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Objective: The goal of the present study was to examine relationships among several predictors of nutrition comprehension. We were particularly interested in exploring whether nutrition knowledge or motivation moderated the effects of attention on comprehension across a wide age range of adults.Methods: Ninety-three participants, ages 18-80, completed measures of nutrition knowledge and motivation and then read nutrition information (from which attention allocation was derived) and answered comprehension questions.Results: In general, predictor variables were highly intercorrelated. However, knowledge, but not motivation, had direct effects on comprehension accuracy. In contrast, motivation influenced attention, which in turn influenced accuracy. Results also showed that comprehension accuracy decreased-and knowledge increased-with age. When knowledge was statistically controlled, age declines in comprehension increased.Conclusion: Knowledge is an important predictor of nutrition information comprehension and its role increases in later life. Motivation is also important; however, its effects on comprehension differ from knowledge.Practice Implications: Health educators and clinicians should consider cognitive skills such as knowledge as well as motivation and age of patients when deciding how to best convey health information. The increased role of knowledge among older adults suggests that lifelong educational efforts may have important payoffs in later life. [ABSTRACT FROM AUTHOR]

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students' label-reading skills and healthy food choices, before they settle into grocery shopping habits.

Background: English-speaking Caribbean (ESC) childhood cancer outcomes are unknown., Procedure: Through the SickKids-Caribbean Initiative (SCI), we established a multicenter childhood cancer database across seven centers in six ESC countries. Data managers entered patient demographics, disease, treatment, and outcome data. Data collection commenced in 2013, with retrospective collection to 2011 and subsequent prospective collection., Results: A total of 367 children were diagnosed between 2011 and 2015 with a median age of 5.7 years (interquartile range 2.9-10.6 years). One hundred thirty (35.4%) patients were diagnosed with leukemia, 30 (8.2%) with lymphoma, and 149 (40.6%) with solid tumors. A relative paucity of children with brain tumors was seen (N = 58, 15.8%). Two-year event-free survival (EFS) for the cohort was 48.5% ± 3.2%; 2-year overall survival (OS) was 55.1% ± 3.1%. Children with acute lymphoblastic leukemia (ALL) and Wilms tumor (WT) experienced better 2-year EFS (62.1% ± 6.4% and 66.7% ± 10.1%), while dismal outcomes were seen in children with acute myeloid leukemia (AML; 22.7 ± 9.6%), rhabdomyosarcoma (21.0% ± 17.0%), and medulloblastoma (21.4% ± 17.8%). Of 108 deaths with known cause, 58 (53.7%) were attributed to disease and 50 (46.3%) to treatment complications. Death within 60 days of diagnosis was relatively common in acute leukemia [13/98 (13.3%) ALL, 8/26 (30.8%) AML]. Despite this, traditional prognosticators adversely impacted outcome in ALL, including higher age, higher white blood cell count, and T-cell lineage., Conclusions: ESC childhood cancer outcomes are significantly inferior to high-income country outcomes. Based on these data, interventions for improving supportive care and modifying treatment protocols are under way. Continued data collection will allow evaluation of interventions and ensure maximal outcome improvements., (© 2018 Wiley Periodicals, Inc.)

There has been significant improvement in medical diagnostic technology, but discrepancy rates between clinical and postmortem diagnoses remain relatively high. This study aimed to identify misdiagnoses and missed (unexpected) findings documented during complete coroner's autopsies performed for trauma at the University of the West Indies (UWI) and evaluate their influence on patient outcome. We retrospectively reviewed the reports of all coroner's autopsies performed for trauma, between 2003 and 2012, at the UWI. For each case, we extracted age, gender, trauma type, mechanism and topography, clinical and postmortem diagnoses and hospitalization duration. The data were used to calculate frequencies, proportions and discrepancy rates. 955 coroner's autopsies were performed during the 10-year period; reports were available for 933. 396 of these were performed for trauma; 365 met the inclusion criteria. 260 (71.2%) of the 365 autopsies had at least one discrepancy. There were 746 clinical and 1118 autopsy diagnoses; 382 were discrepant (372 missed [unexpected] diagnoses, 6 mis-diagnoses and 4 over-diagnoses). The discrepancy rate (misdiagnoses and missed diagnoses) was 33.8%, and the majority (55%) occurred in patients hospitalized for <1 day. Cardiopulmonary diseases were the most commonly missed diagnoses. The discrepancy rate was intermediate to those previously reported in the literature. The short hospitalization duration in most patients suggests that limited time for clinical investigation may be a contributor to discrepancy. However, increased awareness among clinicians of the common major missed diagnoses should enhance their early diagnosis, even when clinical signs are subtle, hopefully producing improved patient outcome.

