Who Cares? Sociodemographic and Health Characteristics of Carers of Older Persons in Jamaica / ¿Quién cuida? Características Sociodemográficas y de Salud de los Cuidadores de Personas Mayores en Jamaica

ABSTRACT Objective: To describe the sociodemographic and health characteristics and implied needs of caregivers to older persons in Jamaica. Method: This was a community-based, nationally representative study in which a sample of 180 caregivers to older persons was interviewed. Findings: Caregivers were aged between 18 and 88 years (mean 50.5; s = 14.7) and most (77%) were informal compared to 23% who were paid to care. There were no differences between urban and rural caregivers with respect to gender, union status, residing with care recipients and holding a regular job while giving care. Urban caregivers were significantly more likely to report attaining secondary education than those in rural communities (χ2 (2) = 7.40, p < 0.05). Over 90% reported they had not received any formal training in caregiving and those ≤ 45 years were more likely than those in age groups ≥ 46 years to say they want to get caregiver training (χ2 (4) = 27.1, p < 0.001). Male caregivers were significantly more likely to report being the 'child/grandchild/in-law' of care recipients than female caregivers, among whom almost one in four reported their relationship as employee (Fisher's Exact test: p = 0.002). Most caregivers (51.7%) reported being diagnosed with one or more medical condition and 89% of those diagnosed reported being prescribed medications for their illnesses. Forty-five per cent of caregivers reported that they performed one or more activity of daily living (ADL) for their care recipients daily. Conclusion: Carers of older persons in Jamaica are predominantly family members, most have not received caregiving training and most have been diagnosed with a medical condition.

RESUMEN Objetivo: Describir las características sociodemográficas y de salud, así como las necesidades implícitas de los cuidadores de las personas mayores en Jamaica. Método: Se trata de un estudio comunitario representativo a nivel nacional, en el que se entrevista una muestra de 180 cuidadores de personas de edad. Resultados: Los cuidadores tenían entre 18 y 88 años (media 50.5; s.d. = 14.7) y la mayoría (77%) eran informales en comparación con el 23% que recibían pago por el cuidado. No hubo diferencias entre los cuidadores urbanos y rurales con respecto a género, estado civil, residir con las personas objeto del cuidado, y mantener un trabajo regular a la par con la atención a los ancianos. Los cuidadores urbanos presentaban una probabilidad significativamente mayor de haber alcanzado educación secundaria en comparación con aquellos de las comunidades rurales (χ2 (2) = 7.40, p < 0.05). Más del 90% reportó no haber recibido ninguna capacitación formal en cuidados, y aquellos con ≤ 45 años eran más propensos que los de los grupos de edad ≥ 46 años a decir que deseaban recibir entrenamiento como cuidadores (χ2 (4) = 27.1, p < 0.001). Los cuidadores hombres presentaban una probabilidad significativamente mayor de ser "hijo/nieto/yerno" de personas receptoras de cuidados, que las mujeres cuidadoras, entre las cuales casi una de cada cuatro reportó su relación como empleado (Prueba exacta de Fisher: p = 0.002). La mayoría de los cuidadores (51.7%) reportaron estar diagnosticados con una o más condiciones médicas, y el 89% de los diagnosticados reportaron recibir prescripciones de medicamentos para sus enfermedades. Cuarenta y cinco por ciento de los cuidadores informó realizar una o más actividades de la vida diaria (AVD) para las personas bajo su cuidado diariamente. Conclusión: Los cuidadores de personas mayores en Jamaica son en su mayoría miembros de la familia; la mayor parte de ellos no ha recibido capacitación como cuidadores; y la mayoría han sido diagnosticados con alguna condición médica.

Hypertension in Older Adults in Jamaica: Prevalence, Treatment and Control / La Hipertensión en los Adultos Mayores en Jamaica: Prevalencia, Tratamiento y Control

ABSTRACT Objective: To examine the prevalence, treatment and control and associated risk factors for hypertension among older adults in Jamaica. Methods: Four parishes in Jamaica were surveyed using a cross-sectional study design involving 2943 participants. The survey used a cluster sampling methodology with probability-proportional-to-size. A sub sample of 373 persons was randomly selected for assessment with regard to hypertension prevalence, treatment and control. Results: The sample consisted of 373 older adults with the majority (56.6%) being female. The age of the participants ranged from 60 to 100 years, with the median age being 70 (interquartile range = 13) years. Reported prevalence of hypertension was 61.7% and significantly (p < 0.001) more females than males (71.4% vs 49.1%, respectively) reported having hypertension. There was no significant difference in being diagnosed with hypertension by age groups, area of residence, highest level of education and union status. Among older adults who reported having hypertension, the majority (90.0%) were being treated while one in ten (10%) reported not being treated. "Based on the Eighth Joint National Committee (JNC-8) definition of control, among older adults who reported having hypertension, only slightly more than a third (34.8%) were controlled; the majority (65.2%) were uncontrolled. Conclusion: The low level of hypertension control documented is of concern given the availability of medication subsidies and the priority attention being given to chronic disease. Further research is needed regarding facilitators and barriers to hypertension control to identify the best interventions to increase control levels.

