The evolving contribution of non-communicable diseases to maternal mortality in Jamaica, 1998-2015: a population-based study.

OBJECTIVE: To describe trends in indirect cause-specific pregnancy-related mortality from 1998 to 2015. DESIGN: Secondary analysis of annual, national cross-sectional database of maternal and late maternal deaths, identified through active surveillance of deaths among women aged 10-50 years. SETTING: Jamaica, a middle-income Caribbean country. POPULATION: Maternal and late maternal deaths. METHODS: Descriptive trend analyses of demographic and cause-specific maternal and pregnancy-related mortality ratios undertaken comparing the periods 1998-2003, 2004-2009 and 2010-2015. Multivariate logistic regression was used to confirm changes in risk of indirect death. MAIN OUTCOME MEASURES: Maternal, pregnancy-related, direct, indirect and cause-specific mortality ratios (deaths/100 000 live births). RESULTS: Maternal deaths from indirect conditions increased between the first two periods (P = 0.004) and stabilised in the third (P = 0.085). Associated with upward movement in cardiovascular deaths (P[trend] = 0.003), women under 25 years were at elevated risk (odds ratio 1.44, 95% CI 1.00-2.08; P = 0.052). Haematological/immunological conditions (69% sickle cell disease) ranked second but did not vary with time. Health service utilisation was similar across age, parity, health region and major cause categories (non-communicable diseases, non-obstetric infections, direct), however women with indirect conditions spent more time in hospital (median 5 days versus 3 days) and more often died after the puerperium. CONCLUSIONS: Medical conditions, especially cardiovascular disease, are increasingly associated with maternal and late maternal mortality. Middle-income countries need to simultaneously improve management of indirect conditions, while redoubling efforts to reduce direct deaths. Postpuerperal medical services should be integrated into routine infant health services to improve continuity of care during this high-risk period. TWEETABLE ABSTRACT: Maternal survival (SDG 3.1) in LMICs requires better care for women with both non-communicable diseases and obstetric conditions.

Factors Associated with Health-related Quality of Life of Ambulatory Stroke Survivors in Jamaica / Factores Asociados con la Calidad de Vida Relacionada con la Salud de los Sobrevivientes de Apoplejía en Jamaica

ABSTRACT Objective: The study aimed to determine the factors associated with health-related quality of life (HRQL) in ambulatory chronic stroke survivors. Methods: Baseline data from a randomized controlled trial (RCT) done to determine the effects of aerobic exercise on HRQL were analysed. The Medical Outcomes 36-Item Short Form Health Survey (SF-36) was used to assess HRQL. Other measures included: functional status (the Barthel Index) and the Older American Resource and Services Questionnaire (OARS), grip strength measured with a dynamometer, lower extremity strength (the Motricity Index), depression (the Geriatric Depression Scale-GDS) and endurance assessed through the six-minute walk test. Data were analysed using the t-test, correlation coefficient and multiple linear regression. Results: One hundred and twenty-eight persons participated (mean age: 64 years, mean time post stroke: 12 months). The Physical Component of the SF-36 was associated with distance walked in six minutes (r = 0.395; p < 0.000), grip strength on the affected side (r = 0.309; p < 0.000) lower limb strength on the affected side (r = 0.287; p = 0.001), Barthel Index (r = 0.253; p = 0.004), OARS (r = 0.378; p < 0.000) and depressive symptoms (p = −0.353; p = 0.000). The independent predictors were: distance walked in six minutes and depressive symptoms. The mental component was significantly related to GDS (r = − 0.391; p = 0.000) and unaffected side lower limb strength (r = 0.251; p = 0.004). Male gender and less depressive symptoms were independently associated with this component. Conclusion: In Jamaican stroke survivors, motor impairment, activity limitation, depression and female gender are associated with poor health-related quality of life long after stroke onset.

