The emergence of qnr-mediated quinolone resistance among Enterobacteriaceae in Jamaica / Surgimiento de la resistencia a las quinolonas mediada por qnr entre las Enterobacteriaceae en Jamaica

OBJECTIVE: Quinolone resistance is usually caused by various chromosomal mutations, but has been more recently associated with plasmids which carry the qnr determinant. The aim of this study is to investigate the prevalence of qnr genes in clinical isolates of Enterobacteriaceae in Jamaica. METHODS: A total of 255 non-duplicate fluoroquinolone-resistant Enterobacteriaceae clinical isolates, comprising 232 Escherichia coli, 20 Klebsiella species and three Enterobacter spp were collected between October 2007 and November 2008 from hospitalized patients in Jamaica. The presence of the qnr gene was screened by PCR using specific primers for qnrA, qnrB and qnrS in extracted plasmid DNA. RESULTS: Eighty-three (32.5%) of these isolates were qnr-positive, of which 47.0% housed the qnrA gene only, 1.2% qnrB and 9.6% qnrS only. Another 36.1% possessed both qnrA and qnrS genes. Approximately 30% of the quinolone-resistant E coli isolates harboured the qnr gene while 50% Klebsiella spp and all Enterobacter spp were positive. CONCLUSION: The emergence of qnr-mediated quinolone resistance among clinical Enterobacteriaceae isolates is described for the first time in Jamaica.

OBJETIVO: La resistencia a la quinolona es generalmente causada por varias mutaciones cromosomáticas, pero más recientemente ha sido asociada con plásmidos portadores del determinante qnr. El objetivo de este estudio fue investigar la prevalencia de genes qnr en los aislados clínicos de Enterobacteriaceae en Jamaica. MÉTODOS: Un total de 255 aislados clínicos no duplicados de Enterobacteriaceae resistentes a la fluoroquinolona, incluyendo 232 de Escherichia coli, 20 especies de Klebsiella y tres Enterobacter spp, fueron recogidos entre octubre de 2007 y noviembre de 2008, de pacientes hospitalizados en Jamaica. La presencia del gen qnr fue tamizada mediante marcadores PCR, usando primers específicos para qnrA, qnrB y qnrS en el ADN plásmido extraído. RESULTADOS: Ochenta y tres (32.5%) de éstos aislados fueron qnr-positivos. De ellos, 47.0% alojaban solamente el gen qnrA, 1.2% el qnrB y 9.6% el qnrS solamente. Otro 36.1% poseía tanto genes qnrA cuanto genes qnrS. Aproximadamente 30% de los aislados E. coli resistentes a la quinolona, albergaban el gen qnr mientras que 50% de Klebsiella spp y todas las Enterobacter spp fueron positivas. CONCLUSIÓN: Se describe por primera vez el surgimiento de la resistencia a las quinolonas mediada por qnr en Jamaica.

The emergence of qnr-mediated quinolone resistance among Enterobacteriaceae in Jamaica.

OBJECTIVE: Quinolone resistance is usually caused by various chromosomal mutations, but has been more recently associated with plasmids which carry the qnr determinant. The aim of this study is to investigate the prevalence of qnr genes in clinical isolates of Enterobacteriaceae in Jamaica. METHODS: A total of 255 non-duplicate fluoroquinolone-resistant Enterobacteriaceae clinical isolates, comprising 232 Escherichia coli, 20 Klebsiella species and three Enterobacter spp were collected between October 2007 and November 2008 from hospitalized patients in Jamaica. The presence of the qnr gene was screened by PCR using specific primers for qnrA, qnrB and qnrS in extracted plasmid DNA. RESULTS: Eighty-three (32.5%) of these isolates were qnr-positive, of which 47.0% housed the qnrA gene only, 1.2% qnrB and 9.6% qnrS only. Another 36.1% possessed both qnrA and qnrS genes. Approximately 30% of the quinolone-resistant E coli isolates harboured the qnr gene while 50% Klebsiella spp and all Enterobacter spp were positive. CONCLUSION: The emergence of qnr-mediated quinolone resistance among clinical Enterobacteriaceae isolates is described for the first time in Jamaica.

Emotions and psychopathology

Few psychological assessment instruments exist for Jamaicans. Studies that address the appropriateness of foreign instruments for Jamaicans are sparse and empirical focus on psychopathology and its aetiology in Jamaican adults is virtually nonexistent. The present study addressed these deficits via Confirmatory Factor Analyses (CFA) which revealed that factors on the Toronto Alexithymia Scale (TAS-20) and Brief Symptom Inventory (BSI) were not replicated for a Jamaican sample (N=352). Exploratory Factor Analyses (EFA) on the TAS-20 revealed one factor labelled Unawareness and Confusion Regarding Emotions (UCRE). Also, EFA yielded six BSI dimensions labelled Somatic Complaints, Paranoia, Hostility, Mild Depression/Dysthymia, Major Depression with Psychotic features, and Agoraphobia with Panic. Regression analyses on the Jamaican-based TAS-20 and BSI factors revealed a positive relationship between UCRE and each BSI factor and total BSI score. Mild Depression, Agoraphobia with Panic, Paranoia, Hostility, Mild Depression and Major Depression were higher for women and younger Jamaicans, respectively, but younger Jamaicans with higher UCRE scores had higher scores on Paranoia, Major Depression, and total score. The findings suggest that Jamaican mental health policy and programmes should focus on the difficulties some Jamaicans experience in recognising and expressing their emotions.(AU)

Emotions and psychopathology.

