Shelly R. McFarlane

/Summary: Sickle cell disease (SCD) is a significant contributor to the global disease burden, particularly in developing countries where access to care is limited, and coordinated multidisciplinary care is often unavailable. Hydroxyurea is the only readily available disease-modifying-drug therapy in many resource-limited settings, such as Jamaica where it is subsidized through the National Health Fund (NHF). This cross-sectional study assessed barriers to healthcare access and hydroxyurea use in Jamaica among adults with SCD and parents or caregivers of children with SCD from four regional health authorities and a specialized SCD centre. Participants completed an interviewer-assisted questionnaire collecting information on sociodemographics, healthcare access, hydroxyurea utilization and associated barriers. All analyses were exploratory. The study recruited 173 adults (mean age 34.0±11.4 years, 73.6% female, 48.6% urban, 75.1% with secondary education) and 189 parents/caregivers (mean age of parents/caregivers 37.2±10.2 years and children 7.1±4.8 years, 55.0% of children female, 50.3% urban, and 64.3% of parents/caregivers with secondary education). Overall, emergency care was most commonly accessed at public hospitals (87.3%), with the SCU (21.5%) and private hospitals (7.7%) less commonly reported. Routine care was accessed at the SCU by 85.9%, with 28.6% also attending hospital outpatient clinics. Enrolment in the National Health Fund (NHF) drug subsidy programme was reported by 50.9% of adults and 36.0% parents/caregivers, while insurance coverage was reported by 34.7% and 31.8%, respectively. Common healthcare access barriers included not being seen quickly enough when in pain (77.8% adults), worry or fear (47.2% overall), long wait times (39.2% overall), frustration or anger (29.3% overall), and high transportation costs (22.4% overall). Hydroxyurea awareness was reported by 62.4% adults and 67.6% parents/caregivers, while 45.0% and 55.0% reported receiving hydroxyurea education, respectively. Awareness and education were both higher among adult females and parents/caregivers of older children, while awareness was also greater among tertiary-educated adults. Overall, 30.2% of adults and 39.4% of children reported initiating hydroxyurea (p=0.18). Among patients advised to take hydroxyurea, 68.4% adults and 77.1% children initiated (p=0.18), and 50.0% adults and 73.4% children (p=0.001) were currently using it. Among adults, lower initiation was associated with reporting insufficient knowledge about hydroxyurea (odds ratio, OR=0.1), disinterest in another medication (OR=0.1), and having neither NHF coverage nor other health insurance (OR=0.1). Among parents/caregivers, initiation and current use were lower among those who were disinterested in another medication (OR=0.1 and 0.02, respectively) and concerned about side effects (both OR=0.2). Poor adherence was most commonly attributed to forgetting to take the medication. Adherence was lower among adults who reported inadequate social support and healthcare being too expensive, including co-pay. Among children, adherence was greater among females, younger children and those with tertiary-educated parents. Findings suggest hydroxyurea awareness and education are inadequate, and initiation and continued use remain suboptimal, highlighting the need for improved education strategies and NHF enrolment. Strategies should be tailored to better engage males, parents and patients of different age groups, and those with lower educational attainment. Greater support is needed to address mental health and transportation challenges, alongside protocols aimed at reducing wait times.

Environmental heavy metal pollutants are highly toxic and are usually of human origin. Studies have suggested a link between cadmium and arsenic carcinogenesis and geographical location. This review was conducted to explore the methodologies that have been used to determine the risk of carcinogenesis as it relates to cadmium & arsenic exposure as well as geographical location. A search of pertinent literature published up to December 2024 was conducted using the databases, PubMed, and EBSCO. The following MeSH terms were used primarily to search the databases, “heavy metals,” “cadmium,” “arsenic,” “carcinogenesis,” “malignancy,” and “toxicity.” Articles were removed if they were not closely related to the review topic. As evidenced in this review, there has been several research done over the years exploring the heavy metal exposure and the risk for carcinogenesis. The methodologies used to determine this risk are quite uniformed across the various studies. However, there is a paucity of studies dealing with the potential influence of geographical location in relation to the risk of carcinogenesis. This gap in knowledge shows that more work needs to be done to improve on the current knowledge of arsenic and cadmium and carcinogenesis.

