Associations of whole-blood fatty acids and dietary intakes with prostate cancer in Jamaica.

OBJECTIVE: To investigate the association of whole-blood fatty acids and reported intakes of fats with risk of prostate cancer (PCa). DESIGN: Case-control study of 209 men 40-80 years old with newly diagnosed, histologically confirmed prostate cancer and 226 cancer-free men attending the same urology clinics. Whole-blood fatty acid composition (mol%) was measured by gas chromatography and diet assessed by food frequency questionnaire. RESULTS: High whole-blood oleic acid composition (tertile 3 vs. tertile 1: OR, 0.37; CI, 0.14-0.0.98) and moderate palmitic acid proportions (tertile 2: OR, 0.29; CI, 0.12-0.70) (tertile 3: OR, 0.53; CI, 0.19-1.54) were inversely related to risk of PCa, whereas men with high linolenic acid proportions were at increased likelihood of PCa (tertile 3 vs. tertile 1: OR, 2.06; 1.29-3.27). Blood myristic, stearic and palmitoleic acids were not associated with PCa. Higher intakes of dietary MUFA were inversely related to prostate cancer (tertile 3 vs. tertile 1: OR, 0.39; CI 0.16-0.92). The principal source of dietary MUFA was avocado intake. Dietary intakes of other fats were not associated with PCa. CONCLUSIONS: Whole-blood and dietary MUFA reduced the risk of prostate cancer. The association may be related to avocado intakes. High blood linolenic acid was directly related to prostate cancer. These associations warrant further investigation.

Body size and risk of prostate cancer in Jamaican men.

We investigated the associations between body size and risk of prostate cancer in a hospital-based case-control study in Jamaica. Height, weight, waist, and hip circumference were measured at enrollment, and data collected on medical and lifestyle factors for newly diagnosed cases (n = 243) and controls (n = 275). Compared with men in the normal range of waist-hip ratio (WHR), men with WHR > or =0.95 were at greater risk of total prostate cancer (OR,1.72; CI, 1.01-3.00) and high-grade cancer (OR, 2.02; CI, 1.03-3.96). With additional control for BMI, the association with WHR remained significant for total prostate cancer (OR, 1.90; CI, 1.01-3.53) and high-grade disease (OR, 2.94; CI, 1.34-6.38). There was no association between waist circumference and cancer without control for BMI but after controlling for BMI, waist circumference >90 cm (OR, 2.45; CI, 1.01-5.94) and >102 cm (OR, 5.57; CI, 1.43-18.63) showed a dose-response relationship with high-grade disease. Height and BMI were not associated with risk of prostate cancer. Abdominal obesity may be associated with risk of high-grade prostate cancer. Risk may be greater in those with higher abdominal obesity relative to overall size. The results further highlight the importance of investigating relationships by characteristics of the tumor.

The potential of saponin from Jamaica's Blighia sapida (ackee) as a substitute for sodium lauryl sulphate in toothpaste.

Discovering novel means of protection from harmful substances in toothpaste is essential due to its mass production, and frequent exposure to its ingredients by consumers. This method of safeguarding through discovery demonstrates toothpaste safety, which is at risk of being stifled by other commercial priorities. Among the ingredients in toothpaste that cause adverse effects is sodium lauryl sulphate (SLS). An understanding of this source and its effects therefore allows for investigating preventative strategies through the use of safer alternatives. Saponin, a naturally occurring chemical in several plant species was discovered to be an alternative compound that may parallel the effects of sodium lauryl sulphate, yet exude less ill effects. This article highlights the benefits of saponin and its presence in a heavily consumed and exported fruit in Jamaica (ackee, Blighia sapida). The possibility of extracting saponin from ackee, and its use in the toothpaste industry as an alternative to sodium lauryl sulphate are discussed. Through consideration of this alternative, the potential exists to improve the safety of toothpastes and consequently improve oral health.

Teaching medical students in their last leg of the undergraduate journey.

BACKGROUND: This short biographical piece provides a brief description of the experience of a medical teacher at the University of the West Indies in Jamaica. It traces his initial response to being chosen as a teacher and shows movement from self-doubt to assertive thinking about the role of the teacher. The development of the teacher, though buttressed by a formal training intervention, is couched within a sensitive understanding of the whole student.

Public and private health care utilization differences between socioeconomic strata in Jamaica.

OBJECTIVE: To assess trends in the use of private and public health care services among Jamaicans over a 15-year period (1991-2007). DESIGN AND METHODS: Statistics on the use of health care services were taken from the Jamaica Survey of Living Conditions (JSLC) for the 15-year period 1993 to 2007. Use of hospital services were represented in income quintiles and compared for private and public facilities. The difference in percentage use between public and private was compared by quintiles over the period and the variability in those differentials assessed. RESULTS: This study highlights the increasing use of private services by increasing wealth, exaggerated for the wealthiest quintile. There is a widening of the differences in utilization between public and private centers as income level increases (P < 0.001). CONCLUSIONS: Internal and external economic conditions influence the use of private and public health care services in Jamaica. Although the relative increase in the cost (to the user) of public health care is more than that for private health care, the actual cost to use the public health care system is still significantly cheaper than using the private system. Lower income health care users tend to take the lesser cost option.

