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Adolescent health in Jamaica and the wider English-speaking Caribbean has over the past three decades advanced in achieving improved healthcare services for adolescents. The path taken to achieve success thus far is reviewed – including a historical perspective on the services offered, revision of the relevant policy and legislation frameworks, improved service delivery through education and training of relevant stakeholders and providers, improved youth participation, and sustained involvement of advocates.

OBJECTIVE: To review Jamaican physicians' adolescent health screening practices by determining their frequency in areas of biomedical, psychological, social, and educational health; the factors that influence these practices; and physicians' perceived level of self-efficacy and their awareness of screening tools and guidelines. METHODS: A questionnaire was mailed to general practitioners, family medicine specialists, and pediatricians in Jamaica. The primary outcome variable was the frequency of physician screening for a range of biomedical, psychosocial, and educational developmental issues in the majority (> 50%) of adolescent patients. Bivariate analyses were performed to determine differences between professional groups. RESULTS: The response rate was 32.3% (n = 213), with 209 responders being suitable for further analysis. The sample comprised 48.8% general practitioners, 33.0% family medicine specialists, and 18.2% pediatricians. Physicians more often screened for biomedical risks than for psychosocial risks, with very low frequencies of screening for psychosocial issues such as mood, suicidal ideation, sexual orientation, and safety concerns. Physicians reported high levels of confidence in discussing most psychosocial issues with adolescent patients. Time limitation and an insufficient knowledge base were the main factors identified as influencing screening practices. CONCLUSIONS: The data suggest unsatisfactory frequency of adolescent health screening by Jamaican physicians, in particular for psychosocial factors. The primary factors identified by physicians as influencing their screening practices have potential for improvement through continued medical education.

OBJECTIVE: To review Jamaican physicians' adolescent health screening practices by determining their frequency in areas of biomedical, psychological, social, and educational health; the factors that influence these practices; and physicians' perceived level of self-efficacy and their awareness of screening tools and guidelines. METHODS: A questionnaire was mailed to general practitioners, family medicine specialists, and pediatricians in Jamaica. The primary outcome variable was the frequency of physician screening for a range of biomedical, psychosocial, and educational developmental issues in the majority (> 50%) of adolescent patients. Bivariate analyses were performed to determine differences between professional groups. RESULTS: The response rate was 32.3% (n = 213), with 209 responders being suitable for further analysis. The sample comprised 48.8% general practitioners, 33.0% family medicine specialists, and 18.2% pediatricians. Physicians more often screened for biomedical risks than for psychosocial risks, with very low frequencies of screening for psychosocial issues such as mood, suicidal ideation, sexual orientation, and safety concerns. Physicians reported high levels of confidence in discussing most psychosocial issues with adolescent patients. Time limitation and an insufficient knowledge base were the main factors identified as influencing screening practices. CONCLUSIONS: The data suggest unsatisfactory frequency of adolescent health screening by Jamaican physicians, in particular for psychosocial factors. The primary factors identified by physicians as influencing their screening practices have potential for improvement through continued medical education.OBJETIVO: Analizar las prácticas de examen sistemático de la salud de los adolescentes por parte de los médicos de Jamaica mediante la determinación de la frecuencia con la que llevan a cabo reconocimientos sistemáticos de salud en las áreas biomédica, psicológica, social y educativa; los factores que afectan dichas prácticas sistemáticas; el nivel de autoeficacia percibida por los médicos respecto a ellas y su conocimiento de los instrumentos y las recomendaciones con respecto a los exámenes sistemáticos. MÉTODOS: Se envió por correo un cuestionario a médicos generales, especialistas en medicina familiar y pediatras de Jamaica. La principal variable de evaluación fue la frecuencia con la que los médicos llevan a cabo exámenes sistemáticos sobre varios aspectos biomédicos, psicosociales y del desarrollo educativo en la mayoría (> 50%) de los pacientes adolescentes. Se realizaron análisis bifactoriales a fin de establecer las diferencias entre los grupos de profesionales. RESULTADOS: La tasa de respuesta fue de 32,3% (n = 213) y se consideró que 209 participantes eran adecuados para el análisis posterior. En la muestra, 48,8% eran médicos generales, 33,0% eran especialistas en medicina familiar y 18,2% eran pediatras. Los médicos llevaban a cabo exámenes sistemáticos con más frecuencia para evaluar los riesgos biomédicos que los riesgos psicosociales, y los exámenes sobre aspectos psicosociales como el estado de ánimo, la presencia de ideas suicidas, la orientación sexual y temas relacionados con la seguridad se exploraron muy poco. Los médicos informaron altos niveles de confianza para tratar la mayoría de los temas psicosociales con los pacientes adolescentes. Los principales factores que afectaran las prácticas de examen sistemático fueron la falta de tiempo y la carencia de conocimientos suficientes. CONCLUSIONES: Los datos indican que la frecuencia con la que los médicos de Jamaica llevan a cabo prácticas de examen sistemático relacionadas con la salud de los adolescentes es insuficiente, en particular en lo que respecta a los factores psicosociales. Los principales factores que, según los médicos, afectan sus prácticas con respecto a este tema pueden mejorarse mediante programas de formación médica continua.