Objective: College students are at risk for poor dietary choices. New skills can empower individuals to adopt healthful behaviors, yet eHealth tools designed to develop food-choice skills, such as label-reading skills, are uncommon. We investigated the effects of web-based label-reading training on college students' perceptions of healthful food-choice empowerment., Methods: Students completed label-reading training in which they practiced selecting the more healthful food using nutrition labels. We examined improvements in label-reading accuracy (correct healthfulness decisions) and perceptions of empowerment, using a 6-item scale. Repeated measures ANOVAs and paired-samples t -tests were used to examine changes in accuracy and empowerment across the training session., Results: In addition to increases in label-reading accuracy with training, we found increases in healthful food-choice empowerment scores. Specifically, the proportion of correct (i.e., more healthful) food choices increased across the three blocks of practice ( p  = 0.04) and food-choice empowerment scores were about 7.5% higher on average after training ( p  < 0.001)., Conclusion and Implications: Label-reading training was associated with increased feelings of empowerment associated with making healthful food choices. Skill focused eHealth tools may offer an important avenue for motivating behavior change through skill development.

Purpose: To determine the histological distribution and trends in incidence of sinonasal malignancies in Jamaica., Methods: Cases of all sinonasal malignancies diagnosed between 1973 and 2007 were extracted from the archives of the Jamaica Cancer Registry. Data recorded for each case included age at diagnosis, sex, year of diagnosis, topography, and histology. Data were used to calculate frequencies, age-specific incidence rates, and age-standardized incidence rates (ASRs). Linear regression analysis was used to determine significance of trends in incidence rates; p values of ≤0.05 were significant., Results: Sinonasal malignancies were commoner in males (male: female ratio, 1.1:1), and the median ages were 62 (males) and 66 years (females). Most were located in either the maxillary sinus (61.3%) or nasal cavity (24.3%). The commonest histological types were squamous cell carcinoma (SCC) (55.9%) and non-Hodgkin's lymphoma (17.1%), which were predominantly of T-cell immunophenotype, in both the nasal cavity and sinuses. There was no documentation in registry data regarding separation into NK/T and peripheral T-subtypes. The ASRs in males and females were consistently less than 1.5 per 100,000 per year. In males, there was a significant decrease in SCC ASR (p = 0.014) over time., Conclusions: The age, gender, and anatomical and histological distribution patterns of sinonasal malignancies in Jamaica are similar to those reported internationally, and the low ASRs are in keeping with previous global reports. Broader local immunohistochemistry panels are warranted for further delineation of sinonasal T-cell lymphomas. Investigation into factors contributing to the decreasing incidence of sinonasal SCC is also required.

Objective: The ability to use serving size information on food labels is important for managing age-related chronic conditions such as diabetes, obesity and cancer. Past research suggests that older adults are at risk for failing to accurately use this portion of the food label due to numeracy skills. However, the extent to which older adults pay attention to serving size information on packages is unclear. We compared the effects of numeracy and attention on age differences in accurate use of serving size information while individuals evaluated product healthfulness., Design: Accuracy and attention were assessed across two tasks in which participants compared nutrition labels of two products to determine which was more healthful if they were to consume the entire package. Participants' eye movements were monitored as a measure of attention while they compared two products presented side-by-side on a computer screen. Numeracy as well as food label habits and nutrition knowledge were assessed using questionnaires., Setting: Sacramento area, California, USA, 2013-2014., Subjects: Stratified sample of 358 adults, aged 20-78 years., Results: Accuracy declined with age among those older adults who paid less attention to serving size information. Although numeracy, nutrition knowledge and self-reported food label use supported accuracy, these factors did not influence age differences in accuracy., Conclusions: The data suggest that older adults are less accurate than younger adults in their use of serving size information. Age differences appear to be more related to lack of attention to serving size information than to numeracy skills.