RESUMEN Objetivo: El presente estudio estuvo dirigido a determinar los factores asociados con la calidad de vida relacionada con la salud (CVRS) en sobrevivientes de apoplejía crónicos ambulatorios. Métodos: Se analizaron los datos de base de un ensayo controlado aleatorio (ECA) para determinar los efectos del ejercicio aeróbico en la CVRS. La calidad de vida relacionada con la salud se evaluó utilizando los resultados médicos del Cuestionario de Salud de Formulario Breve de 36 Preguntas (SF-36). Otras mediciones incluyeron: el estado funcional (índice de Barthel) y el Cuestionario de Recursos y Servicios para Personas de Edad Avanzada (OARS, en inglés), la fuerza de prensión medida con un dinamómetro, la fuerza de las extremidades inferiores (índice de motricidad), la depresión (Escala de Depresión Geriátrica - EDG), y la resistencia evaluada mediante la prueba de una caminata de seis minutos. Los datos fueron analizados mediante la Prueba t, el coeficiente de correlación, y la regresión lineal múltiple. Resultados: Ciento veintiocho personas participaron (edad promedio: 64 años; tiempo promedio después del accidente cerebrovascular: 12 meses). El componente físico del Cuestionario SF-36 se asoció con la distancia recorrida en seis minutos (r = 0.395; p < 0.000), fuerza de prensión en el lado afectado (r = 0.309; p < 0.000, la fuerza de la extremidad inferior en el lado afectado (r = 0.287; p = 0.001), el índice de Barthel (r = 0.253; p = 0.004), la escala de OARS (r = 0.378; p < 0.000), y los síntomas depresivos (p = −0.353; p = 0.000). Los predictores independientes fueron: la distancia recorrida en seis minutos y los síntomas depresivos. El componente mental estuvo relacionado significativamente con la EDG (r = − 0.391; p = 0.000) y la fuerza del miembro inferior del lado no afectado (r = 0.251; p = 0.004). El género masculino y síntomas menos depresivos estuvieron independientemente asociados con este componente. Conclusión: En los sobrevivientes jamaicanos de apoplejía, el deterioro motor, la limitación de la actividad, la depresión, y el género femenino están asociados con una pobre calidad de vida mucho después del inicio del accidente cerebrovascular.

The Quality and Completeness of 2008 Perinatal and Under-five Mortality Data from Vital Registration, Jamaica.

OBJECTIVE: To evaluate the completeness and timeliness of registration of stillbirths and under-five deaths and the validity of the certification and coding process. SUBJECTS AND METHODS: Registered stillbirths and under-five deaths occurring in 2008 were compared to hospital, police, forensic pathologist and coroner's records. Missed cases and new information such as birthweight, gestation and date of birth were added to the database. A 10% random sample was evaluated to measure the quality of certification and coding. RESULTS: Of 646 stillbirths [≥ 1000 g] and 933 under-five deaths, 69% and 79%, respectively were registered by December 31, 2009, for inclusion in the 2008 final demographic returns. Non-reporting of stillbirths was associated with infant gender, region and place of death (seven of 21 public hospitals accounted for 96% of unregistered stillbirths). Among under-five deaths, age at death, region, place and cause of death were important. Injury and community deaths increased with age. Registration delays including non-registration were associated with coroner's inquests. Most [80%] stillbirth certificates lacked usable cause of death data. Neonatal deaths due to prematurity and perinatal asphyxia were often misclassified by coders. The stillbirth [≥ 1000 g], infant and under-five mortality rates were 15, 20 and 22/1000 births/live births, respectively. CONCLUSIONS: While registration of stillbirths and under-five deaths improved between 1998 and 2008, persistent under-reporting reduced official rates by 20-31%. A new perinatal death certificate documenting maternal and fetal causes of death and risk factors such as birthweight, gestation and age at death would improve stillbirth and neonatal death (0-28 days) data quality.

The association between personality types and medication adherence among adult hypertensive patients

OBJECTIVE: To investigate the prevalence of adherence to antihypertensive medication and its association with personality types among adult hypertensive patients. DESIGN AND METHODS: This was a cross-sectional study, which used the Big Five Inventory to assess personality types and Morisky Medication Adherence Scale (MMAS-8) to measure antihypertensive medication adherence, among a convenience sample of 301 hypertensive primary-care patients. Chi square tests, t-tests, correlations and regression techniques were used to examine associations between variables. RESULTS: The mean MMAS-8 score was 5.00 ñ 1.69. Most respondent (60%) demonstrated low adherence (score <6) with only 7% achieving high adherence (score = 8). Persons who scored highly for neuroticism were less likely to be adherent [OR = 0.30; (0.10-0.88)], as were the employed compared to the unemployed [(OR = 0.34; (0.14-0.86)]. In contrast, older persons demonstrated higher adherence levels [(OR = 1.06 (1.01-1.11)]. Regression model variables accounted for 13% of variance in antihypertensive adherence. CONCLUSIONS: This sample demonstrated low antihypertensive adherence; lowest for those high on the neuroticism scale, the employed and younger participants. This implies personality type should be considered in managing chronic diseases to identify clients requiring intervention, thereby improving control, reducing morbidity and enhancing efficient use of scarce resources. Efforts are also needed to address other risk factors that impact adherence.

