Fathers' Experiences during Delivery of Their Newborns: A Content Analysis.

Background: Paternal involvement during pregnancy has been shown to have a positive impact on the mother-baby dyad during and after birth. The presence of the father during birth also positively influences father-child attachment, reduces, apprehension, and stress, increases maternal satisfaction, and increases love and respect for the partners. This study explored the experiences of fathers who were present in the delivery room during the delivery process. Methods: This qualitative content analysis study was conducted at a maternity hospital in Kingston, Jamaica from June to July 2022. A total of ten (10) fathers of babies delivered within six weeks were purposefully selected to be interviewed via telephone over four weeks. Data were analysed using a thematic approach. Results: Four sub-themes and one theme were extracted from data analysis. Fathers perceived satisfaction and empowerment in the shadow of positive and negative feelings as the theme. Sub-themes emerged from the data including "clinician's acceptance and support", "close bonding and attachment with mother and baby", "preparedness of fathers to give support", and "inspiring and amazing feeling by fatherhood experiences". Conclusion: Fathers experienced the feeling of empowerment and wished to take up their role during the delivery of their newborns. Their experiences were influenced by the midwives and the resources available to support their accommodation. More policies are needed to strengthen the fathers' involvement during antenatal clinic visits, delivery, and postnatal care.

Marijuana use and its correlates among school-going Jamaican adolescents: a finding from a national survey.

Introduction: The recent data indicate almost a fifth of Jamaican adolescents used marijuana in the past 30 days. To ensure the optimal allocation of resources, a country-specific understanding of factors associated with marijuana use among adolescents is essential. Therefore, this study aimed to address this gap among adolescents aged 13-17 years in Jamaica. Methods: We analyzed data from the recent Jamaica Global School-Based Student Health Survey conducted in 2017. The sample consists of school-going Jamaican adolescents of 7th-12th grades. The prevalence of recent marijuana use was assessed and compared across different demographics, substance use, and risk behaviors using bivariate and multivariable logistic regression analyses. Results: Older adolescents and men had a higher likelihood of recent marijuana use. Psychosocial risks, such as loneliness, frequent worry, suicidal ideation, physical attacks, and school absenteeism, were associated with higher marijuana usage. Parental smoking increased the odds, whereas strong parental support and awareness decreased it. Other substance uses, especially amphetamine and tobacco products, had strong associations with marijuana use. Early initiation of substances was associated with a higher risk of marijuana use. Sexually active adolescents, especially those initiated before the age of 14 years, had higher rates of marijuana use. Conclusion: The intricate link between harmful and supportive psychosomatic and risk behaviors with recent marijuana use highlights the importance of holistic interventions and policies focusing on emotional health, parental guidance, substance education, and sexual activity implications.

Knowledge, attitudes and practices among healthcare professionals regarding complementary alternative medicine use by patients with hypertension and type 2 diabetes mellitus in Western Jamaica.

OBJECTIVES: This study investigated the knowledge, attitudes, and practices (KAP) of healthcare professionals (HCPs) regarding CAM use for Hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM) among patients in western Jamaica, and to determine HCPs' perceptions of the need for training on CAM. DESIGN: A cross-sectional study was conducted from May to August 2019. SETTING: HCPs serving patients with HTN and T2DM in chronic disease clinics in western Jamaica completed a self-administered questionnaire that provided data on their sociodemographic characteristics, training, and KAP of CAM. MAIN OUTCOME MEASURE: The data identified factors associated with discussion and recommendation of CAM to patients and personal use of CAM by HCPs. RESULTS: Type of profession (physicians vs nurses OR = 2.17; 95 % CI = 1.07-4.42 and pharmacists vs nurses OR = 8.67; 95 % CI = 2.83-26.57) was significantly associated with discussion of CAM. Training on CAM was significantly associated with discussion (OR = 2.36; 95 % CI = 1.26-4.42), recommendation (OR = 2.72; 95 % CI = 1.36-5.42), and personal use of CAM (OR = 2.90; 95 % CI = 1.69-4.97). Dieticians and nutritionists had 4.56 higher odds of personal use of CAM (95 % CI = 1.16-17.86), and personal use of CAM was significantly associated with discussion (OR = 8.94; 95 % CI = 4.76-16.80) and recommendation (OR = 7.17; 95 % CI = 3.54-14.51) of CAM. The majority of HCPs (70-89 %) agreed that there is a need to include CAM in professional training programs. CONCLUSION: The results of this study can be used to guide development of programs for training HCPs on knowledge and safe use of CAM so that they can better serve their patients.

