Post­World War II epidemiological transitions in Caribbean Societies: Interpretive insights based on age-associated mortality profiles

Objective: Life expectancy at birth is a robust indicator of the mortality profile in any spatial unit. The paper draws on age-associated life expectancy estimates from six Caribbean nations between 1950 and 2015 to assess variable gain in longevity of life at various stages of human lifespan and make claims about the variable impact of nation-specific sociomedical interventions as well as likely lessons to be learned. Design and Methodology: Using Mixed Methodology, secondary data are drawn from the United Nations Population Databases that reflect mortality profiles at national and regional levels. The data relate to six Caribbean nations ­ Cuba, Barbados, Jamaica, Trinidad and Tobago, Guyana and Haiti and permit the detection of changes in age-associated life expectancy over 20-year intervals including four time points ­ 1955, 1975, 1995 and 2015. Descriptive statistics are used to discern variable national trends that could be understood drawing on qualitative evidence obtained from documentary research and elite interviews. Results: Three distinct mortality profiles emerge with the most favourable being in Cuba and Barbados, the least favourable in Guyana and Haiti, and Jamaica and Trinidad and Tobago being located between the two extremes. The timing and magnitude of gains in infant, child, adult and geriatric health states can be discerned from the results. Conclusion: The paper is heuristic and constitutes a basis comparing the effectiveness of primary, secondary and tertiary health care in promoting human resilience to mortality. As such, the paper provides important ameliorative lessons that have implications for critically informing the administration of health policies.

Leprosy in transplant recipients: report of a case after liver transplantation and reviewof the literature

Leprosy still is an important public health problem in several parts of the world including Brazil...

Chronic pulmonary paracoccidioidomycosis (South American blastomycosis): high-resolution CT findings in 41 patients.

OBJECTIVE: To assess the pulmonary parenchymal findings on high-resolution CT in 41 patients with the chronic form of paracoccidioidomycosis (South American blastomycosis). SUBJECTS AND METHODS: The study included 41 consecutive patients in whom chronic paracoccidioidomycosis had been proven. All patients underwent high-resolution CT (1-mm collimation, high-spatial-frequency reconstruction algorithm) at 12 equally spaced intervals through the chest. The images were analyzed by two radiologists, and each final decision was reached by consensus. RESULTS: Thirty-eight (93%) of the 41 patients had CT scans with abnormal findings. The findings included interlobular septal thickening in 36 patients (88%), 1-25 mm diameter nodules in 34 (83%), peribronchovascular interstitial thickening in 32 (78%), centrilobular opacities in 26 (63%), intralobular lines in 24 (59%), ground-glass opacities in 14 (34%), cavitation in seven (17%), air-space consolidation in five (12%), traction bronchiectasis in 34 (83%), and paracicatricial emphysema in 28 (68%). In approximately 90% of patients, the abnormalities were bilateral and symmetrical and involved all lung zones. CONCLUSION: High-resolution CT findings of paracoccidioidomycosis consist predominantly of interstitial abnormalities and nodules associated with traction bronchiectasis and paracicatricial emphysema in a bilaterally symmetrical distribution.

Low dose aspirin in pregnancy are there any benefits

Although the question of major prophylactic benefits of low-dose aspirin in preventing pre-eclampsia or intrauterine growth retardation in pregnancies of mothers who had had such a history has been convincingly negated by the CLASP study, there has remained a question whether pregnancies of primiparae (the group most at risk of such outcomes) might benefit. This study was designed as a randomized controlled trial to address this possibility and other hypotheses arising from the CLASP study. The hypotheses addressed concerns whether low-dose aspirin prevented in or delayed the onset of the hypertensive disorders of pregnancy, including pre-eclampsia, and eclampsia, and whether preterm delivery or low birthweight rates were reduced. In addition, the study was designed to assess whether enrolment, early rather than late, had the most beneficial effect. In parallel, possible adverse effects on mother and infant were monitored. A total of 6275 primiparae were enrolled from 12 weeks gestation in community clinics in Kingston and St. Andrew in Jamaica; 97 percent of them were followed throughout pregnancy. There were no differences in the development of markers of hypertensive disorders, the prevalence of pre-eclampsia or eclampsia except for oedema, which was more prevalent in those on placebo. Mothers on the drug showed no differences in mean diastolic bloodpressure at any stage of pregnancy - they were not less likely to deliver preterm or have a larger foetus. They were, however, significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum. It is concluded that low-dose aspirin has no place in the management of normal pregnancy (AU)

Identifying maternal deaths in developing countries: experience in Jamaica.

