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1.
Nurse Educ Today ; 84: 104242, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31683139

RESUMO

BACKGROUND: Exposure of nursing students to global health care systems and cultures that are vastly different from which they are accustomed allow them to gain a unique perspective of our global village. A plethora of research has studied the lived experiences of visiting students during international clinical placements. Many studies have noted a multitude of benefits for visiting students. However, very little research examined the perspectives of host participants. OBJECTIVES: This study explores both visiting and host students and faculty's perceptions of reciprocity during international learning experiences. DESIGN: A qualitative descriptive design was utilised. SETTING: Intercultural collaboration between visiting and host participants occurred over a two week clinical learning experience in a regional hospital in Jamaica. PARTICIPANTS: Ten third year undergraduate Bachelor of Nursing students and two faculty from Canada engaged in clinical learning experiences with twelve fourth year host nursing students and three faculty from Jamaica. METHOD: Visiting students submitted reflective papers, participated in interviews, and a focus group two months later. Two separate focus groups were held to gather data from the hosting students and faculty. All data was analysed using thematic analysis for recurring themes. RESULTS: The findings of this study show that both host and visiting students and faculty mutually gain benefits from intercultural exchange and collaboration. Reciprocity was noted in experiential knowledge acquisition, cultural awareness from educational and professional perspectives, and personal and professional transformative learning. Although notable differences from contrasting health care worlds were identified, the recognition of similarities and opportunities for transformative learning greatly outweighed the differences. CONCLUSION: There are reciprocal benefits to be gained in nursing education for visiting and host participants through the development of collaborative international partnerships. More research is required to further explore mutuality for students and faculty from different countries.


Assuntos
Intercâmbio Educacional Internacional , Estudantes de Enfermagem/psicologia , Canadá , Bacharelado em Enfermagem , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Jamaica , Masculino , Adulto Jovem
2.
Nurse Educ Today ; 84: 104221, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31683134

RESUMO

BACKGROUND: International service learning is becoming widely used in nursing education as a means to provide global learning opportunities as well as part of a clinical learning experiences. Concrete outcomes for these experiences have not been clearly supported in previous research. Professional nursing values are an important learning outcome for nursing students and development of professional nursing values has been found to occur through various learning experiences. Determining if international service learning experiences facilitate the development of professional nursing values can support the use of international service learning as a viable pedagogy. OBJECTIVE: The purpose of the study was to determine if there was a difference in professional nursing values development in students who participate in international service learning as part of their clinical experiences compared to those who do not. DESIGN: The research was a quasi-experimental study with a pre-test, post-test design. SETTING/PARTICIPANTS: Undergraduate students participating in one week international service learning as part of their clinical hours were compared with students who did not participate in international service learning. METHODS: Comparison of professional nursing values development between the experimental and control group was completed using the Nurses Professional Values Scale. RESULTS: The study showed the use of international service learning as part of clinical was at least equivalent in the development of professional nursing values as traditional clinical. In addition, it supported the development of professional nursing values through clinical learning overall. CONCLUSION: The use of international service learning is a viable option for clinical experiences as a means to develop professional nursing values.


Assuntos
Intercâmbio Educacional Internacional/estatística & dados numéricos , Valores Sociais , Estudantes de Enfermagem/psicologia , Bacharelado em Enfermagem/métodos , Feminino , Guatemala , Humanos , Jamaica , Aprendizagem Baseada em Problemas/métodos , Psicometria/instrumentação , Psicometria/métodos , Psicometria/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Adulto Jovem
3.
PLoS One ; 14(12): e0227144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31881050

