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OBJECTIVES: To evaluate the effectiveness of newborn screening for sickle cell disease in eastern Jamaica by determining what proportion of screen-positive infants were registered with the Sickle Cell Unit by 2 months (60 days) of age and identifying parents' perceptions of facilitators and barriers impacting age at registration. STUDY DESIGN: This cross-sectional study used a mixed method approach. Ages at diagnosis confirmation and first clinic visit were recorded for screen-positive infants born between February 1, 2015, and November 15, 2017. All parents were invited to complete the survey, and early and late attendees were invited to participate in the qualitative aspect of the study. A researcher-designed questionnaire and an interview guide based on the Capability, Opportunity, Motivation, Behavior, and health belief models examined factors that may affect time to registration. Quantitative data were analyzed to yield descriptive statistics using Stata®v14. All interview data were coded. Similar codes were grouped together into themes. RESULTS: Most (97.7%) of the 133 screen-positive infants had their diagnosis confirmed. Only 40% had their first clinic visit by age 60 days. Denial of the diagnosis, poor communication, and the costs of treatment and transportation were perceived barriers to registration, whereas family support was a facilitator. CONCLUSIONS: Diagnosis confirmation was almost universal, but most infants did not attend clinic by 2 months of age. In-depth interviews have identified several facilitators and barriers that can be targeted to improve early registration.
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Anemia Falciforme , Recém-Nascido , Humanos , Lactente , Jamaica , Estudos Transversais , Anemia Falciforme/diagnóstico , Triagem Neonatal , PaisRESUMO
The current study examines gender effects on disease knowledge and quality of life in adolescents with sickle cell disease (SCD) in Jamaica. We report the baseline results on 76 girls and 74 boys with mean age (16.9 ± 1.8 vs. 16.2 ±2.0 years), recruited in a larger intervention study. Girls had higher knowledge scores (15.3 ± 4.2 vs. 13.3 ± 4.2 p=.004), poorer overall QOL scores (70.1 ± 19.6 vs. 77.2 ± 17.8 p=0.02) but similar severity scores to boys. Girls also had significantly lower scores on many QOL domain scores: Pain occurrences over the course the past month (Pain and Hurt:77.49 ± 23.3 vs. 85.37 ± 17.13); concerns about seeking health services for pain (Worry1:63.73 ± 26.21 vs. 75.33 ± 24.62); confidence in self-management & treatment effects (Treatment: 72.25 ± 23.6 vs. 80.73 ± 18.90) and SCD disclosure & empathy from others (Communication II: 47.44 ± 1.02 vs. 61.71 ± 29.41). Knowledge was positively predicted by age, higher education, greater household possessions and was higher in girls; whereas QOL was lower in girls and those with greater disease severity and higher with higher education. In conclusion, there is a significant gender differential in disease knowledge and QOL among adolescents with SCD. Interventions will need to address the lower QOL in girls and lower disease knowledge among boys.
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Anemia Falciforme/psicologia , Qualidade de Vida , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Jamaica , Masculino , Análise de Regressão , Autogestão , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Increasing knowledge and understanding of disease is known to improve outcomes in persons living with a chronic illness. In this paper, we aim to compare the disease knowledge of children with sickle cell disease (SCD), age 6-10 years, who received an intervention (an educational colouring book on SCD) geared towards improving disease knowledge, to those who did not received the colouring book. METHODS: A quasi-experimental study was conducted where disease knowledge was determined in 56 children who had received the colouring book and compared to 60 children who did not receive this intervention. RESULTS: The mean knowledge score was significantly higher in the intervention group (mean difference = 2.65; 95% CI [1.43, 3.86]), as well as in older children and in those in higher grades but there was no difference between sexes. In a multiple regression model (adjusted R2 : 0.39; p value < .001), knowledge score was significantly higher in those who received the intervention (ß: 2.62; 95% CI [1.48, 3.76]) while adjusting for age, gender, persons living at home, and the father's employment status. CONCLUSION: The study highlights that a simple, inexpensive (cost: US$1/book) child-friendly intervention can significantly improve knowledge about SCD even in young children. It also underlines various social factors that are associated with children's understanding of their disease.