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective

Al igual que el resto del mundo, el Caribe ha sido testigo del drástico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y crónicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinámica, creada por la emergencia de enfermedades transmisibles -como la infección por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este artículo se hace una revisión de la historia de la atención sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientación en la atención primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaración de Alma-Ata sirvió como importante punto de giro y ofreció orientación, apoyo y dirección a medida que los países perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeño en la reestructuración de la APS, ante los retos económicos, sociales, culturales, de recursos humanos y de políticas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extensión de los programas sociales, los esquemas nacionales de seguros de salud, los programas específicos de promoción de salud y la ampliación de la investigación en apoyo al desarrollo de políticas continúan evidenciando el esfuerzo caribeño para responder a los cruciales retos epidemiológicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Además, la Carta del Caribe para la Promoción de la Salud ha servido como elemento crítico para el desarrollo de la APS.

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective / Retos y respuestas del sector salud más allá de la declaración de Alma-Ata: una perspectiva Caribeña

Al igual que el resto del mundo, el Caribe ha sido testigo del drástico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y crónicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinámica, creada por la emergencia de enfermedades transmisibles -como la infección por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este artículo se hace una revisión de la historia de la atención sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientación en la atención primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaración de Alma-Ata sirvió como importante punto de giro y ofreció orientación, apoyo y dirección a medida que los países perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeño en la reestructuración de la APS, ante los retos económicos, sociales, culturales, de recursos humanos y de políticas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extensión de los programas sociales, los esquemas nacionales de seguros de salud, los programas específicos de promoción de salud y la ampliación de la investigación en apoyo al desarrollo de políticas continúan evidenciando el esfuerzo caribeño para responder a los cruciales retos epidemiológicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Además, la Carta del Caribe para la Promoción de la Salud ha servido como elemento crítico para el desarrollo de la APS.

Health sector challlenges and responses beyond the Alma-Ata declaration: a Caribbean perspective

Primary health care (PHC) is defined as "essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination." For the effective delivery of PHC to occur, it must be undergirded by a national health system infrastructure that has five key components: (1) development of health resources, such as manpower, facilities, equipment and supplies; (2) organized arrangement of health resources through the establishment of national health authorities, the provision of national health insurance, and the integration of public and private health services; (3) delivery of health care through the media of primary, secondary and tertiary health services; (4) economic support through sources, such as public financing and foreign aid; and (5) management through strong leadership, policy formulation, regulation and monitoring and evaluation (AU)

The electoral register as a sampling frame in a community health survey

Experience with the electoral register as a sampling frame in a cross-sectional health study of a Jamaican community is outlined. A satisfactory yield of 83.7 percent (of possible minimum) was obtained with non-sample or wastage accounting for 7.3 percent of the chosen sample. The social organisation of the community is seen as limiting the applicability of the register, but overall, it presents itself as a potentially useful tool in community health surveys (AU)

A rapid epidemiological assessment of rubeola resurgence in a suburban Jamaican community - abstract

An assessment of a measles (rubeola) resurgence in a small surburban Jamaican community was undertaken so as to relate the development and progress of the outbreak to salient epidemiological variables. Measles immunization histories were assessed for cases presenting at the local health centre and individual and community morbididty determined. Data were collected with the help of a community health aide from community visits to all basic and primary schools and two backyard nurseries and from clinical records during the ninth week of the outbreak, and on an on-going basis from clinic records. The outbreak of measles (75 cases) in this community lasted 22 weeks with an epidemic curve showing a picture of a propagated epidemic. Clustering was noted in the more deprived areas, with fifty percent of the individuals presenting belonging to addresses with more than one case. The male-female ratio was 1.3:1 with a modal age group of 1 to 5 years (45.8 percent of cases), infants (<1 yr.) accounting for 8.3 percent. Of the cases presenting, 44.2 percent were previously vaccinated against measles (61.5 percent in the general clinic population). Fever, cough and skin rash were the most common recorded presenting clinical features (78, 74 and 88 percent, respectively). One death was reported in a four-year-old child. The incidence of the disease for the first three months in the schools visited ranged from 1 in 9 children in a medium-sized basic school to 1 in 27 in a large primary school. Follow-up with respect to immunization following school entry was found to be generally poor. The formal approach to epidemic investigation may connote large scale efforts consuming much time and manpower. This report, however, shows what can be done in a short time with limited resources. The rapid epidemiological assessment was facilitated by the positive response of the community to the investigation and the ability of the team, including the community health aide, to make prompt yet effective contact with community members. Despite the expected defects in the data collected, a working picture of the epidemiological status of the community was quickly constructed. This picture provides the basis for primary health care intervention such as the targeting of high-risk groups in more deprived areas, reviewing and evaluating the immunization process, and monitoring and enforcing adequate standards of school health (AU)