RESUMEN Objetivo: Examinar la prevalencia, tratamiento y control, así como los factores de riesgo asociados con la hipertensión entre los adultos mayores en Jamaica. Métodos: Cuatro parroquias en Jamaica fueron encuestadas usando un diseño de estudio transversal que abarcó 2943 participantes. La encuesta utilizó una metodología de muestreo por conglomerados con probabilidad proporcional al tamaño. Una submuestra de 373 personas fue seleccionada aleatoriamente para su evaluación con respecto a la prevalencia, tratamiento y control de la hipertensión. Resultados: La muestra constó de 373 adultos mayores, de los cuales la mayor parte (56. 6%) eran mujeres. La edad de los participantes fluctúo de 60 a 100 años, siendo la edad mediana 70 años (rango intercuartil = 13). La prevalencia de hipertensión reportada fue 61.7%, y significativamente (p < 0.001) más hembras que varones (71.4% vs 49.1%, respectivamente) reportaron tener hipertensión. No hubo diferencia significativa alguna en ser diagnosticado con hipertensión por grupos de edad, área de residencia, nivel más alto de educación, y estado de la unión. Entre los adultos mayores que reportaron tener hipertensión, la mayoría (90.0%) estaban siendo tratados, mientras que uno de cada diez (el 10%) reportaron no tener tratamiento. Basándose en la definición de control ocho del Comité Nacional Conjunto (JNC, siglas en inglés) entre los adultos mayores que reportaron tener hipertensión, sólo poco más de un tercio (34.8%) eran controlados. La mayoría (65.2%) no eran controlados. Conclusión: El bajo nivel de control de la hipertensión documentado es asunto de preocupación, dada la disponibilidad de subsidios para medicamentos y la atención prioritaria que se da a las enfermedades crónicas. Se necesitan investigaciones adicionales sobre facilitadores y barreras al control de la hipertensión para identificar mejores intervenciones para aumentar los niveles de control.

Sinking Teeth into Dental Health of Older Adults in Jamaica / Compromiso Entusiasta con la Salud Dental de los Adultos Mayores en Jamaica

ABSTRACT Objectives: To describe the prevalence of tooth loss, denture use and dental care utilization among older persons by age, gender, union, residence, education, chronic illness and health insurance status and to identify independent predictors of dental service use and tooth loss. Methods: A cross-sectional survey utilizing a nationally representative sample of 2943 older persons in Jamaica was conducted. Data related to tooth loss, dental care use and sociodemographic data were obtained. Relationships between variables were assessed in bivariate analyses and logistic regression models subsequently developed to identify predictors of tooth loss and dental care use. Results: Tooth loss (any) prevalence was 94% and among those who reported tooth loss, 61.1% had dentures: the majority of those with dentures reported using them. Non-use was mainly related to damaged denture or discomfort. Only 35% of persons reported a dental visit within the last 12 months. Age, union status and educational level were significant predictors of both tooth loss and dental visit within the past year. Additionally, gender, residence and having health insurance predicted dental care utilization. Conclusion: Dental health issues are important in the care of older persons and assume increasing relevance given rapid ageing of the population. Jamaica must craft strategies to address emergent needs in its response to the challenges of oral healthcare for older persons.

RESUMEN Objetivos: Describir la prevalencia de la pérdida de dientes, el uso de prótesis dentales, y la utilización de la atención dental entre las personas mayores por edad, género, estado civil, residencia, educación, enfermedad crónica, y posesión de seguro médico, e identificar predictores independientes de la utilización de la atención dental, así como de la pérdida de dientes. Métodos: Se realizó una encuesta transversal utilizando una muestra representativa de 2943 personas de edad a nivel nacional en Jamaica. Se obtuvo datos sobre la pérdida de dientes, el uso de los servicios dentales, y la demografía. Las relaciones entre las variables se evaluaron en análisis bivariados y modelos de regresión logística desarrollados posteriormente para identificar los predictores de la pérdida de dientes y la utilización de la atención dental. Resultados: La prevalencia de la pérdida de dientes (cualesquiera) fue 94%, y entre los que informaron pérdida de dientes, un 61.1% utilizaban prótesis dentales: la mayoría de los que utilizaban prótesis dentales reportaron su uso. El no uso se relacionó principalmente con prótesis dentales dañadas o molestias. Sólo el 35% de las personas reportaron una visita dental en los últimos 12 meses. La edad, el estado civil, y el nivel educacional fueron predictores significativos de la pérdida de dientes y la visita dental el año anterior. Además, el género, la residencia y la posesión del seguro médico fueron predictores de la utilización de la atención dental. Conclusión: Los problemas de salud dental son importantes en el cuidado de las personas de edad y adquieren una relevancia creciente dado el rápido envejecimiento de la población. Jamaica debe elaborar estrategias para abordar las necesidades emergentes en su respuesta a los desafíos de la salud oral de las personas mayores.

Non-communicable diseases in an older, aging population: a developing country perspective (Jamaica).

UNLABELLED: Changes in the non-communicable disease (NCD) profile of older adults living in a rapidly-aging, developing country are described. METHODS: Data from a 2012 nationally representative survey of 2,943 older adults were used to determine the burden of NCDs important to elder health. Additionally, the percentage change in NCD prevalence over a 23-year period (1989-2012) was determined. RESULTS: In 2012, approximately 75.3% of the sample reported at least one NCD; 47.5% reported comorbidities. High blood pressure (61%), arthritis (35%) and diabetes (26%) were the most reported conditions, peaking in the 70-79 age group. Females reported higher rates of disease than males. Significant increases in prevalence occurred for all conditions except arthritis; the most significant were in diabetes (157%) and cancer (118%). CONCLUSION: Rapid increases in NCDs are of great public health importance. Strengthening of primary health care and improvements in human resources must occur if the well-being of older adults is to be improved.

