RESUMEN
ABSTRACT Objective: To determine the prevalence of dementia and dementia types in Jamaica. Methods: An embedded case-control design was used to investigate dementia within the ageing population. Cases (Mini-Mental State Examination [MMSE] scores of < 20) and controls (MMSE scores of > 20) were evaluated using DSM-IVprotocol and magnetic resonance imaging. Prevalences (crude and age-adjusted) were calculated and distribution of dementia by type described. Results: Dementia prevalence was 5.9%. Alzheimer's pattern dementia accounted for 61.8% and vascular dementia 32.4%. However, vascular disease was prominent in 45.5% of the Alzheimer's cases. Female gender and increasing age were associated with higher rates of dementia. Dementia was 38 times more likely in participants with MMSE scores below 20. Conclusion: This first nationally representative study indicated that dementia rates in Jamaica were comparable with regional and global estimates. Regardless of the dementia type, vascular change was pervasive and suggested that synergistic efforts should be made to address underlying contributory factors. Cardiovascular and cerebrovascular risk reduction should be deliberately pursued as integral adjuncts to dementia risk reduction.
RESUMEN Objetivo: Determinar la prevalencia de los tipos de demencia y demencia en Jamaica. Métodos: Se utilizó un diseño de caso-control incrustado para investigar la demencia dentro de la población en proceso de envejecimiento. Los casos (puntuación < 20 en el Mini Examen del Estado Mental [MEEM]) y los controles (puntuación > 20 en el MEEM) fueron evaluados usando el protocolo DSM-IVy la imagen por resonancia magnética. Se calcularon prevalencias (crudas y ajustadas por edad) y se describió la distribución de la demencia por tipo. Resultados: La prevalencia de demencia fue de 5.9%. El Alzheimer representó el 61.8% y la demencia vascular 32.4%. Sin embargo, la enfermedad vascular fue prominente en el 45.5% de los casos de Alzheimer. El género femenino y la edad creciente se asociaron con tasas más altas de demencia. La demencia fue 38 veces más probable en los participantes con puntuaciones de MEEM por debajo de 20. Conclusión: Este primer estudio nacionalmente representativo indicó que las tasas de demencia en Jamaica eran comparables con los estimados regionales y globales. Independientemente del tipo de demencia, el cambio vascular fue generalizado y sugirió que se hicieran esfuerzos sinérgicos para abordar los factores contribuyentes subyacentes. Debe buscarse deliberadamente la reducción del riesgo cardiovascular y cerebrovascular como adjuntos integrantes de la reducción del riesgo de demencia.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Envejecimiento , Demencia/epidemiología , Imagen por Resonancia Magnética , Estudios de Casos y Controles , Prevalencia , Demencia/clasificación , Demencia/diagnóstico por imagen , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Distribución por Edad y Sexo , Política de Salud , Jamaica/epidemiologíaRESUMEN
We explored the potential to diagnose Zika virus (ZIKV) infection by analyzing peptides in saliva during a convalescent phase of infection, long after resolution of acute disease. A 25-y-old woman clinically diagnosed with Zika fever in the first trimester was enrolled with her dizygotic twins for a 3-mo postnatal sample of saliva (9-mo after maternal infection). The female baby (A) had microcephaly while the male baby (B) was born healthy. Peptidomic analysis was completed by mass spectrometry (MS/MS), and ZIKV peptides were identified using the National Institutes of Health Zika Virus Resource database, then aligned and mapped to the ZIKV polyprotein to determine proteome coverage and phylogenetic studies. A total of 423 (mother), 607 (baby A), and 183 (baby B) unique ZIKV peptides were identified in saliva by MS/MS, providing a coverage of 67%, 84%, and 45%, respectively, of the entire ZIKV polyprotein (>3,400 amino acids). All peptides were aligned to other flaviviruses that are circulating in Brazil (dengue and yellow fever) to discard false-positive matches. Nine peptides identified were highly conserved to dengue virus. Alignment of a contiguous peptide sequence for mother/babies with the 74 ZIKV sequences suggested that the virus may have entered the oral cavity through the salivary glands, leading to an infection that persists into the postnatal period (vertical transmission). Furthermore, we identified 9 sequence variations that were unique to the baby with microcephaly (not found in the mother or the twin). This sequence information could provide a template for future neuropathogenic studies. A much larger sample size is required to determine whether sequence variation in the envelope protein significantly associates with microcephaly. Finally, from a public health perspective, it will be important to determine whether viral replication is still taking place after birth and whether the virus can be transmitted through salivary contact.
