L. Sargeant - Academia.edu (original) (raw)

Papers by L. Sargeant

The West Indian medical journal, 1999

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to t... more A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7% of total admissions to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62% were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7% of admissions, the commonest being renal and/or hepatic impairment; anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35% of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).

Revista Panamericana de Salud Pública, 2001

Objectives. To evaluate the quality of diabetic care in three clinics (one of them private and th... more Objectives. To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13%) of diabetes. Methods. During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"

The Lancet, 2013

Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Po... more Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefi ts of screening for type 2 diabetes. We assessed the eff ect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40-69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA 1c) tests, a fasting capillary blood glucose test, and a confi rmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were fl agged for mortality surveillance by the England and Wales Offi ce of National Statistics. Analysis was by intention-toscreen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001-06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9•6 years [IQR 8•9-9•9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1•06, 95% CI 0•90-1•25). We noted no signifi cant reduction in cardiovascular (HR 1•02, 95% CI 0•75-1•38), cancer (1•08, 0•90-1•30), or diabetes-related mortality (1•26, 0•75-2•10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefi ts of screening might be smaller than expected and restricted to individuals with detectable disease.

Diabetes Care, 2007

OBJECTIVE—We examined the associations of objectively measured sedentary time and physical activi... more OBJECTIVE—We examined the associations of objectively measured sedentary time and physical activity with continuous indexes of metabolic risk in Australian adults without known diabetes. RESEARCH DESIGN AND METHODS—An accelerometer was used to derive the percentage of monitoring time spent sedentary and in light-intensity and moderate-to-vigorous–intensity activity, as well as mean activity intensity, in 169 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) participants (mean age 53.4 years). Associations with waist circumference, triglycerides, HDL cholesterol, resting blood pressure, fasting plasma glucose, and a clustered metabolic risk score were examined. RESULTS—Independent of time spent in moderate-to-vigorous–intensity activity, there were significant associations of sedentary time, light-intensity time, and mean activity intensity with waist circumference and clustered metabolic risk. Independent of waist circumference, moderate-to-vigorous–intensity activity time ...

Epidemiology and Infection

In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases o... more In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ...

I have with great interest read the article, "Proinflammatory Cytokines and Early Neurological Wo... more I have with great interest read the article, "Proinflammatory Cytokines and Early Neurological Worsening in Ischemic Stroke," by Vila et al. 1 Bearing in mind the complexities of interleukin (IL)-6 effects, I would like to ask the authors the following questions: Are the patients included in this study the same patients as in the earlier published studies 2 from the same research group concerning glutamate? If so, is there a relationship between IL-6 and glutamate that can be identified in the material?

Diabetes Care, 2001

OBJECTIVE—To describe the relationship between total dietary fat and the pattern of fat intake an... more OBJECTIVE—To describe the relationship between total dietary fat and the pattern of fat intake and HbA1c. RESEARCH DESIGN AND METHODS—In this cross-sectional study, 2,759 men and 3,464 women (40–78 years of age) without a previous diagnosis of type 2 diabetes were recruited from a population-based sampling frame. Diet was assessed using a self-reported semiquantitative food frequency questionnaire. RESULTS—The HbA1c level was negatively associated with the polyunsaturated fat–to–saturated fat ratio (P:S ratio) of the diet (β = −0.0338 HbA1c% per SD change in P:S ratio; P < 0.001) and positively associated with the total level of fat intake (β = 0.0620 HbA1c% per SD change in total fat intake; P < 0.001), adjusted for age and total energy intake. The associations remained significant when adjusted for each other and for total energy, protein, age, sex, family history of diabetes, BMI, waist-to-hip ratio, physical activity, and smoking (for P:S ratio, β = −0.0200 HbA1c% per SD c...

European Journal of Clinical Nutrition, 2001

Objective: To investigate whether self-reported frequency of fruit and vegetable consumption was ... more Objective: To investigate whether self-reported frequency of fruit and vegetable consumption was associated with HbA 1C levels in individuals not known to have diabetes, and what dietary and lifestyle factors might explain this association. Design: Cross-sectional study. Setting: The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. Subjects and methods: A total of 2678 men and 3318 women (45 ± 74 y) not known to have diabetes reported weekly consumption of fruit, green leafy vegetables and other vegetables. Results: Among men, 274 (10.2%) reported seldom or never eating fruit and 127 (4.7%) seldom or never eating green leafy vegetables. Corresponding numbers in women were 157 (4.7%) and 92 (2.8%), respectively. Participants who reported never or seldom having both fruit and green leafy vegetables had higher mean (s.d.) HbA 1C measurements (5.43% (0.71)) than those who reported more frequent consumption (5.34% (0.67); P 0.046). Differences by category of fruit or green leafy vegetable consumption were not substantially changed after adjustment for saturated fat, dietary ®bre and plasma vitamin C. Conclusion: These ®ndings support the hypothesis that high intake of fruit and green leafy vegetables may in¯uence glucose metabolism independent of dietary ®bre or vitamin C alone and that increased consumption may contribute to the prevention of diabetes.