Background: Nutrition labels offer the information needed to follow Dietary Guidelines for Americans, yet many individuals use labels infrequently or ineffectively due to limited comprehension and the effort required to use them., Objective: The objective of our study was to develop and test a Web-based label-reading training tool to improve individuals' ability to use labels to select more healthful foods. We were particularly interested in determining whether practice can lead to increased accuracy using labels as well as decreased effort, together reflecting greater efficiency. We compared a basic and an enhanced, prior-knowledge version of the tool that contained an additional component, a brief nutrition tutorial., Methods: Participants were 140 college students with an average age of 20.7 (SD 2.1) years and education 14.6 (SD 1.2) years, who completed 3 sets of practice that were designed to teach them, through repetition and feedback, how to use nutrition labels to select more healthful products. Prior to training, participants in the prior-knowledge group viewed a multimedia nutrition presentation, which those in the basic group did not receive. Mixed-effects models tested for improvement in accuracy and speed with practice, and whether improvements varied by group., Results: The training led to significant increases in average accuracy across the 3 practice sets (averaging 79% [19/24 questions], 92% [22/24], 96% [23/24] respectively, P<.001), as well as decreases in time to complete with mean (SD) values of 8.7 (2.8), 4.6 (1.8), and 4.1 (1.7) seconds, respectively. In block 3, the odds of a correct answer for the prior-knowledge group were 79% higher (odds ratio, OR=1.79, 95% CI 1.1-2.9) than those for the basic group (P=.02). There was no significant difference between the groups in block 2 (P=.89)., Conclusions: Practice led to improvements in nutrition label reading skills that are indicative of early stages of automatic processing. To the extent that automatic processes are at the core of healthy habit change, this may be an efficient way to improve dietary decision-making., Competing Interests: Conflicts of Interest: None declared., (©Lisa M Soederberg Miller, Laurel A Beckett, Jacqueline J Bergman, Machelle D Wilson, Elizabeth A Applegate, Tanja N Gibson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.01.2017.)

Front-of-package nutrition symbols (FOPs) are presumably readily noticeable and require minimal prior nutrition knowledge to use. Although there is evidence to support this notion, few studies have focused on Facts Up Front type symbols which are used in the US. Participants with varying levels of prior knowledge were asked to view two products and decide which was more healthful. FOPs on packages were manipulated so that one product was more healthful, allowing us to assess accuracy. Attention to nutrition information was assessed via eye tracking to determine what if any FOP information was used to make their decisions. Results showed that accuracy was below chance on half of the comparisons despite consulting FOPs. Negative correlations between attention to calories, fat, and sodium and accuracy indicated that consumers over-relied on these nutrients. Although relatively little attention was allocated to fiber and sugar, associations between attention and accuracy were positive. Attention to vitamin D showed no association to accuracy, indicating confusion surrounding what constitutes a meaningful change across products. Greater nutrition knowledge was associated with greater accuracy, even when less attention was paid. Individuals, particularly those with less knowledge, are misled by calorie, sodium, and fat information on FOPs.

Nutrition information on packaged foods supplies information that aids consumers in meeting the recommendations put forth in the US Dietary Guidelines for Americans such as reducing intake of solid fats and added sugars. It is important to understand how food label use is related to dietary intake. However, prior work is based only on self-reported use of food labels, making it unclear if subjective assessments are biased toward motivational influences. We assessed food label use using both self-reported and objective measures, the stage of change, and dietary quality in a sample of 392 stratified by income. Self-reported food label use was assessed using a questionnaire. Objective use was assessed using a mock shopping task in which participants viewed food labels and decided which foods to purchase. Eye movements were monitored to assess attention to nutrition information on the food labels. Individuals paid attention to nutrition information when selecting foods to buy. Self-reported and objective measures of label use showed some overlap with each other (r=0.29, p<0.001), and both predicted dietary quality (p<0.001 for both). The stage of change diminished the predictive power of subjective (p<0.09), but not objective (p<0.01), food label use. These data show both self-reported and objective measures of food label use are positively associated with dietary quality. However, self-reported measures appear to capture a greater motivational component of food label use than do more objective measures.

