H. pylori predictors and outcomes among adults undergoing upper endoscopy at a Jamaican teaching hospital: A cross-sectional study.

BACKGROUND: Recent data on the prevalence of H. pylori infection in Jamaica are lacking. It is postulated that there has been a decline in the prevalence of H. pylori infection and its associated complications. We determined sociodemographic characteristics, prevalence of H. pylori infection and clinical outcomes among adults undergoing esophagogastroduodenoscopy (EGD) and histology at the University Hospital of the West Indies (UHWI) between May 2018 and December 2020. MATERIALS AND METHODS: A cross-sectional study of patients (≥18 years old), who underwent EGD and histological evaluation for H. pylori infection, was conducted. Associations of H. pylori positivity and gastric cancer with sociodemographic/clinical variables and endoscopic findings were determined by stepwise logistic regression using backward selection. Unadjusted and adjusted odds ratios with related 95% confidence intervals (Cis) were calculated for H. pylori positivity and gastric cancer status. RESULTS: There were 323 participants (mean age 58.6 ± 17.8 years, 54.2% females). H. pylori prevalence was 22.2% (n = 70 of 315), 5.6% had gastric neoplasia (GN), 15.5% gastric atrophy, 11.4% intestinal metaplasia and 3.7% dysplasia on histology. Mucositis (64.5%), gastric ulcer (14.9%), and duodenal ulcer (13.9%) were the most common endoscopic findings. Participants with peptic ulcer disease (PUD) (unOR = 4.0; p = .017), gastric cancer (unOR = 9.5; p = .003), gastric atrophy (unOR = 12.8; p < .001), and intestinal metaplasia (unOR = 5.0; p < .001) had a significantly higher odds of being H. pylori positive, but after multivariable analyses only gastric atrophy remained significant (aOR = 27.3; p < .001). Participants with mucositis had a significantly lower odds of gastric cancer (unOR 0.1; p = .035) while participants with dysplasia had significantly higher odds (unOR 8.0; p = .042), but these were no longer significant after multivariable analyses (aOR = 0.2; p = .156 and aOR = 18.9; p = .070, respectively). CONCLUSIONS: Histology based prevalence of H. pylori infection is lower than previously reported in Jamaica. Gastric atrophy is a significant predictor of H. pylori positivity.

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.

The chronic disease passport: an assessment of its effectiveness in improving hypertension control in Jamaicans

OBJECTIVE: To assess whether the Chronic Disease Passport (CDP) was effective in improving blood pressure control in patients in Montego Bay, Jamaica. DESIGN AND METHODS: A retrospective cohort study was conducted on a convenient sample of 264 patients aged 18-74 years with hypertension (HPT) who attended the Type 5 Health Centre in Montego Bay between May and July 2014. Blood pressure control was assessed at baseline and one year post exposure, using data from medical records. Knowledge, attitude and behaviour towards HPT and the CDP were gathered through an interviewer-administered questionnaire. In-depth semi-structured interviews were conducted with 6 persons who had received the CDP. RESULTS: Seventy-seven percent of respondents (n=204) were exposed to the CDP. At baseline HPT control was significantly better in the exposed group (20.7%), versus the non-exposed group (5.0%) (p<0.01). At the one year follow-up endpoint, there was no significant association between exposure to the CDP and HPT control with the relative risk of having a controlled SBP being significantly lower in the exposed group (RR = 0.44, 95% CI: 0.24, 0.81). Control of HPT among the exposed group also worsened by 17.3% (p<0.001), but remained unchanged for the non-exposed group. Participants cited medication supply as an issue of concern. CONCLUSION: Exposure to the CDP was not associated with better control of HPT. More research is needed to explore other impacting factors, including issues surrounding medication supply.

Chronic disease in the Caribbean: strategies to respond to the public health challenge in the region. What can we learn from Jamaica's experience?

With the advent of the epidemiological transition, chronic non-communicable diseases (CNCDs) have emerged as the leading cause of death globally. In this paper we present an overview of the burden of CNCDs in the Caribbean region and use Jamaica as a case-study to review the impact of policy initiatives and interventions implemented in response to the CNCD epidemic. The findings show that while Jamaica has implemented several policy initiatives aimed at stemming the tide of the CNCD epidemic, a comparison of data from two national health and lifestyle surveys conducted in Jamaica in 2000/01 and 2007/08 revealed that there was an increase in the prevalence of intermediate CNCD risk factors such as hypertension and obesity. We therefore present recommended strategies which we believe will enhance the current CNCD response and thus reduce, or at least stem, the current epidemic of CNCDs.

