, OR 3.57, 95CI 2.16 - 5.90, p < 0.0001). Males had significant association between STI seropositivity and having fathered children with two or more women (p = 0.0085), unprotected sexual intercourse with several persons (p = 0.0326), and history of genital herpes (p = 0.0121). Significant risk factors identified among females were unprotected sex with several partners (p = 0.0385); having more than ten lifetime partners (p = 0.0105); and use of depoprovera (p = 0.0028). This study confirms higher rates of STI among deferred blood donors and supports the donor deferral system in Jamaica.

La prueba y selección crítica del donante aumenta la seguridad de la transfusión de sangre, excluyendo a los donantes con riesgo de transmitir infecciones. Este estudio investigó la seroprevalencia de las infecciones transmitidas sexualmente (ITS) entre los donantes de sangre aceptados y diferidos en Jamaica. Un total de 1015 donantes de sangre consistente en 794 (78%) donantes aceptados, y 221 (22%) donantes diferidos que acudieron al Banco de Sangre Central en Jamaica por un periodo de seis meses, fueron reclutados para este estudio. A cada uno de los participantes se le aplicó una encuesta estandarizada, y se obtuvo una muestra de sangre para la detección del antígeno de superficie de la hepatitis B, los anticuerpos del Treponema pallidum, el virus de la inmunodeficiencia humana (VIH), y el virus linfotrópico humano de células T tipo 1 (HTLV-1). Los donantes diferidos presentaron una probabilidad tres veces mayor de ser seropositivos que los donantes aceptados (16.3% frente a 5.2%, OR 3.57, 95% CI 2.16 - 5.90, p <0.0001). En los varones se dio una asociación significativa entre la seropositividad de ITS y el haber engendrado hijos con dos o más mujeres (p = 0.0085), el intercambio sexual desprotegido con distintas personas (p = 0.0326), y una historia de herpes genitales (p = 0.0121). Los factores de riesgo significativos identificados entre las hembras fueron el sexo desprotegido con diferentes parejas (p = 0.0385), el haber tenido más de diez parejas a lo largo de su vida (p = 0.0105), y el uso de depoprovera (p = 0.0028). Este estudio confirma que las tasas de ITS entre los dotantes de sangre diferidos son más altas, y respalda el sistema de aplazamiento de donantes en Jamaica.

Marginal validity of syndromic management for reproductive tract infections among pregnant women in Jamaica.

We assessed the validity of a syndromic case management approach for reproductive tract infections (RTIs) among 371 pregnant women attending antenatal care facilities in Kingston, Jamaica, using an algorithm previously validated in high-risk Jamaican women. For our antenatal attenders, the algorithm had low sensitivities for all RTIs (66.7% for cervicitis, 35.4% for trichomoniasis, 11.1% for bacterial vaginosis (BV) and 24% for candidiasis). Specificities for BV (88.9%) and candidiasis (81.1%) were higher than for cervicitis (62.8%) and trichomoniasis (68.5%). The positive predictive values were lower than 36% for all diagnoses, especially BV (6.9%). Syndromic management of RTIs in pregnant women was problematic using a clinical algorithm that had worked well for high-risk women. Syndromic management for RTIs in Jamaican antenatal clinics is only a temporary solution until more simple and affordable diagnostic tests for RTIs are developed and/or until laboratory support and clinical care can be upgraded at antenatal clinics.

Vaginal infections in pregnant women in Jamaica: prevalence and risk factors.

Trichomoniasis, bacterial vaginosis (BV) and candidiasis are reproductive tract infections (RTIs) of the vagina. We conducted a cross-sectional study in 4 prenatal clinics in Kingston, Jamaica, to estimate the prevalence of these infections and the risk factors that may facilitate their transmission among pregnant women. Of the 269 women studied, 18.0% had culture-positive trichomoniasis, 44.1% had BV (Nugent score > or = 7) and 30.7% were positive for candidiasis by wet mount. A multiple logistic regression analysis showed that having a malodorous discharge was associated with trichomoniasis (odd ratios [OR]=3.9, confidence intervals [CI]=1.04-14.7) and BV (OR=3.4, CI=1.3-8.7). Women who took action to prevent HIV infection had lower BV prevalence (OR=0.34, CI=0.12-0.98). Women who were employed were less likely to have any of the infections (OR=0.61, CI=0.36-1.03). The strong association of a symptomatic presentation with trichomoniasis and BV suggests the merit of considering syndromic management of vaginitis in this population.

Genital ulcers: etiology, clinical diagnosis, and associated human immunodeficiency virus infection in Kingston, Jamaica.

