Climate and painful crisis of sickle-cell disease in Jamaica.
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In a 10-year retrospective study a close correlation was found between low temperatures and hospital admissions for severe painful crises of sickle-cell disease. (+info)
Growth retardation is associated with changes in the stress response system and behavior in school-aged jamaican children.
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In the developing world, 39% of children <5 y old are short for their age (stunted, defined as height-for-age less than -2 SD of National Center for Health Statistics references), and many have poor levels of mental development along with behavioral problems. We showed previously that 8- to 10-y-old children from a longitudinal cohort who experienced early childhood stunting had altered hypothalamic-pituitary-adrenocortical (HPA) and sympathetic-adrenomedullary (SAM) system activity. We repeated the study with 31 newly recruited, stunted Jamaican school children (less than -2.0 SD height-for-age) and nonstunted controls (n = 31, more than -1.0 SD height-for-age) matched for sex, age and school. All children were tested in a 1.5-h session, including psychological and physiologic stressors, in which their behaviors, salivary cortisol concentrations and heart rates were measured. In addition, we measured urinary catecholamine (epinephrine, norepinephrine, dopamine) concentrations, which were not reported for the children in the longitudinal cohort. After controlling for covariates that differed between groups (child intelligence quotient, body mass index and birth weight), stunted children had faster resting heart rates while lying and sitting (P < 0.05) and also during psychological testing (P < 0.05), as well as higher concentrations of urinary epinephrine (P < 0.05) and norepinephrine (P < 0.05), compared with nonstunted children. In addition, the stunted children were less happy (P < 0.01), more inhibited (P < 0.01) and more frustrated (P < 0.05) during the psychological tests than nonstunted children. These results suggest that growth retardation is associated with alterations in stress-sensitive systems, particularly the SAM system, and that this connection may contribute to the poor levels of development observed in stunted children. (+info)
The quantitative assessment of body iron.
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Current initiatives to reduce the high prevalence of nutritional iron deficiency have highlighted the need for reliable epidemiologic methods to assess iron status. The present report describes a method for estimating body iron based on the ratio of the serum transferrin receptor to serum ferritin. Analysis showed a single normal distribution of body iron stores in US men aged 20 to 65 years (mean +/- 1 SD, 9.82 +/- 2.82 mg/kg). A single normal distribution was also observed in pregnant Jamaican women (mean +/- 1 SD, 0.09 +/- 4.48 mg/kg). Distribution analysis in US women aged 20 to 45 years indicated 2 populations; 93% of women had body iron stores averaging 5.5 +/- 3.35 mg/kg (mean +/- 1 SD), whereas the remaining 7% of women had a mean tissue iron deficit of 3.87 +/- 3.23 mg/kg. Calculations of body iron in trials of iron supplementation in Jamaica and iron fortification in Vietnam demonstrated that the method can be used to calculate absorption of the added iron. Quantitative estimates of body iron greatly enhance the evaluation of iron status and the sensitivity of iron intervention trials in populations in which inflammation is uncommon or has been excluded by laboratory screening. The method is useful clinically for monitoring iron status in those who are highly susceptible to iron deficiency. (+info)
Clinical features of nasopharyngeal carcinoma in Jamaica.
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Nasopharyngeal carcinoma is endemic in China, Hong Kong, and the Philippines. However, this disease is rare in North America and the Caribbean. This paper discusses the clinical features, prognosis, treatment outcomes, and survival rates of nasopharyngeal carcinoma in Jamaica. The incidence in Jamaica is 1.4 per 100,000. The National Cancer Registry in Jamaica keeps a record of all cancers. A retrospective cohort study of patients with nasopharyngeal carcinoma between 1988-2000 was reviewed. The presenting features, staging, histological diagnosis, treatment, and patient outcome were assessed. All patients received radiation therapy, and 89% of the patients completed the course of therapy. Seventeen percent received chemotherapy, consisting of cisplatin and 5-fluorouracil. Surgery played a minor role in the definitive management of nasopharyngeal carcinoma in this study. Three-year survival rates were 21%. The study demonstrates findings unique to the Caribbean nation of Jamaica. There is a bimodal pattern to the age distribution typical in non-endemic areas, such as shown in this study. Nasopharyngeal carcinoma evades early diagnosis because of its anatomic location and varied symptomatology. Prognostic indicators include intracranial extension, cervical node, and distant metastasis. (+info)
Serotypes of respiratory tract isolates of Streptococcus pneumoniae from Jamaican children.