Preliminary report on the validation of a questionnaire measuring patient satisfaction with services at the Sickle Cell Unit in Jamaica / Reporte preliminar sobre la validación de un cuestionario para medir la satisfacción de los pacientes con respecto a los servicios de la Unidad de Anemia Falciforme en Jamaica

OBJECTIVE: Patient satisfaction has become an increasingly important component of quality assessment. This cross-sectional study was conducted to assess the psychometric properties of a Patient Satisfaction Questionnaire modified for use in the Sickle Cell Unit, Jamaica. METHODS: A total of 85 persons were interviewed. Construct validity, including exploratory factor analysis and internal reliability were assessed. Data were analysed using SPSS (version 11.5 for Windows) and Intercooled STATA (version 8.2). RESULTS: The Patient Satisfaction Questionnaire modified for use in the Sickle Cell Unit demonstrated good internal reliability for the 'doctors', 'nurses', 'social worker' and 'facilities' subscales (Cronbach's a > 0.70). Exploratory factor analysis revealed only four of the seven 'specific' subscales retaining a single factor, namely the 'nurses', 'facilities', 'appointments'and 'social worker'subscales. Those who attended more frequently gave a statistically significant higher score for 'facilities' and lower score for 'nurses'. However there was no statistically significant difference in the mean scores by age, gender and genotype. The 'general satisfaction' subscale scores showed a significant positive correlation with scores for 'doctors', 'nurses', 'laboratory' and 'facilities' and 'appointments'. CONCLUSION: This preliminary report on the validation of the Patient Satisfaction Questionnaire modified for use in the Sickle Cell Unit reveals it has the potential for serving as a useful tool in the assessment ofpatient satisfaction among sickle cell patients. However, further work is necessary on the instrument.

OBJETIVO: La satisfacción del paciente se ha convertido en un componente cada vez más importante de la evaluación de la calidad. Este estudio transversal se llevó a cabo a fin de evaluar las propiedades psicométricas de una Cuestionario de Satisfacción del Cliente, modificado para su uso en la Unidad de Anemia Falciforme, Jamaica. MÉTODOS: Se entrevistó un total de 85 personas. Se evaluó la validez del constructo, incluyendo el análisis exploratorio de factores y la confiabilidad interna. Los datos fueron analizados utilizando el SPSS (versión 11.5 para Windows) e Intercooled STATA (versión 8.2). RESULTADOS: El Cuestionario de Satisfacción del Cliente para uso en la Unidad de Anemia Falciforme demostró buena confiabilidad interna para las subescalas de 'doctores', 'enfermeras', 'trabajadores sociales'e 'instalaciones'(Cronbach: a > 0.70). El análisis exploratorio de factores reveló solamente cuatro de las siete subescalas "específicas" que retienen un solo factor, a saber, "enfermeras", "instalaciones ", "citas " y "trabajadores sociales ". Aquellos que asistían con mayor frecuencia, arrojaron - desde el punto de vista de las estadísticas - una puntuación significativamente más alta para las "instalaciones", y una puntuación más bajas para las "enfermeras ". Sin embargo, no hubo diferencias estadísticas significativas en las puntuaciones promedio por edad, género o genotipo. Las puntuaciones de subescala de la "satisfacción general" mostraron una correlación significativamente positiva con respecto a las puntuaciones para "doctores", "enfermeras", "laboratorio" e "instalaciones, y "citas". CONCLUSIÓN: Este reporte preliminar sobre la validación del Cuestionario de Satisfacción del Paciente, modificado para su uso en la Unidad de Anemia Falciforme, revela que esta Unidad tiene el potencial necesario para servir como instrumento útil a fin de evaluar el grado de satisfacción del servicio entre los pacientes de anemia falciforme. No obstante, el instrumento requiere ulterior elaboración.

Preliminary report on the validation of a questionnaire measuring patient satisfaction with services at the sickle cell unit in Jamaica.

