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McKenzie JA, Younger NO, Tulloch-Reid MK, Govia I, Bennett NR, McFarlane S, Walters R, Francis DK, Webster-Kerr K, Grant A, Davidson T, Wilks R, Williams DR, Ferguson TS. Ideal cardiovascular health in urban Jamaica: prevalence estimates and relationship to community property value, household assets and educational attainment: a cross-sectional study. BMJ Open 2020; 10:e040664. [PMID: 33323436 PMCID: PMC7745314 DOI: 10.1136/bmjopen-2020-040664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Ideal cardiovascular health (ICH) is associated with greater longevity and reduced morbidity, but no research on ICH has been conducted in Jamaica. We aimed to estimate the prevalence of ICH in urban Jamaica and to evaluate associations between ICH and community, household, and individual socioeconomic status (SES). DESIGN Cross-sectional study. SETTING Urban communities in Jamaica. PARTICIPANTS 360 men and 665 women who were urban residents aged ≥20 years from a national survey, the Jamaica Health and Lifestyle Survey 2016-2017. EXPOSURES Community SES, using median land values (MLV); household SES, using number of household assets; and individual SES, using education level. PRIMARY OUTCOME The main outcome variable was ICH, defined as having five or more of seven ICH characteristics (ICH-5): current non-smoking, healthy diet, moderate physical activity, normal body mass index, normal blood pressure, normal glucose and normal cholesterol. Prevalence was estimated using weighted survey design and logistic regression models were used to evaluate associations. RESULTS The prevalence of overall ICH (seven characteristics) was 0.51%, while the 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 with men in the upper tertile (lowest tertile: OR 0.33, 95% CI 0.12 to 0.91, p=0.032; middle tertile: OR 0.46, 95% CI 0.20 to 1.04, p=0.062). Women from communities in the lower and middle tertiles of MLV also had lower odds of ICH-5, but the association was not statistically significant. Educational attainment was inversely associated with ICH-5 among men and positively associated among women. CONCLUSION Living in poorer communities was associated with lower odds of ICH-5 among men in Jamaica. The association between education level and ICH-5 differed in men and women.
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Affiliation(s)
- Joette A McKenzie
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Novie O Younger
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Marshall Kerr Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Nadia R Bennett
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Shelly McFarlane
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, University of the West Indies at Mona, Kingston, Saint Andrew, Jamaica
| | - Renee Walters
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Damian K Francis
- School of Health and Human Performance, Georgia College and State University, Milledgeville, Georgia, USA
| | - Karen Webster-Kerr
- Office of the Prinicpal Medical Officer, National Epidemiology Unit and Non-Communicable Diseases and Injuries Prevention Unit, Ministry of Health and Wellness, Kingston, Jamaica
| | - Andriene Grant
- Office of the Prinicpal Medical Officer, National Epidemiology Unit and Non-Communicable Diseases and Injuries Prevention Unit, Ministry of Health and Wellness, Kingston, Jamaica
| | - Tamu Davidson
- Office of the Prinicpal Medical Officer, National Epidemiology Unit and Non-Communicable Diseases and Injuries Prevention Unit, Ministry of Health and Wellness, Kingston, Jamaica
| | - Rainford Wilks
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
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Ferguson TS, Younger-Coleman NOM, Mullings J, Francis D, Greene LG, Lyew-Ayee P, Wilks R. Neighbourhood socioeconomic characteristics and blood pressure among Jamaican youth: a pooled analysis of data from observational studies. PeerJ 2020; 8:e10058. [PMID: 33083129 PMCID: PMC7546221 DOI: 10.7717/peerj.10058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Neighbourhood characteristics are associated with several diseases, but few studies have investigated the association between neighbourhood and health in Jamaica. We evaluated the relationship between neighbourhood socioeconomic status (SES) and blood pressure (BP) among youth, 15-24 years old, in Jamaica. Methods A pooled analysis was conducted using data from three studies (two national surveys and a birth cohort), conducted between 2005-2008, with individual level BP, anthropometric and demographic data, and household SES. Data on neighbourhood SES were obtained from the Mona Geo-Informatics Institute. Neighbourhood was defined using community boundaries