Ernest J Pate

Adolescent Health in the Caribbean: Risk and Protective Factors

OBJECTIVES This study sought to identify, among youths, factors associated with characteristics such as poor health status, substance use, and suicide risk and to explore the extent to which the risk and protective factors identified cut across health-compromising behaviors. METHODS A survey was administered to representative samples of young people from 9 Caribbean countries. RESULTS Physical/sexual abuse and having a friend or relative who had attempted suicide were associated with an increased prevalence of health-compromising behaviors. Connectedness with parents and school and attendance at religious services were associated with fewer health risk behaviors. CONCLUSIONS When the identified risk and protective factors were compared with those seen among young people in the United States, similarities as well as important differences were found.

Adolescent Health in the Caribbean: A Regional Portrait

OBJECTIVES This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. METHODS We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others. RESULTS Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse. CONCLUSIONS Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.

Human T cell lymphotropic virus type I-associated infective dermatitis in Jamaica: a case report of clinical and biologic correlates

Infective dermatitis was first characterized in Jamaican children as an exudative and crusting eczema (involving the nostrils, ears and scalp) with frequent relapse after treatment. 2 In 1990 a case series of infective dermatitis from Jamaica provided the first link with early life infection with human T cell lymphotropic virus type I (HTLV-I). A subsequent casecontrol study confirmed this association and established criteria for diagnosis of HTLV-I-associated infective dermatitis. The diagnostic criteria include HTLV-I seropositivity; eczema of at least two of seven sites (scalp, external ear, retroauricular areas, eyelid margins, paranasal skin and/or neck, axillae, groin); chronic watery nasal discharge without other signs of rhinitis and/or crusting of the anterior nares; and either early childhood onset or chronic relapsing dermatitis. The prevalence of HTLV-I in the general population of Jamaica is 6.1%, and among women of reproductive age it is 3.8%. 6 In Jamaica maternalchild transmission occurs at a rate of 18%, is primarily through breast-feeding and results in a HTLV-I prevalence of ,2% among children younger than 10 years of age. 6 Cases of infective dermatitis in HTLV-Iinfected children have also been reported in Japan, Brazil, Colombia and Trinidad. Infective dermatitis is the earliest disease manifestation of HTLV-I infection in children, whereas adult T cell leukemia/lymphoma and HTLV-I-associated myelopathy/tropical spastic paraparesis and HTLV-Iassociated uveitis occur primarily among adults. Linking these childhood and adult diseases are reports that patients with adult T cell leukemia/lymphoma and those with HTLV-I-associated myelopathy/tropical spastic paraparesis had been diagnosed with infective dermatitis 12 to 25 years earlier. 12, 13 Thus infective dermatitis in childhood may be a harbinger of HTLVI-associated diseases in adult life. In this report we describe an infective dermatitis case that arose among 28 HTLV-I-infected Jamaican children prospectively followed for up to 9 years to elucidate events leading to the onset of disease and to identify potential markers for persons at risk for HTLV-I-associated disease in adulthood.