Factors associated with the use of complementary and alternative therapies among patients with hypertension and type 2 diabetes mellitus in Western Jamaica: a cross-sectional study.

BACKGROUND: This study examined the prevalence and predictors of complementary and alternative medicine use among clinic patients with hypertension and/or type 2 diabetes mellitus in western Jamaica. METHODS: A cross-sectional study using an investigator-administered questionnaire was conducted from May to August 2017. Data on sociodemographic factors, complementary and alternative medicine use, and knowledge and perceptions of complementary and alternative medicine were collected from the patients. Multivariable logistic regression analysis was used to examine associations between patient characteristics and knowledge and perceptions of complementary and alternative medicine and complementary and alternative medicine use. RESULTS: A total of 362 patients were invited to participate and 345 (95.3%) completed the questionnaire; 311 (90.1%) had hypertension, 130 (37.7%) had type 2 diabetes mellitus and 96 (27.8%) had both diseases. Seventy-nine percent of the participants with hypertension and 65% with type 2 diabetes mellitus reported current use of complementary and alternative medicine. Self-reported knowledge of complementary and alternative medicine (none/poor vs average/good/excellent) was significantly associated with complementary and alternative medicine use for hypertension (AOR = 0.33, 95% CI = 0.13-0.87) and type 2 diabetes mellitus (AOR = 0.06, 95% CI = 0.01-0.37). Believing that complementary and alternative medicine is a natural method for treating hypertension was significantly associated with complementary and alternative medicine use among patients with hypertension (AOR = 3.9, 95% CI = 1.26-12.00), and belief that it is acceptable to use prescription medication and complementary and alternative medicine simultaneously was significantly associated with complementary and alternative medicine use among patients with type 2 diabetes mellitus (AOR =7.19, CI = 1.34-38.52). CONCLUSIONS: Participants' perceptions of their knowledge and beliefs regarding complementary and alternative medicine strongly influence their use of complementary and alternative medicine. These findings can be used in designing educational interventions to promote the proper use, and mitigate detrimental effects, of complementary and alternative medicine in this population.

Issues in the establishment of a therapeutic cannabis market under Jamaica's Dangerous Drugs Amendment Act 2015.

INTRODUCTION: In 2015, Jamaica became the first Caribbean country to decriminalise personal cannabis possession, legalise home cultivation and establish a commercial therapeutic cannabis market via the passage of the Dangerous Drugs Amendment Act (DDAA). AIM: To critically analyse implementation of the legal therapeutic cannabis market under the DDAA. METHODS: Synthesis of findings from semi-structured face-to-face interviews with 22 key informants (KIs) from the government, industry, academia and NGO sector, unstructured interviews with illegal growers, and field observations of licensed and illegal operators. RESULTS: KIs identified a number of challenges in implementing therapeutic market provisions under DDAA, including a limited buy-in from key government agencies; delays in developing a framework for quality assurance; and lack of access to banking services. Public sector actors stressed the challenges imposed by the UN drug conventions and need to maintain favourable diplomatic relationship with the US federal government, with the consequence of prioritising enforcement to prevent diversion and inversion. Implementation of the Alternative Development Programme in two traditional cannabis-growing communities experienced challenges with land titles and frictions in local communities. High compliance costs and limited skills to meet the envisioned medical standards presented barriers for traditional farmers. Many KIs conceptualised the purchasing of cannabis from the regulated market as "recreational" rather than medical, reflecting the marketing and limited information on medical applications at point of sale. Licensees' reliance on foreign investment puts local industry at risk of predatory shareholder agreements, but also provides needed investment and expertise. CONCLUSION: External international factors (e.g. UN treaties, correspondent banking with the US) and conflicting domestic government agency visions for the reform played a significant role in the DDAA implementation. As cannabis law reform spreads beyond Western jurisdictions, consideration of pre-existing social, cultural and economic conditions of developing countries will be important.

Risk-Benefit Assessment for Total Mercury, Arsenic, Selenium, and Omega-3 Fatty Acids Exposure from Fish Consumption in Jamaica.