Recent studies have suggested that high levels of social support can encourage better health behaviours and result in improved cardiovascular health. In this study we evaluated the association between social support and ideal cardiovascular health among urban Jamaicans. We conducted a cross-sectional study among urban residents in Jamaica’s south-east health region. Socio-demographic data and information on cigarette smoking, physical activity, dietary practices, blood pressure, body size, cholesterol, and glucose, were collected by trained personnel. The outcome variable, ideal cardiovascular health, was defined as having optimal levels of ≥5 of these characteristics (ICH-5) according to the American Heart Association definitions. Social support exposure variables included number of friends (network size), number of friends willing to provide loans (instrumental support) and number of friends providing advice (informational support). Principal component analysis was used to create a social support score using these three variables. Survey-weighted logistic regression models were used to evaluate the association between ICH-5 and social support score. Analyses included 841 participants (279 males, 562 females) with mean age of 47.6 ± 18.42 years. ICH-5 prevalence was 26.6% (95%CI 22.3, 31.0) with no significant sex difference (male 27.5%, female 25.7%). In sex-specific, multivariable logistic regression models, social support score, was inversely associated with ICH-5 among males (OR 0.67 [95%CI 0.51, 0.89], p = 0.006) but directly associated among females (OR 1.26 [95%CI 1.04, 1.53], p = 0.020) after adjusting for age and community SES. Living in poorer communities was also significantly associated with higher odds of ICH-5 among males, while living communities with high property value was associated with higher odds of ICH among females. In this study, higher level of social support was associated with better cardiovascular health among women, but poorer cardiovascular health among men in urban Jamaica. Further research should explore these associations and identify appropriate interventions to promote cardiovascular health.

Jamaica has one of the highest teenage pregnancy rate and therefore identifying the context of adolescent sexual and reproductive health is important, especially since there is paucity of research on preadolescents in the Jamaican context. The study was a nationally representative cross-sectional, interviewer administered, school-based survey of 10 -15 year olds. Summary statistics of the demographics and bivariate analyses were performed to assess the association of sexual initiation and given risk and resiliency factors. 1,422(47.4%) males, 1,581 (52.6%) females, mean age (SD) 12.5 (1.6) years were surveyed. Mean age of first sex was 11.0 (±2.5) years. Factors significantly with sexual initiation were, female sex (OR 0.17; 95% CI 0.12-0.23), caring relationships inside the home (OR 0.85; 95%CI 0.83-0.97) rare church attendance (OR1.36; 95%CI1.0-1.8), age (OR 1.75; 95%CI1.6-1.9) and community disorganization (OR 1.02 95% CI 1.01-1.07). Sexual initiation of early adolescents is positively influenced by environmental factors such as family connectedness and religious involvement. The negative correlates are societal risk factors such as community disorganization. Empowerment through learned sexual negotiation skills, should be incorporated into the education programme of pre-adolescents to facilitate adolescents embracing their intrinsic power to delay sexual debut and if sexually active to insist on condom use.

Introduction: Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. Methods: Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. Results: Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. Conclusion: Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.

This study aimed to estimate dietary sodium and potassium consumption among Jamaicans and evaluate associations with sociodemographic and clinical characteristics. A cross-sectional study was conducted using data from the Jamaica Health and Lifestyle Survey 2016–2017. Participants were noninstitutionalized Jamaicans aged ≥15 years. Trained staff collected sociodemographic and health data via interviewer-administered questionnaires and spot urine samples. The Pan American Health Organization formula was used to estimate 24-hour urine sodium and potassium excretion. High sodium level was defined as ≥2000 mg/day, and low potassium levels as P < .001). The mean potassium excretion was 2052 mg/day (males, 2210 mg/day; females, 1904 mg/day; P = .001). The prevalence of high sodium consumption was 66.6% (males 72.8%, females 60.7%, P < .001) and that of low potassium intake was 88.8% (85.1% males, 92.3% females, P < .001). Sodium consumption was inversely associated with older age, higher education, and low glomerular filtration rate but was directly associated with being male, current smoking, and obesity. Overall, males had higher sodium consumption than women, with the effect being larger among hypertensive men. Women with hypertension had lower sodium consumption than nonhypertensive women; however, hypertensive men had higher sodium consumption than nonhypertensive men. Potassium consumption was higher among men, persons with obesity, and those with high total cholesterol but was lower among men with “more than high school” education compared to men with “less than high school” education. We conclude that most Jamaican adults have diets high in sodium and low in potassium. In this study, sodium consumption was directly associated with male sex, obesity, and current smoking but was inversely associated with older age and higher education. High potassium consumption was associated with obesity and high cholesterol levels. These associations should be further explored in longitudinal studies and population-based strategies should be developed to address these cardiovascular risk factors.

