Disparity between adolescents' health information needs and the information received in a middle-income country.

AIM: This study sought to identify adolescents' health information sources and determine the gap between what adolescents want to hear and what they actually hear from their healthcare providers (HCPs), a proxy for unmet health needs. METHODS: A cross-sectional study was conducted in four high schools conveniently selected in Jamaica to ensure adequate representation in rural and urban locales. Adolescents 11-19 years old with relevant assent/consent completed a paper-based self-administered questionnaire. Questions were adapted from the Young Adult Health Care Survey to determine proportion of adolescents receiving confidential care, the level of counselling offered and difference between location and unmet needs. RESULTS: Adolescents acknowledged multiple sources of information, with urban adolescents reporting television, radio and parents as sources more frequently than in rural setting (p < 0.05). They most commonly wanted to discuss weight management (n = 308, 64.2%), nutrition (n = 418, 87.1%), exercise (n = 361, 75.2%); and emotions they are experiencing (n = 246, 51.3%). Unmet needs differed by location; more rural than urban adolescents found that their desire to discuss school performance (p < 0.05) and sexual orientation (p < 0.05) was unmet, while more urban youth felt their need for discussions about STIs was unmet (p < 0.05), when compared to their rural counterparts. CONCLUSION: This study highlights that while there is some access to health information in Jamaica, especially via television, radio and internet, the needs of the adolescent population remain unmet. HCPs need to employ a patient-centred approach where confidentiality is established and screening is done for unmet needs in an effort to optimize health outcomes.

Health-Related Quality of Life in Adolescents With Chronic Illness in Jamaica: Adolescent and Parent Reports.

PURPOSE: The aim of this study is to assess the level of agreement between adolescents' self-assessment and parent-proxy reports on health-related quality of life (HRQOL) in Jamaican adolescents with chronic illness. METHODS: A cross-sectional study was conducted, recruiting adolescents living with a chronic illness (ALCIs)-asthma, human immunodeficiency virus, insulin-dependent diabetes mellitus, or sickle cell disease and age/sex-matched healthy adolescents. Data were collected on HRQOL from adolescents and parents using the Pediatric Quality of Life Scale. Parent-adolescent agreement was determined at group level (Wilcoxon signed-rank test) and individual level (intraclass correlation coefficient). RESULTS: Two hundred twenty-six (226) parent/adolescent pairs participated: 130 ALCIs and 96 healthy peers; mean age 14.9 ± 2.8 years; 58% females. Adolescents with and without chronic illness reported similar HRQOL; parent-proxies reported better HRQOL for healthy adolescents compared to ALCIs. Intraclass correlation demonstrated higher levels of parent-adolescent correlation for ALCIs than healthy adolescents (ALCIs: 0.11-0.34; healthy adolescents: 0.01-0.10). At group level, analyses demonstrated better parent-proxy rating of QOL in all of the scores with the exception of the general health score. Parent-proxies overestimated QOL for asthma and insulin-dependent diabetes mellitus but not for sickle cell disease and human immunodeficiency virus. Linear regression modeling revealed that female sex and living with chronic illness were significant predictors of agreement. DISCUSSION: Parent-proxies overestimated adolescents' QOL compared to adolescents' report regardless of whether the adolescent was living with a chronic illness or not. As such, health care providers should elicit feedback from the adolescent wherever possible and proxy reports should be used as complementary information rather than primary source.

Hospitalized children with SARS-CoV-2 infection and MIS-C in Jamaica: A dive into the first 15 months of the novel pandemic.

