RESUMO
BACKGROUND: Sexually transmitted infections (STIs) and STI treatment remain a challenge in public health. There is little understanding of related factors influencing health seeking behaviour and delay of care among clinic attendees in Jamaica. AIM: To determine socio-demographic profile of clinic attendees with STI and identify factors associated with delay in seeking care for STI-related symptoms. METHODS: A cross-sectional study was done. 201 adult patients presenting with STI symptoms from four health centres in Kingston and St Andrew were selected. A 24-item interviewer-assisted questionnaire was used to obtain data on socio-demographic characteristics, patients' symptoms and duration, previous STIs, knowledge of complications and seriousness of STIs, and factors influencing decision to seek medical care. RESULTS: Almost 75% delayed seeking care for STIs. Recurrent STIs was identified in 41% of patients. 'Could not find time' was the most commonly reported reason for delay in seeking care (36%). Females were 3.4 times more likely to delay seeking care for STI symptoms than males (OR 3.42, 95% CI: 1.73-6.73). Those with primary level education and below were 5 times more likely to delay seeking care for STI symptoms than those with at least secondary level education (OR 5.05, 95% CI: 1.09-23.46). Participants viewed staff as confidential (68%) and 65% thought health-care workers spent adequate time during consultations. CONCLUSION: Lower education level and the female gender are associated with delay in seeking care for STI-related symptoms. These factors should be considered when developing interventions to reduce delay in care for STI-related symptoms.
Assuntos
Países em Desenvolvimento , Infecções Sexualmente Transmissíveis , Adulto , Masculino , Humanos , Feminino , Estudos Transversais , Jamaica , Infecções Sexualmente Transmissíveis/diagnóstico , Instituições de Assistência AmbulatorialRESUMO
Income and employment are recognised as social determinants of health. Occupationally related exposures and working conditions impact health behaviours. Taxi drivers have been recognised as an occupationally COVID-19 at-risk group. COVID-19 threatens their lives and livelihoods. This study describes self-reported income changes attributed to the COVID-19 pandemic among taxi drivers. Associations between percentage change in income and reported prevention practices were ascertained. In May 2020, a cross-sectional study was done among 282 taxi drivers in the Kingston and St. Andrew Metropolitan Area in Jamaica. Multi-stage sampling was used to select taxi driver from seven hubs. Data collection utilised a 28-item questionnaire. Self-reported income before and during the COVID-19 pandemic was ascertained and correlations between relative changes in income and COVID-19 prevention practices were assessed. The median pre-COVID-19 monthly income was USD 1,428.57 (IQR = 1,467.26), about USD 51/day. Median monthly income since the COVID-19 outbreak was USD 500 (IQR = 472.37), about USD 18/day, representing a 65% reduction in income. There was a statistically significant association between the relative change in income and the practice of wearing mask while transporting passengers. Generally, as the relative change (decline) in income increased, reported compliance with mask wearing decreased (Spearman's rho = -0.15, p = 0.02). Taxi drivers have experienced marked decline in income due to the COVID-19 pandemic, with implications for health practices and the maintenance of desired health behaviours. Authorities should be cognisant of the economic impact and COVID-related consequences in the taxi industry, as they seek to develop COVID-19 occupationally related prevention and control programmes.
Assuntos
Condução de Veículo , COVID-19 , COVID-19/epidemiologia , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Jamaica/epidemiologia , PandemiasRESUMO
Internship programmes have the potential to provide learning and professional experiences, build students' competency and strengthen partnerships between community and training institutions. In this paper, we examine the extent to which a structured internship at The University of the West Indies contributed to experience and competency-building, provided focus and met learners' expectations and satisfaction among a cohort of unpaid health promotion interns. The contribution of placements to the strengthening of health education and promotion competencies and interns' feelings about their experiences are included. Twenty-four (24) internship reports were reviewed using a mix of quantitative and qualitative methods. The majority of interns were Jamaicans (70.8%), 12.5% were from Dominica and the remaining 16.7% represented other nationalities. Health professionals comprised the highest percentage of cohorts (79.2%) and governmental agencies comprised the largest proportion (63%) of internship sites. Activities undertaken were in the areas of planning, implementing and evaluating programmes (71%) and conducting needs assessments (63%). Communication-related activities were reported by 43% of interns. Twenty-one per cent were engaged in lobbying and collaboration with other partners, while 23% established committees to oversee the sustainability of initiatives. While some interns reported negative experiences with supervision at their placement agencies, all valued internship seminars, which they found as a supportive environment in which they were able to share their progress with peers and academics. The opportunity for applying theory to practice and acting as resource persons were reflected as positives. The structured internship approach seems to have merits for building competence and engendering individual satisfaction.