RESUMO

Understanding determinants associated with dropout from sport is important for talent development. This study aimed (i) to determine dropout rates for Jamaican track and field athletes and (ii) to examine contextual factors (i.e., relative age effect and place of development) as potential determinants of junior athletes progressing to the senior level. A sample of 1552 track and field athletes (mean age 18.57±0.41 years) who were finalists at the national high school (junior) championships in Jamaica between 2000 and 2017 were evaluated from the Jamaica Athletics Administrative Association database. The database provided birth date, school attendance and performance results. A retrospective analysis was completed to investigate the relationship between junior and senior successes and dropout rates. Chi-square analyses were conducted to examine the distribution of birth date quartiles based on the selection year. Using the Jamaican census information, the population size of regions where participants attended school were categorized and used as a proxy for athletes' place of development. Results showed that the majority of the participants did not progress to senior levels (81%). The relative age effect was evident for athletes who progressed to the senior level but was not evident for athletes who did not progress. There was a bias towards participants who attended school in regions with a population size between 5000-29 999. This study illuminates some of the contextual factors that may influence the likelihood of progressing from junior to senior levels which may help to inform talent identification, selection and development in the sport of track and field.


Assuntos
Desempenho Atlético , Atletismo , Adolescente , Adulto , Atletas , Feminino , Humanos , Jamaica , Masculino , Instituições Acadêmicas , Adulto Jovem
4.
Nat Commun ; 10(1): 5791, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31857576

RESUMO

Edematous severe acute childhood malnutrition (edematous SAM or ESAM), which includes kwashiorkor, presents with more overt multi-organ dysfunction than non-edematous SAM (NESAM). Reduced concentrations and methyl-flux of methionine in 1-carbon metabolism have been reported in acute, but not recovered, ESAM, suggesting downstream DNA methylation changes could be relevant to differences in SAM pathogenesis. Here, we assess genome-wide DNA methylation in buccal cells of 309 SAM children using the 450 K microarray. Relative to NESAM, ESAM is characterized by multiple significantly hypomethylated loci, which is not observed among SAM-recovered adults. Gene expression and methylation show both positive and negative correlation, suggesting a complex transcriptional response to SAM. Hypomethylated loci link to disorders of nutrition and metabolism, including fatty liver and diabetes, and appear to be influenced by genetic variation. Our epigenetic findings provide a potential molecular link to reported aberrant 1-carbon metabolism in ESAM and support consideration of methyl-group supplementation in ESAM.


Assuntos
Metilação de DNA , Epigenoma/genética , Desnutrição Aguda Grave/genética , Adolescente , Adulto , Estudos de Casos e Controles , Pré-Escolar , Ilhas de CpG/genética , Epigenômica/métodos , Feminino , Perfilação da Expressão Gênica , Humanos , Lactente , Jamaica/epidemiologia , Malaui/epidemiologia , Masculino , Mucosa Bucal , Estudos Prospectivos , Estudos Retrospectivos , Desnutrição Aguda Grave/mortalidade , Sobreviventes , Adulto Jovem
5.
Nat Commun ; 10(1): 5808, 2019 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-31862890

RESUMO

The causes of impaired skeletal muscle mass and strength during aging are well-studied in healthy populations. Less is known on pathological age-related muscle wasting and weakness termed sarcopenia, which directly impacts physical autonomy and survival. Here, we compare genome-wide transcriptional changes of sarcopenia versus age-matched controls in muscle biopsies from 119 older men from Singapore, Hertfordshire UK and Jamaica. Individuals with sarcopenia reproducibly demonstrate a prominent transcriptional signature of mitochondrial bioenergetic dysfunction in skeletal muscle, with low PGC-1α/ERRα signalling, and downregulation of oxidative phosphorylation and mitochondrial proteostasis genes. These changes translate functionally into fewer mitochondria, reduced mitochondrial respiratory complex expression and activity, and low NAD+ levels through perturbed NAD+ biosynthesis and salvage in sarcopenic muscle. We provide an integrated molecular profile of human sarcopenia across ethnicities, demonstrating a fundamental role of altered mitochondrial metabolism in the pathological loss of skeletal muscle mass and function in older people.