from the Social Development Commission in Jamaica. Community characteristics (poverty, unemployment, dependency ratio, population density, house size, and proportion with tertiary education) were combined into SES scores using principal component analysis (PCA). Multivariable analyses were computed using mixed effects multilevel models. Results Analyses included 2,556 participants (1,446 females; 1,110 males; mean age 17.9 years) from 306 communities. PCA yielded two neighbourhood SES variables; the first, PCA-SES1, loaded highly positive for tertiary education and larger house size (higher value = higher SES); while the second, PCA-SES2, loaded highly positive for unemployment and population density (higher value = lower SES). Among males, PCA-SES1 was inversely associated with systolic BP (β-1.48 [95%CI -2.11, -0.84] mmHg, p < 0.001, for each standard deviation unit increase in PCA-SES1 score) in multivariable model accounting for age, household SES, study, BMI, fasting glucose, physical activity and diet. PCA-SES1 was not significantly associated with systolic BP among females (β -0.48 [-1.62, 0.66], p = 0.410) in a similar model. Associations for PCA-SES2 was assessed using linear splines to account for non-linear effects. The were no significant associations between systolic BP and PCA-SES2 among males. Among females, higher PCA-SES2 (i.e. lower SES) was associated with higher systolic BP at spline 2 [z-score -1 to 0] (β4.09 [1.49, 6.69], p = 0.002), but with lower systolic BP at spline 3 [z-core 0 to 1] (β-2.81 [-5.04, -0.59], p = 0.013). There were no significant associations between diastolic BP and PCA-SES1, but PCA-SES2 showed non-linear associations with diastolic BP particularly among males. Conclusion Higher neighbourhood SES was inversely associated with systolic BP among male Jamaican youth; there were non-linear associations between neighbourhood SES and systolic BP among females and for diastolic BP for both males and females.
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Affiliation(s)
- Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston, Jamaica
| | - Novie O M Younger-Coleman
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston, Jamaica
| | - Jasneth Mullings
- Health Research Resource Unit, Dean's Office, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica
| | - Damian Francis
- School of Health and Human Performance, Georgia College and State University, Milledgeville, GA, United States of America
| | - Lisa-Gaye Greene
- Mona GeoInformatics Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Parris Lyew-Ayee
- Mona GeoInformatics Institute, The University of the West Indies, Mona, Kingston, Jamaica
| | - Rainford Wilks
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston, Jamaica
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Contribution of genetic, biochemical and environmental factors on insulin resistance and obesity in Mexican young adults. Obes Res Clin Pract 2019; 13:533-540. [PMID: 31796261 DOI: 10.1016/j.orcp.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/29/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
Abstract
Overweight/obesity, dyslipidemias, hypertension and hyperglycemia are strongly related to non-communicable diseases (NCD) in which genetic and environmental factors interact with each other. The Mexican population exhibit a genetic disposition to metabolic syndrome, type 2 diabetes, as well as many forms of dyslipidemia. This study aimed to determine the association between biochemical, genetic and environmental factors in the development of metabolic syndrome (MS), obesity and insulin resistance (IR) in Mexican young adults. Young women and men (n=6750 between 19.3±2.3 years old) participated in a health promotion program from the Autonomous University of Querétaro, México (SU-Salud program). A sub-sample of 665 participants was taken for the determination of single nucleotide polymorphisms (SNP) rs964184 (APOAV), rs9282541 (ABCA1) and rs1260326 (GCKR), using QuantStudio 12K Flex Real-Time PCR System. For the multivariate analysis, a multiple logistic regression was performed. A prevalence of 22% of overweight and 7% of obesity was determined. The main metabolic risk factors were low levels of HDL-C (30%), IR (19%), and a high level of triglycerides (15%). The main factors associated with IR were body fat percentage and triglycerides; SNP for the ABCA1 gene was related to MS, obesity and low HDL-C; SNP for GCKR gene was related to high fasting glycemia, while APOAV SNP was related with MS, hypertriglyceridemia and low HDL-C. Our findings show that the Mexican genetic predisposition to NCD affects young adults, who can suffer MS, obesity and IR. Public health strategies must focus on prevention actions from an early age.
