Psychological distress among younger siblings of patients with homozygous sickle cell disease in the Jamaican cohort study

The presence of a chronically ill family member may adversely affect the psychological health of siblings. This study used the General Health Questionnaire and the Modified Social Adjustment Scale to assess psychological distress in 20 younger siblings (4 AA, 16 AS genotypes), aged 16-19 years, of patients with homozygous sickle cell (SS) disease. The results were compared with those previously obtained in the 20 older siblings with SS disease and in 89 controls with a normal haemoglobin (AA) genotype. High levels of psychological distress occurred among all three groups. Greater psychological distress and poorer social adjustment occurred among siblings compared to AA controls but these differences disappeared after adjusting for the reduced age of sibings. The two measures were similar in SS patients and AA controls. The level of psychological distress among siblings of SS patients did not differ from that in SS patients or AA controls.(Au)

Psychological distress among younger siblings of patients with homozygous sickle cell disease in the Jamaican cohort study

The presence of a chronically ill family member may adversely affect the psychological health of siblings. This study used the General Health Questionnaire and the Modified Social Adjustment Scale to assess psychological distress in 20 younger siblings (4 AA, 16 AS genotypes), aged 16-19 years, of patients with homozygous sickle cell (SS) disease. The results were compared with those previously obtained in the 20 older siblings with SS disease and in 89 controls with a normal haemoglobin (AA) genotype. High levels of psychological distress occurred among all three groups. Greater psychological distress and poorer social adjustment occurred among siblings compared to AA controls but these differences disappeared after adjusting for the reduced age of sibings. The two measures were similar in SS patients and AA controls. The level of psychological distress among siblings of SS patients did not differ from that in SS patients or AA controls.

An assessment of stress among clinical medical students of the University of the West Indies, Mona Campus

This study looks at sources of stress amomg the medical students of the University of the West Indies at the Mona campus. Students of the classes 1993 through 1995 were asked to fill out a questionnaire which had been developed for a similar study at the University of Texas in 1983. The return rate was 66 percent. The results were compared for differences between males and females and between the different year groups. The two most stressful items were rated the same by men and women, i.e. 1) the amount of material to be learned, and 2) examinations and/or grades. There was no statistically significant difference between stress levels by gender in this study. The penultimate clinical year was most stressful. It is hoped that the findings of this study will be the basis for discussion about whether the identified stressors are inherent and necessary to the medical training experience and, if so, how students can be better prepared to cope with them. (AU)

An assessment of stress among clinical medical students of the University of the West Indies, Mona Campus

This study looks at sources of stress amomg the medical students of the University of the West Indies at the Mona campus. Students of the classes 1993 through 1995 were asked to fill out a questionnaire which had been developed for a similar study at the University of Texas in 1983. The return rate was 66 percent. The results were compared for differences between males and females and between the different year groups. The two most stressful items were rated the same by men and women, i.e. 1) the amount of material to be learned, and 2) examinations and/or grades. There was no statistically significant difference between stress levels by gender in this study. The penultimate clinical year was most stressful. It is hoped that the findings of this study will be the basis for discussion about whether the identified stressors are inherent and necessary to the medical training experience and, if so, how students can be better prepared to cope with them.

Registration of births, stillbirths and infant deaths in Jamaica

BACKGROUND: Vital statistics underestimate the prevalence of perinatal and infant deaths. This is particularly significant when these parameters affect eligibility for international assistance for newly merging nations. OBJECTIVE: To determine the level of registration of livebirths, stillbirths and infant deaths in Jamaica. METHODOLOGY: Births, stillbirths and neonatal deaths identified during a cross-sectional study (1986): and infant death identified in six parishes (1993) were matched to vital registration documents filed with the Registrar General. RESULTS: While 94 percent of livebirths were registered by one year of age (1986), only 13 percent of stillbirths (1986) and 25 percent of infant deaths (1993) were registered. Post neonatal deaths were more likely to be registered than early neonatal deaths. Frequently the birth was not registered when the infant died. Birth registration rates were highest in parishes with high rates of hospital deliveries (rs=0.97, P<0.001) where institutions notify the registrar of each birth. Hospital deaths, however, were less likely to be registered than community deaths as registrars are not automatically notified of these deaths. CONCLUSIONS: To improve vital registration, institutions should become registration centres for all vital events occurring there (births, stillbirths, deaths). Recommendations aimed at modernizing the vital registration system in Jamaica and other developing countries are also made(AU)

The epidemiology of antepartum fetal death in Jamaica

All perinatal deaths occurring over a 12-month period on the island of Jamaica were classified using the Wigglesworth schema. In all, there were 584 antepartum fetal deaths (incidence 10.7 per 1000 total births). Comparison of the 558 singleton deaths with 9919 singleton survivors revealed, using logistic regression, strong associations with union (marital) status, maternal employment status, the composition of the household, the sole use of a toilet by the household, the parish of residence, whether the mother was trying to get pregnant and the mother's age (the older the mother the higher the risk). Independent of these factors were strong statistically significant relationship with syphilis, diabetes, maternal anaemia, third-trimester bleeding, highest diastolic blood pressure of 90mm or more and highest proteinuria of ++ or more. Mothers who had taken prophylactic iron were at substantially lower risk compared with those who had not. We conclude that appropriated identification and treatment of syphilis, diabetes, anaemia and hypertension give the best chance of reduction of the high antepartum fetal death rate on the island (Summary)

