Knowledge, beliefs, practices, blood pressure and blood glucose control in women with diabetes mellitus [abstract]

OBJECTIVE: To determine the knowledge, beliefs, practices, blood pressure and blood glucose control among women with diabetes mellitus attending a specialist medical clinic. METHOD: A 43-item pre-tested questionnaire was administered to a purposive sample of 28 (26.4 percent) of women attending the University Hospital of the West Indies Diabetes Clinic in May/June 2001. Weight (wt), height (ht), blood pressure (BP), fasting blood glucose (FBG) and two hour post-prandial blood glucose (2hpp), diet and activity were recorded. Body mass index (BMI, wt/ht2) was calculated. RESULTS: Median age of 57 years, range, 21-85 years; median time since diagnosis was 14.5 years, range, 0.5-51 years. Only 27 percent of patients had BP controlled to ó135/85 mm/Hg. There was an association between systolic BP and BMI (r= 0.43, p<0.05). The majority of the patients were inactive, overweight or obese: median BMI, 30.3 kg/m2. The majority did not follow a diabetic diet and had no recent contact with a dietitian. There was an association between reported intake of sucrose and 2hpp (r= 0.75, p<0.001). The majority (82 percent) did not take alcohol; 14 percent smoked cigarettes. Only 28.6 percent were controlled to FBG ó 8 mmol/l and 2 hpp ó10 mmol/l. Sixty-seven percent of the patients were on insulin; 21.3 percent used a glucometer. Medications were missed a median of two days per month. There were inverse associations between years since diagnosis and number of days per month that medications were missed (r= -0.39, p<0.05) and knowledge scores and age (r= -0.47, p<0.01). There were associations between knowledge, practice and educational level (p<0.01). The doctor was the main source of information. The majority reported having had ECG (57 percent), blood cholesterol and renal function tests (64 percent) in the past year. The majority (57 percent) reported never having had a foot examination; 32 percent reported never having had an eye examination. CONCLUSION: The majority of these patients were inactive and obese with limited control of blood glucose and blood pressure. Although fairly compliant with medication, there was little adherence to therapeutic guidelines regarding diet, exercise and maintenance of normal weight. Closer attention should be given to foot and eye examinations for early detection of complications. Closer monitoring and counselling of patients in these areas is recommended. (AU)

Satisfaction among patients attending a specialist medical clinic

OBJECTIVE: To determine the level of satisfaction among patients attending the Cardiac Specialists Clinic at the University Hospital of the West Indies (UHWI), Mona. METHOD: A 25-item pre-tested questionnaire was administered to a purposive sample (n=39), men (n=10) and women (n=29), 43.3 percent of a total population (n=90) attending the clinic in May and June 2001. Their median age was 59 years, range 31-90 years. RESULTS: There were no significant differences between the responses of the men and the women. Respondents travelled a median of eight miles, range 2-183 miles, to attend the clinic, and waited for a median of four hours, range 1-8 hours, before receiving attention. They had attended the clinic a median of four times. Despite this, they reported a high level of satisfaction with all categories of hospital personnel (median rating: 8/10). They, however, rated the caring behaviour of the physicians significantly higher than that of nurses (z=3.2, p<0.001). The majority (71.8 percent) regarded the clinic fees as "reasonable". Fifty percent were eligible for the Drugs for the Elderly Programme but only 21.5 percent were on it. This programme is not offered at the UHWI hospital pharmacy. Only two persons rated the overall facilities as "excellent". They all would recommend the services of the clinics to friends and relatives for "good treatment from knowledgeable doctors and nurses" and "cleanliness of the surroundings". CONCLUSION: Overall, patients were satisfied with the services. The waiting time and time taken to find the dockets were the areas of greatest concern. (AU)

Risk factors for sexually transmitted diseases among females adolescents

OJBECTIVE: To explore the risk factors involved in the occurence of sexually transmitted diseases (STDs) among female adolescents. METHODS: A 38-item pretested questionnaire was administered to a purposive sample of 28 female adolescents, aged 16-19.9 years, diagnosed with more than one sexually transmitted disease, attending the Comprehensive Health Centre, Kingston, Jamaica. Information regarding their socio-demographic characteristics, sex education, sexual behaviour and knowledge of safer sex practices was analysed using SPSS Version 6.13. RESULTS: The median age of their first sexual experience, initiation of alcohol consumption and smoking was 15 years. Sixty-one per cent had one or two children and/or were pregnant. Their reports behaviour was inconsistent with the high scores obtained in the knowledge of safer sex practices. Four of them had HIV. Fifty-seven per cent were unable to say what were their STD diagnosis. Fifty-four per cent had three or more partners, 62 percent consumed alcoholic drinks and 25 smoked cigarettes/marijuana. They seldom used condoms. There was an inverse association between their age at first sexual experience and their number of reported partners (p<.05). CONCLUSION: The early initiation of unprotected sexual activity and substance use in this group of adolescents, the low rate of condom use and the history of multiple partners are a cause for concern. Their apparent knowledge of safer sex practices did not appear to influence their risky behaviour.(Au)