Sensitizing Caribbean medical students to management issues

In the health sector, deficiency in management skills is a feature within all services - though less so in the public health sector. Over the last ten years, the University of the West Indies has developed and conducted a health management course for medical undergraduates aimed at sensitizing them to management as it relates to medicine and health care. The course is delivered during the penultimate year of the curriculum and thus far has a potential target audience of approximately 600 students. Didactic lectures have accounted for 83 percent of contact time with the remaining time utilized for debates, video presentations and student presentations. Five short case studies have been developed which have allowed a reduction in the "didactic diet" within more recent times. Students' reactions to the course were rated overall as "fair to good" for presentation, content and relevance; the response to case studies was "interesting, realistic and helpful in their understanding of subject matter". Some students felt that it was important and interesting course but that the time scheduled for lectures sometimes made attendance difficult; in any event their focus at this time was on clinical aspects of their training and they could not spare much time for this course. This experience in teaching management to medical students must be built on and strengthened so as to enhance the cognitive and attitudinal outcomes. Departments, like individual faculty members, sometimes have tubular vision which is to be admired in the pursuit of individual sciences(s), but in an undergraduate programme of medical education, parochial goals must give way to the objectives of the institution as a whole.(AU)

Doctors in the Jamaican Yellow Pages [abstract]

OBJECTIVE: To determine the characteristics of listings under the "Physicians and Surgeons" section of the Jamaican telephone directory Yellow Pages. METHODS: A review of the Greater Kingston Telephone Directories published by Cable and Wireless Jamaica Ltd for the period 1994/95 to 1999/00 was made. The section captioned "Physicians and Surgeons" in the National Yellow Pages of each of the five directories was used to obtain the following: a count of all listings and the font type (case, colour and emphasis) of each listing. Where listings were advertisements, than a structured content analysis was done to guage informativeness. RESULTS: For the five-year period of review, the mean number of listings was 244 (Standard Deviation (SD) = 24). There was a steady increase in the number of listings between 1994/95 (n = 219) and 1999/00 (n = 278). The proportion of listings that were in bold uppercase black font was fairly consistent throughout the period (mean of 32 percent). However, listings in bold uppercase red font showed an increase from 0.5 percent in 1994/95 to 2.5 percent in 1996/97, thereafter remaining close to this level. Listings qualifying as advertisements increased from 1.36 percent at the start of the period to 2.5 percent at the end. Consistent with this increase was an increase in total space occupied by advertisements and the diversity of colours and informational content. The majority of advertisements were by medical centres, of which dermatology services were the most frequent and consistent. The most informative advertisement over the period was by and individual physician. CONCLUSIONS: There has been an increase in listings in the "Physicians and Surgeons" section of the Jamaican National Yellow Pages over the five-year period of the study with an apparent trend towards more visible and sophisticated promotion services. (AU)

Health promotions: issues and answers

In recent years, increased attention has been given to the development of health promotion programmes in a number of countries worldwide. Although health promotion itself is not new, a number of issues have been emerged as the underlying concepts are articulated and put into practice. These relate to its relevance and ownership and to practical issues such as measurement of outcomes. This article provides a brief discussion on some of these issues and makes reference to Caribbean framework for implementing health promotion (AU)

Curriculum development in Community Health: drift or shift?

The curriculum in community health is best described as eclectic and dynamic. Its relevance is maintained by its response to the macro-environment; this response, whether innovative or otherwise, may be incremental on the one hand or feature wholesale change consequent on radical rethinking on the other. This paper reviews the content of the emerging curriculum in community health and the University of the West Indies, Jamaica, and attempts to discern the process of change and the factors which have informed these developements.(AU)

Student learning experiences with Jamaican practitioners

Due to the destruction of teaching facilities in primary care by a recent hurricane, first clinical year medical students were placed with general practitioners, in order to fulfil the requirements of a community medicine clerkship. Student feedback indicated a very high level of interest, with a varity of learning experiences - the attitudinal attributes of general practitioners ranking highest. This experience has provided a useful opportunity to enhance the training of medical students and to develop collaborative links with non - university physicians. This paper summarizes the experiences of the first 39 students involved in the clerkship. (AU)

The prevalence of health insurance in a Jamaica suburb and its correlations with service utilisation