Perinatal factors in students admitted to the university of the West Indies data from the jamaican perinatal study / Factores perinatales en estudiantes de nuevo ingreso en la Universidad de West Indies datos del estudio perinatal de Jamaica

OBJECTIVE: To compare perinatal and social factors in students admitted to The University of the West Indies (UWI), Kingston, Jamaica, at age 18 years with those in the rest of the Jamaican Perinatal Cohort. METHODS: The Jamaican Perinatal Survey recorded demographic and perinatal details in 10 527 or 97% of births in Jamaica in September and October 1986. Eighteen years later, 140 of these were admitted to the UWI in Kingston, Jamaica. The perinatal features of these UWI students have been compared with the rest ofthe Perinatal Survey Cohort. RESULTS: Mothers of UWI students were older (p < 0.001), more likely to be married at the time of birth (p < 0.001), had earlier and more complete antenatal care (p < 0.05) and greater educational achievement at time of pregnancy (p < 0.001). These mothers of UWI students were also more likely to have diabetes (p < 0.01), operative deliveries (p < 0.01) and to attend private hospitals (p < 0.01). The UWI students had fewer siblings by their mothers (p < 0.05), were less likely to be low birthweight babies (p = 0.035) and more likely to be full term (37-42 weeks) than lower gestational age (p = 0.005). Differences in Apgar scores did not reach statistical significance. CONCLUSIONS: The students of the University of the West Indies were more likely to come from smaller families with features indicative of a better quality of life. They were also of higher birthweight and tended to be full term. The lack of association of Apgar scores with educational attainment is noteworthy.

OBJETIVO: Comparar los factores perinatales y sociales en estudiantes aceptados para sus estudios en la Universidad de West Indies (UWI), Kingston, Jamaica, a la edad 18 años, con los del resto de la Cohorte Perinatal de Jamaica. . MÉTODO: El Estudio Perinatal de Jamaica registró los detalles demográficos y perinatales en el caso de 10 527 o 97% de nacimientos en Jamaica en septiembre y octubre de 1986. Dieciocho años después, 140 de ellos ingresaron a UWI en Kingston, Jamaica. Las características perinatales de estos estudiantes de UWI con el resto de la Cohorte del Estudio Perinatal. RESULTADOS: Las madres de los estudiantes de UWI eran de mayor edad (p < 0.001), presentaban una mayor probabilidad de estar casadas al momento del nacimiento (p < 0.001), tuvieron cuidados prenatales más completos y más tempranos (p < 0.05), así como mayores logros en su educación al momento del embarazo (p < 0.001). Estas madres de estudiantes de UWI presentaban también una probabilidad mayor de diabetes (p < 0.01), partos operativos (p < 0.01) y asistencia a hospitales privados (p < 0.01). Los estudiantes de UWI tenían menos hermanos y hermanas por parte de sus madres (p < 0.05), tenían una menor probabilidad de ser bebés de bajo peso al nacer (p = 0.035) y una mayor probabilidad de ser bebés de término completo (37-42 semanas) que tener una edad gestacional menor (p = 0.005). Las diferencias en puntuación de Apgar no alcanzaron a tener importancia estadística. CONCLUSIONES: Los estudiantes de la Universidad de West Indies, presentaban una mayor probabilidad de provenir de familias más pequeñas con rasgos que indicaban una mayor calidad de vida. También poseían mayor peso al nacer y tendencia a término completo. La falta de correspondencia entre la puntuación de Apgar con los logros educacionales, fue cuestión de interés.

Impact of the Jamaican birth cohort study on maternal, child and adolescent health policy and practice.

The Jamaica Perinatal Morbidity and Mortality Survey (JPMMS) was a national study designed to identify modifiable risk factors associated with poor maternal and perinatal outcome. Needing to better understand factors that promote or retard child development, behaviour and academic achievement, we conducted follow-up studies of the birth cohort. The paper describes the policy developments from the JPMMS and two follow-up rounds. The initial study (1986-87) documented 94% of all births and their outcomes on the island over 2 months (n = 10 508), and perinatal (n = 2175) and maternal deaths (n = 62) for a further 10 months. A subset of the birth cohort, identified by their date of birth through school records, was seen at ages 11-12 (n = 1715) and 15-16 years (n = 1563). Findings from the initial survey led to, inter alia, clinic-based screening for syphilis, referral high-risk clinics run by visiting obstetricians, and the redesign and construction of new labour wards at referral hospitals. The follow-up studies documented inadequate academic achievement among boys and children attending public schools, and associations between under- and over-nutrition, excessive television viewing (>20 h/week), inadequate parental supervision and behavioural problems. These contributed to the development of a television programming code for children, a National Parenting Policy, policies aimed at improving inter-sectoral services to children from birth to 5 years (Early Childhood Commission) and behavioural interventions of the Violence Prevention Alliance (an inter-sectoral NGO) and the Healthy Lifestyles project (Ministry of Health). Indigenous maternal and child health research provided a local evidence base that informed public policy. Collaboration, good communication, being vigilant to opportunities to influence policy, and patience has contributed to our success.

