Antihypertensive medication class and diastolic orthostatic hypertension in older Caribbean adult patients.

In the Caribbean there is limited data on orthostatic hypertension (OHT) in elderly hypertensive patients with atherosclerotic disease who are at risk for cardiovascular events. The authors examined the association of antihypertensive classes of drugs with diastolic OHT in patients 60 year and older with hypertension and hyperlipidemia attending public primary care facilities. These relationships were evaluated in a cross-sectional study of hypertensive hyperlipidemic older patients (n = 400) to determine orthostatic changes in blood pressure based on seated to standing measurements. OHT was defined as an increase in systolic blood pressure of ≥20 mm Hg and/or increase in diastolic blood pressure of ≥10 mm Hg upon orthostasis at 3 min. Patients were categorized based on their orthostatic blood pressure response: orthostatic normotensive (n = 200) and blood pressure dysregulated (n = 200) of which 168 were diastolic OHT. Multivariable logistic regression models were used to examine associations of antihypertensive classes and diastolic OHT. Renin-angiotensin-aldosterone-system (RAAS) blockers were the most commonly prescribed (79.3%), followed by diuretics (DIUs) (61.6%), dihydropyridine calcium channel blockers (dCCBs) (53.8%), and beta-blockers (BBs) (19.3%). Most normotensive (76.0%) and diastolic OHT (75.0%) patients were prescribed two or more antihypertensive medications. Pharmaceutical prescription of triple combination RAAS blockers + dCCBs + DIUs (OR, 0.55; 95% CI, 0.31-0.99) or RAAS blockers + dCCBs + BBs (OR, 0.23; 95% CI, 0.06-0.92) showed a protective effect of diastolic OHT in analyses adjusted for age, sex, sitting diastolic blood pressure, and comorbidities. Our study suggests prescription of triple combination antihypertensive drugs of RAAS blockers + dCCBs + DIUs or RAAS blockers + dCCBs + BBs may reduce the likelihood of diastolic OHT.

2020 family medicine postgraduate examinations at The University of the West Indies: successes and challenges in the time of COVID-19 pandemic.

Little has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.

Nurses' perception of preparedness for moving mental health care from psychiatric to general hospitals in Jamaica.

OBJECTIVES: To examine nurses' perception of readiness to care for patients with mental illness at two general hospitals in St. Catherine, Jamaica. METHODS: This mixed-methods, cross-sectional study was conducted among nurses on the medical wards of two hospitals. A 39-item, self-administered questionnaire containing open- and closed-ended questions and personal interviews was used to assess the nurses' preparedness to care for mentally ill patients; their awareness regarding protocol for care of mentally ill patients; their attitudes towards the integration of mental health care into the general hospital setting; and any associations between these and select variables, e.g., education level, work experience; and perceptions of the integration process. RESULTS: In all, 105 nurses completed the questionnaire (response rate: 80%) and six nursing supervisors were interviewed. Almost all (99%) felt the ward was unsuitable for admitting mentally ill patients; 95% felt inadequately prepared; and 73% were not aware that a standard management protocol for treating patients with mental illness was available. Staff training was deemed important. It was felt that a special area should be established for managing mentally ill patients. CONCLUSIONS: The shift of mental health services was a strategic policy decision aligned with the recommendations and support of the Pan American Health Organization. This study shows the need for medication, equipment, implementation of standard operating procedures, adequate accommodation for patients, and staff trained to provide quality care for patients with mental illness.

Nurses' perception of preparedness for moving mental health care from psychiatric to general hospitals in Jamaica / Percepción de las enfermeras sobre la preparación para trasladar la atención de salud mental de los hospitales psiquiátricos a los hospitales generales en Jamaica / Percepção das enfermeiras sobre a preparação para transladar a atenção à saúde mental dos hospitais psiquiátricos para os hospitais gerais em Jamaica

ABSTRACT Objectives To examine nurses' perception of readiness to care for patients with mental illness at two general hospitals in St. Catherine, Jamaica. Methods This mixed-methods, cross-sectional study was conducted among nurses on the medical wards of two hospitals. A 39-item, self-administered questionnaire containing open- and closed-ended questions and personal interviews was used to assess the nurses' preparedness to care for mentally ill patients; their awareness regarding protocol for care of mentally ill patients; their attitudes towards the integration of mental health care into the general hospital setting; and any associations between these and select variables, e.g., education level, work experience; and perceptions of the integration process. Results In all, 105 nurses completed the questionnaire (response rate: 80%) and six nursing supervisors were interviewed. Almost all (99%) felt the ward was unsuitable for admitting mentally ill patients; 95% felt inadequately prepared; and 73% were not aware that a standard management protocol for treating patients with mental illness was available. Staff training was deemed important. It was felt that a special area should be established for managing mentally ill patients. Conclusions The shift of mental health services was a strategic policy decision aligned with the recommendations and support of the Pan American Health Organization. This study shows the need for medication, equipment, implementation of standard operating procedures, adequate accommodation for patients, and staff trained to provide quality care for patients with mental illness.