Objectives: COVID-19 in children was initially mild until the emergence of Multisystem Inflammatory Syndrome in Children (MIS-C). We describe pediatric COVID-19 in a developing country within the Caribbean. Methods: Jamaican children who were hospitalized with SARS-CoV-2 infection, in one Caribbean regional academic referral center from April 2020 through June 2021 were included. Prospective surveillance and pediatric infectious disease consultations were performed using the CDC's MIS-C case definition. Data were extracted from patients' hospital charts using WHO's reporting form, entered into the RedCap database, and SPSS 28 was used for analysis. MIS-C and non-MIS-C patients were compared using independent sample t-tests for continuous variables and Fisher's exact test for categorical variables, p values < 0.05 were statistically significant. Results: Seventy-nine children with COVID-19 with/without MIS-C presented to UHWI. Thirty-eight (48%) were mild ambulatory cases. Hospitalizations occurred in 41 (52%) children, with median age of 10 1 2 years. SARS-CoV-2 RT-PCR positivity was present in 26 (63%), Immunoglobulin M, or Immunoglobulin G (IgM/IgG) positivity in 8 (20%), with community exposures in 7 (17%). Eighteen (44%) MIS-C positive patients were significantly more likely than 23 MIS-C negative patients (56%) to present with fever (94% vs. 30%; p < 0.001), fatigue/lethargy (41% vs. 4%; p = 0.006), lymphadenopathy (33% vs. 0%; p = 0.003), elevated neutrophils (100% vs. 87%; p = 0.024), and ESR (78% vs. 9%; p = 0.002). Involvement of > two organ systems occurred more frequently in MIS-C positive cases (100% vs. 34%; p < 0.001), including gastrointestinal (72% vs. 17%; p < 0.001); vomiting/nausea (39% vs. 9%; p < 0.028); hematological/coagulopathic (67% vs. 4%; p < 0.001); dermatologic involvement (56% vs. 0%; p < 0.001); and mucositis (28% vs. 0%; p = 0.001). MIS-C patients had Kawasaki syndrome (44%), cardiac involvement (17%), and pleural effusions (17%). MIS-C patients had >4 abnormal inflammatory biomarkers including D-dimers, C-reactive protein, ESR, ferritin, troponins, lactate dehydrogenase, neutrophils, platelets, lymphocytes, and albumen (72%). MIS-C patients were treated with intravenous immune gamma globulin (78%), aspirin (68%), steroids (50%), and non-invasive ventilation (11%). None required inotropes/vasopressors. MIS-C negative patients received standard care. All recovered except one child who was receiving renal replacement therapy and developed myocardial complications. Conclusions: In this first report of COVID-19 from the Caribbean, children and adolescents with and without MIS-C were not very severe. Critical care interventions were minimal and outcomes were excellent.

Exploring the impact of BMI on body dissatisfaction and eating behaviors among Caribbean university women.

This study aimed to examine the role of BMI in body dissatisfaction and eating pathology among 570, Indo-Caribbean and Afro-Caribbean female university students. Participants, 18-59 years, completed self-reports on body image, weight perceptions and eating behaviors. Data analysis included: analysis of variance, multiple regression, and descriptive discriminant analyses. The majority (67.5%) expressed satisfaction with their bodies. Afro-Caribbean participants reported greater body satisfaction than Indo-Caribbean participants (F(2, 554) = 3.51, p = .031). As BMI increased, so too did body dissatisfaction and disordered eating (F(3, 535) = 19.92, p < .001). Participants with obesity reported more body dissatisfaction and disordered eating (M - F(18, 254 384.046) = 1.580, p = .056). BMI should be considered when examining body dissatisfaction and eating pathology among Caribbean female university students, particularly among those with overweight/obesity. In the Caribbean, previous studies indicate an appreciation for the overweight or 'fluffy' female body ideal but more recently the thick ideal, particularly among Black women. More clarity is needed on the current ideal endorsed by BMI and ethnic categories among Caribbean females.Level of evidenceLevel V: cross-sectional descriptive study.

Physical activity and disordered eating behaviours: Are Caribbean adolescents at risk?

Excessive physical activity (PA) has been linked to increased risk for disordered eating behaviours and eating disorders. This study investigates the relationship between PA and disordered eating behaviours and attitudes (DEBAs) among Jamaican adolescents. This cross-sectional study included 521 adolescents, 12-19 years. Anthropometric measurements were collected, and adolescents completed questionnaires on disordered eating behaviours (EAT-26), physical activity, self-esteem and affect. Associations were assessed using sex-specific mixed-effect linear and logistic regression models. Participants reported exercising an average of 3 days per week. Adolescents who exercised for a longer duration had greater odds of having elevated EAT-26 scores (at least 1 hour-OR = 2.04; 95% CI = 1.03, 4.06; p = .042), while a higher exercise frequency among males (3-5 days per week) was protective against DEBAs (OR 0.38; 95% CI = 0.16, 0.88; p = .025). Female adolescents reported higher prevalence of elevated EAT-26 scores than males (p < .01). Increased negative affect increased odds of an elevated EAT-26 score. Exercise duration and frequency play a role in disordered eating behaviours in Jamaican adolescents and vary by gender. Our findings have implications for weight management interventions and policies, encouraging healthcare providers to monitor PA levels as well as negative affect in adolescents who display disordered eating behaviours.