Fish is important in the traditional diet of Jamaicans, and the fishing industry contributes to social and economic development, as well as food security in Jamaica. However, there are associated health risks from contaminant exposure. The aim of this paper was to use risk-benefit analysis methods to determine the best fish species for consumption. Composite samples consisting of 14 fish species were collected from major fishing villages in 2016 and measured for total mercury, arsenic, selenium, and omega-3 fatty acids (EPA and DHA). Food frequency questionnaires were randomly distributed to 400 participants from different locations on the island. Participants were asked to identify the types of fish, portion size, and the frequency of consumption. An estimate of their weight was also recorded. Total mercury concentrations in fish samples ranged from 0.003 to 0.215 µg/g. The range of arsenic concentrations was 0.11 to 7.8 µg/g. The range of selenium concentrations was 0.302 µg/g to 1.08 µg/g. The mean omega-3 fatty acid concentration was 123.1 ± 93.6 mg/100 g. The fish consumption rates range from 3.2 to 1132.8 g/day. Cod fish was the most consumed species at 23.2 g/day. Four risk-benefit analysis methods were able to recommend four fish species that were best for consumption based on the levels of mercury, arsenic, selenium, and omega-3 fatty acids. They were doctorfish, parrotfish, snappers, and cod fish. The results of this study concluded that there was a low risk of mercury exposure from fish consumed in Jamaica.

Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer.

Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.

Bioaccumulation of cadmium in potato tuber grown on naturally high levels cadmium soils in Jamaica.

Jamaican soils have been reported to have naturally high level of cadmium (Cd), and its bioaccumulation in edible crops is of great concern for farmers, stakeholders, and public health authorities. The aim of this study was to determine the levels of Cd in soils in Jamaica and its bioaccumulation in potato tubers, and to determine the dominant soil factors influencing this bioaccumulation in potato. In addition, other soil factors were investigated such pH, electric conductivity (EC), cation exchange capacity (CEC), texture, organic matter content (OMC), and soil zinc (Zn) concentration. The soils' pH and Zn concentration were found to be the dominant factors influencing Cd accumulation in potato tubers, and this was confirmed by using a step-wise multiple regression analysis with the soil factors and tuber Cd (P < 0.05). With soil Cd ranging between 0.05 and 62.3 mg kg-1 and tuber Cd ranging between 0.01 and 0.22 mg kg-1 fresh weight, the bioaccumulation factor (BCF) of Cd in potato tuber gave a precise assessment of the influence of soil variables on Cd accumulation in potato tuber. The Cd concentration in potato tubers was found 50% higher than that recommended by the World Health Organization (WHO) regulation for potatoes (0.05 mg kg-1 fresh weight), and therefore, this should raise real concerns about the human health risk in Jamaica.

Transfer is not a transition - voices of Jamaican adolescents with HIV and their health care providers.

Increasing access to antiretroviral therapy in resource-limited settings (RLS) has resulted in the survival of perinatally HIV-infected children into adulthood. We characterized the transition process from pediatric to adult care by conducting semi-structured interviews of HIV-infected adolescents and health care providers in Jamaica. Using an inductive content analytic approach, four themes emerged: (1) Transition should be holistic and a process; (2) Pediatric clinics were like families; (3) Rootedness in the pediatric clinic; and (4) Need for adolescent-centered services to bridge the gap between pediatric and adult-centered services. Adolescent informed- and centered-transition approach may result in better outcomes for HIV-infected adolescents.

The Jamaican Haemophilia Registry: Describing the burden of disease.

INTRODUCTION: Jamaica has an estimated 200 persons with haemophilia (PWH), who face significant constraints in access to specialized haemophilia care, including access to clotting factor concentrates. AIM: The aim of this paper is to establish the current burden of disease in PWH in Jamaica. METHODS: PWH were enrolled through the University Hospital of the West Indies, Jamaica. The impact of haemophilia was assessed using a comprehensive battery of heath outcome measures that included the following: laboratory, clinical information and validated outcome measures of joint structure and function, activity, and health-related quality of life (HRQoL) to provide a health profile of the Jamaican haemophilia population. RESULTS: In all, 45 PWH were registered (mean age: 29, range: 0.17-69 years), including 13 children (<18 years of age) and 32 adults. In this sample, 41 had haemophilia A (30 severe) and 4 had haemophilia B (3 severe); 10 patients with haemophilia A were inhibitor positive. The results indicate that adults with haemophilia in Jamaica have significant joint damage: mean Haemophilia Joint Health Score (HJHS) = 42.1 (SD = 17.3); moderate activity levels - mean Haemophilia Activities List (HAL) score = 64.8 (SD = 17.8); and low HRQoL scores - mean Haemo-QoL-A score = 62.3 (SD = 19.4). Results for children are also reported but should be interpreted with caution due to the small sample size. CONCLUSIONS: There is a very high burden of disease in PWH in Jamaica. The health profiles reported in this paper are an essential first step in advocating for a multidisciplinary Comprehensive Care Program for assessment and care of PWH in Jamaica.