Summary In 2006, after 44 years of eradication of malaria, Jamaica had an outbreak of Plasmodium falciparum: 406 confirmed cases between September 2006 and December 2009 with a peak of the epidemic in December 2006. In response to the outbreak, the Ministry of Health launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Ninety percent (361) of cases were residents of Kingston, and 63.6% were identified through house to house surveillance visits. For 56% of the confirmed cases, treatment with chloroquine was initiated within a week of onset of symptoms. Only one (0.3%) of 358 cases who had a post-treatment smear on day 7 had a persistent asexual parasitaemia, while none of the 149 persons who had a follow-up smear on day 28 was positive. The outbreak highlighted the need for increased institutional capacity for surveillance, confirmation and treatment of malaria as well as effective prevention and control of outbreaks which can occur after elimination. Jamaica appears to have successfully eliminated malaria after its reintroduction. En 2006, 44 ans apres l’eradication de la malaria, la Jamaique a connu une epidemie de malaria aPlasmodium falciparum: 406 cas confirmes entre septembre 2006 et decembre 2009 avec un pic de l’epidemie en decembre 2006. En reponse a l’epidemie, le Ministere de la Sante a lance une action d’urgence par la detection precoce et le traitement rapide des cas, la lutte contre le vecteur, l’education publique et la collaboration intersectorielle. 90% (361) des cas etaient des residents de Kingston et 63,6% ont ete identifies a travers des visites de surveillance de maison a maison. Pour 56% des cas confirmes, le traitement a la chloroquine a ete initie dans la semaine suivant l’apparition des symptomes. Seul un (0,3%) des 358 cas pour lesquels un frottis a ete effectue 7 jours post-traitement avait une persistante parasitemie asexuee, tandis qu’aucune des 149 personnes qui ont eu un frottis de suivi a 28 jours n’a ete positive. L’epidemie a souligne la necessite d’une capacite institutionnelle accrue pour la surveillance, la confirmation et le traitement de la malaria ainsi que la prevention et le controle efficaces des epidemies qui peuvent survenir apres l’elimination. La Jamaique semble avoir reussi aeliminer la malaria apres sa reintroduction. En el 2006, tras 44 anos de la erradicacion de la malaria, Jamaica sufrio un brote de Plasmodium falciparum: 406 casos confirmados entre Septiembre 2006 y Diciembre 2009, con el pico de la epidemia en Diembre del 2006. Como respuesta al brote, el Ministerio de Salud lanzo un plan de emergencia con una deteccion temprana y un rapido tratamiento de los casos, control vectorial, educacion publica y colaboracion intersectorial. Un 90% (361) de los casos eran residentes de Kingston y 63·6% fueron identificados mediante visitas realizadas casa por casa. Para un 56% de los casos confirmados, se inicio tratamiento con cloroquina dentro de la semana siguiente a la aparicion de los sintomas. Solo uno (0·3%) de los 358 casos que tenian una lamina post-tratamiento en el dia 7 tenian una parasitemia asexual persistente, mientras que ninguna de las 149 personas que tenian una lamina de seguimiento del dia 28 era positiva. El brote epidemico enfatizo la necesidad de una mayor capacidad institucional para realizar una vigilancia, confirmacion y tratamiento de la malaria, asi como una prevencion efectiva y el control de brotes epidemicos que pueden ocurrir despues de la eliminacion. Jamaica parece haber eliminado la malaria con exito tras su reintroduccion.

