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The interface formation and chemical and electronic structure of the (Cd,Zn)S:Ga/CuSbS2 thin-film solar cell heterojunction were studied using hard X-ray photoelectron spectroscopy (HAXPES) of the bare absorber and a buffer/absorber sample set for which the buffer thickness was varied between 1 and 50 nm. We find a heavily intermixed interface, involving Cu, Zn, and Cd as well as significant Ga and Cu profiles in the buffer. The valence band (VB) offset at the buffer/absorber interface was derived as (-1.3 ± 0.1) eV, which must be considered an upper bound as the Cu diffused into the buffer might form a Cu-derived VB maximum located closer to the Fermi level. The estimated conduction band minimum was 'cliff'-like; a situation made more severe considering the Cu-deficiency found for the CuSbS2 surface. The complex interface structure's effect on the performance of (Cd,Zn)S:Ga/CuSbS2-based solar cells and its limitation is discussed together with possible mitigation strategies.
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The local valence orbital structure of solid glycine, diglycine, and triglycine is studied using soft X-ray emission spectroscopy (XES), resonant inelastic soft X-ray scattering (RIXS) maps, and spectra calculations based on density-functional theory. Using a building block approach, the contributions of the different functional groups of the peptides are separated. Cuts through the RIXS maps furthermore allow monitoring selective excitations of the amino and peptide functional units, leading to a modification of the currently established assignment of spectral contributions. The results thus paint a new-and-improved picture of the peptide bond, enhance the understanding of larger molecules with peptide bonds, and simplify the investigation of such molecules in aqueous environment.
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Modelos Químicos , Peptídeos/química , Difusão Dinâmica da Luz , Elétrons , Glicina/química , Glicilglicina/química , Oligopeptídeos/química , Teoria Quântica , Água/química , Difração de Raios XRESUMO
The occupied and unoccupied electronic structure of imidazole (C3N2H4) and imidazolium (C3N2H5+) in aqueous solutions is studied by X-ray emission spectroscopy (XES) and resonant inelastic soft X-ray scattering (RIXS). Both systems show distinct RIXS fingerprints with strong resonant effects. A comparison with calculated X-ray emission spectra of isolated imidazole and imidazolium suggests only a small influence of hydrogen bonding in the aqueous solution on the electronic structure of imidazole and imidazolium, and allows the attribution of specific spectral features to the non-equivalent nitrogen and carbon atoms in the molecules. In the case of nitrogen, this can also be achieved by site-selective resonant excitation. Furthermore, we find spectator shifts and symmetry selectivity in the RIXS spectra, as well as indications for rapid proton dynamics on the femtosecond timescale of the RIXS process, and derive the HOMO-LUMO gaps for the two molecules in aqueous solution.
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The electronic structure of gas-phase methanol molecules (H3COH, H3COD, and D3COD) at atmospheric pressure was investigated using resonant inelastic soft X-ray scattering (RIXS) at the O K and C K edges. We observe strong changes of the relative emission intensities of all valence orbitals as a function of excitation energy, which can be related to the symmetries of the involved orbitals causing an angularly anisotropic RIXS intensity. Furthermore, all observed emission lines are subject to strong spectator shifts of up to -0.9 eV at the O K edge and up to -0.3 eV at the C K edge. At the lowest O K resonance, we find clear evidence for dissociation of the methanol molecule on the time scale of the RIXS process, which is illustrated by comparing X-ray emission spectra of regular and deuterated methanol.
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Type 1 diabetes results from the autoimmune destruction of the insulin-producing pancreatic beta (ß) cells. Patients with type 1 diabetes control their blood glucose levels using several daily injections of exogenous insulin; however, this does not eliminate the long-term complications of hyperglycaemia. Currently, the only clinically viable treatments for type 1 diabetes are whole pancreas and islet transplantation. As a result, there is an urgent need to develop alternative therapies. Recently, cell and gene therapy have shown promise as a potential cure for type 1 diabetes through the genetic engineering of 'artificial' ß cells to regulate blood glucose levels without adverse side effects and the need for immunosuppression. This review compares putative target cells and the use of pancreatic transcription factors for gene modification, with the ultimate goal of engineering a glucose-responsive 'artificial' ß cell that mimics the function of pancreatic ß cells, while avoiding autoimmune destruction.