Perinatal factors in students admitted to the University of the West Indies data from the Jamaican Perinatal Study.

OBJECTIVE: To compare perinatal and social factors in students admitted to The University of the West Indies (UWI), Kingston, Jamaica, at age 18 years with those in the rest of the Jamaican Perinatal Cohort. METHOD: The Jamaican Perinatal Survey recorded demographic and perinatal details in 10 527 or 97% of births in Jamaica in September and October 1986. Eighteen years later 140 of these were admitted to the UWI in Kingston, Jamaica. The perinatal features of these UWI students have been compared with the rest of the Perinatal Survey Cohort. RESULTS: Mothers of UWI students were older (p < 0.001), more likely to be married at the time of birth (p < 0.001), had earlier and more complete antenatal care (p < 0.05) and greater educational achievement at time of pregnancy (p < 0.001). These mothers of UWI students were also more likely to have diabetes (p < 0.01), operative deliveries (p < 0.01) and to attend private hospitals (p < 0.01). The UWI students had fewer siblings by their mothers (p < 0.05), were less likely to be low birthweight babies (p = 0.035) and more likely to be full-term (37-42 weeks) than lower gestational age (p = 0.005). Differences in Apgar scores did not reach statistical significance. CONCLUSIONS: The students of the University of the West Indies were more likely to come from smaller families with features indicative of a better quality of life. They were also of higher birthweight and tended to be full-term. The lack of association of Apgar scores with educational attainment is noteworthy.

Small victories, new challenges: two decades of maternal mortality surveillance in Jamaica / Pequeñas victorias, nuevos desafíos: dos décadas de vigilancia de la mortalidad materna en Jamaica

OBJECTIVES: The paper summarizes the changing epidemiology of maternal mortality and the new challenges as Jamaica seeks to contribute to the international goal to reduce maternal mortality by 75% worldwide between 1990 and 2015. METHODS: This is a review of Jamaica's two decades of maternal mortality surveillance experience. RESULTS: Jamaica began episodic reproductive age mortality surveys between 1981 and 1983. In order to move to continuous surveillance, maternal deaths were made a Class 1 notifiable event in 1998. Reporting has steadily improved with over 80% of deaths notified, however events in the first trimester and after the first week post-partum were less likely to be reported. While gestational hypertension remains the leading cause of death, the cause-specific mortality rate has declined in response to specific efforts to reduce its prevalence and consequences. Haemorrhage and infection also declined significantly in prevalence and rank. HIV disease moved rapidly to become the fourth-ranked cause of maternal death. Another lifestyle problem is the growing prevalence of obesity, with its contribution to deaths from heart disease, diabetes mellitus and gestational hypertension. A national maternal mortality surveillance committee has been established to monitor national trends and address policy issues. One of its first tasks will be to develop clinical guidelines to standardize management of the leading direct and indirect complications of pregnancy. CONCLUSION: Jamaica has the capacity to achieve MDG5, however, local and national maternal mortality committees and health teams will have to systematically address the deficiencies identified.