Assuntos
Internato e Residência , Competência Clínica , Países em Desenvolvimento , Promoção da Saúde , Humanos , JamaicaRESUMO
The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were 'personal strain', 'social relations disruption', 'resource strain/imbalance' and 'role intensity'. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.
Assuntos
Cuidadores , Vida Independente , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Humanos , Jamaica , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The objective of this study was to determine and characterize caregiver burden among caregivers of community-dwelling older persons in Jamaica. METHOD: A nationally representative cross-sectional study was done among persons providing noninstitutional care for a single person (≥60 years). The Zarit Burden Interview (ZBI) and a structured questionnaire were administered to 180 caregivers from four geographic health regions. RESULTS: The ZBI scores ranged from 0 to 56 (median = 15). Independently associated factors were relationship to care recipient and age. Children/grandchildren had higher caregiver burden scores than formally employed caregivers (odds ratio = 2.9: 95% confidence interval: [1.02, 8.34]). Compared with caregivers 35 to 44 years, those aged 45 to 65 were almost 5 times more likely to report higher caregiver burden scores. CONCLUSION: Caregiver burden as identified by the ZBI was low. Age (45-65 years) and being the child/grandchild of the care recipient were independently associated with greater caregiver burden. Interventions to address caregiver burden must embrace strategies that recognize that these factors.
Assuntos
Cuidadores , Efeitos Psicossociais da Doença , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Jamaica , Inquéritos e QuestionáriosRESUMO
The provision of care to older persons can impose significant burden on those providing care, burdens influenced by care recipient characteristic, caregiver attributes and availability of social support. This paper focuses on identifying relationships between caregiver burden and the socio-demographic, health and functional status attributes of care recipients age 60 years and older in Jamaica. A nationally representative cross-sectional study was done among persons providing non-institutional care for a single person 60 years and older. Data were obtained from a total of 180 caregivers from the four geographic health regions of Jamaica using the Zarit Burden Interview and a 44-question structured questionnaire. Associations between caregiver burden and socio-demographic, health and functional status of care recipients were examined and logistic regression applied to ascertain independent predictors of caregiver burden. The results revealed statistically significant relationships between caregiver burden and care recipients' receipt of conditional cash transfer grants and the ability to toilet independently. In multivariate analysis, ability to toilet remained a significant predictor of caregiver burden-Caregivers who had care recipients who were able to toilet independently were 71% less likely to have mild to severe caregiver burden compared to those who had care recipients that were not able to toilet (OR 0.29; 95% CI 0.14-0.57). Families, health care providers, social workers, state actors and caregivers should take this into account as they develop strategies to mitigate associated caregiver burden.
Assuntos
Envelhecimento/psicologia , Sobrecarga do Cuidador/psicologia , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Nível de Saúde , Idoso , Idoso de 80 Anos ou mais , Sobrecarga do Cuidador/epidemiologia , Cuidadores/estatística & dados numéricos , Estudos Transversais , Estado Funcional , Humanos , Jamaica , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Apoio Social , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To examine the performance of the Mini-Mental State Examination (MMSE) in community-dwelling older persons in a developing country (Jamaica) undergoing rapid population aging. METHODS: An embedded validity study was conducted utilizing participants from a nationally representative sample of 2782 older persons. Standardized MMSE scores were obtained for study participants. A random selection of 170 persons with MMSE scores greater than 20 and 170 persons with scores 20 or less was done. Field staff were trained to apply the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for the diagnosis of dementia. In total, 300 participants (167 participants with MMSE score of 20 or less, 133 participants with scores greater than 20) were assessed and categorized according to dementia status. Performance characteristics of the MMSE tool were determined for study participants and appropriate adjustment and analyses subsequently applied to facilitate extrapolation to the nationally representative sample. RESULTS: The mean MMSE scores for participants with score of 20 and less was 17.1 (standard deviation [SD] = 3.2) and 24.5 (SD = 2.8) for those with scores greater than 20. Dementia was identified in 34 participants. The receiver operating characteristic curve for MMSE scores in relation to dementia diagnosis had an area under the curve value of 0.935 (95% confidence interval, 0.893-0.977). The optimal MMSE cut-point was 18/19 and was consistently so regardless of age category, gender, educational level, and number of chronic illnesses. CONCLUSION: There is merit in using the MMSE examination as a screening tool for dementia in Jamaica. The findings of this study coupled with widespread use and familiarity among practitioners give credence to the MMSE as a reasonable screening tool for dementia in Jamaica-rapidly aging society.
