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Introduction: Many individuals suffer from chronic or complex wounds that can be very difficult to heal and cause severe pain and hardship. In the absence of any evidence based local information on the topic, this study explored the lived experiences of Jamaican hospital patients with delayed wound healing using physiological, psychological, socio-cultural, developmental and spiritual perspectives. Methods: A qualitative descriptive study design with a purposive sampling method was used to select five patients, two males and three females (aged 33 years old to 56 years old) from a regional hospital in western Jamaica, who were recruited into the study. They each had a single chronic ulcer on an extremity. Following ethical approval and informed consent, individual interviews were conducted and thematic analyses were done on the data. Results: Diabetes mellitus and infection were the etiologic factors in their delayed wound healing. All of the participants experienced social isolation, low self-esteem, “frustration”, job loss/loss of man hours, financial dependence and impaired physical mobility. They desired improved communication with healthcare personnel, more supportive and caring attitudes from family and caregivers; as well as enhanced learning experiences to acquire the self-care skills needed for all aspects of diabetes control and wound care. Conclusions: The patients’ lived experiences and stated needs should be noted by all caring health professionals. Future interventions and care plans should address all the perspectives experienced and described by these patients.

Inadequate glycaemic control in Jamaican adults with type 2 diabetes mellitus (DM) prompted assessment of glycaemic control, oxidative stress, cardiovascular (CV) and renal risk in adults attending a hospital clinic. A random sample of 133 patients men (n=35) and women (n=98), with diabetes mellitus was selected from a population of 510 patients. Fasting blood samples (n=122) were evaluated for metabolic control and dyslipidaemia. Oxidative stress was evaluated by measurement of urinary F2 isoprostane (n=124). The data were analysed using SPSS. The mean age of the participants was 56.7 ± 14.3 years, with mean duration of diabetes of 12.2 years. Mean fasting blood sugar was 8.6 ± 4.3 mmol/L. 77% of patients had HbA1c > 6.5%. 69% of patients were being treated with insulin with no difference in HbA1c levels in these patients compared to those receiving other hypoglycaemic agents. 90% of men (median 1004pg/mg creatinine) and 99% of women (median 1501.3pg/mg) had isoprostane levels above the median for subjects with CV risk. 54% of patients had total cholesterol levels ≥ 5.2 mmol/L, 16% triglyceride levels ≥ 1.5 mmol/L, 25% HDL levels ≤ 1.0mmol/L and 86% LDL ≥ 2.5mmol/L. 63 % of patients had BP >130/85 mmHg. 81% were overweight or obese, with 80% of the men having waist circumferences >88 cm, whereas 87% of the women had waist circumferences of 84.5cm. Microalbuminuria was increased in 37% of the subjects. The high prevalence of overweight, central obesity, elevated LDL and hypertension in these patients indicated high CV and renal risk. The risk was significantly higher in persons with inadequate glycaemic control. Isoprostane levels were high in the majority of subjects but did not correlate with HbA1c or any other variable. (Int J Diabetes 14: 51-54, 2006 )

Purpose: Determine the extent to which the lifestyles of Jamaican men with hypertension met the guidelines of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Design and Methods: Following informed consent, a convenience sample of Jamaican men with hypertension ( n = 48), of African ethnicity, attending a Type 5 Health Center was interviewed over a four week period, using a 31-item interview schedule. Results: Mean age of respondents was 65.2 (± 12.1) years (range = 35-89 years) with 33% having blood pressure (BP) controlled to 130/80 mmHg. Those meeting the guidelines were normal weight 23 (47.9%), DASH (dietary approaches to stop hypertension) diet zero, medication 7 (14.6%), exercise 14 (29.2%), alcohol restriction 38 (79.2%), and smoking cessation 40 (83.3%). Medication adherence was associated with BP control ( r = −0.30, p < .04). More than half of the respondents believed that hypertension could be cured and that they could stop all treatment if their BP was normal. Discussion and Conclusions: Only a third of the sample had BP controlled to ≤130/80 mmHg. Adherence to the JNC 7 lifestyle guidelines was inadequate. Implications for Practice: A nurse led intervention, focusing on perceptions and lifestyle practices, is indicated.