Individuals presenting consecutively with genital ulcers in Kingston, Jamaica, underwent serological testing for human immunodeficiency virus (HIV) infection, chlamydial infection, and syphilis. Ulcer material was analyzed by multiplex polymerase chain reaction (M-PCR) analysis. DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0%), 72 (23.7%), and 31 (10.2%) of 304 ulcer specimens. Of the 304 subjects, 67 (22%) were HIV-seropositive and 64 (21%) were T. pallidum-seroreactive. Granuloma inguinale was clinically diagnosed in nine (13.4%) of 67 ulcers negative by M-PCR analysis and in 12 (5.1%) of 237 ulcers positive by M-PCR analysis (P = .03). Lymphogranuloma venereum was clinically diagnosed in eight patients. Compared with M-PCR analysis, the sensitivity and specificity of a clinical diagnosis of syphilis, herpes, and chancroid were 67.7%, 53.8%, and 75% and 91.2%, 83.6%, and 75.4%, respectively. Reactive syphilis serology was 74% sensitive and 85% specific compared with M-PCR analysis. Reported contact with a prostitute in the preceding 3 months was associated with chancroid (P = .009), reactive syphilis serology (P = .011), and HIV infection (P = .007). The relatively poor accuracy of clinical and locally available laboratory diagnoses pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.

Indicators and the measurement of STD case management in developing countries. STD PI6&7 Working Group.

The paper reviews methodologies for measuring quality of sexually transmitted disease (STD) case management through facility based assessments. These include observations and interviews of providers, as promoted by the World Health Organization's Global Programme on AIDS, and some of the viable alternatives including patient exit interviews, mystery patients, record review and patient encounter forms with supervisory visits. The paper concludes that the alternative approaches are feasible in resource poor settings and that they provide crucial data for evaluation and continued program development.

Improving sexually transmitted disease management in the private sector: the Jamaica experience.

OBJECTIVES: To improve the quality of sexually transmitted disease (STD) case management in Jamaica by providing comprehensive continuing medical education to private practitioners who manage 60% of all STDs on the island. METHODS: Six half-day STD seminars were presented at 3-4-month intervals and repeated in three separate geographic locations. All Jamaican practitioners received invitations. The subjects were as follows: urethritis, genital ulcer disease, HIV infection, vaginal discharge syndrome, STDs in children and adolescents, and a review seminar. The program effectiveness was evaluated with a written, self-reported pre-test and a telephone post-test that measured changes in clinical management. RESULTS: Six hundred and twenty eight practitioners attended at least one seminar. Comparing pre- versus post-test scores, there were practitioner improvement trends in all four of the general STD management categories: counseling/education (69.8-73.3%; P > 0.05); diagnostics/screening (57.2-71.0%; P= 0.042); treatment (68.3-74.5%; P> 0.05); and knowledge (66.4-83.2%; P= 0.002). Obtaining syphilis serologies during pregnancy rose from 38.3 to 83.8% (P= 0.001), and providing effective treatment for gonorrhea rose from 57.8 to 81.1 % (P= 0.002), but correct responses on treatment for mucopurulent cervicitis at the post-test was a low 32.4%. CONCLUSION: The introduction of continuing medical education for improved STD care targeting private physicians in Jamaica was successful based on high attendance rates and self-reported STD management practices. However, efforts should continue to address the weaknesses found in STD management and counseling and to reach the providers who did not participate. In the global effort to reduce HIV transmission by improving STD care services, continuing education programs that target the private sector can be successful and should be included as a standard activity to improve care and provide a public/private link to STD/HIV control.

PIP: The Jamaican Ministry of Health has estimated that over 60% of all sexually transmitted diseases (STDs) are managed within the private sector, where 800 (66%) of the country's 1200 registered physicians practice. To improve the quality of STD case management provided by these practitioners, the Medical Association of Jamaica organized a series of 6 half-day seminars repeated at 3-4 month intervals in three geographic locations between December 1993 and July 1995. Topics addressed included urethritis, genital ulcer disease, HIV/AIDS, vaginal discharge, pelvic inflammatory disease, and STDs in children and adolescents. A total of 628 private practitioners attended at least one seminar and almost half the physicians attended two or more. Comparisons of scores on a written pretest completed before the seminar and those from a post-test conducted by telephone after the seminar revealed significant improvements in all four general STD management categories: counseling/education, diagnostics/screening, treatment, and knowledge. The proportion of practitioners who obtained syphilis serologies during pregnancy rose from 38.3% to 83.8% and those providing effective treatment for gonorrhea increased from 57.8% to 81.1%. Overall, 96% of practitioners were providing some level of risk-reduction counseling at the time of the post-test and 74% were prescribing correct treatment regimens. Ongoing education and motivation by the national STD control program or the Medical Association are recommended to improve STD case management even further.