Assuntos
Demência/epidemiologia , Idoso , Envelhecimento , Estudos de Coortes , Demência/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Jamaica , Masculino , Testes de Estado Mental e Demência/normas , Curva ROCRESUMO
OBJECTIVES: To determine the relative influence of sociodemographic, socioeconomic, psychosocial, and health variables on health service utilization in the last 12 months. METHODS: Data were analyzed for 1,412 men ≥60 years old from a 2012 nationally representative community-based survey in Jamaica. Associations between six health service utilization variables and several explanatory variables were explored. Logistic regression models were used to identify independent predictors of each utilization measure and determine the strengths of associations. RESULTS: More than 75% reported having health visits and blood pressure checks. Blood sugar (69.6%) and cholesterol (63.1%) checks were less common, and having a prostate check (35.1%) was the least utilized service. Adjusted models confirmed that the presence of chronic diseases and health insurance most strongly predicted utilization. A daughter or son as the main source of financial support (vs self) doubled or tripled, respectively, the odds of routine doctors' visits. Compared with primary or lower education, tertiary education doubled [2.37 (1.12, 4.95)] the odds of a blood pressure check. Regular attendance at club/society/religious organizations' meetings increased the odds of having a prostate check by 45%. DISCUSSION: Although need and financial resources most strongly influenced health service utilization, psychosocial variables may be particularly influential for underutilized services.
Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Humanos , Jamaica , Masculino , Pessoa de Meia-IdadeRESUMO
Social participation is critical for maintaining independence and facilitating active ageing. The aim of this paper is to describe participation in social activities among older adults in Jamaica and to identify independently associated socio-demographic and health characteristics. We analysed data from a nationally representative, community-based survey of 2943 persons 60 years and older. Sixty-three percent of older adults attended religious services and 60 % were visited by friends at least once per month in the 12 months preceding the survey. Age was not independently associated with social participation. Persons with post-secondary level education were twice as likely as those with primary education or less, to be visited by friends and to attend meetings of formal organisations. Men, persons not in union, and those with less functional independence had reduced odds of attending meetings of formal organisations. These variables were however not independently associated with having visits with friends. Persons with a positive depression screen were between 42 % and 44 % less likely to be visited by friends. Persons who received an income through livestock/farming were more likely to visit or be visited by friends. The variables independently associated with social participation vary depending on the type of social activity considered. Where possible, health and social interventions should focus on prevention, delay and reversal of risk factors associated with reduced social participation. Social participation programmes should be prioritized and be informed by input from older adults. Future research should include other forms of social interactions and clarify older adults' perceptions of their quality.
Assuntos
Envelhecimento , Relações Interpessoais , Meio Social , Participação Social , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Amigos , Nível de Saúde , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Atividade Motora , Características de Residência , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
AIM: This paper describes morbidity patterns among older people, relevant health-care resources in a localised population in a developing country (Jamaica) and implications for ageing in place in the community. METHODS: Local morbidity patterns among older people were determined in Jamaica from a 2007 cross-sectional study involving record searches at major hospitals and clinics. Age-specific morbidity distributions were compiled. Data on health-care staff complement were also collected. RESULTS: Non-communicable diseases predominate in older people in Jamaica; 50% of diagnoses related to cardiovascular disorders and diabetes. Staff-to-population ratios were low compared with other international data. CONCLUSION: A high prevalence of non-communicable disease coupled with inadequate staffing threatens the likelihood of ageing in place in the Jamaican community. Secondary prevention efforts and social support services which enhance ageing in place are needed.