Assuntos
Envelhecimento/fisiologia , Mitocôndrias/patologia , Músculo Esquelético/patologia , NAD/biossíntese , Sarcopenia/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos de Casos e Controles , Metabolismo Energético/fisiologia , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Mitocôndrias/metabolismo , Músculo Esquelético/citologia , Músculo Esquelético/metabolismo , Oxirredução , Fosforilação Oxidativa , Estresse Oxidativo/fisiologia , Proteostase , Sarcopenia/etnologia , Singapura , Reino Unido
6.
Zootaxa ; 4604(1): zootaxa.4604.1.4, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31717203

RESUMO

Elpidium ostracods are known by their very particular niche (water accumulated in tank-bromeliads), their relatively low dispersal ability and their dependency on amphibians for dispersal and colonization of new bromeliads. All these characteristics make the genus an interesting group for evolutionary, ecological and even taxonomic studies. However, the diversity of the group remains poorly studied. Here, we describe three new species of Elpidium, Elpidium littlei n. sp., Elpidium heberti n. sp. and Elpidium wolfi n. sp., and re-describe Elpidium laesslei, all from Jamaica. These species are characterized by a copulatory process with separated ejaculatory duct and distal glans, a feature so far unique within the genus. Each species can, in turn, be diagnosed by soft part and carapace morphology, most notably comparing hemipenis, valve ornamentation and degree of sexual dimorphism. The observed morphological diversity of Elpidium is discussed in relation to previous genetic estimates that suggested an even higher diversity in Jamaica. We point to intraspecific variation and lack of complete morphological descriptions as possible explanations. We also reaffirm the need of multidisciplinary studies in order to do more objective and secure taxonomic classifications in future studies.


Assuntos
Evolução Biológica , Crustáceos , Animais , Ecologia , Jamaica , Caracteres Sexuais
7.
PLoS One ; 14(11): e0224516, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31756190

RESUMO

The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12-65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.


Assuntos
Crime/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Meio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Criança , Modificador do Efeito Epidemiológico , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
9.
Int J Inj Contr Saf Promot ; 26(4): 399-404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31429368

RESUMO

Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Traumatismos Craniocerebrais/epidemiologia , Estudos Transversais , Educação/estatística & dados numéricos , Feminino , Humanos , Seguro/estatística & dados numéricos , Jamaica/epidemiologia , Licenciamento/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Motocicletas/legislação & jurisprudência , Sistema Musculoesquelético/lesões , Adulto Jovem
10.
PLoS One ; 14(7): e0215262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339887

RESUMO

Oral and fecal microbial biomarkers have previously been associated with cardiometabolic (CM) risk, however, no comprehensive attempt has been made to explore this association in minority populations or across different geographic regions. We characterized gut- and oral-associated microbiota and CM risk in 655 participants of African-origin, aged 25-45, from Ghana, South Africa, Jamaica, and the United States (US). CM risk was classified using the CM risk cut-points for elevated waist circumference, elevated blood pressure and elevated fasted blood glucose, low high-density lipoprotein (HDL), and elevated triglycerides. Gut-associated bacterial alpha diversity negatively correlated with elevated blood pressure and elevated fasted blood glucose. Similarly, gut bacterial beta diversity was also significantly differentiated by waist circumference, blood pressure, triglyceridemia and HDL-cholesterolemia. Notably, differences in inter- and intra-personal gut microbial diversity were geographic-region specific. Participants meeting the cut-points for 3 out of the 5 CM risk factors were significantly more enriched with Lachnospiraceae, and were significantly depleted of Clostridiaceae, Peptostreptococcaceae, and Prevotella. The predicted relative proportions of the genes involved in the pathways for lipopolysaccharides (LPS) and butyrate synthesis were also significantly differentiated by the CM risk phenotype, whereby genes involved in the butyrate synthesis via lysine, glutarate and 4-aminobutyrate/succinate pathways and LPS synthesis pathway were enriched in participants with greater CM risk. Furthermore, inter-individual oral microbiota diversity was also significantly associated with the CM risk factors, and oral-associated Streptococcus, Prevotella, and Veillonella were enriched in participants with 3 out of the 5 CM risk factors. We demonstrate that in a diverse cohort of African-origin adults, CM risk is significantly associated with reduced microbial diversity, and the enrichment of specific bacterial taxa and predicted functional traits in both gut and oral environments. As well as providing new insights into the associations between the gut and oral microbiota and CM risk, this study also highlights the potential for novel therapeutic discoveries which target the oral and gut microbiota in CM risk.


