Tazhmoye Crawford

Prostate Cancer and Metabolic Syndrome: Is there a link?

Metabolic syndrome has become quite prevalent within our society. Over the past two decades, the prevalence of metabolic syndrome has sharply increased worldwide and it has become a major public health problem in several countries. It is associated with the global epidemic of obesity and diabetes mellitus and imposes numerous cardiovascular risks. Prostate cancer is the second most common cancer among men, surpassed only by non-melanoma skin cancer. A considerable body of evidence exists suggesting that some components of the metabolic syndrome have been associated with the risk of prostate cancer. These components include obesity, an abdominal fat distribution, and hyperinsulinemia. Androgen deprivation therapy (ADT) is the most widely used therapeutic modality in prostate cancer. It changed the body composition and lipid profile of men with prostate cancer. Androgen deficiency is associated with increased levels of total cholesterol, low-density lipoprotein (LDL)- cholesterol, increased production of proinflammatory factors, and increased thickness of the arterial wall and contributes to endothelial dysfunction. The aim of this review is to evaluate the association between metabolic syndrome and prostate cancer and to discuss the implications of androgen deficiency in men with cardiovascular risk factors. A comprehensive literature search was carried out with the use of PubMed from 1980 through 2012, and relevant articles pertinent to metabolic syndrome and prostate cancer are evaluated and discussed.

PREVALENCE OF INJURIES AND REPORTING OF ACCIDENTS AMONG HEALTH CARE WORKERS AT THE UNIVERSITY HOSPITAL OF THE WEST INDIES

OBJECTIVES This study investigated the knowledge, awareness and practices of health care workers towards universal precautions at the University Hospital of the West Indies. The study also examined the prevalence of injuries experienced by health care workers, as well as incidence of accidents and compliance with post-exposure prophylaxis. MATERIALS AND METHODS A cross sectional survey was conducted in September and October 2007. A 28-item self-administered questionnaire was provided to two hundred health care workers including medical doctors, medical technologists, nurses and porters to assess knowledge and practices regarding universal precautions, prevalence of injuries and incidence of accidents. RESULTS Almost two-thirds (62.3%) of the respondents were aware of policies and procedures for reporting accidents while one-third (33.2%) were unsure. All nurses were aware of policies and procedures for reporting accidents, followed by medical doctors (88%) and medical technologists (61.2%). The majority (81.5%) of the respondents experienced splashes from bodily fluid. Over three-quarters of medical doctors (78%) and two-thirds of nurses (64%) reported having experienced needle stick injuries, while the incidence among medical technologists was remarkably lower (26%). The majority of the respondents (59%) experienced low accident incidence while just over one-tenth (14%) reported high incidence. Eighty four respondents reported needle stick injuries; just under two-thirds (59.5%) of this group received post-exposure treatment. CONCLUSIONS The study found that majority of health care workers were aware of policies and procedures for reporting accidents. Splashes from body fluids, needle stick injuries and cuts from other objects were quite prevalent among health care workers. There is a need for monitoring systems which would provide accurate information on the magnitude of needle stick injuries and trends over time, potential risk factors, emerging new problems, and the effectiveness of interventions at The University Hospital of the West Indies and other hospitals in Jamaica.

Decomposing Mortality Rates and Examining Health Status of the Elderly in Jamaica

Population ageing in Jamaica follows a global trend where the number of persons aged 60 and over is increasing. This study investigated age-specific death rates, mortality sex ratio and health status of the elderly in Jamaica aged 55 years and over. The study utilized secondary data published by the Statistical Institute of Jamaica on mortality and secondary cross-sectional probability survey data were used to model poor health status in elderly residents. The findings revealed that there is increased life expectancy. In 2005, the age-specific mortality rate for elderly 75 years and older was 4.4 times more than that of the crude death rate for the population; 9.4 times more than that of age-specific death rate at ages 55 to 59 years and that disparity narrows at the elderly gets older. The mortality sex ratio revealed that between 115 to 120 males die for every 100 females. More men die between the ages of 55 and 75, than men 75 years and older. As Jamaicans become older than 55 years their poor health status significantly increased. Poor health status was accounted for significantly by hypertension, diabetes mellitus, and arthritis. Eight factors determine poor health status of elderly Jamaicans. Some of these factors are retirement income (OR = 1.461, 95%CI:1.001, 2.131); cost of medical care (OR = 1.144, 95%CI = 1.073, 1.220); area of residence (other towns - OR = 0.754, 95%CI = 0.597, 0.953); marital status (separated - OR = 1.901, 95%CI = 1.479, 2.445; married - OR = 1.406, 95%CI = 1.103, 1.792); education (secondary - OR = 1.206, 95%CI = 1.001, 1.451; tertiary level education - OR = 0.492, 95%CI = 0.281, 0.861), and number of men in household (OR = 0.987, 95%CI = 0.806, 0.998). This study provides valuable information about the mortality rates and health status of elderly residents in Jamaica. High mortality rates for avoidable and preventable diseases and potential years of life lost are major public health concerns, especially for regional healthcare providers.