Aim: To investigate pathological factors related to long term patient survival post surgical management of gastric adenocarcinoma in a Caribbean population., Methods: This is a retrospective, observational study of all patients treated surgically for gastric adenocarcinoma from January 1(st) 2000 to December 31(st) 2010 at The University Hospital of the West Indies, an urban Jamaican hospital. Pathological reports of all gastrectomy specimens post gastric cancer resection during the specified interval were accessed. Patients with a final diagnosis other than adenocarcinoma, as well as patients having undergone surgery at an external institution were excluded. The clinical records of the selected cohort were reviewed. The following variables were analysed; patient gender, patient age, the number of gastrectomies previous performed by the lead surgeon, the gross anatomical location and appearance of the tumour, the histological appearance of the tumour, infiltration of the tumour into stomach wall and surrounding structures, presence of Helicobacter pylori and the presence of gastritis. Patient status as dead vs alive was documented for the end of the interval. The effect of the aforementioned factors on patient survival were analysed using Logrank tests, Cox regression models, Ranksum tests, Kruskal-Wallis tests and Kaplan-Meier curves., Results: A total of 79 patients, 36 males and 43 females, were included. Their median age was 67 years (range 36-86 years). Median survival time from surgery was 70 mo with 40.5% of patients dying before the termination date of the study. Tumours ranged from 0.8 cm in size to encompassing the entire stomach specimen, with a median tumour size of 6 cm. The median number of nodes removed at surgery was 8 with a maximum of 28. The median number of positive lymph nodes found was 2, with a range of 0 to 22. Patients' median survival time was approximately 70 mo, with 40.5% of the patients in this cohort dying before the terminal date. An increase in the incidence of cardiac tumours was noted compared to the previous 10 year interval (7.9% to 9.1%). Patients who had serosal involvement of the tumour did have a significantly shorter survival than those who did not (P = 0.017). A significant increase in the hazard ratio (HR), 2.424, for patients with circumferential tumours was found (P = 0.044). Via Kaplan-Meier estimates, the presence of venous infiltration as well as involvement of the circumferential resection margin were found to be poor prognostic markers, decreasing survival at 50 mo by 46.2% and 36.3% respectively. The increased HR for venous infiltration, 2.424, trended toward significant (P = 0.055) Age, size of tumour, number of positive nodes found and total number of lymph nodes removed were not useful predictors of survival. It is noted that the results were mostly negative, that is many tumour characteristics did not indicate any evidence of affecting patient survival. The current sample, with 30 observed events (deaths), would have about 30% power to detect a HR of 2.5., Conclusion: This study mirrors pathological factors used for gastric cancer prognostication in other populations. As evaluation continues, a larger cohort will strengthen the significance of observed trends.

Objective: Several countries have reported increasing incidence of oral cavity and oropharyngeal (OCOP) squamous cell carcinoma (SCC) over recent years, particularly among young men and primarily in tongue and tonsil subsites, attributed to human papillomavirus (HPV) infection. This study examines trends in incidence and age distribution of OCOP SCC in Jamaica over a 30-year period., Methods: We extracted all cases of OCOP SCC archived in the Jamaica Cancer Registry files over the 30 year-period from 1978 to 2007 and grouped them according to anatomical site (International Classification of Diseases; ICD-9), age and gender. The data were used to calculate age standardized rates (ASRs) and age-specific incidence rates (ASIRs)., Results: There were 384 patients (age range 21 to 94 years; male to female ratio 2.6:1) with OCOP SCC; the majority (85.4%) was > 50 years. Age standardized rates of all OCOP SCC combined were higher in males than in females and there was a decrease in both genders over the study period. Tongue and tonsil were the commonest subsites, and males showed decreasing ASR in both. Females showed decreasing ASR in tongue and fluctuation in tonsil SCCs. The highest ASIRs for tongue and tonsil SCC were consistently seen in patients older than 50 years of age., Conclusion: The incidence of OCOP SCC is decreasing and continues to predominate among older men. The decreasing trend in incidence of tongue and tonsil SCC is unlike that reported elsewhere. This may be due to differences in sexual practices, small size of this study, or a lag time in emergence of a new trend.

Objectives: There have been several modifications to the classification of childhood cancers since the first report (1968-1981) specific to the Jamaican paediatric population was published in 1988. This paper reports on paediatric cancer incidence in Kingston and St Andrew, Jamaica, for the 20-year period 1983-2002 based on these modifications., Methods: All cases of cancer diagnosed in children (0-14 years), between 1983 and 2002 were extracted from the Jamaica Cancer Registry archives and classified using the International Classification of Childhood Cancer, third edition. Incidence figures were calculated as per the International Agency for Research on Cancer (IARC) reporting format for childhood cancer., Results: There were 272 cases (133 males, 139 females) of childhood cancer identified in the 20-year period. The overall age standardized rate (ASR) was 69.4 per million; that for males was 67.8 per million, and for females, 70.9 per million. The three most common malignancies overall were leukaemia (21.3%), lymphoma (15.8%) and brain and spinal neoplasms (14.0%). In males, the highest ASRs were seen for leukaemia (14.8 per million), lymphoma (12.7 per million), and brain and spinal neoplasms (8.2 per million), and in females, leukaemia (14.4 per million), nephroblastoma (11.3 per million), and brain and spinal neoplasms (10.6 per million)., Conclusions: The rankings of the most common childhood malignancies in Jamaica (leukaemia, brain and spinal neoplasms and lymphomas) have shown few changes since the last review. However, there are differences in frequency and gender distribution of nephroblastoma and brain and spinal neoplasms.