Cardio-Vascular Disease and Cancer: A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country.

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.

Ageing of Jamaica's Population -- What Are the Implications for Healthcare?

The 2011 Census has confirmed the ageing of the Jamaican population. The over-60-year-old population has increased while the under 15-year population has decreased. Other demographic changes of note include the largest increase being in the old-old who are predominantly female. The demographic changes when considered with the increase in chronic disease indicate the need for consideration of healthcare specifically targeting the needs for older persons including increased prevention, continuous medical management, long term care and caregiver support.

Hypertension and Diabetes Prevalence in Older Persons in Jamaica, 2012.

The Jamaican population is experiencing both a demographic and epidemiological transition. This 2012 study of 2943 community dwelling persons over sixty years of age sought to determine the prevalence of hypertension and diabetes and how it has increased since the earlier 1989 study. Hypertension was the most prevalent non-communicable disease with 61.4% and had increased from 41.4% since 1989. It increased with age and was more common in females than males. Diabetes, at 26.3%, was the third most prevalent; it had increased by 157.1% since 1989. While the majority of affected persons were on medication, control of both diseases was less than adequate. Obesity was associated with both diseases. The paper discusses the implications for healthcare systems.

Shaping the research experiences of graduate students using action research.

BACKGROUND: Nursing research capacity is often not optimal in developing countries. Capacity building at the graduate nurse level presents an opportunity for improved research output. Students pursuing a research methods course at a nursing school in Jamaica expressed fear and anxiety towards the course. Action research was used to address this fear and improve learning outcomes. OBJECTIVE: To determine attitudes towards research and to improve the experience of graduate students pursuing a research methods course at a nursing school in Jamaica. METHODS: Students (n=44) registered in the Research Methods course of the MScN at a nursing school in Kingston, Jamaica for the academic year 2010/2011, were invited to participate. Each student was assigned a main supervisor and an alternate supervisor and all had equal access to the course leader and content. On completion of the course three focus group discussions of 10-14 students per group were conducted to determine how students felt about the course experience and their attitude towards the course. RESULTS: Thirty-seven students (mean age of 41.4 ± 1.5 years; 94% female) participated in the exploratory course evaluation exercise. The participants reported that they entered research methods with feelings of apprehension and anxiety. However, these fears were allayed by a combination of factors including interest in students' welfare, affirmation of students, respect for and understanding of students' needs and resourcefulness, and the use of a panel of experts. Barriers included faculty's unrealistic expectations of students' research competencies and the limited time in which to learn and apply concepts. While students thought the course as challenging they felt more confident that they could be successful on completion of the course. CONCLUSION: Significant improvement in attitudes to research was realized among graduate nursing students using action research at an urban school of nursing in Jamaica.

The epidemiology of suicide in Jamaica 2002-2010: rates and patterns / Epidemiología del suicidio en Jamaica de 2002 a 2010: tasas y patrones

OBJECTIVE: Suicide is increasingly recognized as a worldwide problem. There is a paucity of quality data pertaining to suicide in developing countries. Epidemiological analysis of suicide data elucidates prevailing patterns that facilitate risk factor identification and the development of germane programmatic responses. This paper analyses temporal variations in suicide rates for the years 2002-2010 in Jamaica and describes the sociodemographic profile of cases and method of suicide for the latter four years. METHOD: Data pertaining to suicides were extracted from the police (The Jamaica Constabulary Force) records. These were summarized and analysed with respect to person, place and time. Population statistics for the computation of rates were obtained from publications of the Statistical Institute of Jamaica. Age-standardized rates were generated for comparison of trends over time. Poisson and binomial probabilities were used to determine statistically significant differences in rates. RESULTS: Suicide rates in Jamaica have remained relatively stable for the period reviewed with mean overall annual incidence of 2.1 per 100 000 population. Rates for males were significantly higher than those for females. The majority (90.4%) of suicide cases were males. A trend for higher rates of suicide was generally noted in the 25-34-year and the 75-year and over age groups. Hanging was the main method used to commit suicide (77.5%). CONCLUSIONS: Age-adjusted rates of suicide indicate no significant changes in Jamaica over the period 2002 to 2010. Continued surveillance of suicide as well as improved recording of the circumstances surrounding suicides are recommended to promote greater understanding of suicides and this will ultimately inform intervention strategies.

