Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica.

OBJECTIVE: To determine whether there was a difference in wealth and cardiovascular disease (CVD) risk between microcredit loan beneficiaries and community-matched non-beneficiaries (controls). METHODS: Seven hundred and twenty-six households of microcredit loan beneficiaries were matched with 726 controls by age, sex and community. A standardised interviewer administered questionnaire was used to collect data on health and household expenditure. Weights, heights, waist circumference and blood pressure measurements were taken for an adult and one child (6-16 years) from each household. RESULTS: Amongst adults, there was no difference in the prevalence of pre-hypertension and hypertension. More male (68.1% vs. 47.8%) and female beneficiaries (84.5% vs. 77.9%) were overweight/obese. More male (17.2% vs. 7.1%; P < 0.05) and female beneficiaries (68.5% vs. 63.3%; P < 0.05) exhibited substantially increased risk for CVD. Children of beneficiaries displayed higher mean BMI-for-age z-scores than their control peers: males 0.56 [95% CI 0.40-0.72] vs. 0.18 [95% CI 0.02-0.35] (P < 0.001) and females 0.66 [95% CI 0.52-0.80] vs. 0.42 [95% CI 0.29-0.56] (P < 0.001). Based on BMI-for-age z-scores, children of beneficiaries had greater odds of being overweight/obese (OR = 1.46; 95% CI 1.18-1.82) Beneficiaries were economically better off; their mean total annual expenditure and house ownership were significantly higher than controls (P < 0.001). CONCLUSIONS: Microcredit financing is positively associated with wealth acquisition but worsened cardiovascular risk status.

Catalytic mechanism and kinetics of malate dehydrogenase.

Malate dehydrogenase (MDH) is a ubiquitous and central enzyme in cellular metabolism, found in all kingdoms of life, where it plays vital roles in the cytoplasm and various organelles. It catalyzes the reversible NAD+-dependent reduction of L-malate to oxaloacetate. This review describes the reaction mechanism for MDH and the effects of mutations in and around the active site on catalytic activity and substrate specificity, with a particular focus on the loop that encloses the active site after the substrates have bound. While MDH exhibits selectivity for its preferred substrates, mutations can alter the specificity of MDH for each cosubstrate. The kinetic characteristics and similarities of a variety of MDH isozymes are summarized, and they illustrate that the KM values are consistent with the relative concentrations of the substrates in cells. As a result of its existence in different cellular environments, MDH properties vary, making it an attractive model enzyme for studying enzyme activity and structure under different conditions.

Household food insecurity and childhood overweight in Jamaica and Québec: a gender-based analysis.

BACKGROUND: Childhood overweight is not restricted to developed countries: a number of lower- and middle-income countries are struggling with the double burden of underweight and overweight. Another public health problem that concerns both developing and, to a lesser extent, developed countries is food insecurity. This study presents a comparative gender-based analysis of the association between household food insecurity and overweight among 10-to-11-year-old children living in the Canadian province of Québec and in the country of Jamaica. METHODS: Analyses were performed using data from the 2008 round of the Québec Longitudinal Study of Child Development and the Jamaica Youth Risk and Resiliency Behaviour Survey of 2007. Cross-sectional data were obtained from 1190 10-year old children in Québec and 1674 10-11-year-old children in Jamaica. Body mass index was derived using anthropometric measurements and overweight was defined using Cole's age- and sex-specific criteria. Questionnaires were used to collect data on food insecurity. The associations were examined using chi-square tests and multivariate regression models were used to estimate odds ratios (OR) and 95% confidence intervals. RESULTS: The prevalence of overweight was 26% and 11% (p < 0.001) in the Québec and Jamaican samples, respectively. In Québec, the adjusted odds ratio for being overweight was 3.03 (95% CI: 1.8-5.0) among children living in food-insecure households, in comparison to children living in food-secure households. Furthermore, girls who lived in food-insecure households had odds of 4.99 (95% CI: 2.4-10.5) for being overweight in comparison to girls who lived in food-secure households; no such differences were observed among boys. In Jamaica, children who lived in food-insecure households had significantly lower odds (OR 0.65, 95% CI: 0.4-0.9) for being overweight in comparison to children living in food-secure households. No gender differences were observed in the relationship between food-insecurity and overweight/obesity among Jamaican children. CONCLUSIONS: Public health interventions which aim to stem the epidemic of overweight/obesity should consider gender differences and other family factors associated with overweight/obesity in both developed and developing countries.

