The potential of saponin from Jamaica's Blighia sapida (ackee) as a substitute for sodium lauryl sulphate in toothpaste.

Discovering novel means of protection from harmful substances in toothpaste is essential due to its mass production, and frequent exposure to its ingredients by consumers. This method of safeguarding through discovery demonstrates toothpaste safety, which is at risk of being stifled by other commercial priorities. Among the ingredients in toothpaste that cause adverse effects is sodium lauryl sulphate (SLS). An understanding of this source and its effects therefore allows for investigating preventative strategies through the use of safer alternatives. Saponin, a naturally occurring chemical in several plant species was discovered to be an alternative compound that may parallel the effects of sodium lauryl sulphate, yet exude less ill effects. This article highlights the benefits of saponin and its presence in a heavily consumed and exported fruit in Jamaica (ackee, Blighia sapida). The possibility of extracting saponin from ackee, and its use in the toothpaste industry as an alternative to sodium lauryl sulphate are discussed. Through consideration of this alternative, the potential exists to improve the safety of toothpastes and consequently improve oral health.

Associations of whole-blood fatty acids and dietary intakes with prostate cancer in Jamaica.

OBJECTIVE: To investigate the association of whole-blood fatty acids and reported intakes of fats with risk of prostate cancer (PCa). DESIGN: Case-control study of 209 men 40-80 years old with newly diagnosed, histologically confirmed prostate cancer and 226 cancer-free men attending the same urology clinics. Whole-blood fatty acid composition (mol%) was measured by gas chromatography and diet assessed by food frequency questionnaire. RESULTS: High whole-blood oleic acid composition (tertile 3 vs. tertile 1: OR, 0.37; CI, 0.14-0.0.98) and moderate palmitic acid proportions (tertile 2: OR, 0.29; CI, 0.12-0.70) (tertile 3: OR, 0.53; CI, 0.19-1.54) were inversely related to risk of PCa, whereas men with high linolenic acid proportions were at increased likelihood of PCa (tertile 3 vs. tertile 1: OR, 2.06; 1.29-3.27). Blood myristic, stearic and palmitoleic acids were not associated with PCa. Higher intakes of dietary MUFA were inversely related to prostate cancer (tertile 3 vs. tertile 1: OR, 0.39; CI 0.16-0.92). The principal source of dietary MUFA was avocado intake. Dietary intakes of other fats were not associated with PCa. CONCLUSIONS: Whole-blood and dietary MUFA reduced the risk of prostate cancer. The association may be related to avocado intakes. High blood linolenic acid was directly related to prostate cancer. These associations warrant further investigation.

Body size and risk of prostate cancer in Jamaican men.

We investigated the associations between body size and risk of prostate cancer in a hospital-based case-control study in Jamaica. Height, weight, waist, and hip circumference were measured at enrollment, and data collected on medical and lifestyle factors for newly diagnosed cases (n = 243) and controls (n = 275). Compared with men in the normal range of waist-hip ratio (WHR), men with WHR > or =0.95 were at greater risk of total prostate cancer (OR,1.72; CI, 1.01-3.00) and high-grade cancer (OR, 2.02; CI, 1.03-3.96). With additional control for BMI, the association with WHR remained significant for total prostate cancer (OR, 1.90; CI, 1.01-3.53) and high-grade disease (OR, 2.94; CI, 1.34-6.38). There was no association between waist circumference and cancer without control for BMI but after controlling for BMI, waist circumference >90 cm (OR, 2.45; CI, 1.01-5.94) and >102 cm (OR, 5.57; CI, 1.43-18.63) showed a dose-response relationship with high-grade disease. Height and BMI were not associated with risk of prostate cancer. Abdominal obesity may be associated with risk of high-grade prostate cancer. Risk may be greater in those with higher abdominal obesity relative to overall size. The results further highlight the importance of investigating relationships by characteristics of the tumor.

Public and private health care utilization differences between socioeconomic strata in Jamaica.