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45% reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4% reported being on a "special diet". Only 16.5% reported not taking any sugar. Self-care scores were inversely related to HbA1c% (p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23% had blood glucose controlled to HbA1c < or = 6.5%. In women, HbA1c% levels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

The aim of this study was to assess the long term impact of an educational and monitoring intervention on blood pressure control in patients (n = 80) who had blood pressure140/90 mm Hg in January 1999, and attended the Specialist Hypertension Clinic, the University Hospital of the West Indies. Forty-two of these patients (cases) attended the monthly educational and monitoring intervention for six months, in addition to their usual care. The other 38 (controls) attended only one educational intervention at the end of the six months. One year later, patients were traced by telephone or clinic attendance. Data were collected on 73 (91%) patients, 40 (95%) cases and 33 (87%) controls by clinic records or by direct measurement of blood pressure and weight. Three (7.5%) cases and two (6%) controls had died. One (2.5%) case and five (15%) controls had been referred to renal or cardiac clinics. Twenty-five (59.5%) cases, and 14 (36.8%) controls were still attending the clinic. At the end of the year, 26% (7/27) of the cases and 30% (6/20) of the controls had blood pressure (BP) controlled to140/90 mm Hg. These proportions compare to 28% (11/39) cases and 22% (8/36) controls at the end of the six-month intervention. At the end of one year, neither cases nor controls showed significant mean changes in BP, weight, nor body mass index (BMI). There was no significant difference between the median BMI of the cases, 31.2 kg/m2 and that of the controls, 29.3 kg/m2. Seventy-seven per cent (21/27) cases and 84.2% (16/19) controls had BMI25 kg/m2. These data, though limited, are consistent with reports that the impact of lifestyle interventions in chronic diseases may be short lived. This study suggests that therapeutic lifestyle intervention strategies need to be integrated with the overall management of patients so that the effect may be sustained.

Former general practitioner Dover (b 1928; q Aberdeen 1951), d 22 October 2001. After qualifying, she did house jobs at Aberdeen Royal Infirmary, Stracathro Hospital, Royal Victoria Hospital, Folkestone, and Buckland Hospital, Dover. Carol was in general practice in Dover from 1952 to 1988. From 1972 to 1988 she was medical officer to Dover “Across” Trust, in which capacity she accompanied pilgrimages to Lourdes. She was for many years medical officer to Dover College. In her early days in general practice, she accompanied (by boat) several long distance swimmers on cross Channel attempts. She was unmarried.

The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies (UHWI), between January 4 and March 29, 1999, with blood pressure140/90 mmHg (n = 80), were randomly divided into Group 1, cases (n = 42) and Group 2, controls (n = 38). A 40-item pretested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyle and knowledge data. Group 1 attended monthly structured interventions for six months. Except for diastolic blood pressure among male controls, diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p0.01). Knowledge improved among the male patients (p0.01). Among the female patients, activity scores were significantly increased (p0.01), weight (p0.05) and BMI (p0.05) were significantly reduced. There were no differences in these variables among the controls. This intervention had a benefit in blood pressure control.

The purpose of this study was to describe the knowledge of hypertension, its management, anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension. Patients (n = 80) attending the Specialist Hypertension Clinic at the University Hospital of the West Indies (UHWI) who had a baseline systolic BP140 mmHg and/or a diastolic BP90 mmHg were invited to participate in the study. Blood pressure, height, weight, waist and hip circumferences were measured. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. A pretested questionnaire with 40 items eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95% CI 25.7-29.6); mean BMI for women was 30.89 (95% CI 26.1-35.7). In men, there was an association between BMI and WHR, r = 0.62, p0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level (r = -0.42, p0.05). There was also an association between systolic BP and substance use (r = 0.41, p0.05). Although the majority of both men and women were classified as obese, only 12% of men and 7% of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressures in this population, the use of nonpharmacologic therapy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.

Health, nutrition and behavioural determinants of school achievement, attendance and dropout were examined in 452 girls aged 13-14 years, randomly selected from grade 8 in nine schools in inner-city Kingston, Jamaica. Girls who were anaemic, sexually active or aggressive had worse achievement levels. Better achievement levels were associated with possession of school materials and access to reading material outside of school. Poor attendance, early sexual activity, and not living with both parents predicted school dropout in the subsequent year. Strategies to reduce anaemia, to improve sex education and reduce the levels of aggression may benefit school performance.

An increased incidence of obvious live-birth neural tube defects (i.e., spina bifida cystica and encephalocele) occurred in Jamaica 11 to 18 months after Hurricane Gilbert. The conceptions of the affected babies coincided with a rise in megaloblastic change in sickle cell patients, suggesting a wide-spread drop in dietary folate intake. A detailed history was taken from each of the 17 affected mothers (case subjects) and 51 unaffected mothers (matched control subjects). The case subjects reported a significantly lower mean intake of dietary folate in the periconceptional period (154 micrograms/day) than did the control subjects (254 micrograms/day). The temporary increase in neural tube defects was associated with a diet comparatively low in folate in the periconceptional period, suggesting the dietary level of folate that fails to protect against neural tube defects under natural conditions.

We do not often hear nowadays of burglars being detected by cotton stretched across a door or a gate, but the age of ad hoc police ingenuity will never pass. The following short article bears this out.