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Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n = 1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.

BackgroundAcute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalisation. There was previously a dearth of studies exploring the incidence, risk factors and outcome of AP in the Caribbean region.Materials and methodsAll patients with a diagnosis of AP admitted to the University Hospital of the West Indies (UHWI) between 2006 and 2012 were reviewed. The epidemiological profile, risk factors, clinical presentation and outcomes of patients with AP were retrospectively studied.ResultsThere were 70 females and 21 males with a median age of 44 years (range 2–86). The median age of males was significantly higher than that of females (p = 0.041). The incidence of AP was 74 per 100,000 admissions per year. Vomiting and abdominal tenderness were noted in the majority of patients. The most common aetiology was biliary disease (71.4%), idiopathic (12%), post-ERCP (6.6%) and alcohol (5.5%). Alcoholic pancreatitis was only seen in males whereas idiopathic and post-ERCP pancreatitis only occurred in females. The mean duration of hospitalisation was 9.51 ± 8.28 days. Disease severity was mild in 61.1%, moderately severe in 26.7%, and severe in 12.2% of patients. Factors associated with more severe disease included overweight/obesity, idiopathic aetiology and post-ERCP status. The case fatality rate was 2%.ConclusionThe incidence of AP was 74/100,000 hospital admissions annually. There was an unusual female preponderance, with biliary pancreatitis being the most common type occurring at an equal frequency among males and females. Only 12.2% of the total cases seen were severe. The case fatality rate was 2%. Local health policy should target timely interventions for biliary pancreatitis and should also address the local factors affecting disease severity.

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Helicobacter pylori infection is common in Jamaica. Describing its epidemiology in a population-based study depends largely on serology, but serologic assays have not been validated in this population. To address this issue, we examined the presence of H. pylori infection in 30 sequential adult patients with gastroduodenal symptoms by three biopsy-based methods (rapid urease test, histology, and culture) as well as by one research and two commercial enzyme-linked immunosorbent assays (ELISAs). A patient was considered H. pylori positive if the organism was detected by at least one biopsy-based method. Eighteen (60%) of the 30 patients were H. pylori positive by these criteria, whereas 21 (70%) were seropositive for H. pylori immunoglobulin G by our research ELISA. The presence of H. pylori infection in patients with gastric cancer and those with chronic gastritis was missed by biopsy-based methods but was detected by serologic assays. This observation indicates that serologic assays may be better suited for the detection of this infection in a population in which H. pyloriassociated pathology is prevalent. The performance of our research ELISA in detecting biopsy-based H. pyloripositive cases was excellent, with a sensitivity and specificity of 100% and 75%, respectively. Molecular genotyping of the isolates revealed that the predominant H. pylori genotypes in this cohort of Jamaicans were cagA ؉ vacA slb-m1, and iceA2. The validated serologic assay enables us to interpret epidemiologic data from population-based studies in Jamaica by comparison to those from other populations.Helicobacter pylori is a common human gastric pathogen causing chronic gastritis and duodenal ulcers (6, 12). There is strong evidence that H. pylori infection is also associated with gastric cancers and gastric lymphomas (6, 13). Both the prevalence of H. pylori infection and the incidence of gastric cancer are higher in Asia, South America, and the Caribbean than in Europe and the United States. The prevalence of H. pylori infection is also higher among blacks than among caucasians in the United States (10). Because H. pylori infection persists for life in the absence of treatment (6), its clinical sequelae continue to present a major public health burden in areas in which this bacterium is endemic.One of the challenges in epidemiologic studies of H. pylori infection has been the population-specific performance of serologic assays, which has made it difficult to interpret existing data across populations. Variations in bacterial genotype, antigen selections for the immunoassays employed, and host immune responses may affect the performance of serologic assays and their suitability for particular populations.In the present study of Jamaican patients, we evaluated the performance of two commercial enzyme-linked immunosorbent assays (ELISAs) for immunoglobulin G (IgG) antibody to H. pylori and a research ELISA which had been validated in epidemiologic investigations of populations from diverse geographic regions (5, 7, 26). We also describe...