Few psychological assessment instruments exist for Jamaicans. Studies that address the appropriateness of foreign instruments for Jamaicans are sparse and empirical focus on psychopathology and its aetiology in Jamaican adults is virtually nonexistent. The present study addressed these deficits via Confirmatory Factor Analyses (CFA) which revealed that factors on the Toronto Alexithymia Scale (TAS-20) and Brief Symptom Inventory (BSI) were not replicated for a Jamaican sample (N = 352). Exploratory Factor Analyses (EFA) on the TAS-20 revealed one factor labelled Unawareness and Confusion Regarding Emotions (UCRE). Also, EFA yielded six BSI dimensions labelled Somatic Complaints, Paranoia, Hostility, Mild Depression/Dysthymia, Major Depression with Psychotic Features, and Agoraphobia with Panic. Regression analyses on the Jamaican-based TAS-20 and BSI factors revealed a positive relationship between UCRE and each BSI factor and total BSI score. Mild Depression, Agoraphobia with Panic, Paranoia, Hostility, Mild Depression and Major Depression were higher for women and younger Jamaicans, respectively, but younger Jamaicans with higher UCRE scores had higher scores on Paranoia, Major Depression, and total score. The findings suggest that Jamaican mental health policy and programmes should focus on the difficulties some Jamaicans experience in recognising and expressing their emotions.

Behaviour and emotional problems of clinic referred children of the African diaspora

Several factors determine behaviour problem types children exhibit, and actions adults (eg, parents) subsequently take. Factors include children's sociocultural background and clinicians' professional training. Cross-national research on children of similar heritage (eg, the African Diaspora) living in different cultures can address sociocultural issues associated with child psychopathology, but few cross-cultural studies focus on children of African descent. This study begins addressing these issues by surveying clinic records of 696 African American and Jamaican children aged 4-18 years. Trained recorders reviewed clinic records and recorded youngsters' presenting problems. By matching youngsters' problem to the widely used Child Behavior Checklist (CBCL) items, recorders coded and summed problems according to eight CBCL syndromes, internalising, externalising problems, other CBCL-, and non-CBCL problems. Stepwise regression revealed that African American youngsters scored higher on the Somatization syndrome only, a child problem type the Jamaican culture seems to tolerate.(AU)

Self report ratings of psychopathology in Korean and Jamaican women

Women from different nations with different customs may express varying levels of psychological distress and present problems in forms their societies accept. We compared women from Korea and Jamaica where women's roles and behaviour differ, and may influence the types of symptoms they display. Korean culture supports women's dependence, submissiveness, and obedience toward male partners and discourages women from expressing feelings, a custom that causes women distress which is usually expressed as anxiety related disorders. Jamaican women comprise most Jamaica's work force and are described as independent, outwardly expressive, and unlike Korean women may externalize their psychological distress. We tested these hypotheses using the Brief Symptom Inventory (BSI), a multidimensional psychopathology measure, to survey Korean (N = 214) and Jamaican women (N = 282). Using age and nationality as predictors and total score and the nine BSI scales as criterion variables considered separately, multiple regression analyses reveal significantly higher scores on total problems and on all the paranoid scales scores on total problems and on all the paranoid scale scores for Korean than for Jamaica women. Large effect on the Somatization and Obsessive Complusive scales and a medium effect on the anxiety scale indicate that while Korean women generally expressed much more distress than Jamaica women, they are particularly vulnerable for the development of anxiety related problems(AU)

Identification of emotions and emotional confusion in Jamaican men vs women: do they predict severity and types of psychopathology?

In Jamaica, women comprise two-thirds of the workforce, but the society rigidly defines gender roles and behaviour for men versus women. Jamaican women are reportedly independent and outwardly express wide varieties of feelings. Jamaican men have greater difficulty acknowledging, labelling and expressing their emotions, a process labelled alexithymia. Therefore, Jamaican men may report higher levels of alexithymia. Since identification and expression of feelings are positively associated with psychological health, Jamaicans (especially men) with higher alexithymia scores should report higher levels of psychological distress than those with low alexithymia scores. These hypotheses were tested using the Toronto Alexithymia Scale II (TAS-II), and Brief Symptom Inventory (BSI), to survey 400 Jamaican men and women

The prevalence and perception of child abuse in Jamaica

In Jamaica, reporting of child abuse is not mandatory and reported cases are typically extreme. This study was designed to determine the true prevalence, nature and perception of all forms of abuse, including events unlikely to be reported. A representative sample of 156 mothers from three Child Welfare Clinics (two public and one private) were chosen. Information was obtained by a culture specific questionnaire, requesting women to report their own experiences when under 12-years of age. Apart from demographic information, specific questions were asked to elicit events of minor and major physical abuse, emotional abuse, and neglect (physical and emotional). The questionnaire was administered by 3 interviewers with an interobserver reliability of 95 percent. Data were processed by SPSS, using Chi-squared-Mantel Haenszel and Fisher's exact test. Seventy-one point four percent (71.4 per cent) of women experienced some form of abuse with physical, emotional and sexual abuse occurring in 53 percent, 33 percent and 10 percent, respectively. Forty-seven percent (47 per cent) experienced neglect, 38 percent physical and 19 percent emotional. There was a strong association between major and minor physical abuse (p trend < 0.001). Multiple forms of abuse were common with 18 percent, 20 percent, 4 percent experiencing two, three, and four forms of abuse, respectively. No significant differences occurred in prevalence of abuse by age or site, though there were striking demographic differences among mothers. Of women identified as being abused, perception was low, ranging from 26 percent for physical abuse to 58 percent emotional abuse (p < 0.0001). In this population, child abuse in all forms was prevalent, pervasive and persistent over time. Low levels of perception suggest cultural acceptance of abuse, particularly physical abuse, the majority of which was minor. However, minor abuse predicted more severe events. Relatively low levels of emotional neglect suggest a caring population that may be amenable to intervention through education with regard to the effects of abuse and alternative methods of discipline (AU)