Brendan C Bain

SOCIAL AND HEALTH DETERMINANTS OF WELL BEING AND LIFE SATISFACTION IN JAMAICA

Background: Psychological well being and the degree of satisfaction with life are likely to affect a range of social behaviours and determine uptake of health and social services. It is important to identify the factors that inform these constructs. Aims: We sought to identify the variables which best predicted psychological well being in the Caribbean country, Jamaica and also those associated with feelings of satisfaction with life. Methods: Interviews were conducted on young adults aged 15–50 years as part of a sexual decision-making survey in Jamaica. Information was collected on a range of social, health and demographic variables and a measure of psychological well being – Centre for Epidemiological Studies of Depression (CES-D). Satisfaction with life was measured using a Likert scale in response to the question ‘Are you satisfied with your life as a whole?’ Multiple regression analyses were used to determine the predictors of psychological well being and satisfaction with life. Results: There were 2580 respondents (1601 women and 979 men). The mean age was 29.7 years (standard deviation 9.2 years). Women had lower levels of psychological well being and satisfaction with life. Independent predictors of lower psychological well being were having an acute illness, having a chronic illness in women and high religious behaviour in men. Satisfaction with life was predicted by younger age, marital status and employment. Conclusions: Our findings suggest that health variables are more important for psychological well being while social circumstances are more significant for satisfaction with life. There are important gender differences in the mediation of psychological well being as well as age differences in the variables associated with satisfaction with life.

Working women's sexual risk taking in Jamaica

Although the rates of HIV are increasing among female populations in developing countries, there is little information available about factors influencing sexual risk taking among working class women. This paper describes some of the issues discussed by two groups of 58 women working in Jamaica: Informal Commercial Importers and women working in the Freezone. These women discuss their economic vulnerability, expectations about the role of men as providers, multiple partners, perceptions of children as resources and concern about physical abuse as factors that could influence decisions about condom use. The implications of these findings are discussed for their impact on intervention programs targeting working class women in Jamaica.

Household food safety awareness of selected urban consumers in Jamaica.

Home interviews of 110 randomly selected householders representing three distinct socio-economic groups in North Central St Andrew, an urban community in Jamaica, were conducted during January-March 1999. Respondents were interviewed about their awareness of safe food handling, risk perception, food handling practices and attitude to food safety issues. The majority of respondents reported a fairly high knowledge of safe food handling practices; however, more than one-half were unfamiliar with the correct procedure for freezing and thawing of foods. Householders were very concerned about the food they purchased for preparation at home, displayed strong concerns about sanitation of food handling establishments, food handlers practices, and the appearance of foods purchased. The majority of respondents had never contacted their local Health Department or the Ministry of Health regarding food safety concerns. Diarrhea, stomach pain, vomiting and nausea were reported as the major symptoms of food-borne illness, while animal foods including dairy, beef, chicken, pork and fish/shellfish were implicated as the main source of food borne illnesses. There were no significant differences (P<0.5) observed between gender and socio-economic groups in the study, except for concern of the appearance of food and shopping options, respectively. These findings raise concerns about consumer food safety knowledge and practices in Jamaica. It is suggested that a national knowledge, awareness and practices survey should be conducted, followed by a properly designed food safety public education campaign, to enhance household food safety awareness in Jamaica.

Comparison of testing saliva and serum for detection of antibody to human immunodeficiency virus in Jamaica, West Indies

BACKGROUND In Jamaica the reported incidence of AIDS increased from 0.1/100000 in 1985 to 20.2/100000 in 1995. Here there is great reluctance to have voluntary blood testing and, indeed, any blood testing. Since only enzyme-linked immunoassay (EIA) was available for screening serum HIV-1 and 2 antibody, it was considered that a non-invasive saliva screening EIA could be an advantageous alternative. OBJECTIVE this study was designed to evaluate the OraScreen HIV Rapid Test, a new, simple saliva screening EIA for anti-HIV-1&2 and to compare its sensitivity and specificity with a standard serum anti-HIV screening EIA in current use in Jamaica. STUDY DESIGN specificity and sensitivity of HIV antibody assays were compared in matched serum and saliva samples obtained from 257 volunteers from a family planning clinic and from visa applicants, representing a low risk population (Group I), and from 52 volunteers known to be HIV infected (Group II). RESULTS in Group I, 257 volunteers of unknown HIV status, one was positive for anti-HIV-1 in both serum and saliva. One other was seropositive but negative on saliva testing; confirmatory Western Blot (WB) testing on this serum was negative and this subject was tabulated as blood HIV negative. Fifty-one of the known seropositive volunteers (Group II) were saliva antibody positive. One saliva sample was inadequate and this individual was excluded from the study. Serum samples from three others in Group II were grossly haemolysed but their saliva samples were antibody positive. CONCLUSION With the exclusion of one subject whose saliva sample was inadequate, the OraScreen HIV Rapid Test showed 100% specificity identifying 256/256 HIV antibody negative individuals, and 100% sensitivity by identifying 52/52 infected individuals as HIV antibody positive.

Human immunodeficiency virus type-1 (HIV-1) subtypes in Jamaica

The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0%); one (0.8%) isolate each of subtypes C, D and E was found and 7 (4.9%) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.

Pyrexia of unknown origin: a case of uterine leiomyosarcoma

Uterine leiomyomata (fibroids) are relatively common in Jamaica (Lawson & Stewart 1974); at the University Hospital in Jamaica, Persaud & Knight (1968) have reported a prevalence of 0.42% for sarcomatous changes within uterine leiom yomata. This report describes a patient who was found to have a leiomyosarcoma in a fibroid uterus. The case is unusual because the patient’s presenting complaint was fever without symptoms referrable to the genital tract.