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Diabetes Mellitus Tipo 1/terapia , Células Secretoras de Insulina/fisiologia , Animais , Técnicas de Cultura de Células , Desdiferenciação Celular , Transdiferenciação Celular , Reprogramação Celular , Terapia Genética , Humanos , Células Secretoras de Insulina/transplante , Fatores de Transcrição , Transdução GenéticaRESUMO
OBJECTIVE: To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes. METHODS: We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid. RESULTS: Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes. CONCLUSION: Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.
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The interface between solid-phase crystallized phosphorous-doped polycrystalline silicon (poly-Si(n(+))) and aluminum-doped zinc oxide (ZnO:Al) was investigated using spatially resolved photoelectron emission microscopy. We find the accumulation of aluminum in the proximity of the interface. Based on a detailed photoemission line analysis, we also suggest the formation of an interface species. Silicon suboxide and/or dehydrated hemimorphite have been identified as likely candidates. For each scenario a detailed chemical reaction pathway is suggested. The chemical instability of the poly-Si(n(+))/ZnO:Al interface is explained by the fact that SiO2 is more stable than ZnO and/or that H2 is released from the initially deposited a-Si:H during the crystallization process. As a result, Zn (a deep acceptor in silicon) is "liberated" close to the silicon/zinc oxide interface presenting the inherent risk of forming deep defects in the silicon absorber. These could act as recombination centers and thus limit the performance of silicon/zinc oxide based solar cells. Based on this insight some recommendations with respect to solar cell design, material selection, and process parameters are given for further knowledge-based thin-film silicon device optimization.
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Resonant inelastic soft x-ray scattering (RIXS) was used to study the electronic structure of solid cysteine films. A RIXS map approach, i.e., plotting the x-ray emission intensity as a function of excitation and emission energy, allows us to separate the contributions of the three chemically non-equivalent carbon atoms in cysteine. In particular, we can identify orbitals localized near the photoexcited atoms, as well as orbitals that are delocalized over the entire molecule.
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Carbono/química , Cisteína/química , Espalhamento de Radiação , Raios XRESUMO
OBJECTIVE: To estimate the prevalence and correlates of overweight and obesity among children six to ten years old in the North-East Health Region (NEHR) ofJamaica. METHODS: Weights and heights were measured in a representative sample of 5710 children between the ages of six and ten years in 34 schools between October 2008 and March 2009. Overweight and obesity were defined as body mass index (BMI) Z-score > 1SD and >2SD, respectively based on the World Health Organization (WHO)-endorsed age and gender-specific growth standards for children. Point prevalence estimates of overweight and obesity were calculated. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate associations between overweight and obesity and age, gender and school location. RESULTS: Overweight and obesity prevalence among children six to ten years old in NEHR, Jamaica, was 10.6% and 7.1%, respectively. Overweight (OR = 1.11, 95% CI: 1.04, 1.18) and obesity (OR = 1.17, 95% CI: 1.08, 1.26) prevalence increased significantly with age. Overweight (OR = 1.51, 95% CI: 1.27, 1.80) and obesity (OR = 1.36, 95% CI: 1.11, 1.67) prevalence was significantly higher among girls than boys. Children attending rural-public schools had less risk of being overweight (OR = 0.57, 95% CI: 0.46, 0.70) and obese (OR = 0.35, 95% CI: 0.28, 0.44) when compared with urban-public schools and private schools. Both overweight (OR = 2.11, 95% CI: 1.60, 2.78) and obesity (OR = 1.68, 95% CI: 1.24, 2.28) were significantly more common among children attending private schools. After adjusting for age and gender the results still remained statistically significant. CONCLUSIONS: Overweight/obesity prevalence among children six to ten years old in NEHR of Jamaica is 17.7% with older children and girls having higher rates. Children attending urban-public and private schools have higher prevalence than those attending rural schools. Appropriately targeted interventions are needed to combat this problem.