ECD - Pregnancy outcomes of a birth cohort. Are adolescent mothers really at more risk?

This sub-study within the JAKIDS longitudinal cohort study compares medical and psychosocial outcomes of pregnancy in younger adolescent mothers (<16 years), older adolescent mothers (16-19 years) and adult mothers (>19 years) in Jamaica. Participants were recruited from July to September 2011 and included 9521 mother-infant dyads; mean maternal age 26.0 years (SD 6.8). Adolescent mothers represented 19.1% (n = 1822) of the sample - 1704 older adolescent mothers (17.9%) and 118 younger adolescent mothers (1.2%). Participants completed interviewer-administered questionnaires regarding their sexual and reproductive health history, feelings about the current pregnancy, and presence of anxious and depressive symptoms. Data on delivery and perinatal and neonatal outcomes were extracted from hospital charts. Younger adolescent mothers were more likely to deliver preterm (p < 0.001) and low birth weight infants (p < 0.001) than older adolescent and adult mothers. Younger adolescent mothers had lower levels of antenatal anxiety regarding the pregnancy and its outcome (p < 0.001) while prevalence of elevated depressive symptoms antenatally (EPDS ≥11) was similar across age groups. Older adolescent mothers with significant depressive symptoms had increased odds of preterm delivery. These findings call for close antenatal monitoring of younger adolescent mothers and highlight the need for psychological services for all mothers.

Disordered eating behaviours and attitudes among adolescents in a middle-income country.

PURPOSE: Adolescent-disordered eating behaviours and attitudes (DEBA) are noted to be increasing in prevalence internationally. The aim of this study was to explore the DEBAs among Jamaican adolescents and identify those adolescents most at risk. METHODS: 521 high school participants (females, n = 292), ages 11-19 years, completed measures assessing socio-demographic factors, self-esteem, symptoms of anxiety and depression, behavioural factors, and anthropometry. Weight-related behaviours and attitudes were explored using the Eating Attitudes Test (EAT-26). RESULTS: Thirty-one percent of participants reported engaging in at least one disordered eating behaviour, with bingeing as the most common. Female participants had significantly higher mean body mass index (p < 0.01) and mean EAT-26 score (p < 0.05) compared to males. Adolescents with EAT-26 score ≥ 20 were more desirous of being thinner (p < 0.01) and having a lighter skin complexion (p < 0.05). A greater proportion of adolescents with an EAT-26 score ≥ 20 had engaged in self-harm (p < 0.05), had smoked cigarettes (p < 0.05), had been sexually active (p < 0.01), and gave a history of sexual abuse (p < 0.01). Adolescents with overweight/obesity reported higher use of chemical weight manipulation (laxatives, diuretics, and diet pills) (p = 0.01). CONCLUSIONS: Our data are consistent with the global figures showing both male and female adolescents endorsing disordered eating behaviours and attitudes (DEBAs). While this study highlights weight and shape dissatisfaction and associated DEBAs, it also raises the concern of an association with skin bleaching and elevated EAT-26 scores among Jamaican adolescents. LEVEL OF EVIDENCE: Level V: cross-sectional descriptive study.

Increased rates of body dissatisfaction, depressive symptoms, and suicide attempts in Jamaican teens with sickle cell disease.

