Utility of WHOQOL-BREF in measuring quality of life in Sickle Cell Disease

BACKGROUND: Sickle cell disease is the commonest genetic disorder in Jamaica and most likely exerts numerous effects on quality of life (QOL) of those afflicted with it. The WHOQOL-Bref, which is a commonly utilized generic measure of quality of life, has never previously been utilized in this population. We have sought to study its utility in this disease population. METHODS: 491 patients with sickle cell disease were administered the questionnaire including demographics, WHOQOL-Bref, Short Form-36 (SF-36), Flanagan's quality of life scale (QOLS) and measures of disease severity at their routine health maintenance visits to the sickle cell unit. Internal consistency reliabilities, construct validity and "known groups" validity of the WHOQOL-Bref, and its domains, were examined; and then compared to those of the other instruments. RESULTS: All three instruments had good internal consistency, ranging from 0.70 to 0.93 for the WHOQOL-Bref (except the 'social relationships' domain), 0.86-0.93 for the SF-36 and 0.88 for the QOLS. None of the instruments showed any marked floor or ceiling effects except the SF-36 'physical health' and 'role limitations' domains. The WHOQOL-Bref scale also had moderate concurrent validity and showed strong "known groups" validity. CONCLUSION: This study has shown good psychometric properties of the WHOQOL-Bref instrument in determining QOL of those with sickle cell disease. Its utility in this regard is comparable to that of the SF-36 and QOLS.Originally published at http://www.biomedcentral.com/content/pdf/1477-7525-7-75.pd

The global distribution of fatal pesticide self-poisoning: Systematic review

<p>Abstract</p> <p>Background</p> <p>Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.</p> <p>Methods</p> <p>We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.</p> <p>Results</p> <p>We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.</p> <p>Conclusion</p> <p>Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.</p

Histopathological Findings in Women with Postmenopausal Bleeding in Jamaica

We investigated the histopathological findings in women presenting with postmenopausal bleeding in a population predominantly of African descent by conducting a six-year retrospective study of 716 gynaecological surgical specimens from 629 women accessed in the Department of Pathology, The University of the West Indies, Jamaica. Histopathological diagnoses were correlated with patient age, specimen volume, duration of bleeding and length of postmenopausal interval at presentation using ttests and linear regression models. The mean (SD) age was 63.6 (9.3) years. The frequency of the main causes of postmenopausal bleeding was: endometrial hyperplasia (22.3%); endometrial atrophy (21.3%); non-diagnostic (19.9%); endometrial carcinoma (9.5%); cervical carcinoma (6.8%); cervical polyps (4.5%); endometrial sarcoma (3.5%); proliferative endometrium (3.2%). Mean (SD) duration of bleeding was 6.9 (12.7) months. The percentage of women with malignant lesions was two to three times greater than those reported in the United States of America and Europe subsequent to 1980. The delay between the onset of bleeding and presentation is worrisome and suggests the need for public education

Angiomatosis of the Breast in a Male Child

Angiomatosis is a benign vascular lesion that has been described rarely in the breast. We describe a case in a seven-year-old boy of African descent who presented with progressively increasing, unilateral breast enlargement, the first such report in a male child. The patient underwent excisional biopsy of the breast mass followed by mastectomy. Pathologic examination revealed a diffuse proliferation of variably-sized, thin-walled vascular channels lined by flattened endothelium that showed negative immunohistochemical staining for von Willebrand factor, factor VIII-related antigen, CD34 and S-100 protein. There is no evidence of recurrence after 24 months of follow-up

The Pathology of Breast Cancer in Jamaica: The National Public Health Laboratory Study

