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1.
Cancer Causes Control ; 31(7): 651-662, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32358695

RESUMO

PURPOSE: General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. METHODS: Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. RESULTS: A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years. CONCLUSION: Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.


Assuntos
Adiposidade/etnologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/mortalidade , Adulto , Idoso , Antagonistas de Androgênios/administração & dosagem , Índice de Massa Corporal , Estudos de Casos e Controles , Seguimentos , Humanos , Jamaica/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Modelos de Riscos Proporcionais , Neoplasias da Próstata/tratamento farmacológico , Circunferência da Cintura , Relação Cintura-Quadril/estatística & dados numéricos
2.
Nat Commun ; 10(1): 5791, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31857576

RESUMO

Edematous severe acute childhood malnutrition (edematous SAM or ESAM), which includes kwashiorkor, presents with more overt multi-organ dysfunction than non-edematous SAM (NESAM). Reduced concentrations and methyl-flux of methionine in 1-carbon metabolism have been reported in acute, but not recovered, ESAM, suggesting downstream DNA methylation changes could be relevant to differences in SAM pathogenesis. Here, we assess genome-wide DNA methylation in buccal cells of 309 SAM children using the 450 K microarray. Relative to NESAM, ESAM is characterized by multiple significantly hypomethylated loci, which is not observed among SAM-recovered adults. Gene expression and methylation show both positive and negative correlation, suggesting a complex transcriptional response to SAM. Hypomethylated loci link to disorders of nutrition and metabolism, including fatty liver and diabetes, and appear to be influenced by genetic variation. Our epigenetic findings provide a potential molecular link to reported aberrant 1-carbon metabolism in ESAM and support consideration of methyl-group supplementation in ESAM.


Assuntos
Metilação de DNA , Epigenoma/genética , Desnutrição Aguda Grave/genética , Adolescente , Adulto , Estudos de Casos e Controles , Pré-Escolar , Ilhas de CpG/genética , Epigenômica/métodos , Feminino , Perfilação da Expressão Gênica , Humanos , Lactente , Jamaica/epidemiologia , Malaui/epidemiologia , Masculino , Mucosa Bucal , Estudos Prospectivos , Estudos Retrospectivos , Desnutrição Aguda Grave/mortalidade , Sobreviventes , Adulto Jovem
3.
PLoS One ; 14(11): e0224516, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31756190

RESUMO

The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12-65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.


Assuntos
Crime/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Meio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Criança , Modificador do Efeito Epidemiológico , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
4.
Int J Inj Contr Saf Promot ; 26(4): 399-404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31429368

RESUMO

Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Traumatismos Craniocerebrais/epidemiologia , Estudos Transversais , Educação/estatística & dados numéricos , Feminino , Humanos , Seguro/estatística & dados numéricos , Jamaica/epidemiologia , Licenciamento/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Motocicletas/legislação & jurisprudência , Sistema Musculoesquelético/lesões , Adulto Jovem
5.
PLoS One ; 14(7): e0219250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291297

RESUMO

The study examines the potential influence of sub-regional variations in climate, and specifically heavy rain events, in determining relative vulnerabilities of locations in twelve Caribbean countries. An aggregate vulnerability index, referred to as the Caribbean Vulnerability Score (CVS), is created using historical demographic and socioeconomic data and climate data representing extreme rain events. Four scenarios are explored. Firstly, comparative vulnerabilities are determined when heavy rainfall is incorporated in CVS versus when it is excluded. The impact of climate change is also investigated using future climate data derived from statistical downscaling but holding demographic and socioeconomic sub-indices constant. The analysis is repeated with projections of future demographic structure from the Shared Socioeconomic Pathway data (SSP3), future climate projections and constant socioeconomic. Finally, the sensitivity of the results is examined with respect to applying different weights i.e. versus using equal weights for the climate and non-climatic components of CVS as is done for the first three scenarios. Results suggest that the inclusion of historical susceptibility to rainfall extremes influences relative vulnerabilities within the Caribbean when compared to the rankings of vulnerability derived using only socioeconomic and demographic inputs. In some cases significant increases in relative rankings are noted. Projected changes in the intensity of rain events across the Caribbean region in the 2030s and 2050s, do not significantly alter the top and lowest ranked vulnerable locations when demographic and socioeconomic indices are held constant. Changes may however occur in the order of the top ranked locations dependent on scenario and time slice. In general, future shifts in relative vulnerabilities were found to be dependent on (i) changes in both future climate and demographic scenarios, (ii) the time horizons being considered, and (iii) the weighting assigned to climate in the future.


Assuntos
Mudança Climática , Demografia , Fatores Socioeconômicos , Belize/epidemiologia , Região do Caribe/epidemiologia , Cuba/epidemiologia , República Dominicana/epidemiologia , Guiana/epidemiologia , Humanos , Umidade , Jamaica/epidemiologia , Chuva
6.
PLoS One ; 14(7): e0215262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339887

RESUMO

Oral and fecal microbial biomarkers have previously been associated with cardiometabolic (CM) risk, however, no comprehensive attempt has been made to explore this association in minority populations or across different geographic regions. We characterized gut- and oral-associated microbiota and CM risk in 655 participants of African-origin, aged 25-45, from Ghana, South Africa, Jamaica, and the United States (US). CM risk was classified using the CM risk cut-points for elevated waist circumference, elevated blood pressure and elevated fasted blood glucose, low high-density lipoprotein (HDL), and elevated triglycerides. Gut-associated bacterial alpha diversity negatively correlated with elevated blood pressure and elevated fasted blood glucose. Similarly, gut bacterial beta diversity was also significantly differentiated by waist circumference, blood pressure, triglyceridemia and HDL-cholesterolemia. Notably, differences in inter- and intra-personal gut microbial diversity were geographic-region specific. Participants meeting the cut-points for 3 out of the 5 CM risk factors were significantly more enriched with Lachnospiraceae, and were significantly depleted of Clostridiaceae, Peptostreptococcaceae, and Prevotella. The predicted relative proportions of the genes involved in the pathways for lipopolysaccharides (LPS) and butyrate synthesis were also significantly differentiated by the CM risk phenotype, whereby genes involved in the butyrate synthesis via lysine, glutarate and 4-aminobutyrate/succinate pathways and LPS synthesis pathway were enriched in participants with greater CM risk. Furthermore, inter-individual oral microbiota diversity was also significantly associated with the CM risk factors, and oral-associated Streptococcus, Prevotella, and Veillonella were enriched in participants with 3 out of the 5 CM risk factors. We demonstrate that in a diverse cohort of African-origin adults, CM risk is significantly associated with reduced microbial diversity, and the enrichment of specific bacterial taxa and predicted functional traits in both gut and oral environments. As well as providing new insights into the associations between the gut and oral microbiota and CM risk, this study also highlights the potential for novel therapeutic discoveries which target the oral and gut microbiota in CM risk.


Assuntos
Doenças Cardiovasculares/microbiologia , Microbioma Gastrointestinal , Doenças Metabólicas/microbiologia , Boca/microbiologia , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Gana/epidemiologia , Humanos , Jamaica/epidemiologia , Masculino , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , África do Sul/epidemiologia , Estados Unidos/epidemiologia , Circunferência da Cintura
7.
Biom J ; 61(4): 934-954, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31058353

RESUMO

A weighted quantile sum (WQS) regression has been used to assess the associations between environmental exposures and health outcomes. However, the currently available WQS approach, which is based on additive effects, does not allow exploring for potential interactions of exposures with other covariates in relation to a health outcome. In addition, the current WQS cannot account for clustering, thus it may not be valid for analysis of clustered data. We propose a generalized WQS approach that can assess interactions by estimating stratum-specific weights of exposures in a mixture, while accounting for potential clustering effect of matched pairs of cases and controls as well as censored exposure data due to being below the limits of detection. The performance of the proposed method in identifying interactions is evaluated through simulations based on various scenarios of correlation structures among the exposures and with an outcome. We also assess how well the proposed method performs in the presence of the varying levels of censoring in exposures. Our findings from the simulation study show that the proposed method outperforms the traditional WQS, as indicated by higher power of detecting interactions. We also find no strong evidence that the proposed method falsely identifies interactions when there are no true interactive effects. We demonstrate application of the proposed method to real data from the Epidemiological Research on Autism Spectrum Disorder (ASD) in Jamaica (ERAJ) by examining interactions between exposure to manganese and glutathione S-transferase family gene, GSTP1 in relation to ASD.


Assuntos
Biometria/métodos , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Glutationa S-Transferase pi/genética , Humanos , Jamaica/epidemiologia , Manganês/farmacologia , Modelos Estatísticos , Análise de Regressão
9.
Int J STD AIDS ; 30(6): 536-541, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31074362

RESUMO

A cross-sectional survey of 295 persons attending a major sexually transmitted infection clinic in Jamaica's capital city showed that the Ministry of Health's syndromic algorithm has moderate sensitivity and negative predictive value for diagnosing cervicitis. In the absence of diagnostic tests for sexually transmitted infections, a syndromic algorithm continues to be useful for diagnosing sexually transmitted infections.


Assuntos
Doenças Sexualmente Transmissíveis/microbiologia , Cervicite Uterina/diagnóstico , Cervicite Uterina/microbiologia , Adulto , Algoritmos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis , Estudos Transversais , Feminino , Gonorreia/diagnóstico , Gonorreia/microbiologia , Humanos , Jamaica/epidemiologia , Masculino , Neisseria gonorrhoeae , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Síndrome , Cervicite Uterina/epidemiologia
10.
Hum Antibodies ; 27(3): 155-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30909200

RESUMO

BACKGROUND: Pneumococcal infections are a leading global cause of morbidity and mortality, complicated by the increasing antimicrobial resistance of pneumococcal isolates. OBJECTIVE: To evaluate morbidity and mortality associated with both invasive pneumococcal disease (IPD) and non-IPD in Jamaica in both the paediatric and adult population. Pneumococcal isolates (n= 94) were collected over a 2-year period (2008-2009). METHODS: Risk factors for poor clinical outcomes: death, complicated disease and length of hospitalization (LOH) were evaluated and antimicrobial resistance patterns were determined by Kirby-Bauer disc diffusion. RESULTS: The case fatality rate was 6.8%. Independent mortality risk factors included complicated disease [OR 30.9 (3.4-276.6)] and diabetes mellitus [OR 8.3 (1.4-48.8)]. Independent risk factors for the development of complicated disease included sickle cell disease [OR 36.5 (4.2-320.3)] and sepsis [OR 3.5 (1.2-10.4)]. The LOH was increased most in patients with invasive disease (4.6-fold) and resistance to ceftriaxone (4.3-fold). Penicillin (16.0%) and erythromycin (14.9%) resistance was most prevalent, while ceftriaxone (4.3%) resistance was least prevalent. CONCLUSIONS: The high burden of IPD in at-risk groups in our population and the associated increase in morbidity and mortality underlie the need for improved preventive and therapeutic management strategies in these patients.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Humanos , Lactente , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade , Infecções Pneumocócicas/tratamento farmacológico , Fatores de Risco , Streptococcus pneumoniae/efeitos dos fármacos , Adulto Jovem
11.
Pathog Glob Health ; 113(1): 27-31, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30714498

RESUMO

Although traditionally chikungunya virus is considered non-fatal, recent studies suggest that there may be in fact underreporting of deaths in some situations. A major chikungunya epidemic hit Jamaica in 2014 but no chikungunya-associated deaths were reported. We assessed the excess of all-cause deaths during this epidemic. Excess deaths were estimated by difference between observed and expected mortality based on the average age-specific mortality rate of 2012-2013, using the 99% confidence interval. There was an excess of 2,499 deaths during the epidemic (91.9/100,000 population), and a strong positive correlation between the monthly incidence of chikungunya and the excess of deaths (Rho = 0.939, p < 0.005). No significant concomitant epidemiological or climatic phenomenon occurred. Chikungunya is a major contributor to morbidity during epidemics and may be an unrecognized cause of death. Thus, it is urgent to review clinical protocols and improve the investigations of specific-cause deaths during chikungunya epidemics. Excess deaths could be a strategic tool for epidemiological surveillance.


Assuntos
Febre de Chikungunya/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Causas de Morte , Criança , Pré-Escolar , Epidemias , Feminino , Humanos , Lactente , Recém-Nascido , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Adulto Jovem
12.
AIDS Behav ; 23(6): 1530-1540, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30600454

RESUMO

Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Fatores de Proteção , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Sindemia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Resiliência Psicológica , Apoio Social , Adulto Jovem
13.
J Investig Clin Dent ; 10(1): e12365, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30338674