Identification and characterization of Schizophyllum commune type I metacaspases.

The role of programmed cell death in filamentous fungi is not well-understood, but is important due to the role of fungi in opportunistic infections. Plants, fungi and protozoa do not have caspase genes, but instead express the homologous proteins denoted metacaspases. To better understand the role of metacaspases in fungi we present an analysis of the sequences and activities of all five Type I metacaspases from Schizophyllum commune (ScMC), a mushroom-forming basiodmycete that undergoes sexual reproduction. The five Type I metacaspases of S. commune can be divided into two groups based on sequence similarity. Enzymes both with and without the N-terminal prodomain are active, but here we report on the constructs without the prodomains (Δpro). All five ScMCΔpro proteins show the highest enzymatic activity between pH 7 and 8 and require calcium for optimal activity. Optimal Ca2+ concentrations for ScMC1Δpro and ScMC2Δpro are 50 mM, while ScMC3, ScMC4Δpro and ScMC5Δpro activity is optimal around 5 mM calcium. All five S. commune metacaspases have similar substrate specificity. They are most active with Arg in the P1 position and inactive with Asp in the P1 position.

Palliative Care Screening: Appraisal of a Tool to Identify Patients' Symptom Management and Advance Care Planning Needs.

BACKGROUND: The palliative care needs of hospitalized patients often go unmet, resulting in unrelieved symptoms and a lack of understanding about advance care planning. OBJECTIVES: This article analyzes the 10-item Palliative Assessment Screening Tool (PAST) to determine if the PAST aids in the identification of hospitalized patients with palliative care needs and facilitates completion of advance directives. METHODS: A systematic review of studies published from 2012-2016, as well as a retrospective chart review, were used to analyze the PAST. For this 12-week pilot study, all adult patients either admitted or transferred to a 24-bed medical-surgical oncology/orthopedic unit were assessed by the bedside nurse for their potential palliative needs. FINDINGS: Using the PAST seems to improve the identification of patients with palliative needs, leading to better management of symptoms. The PAST is also likely useful in facilitating the completion of advance directives, but this requires further study.

The chemical biology of Cu(II) complexes with imidazole or thiazole containing ligands: Synthesis, crystal structures and comparative biological activity.

The synthesis and characterization of two copper(II) complexes containing 2-(2-pyridyl)benzimidazole (PyBIm) are reported with the biological activity of these two complexes and a third Cu(II) complex containing 2-(2-pyridyl)benzothiazole (PyBTh). Complex 1, [Cu(PyBIm)(NO3)(H2O)](NO3), is a four coordinate, distorted square planar species with one ligand (N,N), nitrate and water bound to Cu(II). The [Cu(PyBIm)3](BF4)2 complex (2) has distorted octahedral geometry with a 3:1 Py(BIm) ligand to metal ratio. The distorted trigonal bi-pyramidal geometry of compound 3, [Cu(PyBTh)2(H2O)](BF4)2, is comprised of two PyBTh ligands and one water. Biological activity of 1-3 has been assessed by analyzing DNA interaction, nuclease ability, cytotoxic activity and antibacterial properties. Complex 3 exhibits potent concentration dependent SC-DNA cleavage forming single- and double-nicked DNA in contrast to the weak activity of complexes 1 and 2. Mechanistic studies indicate that all complexes utilize an oxidative mechanism however 1 and 2 employ O2(-) as the principal reactive oxygen species while the highly active 3 utilizes (1)O2. The interaction between 1-3 and DNA was investigated using fluorescence emission spectroscopy and revealed all complexes strongly intercalate DNA with Kapp values of 2.65 × 10(6), 1.85 × 10(6) and 2.72 × 10(6)M(-1), respectively. Cytotoxic effects of 1-3 were examined using HeLa and K562 cells and show cell death in the micromolar range with the activity of 1 ≈ 2 and were slightly higher than 3. Similar reactivity was observed in the antibacterial studies with E. coli and S. aureus. A detailed comparative analysis of the three complexes is presented.

Joint manipulation curricula in physical therapist professional degree programs.