BACKGROUND: This study aims to examine the association of body image and weight perceptions with risk of depression and suicidal attempts in Jamaican adolescents with sickle cell disease (SCD). METHODS: Adolescents with SCD and a national sample of Jamaican adolescents completed a questionnaire examining body image, weight perceptions, and risk for depression. RESULTS: Perceived and desired body images were similar for both groups. Adolescents with SCD had higher levels of "negative body satisfaction" (43.9% vs. 33.9%; P = 0.03), risk for depression (28.7% vs. 19.3%; P = 0.01), and attempted suicide (12.4% vs. 6.6%; P = 0.02) than national sample. Risk of depression was higher in those who perceived themselves to be over or underweight, and lower in those with more friends and attending school. Females and those with body image dissatisfaction were more likely to have attempted suicide. Within the SCD adolescents, girls were at greater odds of having mental health issues. CONCLUSIONS: Jamaican adolescents with SCD have significantly higher rates of negative body satisfaction and depressive symptoms, and nearly twice the rate of attempted suicide, compared with their healthy peers. This underscores the need for healthcare professionals to better explore and discuss healthy weight, body satisfaction, and coping with the demands and uncertainties of having a chronic illness with Jamaican adolescents with SCD, even while promoting body acceptance and good self-esteem. Screening for mood disorders is strongly recommended and gender-specific interventions should be developed. Healthcare professionals need to encourage positive social interactions that improve adolescents' mental health.

Adolescent health in the Caribbean region: insights from the Jamaican experience.

Adolescent health in Jamaica and the wider English-speaking Caribbean has over the past three decades advanced in achieving improved healthcare services for adolescents. The path taken to achieve success thus far is reviewed - including a historical perspective on the services offered, revision of the relevant policy and legislation frameworks, improved service delivery through education and training of relevant stakeholders and providers, improved youth participation, and sustained involvement of advocates.

Factors Affecting the Choice and Desire to Exclusively Breastfeed in Jamaica: A Cross-Sectional Study at 6 Weeks Postpartum.

BACKGROUND: Exclusive breastfeeding rates (EBRs) may be influenced by sociodemographic and sociocultural factors, including maternal age, socioeconomic status, education, and breastfeeding knowledge. The EBR in Jamaica has been low and declining, leaving a need for better determination of the specific local contributory factors. OBJECTIVES: This study aimed to better elucidate the factors that influence mothers exclusively breastfeeding, including antenatal intentions to breastfeed, mothers' knowledge of the benefits of breastfeeding, and mothers' infant feeding practices in general, inclusive of breastfeeding, formula feeding, and complementary feeding. METHODS: A cross-sectional survey was conducted using a 52-item interviewer-administered questionnaire with mothers attending their 6-week postnatal clinic visit. Sociodemographic data were collected on all participants as well as data regarding participants' breastfeeding knowledge, attitudes, and practices. Statistical analyses were done using χ(2) tests, t tests, and risk analyses. RESULTS: Two hundred participants were interviewed; the mean ± SD age of participants was 26.2 ± 6.46 years (range, 15-46 years). The EBR in this study sample was 32%. Sociodemographic factors, including maternal age and socioeconomic status, as well as antenatal and postnatal breastfeeding sessions, did not significantly affect the likelihood of exclusively breastfeeding at 6 weeks postpartum. The only factor significantly associated with the EBR was mothers' belief that exclusively breastfeeding was able to ensure infant satiety. CONCLUSION: Antenatal and postnatal breastfeeding sessions should place more emphasis on dispelling maternal myths and misperceptions regarding signs of satiety and hunger in infants and reinforcing the knowledge that breast milk alone is sufficient for the first 6 months of life.

Adolescent health screening practices by physicians in Jamaica.

OBJECTIVE: To review Jamaican physicians' adolescent health screening practices by determining their frequency in areas of biomedical, psychological, social, and educational health; the factors that influence these practices; and physicians' perceived level of self-efficacy and their awareness of screening tools and guidelines. METHODS: A questionnaire was mailed to general practitioners, family medicine specialists, and pediatricians in Jamaica. The primary outcome variable was the frequency of physician screening for a range of biomedical, psychosocial, and educational developmental issues in the majority (≥ 50%) of adolescent patients. Bivariate analyses were performed to determine differences between professional groups. RESULTS: The response rate was 32.3% (n = 213), with 209 responders being suitable for further analysis. The sample comprised 48.8% general practitioners, 33.0% family medicine specialists, and 18.2% pediatricians. Physicians more often screened for biomedical risks than for psychosocial risks, with very low frequencies of screening for psychosocial issues such as mood, suicidal ideation, sexual orientation, and safety concerns. Physicians reported high levels of confidence in discussing most psychosocial issues with adolescent patients. Time limitation and an insufficient knowledge base were the main factors identified as influencing screening practices. CONCLUSIONS: The data suggest unsatisfactory frequency of adolescent health screening by Jamaican physicians, in particular for psychosocial factors. The primary factors identified by physicians as influencing their screening practices have potential for improvement through continued medical education.

