The Utilization and Benefits of Telehealth Services by Health Care Professionals Managing Breast Cancer Patients during the COVID-19 Pandemic.

Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients and there is increasing demand for telehealth services. Globally, telehealth has become an essential means of communication between patient and health care provider. The application of telehealth to the treatment of BCa patients is evolving and increasingly research has demonstrated its feasibility and effectiveness in improving clinical, psychological and social outcomes. Two areas of telehealth that have significantly grown in the past decade and particularly since the beginning of the COVID-19 pandemic are telerehabilitation and teleoncology. These two technological systems provide opportunities at every stage of the cancer care continuum for BCa patients. We conducted a literature review that examined the use of telehealth services via its various modes of delivery among BCa patients particularly in areas of screening, diagnosis, treatment modalities, as well as satisfaction among patients and health care professionals. The advantages of telehealth models of service and delivery challenges to patients in remote areas are discussed.

Prospective Comparison of 24-Hour Urine Creatinine Clearance with Estimated Glomerular Filtration Rates in Chronic Renal Disease Patients of African Descent.

BACKGROUND: The 24-hour (24-h) creatinine clearance (CrCl) is the most common method for measuring GFR in clinical laboratories. However, the limitations of CrCl have resulted in the widespread acceptance of mathematically derived estimated glomerular filtration rate (eGFR) using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in predicting eGFR. The aim of the study was to compare 24-h CrCl with eGFR derived from these formulae and to identify which could be the best alternative. METHOD: A prospective study was conducted involving 140 CKD patients. Creatinine and cystatin C concentrations were determined using the cobas 6000 analyzer. The eGFR was calculated using the CG formula, 4-variable MDRD and CKD-EPI equations, and Bland-Alman plots bias was determined. RESULTS: The CG and MDRD formulas had mean eGFR values similar to CrCl and correlation coefficients (r) were highest for CG (0.906) and lowest for MDRD (0.799). The CG equation was in agreement with 24-h CrCl in all but stage V CKD while the MDRD equation compared well in all except Stage IV CKD. The CG equation was positively biased (0.9857) while the MDRD had a negative bias (-0.05). CONCLUSION: The Cockcroft-Gault formula provides a more accurate assessment of GFR than 24-h CrCl and would be recommended as a substitute to provide the best estimate of GFR in our population.

Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis.

Globally, millions of persons have contracted the coronavirus disease 2019 (COVID-19) over the past several months, resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.

Cerebrospinal Fluid Biomarkers of Alzheimer's Disease: Current Evidence and Future Perspectives.

Alzheimer's disease is a progressive, clinically heterogeneous, and particularly complex neurodegenerative disease characterized by a decline in cognition. Over the last two decades, there has been significant growth in the investigation of cerebrospinal fluid (CSF) biomarkers for Alzheimer's disease. This review presents current evidence from many clinical neurochemical studies, with findings that attest to the efficacy of existing core CSF biomarkers such as total tau, phosphorylated tau, and amyloid-ß (Aß42), which diagnose Alzheimer's disease in the early and dementia stages of the disorder. The heterogeneity of the pathophysiology of the late-onset disease warrants the growth of the Alzheimer's disease CSF biomarker toolbox; more biomarkers showing other aspects of the disease mechanism are needed. This review focuses on new biomarkers that track Alzheimer's disease pathology, such as those that assess neuronal injury (VILIP-1 and neurofilament light), neuroinflammation (sTREM2, YKL-40, osteopontin, GFAP, progranulin, and MCP-1), synaptic dysfunction (SNAP-25 and GAP-43), vascular dysregulation (hFABP), as well as CSF α-synuclein levels and TDP-43 pathology. Some of these biomarkers are promising candidates as they are specific and predict future rates of cognitive decline. Findings from the combinations of subclasses of new Alzheimer's disease biomarkers that improve their diagnostic efficacy in detecting associated pathological changes are also presented.

Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients.

BACKGROUND: The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. METHODS: A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. RESULTS: 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. CONCLUSIONS: 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.