OBJECTIVE: To assess trends in the use of private and public health care services among Jamaicans over a 15-year period (1991-2007). DESIGN AND METHODS: Statistics on the use of health care services were taken from the Jamaica Survey of Living Conditions (JSLC) for the 15-year period 1993 to 2007. Use of hospital services were represented in income quintiles and compared for private and public facilities. The difference in percentage use between public and private was compared by quintiles over the period and the variability in those differentials assessed. RESULTS: This study highlights the increasing use of private services by increasing wealth, exaggerated for the wealthiest quintile. There is a widening of the differences in utilization between public and private centers as income level increases (P < 0.001). CONCLUSIONS: Internal and external economic conditions influence the use of private and public health care services in Jamaica. Although the relative increase in the cost (to the user) of public health care is more than that for private health care, the actual cost to use the public health care system is still significantly cheaper than using the private system. Lower income health care users tend to take the lesser cost option.

Teaching medical students in their last leg of the undergraduate journey.

BACKGROUND: This short biographical piece provides a brief description of the experience of a medical teacher at the University of the West Indies in Jamaica. It traces his initial response to being chosen as a teacher and shows movement from self-doubt to assertive thinking about the role of the teacher. The development of the teacher, though buttressed by a formal training intervention, is couched within a sensitive understanding of the whole student.

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective

Al igual que el resto del mundo, el Caribe ha sido testigo del drástico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y crónicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinámica, creada por la emergencia de enfermedades transmisibles -como la infección por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este artículo se hace una revisión de la historia de la atención sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientación en la atención primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaración de Alma-Ata sirvió como importante punto de giro y ofreció orientación, apoyo y dirección a medida que los países perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeño en la reestructuración de la APS, ante los retos económicos, sociales, culturales, de recursos humanos y de políticas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extensión de los programas sociales, los esquemas nacionales de seguros de salud, los programas específicos de promoción de salud y la ampliación de la investigación en apoyo al desarrollo de políticas continúan evidenciando el esfuerzo caribeño para responder a los cruciales retos epidemiológicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Además, la Carta del Caribe para la Promoción de la Salud ha servido como elemento crítico para el desarrollo de la APS.

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective / Retos y respuestas del sector salud más allá de la declaración de Alma-Ata: una perspectiva Caribeña

Al igual que el resto del mundo, el Caribe ha sido testigo del drástico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y crónicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinámica, creada por la emergencia de enfermedades transmisibles -como la infección por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este artículo se hace una revisión de la historia de la atención sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientación en la atención primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaración de Alma-Ata sirvió como importante punto de giro y ofreció orientación, apoyo y dirección a medida que los países perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeño en la reestructuración de la APS, ante los retos económicos, sociales, culturales, de recursos humanos y de políticas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extensión de los programas sociales, los esquemas nacionales de seguros de salud, los programas específicos de promoción de salud y la ampliación de la investigación en apoyo al desarrollo de políticas continúan evidenciando el esfuerzo caribeño para responder a los cruciales retos epidemiológicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Además, la Carta del Caribe para la Promoción de la Salud ha servido como elemento crítico para el desarrollo de la APS.

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective

Al igual que el resto del mundo, el Caribe ha sido testigo del drástico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y crónicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinámica, creada por la emergencia de enfermedades transmisibles -como la infección por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este artículo se hace una revisión de la historia de la atención sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientación en la atención primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaración de Alma-Ata sirvió como importante punto de giro y ofreció orientación, apoyo y dirección a medida que los países perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeño en la reestructuración de la APS, ante los retos económicos, sociales, culturales, de recursos humanos y de políticas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extensión de los programas sociales, los esquemas nacionales de seguros de salud, los programas específicos de promoción de salud y la ampliación de la investigación en apoyo al desarrollo de políticas continúan evidenciando el esfuerzo caribeño para responder a los cruciales retos epidemiológicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Además, la Carta del Caribe para la Promoción de la Salud ha servido como elemento crítico para el desarrollo de la APS.(AU)

Health sector challlenges and responses beyond the Alma-Ata declaration: a Caribbean perspective