STUDY DESIGN: Descriptive observational survey. OBJECTIVE: To describe the status of joint manipulation curricula within physical therapist professional degree programs in the United States. BACKGROUND: Studies have described the evolution of manual therapy curricula, including spinal and extremity joint mobilization, in physical therapist professional programs, but minimal information exists related to joint manipulation curricula. METHODS AND MEASURES: Primary faculty members responsible for teaching manual therapy curricular content at the 199 physical therapist professional degree programs located in the United States recognized by the Commission on Accreditation in Physical Therapy Education were asked to participate in this project. The survey documented joint manipulation curricula, faculty qualifications, attitudes and experience, and programs' future plans for teaching manipulation. RESULTS: Of the 116 programs responding to our survey, 87 (75%) currently include joint manipulation in their curriculum or plan to soon include such content in their curriculum. Of the programs currently teaching joint manipulation, 75% taught it as part of a required integrated clinical science course. Faculty teaching manipulation content appear to be well qualified and are in clinical practice an average of 12 hours per week. The programs currently not teaching joint manipulation reported reasons, including belief that it was not an entry-level skill (45%), lack of time (26%), lack of qualified faculty (71%), and perceived lack of scientific evidence regarding efficacy (7%). CONCLUSIONS: Of the responding professional degree programs, 75% are either currently teaching joint manipulation or soon plan to do so. Our research may serve as a benchmark for faculty to assess existing manual therapy curricula and as a guide for developing curricula in new or existing physical therapy programs.

The role of the acute care nurse practitioner in the implementation of the commission on cancer's standards on palliative care.

As valuable members of the oncology team, acute care nurse practitioners (ACNPs) are in the perfect position to deliver high-quality palliative care. They are instrumental in coordinating the palliative care needs of their patients. Through proper training, ACNPs are able to assess, plan, implement, and evaluate palliative care interventions. Along with oncology-certified nurses, ACNPs help their patients navigate the complexities of the healthcare system. The skills that the American College of Surgeons Commission on Cancer identified in its standard for palliative care are skills possessed by ACNPs, making them the perfect fit to carry out these standards in healthcare institutions around the United States.

Synthesis, characterization, crystal structures and biological activity of set of Cu(II) benzothiazole complexes: artificial nucleases with cytotoxic activities.

A series of Cu(II) complexes with ligand frames based on quinoline derivatives appended with a benzothiazole substituent has been isolated. The complexes, Cu(Q(oBt))(NO3)2(H2O)∙CH3OH (1∙CH3OH), Cu(8OHQ(oBt))Cl2∙CH3OH (2∙CH3OH), Cu(8OQ(oBt))Cl(CH3OH)∙CH3OH (3∙CH3OH) and [Cu(8OH1/2Q(oBt))(CH3OH)(NO3)]2(NO3) (4) have been characterized by single crystal X-ray diffraction, IR and UV-visible spectroscopies, and elemental analysis. The ligand frame within the set of complexes differs in the substituent on the quinoline ring: complex 1 remains unsubstituted at this position while complexes 2-4 have a substituted OH group. In complex 2, the bound phenol remains protonated while in 3 it is a phenolato group. Complex 4 contains two complexes within the unit cell and one NO3(-) giving rise to an overall 'half-protonation'. The interaction between complexes 1-3 with CT-DNA was investigated using fluorescence emission spectroscopy and revealed 2 and 3 strongly intercalate DNA with Kapp values of 1.47×10(7)M(-1) and 3.09×10(7)M(-1), respectively. The ability of complexes 1-3 to cleave SC-DNA was monitored using gel electrophoresis. Each complex exhibits potent, concentration dependent nuclease activity forming single and double-nicked DNA as low as 10µM. The nuclease activity of complexes 1-3 is primarily dependent on (1)O2 species while ·OH radicals play a secondary role in the cleavage by complexes 2 and 3. The cytotoxic effects of 1-3 were examined using HeLa cells and show cell death in the micromolar range. The distribution of cell cycle stages remains unchanged when complexes are present indicating DNA damage may be occurring throughout the cell cycle.

Foundational concepts and underlying theories for majors in "biochemistry and molecular biology".