Medicinal Herbs Used in Traditional Management of Breast Cancer: Mechanisms of Action.

Background: Breast cancer is one of the principal causes of death among women and there is a pressing need to develop novel and effective anti-cancer agents. Natural plant products have shown promising results as anti-cancer agents. Their effectiveness is reported as decreased toxicity in usage, along with safety and less recurrent resistances compared with hormonal targeting anti-cancer agents. Methods: A literature search was conducted for all English-language literature published prior to June 2020. The search was conducted using electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library. The search strategy included keywords such as breast cancer, herbs, anti-cancer biologically active components, clinical research, chemotherapy drugs amongst others. Results: The literature provides documented evidence of the chemo-preventative and chemotherapeutic properties of Ginseng, garlic (Allium sativum), Black cohosh (Actaea racemose), Tumeric (Curcuma longa), Camellia sinenis (green tea), Echinacea, Arctium (burdock), Flaxseed (Linum usitatissimum) and Black Cumin (Nigella sativa). Conclusions: The nine herbs displayed anti-cancer properties and their outcomes and mechanisms of action include inhibition of cell proliferation, angiogenesis and apoptosis as well as modulation of key intracellular pathways. However, more clinical trials and cohort human studies should be conducted to provide key evidence of their medical benefits.

Pre-analytical Errors at the Chemical Pathology Laboratory of a Teaching Hospital.

INTRODUCTION: The Chemical Pathology Laboratory at the University Hospital of the West Indies (UHWI) processes specimens received from inpatients, the outpatient department and other medical facilities in Jamaica. Specific rejection criteria are used to determine samples unsuitable for analysis. It has been noted that despite efforts to reduce the number of unacceptable samples received in the laboratory, the problem persists. AIM: The study seeks to provide empirical evidence of the inadequacies from which improvements can be formulated. MATERIALS AND METHODS: Errors recorded in the rejection log in the Chemical Pathology laboratory at the University Hospital of the West Indies for the period were assessed. The types and frequency of errors were determined manually. The yearly rejection ratios over a four-year period were evaluated. RESULTS: The most common causes for rejection were unlabelled samples (37%), incorrectly labelled specimens (23%), samples submitted in an inappropriate tube (14%) and incomplete or inaccurately completed requisition forms (14%). The rejection ratio for 2015-2016 was 2.1%. CONCLUSION: The laboratory must initiate programmes directed at improving the preanalytical process in order to ensure patient safety.

Attitude Towards Alzheimer's Disease Among Undergraduate Students of University of the West Indies, Trinidad and Tobago.

BACKGROUND: Alzheimer's disease is most common among the dementias and is characterized by gradual declines in functional and cognitive abilities. Caregivers including family members play a key role in providing critically needed care for these patients. OBJECTIVE: This study compared the knowledge and attitudes of pre-healthcare and non-medical undergraduate students towards patients with Alzheimer's disease. MATERIALS AND METHODS: A cross-sectional study was conducted involving quota sampling of 691 undergraduate students (369 pre-healthcare and 322 non-medical). A 28-item questionnaire was utilised comprising of closed-ended questions and some based on a scale rating. The students' knowledge of Alzheimer's disease was arranged into categories such as: 0 for no knowledge about Alzheimer's disease, 1 for very little knowledge about Alzheimer's disease, 2 for fair knowledge about Alzheimer's disease and 3 for great knowledge about Alzheimer's disease. STATISTICAL ANALYSIS: The data was analysed using the computer software SPSS and the Chi squared test of independence was also used to determine which knowledge variables were independent of student's status. RESULTS: Overall, 40.01% of the students have great or fair knowledge of Alzheimer's disease, with that of pre-healthcare students being satisfactory (54.47%). Pre-healthcare students have a more positive attitude towards Alzheimer's disease and 82.2% of students wished to take advantage of predictive test for Alzheimer's disease. Age and genetics were identified as risk factors of the disease. CONCLUSION: Pre-healthcare students had greater understanding of Alzheimer's disease and depicted a more empathetic and caring attitude towards patients. This can be attributed mainly to their knowledge and exposure toward the disease.

