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The paper compares the case of Jamaica, which despite a two-decade-long journey, has experienced unsatisfactory progress in implementing e-Government, with that of Singapore, which has achieved considerable success, despite being small island-states of similar-sized populations with British colonial histories, with both nations gaining their independence around the same time in the mid-1960s. Qualitative data gathered from interviews and documentation from supply-side stakeholders were analyzed to better understand the drivers for, and barriers to, the successful implementation of e-Government initiatives. Based on the existing literature, a novel conceptual framework was used to guide the data collection and analysis process. This enabled the presence of previously identified drivers and barriers for e-Government initiatives to be assessed in the context of both countries. The study was also able to surface new and additional factors influencing e-Government implementation, which have not been previously identified within the e-Government research literature, namely Administration/Leadership, e-Readiness, and Communication. The research findings enabled practical and actionable recommendations to those leading e-Government initiatives in Jamaica to improve implementation by overcoming forces that hinder progress. The findings from this study are limited as the research draws on data from limited sources in just two countries. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Delayed child skill development is a common phenomenon in low- and middle-income countries. Effective and low-cost strategies suitable for application to less-developed countries are needed. We summarize empirical findings from recent papers that study a replication of the Jamaica Reach Up and Learn home visiting program in China, China REACH, and compare child skill growth profiles in the China Reach Up and Jamaica interventions. METHODS: Different interventions often use different measures for assessing early childhood skill development. To estimate the growth of underlying skills across programs, we address the challenge that different programs use different assessments. We use a modified version of the Rasch model to anchor scores on common items to estimate skill development. RESULTS: Language skill growth curves are comparable for both interventions. This pattern is consistent for the treatment and control groups across the interventions. Skill growth curves are not statistically significantly different between China REACH and Jamaican interventions. We find evidence of the importance of early investment. CONCLUSIONS: The China REACH intervention significantly improves the development of multiple skills. At the same ages, treatment effect sizes and skill growth curves are comparable across the Jamaica and China REACH interventions, despite differences in scale and cultural settings. The scale of the program is much greater in China than in Jamaica, showing that the Jamaican curriculum can be effectively expanded to larger populations. Annual costs per child are roughly $500 (2015 US dollars). [ABSTRACT FROM AUTHOR]

• COVID-19 is a threat to recent progress in expanding access to quality early childhood education ECE in low- and middle- income countries. • Governments in the study did not prioritize ECE in their responses to the pandemic. • Some conditions that previously helped ECE advance on national agendas worsened. • Lessons from this analysis have implications for prioritizing ECE postpandemic. Despite strong evidence of its importance to the welfare of children and societies, early childhood education has been comparatively neglected as a policy priority both before and during the COVID-19 pandemic. This paper seeks to understand what factors have contributed to the relative lack of priority for early childhood education in distance learning and school reopening plans by applying a political prioritization framework to the pandemic context in 4 low- and middle-income countries: Ethiopia, Jamaica, Liberia, and Pakistan (Punjab Province). Some aspects of the pre-COVID-19 status quo which disfavored early childhood education have continued, including a lack of cohesive support from civil society and a greater focus by international partners on norm promotion and technical assistance than financing. In other respects, the pandemic put early childhood education at an even greater disadvantage. These include perceptions that early childhood education is less suited to distance delivery than other levels of education, concerns about young children's ability to comply with health protocols, and competition with high-stakes examinations for education ministries' attention. Previous country experience with pandemics (in Liberia) and a strong coordinating entity (in Jamaica) were mitigating factors. These results point to an urgent need to elevate priority for early childhood education in more normal times and to capture the lessons of COVID-19 to improve the resilience of early childhood education in future crises. [ABSTRACT FROM AUTHOR]

Between 1960 and 2010, Singapore's real gross domestic product (GDP) per capita skyrocketed from $4,383 to $55,862, while Jamaica's barely increased from $6,417 to $8,539. It is plausible that differing rates of GDP growth are associated with differences in the development of education systems but causally the linkage is not well understood. Using a comparative analysis of education in Jamaica and Singapore, this paper explores the critical factors in education development in small states. This article argues that education development can substantively help small states overcome many of the limitations of their smallness that are exacerbated in an increasingly global economy. Three significant factors that shaped the education development of Jamaica and Singapore are identified. First, the timing of reforms is important, not just the content of educational reforms. Second, having a vocational strategy is key. Third, a balanced, forward-looking education development strategy that closely ties education, economic and national development is crucial. [ABSTRACT FROM AUTHOR]