OBJETIVO: El suicidio adquiere cada vez mayor reconocimiento como problema mundial. Existe una escasez de datos cualitativos en relación con el suicidio en los países en vías de desarrollo. El análisis epidemiológico de los datos sobre suicidio dilucida los patrones prevalecientes que facilitan la identificación de factores de riesgo y el desarrollo de respuestas programáticas relacionadas. El presente trabajo analiza las variaciones temporales de las tasas de suicidio durante los años 2002-2010 en Jamaica, y describe el perfil demográfico de los casos y métodos de suicidio durante los últimos cuatro años. MÉTODO: Datos relacionados con el suicidio fueron tomados de los archivos de la policía (Jamaica Constabulary Force). Los mismos fueron resumidos y analizados con respecto a la persona, el lugar y el tiempo. Se obtuvieron estadísticas de la población para el cómputo de tasas, Las estadísticas fueron tomadas de las publicaciones del Instituto Estadístico de Jamaica. Se generaron tasas estandarizadas por edad con el fin de hacer una comparación de las tendencias a través del tiempo. Se usaron probabilidades binomiales y de Poisson, para determinar las diferencias estadísticamente significativas en las tasas. RESULTADOS: Las tasas de suicidio en Jamaica han permanecido relativamente estables en el periodo bajo estudio, con una incidencia promedio anual general de 2.1 por 100 000 habitantes. Las tasas de los varones fueron significativamente más altas que las de las hembras. La mayoría (90.4%) de los casos de suicidio fueron varones. Se observó generalmente una tendencia a tasas más altas de suicidio en los grupos de edades de 25-34 años, y 75 años o más. El ahorcamiento fue el método principal usado para cometer suicidio (77.5%). CONCLUSIONES: Las tasas de suicidio ajustadas por edad no indican ningún cambio significativo en Jamaica en el periodo de 2002 a 2010. Se recomienda una vigilancia continuada de los actos de suicidio así como el mejoramiento de los registros de las circunstancias en torno a los mismos, a fin de promover un mayor entendiendo de estos, con lo cual se podrán lograr a la larga estrategias de intervención bien informadas.

Suicide among adolescents in Jamaica: what do we know? / El suicidio entre los adolescentes de Jamaica: ¿qué sabemos?

Suicide is increasingly acknowledged as a global problem. Yet little is known worldwide about suicide rates among adolescents. Several social factors that exist in Jamaica present as stressors and may predispose to suicide. Ascertaining prevailing patterns and associated factors is important for crafting interventions. This paper establishes adolescent suicide rates for the years 2007-2010 in Jamaica and provides related epidemiological data. METHOD: Data pertaining to suicides were extracted from standardized data collected by the police. Information regarding the number of suicides among adolescents, 9-19 years of age, was reviewed for the years 2007-2010. Sociodemographic characteristics of cases: gender, location and occupation along with related variables were also examined. Variation of rates over time was ascertained. Statistically significant associations were determined by reference to p-values and confidence intervals. RESULTS: The incidence for suicide in adolescents was 1.1 per 100 000. Rates for males were significantly higher than females. Most suicide cases were students and the majority of cases was from rural areas (65%). Hanging was the main method used to commit suicide (96.2%). Items of clothing were commonly used for this purpose. CONCLUSION: Male adolescent suicide rates showed an upward trend in contrast to the downward trend for females in the four-year period studied. Continued surveillance is needed for greater understanding of adolescent suicides. Collaboration among health services, parents, schools and communities is integral in prevention efforts. Recent media coverage of suicides provides a window of opportunity to galvanize support for research and the development of intervention strategies.

OBJETIVO: El suicidio se reconoce cada vez más como un problema mundial. Sin embargo, poco se sabe sobre las tasas de suicidio entre los adolescentes. Varios factores sociales en Jamaica constituyen factores estresantes que pueden predisponer al suicidio. Determinar los patrones prevalecientes y los factores asociados, resulta importante a la hora de diseñar las intervenciones. El presente trabajo establece tasas de suicidio entre adolescentes en los años 2007-2010 en Jamaica, y proporciona datos epidemiológicos relacionados. MÉTODO: Se extrajeron datos en relación con los suicidios a partir de los datos estandarizados recopilados por la policía. Se examinó la información sobre el número de suicidios entre los adolescentes de 9-19 años de edad, durante los años 2007-2010. También se examinaron las características socio-demográficas de los casos - género, lugar, y ocupación - junto con otras variables relacionadas. Se estableció la variación de las tasas a través del tiempo. Se determinaron las asociaciones estadísticamente significativas mediante nm la referencia a los valores p y los intervalos de confianza. RESULTADOS: La incidencia de suicidios en adolescentes fue 1.1 por 100 000. Las tasas para los varones fueron significativamente más altas que para las hembras. La mayoría de los casos de suicidios se trató de estudiantes, y la mayor parte de los suicidios tuvo lugar en áreas rurales (65%). El ahorcamiento fue el método principal usado para cometer suicidio (96.2%). Artículos de vestir fueron comúnmente usados para este propósito. CONCLUSIÓN: Las tasas de suicidio entre adolescentes varones mostraron una tendencia creciente, en contraste con la tendencia descendente para las hembras en el periodo de cuatro años bajo estudio. Se necesita una vigilancia permanente a fin de lograr una mayor comprensión del suicidio entre adolescentes. La colaboración entre los servicios de salud, los padres, la escuela, y la comunidad, son fundamentales para lograr esfuerzos integrados para prevenir los casos de suicidio. La cobertura reciente de los medios de difusión sobre los casos de suicidio abre una ventana que impulsa el apoyo a la investigación y al desarrollo de estrategias de intervención.

Suicide among adolescents in Jamaica: what do we know?

