Who moves in vulnerable Caribbean neighborhoods? Positive deviance for physical activity: Findings from the Jamaica health and Lifestyle Survey 2017 (JHLS III).

Decreased physical activity (PA) has been associated with residents living in neighborhoods perceived as being disordered or having high crime levels. What is unknown are the characteristics of individuals who engage in moderate to vigorous levels of PA (MVPA) despite living in these vulnerable neighborhoods, or who may be referred to as positive deviants (PD). We examined the factors associated with PD for PA among Jamaicans. Between 2016 and 2017 the Jamaica Health and Lifestyle Survey, a cross-sectional nationally representative survey (n = 2807), was conducted on individuals aged 15 years and older. Regression analyses were performed to identify associations with PD, defined using engagement in MVPA among persons living in vulnerable neighborhoods (N = 1710). Being female (odds ratio [OR]a = 0.64 (0.48, 0.86); p = 0.003), obese while living in an urban area (ORa = 0.39; 95 % CI = 0.26, 0.59; p < 0.0001), unemployed (ORa = 0.53; 95 % CI = 0.39, 0.73; p < 0.0001), or a student (ORa = 0.62; 95 % CI = 0.39, 0.98); p = 0.041) was associated with a significantly lower likelihood of PD, while having a personal medical history of at least one chronic disease significantly increased likelihood (ORa = 1.43; 95 % CI = 1.08, 1.90; p = 0.014). Taking a PD approach may be one angle to consider in trying to determine what is working and for whom, so that this may be harnessed in policy, prevention and intervention programming to increase PA.

Parish Prevalence Estimates of Obesity, Diabetes and Hypertension in Jamaica: Is It Now Time for More Targeted Public Health Interventions? / Estimados de la Prevalencia de la Obesidad, la Diabetes y la Hipertensión por Parroquia en Jamaica: ¿Es ya Tiempo de Realizar Intervenciones de Salud Pública Más Específicas?

ABSTRACT Objective: Geographic variation in obesity, Diabetes mellitus (DM) and hypertension (HTN) prevalence at the parish level was examined using the Jamaica Health and Lifestyle Survey 2008 (JHLS II). Methods: Total and sex-specific parish age-adjusted prevalence estimates of obesity, DM and HTN were obtained and ranked. Binary logistic regression models were adjusted for age, urbanicity, educational level, physical activity and diet. Results: Parish prevalence ranges were obesity 19.5-37.8% (1.7-31.0% in men versus 27.39-48.30% in women); DM 5.08-37.82% (0-26.45% in men versus 7.11-14.17% in women) and HTN 19.50-36.02% (10.94-48.39% in men versus 18.85-36.61% in women). The highest parish prevalences were St Elizabeth for obesity, Portland for DM and St Mary for HTN. Men residing in St Elizabeth were 16 times more obese compared to those in Portland [(Odds Ratio) OR = 15.84; 95% CI = 2.00, 125.51, p < 0.01], while women in St Elizabeth had twice the odds of being obese compared to those in St Ann [OR = 2.3; 95% CI, 1.007, 5.3). Men in Portland were eight times more likely to have HTN compared to those residing in St Ann (OR = 7.70; 95% CI = 2.34, 25.40, p = 0.001) whilst women in St Mary were three times more likely to be hypertensive compared to those living in St Thomas (OR = 3.05; 95% CI = 1.63, 5.72, p = 0.001). No significant associations were seen with DM. Conclusion: Significant heterogeneity exists at the parish level in obesity, DM and HTN, with important sex differences. Further analyses are needed to understand the determinants and work toward context-specific prevention and intervention programming.