Adolescent health screening practices by physicians in Jamaica / Prácticas de examen sistemático de la salud de los adolescentes por parte de los médicos en Jamaica

OBJECTIVE: To review Jamaican physicians' adolescent health screening practices by determining their frequency in areas of biomedical, psychological, social, and educational health; the factors that influence these practices; and physicians' perceived level of self-efficacy and their awareness of screening tools and guidelines. METHODS: A questionnaire was mailed to general practitioners, family medicine specialists, and pediatricians in Jamaica. The primary outcome variable was the frequency of physician screening for a range of biomedical, psychosocial, and educational developmental issues in the majority (> 50 percent) of adolescent patients. Bivariate analyses were performed to determine differences between professional groups. RESULTS: The response rate was 32.3 percent (n = 213), with 209 responders being suitable for further analysis. The sample comprised 48.8 percent general practitioners, 33.0 percent family medicine specialists, and 18.2 percent pediatricians. Physicians more often screened for biomedical risks than for psychosocial risks, with very low frequencies of screening for psychosocial issues such as mood, suicidal ideation, sexual orientation, and safety concerns. Physicians reported high levels of confidence in discussing most psychosocial issues with adolescent patients. Time limitation and an insufficient knowledge base were the main factors identified as influencing screening practices. CONCLUSIONS: The data suggest unsatisfactory frequency of adolescent health screening by Jamaican physicians, in particular for psychosocial factors. The primary factors identified by physicians as influencing their screening practices have potential for improvement through continued medical education.

OBJETIVO: Analizar las prácticas de examen sistemático de la salud de los adolescentes por parte de los médicos de Jamaica mediante la determinación de la frecuencia con la que llevan a cabo reconocimientos sistemáticos de salud en las áreas biomédica, psicológica, social y educativa; los factores que afectan dichas prácticas sistemáticas; el nivel de autoeficacia percibida por los médicos respecto a ellas y su conocimiento de los instrumentos y las recomendaciones con respecto a los exámenes sistemáticos. MÉTODOS: Se envió por correo un cuestionario a médicos generales, especialistas en medicina familiar y pediatras de Jamaica. La principal variable de evaluación fue la frecuencia con la que los médicos llevan a cabo exámenes sistemáticos sobre varios aspectos biomédicos, psicosociales y del desarrollo educativo en la mayoría (> 50 por ciento) de los pacientes adolescentes. Se realizaron análisis bifactoriales a fin de establecer las diferencias entre los grupos de profesionales. RESULTADOS: La tasa de respuesta fue de 32,3 por ciento (n = 213) y se consideró que 209 participantes eran adecuados para el análisis posterior. En la muestra, 48,8 por ciento eran médicos generales, 33,0 por ciento eran especialistas en medicina familiar y 18,2 por ciento eran pediatras. Los médicos llevaban a cabo exámenes sistemáticos con más frecuencia para evaluar los riesgos biomédicos que los riesgos psicosociales, y los exámenes sobre aspectos psicosociales como el estado de ánimo, la presencia de ideas suicidas, la orientación sexual y temas relacionados con la seguridad se exploraron muy poco. Los médicos informaron altos niveles de confianza para tratar la mayoría de los temas psicosociales con los pacientes adolescentes. Los principales factores que afectaran las prácticas de examen sistemático fueron la falta de tiempo y la carencia de conocimientos suficientes. CONCLUSIONES: Los datos indican que la frecuencia con la que los médicos de Jamaica llevan a cabo prácticas de examen sistemático relacionadas con la salud de los adolescentes es insuficiente, en particular en lo que respecta a los factores psicosociales. Los principales factores que, según los médicos, afectan sus prácticas con respecto a este tema pueden mejorarse mediante programas de formación médica continua.