Identification of Pre-examination Errors in the Chemical Pathology Laboratory at the University Hospital of the West Indies.

This study evaluated the types and frequencies of pre-examination errors recorded in the chemical pathology laboratory at the University Hospital of the West Indies, Jamaica. This was a retrospective analysis of errors recorded over a three year period. Data analysis was done on an average of 519,084 samples collected and tested per year. Samples included blood, urine, stool and other fluids. Pre-examination errors were identified and recorded following visual inspection of the samples and corresponding request forms by laboratory staff, then subsequently by the Senior Medical Technologist. Errors were generally classified as inappropriate sample (58 %), inappropriate form (23.4 %), inappropriate sample volume (9.3 %) and inappropriate sample tube (9.3 %). Over 90 % of recorded pre-examination errors were related to blood samples while urine samples accounted for 6.8 % error. Pre-examination errors were lower at this study location than elsewhere. Measures aimed at reducing instances of these errors are recommended for improved laboratory quality output.

Epidemiological Features of violence-related Injuries in Jamaica.

BACKGROUND: Violence-related injuries are common in Caribbean countries such as Jamaica and are a major cause of mortality and morbidity. The study examined the epidemiology of violence-related injuries and ascertained the extent to which the utilization of violence-related injury reports and surveillances inform health policy and programme planning implementation in Jamaica. MATERIALS AND METHODS: Primary data was gathered by the Ministry of Health through its Public Hospital Monthly Statistical Reporting System (HMSR) and the Jamaica Injury Surveillance System (JISS). These data files were collected over a four and five year period respectively. The sample size comprised 187,610 cases (117,615 from HMSR) and (69,995 from JISS) which were seen and treated at the public hospitals in Jamaica because of violence-related injuries. This study employed a descriptive analysis of visits and cases (episodes) relating to violence-relating injuries. Simple random sampling method was used in this study and the data was analysed using both Microsoft Excel and the Statistical Package for Social Scientists 18.0. RESULTS: The highest number of violence-related injuries was in 2007 and assault (stab wounds, gunshot and blunt injury) was the most frequent violence-related injury with human bites, and burns being the least. The highest number of violence-related injuries in males and females was in the age group 20-29 y. More males experienced violence-related injuries compared with females with male to female ratio of 1.35:1 to 1.45:1 in the years considered. CONCLUSION: The findings of this study are consonant with local and international studies and confirm that assault was the most frequent violence-related injury. Males compared with their female counterparts are a stronger demographic risk factor where violence-related injuries are concerned. Violence-related injuries have spurred the charge for effective interventions, policy initiatives, and strategic and programme planning by the Ministry of Health, through multi-sectoral and multi-agency approaches in Jamaica.

Effect of yoga exercise therapy on oxidative stress indicators with end-stage renal disease on hemodialysis.

BACKGROUND: Oxidative stress promotes endothelial dysfunction and atherosclerosis in chronic renal disease. OBJECTIVES: This study investigated the impact of Hatha yoga on oxidative stress indicators and oxidant status, in patients with end-stage renal disease (ESRD) on hemodialysis. DESIGN: This prospective randomized study consisted of 33 ESRD patients in the Hatha yoga exercise group who were matched with 35 ESRD patients in the control group. OUTCOME MEASURES: The oxidative stress indicators (malondialdehyde - MDA, protein oxidation - POX, phospholipase A2 - PLA2 activity) and the oxidative status (superoxide dismutase (SOD) and catalase activities) were determined in the blood samples taken at the pre-hemodialysis treatment, at baseline (0 months) and after four months. RESULTS: In patients in the Hatha yoga exercise group, lipid peroxidation, as indicated by MDA decreased by 4.0% after four months (P = 0.096). There was also a significant reduction in the activity of PLA from 2.68 ± 0.02 IU / L to 2.34 IU / L (- 12.7%; P = 0.010) and POX from 2.28 ± 0.02 nmol / mg to 2.22 ± 0.01 nmol / mg (- 22.6%; P = 0.0001). The activity of SOD significantly increased from 12.91 ± 0.17 U / L to 13.54 ± 0.15 U / L (4.65%; P = 0.0001) and catalase from 79.83 ± 0.63 U / L to 80.54 ± 0.80 U / L (0.90%; P = 0.0001). There was a significant correlation between the pre-hemodialysis oxidative stress parameters at the zero month and after four months for the activities of PLA (r = 0.440), catalase (r = 0.872), and SOD (r = 0.775). CONCLUSIONS: These findings suggest that the Hatha yoga exercise has therapeutic, preventative, and protective effects in ESRD subjects, by decreasing oxidative stress.