OBJETIVOS: El presente trabajo resume la epidemiología cambiante de la mortalidad materna y los nuevos desafíos en el momento en que Jamaica busca contribuir a la meta internacional de reducir la mortalidad materna en un 75% a nivel mundial entre 1990 y 2015. MÉTODOS: Éste es un examen de la experiencia de Jamaica durante dos décadas de vigilancia de mortalidad materna, en el que se resumen los hallazgos claves del estudio durante el período, junto con la evidencia internacional. RESULTADOS: Jamaica empezó las encuestas episódicas de mortalidad en la edad reproductiva entre 1981 y 1983. Con el propósito de pasar a una vigilancia continua, las muertes maternas comenzaron a ser tratadas como eventos notificables de clase 1 en 1998. Se ha producido un mejoramiento constante en el número de reportes, con la notificación de más del 80% de las muertes. Sin embargo, los eventos en el primer trimestre y después de la primera semana postnatal, presentaron una probabilidad menor de ser reportados. Si bien la hipertensión gestacional sigue siendo la causa principal de muerte, la tasa de mortalidad específica por causa ha disminuido en respuesta a los esfuerzos específicos por reducir su prevalencia y sus consecuencias. Las hemorragias e infecciones también disminuyeron significativamente en prevalencia y rango. La enfermedad de VIH pasó rápidamente a ocupar la cuarta posición como causa de muerte materna. Otro problema de estilo de vida es la creciente prevalencia de la obesidad, con su contribución a las muertes por enfermedad cardíaca, diabetes mellitus e hipertensión gestacional. Se ha creado un comité nacional de vigilancia de la mortalidad materna a fin de monitorear las tendencias nacionales y abor-dar los problemas de las políticas a seguir. Una de sus primeras tareas será desarrollar lineamientos clínicos a fin de estandardizar el tratamiento (manejo) de las principales complicaciones directas e indirectas del embarazo. CONCLUSIÓN: Jamaica tiene la capacidad de lograr MDG5. Sin embargo, los comités de mortalidad materna y equipos de salud a nivel nacional y local, tendrán que abordar sistemáticamente las deficiencias identificadas.

Health status and health maintenance practices among doctors and nurses at two hospitals in Jamaica / El nivel de salud y las prácticas de mantenimiento de la salud entre los doctores y enfermeras en dos hospitales de Jamaica

The health of doctors and nurses is of paramount importance because they must be well to perform their jobs optimally under difficult conditions. However, the challenge of their working environment and the culture of their professions often lead to physical and mental illnesses. Despite this, there are several barriers to doctors and nurses seeking healthcare. In this study, the health status and health maintenance practices of doctors and nurses at two hospitals in Kingston, Jamaica, were assessed. This population was previously reported to have a 27% prevalence of probable mental distress based on the General Health Questionnaire 30 (GHQ30). Two hundred and twelve doctors and nurses were recruited into the study. The reported prevalence of chronic diseases was determined while mental health status was based on the GHQ30, reported signs and symptoms of stress and job satisfaction. Health maintenance practices studied included, health-seeking behaviour, willingness to seek counselling, reported source of emotional support and use of alcohol and tobacco as coping strategies. Although, less than 50% of study participants reported that they were satisfied with their job, the mean number of days missed from work in the "last six months" was less than two and a half days. The mean time for "last doctor's visit" for nurses and doctors in the current study were 0.93 and 2.4 years, respectively. Females were more willing to seek medical attention than males. More than 50% reported signs and symptoms of stress and major sources of emotional support were friends (55.7%), followed by spouses (36.0%) and colleagues (12.3%). The prevalence of chronic diseases was less than1% and alcohol and tobacco did not appear to be major coping strategies. The population appeared to be physically healthy and despite the known prevalence of probable mental distress, doctors and nurses appeared unwilling to seek healthcare. Probable barriers to seeking healthcare included confidentiality issues and the need to appear healthy to colleagues, patients and the community.

La salud de doctores y enfermeras es un asunto de importancia primordial porque ellos tienen que gozar de salud para poder realizar su trabajo de manera óptima bajo condiciones difíciles. Sin embargo, los retos de su ambiente de trabajo y la cultura de sus profesiones conducen a menudo a enfermedades físicas y mentales. A pesar de esto, existen varios obstáculos para los doctores y enfermeras que buscan el cuidado de la salud. En este estudio, se evaluaron el nivel de salud y las prácticas de mantenimiento de la salud de doctores y enfermeras en dos hospitales en Kingston, Jamaica. Previamente se reportó que esta población tenía una prevalencia de un 27% de probable distrés mental, sobre la base del Cuestionario General de Salud 30 (GHQ30). Se reclutaron doscientos doce doctores y enfermeras para el estudio. Se determinó la prevalencia de enfermedades crónicas a partir de reportes, mientras que el nivel de salud se basó en el GHQ30, y los signos y señales de estrés así como la satisfacción del trabajo reportados. Las prácticas de mantenimiento de la salud estudiadas incluyeron el comportamiento de búsqueda de la salud, la disposición a buscar aconsejamiento, reportes de fuentes de apoyo emocional y uso del alcohol y el tabaco como estrategias de enfrentamiento. Aunque menos de 50% de los participantes en el estudio reportaron que estaban satisfechos con su trabajo, el número promedio de días de trabajo perdidos en "los últimos seis meses" fue menos de dos días y medio. El tiempo promedio de "la última visita del médico" para enfermeras y doctores en el estudio presente fue 0.93 y 2.4 años, respectivamente. Las mujeres estuvieron más dispuestas a buscar asistencia médica que los hombres. Más del 50% reportaron signos y síntomas de estrés, y las fuentes principales de apoyo emocional fueron los amigos y amigas (55.7%), seguidos por cónyuges (36.0%) y colegas (12.3%). La prevalencia de las enfermedades crónicas fue menos del 1%, y el alcohol y el tabaco no parecieron ser las estrategias principales de estrategias de enfrentamiento. La población parecía estar físicamente saludable y a pesar de la prevalencia conocida del probable distrés mental, tanto doctores como enfermeras parecían poco dispuestos a buscar atención a la salud. Los obstáculos probables a la búsqueda de la salud incluyeron problemas de confidencialidad y la necesidad de parecer saludable ante sus colegas, sus pacientes y la comunidad.