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Microcefalia/virología , Péptidos/análisis , Saliva/virología , Infección por el Virus Zika/diagnóstico , Virus Zika/aislamiento & purificación , Adulto , Brasil , Femenino , Humanos , Lactante , Masculino , Espectrometría de Masas , Embarazo , Proteómica , Gemelos DicigóticosRESUMEN
BACKGROUND/OBJECTIVES: Earlier we reported an association between iron deficiency and overweight in Brazilian preschoolers. Here, we investigate whether this is the result of adipose-related inflammation. SUBJECTS/METHODS: Fasting serum C-reactive protein, α-1-acid glycoprotein (AGP), hepcidin, interleukin-6 (IL-6) and leptin, together with two iron biomarkers (serum ferritin and transferrin receptor (sTfR)), were measured in 364 disadvantaged preschoolers with a mean BMIZ (standardised Z-score for BMI) of 0.015, aged 3-6 years and attending day care in Salvador, Brazil. The role of genetic haemoglobin (Hb) disorders, intestinal parasites and dietary iron supply (calculated from serving sizes of 20 weekday menus) were also examined. RESULTS: Forty-eight children (13%) were overweight (BMIZ >1). Prevalence of tissue iron deficiency (sTfR >113.3 nmol/l; 30.6 vs 12.5%; P=0.002) and chronic inflammation (AGP >25 µmol/l; 19 vs 10%; P=0.025) were higher in overweight than in normal-weight children. From multiple regression, BMIZ was a positive predictor of log serum sTfR, ferritin and leptin, but not of log hepcidin or IL-6. Instead, major positive predictors of log hepcidin were log IL-6, followed by an elevated AGP and sex (male), whereas for log IL-6 elevated AGP was the only significant predictor. Besides BMIZ, sex (female) was also a major positive predictor of leptin. Heterozygous variant of sickle cell Hb (n=20), but not helminths, was also a positive predictor of log sTfR. Median dietary iron supply (mg/day) was above the WHO Recommended Nutrient Intake assuming moderate bioavailability and appeared adequate. CONCLUSIONS: The role of adiposity-related inflammation in tissue iron deficiency should be considered even when the prevalence of overweight is relatively low.
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Tejido Adiposo , Anemia Ferropénica/etiología , Inflamación/complicaciones , Deficiencias de Hierro , Obesidad/complicaciones , Adiposidad , Anemia Ferropénica/sangre , Anemia Ferropénica/epidemiología , Biomarcadores/sangre , Brasil/epidemiología , Niño , Preescolar , Femenino , Ferritinas/sangre , Hepcidinas/sangre , Humanos , Inflamación/sangre , Inflamación/epidemiología , Interleucina-6/sangre , Hierro de la Dieta/administración & dosificación , Leptina/sangre , Masculino , Obesidad/sangre , Obesidad/epidemiología , Orosomucoide/metabolismo , Prevalencia , Receptores de Transferrina/sangre , Factores Sexuales , Poblaciones VulnerablesRESUMEN
The case of a 16-year old Jamaican girl who presented to the psychiatric service of a general hospital with features of Capgras syndrome is presented. Her history, treatment, progress and relevant psychodynamic and neurocognitive issues are explored. This is the first known published case of an adolescent with Capgras syndrome from the Caribbean. The case highlights that the syndrome may occur in different cultural contexts and that clinicians should be sensitive to its existence in order to avert under-diagnosis or misdiagnosis.
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Benzodiazepinas/administración & dosificación , Síndrome de Capgras , Depresión , Dibenzotiazepinas/administración & dosificación , Sertralina/administración & dosificación , Adolescente , Antidepresivos/administración & dosificación , Antipsicóticos/administración & dosificación , Síndrome de Capgras/diagnóstico , Síndrome de Capgras/tratamiento farmacológico , Síndrome de Capgras/psicología , Región del Caribe , Depresión/diagnóstico , Depresión/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Relaciones Familiares , Femenino , Humanos , Pruebas Neuropsicológicas , Olanzapina , Escalas de Valoración Psiquiátrica , Fumarato de Quetiapina , Inducción de Remisión , Ideación Suicida , Resultado del TratamientoRESUMEN
OBJECTIVE: To explore possible associations of age, gender, socio-economic status, educational level and level of cognitive functioning with depressive symptoms in a community sample of elderly persons. METHOD: Two hundred elderly persons from two communities in Kingston, Jamaica, were randomly selected for participation in the study. They or their caregivers provided sociodemographic information and participants also completed the Zung Self-rating Depression Scale (ZSDS) and the Mini Mental Status Examination (MMSE). Variables of interest were entered in a multiple variable regression model using ZSDS score as the outcome variable. RESULTS: Predictors of depression were older age (B = 0.26, se = 0.08, p < 0.01), female gender (B = 3.98, se = 1.44, p < 0.01), low socio-economic status (B = 5.14, se = 1.50, p = 0.01) and low level of cognitive function (B = -0.38, se = 0.18, p < 0.05). No statistically significant association was found between educational attainment and depressive symptoms. CONCLUSION: The findings highlight the need for further exploration of the extent to which the associations identified are relevant for the overall population of elderly persons as well as the potential value of targeted preventive and treatment interventions.