Objective: To determine the distribution of malignancies in adolescents and young adults (AYA; 15 to 29 years) in Jamaica., Methods: All cases of malignancies diagnosed in AYA in the period 1988-2007, were extracted from the files of the Jamaica Cancer Registry. For each case, age, gender and diagnosis were recorded and the diagnoses categorized according to the recently proposed diagnostic groups for cancers in AYA. The data were used to calculate incidence rates and relative frequencies., Results: Among males, the age-specific incidence rate for the oldest age group (25-29 years) was higher than that recorded for each of the younger groups. In females, there was a progressive increase in incidence with increasing age. The age-standardized rates (ASRs) per million were 131.4 (males) and 226.1 (females). In males, the highest ASRs (per million) were those for lymphoma (34.7), carcinoma (29.3) and soft tissue sarcoma (17.2), and in females, carcinoma (121.6), lymphoma (31.4) and germ cell and trophoblastic neoplasms (14.6). Lymphoma was the commonest diagnosis in younger males, and ranked second to carcinoma in the oldest. Carcinoma and lymphoma were the commonest and second commonest diagnoses, respectively, among all three age groups in females, with carcinomas accounting for progressively greater proportions of tumours with increasing age., Conclusion: The incidence of malignancy in AYA in Jamaica is higher in females than in males. In both genders, increasing age is accompanied by increasing incidence and a shift from non-epithelial to epithelial malignancies. This shift occurs at an earlier age in females.

Objective: To determine the distribution of histologic subtypes of soft tissue sarcomas (STS) in Kingston and St Andrew, Jamaica, according to age and topography., Methods: From the Jamaica Cancer Registry (JCR) archives, all cases of STS diagnosed between 1958 and 2007 were extracted. For each case, age, gender, histological diagnosis and anatomical site of tumour were recorded. Patients were categorized according to age at diagnosis as: children (0-14 years) and adults (> 14 years), and the distribution of histologic diagnoses with respect to age and anatomical site were analysed., Results: There were 432 cases (67 children, 364 adults, one person of unknown age) of STS recorded in the JCR over the 50-year period (218 males, 214 females). The commonest STS in adults were "sarcoma, not otherwise specified [NOS]" (20.1%), malignant fibrous histiocytoma [MFH] (17.9%), fibrosarcoma (12.4%), liposarcoma (10.7%) and malignant peripheral nerve sheath tumour [MPNST] (10.2%). In children, they were neuroblastoma (38.8%), rhabdomyosarcoma (23.9%), "sarcoma, NOS" (9%), fibrosarcoma (6%) and MFH (6%). In adults, the lower limb was the commonest location, followed by trunk and/or upper limb for MFH, fibrosarcoma and liposarcoma, and head and neck for MPNST. In children, head and neck was the commonest site for rhabdomyosarcoma, head and neck and upper limb for MFH, retroperitoneum for neuroblastoma and trunk for fibrosarcoma., Conclusion: A high proportion of soft tissue sarcomas in Jamaica are unclassified and the anatomical distribution of common classified sarcomas shows some differences with the literature. Limited access to immunohistochemistry/molecular diagnostics and increasing core biopsy diagnosis may contribute to these phenomena.

