Decreased Prevalence of Diabetes Mellitus in Jamaica.

The purpose of this paper is to report the dramatic changes in the point prevalence of diabetes mellitus in the adult population of Jamaica following education intervention. The initial prevalence in the 15-and-over age group was determined by a two-stage stratified random sampling design in 1993. In 1997, the University of the West Indies Diabetes Outreach Project thru its public service arm, the Diabetes Association of Jamaica, developed and implemented a Peer Facilitators Diabetes Education Programme. This effort has realized an increased patient and public education as well as concomitant increased patient compliance and a reduction in related complications. The Jamaica Health and Lifestyle Survey 2008 examined, using a stratified, random, two-stage cluster sample survey, and a nationally representative sample of 2848 Jamaicans aged 15-74. The most dramatic outcome is the decrease in the prevalence from 17.9% to 7.9% in the adult population, age 15+.

The role of high-density lipoproteins in reducing the risk of vascular diseases, neurogenerative disorders, and cancer.

High-density lipoprotein (HDL) is one of the major carriers of cholesterol in the blood. It attracts particular attention because, in contrast with other lipoproteins, as many physiological functions of HDL influence the cardiovascular system in favourable ways unless HDL is modified pathologically. The functions of HDL that have recently attracted attention include anti-inflammatory and anti-oxidant activities. High anti-oxidant and anti-inflammatory activities of HDL are associated with protection from cardiovascular disease. Atheroprotective activities, as well as a functional deficiency of HDL, ultimately depend on the protein and lipid composition of HDL. Further, numerous epidemiological studies have shown a protective association between HDL-cholesterol and cognitive impairment. Oxidative stress, including lipid peroxidation, has been shown to be the mediator of the pathologic effects of numerous risk factors of Alzheimer's disease. Lifestyle interventions proven to increase HDL- cholesterol levels including "healthy" diet, regular exercise, weight control, and smoking cessation have also been shown to provide neuro-protective effects. This review will focus on current knowledge of the beneficial effects of HDL-cholesterol as it relates to cardiovascular diseases, breast and lung cancers, non-Hodgkin's lymphoma, as well as its neuroprotective potential in reducing the risk of Alzheimer's disease and dementia.

Isolation and purification of the hypoglycaemic principle present in Capsicum frutescens.

Capsicum frutescens has been used to treat diabetes mellitus by traditional healers in Jamaica. Purification experiments employing thin layer chromatography (TLC) and high performance liquid chromatography led to the extraction of the active principle, capsaicin. Purified capsaicin caused a decrease in blood glucose levels to 4.91 +/- 0.52 (n = 6) mmol/dL versus 6.40 +/- 0.13 mmol/dL (n = 6) for the control (p < 0.05) at 2.5 h in an OGTT in dogs. There was a concomitant elevation in plasma insulin levels (p < 0.05). In conclusion, it can be stated that capsaicin is the major constituent of Capsicum frutescens that is responsible for the hypoglycaemic episodes seen in the dogs. It is also apparent that the latter is mediated by insulin release.

Controlloing hypertension in diabetes

High blood pressure (hypertension) takes a toll on the heart and blood vessels. So does diabetes mellitus. When both are present in the same individual, it stands to reason that there must be an increase in the risk of cardiovascular problems

Three novel mtDNA restriction site polymorphisms allow exploration of population affinities of African Americans.

To develop informative tools for the study of population affinities in African Americans, we sequenced the hypervariable segments I and II (HVS I and HVS II) of mitochondrial DNA (mtDNA) from 96 Sierra Leoneans; European Americans; rural, Gullah-speaking African Americans; urban African Americans living in Charleston, South Carolina; and Jamaicans. We identified single nucleotide polymorphisms (SNPs) exhibiting ethnic affinities, and developed restriction endonuclease tools to screen these SNPs. Here we show that three HVS restriction site polymorphisms (RSPs), EcoRV, FokI, and MfeI, exhibit appreciable differences in frequency (average delta = 0.4165) between putative African American parental populations (i.e., extant Africans living in Sierra Leone and European Americans). Estimates of European American mtDNA admixture, calculated from haplotypes composed of these three novel RSPs, show a cline of increasing admixture from Gullah-speaking African American (m = 0.0300) to urban Charleston African American (m = 0.0689) to West Coast African American (m = 0.1769) populations. This haplotype admixture in the Gullahs is the lowest recorded to date among African Americans, consistent with previous studies using autosomal markers. These RSPs may become valuable new tools in the study of ancestral affinities and admixture dynamics of African Americans.