Purpose: There is a shortage of available methods to accurately inform the developmental status of children whose cultural and linguistic backgrounds vary from the mainstream. The purpose of this review article was to describe different approaches used to support the accurate characterization of speech, language, and functional communication in children speaking Jamaican Creole and English, an understudied paradigm in the speech pathology research. Method: Approaches used across four previously published studies in the Jamaican Creole Language Project are described. Participants included 3- to 6-year-old Jamaican children (n = 98-262) and adults (n = 15-33). Studies I and II described validation efforts about children's functional communication using the Intelligibility in Context Scale (ICS; speech) and the Focus on the Outcomes of Communication Under Six (FOCUS; speech and language). Study III described efforts to accurately characterize difference and disorder in children's expressive grammar using adapted scoring, along with adult models to contextualize child responses. Last, Study IV applied acoustic duration (e.g., whole word) and an adapted scoring protocol to inform variation in speech sound productions in the Jamaican context where a post-Creole continuum exists. Results: Studies I and II offered promising psychometric evidence about the utility of the ICS and the FOCUS. Study III revealed strong sensitivity and specificity in classifying difference and disorder using adult models. Last, in Study IV, linguistically informed acoustic analyses and an adapted protocol captured variation in speech productions better than a standard approach. Conclusions: Applying culturally responsive methods can enhance the accurate characterization of speech, language, and functional communication in Jamaican children. The innovative methods used offer a model approach that could be applied to other linguistic contexts where a mismatch exists between speech-language pathologists and their clientele. Presentation Video: https://doi.org/10.23641/asha.23929461 [ABSTRACT FROM AUTHOR]

Summary: This paper examines the social determinants of the rule of law by comparing Jamaica and Barbados, two countries with many similarities, but with divergent outcomes concerning the rule of law. The research takes a comparative historical approach, specifically investigating the origins of the divergence of the rule of law between Jamaica and Barbados by focusing on the late colonial period (1937–1966). Using new data collected from archival research, state legitimacy is identified as the key factor that helps explain the divergent trajectories of the rule of law in Jamaica and Barbados post-independence. Going beyond state-based explanations of the rule of law, the analysis suggests that the rule of law not only depends on characteristics of the state, but also on characteristics of society. [ABSTRACT FROM AUTHOR]

This article advocates for a new perspective on Caribbean performance traditions by adopting an Afro-Iberian perspective. It argues that we are able to acquire a better understanding of the historical development of some of the most enigmatic Caribbean performances, including Jankunu, by taking into consideration that many of those who built the foundations of Afro-Caribbean culture had already adopted cultural and religious elements rooted in Iberian traditions before their arrival in the Americas. A comparative analysis demonstrates a series of parallels between early witness accounts of Jankunu and Iberian calenda traditions. In order to explain this, the article points to Iberian dominance in the early-modern Atlantic and, in particular, Portuguese influences in Africa. It highlights the importance of confraternities and argues that it was in the context of African variants of these mutual-aid and burial societies that elements rooted in Iberian traditions entered Afro-Caribbean culture. [ABSTRACT FROM AUTHOR]

Efforts to combat continuing gender inequalities in academia need to be informed by evidence about where differences occur. Citations are relevant as potential evidence in appointment and promotion decisions, but it is unclear whether there have been historical gender differences in average citation impact that might explain the current shortfall of senior female academics. This study investigates the evolution of gender differences in citation impact 1996–2018 for six million articles from seven large English‐speaking nations: Australia, Canada, Ireland, Jamaica, New Zealand, UK, and the USA. The results show that a small female citation advantage has been the norm over time for all these countries except the USA, where there has been no practical difference. The female citation advantage is largest, and statistically significant in most years, for Australia and the UK. This suggests that any academic bias against citing female‐authored research cannot explain current employment inequalities. Nevertheless, comparisons using recent citation data, or avoiding it altogether, during appointments or promotion may disadvantage females in some countries by underestimating the likely greater impact of their work, especially in the long term. [ABSTRACT FROM AUTHOR]