Studies using Posner's spatial cueing paradigm have demonstrated that participants can allocate their attention to specific target locations based on the predictiveness of preceding cues. Four experiments were conducted to investigate attentional orienting processes operating in a high probability condition (cues 75% predictive) as compared to a low probability condition (cues 50% predictive) using various types of centrally-presented cues. Spatially-informative cues (arrows and circles with gaps) resulted in cueing effects (CEs) for both probability conditions, with significantly larger CEs in the high probability conditions than the low probability conditions. Participants in the high probability conditions reported little or no awareness of cue-target probabilities after task completion. Our results provide support for an implicit learning account of the proportion valid effect under experimental conditions involving spatially-informative central cues and relatively short stimulus onset asynchronies (SOAs)., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To compare the distribution of histological subtypes of thyroid cancer in Kingston and St Andrew (KSA), Jamaica, within two consecutive 15-year periods., Methods: We extracted all cases of thyroid carcinoma archived in the Jamaica Cancer Registry files over the 30-year period from 1978 to 2007. The cases were separated into two groups: 1978-1992 (Group I) and 1993-2007 (Group II). We analysed age, gender and histological subtype distribution within each group, and then made comparative analyses between the two periods., Results: There were 311 cases in which the histological subtype was documented. The patients ranged in age from 12 to 94 years, with male to female ratios of 1:4.2 (group I) and 1:5.6 (group II). The highest frequencies of cases occurred in patients between the ages of 20 and 59 years. The commonest histological subtype in group I was follicular (52.7%); in group II, it was papillary (60%), followed by follicular (26.7%) and medullary (6.7%). There was an overall 263% increase in the papillary to follicular cancer ratio from group I (0.62) to group II (2.25). The increase in papillary carcinomas was statistically significant (p < 0.001) overall, and in patients less than 50 years of age (p < 0.001)., Conclusion: The recent KSA thyroid cancer data show a histological profile similar to that described globally, with papillary carcinomas being commonest, followed by follicular and then medullary. The significant increase in papillary cancer frequency in KSA is most likely the result of gradual recognition of the entity follicular variant of papillary cancer

Prior knowledge, working memory capacity (WMC), and conceptual integration (attention allocated to integrating concepts in text) are critical within many contexts; however, their impact on the acquisition of health information (i.e. learning) is relatively unexplored.We examined how these factors impact learning about nutrition within a cross-sectional study of adults ages 18 to 81. Results showed that conceptual integration mediated the effects of knowledge and WMC on learning, confirming that attention to concepts while reading is important for learning about health. We also found that when knowledge was controlled, age declines in learning increased, suggesting that knowledge mitigates the effects of age on learning about nutrition.

Objective: To investigate the positive predictive value (PPV) of urinary vanillylmandelic acid (VMA) testing in the diagnosis of phaeochromocytoma and to describe the features associated with phaeochromocytoma at the University Hospital of the West Indies (UHWI)., Subjects and Methods: There were 551 VMA tests performed from January 2003 to June 2009 and 122 tests in 85 patients were elevated (ie > or = 35 micromol/24 hr). The study patients were categorized as: (i) 'surgical' (5 patients who underwent surgery) or (ii) 'non-surgical' (remaining 80 patients). Forty medical charts (out of 85) were reviewed using a standardized data extraction form., Results: The median age for patients in the non-surgical group (with charts reviewed, n = 35) was 36 years (range 9-70) and the median VMA was 43 micromol/24 hr (IQR 38-51). Of these patients, 83% had one or no symptom typical of phaeochromocytoma. In the surgical group the median VMA was 58 micromol/24 hr (IQR 44-101); phaeochromocytoma was confirmed histologically in 3 patients, all of whom had several symptoms typical of catecholamine excess. VMA testing had a PPV of 8%, specificity of 79% and sensitivity of 100%., Conclusions: VMA testing at UHWI has poor specificity and high sensitivity. These results contrast with international data showing that VMA testing is poorly sensitive but highly specific. The use of assays with higher specificity (eg plasma or urinary metanephrines) may represent a more cost-effective approach to biochemical screening at UHWI.

Objective: To investigate the trends in incidence and age-distribution of prostate cancer in Kingston and St Andrew (KSA), Jamaica, over the 30-year period 1978-2007., Methods: From published Jamaica Cancer Registry (JCR) data, we extracted age-standardized rates of prostate cancer for the six 5-year reporting periods that comprised the 30-year study span, and from the archived files of the JCR, the patient ages at diagnosis for all prostate cancer cases recorded over the 30-year period were extracted. The results were compared with data from other black populations., Results: The incidence of prostate cancer in KSA, Jamaica, is lower than that in black men in the United States and United Kingdom. The KSA incidence showed a progressive increase since the 1983-1987 reporting period, and the greatest 5-year percentage increases were seen over the period 1983 to 1997. Men in the 60-74-year age group were the commonest contributors to prostate cancer total in all 5-year periods examined, and between 1988 and 2007, there were increases in the proportionate contributions from the 25-59 and 60-74-year age groups, and a decrease in contribution from men aged 75 years and older., Conclusion: The incidence of prostate cancer in KSA, Jamaica, has been progressively increasing since 1983, and there has been a concomitant increase in the proportionate contribution from younger men. Continued increase is likely over the next several years, but KSA currently appears to be a relatively low-risk region for prostate cancer, compared to black populations in developed Western countries.

A total of 4981 cancers were recorded in Kingston and St. Andrew during the period 2003-2007: 2536 in males and 2445 in females. Age standardized rates per 100,000 per year (ASR) were 188.8 and 144.2 for males and females respectively, and are relatively unchanged, compared to the previous report (188.6 for males and 144.2 for females, 1998-2002). In males, the leading sites for cancer were prostate, bronchus and large bowel, while in females, they were breast, cervix uteri and large bowel. The leading sites for both genders have been maintained in the same order as in the previous report, but for males, there were increases in the incidence of prostate (ASR 65.5 vs. 78.1 per 100,000 per year) and colorectal (ASR 13.7 vs. 17.2 per 100,000 per year) cancers and a decrease in the incidence of cancer of the bronchus (ASR 22.8 vs. 18.6 per 100,000 per year). For females, there was a modest decrease in incidence of cervical cancer (ASR 19 vs. 17.4 per 100,000 per year) while the incidence of cancers of the breast and large bowel remained relatively stable (ASR 40.1 vs. 43 per 100,000 per year for breast and ASR 13 vs. 12.8 per 100,000 per year for colorectal cancer). These data support the need for urgent institution of formal programmes for prevention and control of cancers of the breast and large bowel in the Jamaican population. Malignancies of unknown primary site were common in both genders and require further investigation.

Introduction: A minority of patients with unlocalised massive lower gastrointestinal bleeding (LGIB) will require treatment with emergency subtotal colectomy (STC)., Methods: To determine the outcome of STC in this high-risk group, we retrospectively reviewed the histopathology reports and case records of all subtotal colectomies performed for LGIB over a 8-year period., Results: Fifty-eight patients (mean age: 71 years; male to female ratio, 1 : 1) underwent emergency surgery for unlocalised LGIB, 45% of which were massive on admission, and unresponsive to resuscitation. The remainder had persistent or recurrent bleeding during the index hospitalisation. The hospitalisation for colectomy represented the first for LGIB for 56% of the study group, while 38% were on at least their third such admission. All but three patients underwent preoperative rigid proctosigmoidoscopy. Fifty-five of the 58 patients were treated with STC and primary ileorectal anastomosis. The major causes of bleeding were diverticular disease only (68%), angiodysplasia only (12%) and both diseases (12%). Overall mortality was 17%, with the main contributor being sepsis resulting from anastomotic leak. Non-fatal complications occurred in 20%, resulting in a mean postoperative length of stay of 13 days. All patients were doing well on their first follow-up visit with a mean number of four stools per day after 1 month., Conclusion: While emergency STC is an effective and definitive method of treating unlocalised massive LGIB, its associated morbidity and mortality may limit its usefulness.

A total of 4737 cancers were recorded in Kingston and St Andrew during the period 1998-2002: 2387 in males and 2350 in females. Age standardized rates per 100,000 per year (ASR) were 188.6 and 144.2 for males and females respectively. In males, the leading sites for cancer were prostate (873 cases), bronchus (269 cases) and large bowel (176 cases) while in females, the leading sites were breast (639 cases), cervix uteri (318 cases) and large bowel (218 cases). The number of new cases has remained relatively stable, compared to the previous five-year period (1993-1997), but the ASR for females has fallen from 156.7 to 144.2 per 100,000 per year and that for males has increased from 176.7 to 188.6 per 100,000 per year. The leading sites of cancer for both males and females have also been maintained in the same order but there was a moderate increase in prostate cancer (ASR 56.4 vs 65.5 per 100,000 per year) and a moderate decrease in cervical cancer (ASR 25.2 vs 19 per 100,000 per year). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 vs 40.1 per 100,000 per year). In both males and females, colon cancer incidence rates remain high at ASR of 9.9 per 100,000 per year in males and 9.4 per 100,000 per year in females. These data support the continuation of existing programmes for prevention and control of cancers of the prostate, lung, breast and cervix uteri and the introduction of new programmes specifically for cancers of the large bowel in the Jamaican population.