Primary health care (PHC) is defined as "essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination." For the effective delivery of PHC to occur, it must be undergirded by a national health system infrastructure that has five key components: (1) development of health resources, such as manpower, facilities, equipment and supplies; (2) organized arrangement of health resources through the establishment of national health authorities, the provision of national health insurance, and the integration of public and private health services; (3) delivery of health care through the media of primary, secondary and tertiary health services; (4) economic support through sources, such as public financing and foreign aid; and (5) management through strong leadership, policy formulation, regulation and monitoring and evaluation (AU)

Hyperlipidaemia screening among patients with both diabetes mellitus and hypertension-experience at a public health centre

OBJECTIVE: To assess the frequency of screening for hyperlipidaemia among patients with both diabetes mellitus and hypertension who attended a public health centre in Jamaica between June 1997 and December 2000. METHODS: This study was conducted among all patients with both diabetes mellitus and hypertension who attended the Hermitage August Town Health centre between June 1997 and December 2000. Subjects were identified from the clinic daily register using the International Classification of Disease (ICD-9) codes for hypertension (ICD-401) and diabetes mellitus (ICD-250). Patients' dockets were reviewed to identify those who had any test for hyperlipidaemia during this period. Results of these tests were noted. Abnormal blood lipid results (in mmol/l) were assessed as: total cholestorol> 6.50; low density lipoprotein> 3.60; triglycerides> 2.37; high density lipoprotein< 1.17. RESULTS: For the period of the study, 127 persons with both diabetes mellitus and hypertension were seen at the clinic (78 percent females and 22 percent males) ranging in age from 37 to 91 years with a median age of 61 years. Only 17 (13.4 percent) patients had a screening test for cholesterol over the study period. Six patients were screened only for cholesterol and 11 screened for both cholesterol and triglycerides. Screening frequency was slightly among persons older than 60 years compared to those less than 60 years (14.2 percent vs 12 percemnt; p> 0.05). Men were more likely to be screened than women (17 percent vs 12 percent; p> 0.05). Of the 17 patients screened, 46 percent had hypercholesterolaemia (total cholesterol> 6.5 mmol/l). CONCLUSIONS: Screening frequency for abnormal lipid profiles was extremely low in this sample of patients. The results of this study, though not generizable to all health centres, highlight what may be a major public health deficit in the control of atherosclerotic-related chronic non-communicable disease in Jamaica. (AU)

Perception of susceptibility to prostate cancer and screening behaviour - insights from a case-control study [abstract]

OBJECTIVE: The aim of this study was to assess the perception of Jamaican men regarding their susceptibility to prostate cancer and to determine how this perception is associated with their decision to attend for screening of this condition. METHODS: A case-control study was conducted among 200 men between the ages of 40 and 75 years attending three health-related clinics in Kingston, Jamaica. A case was defined as any male who had a digital rectal examination or prostate specific antigen (PSA) within the last two years as a check for prostate cancer. Controls were men who did not have any of these screening tests. Factors affecting decision to attend for screening for prostate cancer were assessed through a structured interview. Specifically, participants were asked whether they perceived themselves at risk for prostate cancer. In-depth discussions were done to obtain additional insights about screening. RESULTS: The majority of screeners (70 percent) perceived themselves as being at risk of getting prostate cancer compared to 45 percent of non-screeners. Men who perceived themselves as being at risk were more likely to attend for screening than were men who did not perceive or were unsure about their risk Odds Ratio (OR) (2.85, 95 percent) Confidence Interval (CI) (1.59,3.02). There was no significant association between age and perception of risk (p> 0.05). Men felt that screening for prostate cancer was not given the level of promotion which cancers of women was given. Men who were screened were also likely to have had screening recommended by a physician (un-adjusted OR 44, 95 percent CI 17.9,108. CONCLUSIONS: Consistent with a construct of the health belief model of behaviour change, perception of susceptibility to prostate cancer appears to influence screening behaviour among men in this study. Well-designed cancer screening promotion with due consideration to screening barriers, and physician's advice are likely cues to getting screened. (AU)