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Obesidade/epidemiologia , Distribuição por Idade , Índice de Massa Corporal , Criança , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Razão de Chances , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Distribuição por Sexo , Magreza/epidemiologia , População Urbana/estatística & dados numéricosRESUMO
OBJECTIVES: To estimate the prevalence of diabetic foot complications among patients at a specialist diabetes clinic in Jamaica and identify factors associated with foot complications. METHODS: A stratified random sample of 188 patients were interviewed and examined between 2009 and 2010. Trained nurses obtained demographic and clinical data, measured anthropometrics and performedfoot examinations including inspection for amputations, ulcers or infection and assessment of pain, vibration and pressure perception. RESULTS: Participants included 143 women and 45 men (mean age 56years; mean diabetes duration 16 years). The prevalence of amputations was 8.5% (95% CI 4.5, 12.5%) and was higher among men (22.2%) compared to women (4.2%, p < 0.05). Prevalence of current ulcers and current foot infections was 4.3% and 3.7%, respectively. Overall, 12% ofpatients had at least one of these foot complications. Foot complications were more prevalent among men, patients with high blood pressure (BP > or = 130/80 mmHg) or peripheral neuropathy In multivariable logistic regression models, factors associated with foot complications were: neuropathy (OR 9.3 [95% CI 2.8, 30.3]), high BP (OR 7.9 [1.3, 49.7]) and diabetes duration (OR 1.32 [1.02, 1.72]). CONCLUSION: Approximately one of every eight patients in this specialist clinic had a major foot complication. Associated factors were neuropathy, high blood pressure and longer duration of diabetes.
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Diabetes Mellitus/epidemiologia , Pé Diabético/epidemiologia , Neuropatias Diabéticas/epidemiologia , Hipertensão/epidemiologia , Doenças Vasculares Periféricas/epidemiologia , Adulto , Idoso , Instituições de Assistência Ambulatorial , Amputação Cirúrgica/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Jamaica/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores de TempoRESUMO
Over the last six decades, comprehensive national health surveys have become important data-gathering mechanisms to inform countries on their health status and provide information for health policy and programme planning. Developing countries have only recently begun such surveys and Jamaica has been at the forefront of this effort. Jamaica's Reproductive Health Surveys and programme response to their findings have resulted in an almost 50% reduction infertility rates over three decades as well as a 40% reduction in unmet contraceptive needs and a 40% reduction in unplanned pregnancies over the last two decades. The Jamaica Health and Lifestyle Surveys have served to reinforce the major burden that non-communicable diseases place on the society and the extent to which these are driven by unhealthy lifestyles. These surveys have shown that obesity, hypertension, diabetes and dyslipidaemia affect approximately 50%, 25%, 10% and 10% of the adult population, respectively. These surveys have documented low rates of treatment and control for these chronic non-communicable diseases despite two major policy initiatives, the National Programme for the Promotion of Healthy Lifestyles and the creation of the National Health Fund which subsidizes healthcare provision for chronic diseases. In order to maximize the uptake of the findings of future surveys into effective health policy, there will need to be effective collaborations between academia, policy-makers, regional and international health agencies, non-government organizations and civil society. Such collaborations should take into account the social, political and economic issues, thus ensuring a more comprehensive approach to health policy and result in improvement of the nation's health status and by extension national development.
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Política de Saúde , Nível de Saúde , Inquéritos Epidemiológicos , Doença Crônica/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Jamaica/epidemiologia , Estilo de VidaRESUMO
OBJECTIVE: To estimate the prevalence of high-risk sexual behaviours among Jamaican adults and evaluate associations with sociodemographic and religious factors. METHODS: We performed a cross-sectional study, using a nationally representative sample of Jamaicans, 15-74 years old. Participants completed an interviewer-administered questionnaire including questions on sexual activity, sociodemographic factors and religious practice. Having two or more sexual partners in the past year, non-use of condoms among persons with multiple partners and a history of previous sexually transmitted infection (STI) were the high-risk characteristics considered in the analysis. We obtained crude and category specific prevalence estimates for high-risk behaviour and estimated odds ratios for association with sociodemographic and religious factors. RESULTS: Data from 2833 participants who reported on sexually activity were analysed. Approximately 25% (95% CI 22, 27) of Jamaican adults had two or more sexual partners in the past year while 15% (95% CI 13, 17) had a past history of an STI. Approximately 6% (95% CI 5, 7) of persons with multiple partners did not use condoms during sexual intercourse. Overall, 32% (95% CI 30, 35) had any one of the three high-risk characteristics (male, 48%; female, 17%, p < 0.001). Being married, active religious practice and weekly attendance at religious meetings were associated with lower odds of high-risk sexual behaviour while being in a visiting relationship was associated with higher odds of high-risk behaviour CONCLUSION: A third of Jamaicans reported sexual practices that increase their risk of HIV infection. High-risk sexual behaviour was more common among men. Being married and weekly attendance at religious services were associated with lower odds of high-risk behaviour