RESUMEN Objetivo: La variación geográfica de la prevalencia de la obesidad, la diabetes mellitus (DM) y la hipertensión (HT) a nivel parroquia, se examinó usando la Encuesta 2008 sobre Salud y Estilo de Vida de Jamaica (JHLS-2). Métodos: Los estimados totales y específicos por género, ajustados por edad y a nivel de parroquia, de la prevalencia de la obesidad, DM y HT, fueron obtenidos y clasificados. Los modelos de regresión logística binaria fueron ajustados por edad, urbanidad, nivel educacional, actividad física, y dieta. Resultados: Los rangos de prevalencia por parroquia fueron como sigue: obesidad 19.5- 37.8% (1.7-31.0% en hombres versus 27.39-48.30% en mujeres); DM 5.08-37.82% (0- 26.45% en hombres versus 7.11-14.17% en mujeres); y HT 19.50-36.02% (10.94-48.39% en hombres versus 18.85-36.61% en mujeres). Las prevalencias más altas por parroquia fueron: Saint Elizabeth en obesidad, Portland en DM, y Saint Mary en HT. Los hombres de Saint Elizabeth eran 16 veces más obesos en comparación con los de Portland [(Odds Ratio) OR = 15.84; 95% IC = 2.00, 125.51, p < 0.01], mientras que las mujeres de Saint Elizabeth tenían el doble de probabilidades de ser obesas en comparación con las de Saint Ann (OR = 2.3; 95% IC, 1.007, 5.3). Los hombres de Portland eran ocho veces más propensos a padecer de HT en comparación con los residentes en Saint Ann (OR = 7.70; 95% IC = 2.34, 25.40, p = 0.001) en tanto que las mujeres de Saint Mary tenían tres veces más probabilidades de ser hipertensas comparadas con las que viven en Saint Thomas (OR = 3.05; 95% IC = 1.63, 5.72, p = 0.001). No se observaron asociaciones significativas con DM. Conclusión: Existe una heterogeneidad significativa a nivel de parroquias en cuanto a obesidad, DM, y HT, con importantes diferencias de género. Se necesitan más análisis para entender las determinantes y trabajar hacia la programación de intervenciones y prevenciones específicas del contexto.

Prevalence of Chronic Kidney Disease among Patients Attending a Specialist Diabetes Clinic in Jamaica.

OBJECTIVE: To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes. METHODS: We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid. RESULTS: Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes. CONCLUSION: Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.

Ischaemic Heart Disease at the University Hospital of the West Indies: Trends in Hospital Admissions and Inpatient Mortality Rates 2005-2010.

OBJECTIVES: This study aimed to estimate hospital admission rates and inpatient mortality rates for ischaemic heart disease (IHD) and its subtypes at the University Hospital of the West Indies (UHWI) for the years 2005─2010, and to identify factors associated with inpatient mortality. METHODS: Data from electronic discharge summaries for patients diagnosed with acute myocardial infarction (A-MI), unstable angina (UA) or other IHD were obtained from the Patient Information Management Systems database of the Medical Records Department of the UHWI. Data were entered into an electronic database and analysed using Stata 10.1. Random effects logistic regression was used to identify factors associated with inpatient mortality. RESULTS: Analysis included 3794 admissions (2821 persons: 1415 males, 1406 females; mean age 63.9 ± 13.5 years). Overall admission rates for IHD were 12.1% (95% CI 11.7, 12.5) for medical admissions and 4.02% (95% CI 3.89, 4.15) for non-paediatric admissions. Admission rates were higher among males compared to females. There was a statistically significant trend for an overall increase in the rates for IHD admissions over the study period. Inpatient mortality rate was 18.9% for A-MI, 1.6% for UA and 7.8% for other IHD. In multivariable models, adjusted for age and gender, A-MI was associated with higher mortality compared to other IHD (OR 3.38, p < 0.001). CONCLUSIONS: Ischaemic heart disease admission rate is increasing at the UHWI and accounts for approximately one of every eight medical admissions. Inpatient mortality for acute myocardial infarction is approximately 19%. Further studies are required to determine the factors associated with inpatient mortality and to inform strategies for improving outcomes.