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Abdul-Kareem K, Lindo JLM, Stennett R. Medical-surgical nurses' documentation of client teaching and discharge planning at a Jamaican hospital. Int Nurs Rev 2019; 66:191-198. [PMID: 30734275 DOI: 10.1111/inr.12487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study sought to review documentation of client teaching and discharge planning performed on the medical wards of an urban Jamaican hospital. BACKGROUND Amid a chronic disease epidemic in Jamaica, adequate discharge planning and client education among hospitalized clients are essential to ensure optimal health outcomes and reduced healthcare costs. METHOD A total of 131 records from six medical wards were audited. The audit instrument was developed based on the Ministry of Health, Jamaica guidelines, and appraised the completeness of assessment, use of the nursing process, client teaching and discharge planning. Quota sampling facilitated the selection of medical records which met the inclusion criteria. The SPSS® version 22 for Windows® facilitated data analysis. RESULTS Eighty-eight adult (67.2%) and 43 (32.8%) paediatric records were audited; 89.3% indicated the clients were diagnosed with at least one non-communicable disease. Fourteen percent of records reflected documented evidence of client teaching within the first 72 h of admission. On the day of discharge, only 18.3% reflected client teaching. Nurses seldom began discharge planning within the first 24 h of admission as only 6.9% records had documented evidence. These trends were common to adult and paediatric units. DISCUSSION AND CONCLUSION The requisite client teaching and discharge planning appeared to be lacking in the records reviewed and may be contributory to deficiencies noted in self-care management. Research is needed to determine factors which could facilitate improved client teaching and discharge planning in the local context. Failure to address this gap in nursing care can significantly affect the country's ability to the reduce the economic burden associated with chronic diseases. IMPLICATIONS FOR NURSING AND HEALTH POLICY This study highlighted an opportunity for advocacy among nurses and requires nursing leadership to collaboratively develop policies and guidelines to address discharge planning and client education among hospitalized clients. Given the significant health costs associated with non-communicable diseases this should be made a priority in the National Strategic and Action Plan for the Prevention and Control Non-communicable Diseases in Jamaica with clear articulations.
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Affiliation(s)
- K Abdul-Kareem
- The University of the West Indies, The UWI School of Nursing, Mona, Kingston, Jamaica
| | | | - R Stennett
- McMaster University, Continuing Education, Ontario, Canada
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Greene J, Guanais F. An examination of socioeconomic equity in health experiences in six Latin American and Caribbean countries. Rev Panam Salud Publica 2018; 42:e127. [PMID: 31093155 PMCID: PMC6386092 DOI: 10.26633/rpsp.2018.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/08/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Most Latin American and Caribbean (LAC) countries are working toward the provision of universal health coverage, and ensuring equity is a priority for those nations. The goal of this study was to examine the extent to which adults' socioeconomic status was related to health care experience in six LAC countries. METHODS This cross-sectional study examined the relationship between educational attainment and seven health experience outcomes in three areas: assessment of the health system, access to care, and experience with general practitioner. For this work, we used data from an Inter-American Development Bank survey of adults in Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama that was conducted in 2012-2014. RESULTS Brazil and Jamaica, the two countries with unified public coverage, stood out for having substantially greater inequality, according to the results of bivariate analyses, with more-educated respondents reporting better health care experiences for five of the seven outcomes. For Jamaica, educational differences largely remained in multivariate analyses: college graduates were less likely (odds ratio (OR) = 0.37) than those with primary education to report their health system needs major reform and were more likely (OR = 2.57) to have a regular doctor. In Brazil, educational differences were mostly eliminated in multivariate models, though people with private insurance consistently reported better outcomes than those with public coverage. Colombia, in contrast, exhibited the least inequality despite having the highest income inequality of the six countries. CONCLUSIONS Future research is needed to understand the policies and strategies that have resulted in Colombia achieving high levels of equity in patient health care experience, and Jamaica and Brazil demonstrating high levels of inequality.