Assuntos
Doenças Cardiovasculares/microbiologia , Microbioma Gastrointestinal , Doenças Metabólicas/microbiologia , Boca/microbiologia , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Gana/epidemiologia , Humanos , Jamaica/epidemiologia , Masculino , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , África do Sul/epidemiologia , Estados Unidos/epidemiologia , Circunferência da Cintura
11.
Acta Trop ; 199: 105112, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31351894

RESUMO

This report describes the presence of Aedes albopictus (Skuse) in Jamaica. The adults were found while conducting an ongoing survey of mosquitoes on the island. Specimens were collected using a combination of modified Center for Disease Control (CDC) miniature light traps and BG sentinel traps. A total of six adult female Ae. albopictus mosquitoes were collected at two different locations in October of 2018. This finding increases the number of Aedes mosquito species on the island bringing with it public health implications.


Assuntos
Aedes , Animais , Feminino , Jamaica , Controle de Mosquitos , Saúde Pública
12.
PLoS One ; 14(7): e0219250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291297

RESUMO

The study examines the potential influence of sub-regional variations in climate, and specifically heavy rain events, in determining relative vulnerabilities of locations in twelve Caribbean countries. An aggregate vulnerability index, referred to as the Caribbean Vulnerability Score (CVS), is created using historical demographic and socioeconomic data and climate data representing extreme rain events. Four scenarios are explored. Firstly, comparative vulnerabilities are determined when heavy rainfall is incorporated in CVS versus when it is excluded. The impact of climate change is also investigated using future climate data derived from statistical downscaling but holding demographic and socioeconomic sub-indices constant. The analysis is repeated with projections of future demographic structure from the Shared Socioeconomic Pathway data (SSP3), future climate projections and constant socioeconomic. Finally, the sensitivity of the results is examined with respect to applying different weights i.e. versus using equal weights for the climate and non-climatic components of CVS as is done for the first three scenarios. Results suggest that the inclusion of historical susceptibility to rainfall extremes influences relative vulnerabilities within the Caribbean when compared to the rankings of vulnerability derived using only socioeconomic and demographic inputs. In some cases significant increases in relative rankings are noted. Projected changes in the intensity of rain events across the Caribbean region in the 2030s and 2050s, do not significantly alter the top and lowest ranked vulnerable locations when demographic and socioeconomic indices are held constant. Changes may however occur in the order of the top ranked locations dependent on scenario and time slice. In general, future shifts in relative vulnerabilities were found to be dependent on (i) changes in both future climate and demographic scenarios, (ii) the time horizons being considered, and (iii) the weighting assigned to climate in the future.


Assuntos
Mudança Climática , Demografia , Fatores Socioeconômicos , Belize/epidemiologia , Região do Caribe/epidemiologia , Cuba/epidemiologia , República Dominicana/epidemiologia , Guiana/epidemiologia , Humanos , Umidade , Jamaica/epidemiologia , Chuva
13.
BMC Public Health ; 19(1): 894, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286918

RESUMO

BACKGROUND: Small island Caribbean countries such as Jamaica are now facing an epidemic of obesity and decreased physical activity (PA) levels. Public parks have been shown to be important resources for PA that also provide psychological and social benefits associated with increased PA. There are no studies that document PA in parks in the Caribbean. METHODS: This study utilized a mixed method approach by using the System for Observing Play and Recreation in Communities (SOPARC) to obtain baseline data on park usage patterns in Emancipation Park, a large urban public park in Jamaica. In addition, in-depth interviews were conducted to gain additional insights on the park's use for PA. RESULTS: The park was used mostly by females, in the evenings and by persons 18-64 years old. Females had significantly lower mean energy expenditure (EE) than males (0.078 versus 0.080 kcal/kg/min, p < 0.05). In-depth interviews revealed that safety, a central location within a business district, aesthetic appeal, a walking track and individual health benefits were key reasons for persons engaging in PA at the park. CONCLUSIONS: This is the first study to describe the usage of a public park for PA in Jamaica. The study elicited aspects of park use for PA in a major urban park in Jamaica from different vantage points by using direct systematic observation augmented with a qualitative approach. It revealed important differential park use for PA by sex, age group and EE levels, and provided insights into factors that motivate and hinder park usage for PA. This can be used by policymakers in Jamaica to inform PA interventions to reduce obesity, provide baseline data for comparisons with other parks in developing countries and to advocate for well-designed public parks.