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Depresión/epidemiología , Anciano , Anciano de 80 o más Años , Escolaridad , Femenino , Humanos , Jamaica , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Clase SocialRESUMEN
Involuntary commitment and custodialization were the principal tenets of British colonial public policy provisions for the management of the violent, disturbed mentally ill in Jamaica and the West Indies. Over the fifty years following Jamaica's political independence from Britain, a community engagement mental health programme has developed through a decolonization process that has negated involuntary certification, incarceration and custodialization, has promoted family therapy and short stay treatment in conventional primary and secondary care health facilities, and has promoted reliance on traditional and cultural therapies that have been extremely successful in the treatment of mental illness and the reduction of stigma in Jamaica. Collaborations involving The University of the West Indies, the Jamaican Ministry of Health and the Pan American Health Organization have been seminal in the development of the decolonizing of public policy initiatives, negating the effects of involuntary certification that had been imposed on the population by slavery and colonization. This collaboration also catalysed the psychiatric training of medical, nursing and mental health practitioners and the execution of community mental health policy in Jamaica.
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Política de Salud , Trastornos Mentales/historia , Enfermos Mentales , Colonialismo/historia , Servicios Comunitarios de Salud Mental/tendencias , Historia del Siglo XIX , Historia del Siglo XX , Hospitales Psiquiátricos/historia , Humanos , Jamaica , Trastornos Mentales/terapia , Problemas Sociales/historiaRESUMEN
Studies have shown that the metabolic syndrome (MetS), a major risk factor for the development of Type 2 diabetes mellitus and cardiovascular disease, is higher among psychiatric patients on antipsychotic medications than the general population. While studies on the prevalence of MetS in the Jamaican adult population have been undertaken, no such study has been done on the corresponding psychiatric population. The purpose of this study was to determine the prevalence of MetS in a Jamaican adult psychiatric inpatient population. The study group comprised thirty-eight patients with a primary DSM-IV-TR Axis 1 diagnosis. Criteria for the diagnosis of MetS were the presence of any three or more of five factors as defined by using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) consensus agreement. The prevalence of MetS in this cohort was 28.9% and was associated with significantly higher abdominal obesity (p = 0.010), elevated blood pressure (p = 0.000), elevated triglycerides (p = 0.019) and low high density lipoprotein-cholesterol (p = 0.016) when compared with patients not diagnosed with MetS. Metabolic syndrome was common in this group of psychiatric patients and likely represents a pathway to the future development of Type 2 diabetes mellitus and cardiovascular disease. Screening and continuous monitoring will allow for early intervention and possibly prevention of increased morbidity and mortality in this vulnerable population.
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Trastornos Mentales/epidemiología , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/epidemiología , Adolescente , Adulto , Femenino , Hospitales Universitarios , Humanos , Hipertensión/epidemiología , Hipertrigliceridemia/epidemiología , Jamaica/epidemiología , Masculino , Obesidad Abdominal/epidemiología , Prevalencia , Adulto JovenRESUMEN
OBJECTIVE: The prevalence of cardiovascular disease in Jamaica and other Caribbean countries has been steadily rising. Depression has been associated with increased morbidity and mortality in patients with cardiovascular disease. Against this background, the authors compared the co-occurrence of depressive illnesses among general hospital inpatients with cardiovascular disease and those without cardiovascular disease. METHOD: Psychiatric and non-psychiatric diagnoses on all inpatients referred to the consultation-liaison psychiatry service at a general hospital in Jamaica were recorded over a one-year period and analysed using chi-square, t-tests, binary logistic regression and odds ratio. Statistical significance was taken at the 0.05 level. RESULTS: Of the 201 patients referred, 17.9% had cardiovascular disease and 19.9% had depressive illnesses. One third of patients with cardiovascular disease were depressed. They were also significantly more likely than other patients to have a depressive illness (OR = 2.93, 95% CI: 1.25, 6.85). CONCLUSION: Special attention to the prevention, detection and treatment of depression should be applied to patients with cardiovascular disease.