Perinatal mortality survey in Jamaica: aims and methodology

The Jamaican Perinatal Mortality survey was designed to identify the true perinatal mortality rate, and assess the factors which could contribute towards a reduction in perinatal mortality on the island. All births in a 2-month period (n=10527) were compared with all perinatal deaths occurring over a 12-month period (n=2069). Over half the deaths (n=1058) received a detailed post-mortem examination. Use of the Wigglesworth classification identifies the major component of perinatal death in this country to be associated with intrapartum asphyxia (44 percent of deaths). Deaths due to congenital malformations and miscellaneous causes contribute relatively little (<10 percent) to the overall mortality rate. Over a quarter of deaths apparently occur before the onset of labour, a a fifth are prematurely liveborn but die of causes related to immaturity (Summary)

An assessment of stress among clinical medical students of the University of the West Indies

This study attempted to look at the sources of stress among the clinical medical students of the University of the West Indies at Mona campus. Students of the classes 1993 through 1995 were asked to fill out a questionnaire which had been developed for a similar study at the University of Texas in 1993. The return rate was 68.2 percent. The results were compared for differences between males and females and between the different year groups. The two most stressful items were rated the same by men and women; i.e., 1) the amount of material to be learned, and 2) examinations and/or grades. The top eight stressors though rated differently, were the same for both groups. It is hoped that the findings of this study will be the basis for discussion about whether the identified stressors are inherent and necessary to the medical training experience and if so, how students can be better prepared to cope with them. (AU)

Neonatal mortality determinants in Jamaica

The Jamaican Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths (Wigglesworth Classification), and the determination of characteristics of both mother and infant that are associated with increased mortality. A death questionaire was completed on babies who were born between September 1986 and August 1987, and who died in the neonatal period throughout the island of Jamaica. The neonatal mortality rate was 17.9 per 1000 live births with early and late rates of 16.0 and 1.9 per 1000 respectively. The major contributors to neonatal demise were prematurity and intrapartum asphyxia (74 per cent). Twins had a seven- fold greater risk of dying than singletons. Babies born to mothers under 15 years had a four-fold greater risk of dying than those of mothers 25-29 years. The neonatal mortality rate for Jamaica is high, with room for improvement, particularly in the prevention of perinatal asphyxia. (AU)

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12-month period between September 1986 and August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop. (AU)

Registration of livebirths, stillbirths and neonatal deaths in a cohort study of Jamaican mothers (1986) - abstract

Registration of vital events provides essential information for monitoring the health status of a country and planning for health and other social services. This study aimed to determine the extent of under-registration of livebirths, stillbirths and neonatal deaths among a cohort of mothers delivering island-wide in September and October, 1986 and determine the case ascertainment rate of the Jamaican Perinatal Morbidity and Mortality Survey. Lists by parish of delivery of all mothers interviewed in the study were matched to registration documents for livebirths, stillbirths and neonatal deaths filed in the Registrar General's Department for infants delivered in September and October, 1986 and registered between September, 1986 and October, 1987. Whlie 91 percent of all identified livebirths were registered, only 9 per cent of the stillbirths and 6.5 percent of the neonatal deaths were registered one year after the event had occurred. When the infants died in the neonatal period, the birth tended not to be registered; only 47 percent of these births were registered compared to 92 percent of those surviving the neonatal period. The Perinatal Study managed to interview 94 percent of mothers of liveborn infants during the study period. While livebirth registrations are fairly complete, the level of registration of stillbirths and neonatal deaths is unacceptable and gives an inaccurate impression of the state of the nation and the health services (AU)

Neonatal mortality determinants in Jamaica - abstract

The Perinatal Survey included among its objectives the quantification of the island's neonatal mortality rate, the identification of the causes of these deaths and the determination of characteristics of both mother and infant that are associated with an increased risk of death, so that intervention and reduction would be possible. Data were collected on babies born between September 1986 and August 1987 and who died in the first 28 days of life, anywhere in Jamaica. Postmortems were performed where feasible. A death questionnaire provided information on date, place and time of death, age of mother and classification of death by the Wigglesworth method. Additional social, environmental, medical, obstetric and neonatal data were included on a main questionnaire. Data from the death questionnaire were analyzed, using SPSS. There were 950 neonatal deaths identified over the 12-month period of study. The neonatal mortality was 17.9 per 1,000 live births, with the early and late neonatal mortality rates being 16.0 and 1.9 per 1,000 respectively. The major contributors to neonatal death were prematurity and perinatal asphyxia (73.5 percent). The majority of deaths (56.2 percent) occurred in the first day of life. Twins had a sevenfold greater risk of dying than singletons, with 58.6 per cent of deaths among second twins. One-third of neonatal deaths were to teenage mothers although they accounted for 26 percent of total births. Babies born to mothers under 15 years of age were four times more likely to die than infants of mothers 25 - 29 years of age. The neonatal death rate in Jamaica is high with room for improvement, particularly in the prevention of perinatal asphyxia and the early identification and management of mothers whose infants are at high risk of neonatal death (AU)

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12 month period September 1986 to August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated population of 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop (AU)

The perinatal morbidity and mortality survey of Jamaica 1986-1987

The Jamaican Perinatal Morbidity and Mortality Survey was conducted between September 1986 and August 1987. A total of 10310 consecutive birth were identified and mothers interviewed in the first 2 months (main cohort study), 1405 neonatal admissions were evaluated over a 6-month period (morbidity study), and 1855 perinatal deaths and 73 late neonatal deaths identified over 12 months (mortality study - 55 percent of the deaths were given postmortem examinations. The perinatal mortality rate for the cohort study was 38.1 percent per 1000 births. This was 36.6 percent higher than the 1982 estimate of 27.9/1000 based on deliveries at the Victoria Jubilee Hospital, a specialist maternity institution which has at least 13 000 deliveries per annum (AU)