Attitudes of patients towards being cared for by male nurses in a Jamaican hospital.

AIM: To determine the attitudes of patients towards male nurses in a Jamaican hospital. BACKGROUND: More males in nursing will help to address the nursing shortage and provide diversity in the profession. Patient attitudes towards male nurses will influence recruitment and retention. METHODS: A cross-sectional study was used. Data were collected using a self-administered questionnaire and an attitudinal measuring scale. RESULTS: Seventy-three patients responded (response rate 91%). Male nurses were perceived negatively by 51% of respondents. However, only 10% had a negative perception of the care they received from male nurses. More males (80%) than females (54%) had a negative attitude towards receiving an enema from a male nurse. CONCLUSIONS: Patients generally had a negative attitude towards male nurses but had a positive view if they were cared for by a male nurse. These traits can be used as the basis of changing the gender balance of nurses in Jamaica.

'The white blood cell always eat the red': how Jamaicans with sickle cell disease understand their illness.

OBJECTIVE: To explore lay understandings of sickle cell disease (SCD) among Jamaicans living with the illness. There is no qualitative research on this subject in Jamaica, where SCD is the most common genetic disorder. DESIGN: Thirty in-depth semi-structured interviews (50% males, 50% urban residence) were conducted with adult patients attending the Sickle Cell Unit in Jamaica. Transcribed data were analysed using thematic analysis. RESULTS: Patients' narratives focused on two main themes: lay understandings of how SCD works (using ideas of attack and fortification, and blockage and flow); and what causes the illness (lay ideas of inheritance). The most common description of SCD was that their white blood cells were 'eating/sucking out/feeding on' their red blood cells. Hence, treatment required 'building up' their blood, while a key to good health was ensuring an unimpeded flow of blood. Most participants believed SCD was hereditary, but there were various understandings of the mechanism and probability of its transmission. Belief in the possibility of transmitting SCD was not always a barrier to reproduction, nor did participants always insist on their partner or child being tested. CONCLUSIONS: Participants engaged in medical pluralism, a dynamic combination of folk and biomedical beliefs. Their concerns, experiences and interpretations were powerful motivators of reproductive and screening behaviour. Their narratives of SCD transcend the individual to express social, societal and cultural realities. Health care professionals and policy-makers should communicate clearly to ensure understanding, and recognize and engage with their patients' sociocultural context.

TRAMIL ethnomedicinal survey in Jamaica.

ETHNOPHARMACOLOGICAL RELEVANCE: A survey was undertaken in Jamaica to document medicinal plants frequently used in the treatment or prophylaxis of illness and trends in their use, following the methodology established by the TRAMIL network. TRAMIL, a Caribbean-wide applied research programme, scientifically evaluates and documents the efficacy and safety of medicinal plant remedies used for primary health care. Initial results from this survey, on an aspect of safety, focusing on the concomitant use and prevalence of medicinal plant use in combination with pharmaceutical drugs in Jamaica, were published in an earlier paper in 2011. This paper now reports survey results on the ethnobotanical use of medicinal plants by Jamaicans. MATERIALS AND METHODS: A survey using a structured and modified TRAMIL questionnaire was administered to 407 adults selected randomly from systematically selected households within randomly selected clusters. The clusters were selected from each of the three areas that were purposefully selected. KEY FINDINGS: Respondents identified their use of 107 botanically identified medicinal plants distributed in 51 plant families to treat illnesses or maintain health in the previous twelve months. Fourteen plants, with significant use equal to or greater than 20% for a specified health issue were shortlisted, representing Jamaica׳s first submission to the TRAMIL database. Andrographis paniculata (Burm. f.) Nees (Rice Bitters) was reported as a plant remedy with significant use for the first time in a TRAMIL survey. Informant consensus factor (ICF) values were high for a number of health issues such as mental health (nerves, insomnia, etc.), respiratory system (cold/flu/cough etc.) and for health maintenance with tonics (washout and blood cleanse), indicating strong cultural coherence in medicinal plant selection for these categories. Forty two per cent (113/270) of medicinal plant users utilised mixtures, combining more than one plant. Leaf material was the most commonly used plant part (69%), with fresh material (98%) most commonly prepared as a tea for internal use by decoction (87%). The majority of medicinal plant respondents sourced plants from their backyards (75%) and cited grandmothers (33%) and mothers (32%) as their main sources of information. Jamaicans reported limited use of complementary and alternative medicine (CAM), supporting the assertion that a significant number of citizens in developing countries continue to rely on the use of medicinal plants for primary healthcare. CONCLUSIONS: Medicinal plant use continues to play an important role in primary healthcare in Jamaica. Fourteen plant remedies with significant use are reported, five previously reported elsewhere and recommended (REC) for the same health condition. Eight plant remedies, including one Jamaican endemic, are reported for different health issues for the first time to TRAMIL and will be investigated (INV) for the new health conditions, together with one plant remedy reported for the first time. This latest survey will be followed by literature reviews, appropriate laboratory screens (TRIG) and community outreach activities (TRADIF) in Jamaica.