The prevalence of health insurance in a low-income Jamaican community was determined from a systematic sample of 103 households. A household prevalence for health insurance of 32 per cent was found. Differentials in health service utilisation were more striking for private practitioner services where the highest correlation with coverage was found (r=0.346,p<0.001). A negative correlation with local health centre utilisation was obtained. The level of health insurance coverage in the community and its impact on service utilisation would suggest the possibility of harsh economies in health sector, forcing consumers in low-income groups to seek a buffer for the expenses incurred from needs unmet by the the public services. Part of this favourable prevalence of health insurance may also be due to job-related coverage (AU)

The prevalence of childhood disability in Clarendon, Jamaica - abstract

The experience of the epidemiological transition for developing countries is leading to a revision of paediatric priorities, with increasing concern for the problem of childhood disabilities. Their exists a lack of knowledge of the profile of disability occurrence in Caribbean communities. In a community-based study in the parish of Clarendon, Jamaica, done between 1986 and 1989, the prevalence of six types of childhood disabilities was sought. Within a defined area, data were collected on 5,468 children aged 2-9 years via household surveys. All children screening positive for disability, together with a sample of `normal' children, were assessed by a physician and a psychologist. Disabilities were categorised by types and levels. The prevalence rate for all types and degrees of disabilities was 93 per 1,000 children and for severe disability, 5.4 per 1,000 children. The rates for specific disabilities showed wide variation (cognitive - 81/1000, speech - 14/1000, visual - 10/1000, hearing - 9/1000, motor - 4/1000 and seizure -2.0/1000), with cognitive problems either singly or in combination accounting for a large segment of the disability profile. Seventy per cent of disabled children had only one disability, 23 per cent had two and 6 per cent had three and four. A literature review reveals no data on prevalence for the region that would make meaningful comparisons. International comparisons are difficult, due to conceptual and methodological dissimilarities. The prevalence of childhood disabilities for Clarendon suggests that this aspect of children's functioning should be given greater emphasis by planners and policy-makers. If disability is to be seen as the final outcome of a range of interacting factors, then these prevalence rates, taken with the specific aetiologies, would provide a framework for planning intervention (AU)

Service needs of disabled children in Jamaica - abstract

Parents of children presenting for a medical assessment as part of a two-stage survey of 2 to 9-year-old children in mid and south Clarendon were asked about symptoms relating to six different disabilities: visual, hearing, speech, motor, cognitive and fits and whether they had sought treatment for these symptoms. Their responses were compared with those who were diagnosed as disabled by the professional team. The frequencies of five possible types of intervention for children with disabilities recommended by the physician were analysed and related to the estimated prevalence of the six disabilities in the parish, to estimate the needs of Jamaican children for the various types of services. These were then compared with existing services. For all disabilities, except fits, the percentage of children that received treatment for symptoms was low, ranging from 5 percent for cognitive to 33 percent for motor symptoms. For children found to be disabled, the rates were a little higher except for treatment of fits which was 87 percent and cognitive disability at 5.6 percent. Awareness of the disability was also poor in cognitive, visual and speech disabilities. Fifty-six percent of disabled children needed special education, 29.5 percent needed community-based services, 21 percent needed spectacles, 21 percent needed specialist referral and 6 percent required medical treatment. The vast majority of the estimated needs for Jamaica as a whole are unmet (AU)

Psychological autopsy as a method of investigating suicide in Jamaica [Abstract]

OBJECTIVE: To assess the usefulness of the psychological autopsy in the Jamaican setting for investigating the characteristics of suicides in respect of psychiatric diagnoses and stressful life events. METHODS: The study was conducted in the parishes of Kingston, St.Andrew and St.Catherine, Jamaica. All suicide cases occuring between January 1 and December 31, 1998, were identified on the basis of police records. After obtaining informed consent the autopsy process initiated by interviewing key informants identified by relatives. Semi-structured interviews to assess mental state and stressful life events were conducted by a psychiatrist and supplemented by a review of case notes. A structured questionnaire was used to assess sociodemographic characteristics. An assessment of mental status prior to death was done and DSM IV criteria used to classify psychiatric disorders. Thiry-two suicides were studied using the psychological autopsy method. There was overwhelming willingness among key informants to be interviewed. RESULTS: The approach was fairly time consuming; interviews ranged from forty-five minutes to four hours (mean of 2 hours) having to be extended at times to allow for expression of emotions by informants. The method allowed for fairly easy retrospective formulation of psychiatric diagnosis (90 percent of victims) and for the elucidation of comorbidity. Substancial levels of stressful life events were also exposed. Many relatives expressed relief at being able to discuss these deaths with a neutral person. CONCLUSIONS: The psychological autopsy approach has provided valuable insights into the epidemiological and psychosocial context of suicide occurrence in these three Jamaican parishes. It has potential for ongoing surveillance and in the planning of prevention programmes. Its use among community mental health professionals should be evaluated. (AU)