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Anemia Falciforme/psicologia , Serviços de Saúde da Criança , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Anemia Falciforme/economia , Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/organização & administração , Análise Custo-Benefício , Feminino , Inquéritos Epidemiológicos , Humanos , Jamaica , Masculino , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/métodosRESUMO
OBJECTIVES: To assess the effect of educational interventions on disease knowledge, illness perception (IP) and quality of life (QOL) of adolescents with sickle cell disease (SCD) in Kingston, Jamaica. METHODS: A randomized controlled intervention study was conducted among 150 adolescents (ages 13-19 years) attending for routine visits. Baseline disease knowledge, IP and QOL were assessed prior to randomization to 3 groups (Group A: routine care; B: educational booklet; C: booklet + formal counselling) and all measures were repeated 3 months later. Changes in outcomes were analysed using random effects analysis of variance models. RESULTS: There were 76 girls and 74 boys (Mean age 16.1ñ1.9 years; 77% had homozygous SS disease), of whom 63.3% were reviewed at three months. Baseline knowledge was higher: with age (p value: 0.007) and in girls (p value: 0.024). Teen QOL was lower in girls (p value: 0.038) and lower in severe disease (p value< 0.001). Post-intervention knowledge scores were significantly higher within all 3 groups (increase of 1.68 in group A, 2.03 in B and 2.88 in C), but there was nil effect of interventions. There were no changes in QOL or IPs either. Adolescents who had higher knowledge scores had better understanding that their illness was long lasting (Coef: 0.22; p value: 0.008), and they perceived better personal control (Coef: 0.30; p value<0.001), as well as the effect of treatment (Coef: 0.12; p value: 0.01), in managing their illness. CONCLUSIONS: Participation in the study was associated with improved knowledge scores, but interventions per say appeared to have no effects.
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Educação , Conhecimentos, Atitudes e Prática em Saúde , Qualidade de Vida , Doença da Hemoglobina SC , Adolescente , JamaicaRESUMO
OBJECTIVE: Whereas measurement of albumin:creatinine ratio (ACR) in spot urine samples is indicated for determining microalbuminuria, its performance or that of urinary albumin excretion rate (UAER) in predicting microalbuminuria in sickle cell disease (SCD) is unclear. We therefore tested the diagnostic performance of these measures in spot and timed urine samples in predicting a UAER in 24-hour samples. METHODS: Thirty participants with SCD had spot, two-hour and four-hour, followed by 24-hour urine collections for ACR, urinary albumin concentration (UAC) and UAER determinations. Receiver operating characteristic (ROC) curve analyses were performed. RESULTS: The areas under the ROC curves for microalbuminuria were 0.99 (CI: 0.97, 1.00) for ACR and 0.97 (CI: 0.92, 1.00) for UAC in spot urine samples. For ACR, at the cut-point of 4.13 mg/mmol, there was 100% sensitivity and 82.6% specificity, allowing an 86.2% correct classification. At the cut-point of UAC = 20.9 mg/L, there was 100% sensitivity and 73.9% specificity, allowing a 79.3% correct classification. Corresponding areas for microalbuminuria in two-hour timed samples were 0.99 (CI: 0.95, 1.00) for ACR and 0.96 (CI: 0.89, 1.00) for UAER.For ACR, the cut-point was 4.64 mg/mmol with 83.3% sensitivity and 91.3% specificity, allowing an 89.7% correct classification. Similarly for UAER, at the cut-point of 21.8 µg/min, there was 83.3% sensitivity and 91.3% specificity, allowing 89.7% correct classification. CONCLUSIONS: The diagnostic performance of ACR and UAC in a spot as well as ACR and UAER in two-hour timed urine samples in patients with SCD is excellent. Healthcare professionals can confidently utilize these measures in this patient population.