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Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Comorbilidad , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: Depression in adolescents is often overlooked and misdiagnosed; however it is an important mental health problem which is associated with major functional impairments across daily domains of living, and considerable morbidity. The aim of this research is to examine the prevalence of self-reported depressive symptoms among Jamaican adolescents, and the associated sociodemographic factors. SUBJECTS AND METHOD: This cross-sectional study included 3003 students between 10 and 15 years old in Jamaica. Survey methodology was used in the collection of the data. RESULTS: Of the sample of students, 47% were males. One hundred and thirty-four (4.5%) reported having depressive symptoms. The factors significantly associated with depressive symptoms were negative community attributes (B = 1.1; p = 0.001), protective factors within the home (B = 0.72; p = 0.000), gender (B = 1.92; p = 0.000), and learning problems (B = 3.1; p = 0.000). CONCLUSION: Results indicate rates of depressive symptomatology reported among adolescents in Jamaica are consistent with rates reported in the literature.
Asunto(s)
Depresión/epidemiología , Relaciones Familiares , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Jamaica/epidemiología , Masculino , Prevalencia , Características de la Residencia , Autoinforme , Factores SexualesRESUMEN
OBJECTIVES: To assess the extent to which the current practice for first line therapy concurs with the recommended guidelines and to examine the response of treatment naïve patients to first line Highly Active Antiretroviral Therapy (HAART) at the University Hospital of the West Indies, using CD4 cell counts. METHODS: Over a three-month period, a cross-sectional study design was instituted and data were collected on all patients on HAART at the University Hospital ofthe West Indies (UHWI) outpatient HIV clinic. Information was collected by reviewing patient medical records using data collection sheets. The data obtained from the medical records included: age, gender, date of diagnosis of HIV, date at which HAART was commenced, CD4 cell counts prior to the commencement of antiretrovirals, the initial HAART regimes and subsequent CD4 cell counts. RESULTS: A total of 165 persons who met the criteria of being on HAART therapy were enrolled in the study. The average time span between diagnosis of HIV and commencement of antiretroviral therapy was 1.92 years and the range for this was 0 to 12.29 years. The average CD4 count prior to initiation of HAART was 186 cells/mm³. The most common regime used at the UHWI for first line therapy was combivir and efavirenz, n = 78 (47.3%), followed by combivir and nevirapine, n = 29 (17.6%). The average difference between the initial CD4 count prior to the initiation of HAART and first repeated CD4 count was 102 cells/mm³. The mean time between the first and repeated CD4 cell counts was 376 days. CONCLUSION: The recommended guidelines were adhered to for the majority of patients initiated on antiretrovirals at the UHWI. The treatment outcomes achieved at the UHWI were similar to those achieved in developed countries. This gives substantial evidence in support of international efforts to make antiretroviral therapy available in developing countries.
OBJETIVOS: Evaluar hasta que punto la práctica actual de la terapia de primera línea concuerda con las normas recomendadas y examinar la respuesta al tratamiento por parte de los pacientes nunca antes sometidos a la terapia antiretroviral altamente activa, (TARGA) en el Hospital Universitario, usando conteos de células CD4. MÉTODOS: Por un periodo de tres meses, se instituyó un diseno de estudio transversal, y se recogieron datos de todos los pacientes sometidos a TARGA en la clínica de VIH para pacientes externos en el Hospital Universitario de West Indies (UHWI). La información fue obtenida revisando las historias clínicas de todos pacientes, usando hojas de recogida de datos. Los datos obtenidos de las historias clínicas incluían: edad, género, fecha de diagnóstico de VIH, fecha de comienzo de TARGA, conteo de células CD4 antes del comienzo de los antiretrovirales, los regimenes iniciales de TARGA y los subsecuentes conteos de células CD4. RESULTADOS: Un total de 165 personas que satisfacían los criterios de la terapia TARGA fueron enroladas en el estudio. El tiempo promedio que medió entre el diagnóstico de VIHy el comienzo de la terapia antiretroviral fue 1.92 anos, en tanto el rango para esta fue de 0 a 12.29 anos. El conteo promedio de conteo de CD4 antes del comienzo de TARGA fue 186 células/mm3. El régimen más común usado en UHWIpara la terapia de primera línea fue combivir y efavirenz, n = 78 (47.3%), seguido por el combivir y nevirapine, n = 29 (17.6%). La diferencia promedio entre el conteo inicial de CD4 antes del comienzo de TARGA y elprimer conteo repetido de CD4 fue 102 células/mm3. El tiempo promedio entre los primeros conteos CD4 y los repetidos fue 376 días. CONCLUSIÓN: Se siguieron las normas recomendadas en relación con la mayoría de los pacientes iniciados en el tratamiento con antiretrovirales en UHWI. Los resultados del tratamiento logrados en UHWI fueron similares a los logrados en los países desarrollados. Esto ofrece sólidas evidencias en apoyo a los esfuerzos internacionales por poner la terapia antiretroviral a disposición de los países en vías de desarrollo.