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

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

Access to care and maternal mortality in Jamaican hospitals: 1993-1995.

BACKGROUND: As part of the reproductive health quality assurance programme, the Ministry of Health sought to review maternal deaths in public hospitals. These hospitals attend 95% of institutional births and 82% of all births. METHODS: Deaths among females 10-50 years in public hospitals during 1993-1995 were reviewed to identify pregnancy-related deaths. Cause of death and access to care were compared with previous studies (1981-1983 and 1986-1987 [12 months]). RESULTS: The maternal mortality ratio of 106.2 per 100 000 live births, was no different than the 119.7 observed in 1986-1987 and 118.6 for 1981-1983. The leading causes of death remained pre-eclampsia/eclampsia and haemorrhage. The only significant cause-specific decline occurred among deaths due to ruptured ectopic pregnancy (P = 0.012). While in 1986-1987 access to care was associated with risk of death from gestational hypertension (P = 0.02), these differences are no longer significant. Differences persist, however, for haemorrhage and all other causes, which were less likely to occur at the more skilled institutions. The region with the least obstetricians had the highest mortality ratio but the one with the most did not have the lowest ratio, indicating that quality is more important than quantity. CONCLUSIONS: Regional differences indicate the capacity to reduce maternal mortality by at least 50% with re-allocation of skilled personnel and improved quality. All hospitals must be able to manage haemorrhage cases as patients are unlikely to survive referral.

Adult Obesity: Management Practices of General Practitioners/Family Physicians in Kingston and St Andrew, Jamaica / Obesidad en Adultos: Prácticas de su Tratamiento por Parte de los Médicos Generales/médicos de Familia en Kingston y Saint Andrew, Jamaica

ABSTRACT Objective: To determine the practices of Family Physicians/General Practitioners in Kingston and St Andrew regarding the management of adult obesity and compare their management to the 2013 American College of Cardiology/American Heart Association/Task Force on Practice Guidelines and The Obesity Society (AHA/ACC/TOS) Guidelines for the Management of Overweight and Obesity in Adults. Methods: A cross-sectional study was done of Family Physicians/General Practitioners in the Kingston and St Andrew area. A Census approach was used with the aid of a self-administered questionnaire and practices compared to the American Guidelines for Obesity Management. Results: There were 117 respondents out of the 155 Family physicians/General practitioners. While most physicians were found to have medium to high level practice scores, 23% had low practice scores. Diagnosis of obesity using body mass index (BMI) was high (99%), but only 64% employed hormonal assays. Almost 36% did not refer patients with BMI > 40 kg/m2 for bariatric surgery. Conclusion: Assessed against existing guidelines, physicians were found generally to have medium to high practice levels regarding management of obesity, however, gaps remain to be closed.

RESUMEN Objetivo: Determinar las prácticas de los médicos de familia/médicos generales en Kingston y Saint Andrew en relación con el tratamiento de la obesidad en adultos y comparar su tratamiento con las Pautas para el Tratamiento del Sobrepeso y la Obesidad en Adultos del Colegio Americano de Cardiología/Sociedad Americana del Corazón/Grupo de Trabajo para las Guías Prácticas y la Sociedad de la Obesidad (AHA/ACC/TOS) de 2013. Métodos: Se realizó un estudio transversal de médicos de familia/ médicos generales en el área de Kingston y Saint Andrew. Se usó un enfoque de censo con la ayuda de un cuestionario autoadministrado y prácticas comparadas a las pautas americanas para el tratamiento de la obesidad. Resultados: Hubo 117 encuestados provenientes de los 155 médicos de familia/médicos generales. Si bien se halló que la mayor parte de los médicos tenían niveles de medio a alto en las puntuaciones de la práctica, el 23% tenía puntuaciones bajas de la práctica. El diagnóstico de la obesidad usando el índice de masa corporal (IMC) fue alto (99%), pero solamente el 64% empleó ensayos hormonales. Casi el 36% no remitió pacientes con IMC > 40 kg/m2 para cirugía bariátrica. Conclusión: Evaluados frente a las pautas existentes, los médicos generalmente mostraron niveles de práctica medios a altos con respecto al tratamiento de la obesidad. Sin embargo, quedan aún vacíos por llenar.

Prevalence of self-reported urinary incontinence in the community dwelling elderly population of Westmoreland, Jamaica

OBJECTIVE: To determine the prevalence of urinary incontinence in elderly population of Westmoreland, Jamaica. DESIGN AND METHODS: A cross-sectional study was conducted in twelve community clusters in Westmoreland, Jamaica. Data was gathered using an interviewer-administered questionnaire. Analysis of data was done using the Statistical Package for the Social Sciences SPSS version 17. RESULTS: The majority (53.1%, n = 241) of respondents were males with age of the sample ranging from 60 to 95 years (median age of 69.0; interquartile range [IQR] = 15 years). There was a prevalence of urinary incontinence (UI) of 10.6%; approximately 30% of affected respondents had not reported this to their doctor. Reasons given for not reporting condition to doctors were: - symptoms not bothersome (70%); thought that UI was normal in older age (81.8%); belief that no treatment is available (12.5%); did not know which doctor to attend (25.0%). The two main barriers for reporting UI to the doctor were being ashamed (44.4%) and being unable to afford treatment for UI (66.7%). The majority (76.9%, n = 10) indicated a preference for physician initiated discussion of UI. CONCLUSION: Urinary incontinence was reported in ten per cent of study population and of these thirty percent had not reported this to their doctor. This underscores the need for doctors, especially at the primary care level, to establish a systematic screening regime for older persons, designed to detect symptoms of urinary incontinence in the early period.

The association between personality types and medication adherence among adult hypertensive patients

OBJECTIVE: To investigate the prevalence of adherence to antihypertensive medication and its association with personality types among adult hypertensive patients. DESIGN AND METHODS: This was a cross-sectional study, which used the Big Five Inventory to assess personality types and Morisky Medication Adherence Scale (MMAS-8) to measure antihypertensive medication adherence, among a convenience sample of 301 hypertensive primary-care patients. Chi square tests, t-tests, correlations and regression techniques were used to examine associations between variables. RESULTS: The mean MMAS-8 score was 5.00 ñ 1.69. Most respondent (60%) demonstrated low adherence (score <6) with only 7% achieving high adherence (score = 8). Persons who scored highly for neuroticism were less likely to be adherent [OR = 0.30; (0.10-0.88)], as were the employed compared to the unemployed [(OR = 0.34; (0.14-0.86)]. In contrast, older persons demonstrated higher adherence levels [(OR = 1.06 (1.01-1.11)]. Regression model variables accounted for 13% of variance in antihypertensive adherence. CONCLUSIONS: This sample demonstrated low antihypertensive adherence; lowest for those high on the neuroticism scale, the employed and younger participants. This implies personality type should be considered in managing chronic diseases to identify clients requiring intervention, thereby improving control, reducing morbidity and enhancing efficient use of scarce resources. Efforts are also needed to address other risk factors that impact adherence.