This article criticises the social policy literature for equating universalism to the universal coverage of citizens. The current so-called 'universal' social protection systems guarantee social citizen rights, while the revisited truly universalism guarantees social human rights for everyone. Crisp-set qualitative comparative analysis (csQCA) is used to map and track the level of exclusiveness or inclusiveness into social pensions in the existing 30 social pension programmes on 28 Latin American and Caribbean (LAC) countries. The article examines the various paths of eligibility requirements in social pensions conditioning three specific outcomes: (1) access for every older-age individual (truly universal), (2) access for every category of immigrant (no targeting by citizenship or residency) and (3) access for older-age immigrants with legal resident status (targeting by residency but not by citizenship). The research makes several contributions. First, it offers a useful inventory of the eligibility requirements for access to the 30 social pensions in LAC. Second, it proposes an analytical framework to redefine universalism after considering the migration-social policy nexus. Contrary to what the literature claims, there are no universal social pensions in the region. Third, the analysis indicates that only in two countries, Cuba and Jamaica, social pensions have immigrant-friendly targeting rules, requiring neither citizenship nor any length of residency to become a beneficiary. A total of 12 countries require citizenship and 24 of them a certain number of years of residency. Moreover, the overwhelming majority of social pensions are means tested. Finally, the csQCA allows identifying patterns of targeting mechanisms and is used to propose five exploratory regimes of inclusionary social pensions. The article calls for protected international mobility of the older-age population in the form of a truly universalistic system in which the entire aged population has the right to a social pension. Only then, countries would truly adhere to Article 22 of the Universal Declaration of Human Rights. [ABSTRACT FROM AUTHOR]

Abstract Objectives. To assess the quality of asthma care within the paediatric population who attended health centres in Kingston & St. Andrew (KSA) and compare this quality to Global Initiative for Asthma (GINA) guidelines. Methods and materials. Data were collected from 257 dockets of children aged 2–17 years old with asthma attending seven health centres in KSA. Results. Children aged 6–10 years accounted for 36.6% of the sample and males accounted for the majority (54.1%). There was generally poor documentation of performance indicators for asthma including written asthma action plans (1%), peak expiratory flow measurements (0%), inhaler demonstration (2.1%), and asthma control assessment (8.4%). The best documentation was for controller (60.9%) and reliever medication (63.4%) prescriptions/review. Conclusion. The study indicates that the documentation of paediatric asthma management in health centres in Jamaica is not congruous with international clinical practice guidelines and change is required. [ABSTRACT FROM AUTHOR]

Even though youth work has played a critical role in fostering the holistic development of today's youth, much controversy has surrounded the practice. Nevertheless, youth workers are slowly being accorded professional status, and a code of ethics has been developed in some jurisdictions. Some states are still to adopt this code; consequently the credibility of youth workers and the sector in general sway with the wind. This article presents a comparative analysis of ethical practices of youth work in Jamaica, Australia, New Zealand and the United Kingdom, examining current trends in observing ethics and addressing ethical issues. In the case of Jamaica, the researcher used the non-probability convenience sampling technique and collected primary data from a questionnaire administered to a sample of youth workers. The perspective of the ministerial arm responsible for youth work in Jamaica was also captured through an interview. In the case of Australia, New Zealand and the United Kingdom, the framework of the profession and specifically matters pertaining to ethical practices were examined through the use of secondary data sources, which included reports on youth work practices in the selected countries. A mixed methodology was employed in analysing the data collected. The major findings of this study confirmed that advancing youth work as a profession is dependent on the acceptance and integration of a formal code of ethics, that youth workers must receive training on ethics and that a national youth work policy is important to guide youth work practice. In accordance with the findings, the researcher makes a number of recommendations and highlights notable best practices that may help with the overall professionalisation of the sector. [ABSTRACT FROM AUTHOR]