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Estudios Transversales , Adhesión a Directriz , Infecciones por VIH/epidemiología , Hospitales Universitarios , Jamaica/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aimed to examine factors related to disclosure of HIV serostatus among clinic attendees in an outpatient HIV clinic at the University Hospital of the West Indies (UHWI). METHODS: This was a cross-sectional survey of 107 attendees to a HIV clinic at the University Hospital of the West Indies. Participants were selected on a convenience basis. The instrument was developed for this study and covered socio-demographic data and self-report of disclosure and other variables related to HIV experience such as perceptions of family support. Data were analysed using non-parametric tests. RESULTS: Findings demonstrate a 49% disclosure rate among males and 60% among females. The results further indicate that age, sexual orientation, mode of transmission, and perception of family support were significantly associated with disclosure. Age and perception of family support were found to be significantly associated with consistent condom use. Age and perception of family support were the factors demonstrating the most significant correlations with age being significantly associated with disclosure to partner. Perception of family support was significantly associated with disclosure to family. CONCLUSION: Findings from this study demonstrate a low disclosure rate among HIV clinic attendees. Given that disclosure of HIV serostatus is critical in the control of the spread of HIV, this report highlights the need for the development of prevention interventions focussed on de-stigmatization for both infected and non-infected persons.
OBJETIVO: Este estudio tiene por objeto examinar factores relacionados con el dar a conocer el seroestado de VIH entre los pacientes externos que asisten a la clínica de VIH en el Hospital Universitario de West Indies (UHWI). MÉTODOS: Se realizó un estudio transversal de 107 asistentes a una clínica de VIH en el Hospital Universitario de West Indies. Se seleccionaron los participantes de acuerdo con las conveniencias. El instrumento fue desarrollado para este estudio y abarcó los datos sociodemográficos así como autoreportes de la revelación del estado y otras variables relacionados con la experiencia del VIH, tales como las percepciones de apoyo familiar. Los datos fueron analizados usando pruebas no paramétricas. RESULTADOS: Los resultados muestran una tasa de revelación de 49% entre los varones y 60% entre las hembras. Los resultados también indican que la edad, la orientación sexual, el modo de transmisión, y la percepción de apoyo familiar, estuvieron significativamente asociados con la revelación de esta condición. La edady la percepción del apoyo familiar estuvieron significativamente asociadas con el uso consistente del condón. La edad y la percepción del apoyo familiar fueron los factores que demostraron las correlaciones más significativas, hallándose la edad significativamente asociada con la revelación de la condición a las parejas. La percepción del apoyo familiar estuvo significativamente asociada con la revelación de la condición a la familia. CONCLUSIÓN: Los resultados de este estudio demuestran una baja tasa de revelación entre los asistentes a la clínica de VIH. Puesto que dar a conocer el seroestado de VIH es un aspecto crítico en el control de la diseminación del VIH, este informe resalta la necesidad de desarrollar intervenciones de prevención encaminadas a la desestigmatización tanto para los infectados como para los no infectados.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por VIH/psicología , Autorrevelación , Estudios Transversales , Infecciones por VIH/epidemiología , Jamaica/epidemiología , Estadísticas no ParamétricasRESUMEN
OBJECTIVES: To determine the prevalence of depression among persons attending a HIV/AIDS clinic in Kingston, Jamaica, and to explore the possible role of patient-specific clinical and social issues as intermediary factors in the relationship between HIV/AIDS and depression. SUBJECTS AND METHODS: Over a three-month period, all eligible and consenting patients from a HIV/ AIDS clinic in Kingston, Jamaica, were invited to participate in the study. They were interviewed using the Patient Health Questionnaire (PHQ-9), an instrument validated for the detection of depression in primary care settings. Clinical and socio-demographic data were retrieved for all participating patients from a pre-existing clinic database. Depression prevalence rates were calculated and the association between depression and age, gender, antiretroviral treatment, CD4 count, living arrangement, marital status and major stressors explored. RESULTS: Sixty-three patients participated in the study and 43% (n = 36) of them were depressed. No significant differences in depression rates were found with respect to any of the sociodemographic or clinicalfactors explored (p > 0.05). CONCLUSION: The relatively high prevalence of depression among attendees at the HIV/AIDS clinic underscores the need for depression screening in these patients.