Over the past two years, through an NSF RCN UBE grant, the ASBMB has held regional workshops for faculty members and science educators from around the country that focused on identifying: 1) core principles of biochemistry and molecular biology, 2) essential concepts and underlying theories from physics, chemistry, and mathematics, and 3) foundational skills that undergraduate majors in biochemistry and molecular biology must understand to complete their major coursework. Using information gained from these workshops, as well as from the ASBMB accreditation working group and the NSF Vision and Change report, the Core Concepts working group has developed a consensus list of learning outcomes and objectives based on five foundational concepts (evolution, matter and energy transformation, homeostasis, information flow, and macromolecular structure and function) that represent the expected conceptual knowledge base for undergraduate degrees in biochemistry and molecular biology. This consensus will aid biochemistry and molecular biology educators in the development of assessment tools for the new ASBMB recommended curriculum.

Ontogenetic changes in citrate synthase and lactate dehydrogenase activity in the jumping muscle of the American locust (Schistocerca americana).

Intraspecific studies have repeatedly shown that muscle-specific oxidative enzyme activities scale negatively with body mass while muscle-specific glycolytic enzyme activities scale positively. However, most of these studies have not included juveniles. In this study, we examined how citrate synthase (CS, EC 2.3.3.1) and lactate dehydrogenase (LDH; EC 1.1.1.27) activity in the jumping muscle of Schistocerca americana grasshoppers varied with ontogeny across a 40-fold increase in body size. In contrast to the pattern observed when adult conspecifics are compared, we show that jumping muscle CS activity increased more than 2-fold from 2nd instars to adults, while jumping muscle LDH activity increased more than 5-fold. The increased LDH activity in older grasshoppers supports previous data that older grasshoppers have a reduced jumping endurance. The increased CS activity with age may help older grasshoppers efficiently produce aerobic ATP to bend cuticular springs for energy storage before a jump or alternatively recover from anaerobic metabolism after jumping. Metabolic changes in S. americana jumping muscle are similar to other developing taxa and highlight the importance of including juveniles within intraspecific studies. When compared to adults, juvenile locomotion may have increased selection pressure because of both greater energetic demands during growth and higher predation rates.

Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago.

OBJECTIVES: This article reports the prevalence of two types of interpersonal violence (IPV) (sexual and physical) and one type of aggression (psychological) in three low-to-middle-income Caribbean countries. It examines IPV among adolescents and young adults as both victims and perpetrators. METHOD: This population-based study compares the experiences of 15-30 year olds in countries at different levels of socioeconomic development. The Revised Conflict Tactics Scales (CTS2) and other behavioral instruments were used to assess the level and characteristics of IPV. RESULTS: Out of 3 401 respondents, 70.9% reported victimization by some form of violence, which was most commonly perpetrated by a relationship partner (62.8%). Sexual violence victimization was reported more commonly by women, and was highest in Jamaica. Significant between-country differences in overall levels of reported physical violence, and psychological aggression, were evident when stratifying by perpetrator type. CONCLUSIONS: The very high levels of reported IPV indicate very high levels of tolerance among victims, and suggest a culture of violence and of adversarial intimate relationships may be well entrenched. The findings support the view that co-occurrence of general interpersonal violence and partner violence may be limited, and that one may not necessarily be a predictor of the other. They also reveal that, among partners, not only are there no gender differentials in victimization by physical violence, but more women than men are self-reporting as perpetrators of this type of IPV.

Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago / Violencia interpersonal en tres países del Caribe: Barbados, Jamaica y Trinidad y Tobago

OBJECTIVES: This article reports the prevalence of two types of interpersonal violence (IPV) (sexual and physical) and one type of aggression (psychological) in three low-to-middle-income Caribbean countries. It examines IPV among adolescents and young adults as both victims and perpetrators. METHODS: This population-based study compares the experiences of 15-30 year olds in countries at different levels of socioeconomic development. The Revised Conflict Tactics Scales (CTS2) and other behavioral instruments were used to assess the level and characteristics of IPV. RESULTS: Out of 3 401 respondents, 70.9% reported victimization by some form of violence, which was most commonly perpetrated by a relationship partner (62.8%). Sexual violence victimization was reported more commonly by women, and was highest in Jamaica. Significant between-country differences in overall levels of reported physical violence, and psychological aggression, were evident when stratifying by perpetrator type. CONCLUSIONS: The very high levels of reported IPV indicate very high levels of tolerance among victims, and suggest a culture of violence and of adversarial intimate relationships may be well entrenched. The findings support the view that co-occurrence of general interpersonal violence and partner violence may be limited, and that one may not necessarily be a predictor of the other. They also reveal that, among partners, not only are there no gender differentials in victimization by physical violence, but more women than men are self-reporting as perpetrators of this type of IPV.