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.

Adolescent ears: an avenue into their sexual and reproductive health values / Los oídos de los adolescentes: una vía para adentrarse en sus valores de salud reproductiva y sexual

OBJETIVES: This study sought to understand what sexual and reproductive health messages Jamaican adolescents get via Dancehall music and how themes in these messages can inform the development of a questionnaire for further exploration of the subject. METHODS: Qualitative processes: key informant interviews, content analysis and focus group discussions were used to identify the themes heard in Dancehall songs to which adolescents listen. Adolescent investigators were utilized to enhance the communication flow among their peers while the adult investigator coordinated the analysis process. The data generated by each method were analysed manually and the themes used to inform development of a quantitative questionnaire for further study. RESULTS:Of 43 songs identified by key informants, twenty-five were short-listed as Dancehall songs as they having met the criteria for conveying sexual and reproductive health and relationship themes. Most themes were gender specific with male specific messages relating to sexual roles and behaviours, physical sexual attributes and performance and sexuality related violence. Female specific messages were about female behaviours in a sexual relationship, financial stability and independence in relationships and physical sexual attributes. All themes were confirmed through focus group discussions and additional information gleaned about how adolescents perceived the meanings and context of some expressions in the songs analysed. These themes informed the development of a questionnaire in both language and content. CONCLUSIONS: Gender specific issues about sexual relationships and performance, physical sexual attributes and sexual violence were common themes identified in Dancehall songs listed by adolescents. Focus group discussions confirmed adolescents' listenership to the themes and provided explanation of the perceived context and meaning of some messages.

OBJETIVOS: Este estudio busca entender que mensajes en relación con la salud reproductiva y sexual, reciben los adolescentes jamaicanos a través de la música de Dancehall, y cómo los temas en estos mensajes pueden informar el desarrollo de un cuestionario para una exploración posterior del asunto. MÉTODO: Procesos cualitativos: se utilizaron entrevistas a informantes claves, análisis de contenidos, y discusiones de grupos focales (sesiones de grupo), a fin de identificar los temas divulgados por las canciones de Dancehall escuchadas por los adolescentes. Se usaron investigadores adolescentes para lograr un mejor flujo de la comunicación entre iguales, en tanto que el investigador adulto se encargaba de coordinar el proceso de análisis. Los datos generados por cada método fueron analizados manualmente y los temas fueron usados como base informativa para el desarrollo de un cuestionario cuantitativo para estudios posteriores. RESULTADOS: De 43 canciones identificadas por los informantes claves, veintiséis fueron incluidas como canciones de Dancehall que satisfacían los criterios de trasmitir temas de relación y salud reproductiva y salud. La mayor parte de los temas específicos fueron específicamente de género con mensajes específicamente masculinos relacionados con los roles y comportamientos sexuales, el funcionamiento y los atributos sexuales físicos, y la violencia relacionada con la sexualidad. Los mensajes específicos del género femenino se referían a las conductas femeninas en una relación sexual, la estabilidad financiera y la independencia en las relaciones, así como los atributos sexuales físicos. Todos los temas fueron confirmados mediante discusiones de grupos focales, y se recogió información adicional acerca de cómo los adolescentes percibían los significados y el contexto de algunas expresiones en las canciones analizadas. Estos temas informaron el desarrollo de un cuestionario sobre lenguaje y contenido. CONCLUSIONES: Los asuntos específicos de género, los aspectos del funcionamiento y relaciones en el sexo, atributos sexuales físicos y violencia sexual, fueron temas comunes identificados en las canciones de Dancehall señaladas por los adolescentes. Las sesiones en grupo confirmaron la audiencia adolescente de estos temas, y ofrecieron una explicación acerca del contexto y el significado percibido de algunos mensajes.

Small victories, new challenges: two decades of maternal mortality surveillance in Jamaica.