This study looks at body image disturbance among Jamaicans who bleach their skin. The hypothesis states that there is a positive relationship between skin bleaching and body image disturbance. The study used a convenience sample of 160 participants with a skin bleaching group ( n = 80) and a non-bleaching comparison group ( n = 80). The instrument included demographic questions, the body image disturbance questionnaire (BIDQ), and questions about skin bleaching. The results of a t-test revealed that the skin bleaching group ( M = 1.5255, SD = 0.42169) was not significantly different from the non-bleaching group ( M = 1.4938, SD = 0.74217) in terms of body image disturbance, t(158) = 0.333, p = .740. The participants who bleached did not suffer from body image disturbance. Self-reports revealed that they bleached to acquire beauty, attract a partner, elude the police, and market skin bleaching products. The practice was fashionable and popular and it made some participants feel good, while others were fans of a popular musical artiste who bleached his skin. The majority of participants bleached because of the perceived personal, social, and entrepreneurial benefits of the practice and not because they suffered emotional distress, anxiety, and functional impairment because of their skin colour. However, there was some level of BID among the minority of participants who argued that they bleached because they wanted to be pretty so they were emotionally distressed about there body image and experienced functional impairment. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular risk factors are increasing in most developing countries. To date, however, very little standardized data has been collected on the primary risk factors across the spectrum of economic development. Data are particularly sparse from Africa.Methods: In the Modeling the Epidemiologic Transition Study (METS) we examined population-based samples of men and women, ages 25-45 of African ancestry in metropolitan Chicago, Kingston, Jamaica, rural Ghana, Cape Town, South Africa, and the Seychelles. Key measures of cardiovascular disease risk are described.Results: The risk factor profile varied widely in both total summary estimates of cardiovascular risk and in the magnitude of component factors. Hypertension ranged from 7% in women from Ghana to 35% in US men. Total cholesterol was well under 200 mg/dl for all groups, with a mean of 155 mg/dl among men in Ghana, South Africa and Jamaica. Among women total cholesterol values varied relatively little by country, following between 160 and 178 mg/dl for all 5 groups. Levels of HDL-C were virtually identical in men and women from all study sites. Obesity ranged from 64% among women in the US to 2% among Ghanaian men, with a roughly corresponding trend in diabetes. Based on the Framingham risk score a clear trend toward higher total risk in association with socioeconomic development was observed among men, while among women there was considerable overlap, with the US participants having only a modestly higher risk score.Conclusions: These data provide a comprehensive estimate of cardiovascular risk across a range of countries at differing stages of social and economic development and demonstrate the heterogeneity in the character and degree of emerging cardiovascular risk. Severe hypercholesterolemia, as characteristic in the US and much of Western Europe at the onset of the coronary epidemic, is unlikely to be a feature of the cardiovascular risk profile in these countries in the foreseeable future, suggesting that stroke may remain the dominant cardiovascular event. [ABSTRACT FROM AUTHOR]

Background: The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low- and middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care.Methods: A prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test.Results: Response rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self-pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73-0.82), p = 0.002; workplace policies-pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance-pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising-pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002-and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation-pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). Multivariate results for Kenya and Jamaica were non-significant. Twelve hubs were established; 11 were active at follow-up. Hub members (n = 34) reported significant improvements in their capacity to address care gaps.Conclusions: Leadership hubs, comprising nurses and other stakeholders committed to change and provided with capacity building can collectively identify issues and act on strategies that may improve practice and policy. Overall, hubs did not provide the necessary force to improve the uptake of evidence-informed HIV care in their districts. If hubs are to succeed, they must be integrated within district health authorities and become part of formal, legal organisations that can regularise and sustain them. [ABSTRACT FROM AUTHOR]

Jamaica is home to over 10% of the Caribbean's HIV-positive population. Men who have sex with men (MSM) have a higher prevalence of HIV compared to the general public. Thus, the purpose of this study is to assess characteristics associated with HIV, such as condom use and number of sexual partners, comparing young, those aged 18-24, to older, aged 25 and older, MSM in Jamaica. We hypothesised, and found support for the notion, that younger MSM would have a lower rate of some risky behaviours associated with HIV seropositivity. Service data for 160 self-selected MSM aged 18-62, from Kingston, Jamaica were analysed. The majority identified as homosexual (compared to bisexual), over half of respondents completed a tertiary level of education (e.g. any post-high school training), and 59.1% were employed. Almost all participants reported agreeing to use a condom when requested (93.6%). Prevalence of HIV was 17.8%, much lower than the 32% found in national studies, and is likely an underestimation reflecting patterns of this self-selected sample. Additionally, over one-third reported experiencing sexual abuse. Statistically significant relationships were found between age group and tertiary education, employment status, condom use with a regular partner, and sexual abuse. Younger MSM were more likely to have been sexually abused and were more likely to always wear a condom with their regular partner. A limitation of this study was the extent of missing data, restricting generalisability. However, by acknowledging the heterogeneity of the Jamaican MSM population, and subsequently evaluating behaviours across age groups, nuances emerge which highlight behavioural diversity. Findings may inform public health practitioners in developing targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries.Methods: We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition.Results: Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m(2) in men and from 25.8 to 34.8 kg/m(2) in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA.Conclusion: Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics. [ABSTRACT FROM AUTHOR]

The author has lived and worked in Jamaica since 1981 as a music professional. Here he offers a range of personal insights into the role of the guitar in Jamaican popular music through the use of ethnographic methodologies and the comparative analysis of recording methods. This approach combined with insider knowledge enables him to unpack the range of complex notions bound up with a locally conceived and spontaneous music-making process, given form herein by reference to the terms rhythm, sound and movement. On the surface, these elements can appear deceptively simple and are commonly referred to as ‘vibe’, ‘feel’ and ‘groove’. But this hides a complex system of rhythmic interpretation, which the author begins to reveal through a study of guitar performance, mixing and recording. [ABSTRACT FROM PUBLISHER]