Background: Although extensive studies on adolescent suicidal behavior have been conducted in developed countries such as the United States, little data exist on risk factors for suicide among adolescents in culturally and socially disadvantages settings, such as Jamaica. Aims: To conduct a preliminary investigation of risk factors associated with suicide ideation and attempt among youths in Western Jamaica. Methods: We conducted a cross-sectional study of 342 adolescents aged 10–19 years from 19 schools. Results: Multivariate analysis showed that a history of self-violence, violent thoughts toward others, mental health diagnoses other than depression, and a history of sexual abuse were positively associated with suicide attempt. Sexual abuse, mental health diagnoses other than depression, self-violence, and ease of access to lethal substances/weapons were positively associated with suicide ideation. Conclusions: We found a relatively high prevalence of suicide ideation and suicide attempts among adolescents living in Western Jamaica. An accurate understanding of the prevailing risk factors for suicide attempts will promote a more sympathetic approach to victims and facilitate prevention efforts.

Background Between December 6, 1994 and March 10, 1996, a study of the etiology of diarrhea was carried out among 332 travelers to five all-inclusive hotels in Negril, Jamaica. Methods Stool specimens were collected and sent to Montego Bay for laboratory analysis. Escherichia coli strains isolated at the Jamaican laboratory were sent to Houston for toxin testing. Results A recognized enteropathogen was found in 118 of the 332 (35.5%) cases. Enterotoxigenic E. coli (ETEC) were the most commonly identified pathogen (87/332; 26.2%) followed by Salmonella (4.2%) and Shigella (4.2%). Clustering of etiologically defined cases was studied at each hotel. A cluster was defined as 2 or more cases with the same pathogen identified in the same hotel within 7 days. In the 3 hotels with the highest number of cases of diarrhea, enteropathogens were part of a cluster in 65 of 99 cases (65.7%) of diarrhea of which an etiologic agent was identified. In the other 2 hotels, only 4 of 20 cases (20%) occurred in clusters. Conclusions A total of 25 clusters of travelers' diarrhea cases was detected at the five hotels during the study period. Seventeen of 25 (68%) ETEC isolations occurred as part of a clustering of diarrhea cases. The largest outbreak of pathogen-identified diarrhea consisted of 7 cases of ETEC producing both heat-stable and heat-labile enterotoxins. In the Jamaican hotels with all inclusive meal packages most diarrhea cases occurred as small clusters, presumably as the result of foodborne outbreaks.

A case - control study was conducted to assess the risk factors of stillbirth among pregnant women in Jamaica. A total of 314 women participated (160 with stillborn babies and 154 with live-born babies). A questionnaire designed to collect information on sociodemographic characteristics, antenatal care, medical and sexually transmitted disease (STD) history, method of delivery and infant birth and health status was administered to each woman. Medical records were reviewed to verify medical history. Six variables were found to be significant predictors of stillbirth by multivariate logistic regression. Low birth weight (OR = 4.3, CI = 2.4 - 7.7), complications during pregnancy or delivery (OR = .19, CI = 0.09 - 0.41), method of delivery (caesarean section; OR = 7.2, CI = 1.6 - 33.2), number of living children (OR = 0.54, CI = 0.40 - 0.73), number of antenatal visits (less than three; OR = 2.0, CI = 1.3 - 3.1), and presence of unfavourable and /or adverse fetal outcome (OR = 4.0, CI = 1.8 - 9.2) were found to be associated with stillbirth. These findings have important implications in establishing policies for prenatal care in Jamaica.