RESUMO

AIM: Human papillomavirus (HPV) has been reported to be associated with oral and oropharyngeal cancer. However, little information is available about the epidemiology of oral HPV infection in Jamaica. The purpose of the present study was to assess the prevalence of oral HPV strains using the oral rinse method in HIV and non-HIV Jamaican patients, as well as to determine the association of HPV with sexual practices, smoking, and alcohol use. METHODS: A cross-sectional study was conducted on patients attending The University of the West Indies Mona Dental Polyclinic and the Centre for HIV/AIDS Research and Education Services. Salivary samples were tested through molecular analysis for 37 HPV genotypes using the linear array HPV genotyping test. A survey questionnaire was used to obtain demographic details, smoking history, alcohol practice, sexual practice, and history of HPV testing. RESULTS: The HPV prevalence was 8.65% in 18-64 y olds (N = 104), with a slight female predilection (55%). No high-risk HPV types were found. HPV-84 was the most common type in both HIV and non-HIV patients; 66.7% of HPV-positive participants reported that they had six or more lifetime sexual partners. CONCLUSION: The prevalence of oral HPV was similar to that in other countries. No statistically-significant relationship was observed between the prevalence of HPV and either the number of sexual partners, smoking, or alcohol history. A nationwide study on oral HPV detection might be helpful in developing a HPV vaccination policy in Jamaica.


Assuntos
Genótipo , Infecções por HIV/complicações , Epidemiologia Molecular , Antissépticos Bucais , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Adolescente , Adulto , Estudos Transversais , DNA Viral/análise , Feminino , Técnicas de Genotipagem , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/epidemiologia , Doenças da Boca/virologia , Neoplasias Orofaríngeas , Prevalência , Fatores de Risco , Comportamento Sexual , Fumar , Inquéritos e Questionários , Adulto Jovem
14.
Int Psychogeriatr ; 31(8): 1217-1224, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30421697

RESUMO

OBJECTIVES: We sought to explore factors associated with depressive symptom severity among older persons (≥60 years of age) and to compare the depressive symptoms commonly experienced by older elderly (≥75 years) with those commonly experienced by younger elderly (<75 years). DESIGN: Secondary analysis was conducted on data from a nationally representative survey. SETTING: Four parishes in Jamaica. PARTICIPANTS: A total of 2,943 older community dwellers participated. MEASUREMENTS: The survey included the Zung Self-rating Depression Scale (ZSDS), the Mini Mental State Examination (MMSE), and items on age, sex, and educational level. Linear regression analysis was used to determine the association between ZSDS score and: age, sex, MMSE score, and educational level. Logistic regression analysis was used to determine, for each ZSDS item, whether particular responses were more associated with older or younger elderly. RESULTS: Higher ZSDS scores were associated with increasing age (B = 0.13, p < 0.001), lower MMSE score (B = -0.42, p < 0.001), the female sex (B = 3.52, p < 0.001), and lower educational level (B = -1.27, p < 0.001). The ZSDS items that were endorsed significantly more (p < 0.05) by older elderly related to negative evaluations about their functionality and value. Hopelessness was also more prominent among the older elderly. The items that were endorsed significantly more (p < 0.05) by the younger elderly had less of a focus. CONCLUSION: Among older persons, increasing age was associated with marginally higher levels of depressive symptoms. Female gender, cognitive deficits, preoccupations about value and functionality, and feelings of hopelessness may serve as useful screening parameters.


Assuntos
Envelhecimento/psicologia , Depressão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Jamaica/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Classe Social , Inquéritos e Questionários
15.
Pharm. pract. (Granada, Internet) ; 16(4): 0-0, oct.-dic. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-180979

RESUMO

Background: Pharmacist managed warfarin clinics can improve the anticoagulation status of non-valvular patients. The first of such services was implemented at the Cornwall Regional Hospital in Jamaica in 2013. Objectives: To assess the anticoagulation control of patients on warfarin therapy over six months in the pharmacist managed warfarin clinic at Cornwall Regional Hospital. Methods: Retrospective docket review for the period January 2014 to December 2016 was done to include data of patients attending routine clinic appointments for at least six months. Age, gender, date of visit, indication for warfarin therapy, warfarin dose and International Normalized Ratio readings were extracted. Percentage time spent in therapeutic range (TTR) was calculated by month for six months using the Rosendaal linear interpolation method. Patient anticoagulation status was categorized as poor (TTR<40%), moderate (TTR=40-64%) or good (TTR≥65%) and anticoagulation status at three months and six months was compared. Results: For the period of assessment, 52 patients were identified; the median age was 58 years and 36 patients were males. Deep vein thrombosis was the main indication for therapy (22 of 52) and median warfarin weekly dose ranged was 15.0-130 mg. At time of recruitment most of the patients were outside the target INR range (43 of 52). Within one month, the median TTR attained was 31% [IQR 62-10]. This significantly improved by second month to 60% [IQR 82-23] (p=0.001). By month three, the proportion of patients in good, moderate and poor anticoagulant status was 19/51, 15/51 and 17/51 respectively, which at six months changed to 23/51, 12/51. 16/51 respectively; thus, although coagulation status improved from month one to three, there was no significant improvement from month three to month six (p=0.31). Conclusions: The pharmacist managed warfarin clinic monitoring services were successful in attaining TTRs >40% and sustaining these values over six months. The services should therefore be encouraged