UNLABELLED: Suicide is increasingly acknowledged as a global problem. Yet little is known worldwide about suicide rates among adolescents. Several social factors that exist in Jamaica present as stressors and may predispose to suicide. Ascertaining prevailing patterns and associated factors is important for crafting interventions. This paper establishes adolescent suicide rates for the years 2007-2010 in Jamaica and provides related epidemiological data. METHOD: Data pertaining to suicides were extracted from standardized data collected by the police. Information regarding the number of suicides among adolescents, 9-19 years of age, was reviewed for the years 2007-2010. Sociodemographic characteristics of cases: gender, location and occupation along with related variables were also examined. Variation of rates over time was ascertained. Statistically significant associations were determined by reference to p-values and confidence intervals. RESULTS: The incidence for suicide in adolescents was 1.1 per 100 000. Rates for males were significantly higher than females. Most suicide cases were students and the majority of cases was from rural areas (65%). Hanging was the main method used to commit suicide (96.2%). Items of clothing were commonly used for this purpose. CONCLUSION: Male adolescent suicide rates showed an upward trend in contrast to the downward trend for females in the four-year period studied. Continued surveillance is needed for greater understanding of adolescent suicides. Collaboration among health services, parents, schools and communities is integral in prevention efforts. Recent media coverage of suicides provides a window of opportunity to galvanize support for research and the development of intervention strategies.

The epidemiology of suicide in Jamaica 2002-2010: rates and patterns.

OBJECTIVE: Suicide is increasingly recognized as a worldwide problem. There is a paucity of quality data pertaining to suicide in developing countries. Epidemiological analysis of suicide data elucidates prevailing patterns that facilitate risk factor identification and the development of germane programmatic responses. This paper analyses temporal variations in suicide rates for the years 2002-2010 in Jamaica and describes the sociodemographic profile of cases and method of suicide for the latter four years. METHOD: Data pertaining to suicides were extracted from the police (The Jamaica Constabulary Force) records. These were summarized and analysed with respect to person, place and time. Population statistics for the computation of rates were obtained from publications of the Statistical Institute of Jamaica. Age-standardized rates were generated for comparison of trends over time. Poisson and binomial probabilities were used to determine statistically significant differences in rates. RESULTS: Suicide rates in Jamaica have remained relatively stable for the period reviewed with mean overall annual incidence of 2.1 per 100 000 population. Rates for males were significantly higher than those for females. The majority (90.4%) of suicide cases were males. A trend for higher rates of suicide was generally noted in the 25-34-year and the 75-year and over age groups. Hanging was the main method used to commit suicide (77.5%). CONCLUSIONS: Age-adjusted rates of suicide indicate no significant changes in Jamaica over the period 2002 to 2010. Continued surveillance of suicide as well as improved recording of the circumstances surrounding suicides are recommended to promote greater understanding of suicides and this will ultimately inform intervention strategies.

Chronic disease and ageing in the Caribbean: opportunities knock at the door.

Amidst rapid population ageing, the incidence and prevalence of chronic diseases and their sequelae demand reflective and critical looks at the issue and the subsequent development of informed age-sensitive responses. This paper reviews the burden of chronic diseases in the Caribbean, and its relationship to ageing and the demographic transition. Inter-linkages between the social determinants of health, poverty, ageing, and chronic disease are illustrated. Suggestions are made regarding directions to be pursued and the emerging initiative regarding chronic non-communicable diseases being spearheaded at the United Nations by CARICOM countries

Are parents in tune with music their adolescent children enjoy? Are there missed opportunities for sexual and reproductive health dialogue?

UNLABELLED: The perspectives of adolescents were solicited on the issue of sexual and reproductive health messages they received through dancehall music as well as their perceptions of parents' views of such messages and adolescents' indulgence with this genre of music. METHODS: This sequential mixed methods study was completed in 2008. The study's qualitative component was summarized as the novel ALODAC (Ask, Listen and Observe, Discuss, Analyse and Confirm) model, involving a series of steps to engage adolescents 10-19 years to share their perspectives on sexual and reproductive health messages enunciated in the dancehall music to which they listen. The quantitative component saw 1626 adolescents in public schools responding to an interviewer-administered questionnaire which included questions about their families and how they respond to dancehall content. Five messages determined from content analysis of songs on adolescents' music menu were used to initiate discussions with adolescents about the issues. RESULTS: Almost equal proportions of respondents in the survey lived with either their mothers (37.3%) or both parents (35.6%). Most adolescents reported enjoying dancehall music and learning specific messages even when some parents were against use of such music. There were significant gender differences observed regarding perceptions about parents agreement with lyrics on transactional sex (p < 0.001), prevention of pregnancy (p < 0.01), condom use (p < 0.01) and multiple relationships (p < 0.01). CONCLUSIONS: Whether or not parents are in tune with the music their adolescent children listen to does not seem to affect the pleasure and lessons adolescents gain from this medium. Opportunities for discussing sexual issues common in Jamaican dancehall music exist but are missed.

Chronic disease and ageing in the Caribbean: opportunities knock at the door / Enfermedades crónicas y envejecimiento en el Caribe: las oportunidades llaman a la puerta

Amidst rapid population ageing, the incidence and prevalence of chronic diseases and their sequelae demand reflective and critical looks at the issue and the subsequent development of informed age-sensitive responses. This paper reviews the burden of chronic diseases in the Caribbean, and its relationship to ageing and the demographic transition. Inter-linkages between the social determinants of health, poverty, ageing, and chronic disease are illustrated. Suggestions are made regarding directions to be pursued and the emerging initiative regarding chronic non-communicable diseases being spearheaded at the United Nations by CARICOM countries.