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Religião e Medicina , Fatores Socioeconômicos , Sexo sem Proteção/estatística & dados numéricos , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Inquéritos Epidemiológicos , Humanos , Jamaica , Masculino , Estado Civil , Pessoa de Meia-Idade , Razão de Chances , Fatores Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Decreased physical activity (PA) has been associated with residents living in neighborhoods perceived as being disordered or having high crime levels. What is unknown are the characteristics of individuals who engage in moderate to vigorous levels of PA (MVPA) despite living in these vulnerable neighborhoods, or who may be referred to as positive deviants (PD). We examined the factors associated with PD for PA among Jamaicans. Between 2016 and 2017 the Jamaica Health and Lifestyle Survey, a cross-sectional nationally representative survey (n = 2807), was conducted on individuals aged 15 years and older. Regression analyses were performed to identify associations with PD, defined using engagement in MVPA among persons living in vulnerable neighborhoods (N = 1710). Being female (odds ratio [OR]a = 0.64 (0.48, 0.86); p = 0.003), obese while living in an urban area (ORa = 0.39; 95 % CI = 0.26, 0.59; p < 0.0001), unemployed (ORa = 0.53; 95 % CI = 0.39, 0.73; p < 0.0001), or a student (ORa = 0.62; 95 % CI = 0.39, 0.98); p = 0.041) was associated with a significantly lower likelihood of PD, while having a personal medical history of at least one chronic disease significantly increased likelihood (ORa = 1.43; 95 % CI = 1.08, 1.90; p = 0.014). Taking a PD approach may be one angle to consider in trying to determine what is working and for whom, so that this may be harnessed in policy, prevention and intervention programming to increase PA.
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With the advent of the epidemiological transition, chronic non-communicable diseases (CNCDs) have emerged as the leading cause of death globally. In this paper we present an overview of the burden of CNCDs in the Caribbean region and use Jamaica as a case-study to review the impact of policy initiatives and interventions implemented in response to the CNCD epidemic. The findings show that while Jamaica has implemented several policy initiatives aimed at stemming the tide of the CNCD epidemic, a comparison of data from two national health and lifestyle surveys conducted in Jamaica in 2000/01 and 2007/08 revealed that there was an increase in the prevalence of intermediate CNCD risk factors such as hypertension and obesity. We therefore present recommended strategies which we believe will enhance the current CNCD response and thus reduce, or at least stem, the current epidemic of CNCDs.
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Doença Crônica/epidemiologia , Saúde Pública , Doença Crônica/economia , Doença Crônica/prevenção & controle , Efeitos Psicossociais da Doença , Governo Federal , Política de Saúde , Prioridades em Saúde , Promoção da Saúde , Humanos , Hipertensão/epidemiologia , Jamaica/epidemiologia , Obesidade/epidemiologia , Setor Privado , Fatores de Risco , Índias OcidentaisRESUMO
BACKGROUND: Previous studies have documented a high burden of cardiovascular disease (CVD) risk factors in Jamaica and suggest that mortality from CVD may be increasing. This paper provides an update on the burden of CVD risk factors in Jamaica using data from the most recent national health survey and evaluates the impact of obesity and physical activity on other CVD risk factors. METHODS: The Jamaica Health and Lifestyle Survey 2007-2008 (JHLS-2) recruited a nationally representative sample of 2848 Jamaicans, 15-74 years old between November 2007 and March 2008. An interviewer administered questionnaire was used to obtain data on demographic characteristics, medical history and health behaviour Blood pressure and anthropometric measurements were made using standardized protocols and capillary blood samples were obtained to measure fasting glucose and total cholesterol. Prevalence estimates for the various CVD risk factors were obtained within and across sex and other demographic categories. Data were weighted for the complex survey design, nonresponse to questionnaire items or failure to complete some segments of the evaluation. RESULTS: Prevalence estimates for traditional CVD risk factors were: hypertension, 25%; diabetes, 8%; hypercholesterolaemia, 12%; obesity, 25%; smoking 15%. In addition, 35% of Jamaicans had prehypertension, 3% had impaired fasting glucose and 27% were overweight. A higher proportion of women had diabetes, obesity and hypercholesterolaemia while the prevalence of prehypertension and cigarette smoking was higher in men. Approximately 50% of persons with hypertension, 25% of persons with diabetes and 86% of persons with hypercholesterolaemia were unaware of their risk status. In multivariate analysis, obesity was associated with increased odds of hypertension, diabetes and hypercholesterolaemia while physical inactivity was associated with higher odds of diabetes. CONCLUSION: The burden of CVD risk factors in Jamaica remains very high and warrants interventions to reduce CVD risk.