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Idoso , Idoso de 80 Anos ou mais , Varfarina/uso terapêutico , Conduta do Tratamento Medicamentoso/organização & administração , Anticoagulantes/uso terapêutico , Serviço de Farmácia Hospitalar/organização & administração , Jamaica/epidemiologia , Avaliação de Eficácia-Efetividade de Intervenções , Estudos Retrospectivos
16.
PLoS One ; 13(11): e0206962, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30475802

RESUMO

INTRODUCTION: HIV prevention strategies often include outreach to female sex workers at social venues identified as places where people meet new sexual partners. Patrons and staff at these venues may include female sex workers, their clients, as well as others who have high rates of new sexual partnerships. Few studies have compared HIV/STI among venue-based and general populations, across types of venues, or by sub-group of the venue population. Program planners often assume that the prevalence of infection is highest among female sex workers and considerably lower among other people at these venues, but there are few empiric studies assessing the prevalence of infection by sex worker status and type of venue. METHODS: In 2011, we used the PLACE method to identify public venues where people meet new sexual partners across Jamaica. The study team visited all venues with reported sex work as well as a 10% random sample of other venues and subsequently interviewed and tested a probability sample of 991 venue patrons and workers for HIV and other STI. RESULTS: Community informants identified 1207 venues. All venues where sex work was reported (735 venues) and a random sample of the remainder (134 of 472) were selected for onsite visits. Of these, 585 were found and operational. At a stratified random sample of venues, survey teams interviewed and tested 717 women and 274 men. 394 women reported recent sex work and 211 of these women reported soliciting clients on the street. Women exchanging sex for money were more likely to be infected with HIV (5.4% vs 1.0%; OR = 5.6, 95% CI = 1.8,17.3) or syphilis (11.7% vs. 5.8%, OR = 2.2, 95% CI = 1.7,4,0) than other women, but not significantly more likely to be infected with gonorrhea (8.4% vs 7.8%; OR = 1.1,95% CI = 0.6,1.9), chlamydia (16.2% vs 21.6%;OR = 0.7,95% CI = 0.5,1.0) or trichomoniasis (23.0% vs 17.0%, OR = 1.5,95% CI = 0.9,2.2). Women at venues were more likely to report sex work and multiple partners than women interviewed in a 2008 national population-based household survey commissioned by the Ministry of Health. CONCLUSIONS: In Jamaica, although the highest HIV prevalence was among street-based sex workers, the risk of HIV and STI extends to men and women at high risk venues, even those who do not self-identify as sex workers. Findings confirm the appropriateness of outreach to all men and women at these venues.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Adolescente , Adulto , Comorbidade , Feminino , Infecções por HIV/virologia , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Vigilância da População , Profissionais do Sexo , Adulto Jovem
18.
BMJ ; 362: k3478, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209050

RESUMO

OBJECTIVE: To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35. DESIGN: Randomised, phase III, double blinded international, multicentre clinical trial. SETTING: 70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK). PARTICIPANTS: 2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses. INTERVENTION: Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16 of gestation until delivery. Clinicians, participants, adjudicators, and study staff were masked to study treatment allocation. MAIN OUTCOME MEASURE: The primary outcome was pre-eclampsia, defined as hypertension presenting after 20 weeks' gestation with major proteinuria or HELLP syndrome (haemolysis, elevated liver enzymes, low platelets). RESULTS: Pre-eclampsia occurred in 169/1144 (14.8%) women in the folic acid group and 156/1157 (13.5%) in the placebo group (relative risk 1.10, 95% confidence interval 0.90 to 1.34; P=0.37). There was no evidence of differences between the groups for any other adverse maternal or neonatal outcomes. CONCLUSION: Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-eclampsia in women at high risk for this condition. TRIAL REGISTRATION: Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159.