OBJECTIVE: Patient satisfaction has become an increasingly important component of quality assessment. This cross-sectional study was conducted to assess the psychometric properties of a Patient Satisfaction Questionnaire modified for use in the Sickle Cell Unit, Jamaica. METHODS: A total of 85 persons were interviewed. Construct validity, including exploratory factor analysis and internal reliability were assessed. Data were analysed using SPSS (version 11.5 for Windows) and Intercooled STATA (version 8.2). RESULTS: The Patient Satisfaction Questionnaire modified for use in the Sickle Cell Unit demonstrated good internal reliability for the 'doctors', 'nurses', 'social worker' and facilities' subscales (Cronbach's alpha > or = 0.70). Exploratory factor analysis revealed only four of the seven 'specific'subscales retaining a single factor, namely the 'nurses', 'facilities', 'appointments'and 'social worker' subscales. Those who attended more frequently gave a statistically significant higher score for facilities' and lower score for 'nurses'. However there was no statistically significant difference in the mean scores by age, gender and genotype. The 'general satisfaction' subscale scores showed a significant positive correlation with scores for 'doctors', 'nurses', 'laboratory'and facilities'and 'appointments'. CONCLUSION: This preliminary report on the validation of the Patient Satisfaction Questionnaire modified for use in the Sickle Cell Unit reveals it has the potential for serving as a useful tool in the assessment of patient satisfaction among sickle cell patients. However further work is necessary on the instrument.

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean / Estudio comparativo de la calidad y disponibilidad de la información sobre la salud usada para facilitar el análisis del nivel de costos de la diabetes y la hipertensión en el Caribe

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean. Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

OBJETIVO: Las enfermedades no comunicables (ENC) se cuentan entre las principales amenazas a la salud y el bienestar en el Caribe. Se llevó a cabo un estudio hacia finales de 2005, con el fin de computar la carga económica de la diabetes mellitus y la hipertensión dentro de la Comunidad y el Mercado Común del Caribe (CARICOM). Este reporte constituye un análisis crítico de la calidad y disponibilidad de información sobre la salud, que puede ser usada para facilitar el análisis del nivel de costos de la diabetes mellitus y la hipertensión. MÉTODOS: Se desarrolló y distribuyó un formulario para obtener datos acerca de la utilización de servicios de salud y servicios epidemiológicos. Posteriormente se realizaron visitas a siete países miembros de CARICOM con el propósito de recoger datos. RESULTADOS: Los resultados revelaron (i) algunas deficiencias en cuanto a la confiabilidad y la validez de los datos recibidos, en particular los necesarios para facilitar el análisis de las complicaciones costo-específicas, tales como la enfermedad cardíaca isquémica, la enfermedad cerebrovascular, el fallo renal crónico, la retinopatía hipertensiva y diabética, y las complicaciones circulatorias periféricas; (ii) los sistemas de administración de datos en los hospitales no estaban conectados para facilitar la producción de estimados de costo-efectividad y otras informaciones requeridas para comparar las opciones de inversión para la salud; (iii) a pesar de reiterados intentos de los gobiernos regionales por desarrollar y fortalecer los sistemas de información de salud en el área del Caribe, su sostenimiento ha sido obstaculizado significativamente a causa de restricciones en cuanto a recursos humanos, materiales y financieros, y por el hecho de que el monitoreo y la evaluación actuales son generalmente pobres. CONCLUSIÓN: Existen deficiencias en la calidad y disponibilidad de información sobre la salud, en cuanto a facilitar el análisis del nivel de la magnitud del costo de la hipertensión y la diabetes mellitus en el Caribe. Será necesario un fuerte compromiso por parte de los gobiernos del CARICOM para abordar estos problemas, si se ha de emprender evaluaciones económicas con mayor frecuencia, como parte del esfuerzo por reducir la morbilidad y la mortalidad por estas enfermedades.

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean.

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

Fatal autochthonous eosinophilic meningitis in a Jamaican child caused by Angiostrongylus cantonensis.

A fatal case of infection with Angiostrongylus cantonensis is reported in a 14-month-old Jamaican boy. Although infection with Angiostrongylus was not considered initially, sections of multiple worms were observed in the brain and lungs at autopsy and confirmed the infection. This is the first reported fatality due to this infection in the Western Hemisphere, and follows shortly after an outbreak of eosinophilic meningitis among a group of travelers to Jamaica. The source of infection in this case could not be determined.