Behaviour and Development of Stunted and Nonstunted Jamaican Children

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.     

Common genetic variants and risk for non‐Hodgkin lymphoma and adult T‐cell lymphoma/leukemia in Jamaica

We evaluated whether risk of non‐Hodgkin lymphoma (NHL), particularly adult T‐cell leukemia/lymphoma (ATL) related to human T‐lymphotropic virus (HTLV) infection was associated with 63 single nucleotide polymorphisms (SNPs) from 38 candidate genes. The 395 NHL cases registered in Jamaica were matched by age, sex, calendar‐year and HTLV serostatus to 309 controls from the same population. Interleukin 13 (IL13) Ex4+98A>G SNP (rs20541) was associated with decreased NHL risk (OR_AG/AA = 0.62,95% CI = 0.44–0.87, p = 0.006), as was vascular cell adhesion molecule‐1, VCAM1 Ex9+149G>A SNP (rs1041163) (OR_CT = 0.77, 95% CI = 0.54–1.10, OR_CC=0.35, 95% CI = 0.16–0.76, p‐trend = 0.007). Both results were stronger in analyses restricted to ATL cases and HTLV‐positive controls, suggesting a role for these genes in ATL etiology (IL13 OR_AG/AA = 0.54, 95% CI = 0.36–0.84, p = 0.005; VCAM1 OR_CT = 0.65, 95% CI = 0.42–1.01, OR_CC = 0.20, 95% CI = 0.08–0.54, p‐trend = 0.001). Confirmation of these results in Caribbean and other populations is needed. © 2009 UICC     

Epidemiologic transition in maternal mortality and morbidity: new challenges for Jamaica.

OBJECTIVE: Given interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998-2003. METHOD: Records of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes. RESULTS: Maternal mortality declined (p=0.023) since surveillance began in 1981-83. The fall in direct mortality (p=0.0003) included 24% fewer hypertension deaths (introduction of clinical guidelines, reorganization of antenatal services) and 36% fewer hemorrhage deaths (introduction of plasma expanders). These improvements were tempered by growing indirect mortality (p=0.057), moving to 31% of maternal deaths from 17% in 1993-95. INTERPRETATION: Declines in direct mortality may be associated with surveillance and related improvements in obstetric care. Increased indirect deaths from HIV/AIDS, cardiac disease, sickle cell disease and asthma suggests the need to improve collaboration with medical teams to implement guidelines to care for pregnant women with chronic diseases.     

Using the teach-back method to increase maternal immunization literacy among low-income pregnant women in Jamaica: a pilot study

The purpose of this pilot study was to assess maternal health literacy of pregnant women in Jamaica and evaluate their ability to communicate the benefits, risks, and safety of the Bacillus Calmette-Guerin (BCG) and Hepatitis B (hep B) vaccines after using the teach back method. REALM scores were moderately, positively correlated with identification of the BCG vaccine risks (r = .43, p = .01) and with hep B vaccine benefits (r = .34, p = .05) and risks (r = .42, p = .01). Women who gave incorrect responses about the benefits or risks of the vaccines had lower REALM scores than women who gave completely correct or partially correct responses.     

Quality of life of patients with epilepsy living in Kingston, Jamaica

Quality of life in epilepsy has not been documented in the English-speaking Caribbean. The aim of this study was to explore the quality of life of persons with epilepsy (PWE) living in Jamaica and determine the impact of socioeconomic factors by examining two socially distinct groups in semiprivate (Epilepsy Centre of Jamaica) and public (Kingston Public Hospital) outpatient clinics. One hundred nine consecutive patients were interviewed. Quality of life was assessed using the Quality of Life in Epilepsy-31 inventory (QOLIE-31). Both groups were matched for gender, epilepsy syndrome, epilepsy duration, and number of antiepileptic drugs. Predictors of quality of life included number of antiepileptic drugs (P=0.039), epilepsy duration (P<0.05), and functional status (P<0.001). Neither seizure frequency nor socioeconomic status predicted QOLIE-31 scores. Mean QOLIE-31 total score (61.57 vs 49.2, P<0.001) and QOLIE-31 subscale scores (with the exception of the Seizure Worry score [53.8 vs 48.2, P=0.08]) were significantly higher than the corresponding t scores. The QOLIE-31 can reliably be used in Jamaica. Our findings suggest Jamaicans living with epilepsy perceive themselves as having a better than expected quality of life.     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS‐related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS‐related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti‐stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

Book Reviews

Books reviewed:
J. S. La Fontaine Speak of the Devil: Tales of Satanic Abuse in Contemporary England
E. Schopler, G. B. Mesibov, & L. J. Kunce Asperger Syndrome or High-functioning Autism?
D. Kraijer Autism and Autistic-like Conditions in Mental Retardation
Laurence B. Leonard Children with Specific Language Impairment
G. Gorrell Barnes, P. Thompson, G. Daniel, & N. Burkhardt Growing Up in Stepfamilies     

Epidemiology of Sensorineural Hearing Loss

The paper is based on the author's epidemiological studies of sensorineural hearing loss in Ghana, Jamaica, Nigeria and the United Kingdom. Basically, the method has been one of direct examination of random or total samples. Such a study is more difficult than a study of conductive hearing loss because there is no qualitative difference between sensorineural hearing loss or of normal hearing. These epidemiological, studies therefore, resolve themselves into measuring the hearing levels of ears which have been otologically screened to exclude conductive hearing losses, calculating values for 'average' hearing levels and their dispersion and determining factors which appear to influence these levels.

Whereas in European and North American populations, noise and 'ageing' appear to be the only factors which influence these average values, in other populations, other factors emerge. In particular, there are dietary factors and the influence of systemic disorders becomes apparent.

The evidence from epidemiology is that sensorineural hearing loss can be considered to be not a collection of distinct disorders but one disorder with a multifactorial aetiology where causative factors may or may not interact with one another.