We analyse the interaction between monetary policy and stock prices in Barbados, Jamaica and Trinidad and Tobago (T&T), both individually and jointly as the Caribbean countries using structural VARs, as proposed in Bjornland and Leitemo (2009). Annual and monthly frequencies are used for Barbados while, due to data availability constraints, only annual data is employed for Jamaica and T&T. First, our results show that in Barbados, with monthly (and annual) data, a monetary policy shock that increases the Treasury bill rate by 100 basis points causes stock prices to increase by 0.038% (and fall by 0.06%), while a stock price shock that increases stock prices by 1% results in an increase in the Treasury bill rate of 30 (and 190) basis points, respectively. For Jamaica, a monetary policy shock causes stock prices to fall by 0.3%, while a stock price shock that increases stock prices by 1% results in an increase in the Treasury bill rate of 400 basis points. Likewise for T&T, a shock to monetary policy causes stock prices to fall by 0.1% and a shock leading to a 1% increase in real stock prices causes the Treasury bill to increase by 330 basis points. When we analyse the three Caribbean countries jointly, a positive 1% stock price shock causes the Treasure bill rate to increase by 700 basis points and a positive monetary policy shock cause stock price to fall by 0.027%. Therefore, our results in relation to the signs of the relationships with annual data are similar to those of the US in Bjornland and Leitemo (2009), however the magnitudes are substantially different. The effect of a monetary policy shock is greater in the US, while the effect of a stock price shock is smaller in the US than in our Caribbean economy. We argue that this reflects clear differences between the US and Caribbean economies. Caribbean countries have slower information channels, for example, by targeting the 30-day Certificate of Deposit (COD) rate instead of the overnight Treasury bill rate as in the US. This supports our results that only with annual data we find similar relationships as in the US with monthly data. Moreover, the higher economic instability in the Caribbean is clearly observed in the larger effect that a stock price increase has on interest rates versus the USA. [ABSTRACT FROM AUTHOR]

For close to 50 years, so-called ‘dons’ have positioned themselves as civic leaders in Jamaica, gaining acceptance among poor urban communities and (tacit) political recognition in the wider society. The dons' systematic, coercive organisation of the ghetto community and the counter-hegemonic, executive-style bureaucracy and culture entrenched here resembles the ‘godfather’-led criminal culture and power of the (Italian) Mafia. However, over the last ten years the Mafia has faced a considerable decline in its omnipotence, due to increased state intervention and resistance within civil society, particularly by women in the local Italian communities. This article attempts to ascertain if such a ‘reversible destiny’ is also thinkable in Jamaica. [ABSTRACT FROM AUTHOR]

Background: Weight gain in adulthood is now common in many populations, ranging from modest gains in developing countries to a substantial percentage of body weight in some Western societies. To examine the rate of change across the spectrum of low to high-income countries we compared rates of weight change in samples drawn from three countries, Nigeria, Jamaica and the United States. Methods: Population samples from Nigeria (n = 1,242), Jamaica (n = 1,409), and the US (n = 809) were selected during the period 1995-1999 in adults over the age of 19; participation rates in the original survey were 96%, 60%, and 60%, respectively. Weight in (kg) was measured on 3 different occasions, ending in 2005. Multi-level regression models were used to estimate weight change over time and pattern-mixture models were applied to assess the potential effect of missing data on estimates of the model parameters. Results: The unadjusted weight gain rate (standard error) was 0.34(0.06), 1.26(0.12), 0.34(0.19) kg/year among men and 0.43(0.06), 1.28(0.10), 0.40(0.15) kg/year among women in Nigeria, Jamaica, US, respectively. Regression-adjusted weight change rates were significantly different across country, sex, and baseline BMI. Adjusted weight gain in Nigeria, Jamaica and US was 0.31(0.05), 1.37(.04), and 0.52(0.05) kg/year respectively. Women in Nigeria and the US had higher weight gains than men, with the converse observed among Jamaicans. The obese experienced weight loss across all three samples, whereas the normal weight (BMI < 25) had significant weight gains. Missing data patterns had an effect on the rates of weight change. Conclusion: Weight change in sample cohorts from a middle-income country was greater than in cohorts from either of the low- or high-income countries. The steep trajectory of weight gain in Jamaica, relative to Nigeria and the US, is most likely attributable to the accelerating effects of the cultural and behavioral shifts which have come to bear on transitional societies. [ABSTRACT FROM AUTHOR]