En medio del rápido envejecimiento de la población, la incidencia y prevalencia de las enfermedades crónicas y sus secuelas, requiere echar una ojeada reflexiva y crítica al problema y al desarrollo ulterior de las respuestas informadas sensibles a la edad. El presente trabajo examina la carga de las enfermedades crónicas en el Caribe, y su relación tanto con el envejecimiento como con la transición demográfica. Se ilustran los vínculos existentes entre las determinantes sociales de la salud, la pobreza, el envejecimiento, y las enfermedades crónicas. Se hacen sugerencias en cuanto a los caminos a seguir y la iniciativa emergente en relación con las enfermedades crónicas no comunicables, encabezada por los países del Caricom en las Naciones Unidas.

Are parents in tune with music their adolescent children enjoy? Are there missed opportunities for sexual and reproductive health dialogue? / ¿Están los padres en sintonía con la música que a sus hijos adolescentes les gusta? ¿Se desaprovechan oportunidades para conversar sobre salud sexual y reproductiva?

The perspectives of adolescents were solicited on the issue of sexual and reproductive health messages they received through dancehall music as well as their perceptions of parents' views of such messages and adolescents' indulgence with this genre of music. METHODS: This sequential mixed methods study was completed in 2008. The study's qualitative component was summarized as the novel ALODAC (Ask, Listen and Observe, Discuss, Analyse and Confirm) model, involving a series of steps to engage adolescents 10-19 years to share their perspectives on sexual and reproductive health messages enunciated in the dancehall music to which they listen. The quantitative component saw 1626 adolescents in public schools responding to an intervieweradministered questionnaire which included questions about their families and how they respond to dancehall content. Five messages determined from content analysis of songs on adolescents' music menu were used to initiate discussions with adolescents about the issues. RESULTS: Almost equal proportions of respondents in the survey lived with either their mothers (37.3%) or both parents (35.6%). Most adolescents reported enjoying dancehall music and learning specific messages even when some parents were against use of such music. There were significant gender differences observed regarding perceptions about parents agreement with lyrics on transactional sex (p 0.001), prevention of pregnancy (p 0.01), condom use (p 0.01) and multiple relationships (p 0.01). CONCLUSIONS: Whether or not parents are in tune with the music their adolescent children listen to does not seem to affect the pleasure and lessons adolescents gain from this medium. Opportunities for discussing sexual issues common in Jamaican dancehall music exist but are missed.

Se pidió a un número de adolescentes dar sus perspectivas acerca de los mensajes acerca de la salud sexual y reproductiva recibidos a través de la llamada música dancehall, así como sus percepciones de los puntos de vista de sus padres sobre esos mensajes y la indulgencia de los adolescentes con este género de música. MÉTODOS: Este estudio de métodos mixtos secuenciales se completó en 2008. El componente cualitativo del estudio fue resumido como el modelo novel ALODAC, que incluye una serie de pasos para hacer que adolescentes de 10 a 19 años de edad compartan sus perspectivas sobre los mensajes sobre salud sexual y reproductiva contenidos en la música dancehall que escuchan. El componente cuantitativo comprendió 1626 adolescentes de las escuelas públicas, quienes respondieron un cuestionario administrado por el entrevistador, que incluía preguntas acerca de sus familias y cómo respondían al contenido dancehall. Cinco mensajes determinados a partir del análisis del contenido de canciones en el repertorio musical de los adolescentes, fueron utilizados para iniciar conversaciones con los adolescentes acerca de las cuestiones. RESULTADOS: Casi las mismas proporciones de encuestados en el estudio vivían, bien con sus madres (37.3%), bien con ambos progenitores (35.6%). La mayor parte de los adolescentes reportó disfrutar de la música dancehall y aprender de los mensajes específicos, incluso cuando algunos padres y madres estaban en contra del uso de este tipo de música. Se observaron diferencias significativas de género en relación con las percepciones sobre el acuerdo de los padres con respecto a las letras sobre las transacciones sexuales (p 0,001), la prevención del embarazo (p 0,01), el uso de preservativos (p 0,01) y las relaciones múltiples (p 0,01). CONCLUSIONES: Que los padres estén o no en sintonía con la música que escuchan sus hijos adolescentes, no parece afectar el placer y las lecciones que los adolescentes derivan de este medio. Existen oportunidades para debatir cuestiones sexuales comunes en la música dancehall jamaicana, pero no se aprovechan.

Are women ready to do HIV test? / ¿Están las mujeres preparadas para una prueba de VIH?