Is HIV/STD control in Jamaica making a difference?

OBJECTIVE: To assess the impact of the comprehensive HIV/STD Control Program established in Jamaica since the late 1980s on the HIV/AIDS epidemic. METHODS: AIDS case reports, HIV testing of blood donors, antenatal clinic attenders (ANC), food service workers, sexually transmitted disease (STD) clinic attenders, female prostitutes, homosexuals and other groups were used to monitor the HIV/AIDS epidemic. Primary and secondary syphilis and cases of congenital syphilis were also monitored. National knowledge, attitude and practice (KAP) surveys were conducted in 1988, 1989, 1992, 1994 and 1996. RESULTS: The annual AIDS incidence rate in Jamaica increased only marginally in the past three years from 18.5 per 100000 population to 21.4 in 1997. HIV prevalence in the general population groups tested has been about 1% or less. Among those at high risk, HIV prevalence rates have risen to 6.3% (95% confidence interval 5.0-8.0) in STD clinic attenders, around 10% and 21% in female prostitutes in Kingston and Montego Bay respectively and approximately 30% among homosexuals. Syphilis rates and congenital syphilis cases have declined. The proportion of men aged 15-49 years reporting sex with a non-regular partner declined from 35% in 1994 to 26% in 1996 (P< 0.001). Women ever having used condoms increased from 51% in 1988 to 62.5% in 1992 and 73% in 1994 and 1996 (P< 0.001), while condom use with a non-regular partner increased from 37% in 1992 to 73% in 1996 (P= 0.006). Condom use among men was high over the period: around 81% had ever used condoms and 77% used them with non-regular partners. Gay men, inner-city adults and adolescents aged 12-14 years all reported increases in condom use while condom sales and distribution increased from around 2 million in 1985 to 10 million in 1995. CONCLUSION: HIV/STD control measures appear to have slowed the HIV/AIDS epidemic in Jamaica, however a significant minority of persons continue to have unprotected sex in high risk situations.

A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica.

Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of the other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8% of 23,050 patients had GUD, men (9.3%) more often than women (4.2%; p < 0.001). In 1990/91 the prevalence rate was 12.8%, with increased rates for both men (18.2%) and women (6.8%; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8% and 7.8% of the patients; syphilis, in 12.9% and 18.8%; chancroid, in 12.4% and 13.3%; viral warts, in 5.7% and 6.3%; lymphogranuloma venereum, in 4.1% and 3.9%; and granuloma inguinale, in 3.6% and 2.3%. In men the rate for syphilis was 19% in 1990/91 and 8% in 1982/83 (p = 0.001); and for genital herpes it was 7% in 1990/91 and 17% in 1982/83 (p = 0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4% of cases in 1982/83 (particularly in men), and in 47.6% of cases in 1990/91. GUDs facilitate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by strengthening the STD/HIV control programme.

PIP: The prevalence of genital ulcer disease (GUD) was investigated in two cross-sectional studies of patients presenting to the sexually transmitted disease (STD) clinic at the Comprehensive Health Center in Kingston, Jamaica, between December 1982 and August 1983 (n = 23,050) and between November 1990 and January 1991 (n = 1001). The median age of participants was 26 years for men and 25 years for women; most were low-income inner-city residents. The prevalence of GUD rose from 6.8% (9.3% in men and 4.2% in women) in the 1982-83 survey to 12.8% (18.2% in men and 6.8% in women) in 1990-91. In 1982-83 and 1990-91, respectively, genital herpes was diagnosed in 16.8% and 7.8% of patients, syphilis in 12.9% and 18.8%, chancroid in 12.4% and 13.3%, viral warts in 5.7% and 6.3%, lymphogranuloma venereum in 4.1% and 3.9%, and granuloma inguinale in 3.6% and 2.3%. A clinical diagnosis could not be made in 44.4% of cases in 1982-83 and in 47.6% in 1990-91. Since GUDs facilitate the transmission of HIV, HIV prevention efforts must include the strengthening of STD control programs. All cases of GUD should be screened for both syphilis and HIV, with prompt treatment to reduce the period of GUD transmissibility. Jamaica has revised its national STD case management guidelines to include simplified algorithms for GUD management and strengthened STD surveillance and contact tracing. Changes in GUD prevalence over time may be a useful indicator for evaluating the impact of STD/HIV interventions.