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Depresión/epidemiología , Depresión/psicología , Infecciones por VIH/psicología , Adulto , Instituciones de Atención Ambulatoria , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Entrevistas como Asunto , Jamaica/epidemiología , Masculino , Prevalencia , Factores de RiesgoRESUMEN
OBJECTIVE: To delineate changes in the epidemiology of HIV including morbidity and mortality patterns based on three key time points in Jamaica's HIV response. METHOD: Surveillance data from Jamaica's HIV/AIDS Tracking system (HATS) were analysed and distribution of cases by age, gender sexual practice, risk factors and clinical features were determined for three time periods (1988-1994: formal establishment of HIV surveillance at the national level, 1995-2003: introduction of HAART globally; 2004-June 2008: introduction of HAART and HIV rapid testing in Jamaica). Factors that predicted late stage diagnosis (AIDS or AIDS death) were also determined RESULTS: 22 603 persons with HIV were reported to the Ministry of Health, Jamaica, between 1988 and June 2008. Between the first and last time blocks, the modal age category remained constant (25-49 years) and the proportion of women reported with HIV non-AIDS increased from 32.5% to 61.4% (p < 0.001). However the male:female ratio for persons reported with AIDS remained at 1.3:1 between 1995 and 2008. Although heterosexual transmission was the most frequent mode of transmission in each time period, sexual behaviour was consistently under-reported (4769 persons or 21% of all cases ever reported). Late stage diagnosis (AIDS or AIDS death) decreased significantly between the first and last time blocks (16% decline, p < 0.0001) with men, older persons and persons with unknown risk history being more likely to be diagnosed at AIDS or AIDS death. CONCLUSION: HIV testing and treatment programmes have improved timely diagnosis and reduced morbidity associated with HIV infection in Jamaica. However new strategies must be developed to target men and older persons who are often diagnosed at a late stage of disease. Surveillance systems must be strengthened to improve understanding of persons reported with unknown risk behaviours and unknown sexual practices.
Asunto(s)
Infecciones por VIH/epidemiología , Vigilancia de la Población , Adolescente , Adulto , Factores de Edad , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores SocioeconómicosRESUMEN
OBJECTIVE: To determine the seroprevalence of HIV among inpatients with neuropsychiatric and other central nervous system (CNS) disorders at the University Hospital of the West Indies (UHWI). METHODS: Sera and data of hospital inpatients with disorders of the CNS were prospectively investigated and reviewed at the Virology Laboratory, UHWI, over the period January 1 to December 31, 2007. The study population included inpatients with a principal diagnosis of a neuropsychiatric or other CNS disorder and for whom a serological analysis for HIV had been requested. The CNS disorders were categorized as follows: neuropsychiatric disorder (eg schizophrenia), CNS infection (eg viral, bacterial), motor and psychogenic dysfunction not included in other categories (eg seizures), gross structural brain lesion (eg tumours) and other HIV prevalence rates were calculated and compared according to age, gender and diagnostic category. RESULTS: Eighty-two patients were included. Sixty-one per cent were males and 39% females. The mean age in years (+/- SD) was 37.6 (+/- 16.3). There were significant differences in prevalence rates according to diagnostic category (p = 0.026). All of the patients with psychiatric disorders (n = 40) were HIV-negative and 25% (3 out of 12) of patients with CNS infection were HIV-positive. There were no statistically significant associations demonstrated between HIV and age or gender (p > 0.05). CONCLUSION: Clinicians should have a high index of suspicion for HIV infection when faced with patients with CNS infection. Further research is needed to clearly identify the reasons for the comparatively low prevalence of HIV among the psychiatric patients included in this study.
