TS Ferguson

OBJECTIVES: To estimate the prevalence of diabetic foot complications among patients at a specialist diabetes clinic in Jamaica and identify factors associated with foot complications. METHODS: A stratified random sample of 188 patients were interviewed and examined between 2009 and 2010. Trained nurses obtained demographic and clinical data, measured anthropometrics and performedfoot examinations including inspection for amputations, ulcers or infection and assessment of pain, vibration and pressure perception. RESULTS: Participants included 143 women and 45 men (mean age 56years; mean diabetes duration 16 years). The prevalence of amputations was 8.5% (95% CI 4.5, 12.5%) and was higher among men (22.2%) compared to women (4.2%, p < 0.05). Prevalence of current ulcers and current foot infections was 4.3% and 3.7%, respectively. Overall, 12% ofpatients had at least one of these foot complications. Foot complications were more prevalent among men, patients with high blood pressure (BP > or = 130/80 mmHg) or peripheral neuropathy In multivariable logistic regression models, factors associated with foot complications were: neuropathy (OR 9.3 [95% CI 2.8, 30.3]), high BP (OR 7.9 [1.3, 49.7]) and diabetes duration (OR 1.32 [1.02, 1.72]). CONCLUSION: Approximately one of every eight patients in this specialist clinic had a major foot complication. Associated factors were neuropathy, high blood pressure and longer duration of diabetes.

Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica, School of Graduate Studies and Research, University of the West Indies, Mona, Jamaica, Department of Child Health, University of the West Indies, Mona, Jamaica, Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Jamaica, Early Childhood Commission, Ministry of Education, Kingston, Jamaica and University Health Centre, University of the West Indies, Mona, Jamaica

Background Epidemiological studies in systemic lupus erythematosus have been reported in the literature in many countries and ethnic groups. Although systemic lupus erythematosus in Jamaica has been described in the past, there has not been a detailed evaluation of systemic lupus erythematosus patients in urban Jamaica, a largely Afro-Caribbean population. The goal of this study was to describe the clinical features, particularly disease activity, damage index and immunological features, of 150 systemic lupus erythematosus subjects. Methods 150 adult patients (≥18 years) followed in rheumatology clinic at a tertiary rheumatology hospital centre (one of two of the major public referral centres in Jamaica) and the private rheumatology offices in urban Jamaica who fulfilled Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. Data were collected by detailed clinical interview and examination and laboratory investigations. Hence demographics, SLICC criteria, immunological profile, systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) and SLICC/American College of Rheumatology (ACR) damage index (SDI) were documented. Results Of the 150 patients, 145 (96.7%) were female and five (3.3%) were male. The mean age at systemic lupus erythematosus onset was 33.2 ± 10.9. Mean disease duration was 11.3 ± 8.6 years. The most prevalent clinical SLICC criteria were musculoskeletal, with 141 (94%) of subjects experiencing arthralgia/arthritis, followed by mucocutaneous manifestations of alopecia 103 (68.7%) and malar rash 46 (30.7%), discoid rash 45 (30%) and photosensitivity 40 (26.7%). Lupus nephritis (biopsy proven) occurred in 42 (28%) subjects and 25 (16.7%) met SLICC diagnostic criteria with only positive antinuclear antibodies/dsDNA antibodies and lupus nephritis on renal biopsy. The most common laboratory SLICC criteria were positive antinuclear antibodies 136 (90.7%) followed by anti-dsDNA antibodies 95 (63.3%) and low complement (C3) levels 38 (25.3%). Twenty-seven (18%) met SLICC diagnostic criteria with only positive antinuclear antibodies/anti-dsDNA antibodies and lupus nephritis on renal biopsy. Mean SLEDAI score was 6.9 ± 5.1 with a range of 0-32. Organ damage occurred in 129 (86%) patients; mean SDI was 2.4 ± 1.8, with a range of 0-9. Conclusion These results are similar to the clinical manifestations reported in other Afro-Caribbean populations; however, distinct differences exist with respect to organ involvement and damage, particularly with respect to renal involvement, which appears to be reduced in our participants.

OBJECTIVE: To estimate the prevalence of high-risk sexual behaviours among Jamaican adults and evaluate associations with sociodemographic and religious factors. METHODS: We performed a cross-sectional study, using a nationally representative sample of Jamaicans, 15-74 years old. Participants completed an interviewer-administered questionnaire including questions on sexual activity, sociodemographic factors and religious practice. Having two or more sexual partners in the past year, non-use of condoms among persons with multiple partners and a history of previous sexually transmitted infection (STI) were the high-risk characteristics considered in the analysis. We obtained crude and category specific prevalence estimates for high-risk behaviour and estimated odds ratios for association with sociodemographic and religious factors. RESULTS: Data from 2833 participants who reported on sexually activity were analysed. Approximately 25% (95% CI 22, 27) of Jamaican adults had two or more sexual partners in the past year while 15% (95% CI 13, 17) had a past history of an STI. Approximately 6% (95% CI 5, 7) of persons with multiple partners did not use condoms during sexual intercourse. Overall, 32% (95% CI 30, 35) had any one of the three high-risk characteristics (male, 48%; female, 17%, p < 0.001). Being married, active religious practice and weekly attendance at religious meetings were associated with lower odds of high-risk sexual behaviour while being in a visiting relationship was associated with higher odds of high-risk behaviour CONCLUSION: A third of Jamaicans reported sexual practices that increase their risk of HIV infection. High-risk sexual behaviour was more common among men. Being married and weekly attendance at religious services were associated with lower odds of high-risk behaviour

Objective: To investigate the relationship between intrauterine growth and renal function among Jamaican young adults. Methods: Data from 744 participants from the Jamaica 1986 Birth Cohort Study were analysed.