Doctors in the Jamaican Yellow Pages [abstract]

OBJECTIVE: To determine the characteristics of listings under the "Physicians and Surgeons" section of the Jamaican telephone directory Yellow Pages. METHODS: A review of the Greater Kingston Telephone Directories published by Cable and Wireless Jamaica Ltd for the period 1994/95 to 1999/00 was made. The section captioned "Physicians and Surgeons" in the National Yellow Pages of each of the five directories was used to obtain the following: a count of all listings and the font type (case, colour and emphasis) of each listing. Where listings were advertisements, than a structured content analysis was done to guage informativeness. RESULTS: For the five-year period of review, the mean number of listings was 244 (Standard Deviation (SD) = 24). There was a steady increase in the number of listings between 1994/95 (n = 219) and 1999/00 (n = 278). The proportion of listings that were in bold uppercase black font was fairly consistent throughout the period (mean of 32 percent). However, listings in bold uppercase red font showed an increase from 0.5 percent in 1994/95 to 2.5 percent in 1996/97, thereafter remaining close to this level. Listings qualifying as advertisements increased from 1.36 percent at the start of the period to 2.5 percent at the end. Consistent with this increase was an increase in total space occupied by advertisements and the diversity of colours and informational content. The majority of advertisements were by medical centres, of which dermatology services were the most frequent and consistent. The most informative advertisement over the period was by and individual physician. CONCLUSIONS: There has been an increase in listings in the "Physicians and Surgeons" section of the Jamaican National Yellow Pages over the five-year period of the study with an apparent trend towards more visible and sophisticated promotion services. (AU)

Psychological autopsy as a method of investigating suicide in Jamaica [Abstract]

OBJECTIVE: To assess the usefulness of the psychological autopsy in the Jamaican setting for investigating the characteristics of suicides in respect of psychiatric diagnoses and stressful life events. METHODS: The study was conducted in the parishes of Kingston, St.Andrew and St.Catherine, Jamaica. All suicide cases occuring between January 1 and December 31, 1998, were identified on the basis of police records. After obtaining informed consent the autopsy process initiated by interviewing key informants identified by relatives. Semi-structured interviews to assess mental state and stressful life events were conducted by a psychiatrist and supplemented by a review of case notes. A structured questionnaire was used to assess sociodemographic characteristics. An assessment of mental status prior to death was done and DSM IV criteria used to classify psychiatric disorders. Thiry-two suicides were studied using the psychological autopsy method. There was overwhelming willingness among key informants to be interviewed. RESULTS: The approach was fairly time consuming; interviews ranged from forty-five minutes to four hours (mean of 2 hours) having to be extended at times to allow for expression of emotions by informants. The method allowed for fairly easy retrospective formulation of psychiatric diagnosis (90 percent of victims) and for the elucidation of comorbidity. Substancial levels of stressful life events were also exposed. Many relatives expressed relief at being able to discuss these deaths with a neutral person. CONCLUSIONS: The psychological autopsy approach has provided valuable insights into the epidemiological and psychosocial context of suicide occurrence in these three Jamaican parishes. It has potential for ongoing surveillance and in the planning of prevention programmes. Its use among community mental health professionals should be evaluated. (AU)

Health promotions: issues and answers

In recent years, increased attention has been given to the development of health promotion programmes in a number of countries worldwide. Although health promotion itself is not new, a number of issues have been emerged as the underlying concepts are articulated and put into practice. These relate to its relevance and ownership and to practical issues such as measurement of outcomes. This article provides a brief discussion on some of these issues and makes reference to Caribbean framework for implementing health promotion (AU)

Curriculum development in Community Health: drift or shift?

The curriculum in community health is best described as eclectic and dynamic. Its relevance is maintained by its response to the macro-environment; this response, whether innovative or otherwise, may be incremental on the one hand or feature wholesale change consequent on radical rethinking on the other. This paper reviews the content of the emerging curriculum in community health and the University of the West Indies, Jamaica, and attempts to discern the process of change and the factors which have informed these developements.(AU)