Citrus peel polymethoxylated flavones extract modulates liver and heart function parameters in diet induced hypercholesterolemic rats.

The primary aim of this study was to investigate the effects of Ortanique peel polymethoxylated flavones extract (PMF(ort)) on organ function parameters in the serum of hypercholesterolemic and normal rats. Thirty Sprague-Dawley rats were fed high cholesterol diets supplemented with 1.5% PMF(ort) and niacin respectively for 49days. Hypercholesterolemic rats fed PMF(ort) had significant reductions in the activities of aspartate aminotransferase and alkaline phosphatase (69.12±3.34 and 87.22±8.42U/L respectively) compared to the untreated hypercholesterolemic group (118.61±4.85 and 132.62±10.62U/L respectively, p<0.05). Supplementation of the diet with niacin or PMF(ort) resulted in no significant differences in the serum levels of creatinine or urea in any of the groups. Total bilirubin was highest in the untreated hypercholesterolemic group. Supplementation of the diets of hypercholesterolemic rats with PMF(ort) resulted in significant reductions in the activities of serum creatine kinase and lactate dehydrogenase (119.3±25.3; 222.5±50.3U/L, p<0.05) respectively relative to the untreated hypercholesterolemic group (257.2±48.3; 648.8±103U/L, p<0.05). The results would suggest that PMF(ort) modulates hypercholesterolemia-associated organ injury in rats. PMF(ort) could therefore be a suitable candidate for prophylactic and therapeutic treatment of hypercholesterolemia-associated organ injury.

Tobacco-related chronic illnesses: a public health concern for Jamaica.

BACKGROUND: Tobacco use is a leading cause of preventable morbidity and mortality from non-communicable diseases. The objectives of the study were to determine the percentage of annual income used to purchase tobacco-related products and treat tobacco-related illnesses, and assess the characteristics of smokers and their awareness of the health-related risks of smoking. METHOD: Stratified and snowball sampling methods were used to obtain information (via a 17-item, close-ended questionnaire) from 85 adult respondents (49 males and 36 females). The instrument comprised of demographic characteristics, smoking behavioural/lifestyle, health, and micro socio-economics. RESULTS: There were no significant differences between individuals who were affected by chronic obstructive pulmonary disorder (COPD) (14.1%) and cardiovascular disease (18.8%). It was found that respondents spend 30-39% of their annual income on tobacco-related products. Forty percent (40.0%) and 41.7% of respondents with lung cancer and COPD respectively spend more than 50% of their annual income to treat these diseases. The majority (80%) of those who continues to consume tobacco-related products were uncertain as to why they were doing it. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. CONCLUSION: The majority of the respondents who had tobacco-related illnesses such as lung cancer and COPD spend a significant amount of their income on their health care. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. This suggests the need for increase public awareness where both smokers and non smokers are being fully or adequately informed about the dangers or health risks of tobacco consumption.

Effect of exercise therapy on lipid parameters in patients with end-stage renal disease on hemodialysis.