Assuntos
Suplementos Nutricionais/efeitos adversos , Ácido Fólico/administração & dosagem , Hipertensão/prevenção & controle , Pré-Eclâmpsia/prevenção & controle , Adulto , Argentina/epidemiologia , Austrália/epidemiologia , Canadá/epidemiologia , Diabetes Gestacional/prevenção & controle , Método Duplo-Cego , Feminino , Ácido Fólico/provisão & distribução , Síndrome HELLP/etiologia , Humanos , Jamaica/epidemiologia , Gravidez , Proteinúria/etiologia , Fatores de Risco , Reino Unido/epidemiologia , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/provisão & distribução , Adulto Jovem
19.
Soc Psychiatry Psychiatr Epidemiol ; 53(10): 1063-1070, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30062481

RESUMO

BACKGROUND: Approximately 10% of fathers in the Cultural West (i.e., US, Europe, and Australia) experience depression. We broaden the cultural scope of paternal depression research by investigating the prevalence and predictors of depressive symptoms among Jamaican fathers. METHODS: The present research draws upon structured interviews with 3425 fathers of newborn children participating in a Jamaican birth cohort study-JA Kids-and represents one of the largest sample sizes of any study on postnatal depression among fathers worldwide. This sample of fathers participated from July to September 2011, and represents approximately 30% of all men who became fathers during that time in Jamaica. Fathers answered questions about sociodemographic background, relationship status and quality, social support, health, expectations and views of a partner's pregnancy, and the ten-item Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Analyses reveal that 9.1% (95% CI 8.1-10.1) of these Jamaican fathers of newborns had EPDS scores of 10 or higher, indicative of possible depression. Results suggest that educational attainment was not related to EPDS scores, though higher indices of material wealth (e.g., refrigerator and vehicle) were weakly, negatively related to EDS scores. Paternal age was also weakly negatively predictive of EDS scores. Whereas relationship status was unrelated to depressive symptoms, relationship quality negatively predicted depressive symptoms. Several other measures of social support (lacking a close circle of friends, fewer family, or friends to help in times of trouble) were also associated with higher EPDS scores. CONCLUSIONS: We interpret these findings in light of existing work on paternal depression, including the importance of social context and support.


Assuntos
Depressão/epidemiologia , Pai/psicologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Depressão/etiologia , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Idade Paterna , Período Pós-Parto , Gravidez , Prevalência , Escalas de Graduação Psiquiátrica , Apoio Social , Fatores Socioeconômicos , Adulto Jovem
20.
P R Health Sci J ; 37(2): 115-123, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29905923

RESUMO

OBJECTIVE: To estimate the prevalence, severity, and associated risk factors of gingival inflammation in a group of adults from Kingston, Jamaica; Santo Domingo, Dominican Republic; and San Juan, Puerto Rico. METHODS: In this representative cross-sectional study, participants completed medical and oral health questionnaires and received an oral clinical examination by trained and calibrated examiners. Clinical assessments included: gingival health (modified Löe-Silness index), visible plaque and presence of calculus. Findings were summarized as mean overall and interproximal gingival indices (GI; IGI), gingival bleeding index (GBI), gingival inflammation prevalence (GI>=0.5) and severity (mild, moderate, severe), mean and interproximal visible plaque indices (VPI; IVPI), and calculus index. Multivariate logistic regression was used to evaluate the associations between risk factors and gingival bleeding on probing (BOP) at >= 40% sites;. odds ratios were estimated. RESULTS: All 1,847 participants presented gingival inflammation; most (81.9%) had moderate inflammation. Mean GI, VPI, IVPI, and calculus indices were 1.49, 0.94, 0.96, and 0.66, respectively; most participants presented a VPI >= 30%. BOP >= 40% of sites was significantly associated with education (ORmiddle/technical vs. university education=1.61; p =0.001 and ORnone/basic vs. university= 2.86; p<0.001), calculus index (OR: 10.35), VPI >= 30% (OR: 7.85; p<0.001 for both), and being a resident of Kingston or Santo Domingo (vs. San Juan, OR: 4. 74 and OR: 7.09, respectively), after adjusting for age, gender, smoking, dental visit frequency, diabetes, and hypertension. CONCLUSION: Gingival inflammation was highly prevalent. Most participants presented moderate gingival inflammation. Educational attainment, dental calculus, and VPI >= 30% were strongly associated with gingival inflammation.


Assuntos
Cálculos Dentários/epidemiologia , Placa Dentária/epidemiologia , Gengivite/epidemiologia , Saúde Bucal , Adolescente , Adulto , Estudos Transversais , Índice de Placa Dentária , República Dominicana/epidemiologia , Escolaridade , Feminino , Gengivite/patologia , Humanos , Jamaica/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Índice Periodontal , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
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