Jamaican nurses' perception of their work experiences with foreign nurses

OBJECTIVE: To explore the perception of Jamaican nurses regarding their work experiences with nurses from Cuba, Nigeria and Ghana. METHOD: A 24-item pretested self-administered questionnaire was distributed to 30 Registered Nurses working with foreign nurses on five selected wards at Kingston Public Hospital. Twenty-three nurses (77 percent) completed the questionnaire. Data were analysed using SPSS Version 6.13. RESULTS: In terms of clinical performance, ability to communicate with patients and staff and pleasant work attitude, the nurse rated those from Ghana highest, followed by Nigerians and Cubans (p<0.001). The majority (91 percent) of the respondents were concerned about the cost of recruiting foreign nurses, some of whom they perceived to be lazy and incompetent. They felt that Jamaican nurses should be treated better by improving salaries and benefits. Sixty-one per cent suggested that the benefits to foreign nurses surpassed their own. CONCLUSION: Nurses from Ghana were the most popular with Jamaican nurses. The cost of improving salaries and benefits to retain Jamaican nurses should be weighed against the cost of recruiting foreign nurses to work in Jamaica.(Au)

Impact on blood pressure control of a six-month intervention project

OBJECTIVE: to evaluate the impact of a structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. METHODS: All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies, Kingston, Jamaica, between January 4 and March 29,1999, with blood pressure > 140/90 mmHg (n = 80), were randomly divided into Group 1, cases (n = 42) and Group 2, controls (n =38). Group 1 attended monthly structured intervention programmes for six months: blood pressure and weight monitoring, video presentations, group and individual counselling. A 40-item pre-tested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyle and knowledge data. Both groups kept their usual clinic appointments. RESULTS: Except for diastolic blood pressure among male controls, diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p < 0.01). Knowledge improved significantly among the male patients (P<0.01). Among the female cases, activity scores were significantly increased (p<0.01), weight (p<0.05) and body mass index (p<0.05) were significantly reduced. There were no differences in these variables among the controls. CONCLUSION: This intervention may have a benefit in blood pressure control.(Au)

A comparison of labour and delivery outcomes in mothers induced with cytotec or pitocin

OBJECTIVE: To compare the labour and delivery outcomes among mothers induced with cytotec (misoprostol) and those induced with pitocin (oxytocin) in a retrospective study. METHODS: A stratified random sample of 40 patient records of 20 mothers induced with cytotec (Group 1) and 20 with pitocin (Group 2), was selected from the records of all of the mothers (n = 148) who had induction of labour at Victoria Jubilee Hospital, Kingston, Jamaica, in March 2000. The groups were matched for age, parity and gestation. Mothers with hypertension, diabetes mellitus, sickle cell disease and multiple pregnancies were excluded. A pretested 27-item checklist, based on the standard labour and delivery records, included a list of possible antepartum, intrapartum and immediate postpartum complications and length of hospital stay. SPSS version 7.5 was used for data analysis. RESULTS: There were no significant differences in total time of labour, blood pressure, blood loss, pre- and post-induction foetal heart rates, apgar scores and length of hospital stay. Two mothers in the cytotec group had uterine hyperstimulation and were delivered by Caesarean section. Four babies in the cytotec group and three in the pitocin group were admitted for special care. CONCLUSION: Althoygh the outcome variables for mothers induced with cytotec and those induced with pitocin were similar, the two cases of uterine hyperstimulation in the cytotec group suggest caution in the use of cytotec for the induction of labour. (Au)

Profile of uncontrolled hypertensive patients attending the specialist hypertension clinic, University Hospital of the West Indies

The purpose of this study was to describe the knowledge of hypertension, its management anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension attending the Specialist Hypertension Clinic at UHWI from January to March 1999. Patients (n=80) who had a baseline systolic BP > 140mmHg and/or a diastolic BP > 90 mmHg were invited to participate in the study. BP, height, weight, waist/hip ratios (WHR) were calculated. A 40 item pretested questionnaire eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95 percent CI 17.8, 37.5); mean BMI for women was also 30.89 (95 percent CI 18.5, 43.3). In men there was an association between BMI and WHR, r=0.62, P < 0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level, r=-0.42, P < 0.05. Although the majority of both men and women were classified as obese, only 7 percent of men and 12 percent of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressures in this population, the use of nonpharmacologic therapy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.(AU)

Neural tube defects in Jamaica following Hurricane Gilbert

An increased incidence of obvious live-birth neural tube defects (i.e., spina bifida cystica and encephalocele) occurred in Jamaica 11 to 18 months after Hurricane Gilbert. The conceptions of the affected babies coincided with a rise in megaloblastic change in sickle cell patients, suggesting a wide-spread drop in dietary folate intake. A detailed history was taken from each of the 17 affected mothers (case subjects) and 51 unaffected mothers (matched control subjects). The case subjects reported a significantly lower mean intake of dietary folate in the periconceptional period (154 micograms/day) than did the control subjects (254 micrograms/day). The temporary increase in neural tube defects was associated with a dietary level of folate that fails to protect against neural tube defects under natural conditions. (AU)