Multiple sources were used to identify maternal deaths and their causes in a study carried out in Jamaica. These sources of information included a review of all deaths of women aged 12 to 49 years and included those occurring in hospitals (on maternity, surgical and medical wards and in casualty departments); reported to coroners' offices and the police; on whom post-mortems were carried out at hospitals, public morgues and for the Ministry of National Security; obtained from interviews with public health staff in all parishes and which were registered with the Registrar General's Department. Some 193 maternal deaths were identified giving a maternal mortality rate of 10 per 10,000 live births. No one source independently identified all maternal deaths. Hospital in-patient records yielded 133 deaths (69%), death certificates 74 (38%). Deaths due to certain causes were far more likely to be identified from particular sources eg those due to clinical mismanagement (complications of anaesthesia and blood transfusion) from hospital in-patient records; while deaths from ruptured ectopic pregnancy were more likely to come from coroners', police and morgue records. It is concluded that using multiple sources to identify maternal deaths in developing countries is an effective method to identify all maternal deaths.

Identifying maternal deaths in developing countries: experience in Jamaica

Multiple sources were used to idenify maternal deaths and their causes in a study out in Jamaica. These sources of information included a review of all deaths of women aged 12 to 49 years and included those occurring in hospitals (on maternity, surgical and medical wards and in casualty departments); reported to coroners' offices and the police; on whom post-mortems were carried out at hospital, public morgues and for the Ministry of National Security; obtained from interviews with public health staff in all parishes and which were registered with the Registrar General's Department. Some 193 maternal deaths were identified giving a maternal mortality rate of 10 per 10 000 live births. No one source independently identified all maternal deaths. Hospital in-patient records yielded 133 deaths (69 percent), death certificates 74 (38 percent). Deaths due to certain causes were far more likely to be identified from particular sources, e.g., those due to clinical mismanagement (complications of anaesthesia and blood transfusion) from hospital in-patient records; while deaths from ruptured ectopic pregnancy were more likely to come from coroners', police and morgue records. It is concluded that using multiple sources to identify maternal deaths in developing countries is an effective method to identify all maternal deaths. (AU)

Persistence of high leucocyte sodium and blood pressure after pre-eclampsia

Blood pressure and leucocyte sodium content were measured in black Jamaican patients with pre-eclampsia and pregnant controls. Similar measurements were made in a group of mothers who had pre-eclampsia 36-38 weeks previously and their controls. An increase in cell sodium accompanied the high blood pressure in patients with pre-eclampsis. There was also some elevation of both blood pressure and cell sodium in patients who had had pre-eclampsia 36-38 weeks previously. These findings suggest that disturbances of cellular electrolytes continue into the post-partum period. Changes in intracellular sodium may be important in the pathogenesis of pre-eclampsia as they parallel the increase in blood pressure levels (AU)

The hypertensive disorders of pregnancy in Jamaica

Information on the signs and symptoms of the hypertensive disorders of pregnancy was collected for over 10,000 pregnant women as part of the Jamaican Perinatal Study. The women in the study comprised all those living in Jamaica who delivered singletons weighing more than 1000g after 27 weeks gestation during the months of September and October 1986 (n=10,185). In this population the incidence of antenatal diastolic hypertension was 10.4 percent, the incidence of antenatal proteinuric pre-eclampsia was 4.0 percent and the incidence of eclampsia was 7.1 per 1000. Risk factors for developing antenatal diastolic hypertension included primiparity, maternal age over 30 years, abnormal weight gain during pregnancy, a history of prior hypertensive disorders of pregnancy and the maternal region of residence. Risk factors for developing proteinuric pre-eclampsia were maternal age over 25 years for primiparae and maternal age over 35 years, abnormal maternal weight gain and a history of hypertensive disorders of pregnancy in multiparae. These results are compared with those from the WHO Collaborative Study on the Hypertensive Disorders of Pregnancy (AU)

The hypertensive disorders of pregnancy in Jamaica

Information on the signs and symptoms of the hypertensive disorders of pregnancy was collected for over 10,000 pregnant women as part of the Jamaican Perinatal Study. The women in the study comprised all those living in Jamaica who delivered singletons weighing more than 1000g after 27 weeks gestation during the months of September and October 1986 (n=10,185). In this population the incidence of antenatal diastolic hypertension was 10.4 por ciento , the incidence of antenatal proteinuric pre-eclampsia was 4.0 por ciento and the incidence of eclampsia was 7.1 per 1000. Risk factors for developing antenatal diastolic hypertension included primiparity, maternal age over 30 years, abnormal weight gain during pregnancy, a history of prior hypertensive disorders of pregnancy and the maternal region of residence. Risk factors for developing proteinuric pre-eclampsia were maternal age over 25 years for primiparae and maternal age over 35 years, abnormal maternal weight gain and a history of hypertensive disorders of pregnancy in multiparae. These results are compared with those from the WHO Collaborative Study on the Hypertensive Disorders of Pregnancy.