Health literacy and health seeking behavior among older men in a middle-income nation

Health literacy is a measure of the patient’s ability to read, comprehend and act on medical instructions. This research article examines health literacy and health-seeking behaviors among elderly men in Jamaica, in order to inform health policy. This is a descriptive cross-sectional study. A 133-item questionnaire was administered to a random sample of 2,000 men, 55 years and older, in St Catherine, Jamaica. In this study, 56.9% of urban and 44.5% of rural residents were health literate. Only 34.0% of participants purchased medications prescribed by the medical doctor and 19.8% were currently smoking. Despite the reported good self-related health status (74.4%) and high cognitive functionality (94.1%) of the older men, only 7.9% sought medical care outside of experiencing illnesses. Thirty-seven percent of rural participants sought medical care when they were ill compared with 31.9% of their urban counterparts. Thirty-four percent of the participants took the medication as prescribed by the medical doctor; 43% self-reported being diagnosed with cancers such as prostate and colorectal in the last 6 months, 9.6% with hypertension, 5.3% with heart disease, 5.3% with benign prostatic hyperplasia, 5.3% with diabetes mellitus, and 3.8% with kidney/bladder problems. Approximately 14% and 24% of the participants indicated that they were unaware of the signs and symptoms of hypertension and diabetes mellitus, respectively. The elderly men displayed low health literacy and poor health-seeking behavior. These findings can be used to guide the formulation of health policies and intervention programs for elderly men in Jamaica.

Access to contraception by minors in Jamaica: a public health concern

Background: Access to contraceptive by minors (pre-adolescents and adolescents) has spurred policy and legislative debates, part of which is that in an effort to successfully meet governments objective of a healthy sexual lifestyle among minors. Aims: This study examined factors affecting sexual reproductive health in minors, namely: access to contraceptive advice and treatment, pregnancy, number of sexual partners, sexually transmitted infections (STIs) and confidentiality. Materials and Methods: This research involved quantitative and qualitative data. Two hundred and thirty eight sexually active cases were investigated in Jamaica by the researchers, during the period 2006-2007. The age group population was 9-11, 12-14, and 15-17. Results: The study showed that access to contraceptive advice and treatment by minors was more favorable to males than females. The difference in access to contraceptive between male and female was statistically significant (x2 = 20.16, p<0.05). Of the 80 male respondents, who are contraceptive users, 11 encountered challenges in legitimately accessing contraceptive methods, while 38 of the 40 female users also encountered challenges. This resulted in unintended pregnancies and impregnation (33.2%), as well as the contracting of STIs (21%). Conclusion: The findings of this study will be important in informing the development of reproductive health services and family life education programs for pre-adolescents and adolescents in Jamaica and other Caribbean countries.

Tobacco-Related Chronic Illnesses: A Public Health Concern for Jamaica

BACKGROUND Tobacco use is a leading cause of preventable morbidity and mortality from non-communicable diseases. The objectives of the study were to determine the percentage of annual income used to purchase tobacco-related products and treat tobacco-related illnesses, and assess the characteristics of smokers and their awareness of the health-related risks of smoking. METHOD Stratified and snowball sampling methods were used to obtain information (via a 17-item, close-ended questionnaire) from 85 adult respondents (49 males and 36 females). The instrument comprised of demographic characteristics, smoking behavioural/lifestyle, health, and micro socio-economics. RESULTS There were no significant differences between individuals who were affected by chronic obstructive pulmonary disorder (COPD) (14.1%) and cardiovascular disease (18.8%). It was found that respondents spend 30-39% of their annual income on tobacco-related products. Forty percent (40.0%) and 41.7% of respondents with lung cancer and COPD respectively spend more than 50% of their annual income to treat these diseases. The majority (80%) of those who continues to consume tobacco-related products were uncertain as to why they were doing it. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. CONCLUSION The majority of the respondents who had tobacco-related illnesses such as lung cancer and COPD spend a significant amount of their income on their health care. Not all the smokers were aware of the dangers of tobacco consumption despite their level of education. This suggests the need for increase public awareness where both smokers and non smokers are being fully or adequately informed about the dangers or health risks of tobacco consumption.

LIPID PROFILE AND CLINICAL CHARACTERISTICS OF WOMEN WITH GESTATIONAL DIABETES MELLITUS AND PREECLAMPSIA

Lipid Profile and Clinical Characteristics of Women with Gestational Diabetes Mellitus and Preeclampsia Gestational diabetes mellitus (GDM) is associated with increased risk of pregnancy-induced hypertension and other maternal and foetal complications of pregnancy. The aims of the study were to evaluate the serum lipid profile of women with GDM, and determine the number of women with GDM who have preeclampsia (PE). A retrospective study of 84 women with GDM and 90 pregnant women with normal glucose tolerance (controls) was conducted. Women with GDM had significantly higher parity (p=0.047), total cholesterol (p=0.039) and triglycerides (p=0.033), but non-significantly lower HDL-cholesterol (p=0.086) when compared to controls. Systolic blood pressure was significantly elevated in women with GDM coupled with PE (GDM-PE; p=0.015), the mean birth weight of infants born to women with GDM-PE was significantly lower than that of women with only GDM (p=0.025). Women with GDM-PE had significantly higher triglycerides (p=0.020), had to be more multi-gravida (p=0.047) with significantly elevated VLDL-cholesterol (p=0.037) when compared with women with only GDM. 11.9% of women with GDM had PE. On the basis of these findings, it can be concluded that GDM is associated with hyperlipidaemia as evident by the significantly elevated total cholesterol and triglyceride concentrations. Women with dyslipidaemia and GDM are at risk of developing preeclampsia. It is imperative that blood lipids be evaluated in women with GDM during antenatal care as it would be helpful in the early detection and treatment of PE. Lipidski Profil I Kliničke Karakteristike Žena SA Gestacionim Dijabetes Melitusom I Preeklampsijom Gestacioni dijabetes melitus (GDM) povezan je sa povećanim rizikom od hipertenzije izazvane trudnoćom i drugih komplikacija trudnoće kod majke i fetusa. Ciljevi studije bili su da se odredi lipidski profil žena sa GDM, i utvrdi broj žena sa GDM koje imaju PE. Sprovedena je retrospektivna studija 84 žene sa GDM i 90 trudnica sa normalnom tolerancijom glukoze (kontrola). Žene sa GDM imale su značajno povišen paritet (p=0,047), ukupni holesterol (p=0,039) i trigliceride (p=0,033), ali i neznačajno niži HDL-holesterol (p=0,086) u poređenju sa kontrolom. Sistolni krvni pritisak bio je značajno povišen kod žena sa GDM u kombinaciji sa PE (GDM-PE; p=0,015), a prosečna težina novorođenčadi koju su rodile žene sa GDM-PE bila je značajno niža nego kod žena sa GDM (p=0,025). Žene sa GDM-PE imale su značajno povišene trigliceride (p=0,020), i sklonije su većem broju trudnoća (p=0,047) uz značajno povišen VLDL-holesterol (p=0,037), u poređenju sa ženama samo sa GDM. 11,9% žena sa GDM imalo je PE. Na osnovu tih nalaza može se zaključiti da je GDM povezan sa hiperlipidemijom, što se vidi iz značajno povišenih ukupnih koncentracija holesterola i triglicerida. Kod žena sa dislipidemijom i GDM postoji rizik od razvoja preeklampsije. Veoma je važno određivati lipide u krvi žena sa GDM u okviru prenatalne zaštite jer to pomaže ranom otkrivanju i lečenju PE.

Current use of contraceptive method among women in a middle-income developing country

Background: Jamaica is a mid-range income developing country with an increasing population and public resource constraints. Therefore reproductive health issues are of critical importance in Jamaica. Aim: We examined the use of contraceptives among women and the factors that influence these women to use contraceptives. Materials and method: In the current study we utilized the secondary dataset for the Reproductive Health Survey conducted by the National Family Planning Board. The investigation was carried out with a stratified random sample of 7168 women aged between 15 and 49. The measures included demographic variables method of contraception used being in a relationship number of partners pregnancy status and sexual activity status along with other variables. Results: The majority of participants used some method of contraception (64%). The most popular method of contraception was a condom (32%). Results of a multivariate analysis suggests that the explanatory variables for the method of contraception used are age (OR = 0.98 95% CI: 0.98-0.99) social class (OR = 0.83 95% CI: 0.73-0.95) being in a relationship (OR = 3.35 95% CI: 2.80-4.02) the rural-urban dichotomy (OR = 1.16 95% CI: 1.02-1.32) being currently pregnant (OR = 0.01 95% CI: 0.00-0.02) currently having sex (OR = 2.29 95% CI: 1.95-2.70) number of partners (OR = 1.85 95% CI: 1.57-2.17) the age at which the women began using a contraceptive (OR = 0.99 95% CI: 0.98-1.00) and crowding (OR = 1.40 95% CI: 1.21-1.60). Conclusion: The findings are far-reaching and can be of use for aid policy formulation and intervention.

Examining health status of women in rural, peri-urban and urban areas in Jamaica

Background: A comprehensive review of the literature revealed that less information is available in literature on health status of women, and health status of women in 3 geographical zones in Jamaica. Aims: This study examined data on the health status of women in Jamaica in order to provide some scientific explanation of those factors that account for their health status; and differences based on area of residence. Materials and Methods: The sub-sample for the current study was 8,541 women ages of 15 and 100 years extracted from a national survey of 25,018 respondents. Stratified random sampling technique was used to draw the sample. Data were stored, retrieved and analyzed using SPSS 16.0. Descriptive statistics were used to provide background information on the subsample, and logistic regressions were utilized to model health statuses. Results: Rural women had the lowest health status (OR = 0.819, 95% CI = 0.679-0.989) among all women (peri-urban OR = 1.054, 95% CI = 0.842-1.320; urban OR = 1.00) and that they were the least likely to have health insurance coverage. Health insurance was the critical predictor of good health status of women in Jamaica, and this was equally the same across the 3 geographic areas; and that married women were 1.3 times more likely (OR 1.3, 95 CI = 1.036-1.501) to report good health compared to those who were never married. Conclusion: This study provides an understanding of womens health status in Jamaica as well as the disparity which correlates based on the different geographical regions.

Epidemiological Features of violence-related Injuries in Jamaica.

BACKGROUND Violence-related injuries are common in Caribbean countries such as Jamaica and are a major cause of mortality and morbidity. The study examined the epidemiology of violence-related injuries and ascertained the extent to which the utilization of violence-related injury reports and surveillances inform health policy and programme planning implementation in Jamaica. MATERIALS AND METHODS Primary data was gathered by the Ministry of Health through its Public Hospital Monthly Statistical Reporting System (HMSR) and the Jamaica Injury Surveillance System (JISS). These data files were collected over a four and five year period respectively. The sample size comprised 187,610 cases (117,615 from HMSR) and (69,995 from JISS) which were seen and treated at the public hospitals in Jamaica because of violence-related injuries. This study employed a descriptive analysis of visits and cases (episodes) relating to violence-relating injuries. Simple random sampling method was used in this study and the data was analysed using both Microsoft Excel and the Statistical Package for Social Scientists 18.0. RESULTS The highest number of violence-related injuries was in 2007 and assault (stab wounds, gunshot and blunt injury) was the most frequent violence-related injury with human bites, and burns being the least. The highest number of violence-related injuries in males and females was in the age group 20-29 y. More males experienced violence-related injuries compared with females with male to female ratio of 1.35:1 to 1.45:1 in the years considered. CONCLUSION The findings of this study are consonant with local and international studies and confirm that assault was the most frequent violence-related injury. Males compared with their female counterparts are a stronger demographic risk factor where violence-related injuries are concerned. Violence-related injuries have spurred the charge for effective interventions, policy initiatives, and strategic and programme planning by the Ministry of Health, through multi-sectoral and multi-agency approaches in Jamaica.