Objective To determine the effect of implementing a comprehensive oral and dental care system and protocol on the rate of ventilator-associated pneumonia. Methods Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university-affiliated medical center were studied in 2 consecutive 24-month periods. Patients in the group studied before the intervention (n = 779) had no oral assessments, no suctioning of the subglottic space, no toothbrushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n = 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and toothbrushing was done twice daily. Results Compliance with protocol components exceeded 80%. The groups did not differ significantly in age, sex, or severity of illness. The rate of ventilator-associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention (P = .06). Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality. Conclusion Our findings suggest that use of advanced tools, a comprehensive oral care protocol, and staff compliance with the protocol can significantly reduce rates of ventilatorassociated pneumonia and associated costs. (American Journal of Critical Care.
While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.
This paper explores barriers to consistent condom use among female sex workers in Jamaica in a qualitative study using grounded theory. Multiple perspectives were sought through 44 in-depth interviews conducted with female sex workers, clients, the partners of sex workers and facilitators of sex work. Poverty and lack of education or skills, severely limited support systems as well as childhood abuse served to push the majority of participants into sex work and created vulnerability to HIV and other STIs. Despite these constraints, women found ways to exercise agency, ensure condom use, adopt protective measures and gain economic advantage in various aspects of the Jamaican sex trade. Perceived relationship intimacy between sex workers and their clients and/or their main partners emerged as the main factor contributing to reduced risk perception and inconsistent condom use. Relationship intimacy, with associated trust and affirmation of self, is the most important factor influencing sexual decision-making with respect to lapse in condom use among female sex workers in Jamaica. Study findings provide important insights that can enhance individual psychosocial, interpersonal and community-based interventions as well as inform environmental, structural and policy interventions to reduce risk and vulnerability among female sex workers.
Objective. To identify social and behavioral patterns and mental health concerns associated with intimate partner homicide-suicide (IPHS) in Jamaica through an analysis of media and police reports. Methods. This was an archival data review of police records and print, radio, and television reports of IPHS incidents from January 2007-June 2017 in Jamaica. The 27 cases found were qualitatively analyzed using pre-identified codes and open coding to generate themes and patterns. Results. A prevalence rate of 0.1 per 100 000 was determined. In all cases, males were the homicide-offender. Sociodemographic patterns associated with IPHS incidents-age, personality traits, choice of weapon, and time of occurrence-were consistent with previous findings. Common triggers were offender obsession, sexual jealousy, and fear of separation. Despite reports of mental health concerns in both male and female partners, neither the couples nor community members sought help prior to the homicide-suicide. Conclusion. These findings demand a change in cultural attitudes toward domestic disputes and mental health concerns, and a redefining of the community's responsibility in IPHS. The warning signs associated with IPHS should be part of existing violence and suicide prevention programs.
Objectives. To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. Methods. The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. Results. HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. Conclusions. Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.
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