BACKGROUND: Dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease in chronic kidney disease patients. AIM: This study investigated the impact of Hatha yoga exercise on lipid parameters in patients with end-stage renal disease (ESRD) on hemodialysis. MATERIALS AND METHODS: This prospective randomized study consisted of 33 ESRD patients in the Hatha yoga exercise group that was matched with 35 ESRD patients in the control group. Serum total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol were determined at baseline (0 month) and after 4 months. RESULTS: Comparing values after 4 months versus baseline in the prehemodialysis Hatha yoga exercise group, there was found a significant decrease in total cholesterol from 5.126 ± 0.092 mmol/l to 4.891 ± 0.072 mmol/l (-4.58%; P = 0.0001), triglycerides from 2.699 ± 0.078 mmol/l to 2.530 ± 0.063 mmol/l (-6.26%; P = 0.0001), LDL-cholesterol from 2.729 ± 0.083 mmol/l to 2.420 ± 0.066 mmol/l (-11.32%; P = 0.0001), and total cholesterol/HDL-cholesterol ratio from 5.593 ± 0.119 mmol/l to 4.907 ± 0.116 mmol/l (-12.26%; P = 0.047). For patients in the Hatha yoga exercise group, 51.5% had normal total cholesterol at 0 month while 70.0% had normal total cholesterol (P < 0.05) after 4 four months and 54.5% of patients had normal LDL-cholesterol at 0 month while 84.9% had normal LDL-cholesterol after 4 months (P < 0.05). CONCLUSION: These findings suggest that Hatha yoga exercise has preventive and beneficial effects and may be a safe therapeutic modality in ESRD patients.

Prostate specific antigen and Gleason score in men with prostate cancer at a private diagnostic radiology centre in Western Jamaica.

BACKGROUND: Prostate cancer is the most common malignant tumour in men and the second most common cause of male cancer death. The study examines the clinicopathological features of patients with prostate cancer consecutively diagnosed at a private Diagnostic Radiology Centre in Western Jamaica over a 6-year period. METHOD: The medical records, including the pathology reports of 423 consecutive patients who had transrectal ultrasonography (TRUS) - guided prostate biopsy between January 2006 and December 2011 were reviewed. RESULTS: The mean age at diagnosis of the 191 men with prostate adenocarcinoma was 68.5 ± 0.59 years with the majority in the 70 - 79 year age group (43.5%). Moderately differentiated carcinomas (Gleason score of 6) comprised the largest group with 72 cases (37.9%); poorly differentiated cancers with Gleason scores of 8 - 10 comprised 49 cases (25.8%). The PSA levels increased with Gleason score. The mean PSA levels for men with Gleason score of 6 was 50.1 ± 30.0 ng/mL compared with 136.5 ± 59.9 ng/mL in patients with Gleason score of 8 and 140.5 ± 31.8 ng/mL in patients with Gleason score of 9. Perineural invasion was present in 7.85% of the cases overall; high-grade prostatic intraepithelial neoplasia (HGPIN) was present in 4.71% of the biopsies. CONCLUSION: Although the majority of patients had moderate, and moderate to poor differentiated carcinomas, the number with poorly differentiated carcinoma was high. This is a reflection of the patients' late clinical presentation at the time of diagnosis.

Prostate cancer and metabolic syndrome: is there a link?

Metabolic syndrome has become quite prevalent within our society. Over the past two decades, the prevalence of metabolic syndrome has sharply increased worldwide and it has become a major public health problem in several countries. It is associated with the global epidemic of obesity and diabetes mellitus and imposes numerous cardiovascular risks. Prostate cancer is the second most common cancer among men, surpassed only by non-melanoma skin cancer. A considerable body of evidence exists suggesting that some components of the metabolic syndrome have been associated with the risk of prostate cancer. These components include obesity, an abdominal fat distribution, and hyperinsulinemia. Androgen deprivation therapy (ADT) is the most widely used therapeutic modality in prostate cancer. It changed the body composition and lipid profile of men with prostate cancer. Androgen deficiency is associated with increased levels of total cholesterol, low-density lipoprotein (LDL)- cholesterol, increased production of proinflammatory factors, and increased thickness of the arterial wall and contributes to endothelial dysfunction. The aim of this review is to evaluate the association between metabolic syndrome and prostate cancer and to discuss the implications of androgen deficiency in men with cardiovascular risk factors. A comprehensive literature search was carried out with the use of PubMed from 1980 through 2012, and relevant articles pertinent to metabolic syndrome and prostate cancer are evaluated and discussed.