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

Adolescent students from nine English-speaking Caribbean countries completed a survey that assessed weight-control behaviors. Weight-control behaviors were prevalent and similar across gender. Extreme weight-control behaviors were related to several psychosocial factors and compromising health behaviors. Future interventions should target adolescents who are using weight-controlling behaviors to prevent future eating disturbances and psychosocial and health morbidities.

In 2006, after 44 years of eradication of malaria, Jamaica had an outbreak of Plasmodium falciparum: 406 confirmed cases between September 2006 and December 2009 with a peak of the epidemic in December 2006. In response to the outbreak, the Ministry of Health launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Ninety percent (361) of cases were residents of Kingston, and 63.6% were identified through house to house surveillance visits. For 56% of the confirmed cases, treatment with chloroquine was initiated within a week of onset of symptoms. Only one (0.3%) of 358 cases who had a post-treatment smear on day 7 had a persistent asexual parasitaemia, while none of the 149 persons who had a follow-up smear on day 28 was positive. The outbreak highlighted the need for increased institutional capacity for surveillance, confirmation and treatment of malaria as well as effective prevention and control of outbreaks which can occur after elimination. Jamaica appears to have successfully eliminated malaria after its reintroduction.

The use of condoms can reduce the risk of sexually transmitted infections (STIs) including the human immunodeficiency virus (HIV) infection. We conducted this study to determine factors that impact condom use among patients attending an STI clinic in Montego Bay, Jamaica. A questionnaire containing sections on socio-demographic characteristics, knowledge of STIs and HIV, preventive measures for STI/HIV transmission and sexual practices including condom use was administered to 212 participants. Using logistic regression, we determined the relationship between the different factors and condom use during the last sexual episode. Approximately 43% of study participants reported condom use during the last sexual episode. Employment (OR=2.2; 95%CI=1.1-4.1) and greater knowledge of STIs (OR=1.9, 95%CI=1.02-3.6) were associated with increased likelihood of condom use during the last sexual episode. Having multiple sexual partners was associated with decreased likelihood to report condom use (OR=0.3, 95%CI=0.1- 0.9). Also, persons belonging to a religious organization were less likely to report condom use (OR=0.5, 95%CI=0.2-0.9). The results of this study can be used in formulating effective strategies to increase condom use in Montego Bay. This would decrease the transmission of STIs and HIV.

Purpose To investigate sexual behavior of adolescents in rural Hanover, Jamaica, and to elucidate the cultural contexts of this behavior Methods Focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited from health centers, as well as community-based organizations through the Social Development Commission (SDC) in Hanover, a local youth and community development organization, within the Ministry of Local Government, Youth and Community Development. The discussions focused on the adolescents' knowledge of sex and sexual risks, perceived vulnerability to sexual risks, use of protection, self-efficacy, and societal expectations. Data were analyzed, using the content analysis technique. Results Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous. Conclusions The results show that sexual attitudes and behavior of adolescents in the study setting are shaped by cultural and gender norms that impose different standards on males and females.

ContextTraveler's diarrhea (TD) can incapacitate travelers. Characteristics of TD could be helpful in identifying individuals who might benefit from a vaccine against TD.ObjectiveTo determine epidemiology, etiology, and impact of TD in Jamaica.DesignTwo-armed, cross-sectional survey conducted between March 1996 and May 1997.SettingSangster International Airport and 10 hotels in Montego Bay area, Jamaica.SubjectsTo investigate epidemiology and impact, 30,369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples.Main Outcome MeasuresAttack and incidence rates of reported diarrhea and of classically defined TD (≥3 unformed stool samples in 24 hours and ≥1 accompanying symptom), incapacity, risk factors, and etiology.ResultsThe attack rate for diarrhea was 23.6% overall, with 11.7% having classically defined TD. For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9% (all TD) and 10.0% (classic TD). Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3% of all travelers avoided potentially high-risk food and beverages. The most frequently detected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Salmonella species.ConclusionsA realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal.