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Introduction Intrauterine devices are the most effective long-acting reversible contraceptives, but in many developing countries, such as Jamaica, these devices remain underutilized. Methods A cross-sectional informative intervention was conducted among women ≥ 18 years of age attending postnatal clinics in western Jamaica from May to August 2018. Data were collected using an investigator-administered questionnaire/pre-test followed by a 12-slide PowerPoint® presentation and a post-test. Results Most of the 299 women who participated were 18–29 years of age, with a mean age of 27.1 (SD ± 6.1) years. Most had their first pregnancy between ages 18 and 24 years, with mean age at first pregnancy of 20.2 (SD ± 4.0) years. Only 3.0% of participants reported current use of an intrauterine device; 3.5% reported using an intrauterine device in the past. For nearly every measure of knowledge of intrauterine devices, there was a significant change in the proportion of participants who got the correct answer from the pre-test to the post-test. The mean summed pre-test knowledge score was 9.54 (SD ± 3.46) and the post-test score was 15.23 (SD ± 1.92); the possible total score is 18. The difference between the mean scores (5.69 points) was also significant. Conclusion The intervention resulted in significant change in knowledge of intrauterine devices among the women and cleared up many misconceptions that may have contributed to reluctance of women to use intrauterine devices. Women of reproductive age in Jamaica should be counseled on contraceptive methods including intrauterine devices so that these devices can be considered in their contraceptive choices.

In this study authors aimed to investigate the barriers to participation of a sample of Jamaican women in mammography screening. The data were obtained from a previous survey that was conducted in Jamaica from June to August 2013 in the four parishes (Hanover, St. James, Trelawny, and Westmoreland) served by the Western Regional Health Authority (WRHA). WRHA served four hospitals, five non-randomized health centers, and five sites of community events. The sample consisted of women ranging in age between 35 and 83 years, with the mean age of 50.2 (SD = 10.6). The authors used a logistic regression to determine the extent to which variables were associated with breast cancer screening. The level of significace was 0.1 for the bivariate and multivariable analysis. The main factors associated with the lack of breast cancer screening among the women were: being less than 50 years old, single, never thought about breast cancer screening, in need of childcare, and having more than three children. We identified significant barriers to participation in mammography screening experienced by a sample of Jamaican women. Our results suggest that it is necessary to increase the awareness of the importance of breast screening importance among the women who may never have thought about mammography.

Background This study examined the prevalence and predictors of complementary and alternative medicine use among clinic patients with hypertension and/or type 2 diabetes mellitus in western Jamaica. Methods A cross-sectional study using an investigator-administered questionnaire was conducted from May to August 2017. Data on sociodemographic factors, complementary and alternative medicine use, and knowledge and perceptions of complementary and alternative medicine were collected from the patients. Multivariable logistic regression analysis was used to examine associations between patient characteristics and knowledge and perceptions of complementary and alternative medicine and complementary and alternative medicine use. Results A total of 362 patients were invited to participate and 345 (95.3%) completed the questionnaire; 311 (90.1%) had hypertension, 130 (37.7%) had type 2 diabetes mellitus and 96 (27.8%) had both diseases. Seventy-nine percent of the participants with hypertension and 65% with type 2 diabetes mellitus reported current use of complementary and alternative medicine. Self-reported knowledge of complementary and alternative medicine (none/poor vs average/good/excellent) was significantly associated with complementary and alternative medicine use for hypertension (AOR = 0.33, 95% CI = 0.13–0.87) and type 2 diabetes mellitus (AOR = 0.06, 95% CI = 0.01–0.37). Believing that complementary and alternative medicine is a natural method for treating hypertension was significantly associated with complementary and alternative medicine use among patients with hypertension (AOR = 3.9, 95% CI = 1.26–12.00), and belief that it is acceptable to use prescription medication and complementary and alternative medicine simultaneously was significantly associated with complementary and alternative medicine use among patients with type 2 diabetes mellitus (AOR =7.19, CI = 1.34–38.52). Conclusions Participants’ perceptions of their knowledge and beliefs regarding complementary and alternative medicine strongly influence their use of complementary and alternative medicine. These findings can be used in designing educational interventions to promote the proper use, and mitigate detrimental effects, of complementary and alternative medicine in this population.

Background The simultaneous or intermittent use of alternative treatments and prescription medications for hypertension and type 2 diabetes mellitus can have adverse health effects. Objectives To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients. Methods A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo. Results Most study participants (87–90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73–80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76–90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use. Conclusions This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.

Objectives This study investigated the knowledge, attitudes, and practices (KAP) of healthcare professionals (HCPs) regarding CAM use for Hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM) among patients in western Jamaica, and to determine HCPs’ perceptions of the need for training on CAM. Design A cross-sectional study was conducted from May to August 2019. Setting HCPs serving patients with HTN and T2DM in chronic disease clinics in western Jamaica completed a self-administered questionnaire that provided data on their sociodemographic characteristics, training, and KAP of CAM. Main outcome measure The data identified factors associated with discussion and recommendation of CAM to patients and personal use of CAM by HCPs. Results Type of profession (physicians vs nurses OR = 2.17; 95 % CI = 1.07−4.42 and pharmacists vs nurses OR = 8.67; 95 % CI = 2.83−26.57) was significantly associated with discussion of CAM. Training on CAM was significantly associated with discussion (OR = 2.36; 95 % CI = 1.26−4.42), recommendation (OR = 2.72; 95 % CI = 1.36–5.42), and personal use of CAM (OR = 2.90; 95 % CI = 1.69−4.97). Dieticians and nutritionists had 4.56 higher odds of personal use of CAM (95 % CI = 1.16−17.86), and personal use of CAM was significantly associated with discussion (OR = 8.94; 95 % CI = 4.76−16.80) and recommendation (OR = 7.17; 95 % CI = 3.54–14.51) of CAM. The majority of HCPs (70–89 %) agreed that there is a need to include CAM in professional training programs. Conclusion The results of this study can be used to guide development of programs for training HCPs on knowledge and safe use of CAM so that they can better serve their patients.

Background: Outbreaks of vector-borne diseases (VBDs) such as dengue and malaria can overwhelm health systems in resource-poor countries. Environmental management strategies that reduce or eliminate vector breeding sites combined with improved personal prevention strategies can help to significantly reduce transmission of these infections. Objective: The aim of this study was to assess the knowledge, attitudes, and practices (KAPs) of residents in western Jamaica regarding control of mosquito vectors and protection from mosquito bites. Methods: A cross-sectional study was conducted between May and August 2010 among patients or family members of patients waiting to be seen at hospitals in western Jamaica. Participants completed an interviewer-administered questionnaire on sociodemographic factors and KAPs regarding VBDs. KAP scores were calculated and categorized as high or low based on the number of correct or positive responses. Logistic regression analyses were conducted to identify predictors of KAP and linear regression analysis conducted to determine if knowledge and attitude scores predicted practice scores. Findings: In all, 361 (85 men and 276 women) people participated in the study. Most participants (87%) scored low on knowledge and practice items (78%). Conversely, 78% scored high on attitude items. By multivariate logistic regression, housewives were 82% less likely than laborers to have high attitude scores; homeowners were 65% less likely than renters to have high attitude scores. Participants from households with 1 to 2 children were 3.4 times more likely to have high attitude scores compared with those from households with no children. Participants from households with at least 5 people were 65% less likely than those from households with fewer than 5 people to have high practice scores. By multivariable linear regression knowledge and attitude scores were significant predictors of practice score. Conclusion: The study revealed poor knowledge of VBDs and poor prevention practices among participants. It identified specific groups that can be targeted with vector control and personal protection interventions to decrease transmission of the infections.

A retrospective, matched case-control study was conducted in Jamaica's Western Regional Health Authority (WRHA). Forty-three individuals developing clinical leptospirosis between January 2005 and December 2007 (i.e., cases) were age and neighborhood matched to 89 controls. Odds ratios (OR) and associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases had increased odds of contact with rodents OR 3.52, goats OR 3.38, and being engaged in outdoor labor OR 5.30. Knowledge of leptospirosis and indoor work was protective, OR 0.39 and OR 0.16, respectively. Positive RERI values were noted for joint exposure to rodents and goats (RERI 5.54), outdoor labor and goats (RERI 6.97), and outdoor labor and rodents (RERI 30.59). Our results suggest a synergistic effect of occupational and environmental exposures on clinical human leptospirosis from the WRHA. Knowledge of the disease and its risk factors allows for protection from the disease.

Background Use of the Pap test has resulted in a decline in cervical cancer mortality in developed countries. Yet, despite established cervical cancer screening programs, a significant portion of Jamaican women are not undergoing screening for cervical cancer. This study was carried out to identify factors that affect Jamaican women's decisions to screen for cervical cancer. Methods A population survey was administered to 367 clinic-attending women 25 to 54 years of age in the Parish of Trelawny from May to July of 2005. An interviewer-administered questionnaire assessed the women's knowledge, attitudes, and practices regarding cervical cancer and cervical cancer screening. Results Overall, 11% of the women had never had a Pap smear and only 38% had a Pap test within the last year. Annual visits to a health provider have a strong influence on women's decisions to regularly screen for cervical cancer. Provider recommendation also positively affected initial receipt of a Pap smear as well as continued regular screening. Conclusions Programs that promote annual health checkups, encourage consistent provider recommendations, and emphasize screening as a preventive measure might positively influence women's decisions to screen for cervical cancer.

Despite declines in breast cancer mortality rates in developed countries, mortality rates remain high in Jamaica due to low levels of screening and lack of early detection. We hypothesized that a theory-based health educational intervention would increase awareness of breast cancer and intention to screen among women in Western Jamaica. Two hundred and forty six women attending hospitals or clinics were enrolled in an educational intervention consisting of a pretest, breast cancer presentation, and posttest if they had never been screened or had not been screened in 5 years or more. The questionnaires assessed attitudes and knowledge of risk factors and symptoms related to breast cancer. Participants were followed approximately 6 months after the intervention to determine whether they accessed breast cancer screening. There were statistically significant increases (p < 0.0001) in the percentage of correct knowledge responses and in participants’ intention to screen from pretest to posttest. The greatest posttest improvements were among items measuring knowledge of breast cancer screening tests and risk factors. Of the 134 women who were reached by phone for post-intervention follow-up, 30 women (22.4 %) were screened for breast cancer and 104 women (77.6 %) had not been screened. The use of a theory-based educational intervention positively influenced knowledge of breast cancer risk factors, symptoms, and types of screening and increased screening rates in screening-naive women. This theory-based educational intervention may be replicated to promote awareness of breast cancer and further increase screening rates in other areas of Jamaica and other developing countries.

Objectives There is a paucity of studies on psychosocial disorders in clinic populations in Jamaica. Therefore, we sought to determine the prevalence and correlates of symptoms of depression and anxiety in a clinic population in western Jamaica. Methods A total of 338 participants from four outpatient clinics of : A total of 338 participants from four outpatient clinics of the Western Regional Health Authority (WRHA) were screened for symptoms of depression and anxiety using questions from the Beck Depression Inventory-II and the Beck Anxiety Inventory. The Chi-square test was used to examine differences in symptoms of anxiety and depression by gender. Multivariate linear and logistic regression were used to examine the associations between symptoms and sociodemographic variables with significance set at p Results Approximately 30% of participants had moderate or severe depression symptoms while 18.6% had moderate or severe anxiety symptoms. Participants aged 30-39 years were more likely than older participants to have moderate or severe anxiety symptoms (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.39, 5.56). Women reported a statistically significant higher prevalence of anxiety symptoms (10.0% vs 7.1%, p = 0.003). There was also a statistically significant difference between anxiety means by gender. Furthermore, income was found to be a significant predictor of anxiety for women only (p = 0.0113). Married persons were more likely than those who had never married to have moderate or severe anxiety symptoms (OR: 2.57, 95% CI: 1.14, 5.76). Conclusions Our findings suggest that the prevalence of depression may be higher than global estimates in similar outpatient settings. Screening and intervention efforts may need to focus on younger persons, women, and married persons.

The current procedures that are used to evaluate candidates for epilepsy surgery are time-consuming, costly, and often invasive. Magnetic source imaging (MSI), the combination of magnetoencephalography and anatomic imaging modalities, has shown promise as an efficient noninvasive means of localizing and characterizing seizure sources for possible resection. However, MSI has been limited by the inability to conduct simultaneous bilateral monitoring. In this study, a newly developed dual-magnetometer system was employed to record bilaterally the interictal activity in 30 candidates for epilepsy surgery. A standard monitoring protocol that included concurrent electroencephalographic recording and required a 2- to 3-hour examination period for each patient was developed. As a first step in a series of studies, the resultant MSI indications were compared with the information available from standard magnetic resonance imaging and concurrent electroencephalographic results. In 83% of the cases, this MSI protocol provided new information about the location of interictal epileptic activity that could be directive for subsequent patient care. Based on these results, it seems that MSI may become a cost-effective early step in epilepsy surgery evaluation. To continue the development on this basis, a study intended to validate the accuracy of MSI indicated by comparison with invasive electroencephalography has been initiated.

The P300 component of the event-related brain potential (ERP) elicited with auditory stimuli and pattern-shift visual evoked potentials (VEPs) was obtained from 16 patients with multiple sclerosis (MS) and 16 matched control subjects. P300 latency was significantly longer and component amplitude relatively depressed in the MS patients compared to control subjects. The P100 potential of the VEP also was delayed for both full-field and half-field stimulus conditions in the patients compared to control subjects. The findings suggest that the P300 ERP may reflect the cognitive decline associated with MS.

A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 20 normal young adults. The wave forms were morphologically similar to those observed with invasive procedures. No substantial differences for either the right or left side of stimulation, recording electrode, or subject sex were obtained for any of the individual potential amplitudes or latencies. The same procedures were applied to 10 patients who had been treated with retrogasserian glycerol injections for trigeminal neuralgia. Trigeminal evoked potentials were elicited in all patients, although the quality of the individual wave forms was more variable than that observed for the normal subjects. Comparison of the treated with the unaffected face side in the patients demonstrated significantly smaller N2-P2 amplitudes and longer N2 latencies for the affected face side. The results suggest that these procedures produce reliable evoked potential measures of trigeminal nerve function noninvasively which can provide an objective index of treatment efficacy.

The in-vitro susceptibilities to ofloxacin of 159 clinical sputum isolates of Mycobacterium tuberculosis, comprising 95 isolates sensitive to all drugs, 31 isolates resistant to streptomycin or isoniazid or both, 27 isolates resistant to streptomycin, isoniazid and rifampicin and six isolates resistant to rifampicin (and in three cases to other drugs) were determined. Favourable MICs of ofloxacin (0.63-1.25 mg/l) were demonstrated for 147 isolates (92%). Twenty-two patients with resistant strains (including one patient with rifampicin intolerance) were studied: ten were given 300 mg ofloxacin and ten were given 800 mg ofloxacin, once daily in both cases, together with second-line accompanying drugs, for nine months to one year. Two received 800 mg of ofloxacin once daily alone for similar periods. In the 300 mg-ofloxacin group and the 800 mg-ofloxacin group, five and eight patients, respectively, achieved culture conversion; the rest failed. In the former group, the peak serum ofloxacin concentrations were 3.71-8.08 mg/l and the mean sputum/serum ratio was 0.85. In the latter group, the corresponding values were 10-18.7 mg/l, and 0.76, respectively. All patients tolerated the drugs well. Analysing only patients with accompanying drugs, those on ofloxacin 800 mg once daily had more rapid sputum culture conversion than those on ofloxacin 300 mg once daily (Mann-Whitney Wilcoxon Rank Sum Test: P less than 0.05), indicating more rapid bacteriolysis and implying the definite efficacy of ofloxacin when used together with second-line accompanying drugs in the management of resistant tuberculosis.

Summary: Purpose: To discover whether the spatial distribution of spike sources determined by magnetoencephalography (MEG) provides reliable information for planning surgery and predicting outcomes in pediatric patients with lesional extrahippocampal epilepsy. Methods: We retrospectively studied 12 children with extrahippocampal epilepsy secondary to cortical dysplasia (CD), tumor, or porencephalic cyst. We compared interictal MEG spike source locations and somatosensory evoked fields derived from equivalent-current dipole modeling with intraoperative or extraoperative electrocorticography (ECoG). Results: MEG spike sources were found in proximity to the lesion in all patients and extended from lesions in five patients with CD. Marginal spike sources were noted in three patients with tumors, one patient with a cyst, and one with CD, and extramarginal sources in three patients with tumors. Three patients with tumors underwent lesionectomy only; two had further cortical excisions. One patient with CD underwent lesionectomy only, three had lesionectomy and cortical excisions, and two had lesionectomy and multiple subpial transection. Asymmetric MEG spike sources correlated with ECoG findings in all patients. Residual epileptiform discharges on postexcisional ECoG corresponded to spike sources in three patients with tumors and one patient with a cyst. Eleven patients have been seizure free for 1–6 years (mean, 4 years). One patient had residual seizures after incomplete excision of right temporal CD. Conclusions: MEG delineated asymmetric epileptogenicity surrounding lesions and the eloquent cortex. Complete tumor resection produced favorable outcomes despite residual postexcisional ECoG spikes and extramarginal MEG spike sources. CD characterized by clusters of MEG spike sources within and extending from lesions seen on magnetic resonance imaging (MRI) should be removed to prevent seizures.

We retrospectively compared electroencephalographic (EEG) dipoles of interictal spikes from prolonged video-EEG monitoring with magnetoencephalographic dipoles from short-term recording in four children with extratemporal lobe epilepsy. We analyzed both sets of dipoles using individual interictal spikes and single moving dipole modeling and evaluated the profiles of spike appearance, dipole position, and orientation in EEG and magnetoencephalography. We obtained more than 100 magnetoencephalographic spikes in two patients who manifested frequent interictal EEG spikes throughout both day and night but fewer than 40 magnetoencephalographic spikes in two patients who had interictal EEG spikes mainly during sleep. The dipole positions of EEG and magnetoencephalography were in close proximity and included in the surgical resection area. Most of the dipoles between EEG and magnetoencephalography were oriented perpendicularly. A combination of EEG dipole analysis from prolonged video-EEG monitoring and magnetoencephalographic dipole analysis provides complementary information for presurgical evaluation in children with intractable extratemporal lobe epilepsy. ( J Child Neurol 2001;16:661-667).

Objectives To determine the prevalence of male circumcision (MC) among men in the western region of Jamaica, and to identify factors associated with acceptability of MC for self, infants (

A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 50 normal adults who ranged in age from 20 to 69 years. The waveforms were morphologically similar to those observed with invasive procedures. No substantial effects for subject age, side of stimulation, or recording electrode were obtained for any of the individual trigeminal evoked potential amplitudes or latencies. Female subjects tended to have somewhat larger amplitudes and shorter latencies than male subjects. The results suggest that non-invasive procedures produce reliable evoked potential measures of trigeminal nerve function for patients of all ages.

Experiment 1 elicited the P1, N1, P2, and N2 components of the long latency auditory evoked potential (AEP) using a 1000 Hz tone presented at 30, 50, or 70 dB SPL and 1-, 3-, or 5- second inter-stimulus intervals to assess the relative effects of the combination of these variables on component amplitude and latency. Four blocks of 16 tone presentations each were recorded from each subject to determine if changes in the AEP would occur because of short-term habituation. Both stimulus factors interacted significantly in a systematic fashion for the amplitude measures, with increases in latency also associated with increases in intensity and inter-stimulus interval. Only minor changes across the four trial blocks for either the amplitude or latency measures were observed over the various stimulus presentation conditions. Experiment 2 employed the same tone stimulus presented at 50 dB SPL and a 3-second inter-stimulus interval. Eight blocks of 64 trials were recorded from each subject on each day for four days to investigate long-term habituation effects. No substantial changes in any of the component amplitudes or latencies were obtained across the 32 trial blocks. It was concluded that intensity and inter-stimulus interval interact to determine AEP amplitude as well as latency values and that the constituent components do not change appreciably with repeated stimulus presentations, even after several days.

Mycobacterium fortuitum infection of soft tissue and wound (postoperative or otherwise) has been well reported in medical literature. In 1987, ten patients in our hospital with various cardiac diagnoses requiring open-heart surgery developed M fortuitum infection at the sternotomy site. As successful chemotherapy, in addition to surgical debridement, relies on in vitro susceptibility testing, ofloxacin and amikacin were thus assessed and found to have very satisfactory MIC. For the former: 1.25 mg/L for eight isolates, 2.5 mg/L for one isolate, and greater than 20 mg/L for one isolate were found. For the latter: 1 mg/L for six isolates, 2 mg/L for two isolates, and 4 mg/L and 8 mg/L for the remaining two isolates were found, respectively. These patients were given ofloxacin (300 mg once daily to 1,200 mg daily in divided doses) for three to six months and 500 mg amikacin daily (in two divided doses intravenously or intramuscularly) for three to eight weeks. The clinical outcome was favorable except for one patient who died of bacteremia due to M fortuitum coupled with many medical complications. Encouraged by these preliminary results, a future prospective study with ofloxacin as single agent for soft tissue, particularly postoperative sepsis due to M fortuitum, will be planned.

SYNOPSIS Visual evoked responses (VERs) elicited with two different sizes of checkerboard patterns were obtained from 10 male cluster headache patients and their age-matched controls. Full-and half-field stimulus presentations produced no substantial differences between the subject groups for any of the major component latencies or amplitudes (N75, P100, N145). No differences were obtained for either checkerboard size between the groups or when the specific side of headache pain was assessed separately. The results are discussed in terms of previous VER headache studies.