RESUMEN Objetivos Examinar la percepción de las enfermeras sobre la preparación para atender a pacientes con enfermedades mentales en dos hospitales generales en St. Catherine, Jamaica. Métodos Se llevó a cabo un estudio transversal, de métodos mixtos, entre las enfermeras de los pabellones médicos de dos hospitales. Se utilizó un cuestionario autoadministrado con 39 ítems que contenía tanto preguntas abiertas como cerradas y entrevistas personales, para evaluar la preparación de las enfermeras en cuanto a protocolos y atención de pacientes con enfermedades mentales; sus actitudes hacia la integración de la atención de salud mental en el entorno hospitalario general; cualquier asociación entre estas y las variables seleccionadas, por ejemplo, nivel educativo, experiencia laboral; y sus percepciones acerca del proceso de integración. Resultados En total, 105 enfermeras completaron el cuestionario (tasa de respuesta: 80%) y se entrevistó a seis supervisores de enfermería. Casi todos (99%) consideraron que la sala no era adecuada para admitir pacientes con enfermedades mentales; el 95% consideró que no estaba preparado adecuadamente; y el 73% no sabía que está disponible un protocolo estándar para atender pacientes con enfermedad mental. La capacitación del personal se consideró importante. Se planteó que se debería establecer un área especial para la atención de pacientes con enfermedades mentales. Conclusiones El cambio de los servicios de salud mental fue una decisión política estratégica alineada con las recomendaciones y el apoyo de la Organización Panamericana de la Salud. Este estudio muestra que es necesario disponer de medicamentos, equipos, implementación de procedimientos operativos estándar, una ubicación adecuada de los pacientes y personal capacitado para proporcionar una atención de calidad a los pacientes con enfermedad mental.

RESUMO Objetivos Examinar a percepção das enfermeiras sobre a preparação para atender a pacientes com doenças mentais em dois hospitais gerais em St. Catherine, Jamaica. Métodos Foi realizado um estudo transversal, de métodos mistos, entre as enfermeiras dos pavilhões médicos de dois hospitais. Foi utilizado um questionário autoadministrado com 39 itens que continha tanco perguntas abertas como fechadas e entrevistas pessoais, para avaliar a preparação e conhecimento das enfermeiras em quanto a protocolos e atenção de pacientes com doenças mentais; suas atitudes para a integração da atenção à saúde mental no entorno hospitalar geral; qualquer associação entre estes e das variáveis selecionadas, por exemplo, nível educacional, experiência profissional; e percepções do processo de integração. Resultados Em total, 105 enfermeiras completaram o questionário (taxa de resposta: 80%) e se entrevistou seis supervisores de enfermaria. Quase todos (99%) sentiram que a sala não era adequada para admitir pacientes com doenças mentais; 95% sentiu que não estava se preparado adequadamente; e 73% não sabia que está disponível um protocolo de gestão padrão para tratar pacientes com doença mental. A capacitação do profissional foi considerada importante. Estabeleceu-se que deveria ser creada uma área especial para o controle de pacientes com doenças mentais. Conclusões A mudança dos serviços de saúde mental foi uma decisão política estratégica alinhada com as recomendações e o apoio da Organização Pan-Americana da Saúde. Este estudo mostra a necessidade de medicamentos, equipamentos, a implementação de procedimentos operacionais padrão, um localização adequado dos pacientes e o suporte dos mesmos com pessoal capacitado para prestar cuidado de qualidade a pacientes com doença mental.

Family Medicine at the University of the West Indies: a model for the developing world.

Context and background: To describe the Family Medicine (FM) postgraduate training programme at the University of the West Indies (UWI). Actions and activities: This paper was created through a review of documents, and discussions with past and present coordinators and key stakeholders at four campuses in the English-speaking Caribbean (ESC). LESSONS LEARNED: Despite intermittent setbacks the FM programme in the ESC has grown due to: (1) The presence of an umbrella institution in the UWI. (2) The role of the Caribbean College of Family Physicians providing a unifying force of advocacy and cooperation. (3) Collaboration of staff across four sites despite large distances, differing departmental and campus structures and financial models; and varying levels of local medical and public health support. (4) The use of a modular design for academic content, which means that students have comparable learning experiences. (5) Streamlining of exit examinations, thus sharing resources in the assessment process. (6) A strong presence of FM in the undergraduate curriculum. CONCLUSIONS: Despite a variety of timelines in programme development and funding mechanisms, over 150 physicians have graduated in FM in the past five years. We identify the unifying strategies and institutions which made this possible and present this model as an option for new programmes in the developing world.