Balamuthia mandrillaris therapeutic mud bath in Jamaica.

Balamuthia mandrillaris is an emerging cause of encephalitis in humans. The transmission dynamics are poorly understood due to the high fatality rate and the sporadic nature of cases. Seventy-two soil samples were collected from beaches and the banks of lagoons, rivers, ponds, mineral springs and streams from across Jamaica and assayed for the presence of B. mandrillaris. Seventy-nine sites were sampled and the mitochondrial 16S rDNA gene of B. mandrillaris was amplified and sequenced to confirm the presence of the amoeba. One isolate of B. mandrillaris was recovered from soil from mineral spring which hosts an informal therapeutic mud bath business. Although B. mandrillaris is less frequently isolated from soil than other free-living amoebae, rubbing mud containing the organism onto the skin increases the likelihood of exposure and infection. This first report on the isolation of B. mandrillaris in the Caribbean and its presence in soil where human contact is likely warrants further investigation using serological methods to elucidate exposure patterns.

Vitamin D levels are low in adult patients with sickle cell disease in Jamaica and West Africa.

BACKGROUND: Patients with sickle cell disease in the USA have been noted to have lower levels of vitamin D - measured as 25-hydroxyvitamin D (25(OH)D) - compared to controls. Average serum 25(OH)D levels are also substantially lower in African Americans than whites, while population distributions of 25(OH)D among Jamaicans of African descent and West Africans are the same as among USA whites. The purpose of this study was to examine whether adult patients with sickle cell disease living in tropical regions had reduced 25(OH)D relative to the general population. METHODS: We analyzed serum 25(OH)D in stored samples collected from studies in Jamaica and West Africa of adult patients with sickle cell disease and adult population controls. RESULTS: In samples of 20 Jamaicans and 50 West Africans with sickle cell disease mean values of 25(OH)D were 37% and 39% lower than controls, respectively. Metabolic abnormalities in the absorption and conversion pathways are possible causes for the consistent relative deficiency of 25(OH)D in sickle cell disease. CONCLUSIONS: Low 25(OH)D levels in tropical Africa where the burden of sickle cell disease is highest, deserve further investigation, and a randomized trial is warranted to address efficacy of supplementation.

Cadmium in Jamaican bush teas / El cadmio en las tisanas Jamaicanas

Samples of Jamaican plants used as bush teas were collected from households in high soil-cadmium (Cd) areas of central Jamaica and analysed by graphite furnace atomic absorption spectrophotometry for total cadmium and for cadmium extractable with a hot water brew as prepared for human consumption to determine their contribution to dietary cadmium exposure. The concentrations ranged from < 0.03 to 6.85 µg/g for total Cd, between 1 and 15% of which was extracted with a hot water brew. One cup (200 ml) of the teas examined was found to contain < 0.04-1.18 µg of Cd and would contribute 0.1 - 0.3 µg of Cd to a person's dietary intake. This is significantly below the provisional tolerable weekly intake (PTWI) of 7 µg Cd/kg body weight established by theWorld Health Organization (WHO). While this suggests that bush tea consumption does not contribute significantly to the PTWI, some of the teas examined exceed the WHO recommendation of less than 0.3 mg/kg Cd for medicinal plants.