OBJECTIVE: To identify the factors that influence the stage of change with regards to HIV testing in women (16-45 years old) in Westmoreland using the trans-theoretical model (TTM) of behaviour change. DESIGN AND METHODS: A structured interview-assisted questionnaire was administered to 372 pregnant and non-pregnant respondents in urban and rural areas of Westmoreland after random selection of four public health facilities. The trans-theoretical model which suggests that behaviour change process moves through five stages from pre-contemplation to maintenance was used to evaluate readiness for HIV testing. RESULTS: Most pregnant women who tested previously were at the preparation stage (78.5%) while non-pregnant women who tested previously were at contemplation (68.5%). The significant predictors of being in the action or maintenance stage among pregnant women was being 20-24 years old, experiencing a first pregnancy and being exposed to counselling. For women who had never tested, preparation was significantly associated with being in an unstable union (non-pregnant). No significant association was found for non-pregnant, previously tested females or for pregnant women who had never tested. CONCLUSION: The majority of women lacked self-efficacy as they were unable to maintain the behaviour and did not recognize its importance in the absence of pregnancy. Interventions are needed to target non-pregnant women, especially teenagers, women over 25-years old and women in unions. Integration of testing services into all aspects of primary healthcare, established testing protocols and simultaneous marketing to selected at-risk groups will increase the uptake of HIV testing opportunities and contribute to the control of this epidemic.

OBJETIVO: Identificar los factores que influyen sobre la etapa de cambio en relación con la prueba de VIH en mujeres (16-45 años) en Westmoreland, mediante la utilización del modelo transteórico del cambio de comportamiento (MTT). DISEÑO Y MÉTODOS: Se aplicó un cuestionario estructurado asistido por entrevistas, a 372 encuestadas - embarazadas y no embarazadas - en las áreas rurales y urbanas de Westmoreland, luego de una selección aleatoria de cuatro centros de salud pública. El MTT, que sugiere que el proceso de cambio de comportamiento atraviesa cinco etapas que van desde la precontemplación al mantenimiento, se usó para evaluar el grado de preparación para la prueba de VIH. RESULTADOS: La mayor parte de las mujeres embarazadas que tuvieron la prueba previamente estaban en la etapa de preparación (78.5%), mientras que las no embarazadas que tuvieron la prueba con anterioridad estaban en la etapa de contemplación (68.5%). Los predictores significativos de la etapa de acción o de mantenimiento entre las mujeres embarazadas, fueron: tener 20-24 años, estar experimentando el embarazo por primera vez, y estar expuestas a consejos psicológicos. Para las mujeres que nunca habían hecho la prueba, la preparación estuvo significativamente asociada con tener una unión inestable (no embarazadas). No se halló asociación significativa para las no embarazadas con pruebas anteriores o las embarazadas que nunca tuvieron pruebas. CONCLUSIÓN: A la mayoría de las mujeres les faltaba autoeficacia, ya que no eran capaces de mantener el comportamiento y no reconocían su importancia en ausencia del embarazo. Se necesitan intervenciones a fin de poner las miras en las mujeres no embarazadas, especialmente las adolescentes, las mayores de 25 años, y las mujeres en uniones. La integración de los servicios de pruebas en todos los aspectos de la atención primaria de la salud, el establecimiento de protocolos de pruebas y el marketing simultáneo de grupos de riesgo seleccionados, aumentará el interés en las oportunidades de pruebas de VIH y contribuirá al control de esta epidemia.

Prevention for better health among older persons are primary healthcare clinics in Jamaica meeting the challenge? / Prevención para una mejor salud entre las personas mayores de edad: ¿Están las clínicas de atención primaria a la salud dando respuesta a este desafío en Jamaica? - Hallazgos de un estudio transversal

OBJECTIVES: The study sought to determine the level and type ofpreventive care offered to older persons (persons 50 years and over) in the primary healthcare system and to identify the barriers to preventionrelated activities. METHODS: The study was carried out in three phases utilizing quantitative and qualitative methods. Quantitative data were collected over a six-week period from 738 older patients accessing health centre curative services and from 86 health centre staff. Focus group discussions were used to obtain information from non-users ofhealth centres. RESULTS: The findings showed that while clinical practice was good, there were relatively inadequate levels ofprevention care practices and there were barriers to prevention-related activities for older persons in the primary healthcare system. Only 5.1 %, 24.5% and 9.6% of older persons reported being advised about smoking, physical activity and alcohol consumption respectively by health centre staff. A higher proportion (56.5%) reported being advised about diet. Older persons did not appear to understand the role of prevention in maintaining health status. Barriers identified include inadequate numbers ofstaff, overcrowded clinics, rapid staffturnover, high costs ofinvestigations and medications, and poor staffperception of older persons' abilities to care for themselves. CONCLUSION: Health promotion and secondary prevention for older persons in the primary healthcare clinics need strengthening. Training and facilitation ofhealth workers in age-related age-specific prevention activities are recommended. The provision ofappropriate resources for prevention activities among older persons in primary healthcare settings should be addressed.