Aims: It has previously been shown that the low necropsy request rate at the University Hospital of the West Indies (UHWI) in Jamaica (35.3%) results primarily from clinicians' confidence in clinical diagnoses and laboratory investigations. This study aimed to determine the rates of discrepancy between clinical and necropsy diagnoses at the UHWI, because many previous studies from other institutions have shown persistent high rates of discrepancy, despite advances in medical investigative technology over the past several years., Methods: Data were extracted retrospectively from consecutive necropsies performed at the UHWI over a two year period. The data were analysed to determine the categories and rates of discrepancy, and to determine the relation between discrepancy rates and age, sex, type and number of diagnoses for each patient, hospital service, and length of hospitalisation., Results: Necropsies were performed on 446 patients; 348 were suitable for further analysis. The overall discrepancy rate was 48.4% and the diagnoses with the highest individual discrepancy rates were pneumonia (73.5%), pulmonary thromboembolism (68.3%), and myocardial infarction (66.7%). Males and older patients were more likely to have discrepant diagnoses. There was a high frequency of discrepancies in patients who died within 24 hours of admission, but there was no consistent relation between length of hospitalisation and discrepancy rate., Conclusions: The high discrepancy rates documented at the UHWI are similar to those reported globally. This study supports previous attestations that the necropsy remains a vital tool for determining diagnostic accuracy, despite modern modalities of clinical investigation and diagnosis.

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis.

Aim: To investigate necropsy request practices at the University Hospital of the West Indies, Jamaica, to determine the extent to which these might influence the declining necropsy rates. This is the first such study from a developing country., Methods: The necropsy service was audited prospectively over a six month period, and data relating to non-coroner's (hospital) necropsy requests, including the clinical service and post of the clinician involved, were documented. The reasons for non-request were recorded for deaths in which a necropsy was not requested, in addition to the reasons given by pathologists for not performing necropsies in cases that were requested but not done. The overall, non-coroner's, and coroner's necropsy rates in addition to the non-coroner's necropsy request and success rates were calculated., Results: There were 364 deaths comprising 323 non-coroner's and 41 coroner's cases. The overall, non-coroner's, and coroner's necropsy rates were 29.2%, 20.2%, and 38.7%, respectively. The non-coroner's necropsy request rate was 35.3% with a success rate of 65%. Seventy five per cent of the requests were made by non-consultant clinicians and on the internal medicine service, which accounted for most of the non-coroner's deaths; necropsy requests were biased towards younger patients (p < 0.0001). Confident clinical diagnosis was the main reason for not requesting a necropsy, and the primary reason for refusing to perform a necropsy was that the request had been made too long after death., Conclusions: These findings show a relatively high necropsy success rate in the face of a comparatively low necropsy request rate, and indicate that necropsy rates can be increased if clinicians make more necropsy requests in a timely manner in patients of all ages.

We report the clinicopathological features and outcome of four cases of carcinoma of the male breast diagnosed at the University Hospital of the West Indies between 1988 and 1998. Male breast cancer is most commonly seen in men over age sixty years, and it exhibits the same prognosis, stage for stage, as the disease in females. However, some researchers report overall poorer survival in men, and explain this on the basis of advanced disease at presentation. Other researchers maintain that the majority of breast cancers in males present at early stages, and exhibit survival similar to that in females. The published literature concerning this uncommon malignancy is reviewed, and the data are compared with the features of our cases.

From the search for the ultimate cardiac marker have emerged the cardiac troponins, which have offered high sensitivity and specificity for myocardial damage. Troponin I has arguably been the best of this group, but even this marker is not infallible. We present the case of an elderly woman who died shortly after being diagnosed with acute myocardial infarction on the basis of elevated Troponin I. Autopsy revealed a small cell lung cancer complicated by pulmonary thromboembolism. There was no evidence of myocardial infarction. Explanations for false elevation of serum Troponin I are proposed.

One measure of the efficiency of a surgical pathology service is the rapidity of reporting the diagnosis to clinicians. The turnaround time (TAT) has been used for this purpose. This study showed that the TAT for 66% of specimens submitted to the surgical pathology laboratory in the University Hospital of the West Indies was within 3 days and for 89% within 6 days. The TAT within 7 days was considered acceptable, but it was shown that it was more than 7 days for 9%, of the specimens submitted. The importance of this information is discussed and recommendations made for identifying more accurately the source of delays in those cases in which the TAT was considered to be unusually prolonged.