Recent studies have suggested that high levels of social support can encourage better health behaviours and result in improved cardiovascular health. In this study we evaluated the association between social support and ideal cardiovascular health among urban Jamaicans. We conducted a cross-sectional study among urban residents in Jamaica’s south-east health region. Socio-demographic data and information on cigarette smoking, physical activity, dietary practices, blood pressure, body size, cholesterol, and glucose, were collected by trained personnel. The outcome variable, ideal cardiovascular health, was defined as having optimal levels of ≥5 of these characteristics (ICH-5) according to the American Heart Association definitions. Social support exposure variables included number of friends (network size), number of friends willing to provide loans (instrumental support) and number of friends providing advice (informational support). Principal component analysis was used to create a social support score using these three variables. Survey-weighted logistic regression models were used to evaluate the association between ICH-5 and social support score. Analyses included 841 participants (279 males, 562 females) with mean age of 47.6 ± 18.42 years. ICH-5 prevalence was 26.6% (95%CI 22.3, 31.0) with no significant sex difference (male 27.5%, female 25.7%). In sex-specific, multivariable logistic regression models, social support score, was inversely associated with ICH-5 among males (OR 0.67 [95%CI 0.51, 0.89], p=0.006) but directly associated among females (OR 1.26 [95%CI 1.04, 1.53], p=0.020) after adjusting for age and community SES. Living in poorer communities was also significantly associated with higher odds of ICH-5 among males, while living communities with high property value was associated with higher odds of ICH among females. In this study, higher level of social support was associated with better cardiovascular health among women, but poorer cardiovascular health among men in urban Jamaica. Further research should explore these associations and identify appropriate interventions to promote cardiovascular health.

There are inconsistent findings concerning the association between the serum concentrations of lipid parameters and prostate cancer (PCa), particularly in Caucasian men. There is limited data on men of African ancestry. The study examined the relationship between serum total cholesterol (TC) levels and its fractions and PCa in a hospital-based case-control study in Jamaica. The serum levels of TC, triglycerides (TG), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C) in 46 male patients (cases) who underwent prostate biopsy were measured over an eighteen month period. There were 32 patients without PCa who served as controls. The serum lipid concentrations between cases and controls were compared using an independent samples t-test. Multiple linear regression and binary logistic regression were used to assess the relationship between lipids and overall PCa, as well as disease severity. Based on the results, there were no significant differences between the concentrations of lipids for the cases and controls. The results of the regression analysis revealed that the serum lipid levels were not significant predicators of overall PCa. The outcomes of the binary regression analysis showed the same for PCa severity. The study concluded that there was no association between serum levels of lipids and overall PCa as well as disease severity at the time of diagnosis in the sample of Jamaican men.

Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients and there is increasing demand for telehealth services. Globally, telehealth has become an essential means of communication between patient and health care provider. The application of telehealth to the treatment of BCa patients is evolving and increasingly research has demonstrated its feasibility and effectiveness in improving clinical, psychological and social outcomes. Two areas of telehealth that have significantly grown in the past decade and particularly since the beginning of the COVID-19 pandemic are telerehabilitation and teleoncology. These two technological systems provide opportunities at every stage of the cancer care continuum for BCa patients. We conducted a literature review that examined the use of telehealth services via its various modes of delivery among BCa patients particularly in areas of screening, diagnosis, treatment modalities, as well as satisfaction among patients and health care professionals. The advantages of telehealth models of service and delivery challenges to patients in remote areas are discussed.

BACKGROUND: Ideal cardiovascular health (ICH) is associated with greater longevity and reduced morbidity, but no research on ICH has been conducted in Jamaica. We estimated the prevalence of ICH in urban Jamaica and evaluated associations between ICH and community, household and individual socioeconomic status (SES). METHODS: Cross-sectional study using data from 360 men and 665 women, age ≥20 years in urban Jamaica. ICH was defined as having seven characteristics: current non-smoking, healthy diet, moderate physical activity, and normal body mass index, blood pressure, glucose, and cholesterol. Logistic regression, weighted for survey design, quantified association between the outcome (≥5 ICH characteristics [ICH-5]), and exposure variables (tertiles of community median land value [MLV], tertiles of household assets and educational attainment). RESULTS: Prevalence of ICH (7 characteristics) was 0.51%, while prevalence of ICH-5 was 22.9% (male 24.5%, female 21.5%, p=0.447). In sex-specific multivariable models adjusted for age, education, and household assets, men in the lower tertiles of community MLV had lower odds of ICH-5 compared to men in the upper tertile (lowest tertile: OR 0.33, 95%CI 0.12-0.91, p=0.032; middle tertile: OR 0.46 (0.20-1.04) p=0.062). Women from communities in the lower and middle tertiles of MLV also had lower odds of ICH-5, but association was not statistically significant. Educational attainment was inversely associated with ICH-5 among men and positively associated among women. No significant association was seen for household assets. CONCLUSION: Prevalence of ICH is low in urban Jamaica. Living in poorer communities was associated with lower odds of ICH-5 among men. Higher education was associated with higher odds of ICH-5 among women but lowers odds among men.