OBJETIVOS: Se informa la prevalencia de dos formas de violencia interpersonal (VIP) -la sexual y la física- y de un tipo de agresión -la psicológica- en tres países del Caribe de bajo a mediano ingresos. Se analiza la VIP entre adolescentes y adultos jóvenes, ya sea como víctimas o agresores. MÉTODOS: En este estudio basado en la población se comparan las experiencias de personas de 15 a 30 años de países con diferentes niveles de desarrollo socioeconómico. Se utilizó la escala revisada de tácticas de conflicto (CTS2) y otros instrumentos de análisis conductual para evaluar el nivel y las características de la VIP. RESULTADOS: De las 3 401 personas que respondieron, 70,9% informó haber sido víctima de alguna forma de violencia, más frecuentemente ejercida por sus parejas (62,8%). Las mujeres informaron con mayor frecuencia haber sido víctimas de violencia sexual, y esta fue más frecuente en Jamaica. Se encontraron diferencias significativas entre los países en cuanto a la violencia física y la agresión psicológica, que se hicieron notables al estratificar por el tipo de agresor. CONCLUSIONES: Los muy elevados niveles informados de VIP indican un alto grado de tolerancia entre las víctimas e indican que se puede estar arraigando una cultura de violencia y de relaciones íntimas basadas en el enfrentamiento. Estos resultados confirman que la ocurrencia simultánea de la violencia interpersonal en general y la violencia de pareja puede ser limitada y que una forma no necesariamente es un factor de predicción de la otra. En las parejas no se observaron diferencias en la victimización según el género y más mujeres que hombres se declararon agresoras en esta forma de VIP.

Calidad de la atención en establecimientos públicos y privados de atención primaria de salud: comparaciones estructurales en Jamaica / Quality of care in public and private primary health care facilities: structural comparisons in Jamaica

En este trabajo se examina la calidad de la atención prestada por consultorios de atención primaria de salud de Jamaica. Para ello, se compararon diversos índices estructurales de la calidad obtenidos a partir de una encuesta efectuada en 1990 en 366 consultorios públicos y 189 privados de todo el país. La comparación revela importantes diferencias no previstas en la calidad de la atención entre los consultorios públicos y los privados, y los urbanos en contraposición a los rurales. En los consultorios públicos, los diagnósticos y la orientación prenatales, así como los servicios de planificación familiar eran mejores que los privados. No obstante, los privados contaban con mejor infraestructura, equipo y materiales y obtenían los resultados de ciertas pruebas de laboratorio de forma más oportuna. La comparación entre los consultorios públicos y los rurales indicó que los urbanos estaban algo mejor provistos de equipo, materiales y medicamentos. Sin embargo, era mejor el estado de conservación de los rurales. Las condiciones físicas de los consultorios básicos eran mejores y estaban más adecuadamente dotados de personal que los de nivel superior, mientras que la capacidad de diagnóstico perinatal era similar. Empero, los públicos de nivel superior disponían de más equipo y materiales que los básicos. Si bien las mediciones estructurales de la calidad empleadas en este estudio tienden a estimar deficientemente los resultados de salud, sirven como buenos indicadores del acceso a los servicios cuando los recursos son muy limitados. Los que formulan polítias podrían utilizar los resultados de este estudio para guiar intervenciones concretas, sintetizar los elementos estructurales de la calidad de la atención de salud en distintos tipos de instalaciones y aplicar un método de evaluación menos costoso a los programas destinados a mejorar los servicios en los consultorios de atencion primaria (AU)

Publicado en inglés en: Bull. PAHO. Vol. 28(2), 1994

Quality of care in public and private primary health care facilities: structural comparisons in Jamaica

This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be in better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics

Calidad de la atención en establecimientos públicos y privados de atención primaria de salud: comparaciones estructurales en Jamaica / Quality of care in public and private primary health care facilities: structural comparisons in Jamaica