Objective: To document the pathologic features of breast cancer in Jamaica. Methods: The pathology reports and slides of all patients diagnosed with breast cancer at the National Public Health Laboratory between January 1999 and December 2002 were reviewed. Patient age and gender, side involved, number of tumours identified, tumour size, histologic type, histologic grade, degree of lymph node involvement and parish of origin of the specimens were documented. Results: There were 772 patients, 762 females and 10 males; age range 21 to 96 (mean 57.9 ± 15.9) years. There were 778 specimens (6 bilateral cases), the majority of whom originated from Kingston and St Andrew (34.7%). Manchester (22.9%), St Catherine (13.9%) and St Ann (7.3%) were the next most common sources. The left breast was involved in 50.5% of cases. Gross tumour was identified in 641 (82.4%) specimens, the number of tumours ranging from 1 – 6 (mean 1.1 ± 0.6). The maximum gross tumour dimension ranged from 0.3 to 15 cm (mean 4.1 ± 2.7 cm). Infiltrating duct carcinoma was the predominant histologic type (69.3 %); 13.3%, 49.5% and 37.2 % of all infiltrating tumours were well, moderately and poorly differentiated respectively. In-situ lesions (7.1% of tumours) were all of the ductal phenotype. Axillary lymph nodes were submitted in 296 (38.1%) cases; metastatic disease was identified in 224 (75.7%) of these. The total number of nodes submitted ranged from 1 – 34 (mean 10.8 ± 6.7) with an average of 6.1 (± 5.8) being positive for metastases (range 1 – 29). Conclusions: The pathologic features of breast cancer documented in this series including average tumour size, histologic types and grade and the degree of lymph node involvement are consistent with patient presentation at relatively advanced stages of disease and highlight the urgent need for public health intervention including a national screening programme. Keywords: Breast cancer, screening programme "La Patología del Cáncer de Mamas en Jamaica: Estudio del Laboratorio Nacional de Salud Pública" RESUMEN Objetivo: Documentar los aspectos patológicos del cáncer de mamas en Jamaica. Métodos: Se revisaron los reportes y diapositivas de patología de todas las pacientes diagnosticadas con cáncer de mamas en el Laboratorio Nacional de Salud Pública entre enero de 1999 y diciembre de 2002. Se documentaron la edad y el género de los pacientes, el lado afectado, el número de tumores identificados, el tamaño del tumor, el tipo histológico, el grado histológico, el nivel del nódulo linfático, y el distrito de origen de los especimenes. Resultados: Hubo 772 pacientes (762 hembras y 10 varones); el rango de edad 21 a 96 (media 57.9 ± 15.9) años. Hubo 778 especimenes (6 casos bilaterales), la mayor parte de los cuales provenían de Kingston y St Andrew (34.7%). Manchester (22.9%), St Catherine (13.9%), y St Ann (7.3%) fueron las siguientes fuentes más comunes. La mama izquierda estaba afectada en el 50.5% de los casos. El tumor macroscópico se identificó en 641 (82.4%)especimenes, fluctuando el número de tumores de 1– 6 (media 1.1 ± 0.6). La dimensión máxima del tumor macroscópico osciló de 0.3 a 15 cm. (media 4.1 ± 2.7 cm). El carcinoma ductal infiltrante fue el tipo histológico predominante (69.3%). El 13.3%, 49.5% y 37.2% de todos los tumores infiltrantes estaban bien, moderadamente y pobremente diferenciados respectivamente. Las lesiones in situ (7.1% de los tumores) fueron todas del fenotipo ductal. Nódulos linfáticos axilares fueron sometidos en 296 (38.1%) de los casos; la enfermedad metastática se identificó en 224 (75.7%) de éstos. El número total de nódulos sometidos fluctuó de 1 – 34 (media 10.8 ± 6.7) con un promedio de 6.1 (± 5.8) positivo a las metástasis (rango 1 – 29). Conclusiones: Los aspectos patológicos del cáncer de mamas documentados en esta serie incluyendo el tamaño del tumor, el tipo histológico, y el grado y nivel de afectación del nódulo linfático, concuerdan con la presentación del paciente en etapas relativamente avanzadas de la enfermedad y subrayan la necesidad urgente de la intervención de la salud pública, incluyendo un programa nacional de pesquisaje. Palabras claves: Cancer de mamas, programa de pesquisaj

Utility of Rapid Staining of Fine Needle Aspiration Smears at the University Hospital of the West Indies

In a prospective study at the University Hospital of the West Indies, 187 fine needle aspiration cytology (FNAC) specimens, comprising 100 breast, 75 head and neck, and 12 miscellaneous specimens, were subjected to rapid Papanicolaou staining and immediate assessment. Inadequate aspirates were repeated, and all cases were also evaluated after routine Papanicolaou staining. Histologic and clinical follow-up data were obtained. The overall concordance between rapid and routine cytologic diagnoses ranged from 79% to 87% for the three specimen cohorts. Sensitivity and specificity values were similar for rapid and routine-stained slides and ranged from 80% to 100%. There were no false positive or false negative diagnoses in the cases for which the outcome was known. Rapid staining of cytologic smears is a useful adjunct to the evaluation of aspirated material, improving adequacy rates and overall performance of the FNAC service, and should also result in significant savings in time and cost to patients

Developing Theory to Guide Building Practitioners' Capacity to Implement Evidence-Based Interventions

Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners’ capacity to adopt and implement a variety of EBIs across diverse practice contexts