Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were ‘personal strain’, ‘social relations disruption’, ‘resource strain/imbalance’ and ‘role intensity’. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.     

Cross-generational relationships in rural Jamaica

In keeping with trends in the most affected regions of the world, Jamaican young women are at greater risk of becoming infected with HIV than their male peers. Cross-generational relationships (CGRs), or sexual relationships between younger females and older men, have been reported as contributing to this increased risk. Utilizing a qualitative research design, this study aimed to (1) delineate the context in which CGRs occurred in some rural communities in Jamaica and (2) investigate the sexual risk behaviors that occurred in these relationships. The results indicated that young women engaged in these relationships for three main reasons: economic gain, status, and emotional support. At the intrapersonal, interpersonal, and community levels based on the social ecological model, findings also highlighted various factors which facilitated the occurrence of these relationships in some rural communities, including the transactional nature of the relationships, as well as family knowledge and encouragement. The results also highlighted the occurrence of sexual risk behaviors, such as multiple concurrent partnerships and lack of consistent condom use, which may increase young girls' risk of exposure to HIV and other sexually transmitted infections (STIs). This study's findings are consistent with previous research and underscore the challenges faced by intervention planners when promoting safe sex.     

The nutritive adequacy of some Nigerian peasant diets

The nutritive values of six traditional diets of the people of South‐Eastern Nigeria have been evaluated. A bioassay procedure was used; it involved the measurement of Biological Value, True Digestibility of the dietary nitrogen, Net Protein Utilization (operative) and Net Dietary Protein Calories Percent (NDpCals%). The procedures were applied to diets cooked as for human consumption, then dried and fed unmodified to male weaning albino rats. The results showed that in all cases the digestibility of the dietary nitrogen was high but the nutritive value was significantly low. These results are discussed and compared with the FAO recommended practical allowances for NDpCals% for various physiological ages and states.     

Atrial flutter. Electrocardiographic,vectorcardiographic and echocardiographic correlation

The duration, contour, and amplitude of atrial flutter wave (f) was studied by electrocardiogram (ECG) and vectorcardiogram (VCG) in 32 patients and was related to the size of the left atrium (LA) measured by the echocardiogram (E). The following ECG parameters were analyzed: (1) the duration of left atrial depolarization, i.e., LA wave; (2) the amplitude of LA wave; (3) the surface area of LA wave; (4) maximum amplitude (A) of f in Leads 2 and V₁. There was good correlation between LA size and the duration of depolarization and surface area (p < 0.01), but the maximum amplitude of the f wave in Leads 2 and V₁ failed to predict LA size.The post-conversion sinus P wave showed abnormal LA depolarization time (P > 0.12 sec.) in 62 per cent of patients with enlarged left atrium (ELA) and in 43 per cent of patients with normal size LA (NLA).The VCG of the flutter wave revealed two patterns, (1) an eliptical smooth fsÊ loop in 63 per cent of patients with NLA, and (2) distorted fsÊ loop in 67 per cent of patients with ELA.Both VCG patterns were subdivided in two subgroups according to the number and location of conduction delays. The VCG of post-conversion P wave confirmed conduction delays in both groups.We conclude that both the size of the left atrium and conduction delays play a basic role in the duration and contour of left atrial wave.     

Exploring how teachers teach literacy at grade one in Jamaica: a pilot study of three classrooms

ABSTRACT

This paper presents preliminary findings about how literacy is taught at the elementary level in three grade-one classrooms in Jamaica. While this might seem rudimentary, there is a dearth of information in Jamaica about how teachers teach reading and writing. We attempted to fill this gap by conducting an exploratory small-scale qualitative case study. Interviews and classroom observations were conducted to obtain a snapshot of teachers’ literacy practices in order to explore how teachers teach reading and writing in grade-one classrooms. Three themes emerged from the data. The findings illustrated that while teachers were working to create engaging classroom environments, they tended to adopt a reading readiness orientation to literacy. Also, while teachers valued the children’s home language, they were ambivalent about how to teach literacy in a Creole-speaking environment. The study represents a first step in learning about the teaching practices of grade-one teachers in Creole-speaking environments.     

Role of fruits,grains, and seafood consumption in blood cadmium concentrations of Jamaican children with and without Autism Spectrum Disorder

Human exposure to cadmium has adverse effects on the nervous system. Utilizing data from 110 age- and sex-matched case–control pairs (220 children) ages 2–8 years in Kingston, Jamaica, we compared the 75th percentile of blood cadmium concentrations in children with and without Autism Spectrum Disorder (ASD). In both univariable and multivariable Quantile Regression Models that controlled for potential confounding factors, we did not find any significant differences between ASD cases and typically developing (TD) controls with respect to the 75th percentile of blood cadmium concentrations (P > 0.22). However, we found a significantly higher 75th percentile of blood cadmium concentrations in TD Jamaican children who consumed shellfish (lobsters, crabs) (P < 0.05), fried plantain (P < 0.01), and boiled dumpling (P < 0.01). We also observed that children living in Jamaica have an arithmetic mean blood cadmium concentration of 0.16 μg/L which is similar to that of the children in developed countries and much lower than that of children in developing countries. Although our results do not support an association between blood cadmium concentrations and ASD, to our knowledge, this study is the first to report levels of blood cadmium in TD children as well as those with ASD in Jamaica.     

Seizures in the Jamaica cohort study of sickle cell disease

Although there is some evidence that epilepsy is more common in Sickle Cell Disease (SCD), we sought to establish the incidence rates, risk factors for and specific types of seizures in a SCD cohort followed from birth, and how seizure occurrence affects morbidity and mortality . We examined all records of persons in the Jamaica cohort Study of Sickle Cell Disease (JSSCD) clinically identified as having experienced a seizure during their lifetime. At first presentation, seizures were classified as Febrile Convulsion, Acute Symptomatic Seizure or Single Unprovoked Seizure. The seizure classification was revised to include Epilepsy if seizures recurred. Thirty‐eight persons in the JSSCD (N = 543) were identified with seizures. The 5‐year cumulative incidence of febrile convulsions was 2·2%. The incidence rate of epilepsy (all genotypes) was 100/100 000 person‐years, 139/100 000 for the SS genotype. Despite limited availability of diagnostic investigations, clinical seizures were associated with increased all‐cause mortality. Male gender (Odds Ratio [OR]: 4·0[95% confidence interval [CI]; 1·03–20·0]) and dactylitis in childhood (OR: 17·4 [95% CI; 4·82–62·85]) were associated with increased risk of developing epilepsy. Epilepsy in persons with SCD is 2–3 times more common than in non‐sickle populations and is associated with increased all‐cause mortality in all sickle cell genotypes.     

Recurrent ovarian carcinoma: retreatment utilizing combination chemotherapy including cis-diamminedichloroplatinum in patients previously responding to this agent

Eleven women with advanced ovarian cancer treated postoperatively with combination chemotherapy (cytoxan, hexamethylmelamine, Adriamycin, and cis-platinum) had disease-free intervals of 5 to 46 months (mean: 22 months) and subsequently developed recurrent carcinoma. Each patient was then retreated with combination chemotherapy which included cis-platinum. There was a 72% response rate to retreatment (36% complete, 36% partial). These overall and complete remission rates are comparable to those of platinum-based combination chemotherapy in patients without prior treatment. Those patients who responded to retreatment had a significantly longer mean survival rate than those who did not.