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Enfermedades del Sistema Nervioso Central/epidemiología , Seroprevalencia de VIH , Pacientes Internos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Western Blotting , Distribución de Chi-Cuadrado , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: To assess the extent to which the current practice for first line therapy concurs with the recommended guidelines and to examine the response of treatment naïve patients to first line Highly Active Antiretroviral Therapy (HAART) at the University Hospital of the West Indies, using CD4 cell counts. METHODS: Over a three-month period, a cross-sectional study design was instituted and data were collected on all patients on HAARTat the University Hospital of the West Indies (UHWI) outpatient HIV clinic. Information was collected by reviewing patient medical records using data collection sheets. The data obtained from the medical records included: age, gender date of diagnosis of HIV date at which HAART was commenced, CD4 cell counts prior to the commencement of antiretrovirals, the initial HAART regimes and subsequent CD4 cell counts. RESULTS: A total of 165 persons who met the criteria of being on HAART therapy were enrolled in the study The average time span between diagnosis of HIV and commencement of antiretroviral therapy was 1.92 years and the range for this was 0 to 12.29 years. The average CD4 count prior to initiation of HAART was 186 cells/mm3. The most common regime used at the UHWI for first line therapy was combivir and efavirenz, n = 78 (47.3%), followed by combivir and nevirapine, n = 29 (17.6%). The average difference between the initial CD4 count prior to the initiation of HAART and first repeated CD4 count was 102 cells/mm3. The mean time between the first and repeated CD4 cell counts was 376 days. CONCLUSION: The recommended guidelines were adhered to for the majority of patients initiated on antiretrovirals at the UHWI. The treatment outcomes achieved at the UHWI were similar to those achieved in developed countries. This gives substantial evidence in support of international efforts to make antiretroviral therapy available in developing countries.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Adulto , Recuento de Linfocito CD4 , Estudios Transversales , Femenino , Adhesión a Directriz , Infecciones por VIH/epidemiología , Hospitales Universitarios , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aimed to examine factors related to disclosure of HIV serostatus among clinic attendees in an outpatient HIV clinic at the University Hospital of the West Indies (UHWI). METHODS: This was a cross-sectional survey of 107 attendees to a HIV clinic at the University Hospital of the West Indies. Participants were selected on a convenience basis. The instrument was developed for this study and covered socio-demographic data and self-report of disclosure and other variables related to HIV experience such as perceptions of family support. Data were analysed using nonparametric tests. RESULTS: Findings demonstrate a 49% disclosure rate among males and 60% among females. The results further indicate that age, sexual orientation, mode of transmission, and perception of family support were significantly associated with disclosure. Age and perception of family support were found to be significantly associated with consistent condom use. Age and perception of family support were the factors demonstrating the most significant correlations with age being significantly associated with disclosure to partner. Perception of family support was significantly associated with disclosure to family. CONCLUSION: Findings from this study demonstrate a low disclosure rate among HIV clinic attendees. Given that disclosure of HIV serostatus is critical in the control of the spread of HIV this report highlights the need for the development of prevention interventions focussed on de-stigmatization for both infected and non-infected persons.
Asunto(s)
Infecciones por VIH/psicología , Autorrevelación , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Estadísticas no ParamétricasRESUMEN
OBJECTIVES: Against the public health implications of untreated mental illness among general hospital inpatients, this study aimed firstly to examine hospital physicians' level of referral to a psychiatric service, and secondly, to explore the extent of these doctors' knowledge of psychiatric issues by comparing their reasons for referring patients with patients' final psychiatric diagnoses. METHODS: Over a one-year period, data were collected on all patients referred to a consultation liaison psychiatric service at a multi-disciplinary teaching hospital. Reasons for referral and final psychiatric diagnosis were recorded. Official hospital census data were also used in the calculation of referral rates. Chi-square or Fisher's Exact tests were used as appropriate to explore potential associations between reasons for referral and psychiatric diagnosis. Statistical significance was taken at the 0.05 level. RESULTS: The referral rate was 1.5%. Strange and disruptive behaviour as reasons for referral were strongly associated with the presence of underlying medical conditions as the cause of mental disturbance. Anxiety and psychotic symptoms as reasons for referral were associated with anxiety and psychotic disorders respectively. Depression was often given as a reason for referral when clinical depression was absent, but adjustment issues were prominent. CONCLUSIONS: The psychiatric service was underutilized. Generally, the psychiatric knowledge of physicians was fair However, closer attention to underlying medical conditions as a potential cause for psychiatric, disturbance, as well as to the difference between maladjustment and depression, seems warranted. It is possible that clinicians were less able to detect mild to moderate cases of psychiatric illness.