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Affiliation(s)
- Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, New York City, New York, United States of America
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Wilson TT, Williams-Johnson J, Gossel-Williams M, Goldberg EM, Wilks R, Dasgupta S, Gordon-Strachan GM, Williams EW, Levy PD. Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica. Int J Emerg Med 2018; 11:30. [PMID: 29846823 PMCID: PMC5976560 DOI: 10.1186/s12245-018-0187-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/15/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Elevated blood pressure (BP) is common among emergency department (ED) patients. While some data exist on the association between ED BP and hypertension (HTN) in the USA, little is known about this relationship in Afro-Caribbean nations. The aim of the study was to evaluate the relationship between elevated systolic BP in the ED and a previous diagnosis of HTN, accounting for potential factors that could contribute to poor HTN control among those with a previous diagnosis: socioeconomic status, health-seeking behavior, underlying HTN illness beliefs, medication adherence, and perceived adherence self-efficacy. METHODS This was a cross-sectional survey over 6 weeks, from November 19 through December 30, 2014. Those surveyed were non-critically ill or injured adult ED patients (≥ 18 years) presenting to an Afro-Caribbean hospital. Descriptive statistics were derived for study patients as a whole, by HTN history and by presenting BP subgroup (with systolic BP ≥ 140 mmHg considered elevated). Data between groups were compared using chi-square and t tests, where appropriate. RESULTS A total of 307 patients were included: 145 (47.2%) had a prior history of HTN, 126 (41.4%) had elevated BP, and 89 (61.4%) of those presenting with elevated blood pressure had a previous diagnosis of HTN. Those with less formal education were significantly more likely to present with elevated BP (52.1 vs. 28.8% for those with some high school and 19.2% for those with a college education; p = 0.001). Among those with a history of HTN, only 56 (30.9%) had a normal presenting BP. Those with a history of HTN and normal ED presenting BP were no different from patients with elevated BP when comparing the in duration of HTN, medication compliance, location of usual follow-up care, and HTN-specific illness beliefs. CONCLUSIONS In this single-center study, two out of every five Jamaican ED patients had elevated presenting BP, the majority of whom had a previous diagnosis of HTN. Among those with a history of HTN, 60% had an elevated presenting BP. The ED can be an important location to identify patients with chronic disease in need of greater disease-specific education. Further studies should evaluate if brief interventions provided by ED medical staff improve HTN control in this patient population.
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Affiliation(s)
- Taneisha T. Wilson
- Alpert School of Medicine, Brown University, Emergency Medicine, Rhode Island Hospital, 55 Claverick St. #2, Providence, RI 02903 USA
- University Emergency Medicine Foundation, Kingston, Jamaica
| | - Jean Williams-Johnson
- University Hospital, University of the West Indies, Mona, Kingston, Jamaica
- The University Hospital of the West Indies, Mona, Kingston, West Indies Jamaica
| | - Maxine Gossel-Williams
- Department of Basic Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica
- The University of the West Indies, Mona, Kingston, West Indies Jamaica
| | - Elizabeth M. Goldberg
- Alpert School of Medicine, Brown University, Emergency Medicine, Rhode Island Hospital, 55 Claverick St. #2, Providence, RI 02903 USA
- University Emergency Medicine Foundation, Kingston, Jamaica
| | - Rainford Wilks
- The University of the West Indies, Mona, Kingston, West Indies Jamaica
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Shuvra Dasgupta
- University Hospital, University of the West Indies, Mona, Kingston, Jamaica
- The University Hospital of the West Indies, Mona, Kingston, West Indies Jamaica
| | | | - Eric W. Williams
- University Hospital, University of the West Indies, Mona, Kingston, Jamaica
- The University Hospital of the West Indies, Mona, Kingston, West Indies Jamaica
| | - Philip D. Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI USA
- Emergency Medicine, 6G4 University Health Center, Detroit, MI 48201 USA
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