Poisonous plants of Jamaica

This book is the first of its kind and will provide much needed information about the toxins that are present in fifty of the most poisonous plants here, with data on their effects on the body and very importantly, the antidotes that are needed

Poisonous plants of Jamaica

This book is the first of its kind and will provide much needed information about the toxins that are present in fifty of the most poisonous plants here, with data on their effects on the body and very importantly, the antidotes that are needed

The volunteer in diabetes education

An evaluation system needs to be developed to measure what has been achieved by the Lay Diabetes Education Programme, focusing on its impact at community level. For the 50 percent of volunteers who are from the health sector, this could be done through the structured assessment scheme of the health service. A different approach will be required for other volunteers. However, the programme is already making a positive impact, as indicated by reduced routine visits to tertiary care centres, as well as increased discussion of diabetes in public settings, such as parent-teacher meetings, church groups, and media talk shows! Volunteer diabetes educators should be armed with enough information to assist the patient in the everyday care of his/her condition and to encourage improved compliance, thus reducing the rate of development of complications. Volunteers should promote a positive outlook on diabetes, to help allay the fears of the anxious patient. They should always remember the volunteers' motto: "The greatest service that one can do is that of service to your fellow man. The greatest exercise for the heart is to reach out and help someone in need!" (AU)

An interim report of an intervention strategy for diabetes care in Jamaica

The high prevalence (17.9 percent) of diabetes mellitus and its attendant costs have been recognized for some time. The diabetic public has hitherto been too oriented to seeking health care at the secondary and tertiary health care centers; a much too costly approach. As a part of a wellness promotion thrust as well as an awareness and intervention strategy, a number of health care agencies have collaborated in a training programme of lay diabetes facilitators. This was intended to allow a domino effect of "each one teach one" within the community. This intervention programme was undertaken over an 18 month period. No significant changes were achieved in glycaemia levels. The impact on hospital admissions and community awareness is yet to be assessed. Laboratory results indicated good correlation between glycosuria and hyperglycaemia. This could influence the thrust in maintaining glycosuria assessment alongside blood glucose monitoring. This approach would have a cost benefit for government clinics islandwide. Whilst it may be difficult to identify any one parameter that may be responsible for change, it will be possible to assume that this intervention strategy, the only innovation in the health care delivery modalities, may have contributed.(Au)

Ganga: the Jamaican connection

The controversy and issues about the good and evil effects of cannabis has grown exponentially over the last 20 years. Some of the findings have detracted from the issues of criminalization to focus on its potential as a major medicinal agent. This has led to exploratory studies into the theraputic utility of cannabis. At this time a number of areas of potential medicinal applications have been identified and investigated, for example glaucoma, asthma, pain and multiple sclerosis to name a few. The legal minds, usually with little appreciation for science and medicinal investigation, are the ones that usually put obstacles in the path of future development in this very vital area. The present knowledge about these issues is scattered all over the literature. This book is an atempt to present a reader friendly account of the knowledge and issues at this time, with an emphasis on the knowledge and experience about the subject as it relates to Jamaica

Ganga: the Jamaican connection

The controversy and issues about the good and evil effects of cannabis has grown exponentially over the last 20 years. Some of the findings have detracted from the issues of criminalization to focus on its potential as a major medicinal agent. This has led to exploratory studies into the theraputic utility of cannabis. At this time a number of areas of potential medicinal applications have been identified and investigated, for example glaucoma, asthma, pain and multiple sclerosis to name a few. The legal minds, usually with little appreciation for science and medicinal investigation, are the ones that usually put obstacles in the path of future development in this very vital area. The present knowledge about these issues is scattered all over the literature. This book is an attempt to present a reader friendly account of the knowledge and issues at this time, with an emphasis on the knowledge and experience about the subject as it relates to Jamaica