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OBJECTIVES: Yoga improves cardiovascular health in both healthy individuals and those with diagnosed heart disease. This study compares changes in some cardiovascular parameters before and after the practice of Yoga in healthy medical students. METHODS: Sixty-four healthy medical students (57 females and 7 males), mean age 21.3 +/- 2.6 years, attending a Special Study Module 'Role of Dhyana Yoga in Stress Management', participated in this study. Systolic (SYS) and Diastolic (DIA) blood pressure, Heart Rate (HR), Stroke Volume (SV), Cardiac output (CO), Total Peripheral Resistance (TPR), Interbeat Interval (IBI), Left Ventricular Ejection Time (LVET), Arterial Compliance (Cwk) and Ascending Aorta Impedance (Zao) were measured before and after six weeks of yogic exercises. Various exercises included asanas (Postures), pranayama (Breathing), and dhyana (Meditation). Data were analyzed using Stata for Windows. RESULTS: Two-tailed paired t-test revealed that practice ofyoga caused significant increases in HR (p < 0.05), SV (p < 0.01), CO (p < 0.001) and Cwk (p < 0.01) and decreases in TPR (p < 0.001), IBI (p < 0.05) and Zao (p < 0.001) after practising yoga for 6 weeks as compared to before yoga practice. No significant differences were, however observed in SYS, DIA, Mean arterial blood pressure (MAP) and LVET CONCLUSIONS: Practice of yoga even for a short period showed ability to improve most of the cardiovascular functions. Regular practice of yoga for a longer period may further improve these functions and possibly result in improved management of their daily stress.
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Hemodinâmica , Yoga , Feminino , Humanos , Masculino , Estresse Psicológico/fisiopatologia , Estresse Psicológico/terapia , Estudantes de Medicina , Adulto JovemRESUMO
OBJECTIVES: Yoga improves cardiovascular health in both healthy individuals and those with diagnosed heart disease. This study compares changes in some cardiovascular parameters before and after the practice of Yoga in healthy medical students. METHODS: Sixty-four healthy medical students (57 females and 7 males), mean age 21.3 ±2.6 years, attending a Special Study Module 'Role of Dhyana Yoga in Stress Management', participated in this study. Systolic (SYS) and Diastolic (DIA) blood pressure, Heart Rate (HR), Stroke Volume (SV), Cardiac output (CO), Total Peripheral Resistance (TPR), Interbeat Interval (IBI), Left Ventricular Ejection Time (LVET), Arterial Compliance (Cwk) and Ascending Aorta Impedance (Zao) were measured before and after six weeks of yogic exercises. Various exercises included asanas (Postures), pranayama (Breathing), and dhyana (Meditation). Data were analyzed using Statafor WindowsTM. RESULTS: Two-tailed paired t-test revealed that practice ofyoga caused significant increases in HR (p < 0.05), SV (p < 0.01), CO (p < 0.001) and Cwk (p < 0.01) and decreases in TPR (p < 0.001), IBI (p < 0.05) and Zao (p < 0.001) after practising yoga for 6 weeks as compared to before yoga practice. No significant differences were, however, observed in SYS, DIA, Mean arterial blood pressure (MAP) and LVET. CONCLUSIONS: Practice of yoga even for a short period showed ability to improve most of the cardiovascular functions. Regular practice ofyoga for a longer period may further improve these functions and possibly result in improved management oftheir daily stress.