Muestras de plantas jamaicanas utilizadas en las tisanas o tés herbales, fueron recogidas de los hogares en zonas de Jamaica central, donde el suelo presenta un alto contenido de cadmio (Cd). Las muestras fueron analizadas mediante espectrofotometría de absorción atómica con horno de grafito para investigar el contenido total de cadmio así como el cadmio extraíble con una infusión de agua caliente, al preparar infusiones para el consumo humano, y determinar su contribución a la exposición al cadmio dietético. Las concentraciones fluctuaron de < 0.03 a 6.85 µg/g para el Cd total, extrayéndose entre el 1 y el 15% de este con una infusión de agua caliente. Una taza (200 ml) de las tisanas examinadas contenía < 0,04 - 1.18 µg de Cd, lo cual contribuiría 0.1 - 0.3 µg de Cd al consumo dietético de una persona. Esta cantidad se halla significativamente por debajo de la "Ingesta semanal tolerable provisional" (PTWI por sus siglas en inglés) establecidas en 7 µg Cd/kg peso corporal por la Organización Mundial de la Salud (OMS). Si bien esto sugiere que el consumo de tisanas no contribuye significativamente al PTWI, algunas de las infusiones examinadas exceden la recomendación de la OMS de menos de 0.3 mg/kg Cd para las plantas medicinales.

Evaluation of dietary exposure to minerals, trace elements and heavy metals from the muscle tissue of the lionfish Pterois volitans (Linnaeus 1758).

Twenty-five samples of Pterois volitans caught in Jamaican waters were analyzed for 25 essential, non-essential and toxic elements using Graphite Furnace Atomic Absorption Spectrophotometry (GF-AAS), Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) and Instrumental Neutron Activation Analysis (INAA). The mean values for calcium (355 mg/kg), copper (107 µg/kg), iron (0.81 mg/kg), potassium (3481 mg/kg), magnesium (322 mg/kg), manganese (0.04 mg/kg), selenium (0.47 mg/kg), sodium (700 mg/kg) and zinc (4.46 mg/kg) were used to estimate dietary intake. The percentage contribution to provisional tolerable weekly intake for a 70 kg male and a 65 kg female were also estimated for the toxic elements arsenic (1.28% M, 1.38% F), cadmium (0.26% M. 0.28% F), mercury (3.85% M, 4.15% F) and lead (0.17% M, 0.18% F). To further assess the risk of mercury toxicity and the role of mitigation provided by selenium, selenium-mercury molar ratios were calculated for all samples. All samples were shown to have a molar excess of selenium. In addition the suggested selenium health benefit value was calculated, and was positive for all samples. It was concluded that P. volitans appears to contribute modestly to mineral and trace element nutrition, while not being a significant contributor to dietary exposure of toxic elements.

Traditional and alternative therapy for mental illness in Jamaica: patients' conceptions and practitioners' attitudes.

The aim of this study was to investigate traditional and alternative therapy for mental illness in Jamaica: patients' conceptions and practitioners' attitudes. The sample included 60 psychiatric patients selected from Ward 21 at the University of the West Indies, Kingston as well as Princess Margaret outpatient clinic, and 30 Afro-centric psychiatric nurses, psychiatrist and clinical psychologists from Kingston and St. Thomas, Jamaica. Patients were interviewed with the Short Explanatory Model Interview (SEMI) and practitioners completed a self administered questionnaire on attitudes towards traditional and alternative medicine. Results indicate that among psychiatric patients more than a third expressed the belief that the overall cause of their mental illness was as a result of supernatural factors. In general, the majority of patients felt that their perception of their problems did not concur with the western practitioner, which in turn caused distress for these patients. In case for those who also sought traditional medicine, they were more inclined to feel pleased about their interaction and the treatment they received. Results from western trained practitioners found that although they acknowledged that traditional medicine plays a major role in the treatment of mental illness among psychiatric patients the treatment was not advantageous. For the most part when all three traditional approaches were examined alternative medicine seemed more favourable than traditional healing and traditional herbal treatment. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems in treating mental illness.

Reduction in anaemia in pregnant women in three Caribbean countries. Possible results of different types of interventions.