The efficacy of acarbose in type 2 diabetes mellitus in Jamaica

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8 percent) did not complete the study and were excluded from further analysis. Six (13 percent) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n=15), [Gp B], oral hypoglycaemic agents, OHAs (n=17), [Gp C], or insulin (n=8), Gp D]. In addition, during the run in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3 month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 ñ 1.1 to 8.4 ñ 0.9 (p<0.027) and, from 11.0 ñ 1.0 to 8.7 ñ 0.7 (p<0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 ñ 1.1 percent to 12.2 ñ 1.0 percent (p<0.016) in Gp B, from 14.8 ñ 1.1 to 11.9 ñ 1.1 percent (p<0.002) in Gp C, and from 14.1 ñ 1.4 to 11.8 ñ 1.4 (p<0.02) in Gp D. Twenty-three per cent (23 percent) of the patients experienced flatulence; 7.5 percent changes in bowel habits and 5 percent, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.(Au)

The role of C-peptide in the classification of Diabetes Mellitus

We investigated twenty-one insulin-using patients, who had all been labelled as having diabetes mellitus (IDDM) or type one diabetes. Physicians have been erroneously using the term IDDM loosely to include all diabetics on insulin. The clinical criteria of the National Diabetes Data Group/WHO were used to reclassify these patients. Only thirteen were found to have IDDM and eight non-insulin dependent diabetes mellitus (NIDDM). Using fasting C-peptide values, only five of the thirteen with clinical IDDM truly had IDDM, the others might have maturity onset diabetes of the young (MODY) or diabetes in the young. Of the eight with clinical NIDDM seven had normal to high C-peptide values; the lone patient with low C-peptide values had diabetes diagnosed at 64 years. We conclude that the clinical classification of diabetes mellitus may be inaccurate and that C-peptide evaluation improves the accuracy of the classification.(AU)

The role of C-peptide in the classification of diabetes mellitus

We investigated twenty-one insulin-using patients, who had all been labelled as having diabetes mellitus (IDDM) or type one diabetes. Physicians have been erroneously using the term IDDM loosely to include all diabetics on insulin. The clinical criteria of the National Diabetes Data Group/WHO were used to reclassify these patients. Only thirteen were found to have IDDM and eight non-insulin dependent diabetes mellitus (NIDDM). Using fasting C-peptide values, only five of the thirteen with clinical IDDM truly had IDDM, the others might have maturity onset diabetes of the young (MODY) or diabetes in the young. Of the eight with clinical NIDDM seven had normal to high C-peptide values; the lone patient with low C-peptide values had diabetes diagnosed at 64 years. We conclude that the clinical classification of diabetes mellitus may be inaccurate and that C-peptide evaluation improves the accuracy of the classification.

Some clinical factors contributing to the development of the diabetic foot

Clinical neurological studies, blood pressure measurements and some haematological investigations were performed on a random sample of forty-four patients, at the Diabetes Out-Patient Clinic of the University Hospital of the West Indies (UHWI), to examine some of the factors that predispose to the development of the diabetic foot. Our results revealed that 86 percent of the patients had elevated glycosylated haemoglobin (HbA > 9.0 percent), 82 percent had clinical signs of peripheral sensory neuropathy. 29 percent had signs of autonomic neuropathy in addition to peripheral sensory neuropathy. Sixty-one percent (61 percent) of the patients had ankle/arm systolic blood pressure ration less than 1.0 and were diagnosed as having peripheral vascular disease (PVD). The group with neuropathy was found to have a significantly lower diastolic blood pressure (p < 0.0005) than the group without neuropathy. We believe that hyperglycaemia-induced vasodilation (indicated by a lower diastolic blood pressure) in a significant number of diabetics resulted in compensatory shunting of blood from the deeper tissues, including nerves, to periphery. The resulting endoneural hypoxia could be responsible for the unusually high incidence of peripheral sensory neuropathy detected in this sample of diabetic patients. Metabolic factors may also play a role.(AU)

Controlling hypertension in diabetes

High blood pressure (hypertension) takes a toll on the heart and blood vessels. So does diabetes mellitus. When both are present in the same individual, it stands to reason that there must be an increase in the risk of cardiovascular problems. The management of a chronic condition such as hypertension in the presence of another chronic condition, requires the development of a close inter-relationship between the patient and the healthcare team. The education of the patient about conditions and their potential sequelae, and the empowerment of the patient - ensuring not only his/her acquisition of knowledge but access to 'tools' for monitoring - are important requirements in the overall management of this 'double whammy'! This education and awareness process must not be restricted to patients, healthcare givers, family and support groups. It must also embrace the wider public and decision makers at the political level, in order to ensure that the best quality of life is afforded these patients within their community and country (AU)