There is much variability in the expression of sickle cell disease (SCD) and recent works suggest that environmental and social factors may also influence this variability. This paper aims to use geographic information systems technology to examine the association between socio-environmental exposures and health outcomes in all persons who have attended or currently attend the Sickle Cell Unit in Jamaica. Rural patients presented for clinical care at older ages and had less annual visits to clinic. Persons travelled relatively long distances to seek SCD care and those travelling longer had less health maintenance visits. Urban patients had a higher prevalence of significant pain crises (69.4% vs. 55.8%, p value<0.001) and respiratory events (21.2% vs. 14%, p value<0.001). Prevalence of leg ulcers did not vary between rural and urban patients but was higher in males than in females. Females also had lower odds of having respiratory events but there was no sex difference in history of painful crises. Persons with more severe genotypes lived in higher poverty and travelled longer for healthcare services. Persons in areas with higher annual rainfall, higher mean temperatures and living farther from factories had less painful crises and respiratory events. The paper highlights a need for better access to healthcare services for Jamaicans with SCD especially in rural areas of the island. It also reports interesting associations between environmental climatic exposures and health outcomes.
Cockpit karst landscapes are among the most distinctive landscapes in the world, and have been the focus of long-standing scientific interest. Early researchers used largely descriptive techniques to categorize the terrain, and subsequent work has not attempted to critically re-evaluate descriptions of landscapes using more sophisticated methods. The distinctive surface topography of cockpit karst areas can be characterized in order to compare them with other karst as well as non-karst areas, and to determine geological and/or climatic conditions that are responsible for the observed terrain. Process models of the rate of karst denudation or evolution can only be accurate if the contemporary morphology of the landscape is quantitatively and unambiguously defined. A detailed analysis of cockpit karst terrain is carried out using the latest GIS-based digital morphometric techniques in order to assess the nature of such terrain and provide further information for subsequent modelling, as well as other non-geomorphological applications, such as environmental management and conservation issues. The paper presents the methodology used for the digital analysis of terrain and landforms in the distinctive Cockpit Country area of Jamaica and its environs. The results indicate that cockpit karst may be categorized based on its vertical, horizontal and shape characteristics, as well as by looking at the semivariogram, slope characteristics, and landscape relief scale, which combine measures of vertical and horizontal scales. Copyright of cockpit karst landscapes were qualitative and based largely on field observations alone. Quantitative karst morphometric research has been conducted since the early 1970s, and has led to improved understanding of the nature of such terrain, enabling more precise description and comparative analysis, and assisting investigation of the relationships between morphology and the controls on the karst environment. However, most analyses to date have relied on fairly limited sets of measurements obtained from field surveys or from printed topographic maps. Vast improvements in technology and data available -such as the Global Positioning System (GPS), digital elevation models (DEMs) and high-resolution satellite imagery -now enable a comprehensive reanalysis of cockpit karst terrain. Using such technology, cockpit karst terrain, first described in 1869, may be redefined according to robust, objective criteria derived from high-resolution terrain data.There has been much disagreement over the last century about the cockpit karst phenomenon, and this is reflected in the confusing terminology. For instance, Lehmann (1925) was the first to describe the karst topography of southern China as kegelkarst, and the term has been used since then to describe tropical karst landscapes. However, Sawkins (1869) was the first to describe a terrain as having cockpit topography, noting the resemblance of these karstic depressions to arenas used for cock-fighting. Furthermore, there is confusion over what exactly keg...
We present the novel application of two technologies for use in rock breakdown experiments, i.e. close-range, ground-based 3D triangulation scanning and rapid prototype printing. These techniques aid analyses of form-process interactions across the range of scales relevant to breakdown (μ μ μ μ μm-m). This is achieved through (a) the creation of DEMs (which permit quantitative description and aanalysis of rock surface morphology and morphological change) and (b) the production of more realistically-shaped experimental blocks. We illustrate the use of these techniques, alongside appropriate data analysis routines, in experiments designed to investigate the persistence of fluvially-derived features in the face of subsequent wind abrasion and weathering. These techniques have a range of potential applications in experimental field and lab-based geomorphic studies beyond those specifically outlined here.
The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12–65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.
ObjectiveTo examine whether neighbourhood characteristics are associated with cumulative biological risk (CBR) and sex differences in CBR in a nationally representative sample in Jamaica, a small island developing country with increasing prevalence of non-communicable diseases (NCDs).DesignCross-sectional studySettingA population-based cross-sectional survey, the Jamaica Health and Lifestyle Survey 2008 (JHLS II) recruited persons at their homes over a 4 month period from all 14 parishes and 113 neighbourhoods defined as enumeration districts (EDs).Participants2544 persons aged 15–74 years old from the 2008 Jamaica Health and Lifestyle Survey (JHLS II), who completed interviewer-administered questionnaires and had biomarkers assessed, and whose home addresses could be reliably geocoded.Primary outcomeA summary measure CBR was created using seven markers—systolic and diastolic blood pressure readings, waist circumference, body mass index, total cholesterol, fasting blood glucose levels and self-reported asthma. Weighted multilevel models examined clustering, using the intraclass correlation coefficient (ICC), of CBR across neighbourhoods and the impact of neighbourhood characteristics (recreational space availability and neighbourhood disorder) on CBR.ResultsWomen had significantly higher mean CBR scores than men across all age groups. There was significant clustering of CBR by ED, and among women versus men (ICC: F=6.9%, M=0.7%). Women living in more disordered neighbourhoods were 26% more likely to have high CBR as those in less disordered ones (aOR=1.26, 95% CI=1.08 to 1.47; p<0.05). Individuals living in EDs with greater recreational space availability were 25% less likely to have a high CBR (aOR=0.75, 95% CI=0.64 to 0.90; p<0.05).ConclusionsPolicy-makers in Jamaica should pay greater attention to neighbourhood factors such as recreational space availability and neighbourhood disorder that may contribute to CBR in any effort to curtail the epidemic of NCDs.
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