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Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Efeitos Psicossociais da Doença , Diabetes Mellitus/epidemiologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Jamaica/epidemiologia , Estilo de Vida , Sobrepeso/epidemiologia , Fatores de Risco , População Rural/estatística & dados numéricos , População UrbanaRESUMO
Prehypertension is defined as a systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg in patients not on medication for hypertension. Recent studies have shown that prehypertension has a high prevalence in both western and eastern countries and is associated with cardiovascular disease (CVD) risk factors, incident CVD and CVD mortality. We reviewed data from ongoing epidemiological studies in Jamaica in order to provide an update on the prevalence and predictors of prehypertension in Jamaica. Studies included were the Jamaica Health and Lifestyle Surveys (2000-2001 and 2007-2008), the Jamaica Youth Risk and Resiliency Behaviour Survey 2006, the 1986 Jamaica Birth Cohort Study and the Spanish Town Cohort Study. The prevalence of prehypertension in the most recent national survey was 35% (95% CI 33, 38%). Prevalence was higher in men compared to women (42% versus 29%). Jamaicans with prehypertension were more likely to have other CVD risk factors and were three times more likely to develop hypertension compared with persons with a normal blood pressure. Prevalence was also high among youth, particularly males. Longitudinal analysis from the 1986 birth cohort suggested that prehypertension may be more common in persons with low birthweight or short birth length. Physicians and public health practitioners should recognize the increased CVD risk associated with prehypertension and should begin to institute CVD prevention measures in persons with prehypertension. Sex differences and the early onset of prehypertension in men require further exploration.
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Pré-Hipertensão/epidemiologia , Fatores Etários , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Progressão da Doença , Feminino , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Jamaica/epidemiologia , Estilo de Vida , Masculino , Fatores de RiscoRESUMO
The relevance of loci associated with blood lipids recently identified in European populations in individuals of African ancestry is unknown. We tested association between lipid traits and 36 previously described single-nucleotide polymorphisms (SNPs) in 1,466 individuals of African ancestry from Spanish Town, Jamaica. For the same allele and effect direction as observed in individuals of European ancestry, SNPs at three loci (1p13, 2p21, and 19p13) showed statistically significant association (p < 0.05) with LDL, two loci (11q12 and 20q13) showed association with HDL cholesterol, and two loci (11q12 and 2p24) showed association with triglycerides. The most significant association was between a SNP at 1p13 and LDL cholesterol (p = 4.6 × 10(-8)). This SNP is in a linkage disequilibrium region containing four genes (CELSR2, PSRC1, MYBPHL, and SORT1) and was recently shown to relate to risk for myocardial infarction. Overall, the results of this study suggest that much of the genetic variation which influences blood lipids is shared across ethnic groups.
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População Negra/genética , Loci Gênicos/genética , Lipídeos/sangue , Polimorfismo de Nucleotídeo Único , População Branca/genética , Adulto , Idoso , Feminino , Variação Genética , Estudo de Associação Genômica Ampla , Humanos , Jamaica/etnologia , Masculino , Pessoa de Meia-Idade , Análise de Sequência de DNARESUMO
Epidemiological studies on diabetes mellitus (DM) have been conducted in the Caribbean for more than four decades. In Jamaica, the estimated prevalence of DM among adults ranged from 1.3% in 1960 to 17.9% in 1995. Part of the variation in estimates has been due to the differing age groups that have been studied. The 2007-8 Jamaica Health and Lifestyle Survey (JHLS-2) reported prevalence estimates of 7.9% for diabetes mellitus and 2.8% for impaired fasting glucose in persons 15-74 years old. Across the Caribbean, the overall prevalence of diabetes mellitus is estimated at about 9%. In addition to the high burden of prevalent diabetes, there is also a high burden of complications. In Barbados, the incidence of diabetic foot complications has been found to be second only to a population of Native Americans in Najavo. The Barbados Eye Study revealed that among persons 40-84 years old in Barbados, 28.5% had evidence of diabetic retinopathy on fundus photographs. Regionally, the impact of DM on cardiovascular diseases (CVD) has not been adequately reported. With regards to diabetes care, poor control rates and inadequate surveillance for complications have been reported in Barbados, Trinidad and Tobago, Tortola and Jamaica. The JHLS-2 showed that while more than 70% of persons with diabetes were aware of the condition less than 50% were under control. In light of the expected increase in the number of people with diabetes mellitus, healthcare planners and researchers will need to redouble their efforts to both prevent as well as limit the impact of diabetes mellitus and its complications in Caribbean populations.