OBJECTIVES: The paper summarizes the changing epidemiology of maternal mortality and the new challenges as Jamaica seeks to contribute to the international goal to reduce maternal mortality by 75% worldwide between 1990 and 2015. METHODS: This is a review of Jamaica's two decades of maternal mortality surveillance experience. RESULTS: Jamaica began episodic reproductive age mortality surveys between 1981 and 1983. In order to move to continuous surveillance, maternal deaths were made a Class 1 notifiable event in 1998. Reporting has steadily improved with over 80% of deaths notified, however events in the first trimester and after the first week post-partum were less likely to be reported. While gestational hypertension remains the leading cause of death, the cause-specific mortality rate has declined in response to specific efforts to reduce its prevalence and consequences. Haemorrhage and infection also declined significantly in prevalence and rank. HIV disease moved rapidly to become the fourth-ranked cause of maternal death. Another lifestyle problem is the growing prevalence of obesity, with its contribution to deaths from heart disease, diabetes mellitus and gestational hypertension. A national maternal mortality surveillance committee has been established to monitor national trends and address policy issues. One of its first tasks will be to develop clinical guidelines to standardize management of the leading direct and indirect complications of pregnancy. CONCLUSION: Jamaica has the capacity to achieve MDG5, however local and national maternal mortality committees and health teams will have to systematically address the deficiencies identified.

Health status and health maintenance practices among doctors and nurses at two hospitals in Jamaica.

The health of doctors and nurses is of paramount importance because they must be well to perform their jobs optimally under difficult conditions. However, the challenge of their working environment and the culture of their professions often lead to physical and mental illnesses. Despite this, there are several barriers to doctors and nurses seeking healthcare. In this study, the health status and health maintenance practices of doctors and nurses at two hospitals in Kingston, Jamaica, were assessed. This population was previously reported to have a 27% prevalence of probable mental distress based on the General Health Questionnaire 30 (GHQ30). Two hundred and twelve doctors and nurses were recruited into the study. The reported prevalence of chronic diseases was determined while mental health status was based on the GHQ30, reported signs and symptoms of stress and job satisfaction. Health maintenance practices studied included, health-seeking behaviour willingness to seek counselling, reported source of emotional support and use of alcohol and tobacco as coping strategies. Although, less than 50% of study participants reported that they were satisfied with their job, the mean number of days missed from work in the "last six months" was less than two and a half days. The mean time for "last doctor's visit" for nurses and doctors in the current study were 0.93 and 2.4 years, respectively. Females were more willing to seek medical attention than males. More than 50% reported signs and symptoms of stress and major sources of emotional support were friends (55.7%), followed by spouses (36.0%) and colleagues (12.3%). The prevalence of chronic diseases was less than 1% and alcohol and tobacco did not appear to be major coping strategies. The population appeared to be physically healthy and despite the known prevalence of probable mental distress, doctors and nurses appeared unwilling to seek healthcare. Probable barriers to seeking healthcare included confidentiality issues and the need to appear healthy to colleagues, patients and the community.

Are women ready to do HIV test?

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.

Competition for adolescents' sexual and reproductive health values: is the media winning?

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 57-item 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 of gender specific DSRH messages, some of which contradict standard messages.

Adolescent ears: an avenue into their sexual and reproductive health values.

OBJECTIVES: This study sought to understand what sexual and reproductive health messages Jamaican adolescents get via Dancehall music and how themes in these messages can inform the development of a questionnaire for further exploration of the subject. METHOD: Qualitative processes: key informant interviews, content analysis and focus group discussions were used to identify the themes heard in Dancehall songs to which adolescents listen. Adolescent investigators were utilized to enhance the communication flow among their peers while the adult investigator coordinated the analysis process. The data generated by each method were analysed manually and the themes used to inform development of a quantitative questionnaire for further study. RESULTS: Of 43 songs identified by key informants, twenty-five were short-listed as Dancehall songs as they having met the criteria for conveying sexual and reproductive health and relationship themes. Most themes were gender specific with male specific messages relating to sexual roles and behaviours, physical sexual attributes and performance and sexuality related violence. Female specific messages were about female behaviours in a sexual relationship, financial stability and independence in relationships and physical sexual attributes. All themes were confirmed" through focus group discussions and additional information gleaned about how adolescents perceived the meanings and context of some expressions in the songs analysed. These themes informed the development of a questionnaire in both language and content. CONCLUSIONS: Gender specific issues about sexual relationships and performance, physical sexual attributes and sexual violence were common themes identified in Dancehall songs listed by adolescents. Focus group discussions confirmed adolescents' listenership to the themes and provided explanation of the perceived context and meaning of some messages.