OBJETIVO: El estudio buscó determinar el nivel y tipo de cuidados preventivos ofrecidos a personas mayores (personas de 50 años y más) en el sistema de atención primaria, e identificar las barreras a las actividades relacionadas con la prevención. MÉTODOS: El estudio se llevó a cabo en tres fases utilizando métodos cuantitativos y cualitativos. Los datos cuantitativos fueron recogidos en un periodo de seis semanas, a partir de 738 pacientes mayores que recibían servicios curativos de centros de salud, y a partir de 86 miembros del personal de atención a la salud. Las discusiones del grupo de foco se usaron para obtener información de no usuarios de los centros de salud. RESULTADOS: Los hallazgos mostraron que aunque la práctica clínica era buena, había niveles relativamente inadecuados de prácticas de cuidados preventivos y había barreras a las actividades relacionadas con la prevención, para las personas mayores en el sistema de atención primaria de salud. Sólo 5.1%, 24.5 y 9.6% de las personas mayores reportaron haber recibido consejos de parte del personal del centro de salud, en relación con el hábito de fumar, la actividad física, y el consumo de alcohol respectivamente. Una proporción más alta (56.5%) reportó haber recibido consejos sobre la dieta. Las personas mayores no parecían entender el papel de la prevención en mantener el estado de salud. Las barreras identificadas incluyen: número inadecuado de personal, clínicas abarrotadas, cambio frecuente del personal, alto costo de las investigaciones y los medicamentos, y pobre percepción del personal en relación con la capacidad de las personas mayores para cuidarse a sí mismas. CONCLUSIÓN: La promoción de la salud y la prevención secundaria para las personas mayores en las clínicas de atención primaria de la salud, necesitan ser fortalecidas. Se recomienda el entrenamiento y la capacitación de los trabajadores de la salud en actividades de prevención relacionadas concretamente con edades específicas. Debe abordarse el problema de proveer recursos apropiados para las actividades de prevención entre las personas mayores, en los establecimientos de atención primaria de la salud.

Competition for adolescents' sexual and reproductive health values is the media winning? / Competencia por los valores sexuales y reproductivos de la salud y los adolescentes: ¿Ganan los medios de radiodifusión?

OBJECTIVE: This study aimed to understand the sources and content of sexual and reproductive health (SRH) information among Jamaican adolescents. SUBJECTS AND METHODS: A national survey of adolescents 9-18 years old attending public schools in Jamaica was done using multi-stage stratified cluster sampling techniques. Questions included in a 57item questionnaire assessed adolescents' awareness of SRH messages promoted by the Ministry of Health (SSRHM) and through Dancehall, (DSRHM). The data were analysed using the Statistical Package for the Social Sciences (SPSS) Version 12.0. Descriptive statistics were used to summarize the data and relationships between variables tested using bivariate analysis, with a 'p' value of 0.05 accepted as significant. RESULTS: The mean age of respondents was 12.8 (± 2.06) years for boys and 12.8 years (± 2.23) for girls. Television (76.9%), radio (55.4%) and guidance counsellors (55.2%) were the most common sources of SSRHM with no statistically significant demographic differences. Condom use was the only SSRHM, among the seven assessed, that was reported by more than half of the respondents (85.4% boys and 80.3% girls, p = 0.025). Half the number of the male specific DSRHM assessed was reported by more than 50% of boys. Hurting men who have sex with men, and having many girlfriends were the leading messages reported (69.8% & 65.3%). Among girls, five of nine female-related DSRHM were reported by most girls. Having relationships with males who have material resources (66.8%) and being independent (64%) were the leading messages reported. CONCLUSIONS: The electronic media was the leading source of SSRH messages and condom use was the only SSRHM that outstripped the variety ofgender specific DSRH messages, some ofwhich contradict standard messages.

OBJETIVO: Este estudio tuvo por objeto entender las fuentes y el contenido de la información sobre la salud sexual y reproductiva (SSR) entre los adolescentes jamaicanos. SUJETOS Y MÉTODOS: Se realizó una encuesta nacional entre adolescentes de 9-18 años de edad que asistían a escuelas públicas en Jamaica, para lo cual se usó una técnica de muestreo multifásico estratificado por conglomerados (cluster). Las preguntas incluidas en un cuestionario de 57 ítems evaluaban la conciencia de los adolescentes acerca de los mensajes de SSR promovidos por el Ministerio de Salud (SSRMS) y por la llamada música dance hall (SSRMD). Los datos fueron analizados usando el Paquete Estadístico para las Ciencias Sociales (SPSS), versión 12.0. Se usaron estadísticas descriptivas para resumir los datos y las relaciones entre las variables sometidas a prueba usando un análisis bivariado, en el que el valor 'p'de 0.05 fue aceptado como significativo. RESULTADOS: La edad promedio de los encuestados fue 12.8 (± 2.06) años para los niños y 12.8 años (± 2.23)para las niñas. La televisión (76.9%), la radio (55.4%), y los consejeros a cargo de la orientación (55.2%) fueron las fuentes más comunes de la SSRMS, sin que se produjeran diferencias demográficas estadísticamente significativas. El uso del condón fue el único aspecto del SSRMS entre los siete evaluados, que fue reportado por más de la mitad de los encuestados (85.4% niños y 80.3% niñas, p = 0.025). La mitad de los elementos masculinos específicos del SSRMS evaluados, fue reportada por más del 50% de los varones. Hombres abusivos que tienen sexo con otros hombres y el tener muchas "amigas", fueron los principales reportados (69.8% and 65.3%). Entre las jovencitas, cinco de cada nueve mensajes relacionados con las mujeres, fueron reportados por la mayor parte de ellas. Mantener relaciones con hombres que poseen recursos materiales (66.8%) y el ser independientes (64%) fueron los principales mensajes reportados. CONCLUSIONES: Los medios electrónicos fueron la fuente principal de los mensajes de la SSR y el uso del condón fue el único de la SSRMS que superó la variedad de mensajes específicos de género de la SSRMD, algunos de los cuales contradicen los mensajes standards.