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BACKGROUND: Data are lacking on the pneumococcal serotypes present in many developing regions, including the Caribbean. We examined the serotypes of nasopharyngeal (NP) isolates of pneumococci obtained from Jamaican children. METHODS: We obtained NP samples from children seen in the Emergency Department at the Bustamante Children's Hospital. The samples were transported to Canada for isolation and serotyping of pneumococci. RESULTS: We obtained 94 isolates from 276 children; median age 3.4 years. The majority (57%) had symptoms of acute respiratory infection at the time of sampling. The main serotypes carried were 6B (20.5%), 19F (14.5%), and 14 (8.4%). Non-typable isolates accounted for 10.8% of the isolates. Fifty-nine per cent of the serotypes were present among the 11 being considered for candidate pneumococcal conjugate vaccines (95% CI 48-70%); the corresponding proportion present in the recently licensed 7-valent vaccine was 57% (95% CI 45-67%). A significant proportion of the serotypes found is absent from those to be included in future conjugate vaccines (P<0.0001; reference=85% expected serotype representation). Less than 5% of isolates were non-susceptible to penicillin (3.2%), cefotaxime-ceftriaxone (3.2%) and cefuroxime (3.2%), while 8.4% and 1.l% of isolates were resistant to trimethoprim-sulfamethoxazole and erythromycin respectively. There were three isolates with resistance to two or more classes of drug. These isolates were all resistant to penicillin (MIC 2 micro g/mL); the serotypes were 14, 23F, and 19F. CONCLUSION: A significant proportion of the serotypes found is absent from those to be included in future conjugate vaccines. (+info)
Growth, behaviour, and educational achievement of Jamaican children with sickle-cell trait.
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A longitudinal study of the mental and physical development of 200 children with normal haemoglobin and 21 with the sickle-cell trait was carried out in a small rural community in Jamaica. At about 2 and 10 years of age heights and weights showed no significant differences. At about 10 years of age classroom behaviour, sociability, and educational achievement were similar. The results suggest that the sickle-cell trait does not affect growth and mental development. (+info)
Income, education, and blood pressure in adults in Jamaica, a middle-income developing country.
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BACKGROUND: At present, little is known about how socioeconomic status (SES) is related to blood pressure (BP) and hypertension in developing countries. This cross-sectional study examined associations between SES and BP in 2082 adults from a peri-urban area of Jamaica, a middle-income developing country. METHODS: Hypertension (systolic BP >/=140 mmHg, diastolic BP >/=90 mmHg or current hypertensive medication use) was estimated based on self-reported medication use and the mean of the second and third of three manual BP measurements. Income and education were self-reported. Linear or logistic regressions were used to estimate multivariate associations between BP or hypertension and SES. RESULTS: Hypertension prevalence was 20% in men and 28% in women. In both men and women, the income distributions of BP and hypertension were non-linear, indicating elevated levels in low as well as in high-income groups. In contrast to the negative relationships typical for industrialized countries, multivariate-adjusted BP and hypertension were highest in the wealthiest women. In men with some high school education, income was positively associated with BP, while there were negative associations in men with lesser education. Unlike women, mean BP were highest in poor men with limited education. Low SES men were also least likely to receive diagnosis and treatment. CONCLUSIONS: Socioeconomic status is related to BP and hypertension in Jamaica, although relationships are non-linear. Behavioural and environmental factors that explain elevated BP among both low and high SES adults in developing countries must be identified to develop effective prevention strategies. (+info)
Behcet's disease in patients of west African and Afro-Caribbean origin.
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AIM: To report the presence of Behcet's disease with ocular involvement in patients of west African or Afro-Caribbean origin. METHODS: Case series of eight patients reporting to a tertiary uveitis service. RESULTS: Eight patients with typical features of the disease are presented. Six of the eight patients were tested and found to be HLA-B51 negative. CONCLUSION: Behcet's disease has only been reported in sporadic case reports in the indigenous west African and Afro-Caribbean populations, in whom the incidence of HLA B51 is also very low. A series of patients from the London region presented with the typical symptoms and signs of disease, most of whom were also HLA B51 negative. The presence of disease in this population, when absent in the indigenous population, suggests either that ascertainment of disease is poor in the indigenous population or that acquired factors may be important in the aetiology of the disease. (+info)