Integrating research into policy and programmes examples from the Jamaican experience / Integrando la investigación con las políticas y los programas ejemplos de experiencias en Jamaica

Research into selected health problems across the life cycle are discussed with respect to the application and impact of the findings on policy, programme development and health outcomes. Special emphasis is placed on health research that focussed on the perinatal period, the young child and adolescent, the epidemics of chronic diseases and violence and the linkage between health and tourism. The lessons learnt over more than two decades of practice in the field of public health from conducting research aimed at developing an indigenous evidence base for policies and programmes in Jamaica are summarized.

El presente trabajo discute la investigación de determinados problemas de salud a lo largo del ciclo de la vida, con respecto a la aplicación e impacto de los hallazgos sobre políticas, desarrollo de programas, y resultados de salud. Se pone énfasis especial en las investigaciones de salud enfocadas al período perinatal, el niño y el adolescente, la epidemia de enfermedades crónicas y la violencia, y el vínculo entre la salud y el turismo. Se resumen las lecciones aprendidas en más de dos décadas de práctica en el campo de la salud pública, llevando a cabo investigaciones encaminadas a desarrollar una medicina autóctona basada en la evidencia para las políticas y los programas en Jamaica.

Can research accelerate progress toward millennium development goal 5 (maternal health) in Jamaica? / ¿Pueden las investigaciones acelerar el progreso hacia el cumplimiento del objetivo 5 (salud materna) de desarrollo del milenio en Jamaica?

The Ministry of Health and the University of the West Indies have collaborated over 25 years to develop the evidence base to improve maternal health. The experience is reviewed as a model to accelerate Jamaica's progress toward achieving the Millennium Development Goals (MDGs). The process included measuring the disease burden due to maternal morbidity and mortality; developing and field testing interventions to manage the leading problems, national scale-up, monitoring and evaluation. This began with developing clinical guidelines to manage the hypertensive disorders of pregnancy while establishing high risk (referral) antenatal clinics, expansion and upgrading of referral facilities, and audits to identify barriers to quality healthcare, including establishing maternal mortality surveillance. As we succeed, research funds have become scarce, limiting support to postgraduate students, a reliable, cost effective resource pool capable of undertaking the research needed to provide the evidence base to influence public policy more widely. A locally financed resource pool is needed to support fellowships for graduate students to accelerate their training and availability to contribute to national development. The model from Thailand is put forward for consideration. The operations research model for maternal health can be transferred to other MDG objectives. As Jamaica pursues its goal of developed nation status, and international grant financing shrinks, local civil society will need to fill the vacancy and invest in the most abundant natural resource, young people.

El Ministerio de Salud Pública y la Universidad de West Indies han colaborado por más de 25 años para desarrollar la medicina basada en la evidencia a fin de mejorar la salud materna. Se revisa la experiencia como modelo para acelerar el progreso de Jamaica hacia el cumplimiento de los Objetivos de Desarrollo del Milenio (ODM). El proceso incluyó medición de la carga de enfermedad debido a la morbilidad y la mortalidad maternas, desarrollo y prueba probar en el terreno de las intervenciones para tratar los problemas principales, así como la ampliación, monitoreo y evaluación a escala nacional. Esto comenzó con el desarrollo de guías clínicas para el tratamiento de los trastornos de hipertensión durante el embarazo, al mismo tiempo que se creaban clínicas antenatales (casos referidos) para pacientes de alto riesgo, se establecía la ampliación y mejoramiento de las instalaciones para casos referidos, y se hacían auditorías a fin de identificar los obstáculos para un cuidado de salud de calidad, incluyendo el establecimiento de la vigilancia de la mortalidad materna. En la medida que tenemos éxito, los fondos de investigación se han hecho más escasos. Esto limita el apoyo a los costo-efectivos y confiables que permitan emprender las investigaciones necesarias para ofrecer una medicina basada en la evidencia, con una influencia más amplia en las políticas con el público. Se requiere un fondo de recursos de financiamiento local a fin de apoyar las becas para que los estudiantes graduados puedan acelerar su entrenamiento y aumentar su disponibilidad a contribuir con el desarrollo nacional. El modelo de Tailandia es expone a consideración. El modelo de investigación de operaciones para la salud materna puede transferirse a los ODM. En la medida que Jamaica persigue su objetivo de alcanzar un estatus de país desarrollado, y el financiamiento de becas se reduce, la sociedad civil local necesitará llenar la vacante e invertir en el recurso natural más abundante - la juventud.