The use of the Papanicolaou smear as a screening tool for the detection of early carcinoma of the cervix in a university community

The aim of this study was to identify factors whichmight influence the use of the Papanicolaou (Pap) smear as a screening tool for the early detection ofcarcinoma of the cervix within a university staff population. The study was conducted on the Mona Campus of the University of the West Indies, Kingston, Jamaica, between July 1995 and February 1996. The different union groupings were used as a proxy for educational level and socioeconomic status. These union groups were West Indies Group of University Teachers (WIGUT), representing academic and senior administrative staff, Mona Non-Academic Staff Union(MONASA) representing non-academic/junior administrative staff and University and Allied Workers Union (UAWU) representing ancillary staff. A questionnaire was administered to a random sample of forty persons from the female members of each group, giving a total sample size of one hundred and twenty. There was an overall 72.5 percent response rate - 80 percent in the WIGUT group, 70 percent in the MONASA group and 67.5 percent in the UAWU group. Results showed that while 95.4 percent of the respondents were able to correctly identify early detection of cervical cancer as the main use of the Pap smear and all respondents thought that it was important to have regular Pap smears, only 51.7 percent actually had them regularly. A breakdown of Pap smear frequency by union group showed the lowest rate in the UAWU group. This group also had the highest overall level of risk factors for cervical cancer. It was also noted that members of the UAWU were more likely to use the facilities of the University Health Centre when they did Pap smears as compared to the use of private facilities by the other groups. Based on the findings it was recommended that any Pap smear educational or promotional programme on the Mona Campus should be focussed on the UAWU group which was shown to have the greatest need of this service and was most likely to make use of the University Health Centre facilities(AU)

The papanicolaou (PAP) smear as a screening test for cervical cancer

The overall aim of this study is to investigate the use of the Papanicolaou (PAP) smear as a screening tool for cervial cancer at the University of the West Indies Mona Campus Health Centre. The dockets of 1,320 registered female patients (staff members and dependents), aged 20 years and over at 31st December 1991, were reviewed. The date of the last Pap smear done at the Centre was ascertained, the result and the follow up action taken were noted. The study revealed that of the 1320 persons only 463 (35.1 percent) had at least one Pap smear done during the period 1989 to 1991 and only 126 (9.5 percent) had a Pap smear in 1991. Further analysis showed that of the 463 Pap smear done, 133 (28.7 percent) were normal, 316 (68.35 percent) showed infection or inflammation and 14 (3.0 percent) showed abnormal cells. From the 463 there were 188 (40.6 percent) treated at the Centre, 8 (1.7 percent) were referred to a specialist, 160 (34.6 percent) needed no treatment (133 normal plus 27 with mild inflammation only, 32 (7.6 percent) did not return for follow up note. This study allowed objective assessment of the present use of Pap smears in screening for cervical cancer at the Health Centre. It allowed analysis of the shortcomings of the system and facilitated the making of recommendations to ensure that the University campus (female community) is afforded effective screening for cervial cancer (AU)

Study of a geriatric institution in Jamaica - the Golden Age Home

There is now increasing acknowledgement of the importance of geriatrics. In Jamaica the geriatric population (o60 years old) rose from 6.1 percent in 1921 to 9.6 percent in 1982. With greater emphasis on geriatric care research is needed to identify the main areas of need so as to plan effectively for optimum utilisation of resources. The Golden Age Home, Kingston, Jamaica, was developed as a model geriatric institution, combining modern physical facilities and design with the concept of the elderly actively participating in its functioning. Although essentially a home for the "well elderly", aging is invariably associated with some medical problems, consequently, this study analysed the health related problems of residents and ascertained the opinions of the staff towards the home. Medical assessment of the residents was performed between August 1985 and February 1986. This examined the age/sex profile, the reasons for admission and the most common chronic illnesses and disabilities. Staff members completed a questionnaire investigating their training background and opinions on the home. The largest single group of the residents (29.4 percent) were in the 70 to 79 age group. The sex ratios varied at different ages. Males to females were in the ratio 3 to 2 in the 60 to 79 age group, whereas there was a 2 to 1 female preponderance in those 80 years old and over. The most common reason for admission, other than advanced age, was mental retardation, and this sub-population was mainly in the 20 to 29 age group. The most prevalent chronic illness, hypertension, occurred in 19 percent of residents. Visual impairment and impaired mobility were the most common disabilities occurring in 45.8 percent and 46 percent of the residents respectively. Only 9 percent of the residents were free of both chronic illnesses or disabilities, 26.2 percent having one and 29.6 percent having two complaints. The staff questionnaire provided information about their concepts of the good points of the home, the problems and suggested improvements. The needed improvements included: 1) more activities, including occupational therapy and rehabilitation; 2) improved water supply; 3) more facilities, equipment and drugs; and 4) improvement in inter-personal relationships. Based on the findings, recommendations were made towards improving conditions at the home and areas for further research were identified. Overall, a study of the Golden Age Home, should provide useful information relevant to delivery of care in geriatric institutions in the Caribbean region.(AU)