Assuntos
Exercício Físico/psicologia , Parques Recreativos/estatística & dados numéricos , Recreação/psicologia , Adolescente , Adulto , Metabolismo Energético , Planejamento Ambiental , Feminino , Geografia , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Motivação , Projetos de Pesquisa , Fatores Sexuais , Adulto Jovem
14.
Pan Afr Med J ; 32: 84, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223375

RESUMO

Introduction: Sickle cell disease can result in visually threatening eye disease (proliferative sickle cell retinopathy). This can be prevented with timely eye screening. It is important for patients to understand their role. Our research is to determine the knowledge, beliefs and practices (KBP) regarding eye disease of Sickle Cell patients and the impact of genotype, demographic and socio-economic status. Methods: Cross-sectional study at the Sickle Cell Unit, Jamaica during May 2016. Consecutive non-pregnant adults (>18 years of age) attendees, who were not acutely unwell, were invited to participate. A 26-item single interviewer administered questionnaire was used to obtain socio-demographic data, highest level of education completed, employment status, sickle cell genotype, if known, frequency of clinic attendance and patients' knowledge, beliefs and practices. Ten of these were yes/no questions, whereas eight required that they choose correct answers from four choices. Results: One hundred subjects were recruited, 72% had homozygous SS disease. Their ages ranged from 18-63 years (mean 34.1 years, SD11.3). Fifty six percent were female. Most (75%) had achieved at least secondary education. The majority (62%) were unemployed. The mean belief score was 3.6/6(60%) and the mean knowledge and practice scores were 3.3/7(47%) and 2.2/5(44%) respectively. Milder genotypes had higher knowledge scores vs the more severe genotypes (4.0 vs 3.2, P=0.013). Only 28% had regular eye examinations; less than 50% had seen an ophthalmologist in the past year. Practice scores were higher in employed than in unemployed patients (2.6 vs 1.9, (P=0.04)). Employed patients were more likely than the unemployed to see their eye doctor for regular eye "examinations" (42.1% vs 19.4%, χ2=6.0, P=0.02). The practice and knowledge scores correlated (r2=0.363, P<0.001) and belief score (r2=0.304, P =0.002), except where 98% believed they should see an ophthalmologist annually, but only 42% did, and 21% had never. Conclusion: Knowledge scores were fair, however, the practice was not always in keeping with knowledge.


Assuntos
Anemia Falciforme/complicações , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento/métodos , Doenças Retinianas/etiologia , Adolescente , Adulto , Anemia Falciforme/genética , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Genótipo , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/diagnóstico , Doenças Retinianas/genética , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
16.
J Nurs Educ ; 58(5): 294-297, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039264

RESUMO

BACKGROUND: Nursing programs are instrumental in developing the knowledge, skills, and attitudes necessary for nursing practice. Opportunities are lacking for role formation for successful transition into practice. METHOD: An intraprofessional global clinical immersion program was utilized as the setting for students to develop their role identity. Students from each level of nursing traveled to Jamaica to participate in a clinical immersion experience. Students participated in structured collaboration among students in different programs and acted as the instrument other students utilized to develop their role. Students had the opportunity to work with each other every day, and they provided authentic feedback for each other on their role-formation process. RESULTS: Program evaluation revealed that the immersion helped students gain confidence in their roles as they transition into practice. CONCLUSION: Results of this evaluation support the sustainability of the structured global immersion experiences for professional role formation. [J Nurs Educ. 2019;58(5):294-297.].