PIP: The Caribbean Food and Nutrition Institute conducted a survey of anemia status of pregnant and/or lactating women in Jamaica (1982), Montserrat (1981), and St. Vincent and the Grenadines (1985). After various interventions designed to reduce the prevalence of anemia in pregnant women, follow-up surveys were conducted in the same countries five years after the initial surveys to determine whether or not the prevalence of anemia in pregnant women did indeed fall after these interventions. As of July 1984, the Jamaica Flour Mills began fortifying all baking flour and counter flour with iron (44 mg/kg) (a 70% increase in the amount of iron added), thiamine (6.3 mg/kg), riboflavin (3.9 mg/kg), and niacin (52.8 mg/kg). During the five year period following the initial survey in Montserrat, health workers had changed the type of iron administered to pregnant women, a constant supply of iron tablets was established, and the economy had improved. The changes in St. Vincent and the Grenadines were that the government provided a constant supply of iron folate (ferrous folate) tablets and there was a 1988 workshop on a manual on the control of anemia where nurses were trained in better clinic management of anemia. The prevalence of anemia (Hb 11 g/dl) in pregnant women fell from 61.6% to 53% (p 0.09) in Jamaica. It fell from 82.3% to 22.1% in Montserrat (p 0.0001). The prevalence of anemia (Hb 10 g/dl) in pregnant women fell from 25% to 14.5% (p 0.001) in St. Vincent and the Grenadines. These findings show that different interventions may have contributed to the reduction in the prevalence of anemia in pregnant women in Jamaica, Montserrat, and St. Vincent and the Grenadines.^ieng

Bone turnover in malnourished children.

Pyridinoline (PYD) and deoxypyridinoline (DPD) are cross-linking aminoacids of collagen that are located mainly in bone and cartilage. When bone matrix is resorbed these cross-links are quantitatively excreted in the urine and therefore represent specific markers. We have measured the urinary excretion rate of PYD and DPD in 46 severely malnourished boys to assess their skeletal turnover and to relate this to their subsequent rate of growth. The children were aged 13 months (SD 6), and height-for-age was -3.6 (1.6) Z-score, and weight-for-height was -2.4 (0.8) Z-score. PYD excretion when malnourished and after "recovery" was 11.2 (4.6) nmol h-1m-2 and 32.2 (10.8) nmol h-1m-2 and DPD excretion was 2.6 (1.3) nmol h-1m-2 and 7.5 (3.0) nmol h-1m-2, respectively. The ratio of the two cross-links did not change with recovery. These data show that cartilage and bone turnover is much lower in the malnourished than in the recovered child. There was no difference in the degree of depression of turnover between the children with marasmus, marasmic-kwashiorkor, or kwashiorkor. The rate of height gain during recovery was significantly related to cross-link excretion, age, and weight-for-height on admission. These three factors accounted for 44% of the variance in the height velocity of the children. PYD and DPD excretion rate could be used to assess therapeutic interventions designed to alleviate stunting.

PIP: The Tropical Metabolism Research Unit at the University of the West Indies in Jamaica made anthropometric measurements of 46 13-month-old male infants to assess changes in bone resorption during malnutrition by measuring the urinary excretion rate of pyridinoline (PYD) and deoxypyridinoline (DPD) and to determine whether bone turnover is associated with recovery. Unit staff used standard methods to treat the malnourished boys, including an energy dense diet (cow's milk formulated from Perlargon and corn or coconut oil). Before treatment, their height-for-age stood at -3.6 Z-score and their weight-for-height was -2.4 Z-score. The rate of excretion of PYD and DPD in malnourished children was only about 33% of that after they recovered (11.2 nmol per hour per sq. meter vs. 32.2 nmol per hour per sq. meter and 2.6 nmol vs. 7.5 nmol per hour per sq. meter, respectively; p .001). Therefore, cartilage and bone turnover was considerably lower in the children when they were malnourished than when they recovered. Recovery did not alter the ratio of these 2 cross-link amino acids, however, suggesting that changes in endochondral growth relative to bone remodelling did not occur. The extent of depression in bone turnover was basically the same between children with marasmus, marasmic-kwashiorkor, or kwashiorkor. The rate of height gain of the children during recovery from malnutrition was significantly associated with age (p .001), PYD excretion at admission (p = .003), and weight-for-height at admission (p = .01), all 3 of which explained 44% of the variance in the rate of height gain of the children. Since this study demonstrated that PYD and DPD are associated with longitudinal growth in children recovering from malnutrition, more research on the effect of dietary manipulation on longitudinal growth should be done, which should define requirements for longitudinal growth and identify needed steps to prevent stunting.