The church's response to sexual reproductive health issues among youths: Jamaica's experience.

This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.

Triple negative breast cancer: therapeutic and prognostic implications.

Triple negative breast cancers (TNBC) lack oestrogen receptor (ER), progesterone receptor (PR), nor over-express human epidermal growth factor receptor 2 (HER2). Epidemiologic studies demonstrate that women diagnosed with TNBC manifest a significantly different set of clinic-pathologic features and risk factors when compared to women with other subtypes of breast cancer. They are associated with poor prognosis, as defined by low five-year survival. To date many studies have examined the utility of traditional chemotherapy for the treatment of patients with TNBC and have confirmed the benefits of these agents in both the adjuvant and neoadjuvant settings. Targeted therapy options involving PARP1 and EGFR inhibition, are currently in different phases of development and will hopefully change the paradigm of how patients with TNBC are treated. The present commentary aims to summarize the latest findings on chemotherapy in the treatment of TNBC in both the neoadjuvant and adjuvant setting and explore the ongoing development of newer targeted agents.

Social determinants of physical exercise in older men in Jamaica.

BACKGROUND: Physical activity interventions have been demonstrated to improve health-related quality of life and to be of special benefit to older adults with specific chronic conditions including arthritis, hypertension, diabetes mellitus, and heart disease. AIM: This study examined the extent and social determinants of physical exercise in elderly men in Jamaica. MATERIALS AND METHODS: A sample of 2,000 men 55 years of age and older was extracted from a total of 33,674 males in the parish of St. Catherine. A 132-item questionnaire was used to collect the data. A stratified random sampling technique was used to draw the sample. Descriptive statistics were used to provide background information on the sub-sample, and logistic regressions were utilized to model physical exercise. RESULTS: Of the respondents, 55.4% indicated good health status, 51.0% lived in rural areas; 10.4% had moderate to high functional dependence and 67.3% reported that they did some form of physical exercise. Of those who indicated involvement in physical exercise (n = 1,345), 77.2% jogged, ran, and/or walked; 13.3% did aerobics; 4.7% swam; 2.0% cycled and 0.6% did push-ups or sit-ups. The variables that predicted being engaged in physical exercise were education; age of respondents; current good health status; household head; health plan; employment status, and social support. CONCLUSION: Most of the elderly men were engaged in some form of physical activity and had good health. Age and good health status were the most influential social determinants of physical exercise. However, effective interventions to promote physical activity in older men in Caribbean countries such as Jamaica deserve wide implementation.

Perception of women on cancer screening and sexual behavior in a rural area, Jamaica: Is there a public health problem?

BACKGROUND: The Ministry of Health in Jamaica recommends that cervical cancer screening be undergo by women 25-54 years old. The age range is based on international standards, but this is in need for revision based on the parish of St. Thomas. AIMS: The study aimed to evaluate the perception and practice of Pap smear and the sexual practices of women in St. Thomas in order to aid policy. PATIENTS AND METHODS: This is a cross-sectional descriptive study of 210 women (15-54 years) from St. Thomas, Jamaica. RESULTS: Eighty eight percent of the sample had done a Pap smear and 24% indicated that they did this at least once every 12 months. The Pap smear results revealed that 83.2% of the sample was normal and 11.5% of the participants knew that their Pap smear was abnormal. Eighty percent of those with abnormal Pap smear were aged between 20-35 years. Sixty percent indicated that they did not believe they were infected with any STDs, but the Pap smear results showed that 76.4% of them had STDs. Eighty-three percent of the sample indicated having one sexual partner; 22.1% indicated that they began having sex before 15 years; 71% began having sex at 15-20 years; 76% of the sample used a condom and 12% reported that they had never practiced safe sex. CONCLUSION: This study finds that the age interval for conducting Pap smear screening should be lowered to 20 years for women in the parish of St. Thomas, Jamaica.