Background: Attributes that caregivers assign to complementary foods have been primarily described in the context of illness, but attributes assigned to foods in everyday circumstances must be understood to effectively promote good complementary feeding.Objective: This study aimed to understand how mothers judge complementary foods to be appropriate by cross-cultural examination of food perceptions in four different Latin American and Caribbean countries.Methods: We used semistructured interviews to assess attributes that mothers ascribed to a list of key foods, both home-made and manufactured, and reasons for feeding or not feeding them. We elicited attributes from 79 caregivers with children 6 to 24 months of age from two urban and perirban sites each in Brazil, Jamaica, Mexico, and Panama.Results: Textual analysis based on six home foods common to the four countries and manufactured foods resulted in six attribute categories, five of which could be positive or negative (Nutrient Content, Effects on Child, Child's Response, Availability and Accessibility, and Other Food Attributes); one (Food Quality and Safety) was only negative. Analysis of attributes of home foods (chicken, eggs, beans, carrots, bananas or plantains, and oranges) revealed many beliefs that were common within and across countries, whereas analysis of the attributes of manufactured foods revealed that these foods were less known.Conclusions: The consistency of the attribute categories across countries and across home and manufactured foods suggests their relevance to planning programs to improve complementary feeding in Latin America and the Caribbean and possibly other developing countries. These results can be used programmatically to assess the need for and the focus of food education programs, and to indicate which countries will be more receptive to certain foods as a means of improving complementary feeding. [ABSTRACT FROM AUTHOR]

Objective: To determine whether changes in primary and secondary care service delivery could prevent antenatal eclampsia.Method: One intervention (St. Catherine) and two control (St. Ann, Manchester) parishes were chosen. The health system in St. Catherine was restructured. Primary antenatal clinics had clear instructions for referring patients to a high-risk antenatal clinic or to hospital. Guidelines were provided to high-risk clinics and the antenatal ward for appropriate treatment of hypertension and preeclampsia when induction of labor should occur. Antenatal eclampsia incidence was monitored before and during the intervention and compared with control parishes (no intervention). Each eclampsia case was investigated to identify inadequacies in the system.Results: The process resulted in better identification of women at risk. Antenatal eclampsia incidence dropped dramatically as care improved. Compared with control areas, by completion of the study, the rate was significantly lower than at the start: OR 0.19 (95% CI: 0.13-0.27; p<0.001 trend). Antenatal admissions for hypertensive disorders declined significantly, and the number of bed days halved.Conclusion: Reorganization of maternal care can have major public health benefits and cost savings; however, women need to be alerted to recognise and act upon signs of impending eclampsia. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and acceptability of a patient-held pictorial card aimed at raising awareness and appropriate health seeking behavior in response to prodromal symptoms of imminent eclampsia.Method: Pictorial cards (and posters) were issued to antenatal clinics and used to focus instruction and advice to pregnant women. Mothers were surveyed before and after the cards were introduced to assess maternal likelihood of seeking care if edema was seen, and of attending hospital if so advised. We monitored the eclampsia rate. Health workers were interviewed 6 months after cards and posters were issued to determine the acceptability of using the cards as part of routine antenatal care.Results: The card was seen as widely acceptable by health professionals, and increased their own awareness of the prodromal symptoms of eclampsia and their discussion of these symptoms with antenatal mothers. Mothers' awareness and response to symptoms improved significantly and there was a marked drop in eclampsia incidence. Suggested improvements to the card were made by mothers and health workers.Conclusion: The cost of providing a card for every pregnant mother is likely to be offset by health service delivery savings. [ABSTRACT FROM AUTHOR]

A study is reported of physical growth of Jamaican schoolboys who had been admitted to hospital with severe malnutrition during infancy (index cases). Height, weight and head circumference of the index cases was compared with that of male siblings close in age (siblings), with unrelated classmates or neighbours matched for sex and age (comparisons) and with Jamaican or US growth standards. Index boys were significantly smaller in height and head circumference than comparisons and significantly smaller than sibs only in head circumference. Sibs were intermediate in stature to the index and comparison boys. When the boys were divided into three age groups there was evidence of complete catch-up in height and weight after 7 years of age, but catch-up was incomplete for head circumference in the oldest group. No significant differences in stature at follow-up of the index boys were found in relation to age when admitted to hospital. [ABSTRACT FROM PUBLISHER]