OBJETIVOS: El yoga mejora la salud cardiovascular tanto en individuos sanos como aquellos con diagnóstico de enfermedad cardíaca. Este estudio compara cambios en algunos parámetros cardiovasculares antes y después de la práctica del yoga en estudiantes de medicina saludables. MÉTODOS: Sesenta y cuatro estudiantes de medicina saludables (57 mujeres y 7 hombres), con una edad promedio de 21,3 ± 2.6 años, que asistían a un módulo especial de estudio "Papel de DhyanaYoga en el manejo del estrés", participaron en este estudio. Antes y después de seis semanas de ejercicios yoga, se midieron la presión arterial sistólica (SIS) y diastólica (DIA), ritmo cardíaco (RC), volumen sistólico de eyección (VS), gasto cardíaco (GC), resistencia periférica total (RPT), tiempo de intervalos interpulsos o interlatidos cardiacos (IBI), tiempo de eyección ventricular izquierda (TEVI), distensibilidad arterial Windkessel (Cwk) y la impedancia de la aorta ascendente (Zao). Los diversos ejercicios incluyeron asanas (posturas), pranayama (respiración) y dhyana (meditación). Se analizaron los datos usando Stata de Windows. RESULTADOS: La prueba T pareado de dos colas, reveló que la práctica del yoga causaba importantes aumentos del RC (p < 0,05), VS (p < 0,01), GC (p < 0,001) y Cwk (p < 0,01) y disminuciones de RTP comparación con la situación antes de la práctica de yoga. Sin embargo, no se observaron diferencias significativas en SIS, DIA, MAP y TEVI. CONCLUSIONES: La práctica del yoga incluso durante un corto período mostró capacidad para mejorar la mayoría de las funciones cardiovasculares. La práctica regular del yoga por un período más largo puede mejorar aún más estas funciones, y posiblemente traer como resultado una mejoría en el manejo del estrés cotidiano.
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Feminino , Humanos , Masculino , Adulto Jovem , Hemodinâmica , Yoga , Estresse Psicológico/fisiopatologia , Estresse Psicológico/terapia , Estudantes de MedicinaRESUMO
The authors present a case of a patient with sickle-ß thalassaemia (Sß(0) Thal) who had bilateral psoas abscesses on a background of splenectomy in early childhood. The patient also turned out to have vertebral osteomyelitis and hydronephrosis on the side of the larger abscess. The only organism recovered from the patient was a Bacteroides species. The patient was managed with percutaneous drainage and intravenous antibiotics and made a full recovery.
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Anemia Falciforme/complicações , Infecções por Bacteroides/complicações , Vértebras Lombares , Osteomielite/complicações , Abscesso do Psoas/complicações , Doenças da Coluna Vertebral/complicações , Adulto , Bacteroides , Humanos , Hidronefrose/complicações , Hidronefrose/microbiologia , Vértebras Lombares/microbiologia , Masculino , Abscesso do Psoas/microbiologiaRESUMO
Extensive research has shown that no matter how knowledgeable the physician might be, if he/she is not able to open good communication channels with the patient, he/she may be of no help to the latter Despite this known fact and the fact that a patient-physician consultation is the most widely performed 'procedure' in a physician's professional lifetime, effective communication with the patient has been found to be sadly lacking. This review article seeks to discuss 'the what', 'the why' and 'the how' of doctor-patient communication.
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Comunicação , Relações Médico-Paciente , Competência Clínica , HumanosRESUMO
Intrathoracic extramedullary haematopoiesis is a rare entity encountered in patients with long standing anaemias such as thalassaemia and congenital spherocytosis. It is rare in patients with homozygous sickle cell disease; only 11 cases of intrathoracic and two cases of pelvic extramedullary haematopoiesis have been documented in the literature. We report the case of a 30-year old man with homozygous sickle cell disease with intrathoracic and pelvic extramedullary haematopoiesis, the first case to be documented from the Caribbean.
La hematopoyesis extramedular intratorácica es una entidad que raras veces se encuentra en pacientescon anemias de larga duración tales como la talasemia y la esferocitosis congénita. También es rara en pacientes que padecen la enfermedad de células falciformes homocigóticas. En la literatura se han documentado sólo 11 casos de hematopoyesis extramedular intratorácica y dos casos de hematopoyesis extramedular pélvica. Reportamos el caso de un hombre de 30 años de edad con la enfermedad decélulas falciformes homocigóticas con hematopoyesis extramedular intratorácica y pélvica el primercaso que se documenta en el Caribe.