Emergence of Zika Virus Epidemic and the National Response in Jamaica.

BACKGROUND: Jamaica, along with the Americas, experienced major epidemics of arboviral diseases transmitted by the Aedes aegypti mosquito in recent years. These include dengue fever in 2012, Chikungunya fever in 2014 and Zika virus infection (ZIKV) in 2016. We present the emergence of the ZIKV epidemic in Jamaica and outline the national response. METHODS: The Ministry of Health's preparedness included: heightened surveillance, clinical management guidance, vector control and management, laboratory capacity strengthening, training and staffing, risk communication and public education, social mobilization, inter-sectoral collaboration, resource mobilization and international cooperation. RESULTS: The first case of ZIKV was confirmed on January 29, 2016 with date of onset of January 17, 2016. From January 3 to July 30, 2016 (Epidemiological Week (EW) 1-30), 4648 cases of ZIKV were recorded (4576 suspected, 72 laboratory-confirmed). Leading symptoms were similar among suspected and confirmed cases: rash (71% and 88%), fever (65% and 53%) and joint pains (47% and 38%). There were 17 suspected cases of Guillain Barre syndrome; 383 were reported in pregnant women, with no reports of microcephaly to date. Zika and dengue viruses were circulating predominantly in 2016. At EW30, 1744 cases of dengue were recorded (1661 suspected and 83 confirmed). Dengue serotypes 3 and 4 were circulating with 121 reports of dengue haemorrhagic fever. CONCLUSION: The possibility exists for endemicity of ZIKV similar to dengue and chikungunya in Jamaica. A ZIKV vaccine, similar to the dengue and chikungunya vaccines, is needed to be fast-tracked into clinical trials to mitigate the effects of this disease.

Emergence of zika virus epidemic and the national response in Jamaica

BACKGROUND: Jamaica, along with the Americas, experienced major epidemics of arboviral diseases transmitted by the Aedes aegypti mosquito in recent years. These include dengue fever in 2012, Chikungunya fever in 2014 and Zika virus infection (ZIKV) in 2016. We present the emergence of the ZIKV epidemic in Jamaica and outline the national response. METHODS: The Ministry of Health's preparedness included: heightened surveillance, clinical management guidance, vector control and management, laboratory capacity strengthening, training and staffing, risk communication and public education, social mobilization, inter-sectoral collaboration, resource mobilization and international cooperation. RESULTS: The first case of ZIKV was confirmed on January 29, 2016 with date of onset of January 17, 2016. From January 3 to July 30, 2016 (Epidemiological Week (EW) 1-30), 4648 cases of ZIKV were recorded (4576 suspected, 72 laboratory-confirmed). Leading symptoms were similar among suspected and confirmed cases: rash (71% and 88%), fever (65% and 53%) and joint pains (47% and 38%). There were 17 suspected cases of Guillain Barre syndrome; 383 were reported in pregnant women, with no reports of microcephaly to date. Zika and dengue viruses were circulating predominantly in 2016. At EW30, 1744 cases of dengue were recorded (1661 suspected and 83 confirmed). Dengue serotypes 3 and 4 were circulating with 121 reports of dengue haemorrhagic fever...(AU) CONCLUSION:The possibility exists for endemicity of ZIKV similar to dengue and chikungunya in Jamaica. A ZIKV vaccine, similar to the dengue and chikungunya vaccines, is needed to be fast-tracked into clinical trials to mitigate the effects of this disease.

Capgras syndrome presenting in an adolescent girl in the Caribbean.

The case of a 16-year old Jamaican girl who presented to the psychiatric service of a general hospital with features of Capgras syndrome is presented. Her history, treatment, progress and relevant psychodynamic and neurocognitive issues are explored. This is the first known published case of an adolescent with Capgras syndrome from the Caribbean. The case highlights that the syndrome may occur in different cultural contexts and that clinicians should be sensitive to its existence in order to avert under-diagnosis or misdiagnosis.

Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries.

OBJECTIVES: Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership. METHODS: This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples. RESULTS: The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures. CONCLUSIONS: This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

The impact of a no-user-fee policy on the quality of patient care/service delivery in Jamaica.

This paper is a submission to the Sessional Select Committee on Human Resources and Social Development by the Medical Association of Jamaica on September 25, 2011, and presented orally by both authors on October 20, 2011. It explores the impact of the no-user-fee policy on the quality of patient care/service delivery in Jamaica and makes recommendations for reform.

Validation of the Beck Depression Inventory II in HIV-positive patients / Validación del Inventario de Depresión de Beck II en los pacientes VIH-positivos

OBJECTIVE: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory- II (BDI-II) using HIV-positive patients in Jamaica. METHOD: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5 ± 10 years) were administered the BDI-II along with the Centre for Epidemiological Studies - Depression Scale (CES-D) and the Social Provisions Scale. RESULTS: Overall, the BDI-II was found to have a high degree of reliability (a = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIV-positive patients.

OBJETIVO: La investigación sobre la depresión entre los pacientes VIH-positivos ha estado limitada por la falta de una medida válida y confiable de la depresión. Este proyecto aborda este problema explorando la confiabilidad de la consistencia interna, así como la validez discriminate y concurrente del Inventario de la Depresión de Beck II (BDI-II) usando pacientes VIH-positivos en Jamaica. MÉTODO: A los pacientes de tres clínicas de VIH en Jamaica (n = 191 pacientes; 61% hembras, 39% varones, edadpromedio 40.5 ± 10 anos) se les aplicó el BDI-IIjunto con la Escala de Depresión (CES D) y la Escala de Provisiones Sociales - Centro de Estudios Epidemiológicos. RESULTADOS: En general, se halló que el BDI-II posee un alto grado de confiabilidad (a = 0.89). La escala poseía también una buena validez concurrente, como quedó evidenciado por la elevada correlación con las puntuaciones del CES-D (r = 0.74), Igualmente, se constató que posee una validez discriminante aceptable como lo demuestran las correlaciones moderadas con la Escala de Provisiones Sociales (r = -0.42). Este patrón de puntuaciones sugiere que la mayor parte de la varianza que subyace en el BDI-II da la medida de la depresión (55%), en tanto que un grado menor de la variabilidad (18%) mide un concepto de naturaleza similar pero claramente definido. CONCLUSIÓN: El BDI-II constituye una medida suficientemente confiable y válida para evaluar la depresión en pacientes VIH positivos.

Patterns of depressive symptoms among patients with HIV infection / Patrones de síntomas depresivos entre pacientes con infección por VIH

OBJECTIVE: To identify the level of depressive symptoms among patients with HIV infection and to examine the reported patterns of depressive symptoms not confounded by the physical manifestations of HIV-infection. METHOD: A total of 191 patients with HIV infection (75 males (39%) and 116 females (61%), mean age 40.48 ± 10 years), from three HIV clinics were administered the Beck Depression Inventory - II as well as a demographic questionnaire as part of a larger study. RESULTS: Moderate to severe depressive symptoms were reported by 17.3% of the HIV-infected patients with females reporting significantly higher levels of depressive symptoms than males. A principal components analysis identified three clusters of depressive symptoms: cognitive-affective, negative cognitions and somatic symptoms. The HIV-infected patients were found to display mainly cognitive-affective symptoms of depression. CONCLUSION: HIV-infected patients, especially female patients, may be at an increased risk of experiencing high levels of depressive symptoms. It is recommended that HIV-infected patients be routinely screened for depression, particularly cognitive-affective symptoms of depression.

OBJETIVO: Identificar el nivel de sintomas depresivos entre pacientes con infección por VIHy examinar los patrones reportados sobre los sintomas de depresión, no confundidos por las manifestaciones físicas de la infección por VIH. MÉTODO: A un total de 191 pacientes con infección por VIH (75 varones (39%) y 116 hembras (61%), con edadpromedio 40.45 ± 10 anos), de tres clinicas de VIH, se les aplicó el Inventario de Depresión de Beck II, asi como una encuesta demográfica como parte de un estudio más grande. RESULTADOS: Un 17.3% de los pacientes infectados por VIH, informaron sintomas depresivos de moderados a severos, reportando las hembras niveles de sintomas de depresión significativamente más altos que los varones. Un análisis de los componentes principales identificó tres grupos de sintomas depresivos: cognitivos afectivos, cogniciones negativas y sintomas somáticos. Se halló que los pacientes infectados por VIHpresentaban principalmente sintomas afectivos cognitivos de depresión. CONCLUSIÓN: Los pacientes infectados con VIH, especialmente las hembras, pueden hallarse en un mayor riesgo de experimentar niveles altos de sintomas depresivos. Se recomienda que los pacientes infectados con VIHsean sometidos deforma rutinaria a tamizajes de depresión, particularmente de los sintomas de depresión cognitivos afectivos.

Validation of the Beck Depression Inventory II in HIV-positive patients.

OBJECTIVE: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory-II (BDI-II) using HIV-positive patients in Jamaica. METHOD: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5-10 years) were administered the BDI-II along with the Centre for Epidemiological Studies -Depression Scale (CES-D) and the Social Provisions Scale. RESULTS: Overall, the BDI-II was found to have a high degree of reliability (alpha = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIV-positive patients.

Patterns of depressive symptoms among patients with HIV infection.

OBJECTIVE: To identify the level of depressive symptoms among patients with HIV infection and to examine the reported patterns of depressive symptoms not confounded by the physical manifestations of HIV-infection. METHOD: A total of 191 patients with HIV infection (75 males (39%) and 116 females (61%), mean age 40.48 +/- 10 years), from three HIV clinics were administered the Beck Depression Inventory-II as well as a demographic questionnaire as part of a larger study. RESULTS: Moderate to severe depressive symptoms were reported by 17.3% of the HIV-infected patients with females reporting significantly higher levels of depressive symptoms than males. A principal components analysis identified three clusters of depressive symptoms: cognitive-affective, negative cognitions and somatic symptoms. The HIV-infected patients were found to display mainly cognitive-affective symptoms of depression. CONCLUSION: HIV-infected patients, especially female patients, may be at an increased risk of experiencing high levels of depressive symptoms. It is recommended that HIV-infected patients be routinely screened for depression, particularly cognitive-affective symptoms of depression.

Screening for postpartum depression

Postpartum depression, a potentially serious public health problem can be effectively treated. With the implementation of universal screening with a standardized, self-administered screening tool, in conjunction with appropriate education and training of health care providers to increase awareness of this problem and to impart greater diagnostic suspicion, identification of and early intervention for PPD can be facilitated. There is need for increased collaboration between Obstetric and Consultation Liaison Psychiatric Services, with particular emphasis on the prevention of psychiatric morbidity associated with pregnancy, thereby improving the quality of life for and interaction between mother and child. The establishment of a true Liaison Psychiatric Service dedicated to pregnancy and the postpartum period, with a Psychiatrist employed by the Obstetric Services, may be of great value.

Screening for postpartum depression.

Postpartum depression, a potentially serious public health problem can be effectively treated. With the implementation of universal screening with a standardized, self-administered screening tool, in conjunction with appropriate education and training of health care providers to increase awareness of this problem and to impart greater diagnostic suspicion, identification of and early intervention for PPD can be facilitated. There is need for increased collaboration between Obstetric and Consultation Liaison Psychiatric Services, with particular emphasis on the prevention of psychiatric morbidity associated with pregnancy, thereby improving the quality of life for and interaction between mother and child. The establishment of a true Liaison Psychiatric Service dedicated to pregnancy and the postpartum period, with a Psychiatrist employed by the Obstetric Services, may be of great value.

Community-based prevention of substance abuse

Substance abuse is pervasive in a number of countries throughout the world, placing an enormous burden and strain on their healthcare systems. The relationship between crime and illicit drug use increases the significance of the problem facing countries worldwide. Jamaica has not only become a trans-shipment point for cocaine from South America, but recent Drug Enforcement Agency figures show Jamaica being responsible for 30 of cocaine trafficking into the United States of America. Though all segments of society are involved, disadvantaged groups are disproportionately affected. Substance use and abuse among adolescents is of particular concern. Supply reduction approaches have not been effective enough in reducing the prevalence of substance use and abuse in many countries throughout the world. Substance abuse prevention research over 25 years has led to the identification of a number of factors differentiating substance abusers from others. The presence of risk factors and the absence of protective facts contribute to an increase potential for drug abuse. The impact that these factors have is also determined by the level of psychological and social development of an individual. The presence of risk factors as well as the absence of protective factors leads to increased [quot ]exposure opportunity[quot ], exposure to a potential substance of abuse being closely associated with the potential for initial drug use, transition from initiation to regular use and subsequently dependence. One method of reducing [quot ]exposure opportunity[quot ] is community prevention. The basic aim of community prevention programmes is to decrease the rate of drug use in a population by enhancing protective factors and reversing or reducing risk factors

Community-based prevention of substance abuse.

Substance abuse is pervasive in a number of countries throughout the world, placing an enormous burden and strain on their healthcare systems. The relationship between crime and illicit drug use increases the significance of the problem facing countries worldwide. Jamaica has not only become a trans-shipment point for cocaine from South America, but recent Drug Enforcement Agency figures show Jamaica being responsible for 30% of cocaine trafficking into the United States of America. Though all segments of society are involved, disadvantaged groups are disproportionately affected. Substance use and abuse among adolescents is of particular concern. Supply reduction approaches have not been effective enough in reducing the prevalence of substance use and abuse in many countries throughout the world. Substance abuse prevention research over 25 years has led to the identification of a number of factors differentiating substance abusers from others. The presence of risk factors and the absence of protective facts contribute to an increase potential for drug abuse. The impact that these factors have is also determined by the level of psychological and social development of an individual. The presence of risk factors as well as the absence of protective factors leads to increased "exposure opportunity", exposure to a potential substance of abuse being closely associated with the potential for initial drug use, transition from initiation to regular use and subsequently dependence. One method of reducing "exposure opportunity" is community prevention. The basic aim of community prevention programmes is to decrease the rate of drug use in a population by enhancing protective factors and reversing or reducing risk factors.

Utilization of liaison psychiatric services in a general hospital in Jamaica [abstract]

OBJECTIVE: To identify the pattern and characteristics of Liaison Psychiatry refferals in the University Hospital of the West Indies over a six-month period. METHOD: A prospective cohort analysis was conducted on patients referred to the Liaison Psychiatry service between November 28, 2000 and May 28, 2001. Clinical and sociodemographic data were gathered by individual interviews and mental status examination and a DSM IV diagnosis made. RESULTS: Fifty-nine patients were referred with 28 (47.5 percent) males, and with a mean ñ Standard Deviation age of 39.42 ñ 15.92 years. Significantly more patients were referred from the medical wards (37, 62.5 percent) than from the surgical wards (14, 23.7 percent) or the gynaecological wards (8, 13.6 percent) (x2= 16.803, 2df, p<0.005). The main reason for referral was "strange behaviour" (31, 52.5 percent) and depression (13, 22 percent). There was no statistically significant difference between the referring wards and the reason for referral or diagnostic pattern. An equal number of patients were diagnosed with a psychotic disorder and unipolar depressive disorder (33.9 percent each). CONCLUSION: The medical wards of the University Hospital of the West Indies are the main agents of referral to the Liaison Psychiatric service with the majority of patients presenting with the majority of patients unipolar depressive or psychotic disorders. (AU)