Assuntos
Intercâmbio Educacional Internacional , Papel do Profissional de Enfermagem/psicologia , Estudantes de Enfermagem/psicologia , Humanos , Jamaica , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem
17.
Biom J ; 61(4): 934-954, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31058353

RESUMO

A weighted quantile sum (WQS) regression has been used to assess the associations between environmental exposures and health outcomes. However, the currently available WQS approach, which is based on additive effects, does not allow exploring for potential interactions of exposures with other covariates in relation to a health outcome. In addition, the current WQS cannot account for clustering, thus it may not be valid for analysis of clustered data. We propose a generalized WQS approach that can assess interactions by estimating stratum-specific weights of exposures in a mixture, while accounting for potential clustering effect of matched pairs of cases and controls as well as censored exposure data due to being below the limits of detection. The performance of the proposed method in identifying interactions is evaluated through simulations based on various scenarios of correlation structures among the exposures and with an outcome. We also assess how well the proposed method performs in the presence of the varying levels of censoring in exposures. Our findings from the simulation study show that the proposed method outperforms the traditional WQS, as indicated by higher power of detecting interactions. We also find no strong evidence that the proposed method falsely identifies interactions when there are no true interactive effects. We demonstrate application of the proposed method to real data from the Epidemiological Research on Autism Spectrum Disorder (ASD) in Jamaica (ERAJ) by examining interactions between exposure to manganese and glutathione S-transferase family gene, GSTP1 in relation to ASD.


Assuntos
Biometria/métodos , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Glutationa S-Transferase pi/genética , Humanos , Jamaica/epidemiologia , Manganês/farmacologia , Modelos Estatísticos , Análise de Regressão
18.
Int J STD AIDS ; 30(6): 536-541, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31074362

RESUMO

A cross-sectional survey of 295 persons attending a major sexually transmitted infection clinic in Jamaica's capital city showed that the Ministry of Health's syndromic algorithm has moderate sensitivity and negative predictive value for diagnosing cervicitis. In the absence of diagnostic tests for sexually transmitted infections, a syndromic algorithm continues to be useful for diagnosing sexually transmitted infections.


Assuntos
Doenças Sexualmente Transmissíveis/microbiologia , Cervicite Uterina/diagnóstico , Cervicite Uterina/microbiologia , Adulto , Algoritmos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/microbiologia , Humanos , Jamaica/epidemiologia , Masculino , Neisseria gonorrhoeae , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Síndrome , Cervicite Uterina/epidemiologia
20.
J Geriatr Psychiatry Neurol ; 32(4): 195-204, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30961423

RESUMO

OBJECTIVE: To examine the performance of the Mini-Mental State Examination (MMSE) in community-dwelling older persons in a developing country (Jamaica) undergoing rapid population aging. METHODS: An embedded validity study was conducted utilizing participants from a nationally representative sample of 2782 older persons. Standardized MMSE scores were obtained for study participants. A random selection of 170 persons with MMSE scores greater than 20 and 170 persons with scores 20 or less was done. Field staff were trained to apply the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for the diagnosis of dementia. In total, 300 participants (167 participants with MMSE score of 20 or less, 133 participants with scores greater than 20) were assessed and categorized according to dementia status. Performance characteristics of the MMSE tool were determined for study participants and appropriate adjustment and analyses subsequently applied to facilitate extrapolation to the nationally representative sample. RESULTS: The mean MMSE scores for participants with score of 20 and less was 17.1 (standard deviation [SD] = 3.2) and 24.5 (SD = 2.8) for those with scores greater than 20. Dementia was identified in 34 participants. The receiver operating characteristic curve for MMSE scores in relation to dementia diagnosis had an area under the curve value of 0.935 (95% confidence interval, 0.893-0.977). The optimal MMSE cut-point was 18/19 and was consistently so regardless of age category, gender, educational level, and number of chronic illnesses. CONCLUSION: There is merit in using the MMSE examination as a screening tool for dementia in Jamaica. The findings of this study coupled with widespread use and familiarity among practitioners give credence to the MMSE as a reasonable screening tool for dementia in Jamaica-rapidly aging society.


Assuntos
Demência/epidemiologia , Idoso , Envelhecimento , Estudos de Coortes , Demência/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Jamaica , Masculino , Testes de Estado Mental e Demência/normas , Curva ROC
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