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Diabetes Mellitus/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Diabetes Mellitus/economia , Retinopatia Diabética/epidemiologia , Humanos , Jamaica/epidemiologia , Pessoa de Meia-Idade , Prevalência , Qualidade da Assistência à Saúde , Trinidad e Tobago/epidemiologia , Adulto JovemRESUMO
Human T-cell Lymphotropic Virus type-1 (HTLV-1), the first human retrovirus associated with a malignant disease, is endemic in Jamaica. Vertical transmission and sexual intercourse are the major routes of transmission. Women are at greater risk of contracting the virus as it is more efficiently transmitted from male to female than in the reverse. Prevention of transmission is best achieved by health education on safe practices. The study aims to document the knowledge, attitude and behaviour pattern (KABP) of a group of women five years after they had participated in a mother-to-child transmission of HTLV-1 risk reduction study. A cross-sectional study was conducted using a 46-point structured interviewer-administered questionnaire to capture data from 88 mothers. Overall knowledge scores were computed and four rating categories created. There were large deficiencies in the knowledge and practice of women at risk of being infected with HTLV-1. Only 58% knew that HTLV-1 is sexually transmitted. A minority was aware of HTLV-1 associated diseases: Adult T-cell lymphoma/leukaemia (ATL) -30.7%; Tropical Spastic Paraparesis (TSP) -42%; Infective dermatitis -42%). Ten (11.4%) believed that HTLV-1 infection can cause HIV/AIDS and only 33% knew that there was no cure for the virus. Most women (88.6%) continued to have unprotected sex. Controlling HTLV-1 spread must be based on interrupting transmission. In Jamaica, donated blood is screened for HTLV-1 and sharing of infected needle is an insignificant mode of transmission. However although safe practices in breastfeeding and sexual intercourse are proven ways to reduce HTLV-1 transmission, these data show that knowledge and safe practices among those at risk may not be retained and health education will need to be sustained.
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Aleitamento Materno , Infecções por HTLV-I/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Vírus Linfotrópico T Tipo 1 Humano , Mães , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Demografia , Feminino , Grupos Focais , Infecções por HTLV-I/epidemiologia , Educação em Saúde , Humanos , Transmissão Vertical de Doenças Infecciosas , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To assess the frequency of youth onset Type 2 diabetes mellitus (T2D) in Jamaica and the characteristics of youth with this form of diabetes. METHODS: Patients from two major referral hospitals, diagnosed with diabetes before age 25 years and < 6 years prior to the study, were evaluated. Classification was based on the presence of GAD-65 and IA-2 diabetes autoantibodies (AB), fasting (FCP) and stimulated C-peptide (SCP) measurements, serum leptin and clinical phenotype as follows: (i) Type IA diabetes--AB+, (ii) Type lB diabetes--AB- and FCP < 230 pmol/l and/or SCP < 660pmol/l, (iii) Type 2 diabetes - AB- and FCP > 500 pmol/L and or SCP 2 1160 pmol/l (iv) Untypeable diabetes--AB- and FCP 230-500 pmol/l and or SCP 660-1160 pmol/l and (v) Lipoatrophic diabetes--clinical phenotype and serum leptin. RESULTS: Fifty-eight participants (21M, 37F, age 20-8 years, duration of diabetes 2.6-2 years) were enrolled in the study. Using the classification criteria, Type 1 diabetes was the most common form of diabetes: 18 (31%) Type 1A, 18 (31%) Type IB. Overall 22% (13 patients) had T2D. Patients with T2D were more likely to be female, older at diagnosis, obese and have a higher blood pressure when compared to those with Type 1 diabetes. In logistic regression analysis, age of diabetes onset, gender BMI, systolic and diastolic blood pressure were significantly associated with T2D. Obesity measured by BMI was the strongest predictor of T2D. CONCLUSIONS: While Type 1 diabetes was the predominant form of diabetes in this study, a significant proportion of Jamaicans with youth onset diabetes may have T2D. Obesity is the strongest clinical predictor of Type 2 diabetes in the young diabetic patient.