Maternal deaths in Jamaica

A confidential inquiry into maternal deaths in Jamaica revealed that almost two-thirds were attributable to pre-eclampsia/eclampsia, or sepsis. Avoidable factors that might have increases the probability of death were identified, and recommendations aimed at reducing maternal mortality were presented (AU)

Maternal mortality in Jamaica.

A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10 000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive diseases of pregnancy (26%), haemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.

PIP: This article reports the results of a review of all maternal deaths occurring in Jamaica in 1981-83. A total of 192 maternal deaths were identified, yielding a maternal mortality rate of 10.8/10,000 live births, which was considerably higher than the official rate of 4.8. 15% of these deaths were associated with abortion or ectopic pregnancy. The most common causes of death were hypertensive diseases of pregnancy (26%), hemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. Lowest rates were noted among women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. Avoidable factors were judged to be present in 68% of the deaths. The largest categories of avoidable factors were: nonuse of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of high-risk women; and delays in taking action when signs of complications developed before, during, and after delivery. In response to these findings, the Ministry of Health's Maternal Mortality Committee has called for the following actions: measures to encourage women to seek antenatal care early in pregnancy; improvements in antenatal monitoring; the referral of high-risk women for hospital delivery; the definition of standard procedures for dealing with specific complications of pregnancy, e.g., eclampsia and hemorrhage; regionalization of obstetric services and criteria for referring patients to hospital; and review of provision of blood and plasma for emergency transfusions.

Maternal mortality in Jamaica

A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive disease of pregnancy (10 percent), pulmonary embolus (8 percent), and sepsis (8 percent). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.(AU)

Maternal mortality in Jamaica: a confidential enquiry into all maternal deaths in Jamaica 1981 to 1983

This paper presents an analysis and confidential enquiry into all maternal deaths occurring in Jamaica during the years 1981 to 1983. Details were obtained of all maternal deaths, irrespective of whether they occurred in hospitals or at home, during this three year period. Anonymous case summaries were prepared for all maternal deaths. These case summaries contained general characterisitics of the women, e.g. age and parity, details of the health care (if any) they had received and specific circumstances surrounding their deaths. Each case summary was independently assessed by two practicising Jamaican obstetricians from a panel of seven. They were specifically asked to comment as to whether there were any avoidable factors present in each death which, in their opinion and given their knowledge of current generally accepted standards of satisfactory medical care in Jamaica, may have increased the likelihood of death. Such departures from accepted standards include failure of patients to utilize or cooperate with services, as well as failure to provide or offer adequate care (AU)

G gamma beta+ hereditary persistence of fetal hemoglobin: cosmid cloning and identification of a specific mutation 5' to the G gamma gene

Hereditary persistence of fetal hemoglobin (HPFH) is a benign condition in which the normal shutoff of fetal hemoglobin (Hb F) production fails to occur. In the G gamma beta+ type of HPFH, erythrocytes of adult heterozygotes contain approximately equal to 20 percent Hb F, which is almost exclusively of the G gamma-globin variety, without increased levels of gamma-globin chains from the nearby A gamma-globin gene. Unlike some forms of HPFH, no major deletions in the globin gene cluster have been found by genomic blotting in the G gamma beta+ variety. We report here a family with this condition, from which cosmid clones of the beta-globin gene cluster from the G gamma beta+ HPFH allele have been obtained. Sequencing around the fetal genes has identified a point mutation 202 base pairs 5' to the G gamma-globin gene that is present in genomic DNA of 3/3 unrelated individuals with G gamma beta+ HPFH but in none of more than 100 non-HPFH individuals. Although the mutation could represent a tightly linked polymorphism, its location in a region suggested by recent data to be important in tissue-specific control of gene expression suggests the possibility that the -202 mutation accounts for the phenotype. The sequence created resembles elements of other eukaryotic promoters known to be important for efficient transcription. (AU)