Asunto(s)
Trastornos Mentales/terapia , Rol del Médico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Salud Pública , Derivación y Consulta , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Niño , Femenino , Hospitales Generales , Hospitales de Enseñanza , Humanos , Jamaica , Masculino , Persona de Mediana Edad , Servicio de Psiquiatría en HospitalRESUMEN
This study investigated factors leading to premature discharge from the residential substance abuse treatment programme at the University Hospital of the West Indies (UHWI). Two hundred and twenty-four patients, mean age 36 +/- 9.75 and age range of 16-66 years were studied The patients, 87.5% men, were admitted to the programme over the period July 1999 to June 2002. Sources of data, including a routine patient-monitoring form and patients' medical records, were reviewed. Data analysis, performed using the Statistical Package for Social Sciences (SPSS), included frequencies, cross-tabulations and analyses of variance (ANOYA). Crack cocaine was the drug of impact for 60% of patients, alcohol for 17% and marijuana for 8%. Treatment ended prematurely for 22.8% of persons whose reasons for leaving included signing out against medical advice or self-discharge (27.4%), absconding (19.6%), fighting (9.8%), drug use (5.9%) and other rule breaking, including sexual acting out (15.7%). Premature discharge was uninfluenced by gender, age, marital status, schooling, employment status or geographical location. There were significantly more premature discharges in persons admitted primarily for crack dependence versus those admitted primarily for alcoholism (p < 0.05). There were also significantly more premature discharges in persons with 0-10 years of using their most problematic substance when compared with 21-30 years of use (p < 0.05) but not when compared with 11-20 years or over 30 years of use (p > 0.05). The influence of duration of substance use requires further elucidation.
Asunto(s)
Tiempo de Internación/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Trastornos Relacionados con Sustancias/terapia , Centros Médicos Académicos , Adolescente , Adulto , Anciano , Análisis de Varianza , Escolaridad , Femenino , Humanos , Pacientes Internos , Masculino , Estado Civil , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Factores de Tiempo , Indias Occidentales , Adulto JovenRESUMEN
BACKGROUND: Children and adolescents with HIV/AIDS often have psychological/psychiatric issues that require specialist intervention. We explored whether HIV infection acquired through sexual abuse led to particularly negative psychiatric outcomes and whether good social support is a protective factor in the development of undesirable psychiatric sequelae. METHODS: This study consists of a case series of five persons referred from the Paediatric Infectious Diseases Clinic to the Child Psychiatry Clinic, both at the University Hospital of the West Indies (UHWI) in Jamaica, during July 1 to November 30, 2005. The patients were clinically assessed and diagnosed by a psychiatrist using the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM IV) criteria. Cases were compared according to gender, age, likely route of HIV infection, level offamily/social support and nature of psychiatric outcome. RESULTS: Adolescents who acquired HIV infection through sexual abuse reported more intense feelings of sadness and suicidal ideations. Those with good social support reported less intense feelings of sadness with no suicidal ideations and were more optimistic about their future regardless of the route of acquisition. Two of three adolescents who acquired HIV infection through sexual abuse and one of two who was perinatally infected required ongoing supportive psychotherapy to augment their social support, the characteristic most associated with favourable outcome. CONCLUSION: Both sexual abuse and HIV/AIDS are likely to have negative psychological consequences in children and adolescents. This psychological impact may be intensified when HIV infection results from sexual assault as opposed to other methods of transmission. The findings support the practice of providing HIV prophylaxis to all sexual assault victims of known or suspected HIV-positive perpetrators and of encouraging utilization of existing social support networks.
Asunto(s)
Abuso Sexual Infantil , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Apoyo Social , Trastornos por Estrés Postraumático/prevención & control , Adaptación Psicológica , Adolescente , Adulto , Factores de Edad , Abuso Sexual Infantil/psicología , Femenino , Infecciones por VIH/epidemiología , Humanos , Jamaica/epidemiología , Masculino , Trastornos por Estrés Postraumático/etiología , Estrés Psicológico/complicaciones , Adulto JovenRESUMEN
OBJECTIVE: To compare the medical research output of the Section of Psychiatry, The University of the West Indies (UWI), Mona, before and after the implementation of strategies aimed at stimulating research. METHOD: Specific strategies such as weekly research and journal club meetings, with an emphasis on team activities and the establishment of bi-annual targets for submission of research papers were instituted in 2000. All research outputs from the Section of Psychiatry over the period 1995 to 2005 were identified from the Departmental Reports of the University of the West Indies and the published abstracts of the UWI Faculty of Medical Sciences and the Caribbean Health Research Council annual research conferences. A number of variables were extracted from each paper and comparisons made between the five-year period before and the five-year period after the implementation of the research enhancing strategies. Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS; version 11.5) and included chi-squared and Mann Whitney U tests. RESULTS: One-hundred and sixty-two items of research output were identified for the entire period under study. In the period after the implementation of the research enhancing strategies, there were significant increases in the total research output (p = 0.008) and refereed publications (p = 0.016). CONCLUSIONS: There were considerable increases in the overall research output of the department as well as in many sub-categories of output. These strategies are presented as a model to other departments seeking to augment their output of research.