En este trabajo se examina la calidad de la atención prestada por consultorios de atención primaria de salud de Jamaica. Para ello, se compararon diversos índices estructurales de la calidad obtenidos a partir de una encuesta efectuada en 1990 en 366 consultorios públicos y 189 privados de todo el país. La comparación revela importantes diferencias no previstas en la calidad de la atención entre los consultorios públicos y los privados, y los urbanos en contraposición a los rurales. En los consultorios públicos, los diagnósticos y la orientación prenatales, así como los servicios de planificación familiar eran mejores que los privados. No obstante, los privados contaban con mejor infraestructura, equipo y materiales y obtenían los resultados de ciertas pruebas de laboratorio de forma más oportuna. La comparación entre los consultorios públicos y los rurales indicó que los urbanos estaban algo mejor provistos de equipo, materiales y medicamentos. Sin embargo, era mejor el estado de conservación de los rurales. Las condiciones físicas de los consultorios básicos eran mejores y estaban más adecuadamente dotados de personal que los de nivel superior, mientras que la capacidad de diagnóstico perinatal era similar. Empero, los públicos de nivel superior disponían de más equipo y materiales que los básicos. Si bien las mediciones estructurales de la calidad empleadas en este estudio tienden a estimar deficientemente los resultados de salud, sirven como buenos indicadores del acceso a los servicios cuando los recursos son muy limitados. Los que formulan polítias podrían utilizar los resultados de este estudio para guiar intervenciones concretas, sintetizar los elementos estructurales de la calidad de la atención de salud en distintos tipos de instalaciones y aplicar un método de evaluación menos costoso a los programas destinados a mejorar los servicios en los consultorios de atencion primaria (AU)

Quality of care in public and private primary health care facilities: structural comparisons in Jamaica

This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be in better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics

This article will also be published in Spanish in the BOSP. Vol. 117, 1994

The impact of side effects on family planning use among female clients of the public health services in Jamaica

A one-year longitudal study was undertaken in kingston, Jamaica, to examine (i) the experience of side effects among female contraceptives users, (ii) the role of side effects. The study consisted of 463 women who utilized public health centres in Kingston and were either new users of contraceptives or who were switching contraceptive methods. They were recruited over a two-month period in 1998 and followed up for one year. All follow-up, interviews were done at women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, cotraceptive history, servive factors, experience with method and length of use. Forty eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side efects were irregular bleeding/no period, headaches, nausea; dizziness and weight gain/loss. These side effects occurred mainly among pill and injection users. The occurrence of side effects had a negative impact on continuation rates. Forty seven per cent of the women stated that they had received counselling regarding side effects. The level and impact of side effects among family planning acceptors at public health centres in Jamaica is of significance to the family planning programme. Method options need to be widened and counselling needs to be improved to ensure that women fully understand the issue of side efects and make informed choices about contraception. (AU)

Infant mortality rate in Jamaica, 1993 - abstract

In recent years, accurate estimates of the infant mortality rate in Jamaica have not been available. Official vital statistics gave a rate of 13.1 per 1000 live births in 1990 but this is known to be an underestimate because of gross under-registration of infant deaths. In 1993, a study was undertaken to determine infant mortality rates in Jamaica. Six parishes (Hanover, ST. James, Trelawny, Portland, Clarendon and St. Catherine) were chosen to provide sufficient spread over the island and a reasonable urban/rural distribution. The first three listed parishes had also been studied in 1990 by /Desai et al. A similar methodology was employed in which births and deaths for the six parishes were tracked from all hospitals islandwide, from community reports, from reports from the police stations and from the vital registration office, for the calender year 1993. The infant mortality rate for the six parishes ranged from 9.0 per 1000 in Portland to a high of 37.1 per 1000 in Trelawny with a mean of 24.0 per 1000 for the six parishes. Using data on infant mortality rates for the six parishes and for Jamaica between 1951 and 1980 the correlation was calculated and a national estimate of infant mortality rate of 24.4 per 1000 (95 percent C.I., 23.1 - 26.0 per 1000 compared with 27.0 per 1000 in 1980, suggesting little change over the fourteen-year period. Of the deaths 68.5 percent occurred during the neonatal period. Under-registration of infant deaths was extensive - 75 percent. The mean age of registered infant deaths was 3.9 (ñ3.9) months compared with 0.9 (ñ2.2) months for the unregistered deaths (p<0.0001), showing that under-registration is greatest among early infant deaths. Only 13 percent of hospital deaths were registered. The study recommended that there is an urgent need to improve the quality of health care during the neonatal period; reasons for the wide differences in the infant mortality rates of Portland and Trelawny should be explored; and procedures for ensuring registration of hospital deaths must be developed and implemented (AU)