European Journal of Cardiovascular Prevention & Rehabilitation, 2001

Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that ar... more Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that are associated with arterial and venous thrombosis. We measured aCL in women, aged 15-49 years, to determine if they are an independent risk factor for thromboembolic disease. Case--control study Fifty cases were studied including venous thromboembolism (n=29), stroke and myocardial infarction (n=21), along with 148 age-matched controls. Serum samples were assayed for aCL and anti-beta2 glycoprotein 1 antibodies using the enzyme-linked immunosorbent assay (ELISA). Information on other risk factors was obtained by a standardized questionnaire. aCL were present in 16/50 (32%) of cases compared with 25/148 (17%) of controls (P[?]=[?]0.02). Unadjusted odds ratio (OR) and 95% confidence interval (95% CI) for thromboembolic disease associated with aCL was 2.32 (1.10--4.87). Other risk factors were hypertension, 2.93 (1.20--7.17) and a history of other heart diseases, 12.78 (1.32--123.60). Adjustment for hypertension, diabetes, oral contraceptive use, smoking, alcohol use, varicose veins, a family history of cardiovascular disease and a history of other heart diseases yielded OR (95%CI) 2.99 (1.32--6.80). beta2 glycoprotein 1-dependent aCL were also an independent risk factor, OR 4.56 (1.76--17.83). Subgroup analysis was carried out separately for cases of MI and stroke and for venous thrombosis. Adjusted OR (95% CI) associated with aCL in cases of MI and stroke was 1.76 (0.46--6.73) and 3.32 (1.15--9.54) for venous thromboembolism. aCL are a risk factor for thromboembolic disease in young Jamaican women. They confer a strong independent risk for venous thromboembolism.

Preventive Medicine, 2000

Occupational medicine (Oxford, England), 2012

Work-related psychosocial stress has been hypothesized to increase the individual risk of Type 2 ... more Work-related psychosocial stress has been hypothesized to increase the individual risk of Type 2 diabetes; however, observational epidemiological studies investigating the association between work-related psychosocial stress and Type 2 diabetes have provided an inconsistent picture. To evaluate whether work-related psychosocial stress (defined by a work-related stress model or by long work hours) is associated with the risk of Type 2 diabetes. A systematic review of the literature was conducted until March 2010. Studies eligible for inclusion were published observational epidemiological studies of adult participants in community or occupational settings if they had a measure of work-related stress on a validated scale or a measure of work hours or overtime assessed prior to, or at the same time as, assessment of Type 2 diabetes status. Where possible, meta-analysis was conducted to obtain summary odds ratios of the association. We located nine studies (four prospective, one case-con...

The West Indian medical journal, 2001

Middle income countries like those in the Caribbean can feel proud of their achievements in healt... more Middle income countries like those in the Caribbean can feel proud of their achievements in health care. There has been a dramatic fall-off in infant mortality and crude mortality rates along with significant improvements in life expectancy at birth. However, these countries now find themselves grappling with the burden of chronic non-communicable diseases such as heart disease, stroke, hypertension, diabetes mellitus and cancer. There are good data to support the view that some of these diseases, in particular diabetes mellitus, have assumed epidemic proportions and there is concern that this fact may have been missed by many because of the surreptitious onset, as is the nature of the chronic diseases. The impact of this epidemic may have suffered because of the higher profile of more topical issues like HIV/AIDS even though the former makes a larger contribution to morbidity and mortality statistics. It is now obvious that despite the impact of other factors, lifestyle changes are...

The West Indian medical journal, 2000

To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patient... more To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patients, aged > 30 years, attending a public general clinic (PUBMC) (n = 500), a specialist hypertension clinic (SPMC) (n = 119) and a private group general clinic (PRMC) (n = 137), for more than one year, were reviewed. Duration of follow-up varied among clinics with the longest mean follow-up at PRMC (10.8 yrs) compared to 6.1 years and 4.7 years at the PUBMC and SPMC respectively. Mean age was greatest at the PUBMC (60 yrs) compared to 53 years in the SPMC and 50 years in the PRMC (p < 0.001). Sex distribution differed among clinics with 15% men in the PUBMC, 34% in the SPMC and 54% in the PRMC (p < 0.001). Over 92% of patients had blood pressure (BP) recorded at least once in the 12-month review period. Hypertension was defined as being prescribed antihypertensive medication in clinic records. By this definition 98% SPMC patients were hypertensive, compared to 87% PUBMC and 80% PR...

The West Indian medical journal, 2000

A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a ... more A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7 +/- 0.7 cm and the left 10 +/- 0.7 cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between right or left kidneys in the group as a whole or within either gender. There was a significant association between the weight of males and width of their kidneys; however, this association was not seen in females. The lone association between weight of participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the genders and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the genders. Re...

Lupus, 2003

The majority of patients seen at the renal clinic of the University Hospital of the West Indies (... more The majority of patients seen at the renal clinic of the University Hospital of the West Indies (UHWI) are of African descent. The case notes of patients with systemic lupus erythematosus (SLE) with class 4 nephritis and who were given standard pulse intravenous cyclophosphamide therapy during the period 1990-2000 were retrospectively reviewed. Primary outcomes were doubling of serum creatinine and development of end stage renal disease (ESRD). Secondary outcomes were return of proteinuria to normal and renal remission. A total of 117 patients had a renal biopsy for SLE nephritis at the UHWI between 1990 and 2000. Of the patients, 34 (29%) had diffuse proliferative glomerulonephritis (WHO class 4), of which 29 were reviewed. Twenty-two patients of 24 in whom it was measured (92%) had significant proteinuria at presentation. The 24-hour proteinuria was measured at final review in 16 patients and in 10 patients it went into complete remission. At the beginning of therapy, 24 patients (83%) had renal impairment. Of the 18 who had final creatinine values, the renal function returned to normal in eight patients (44%) and an additional six patients showed a significant improvement in renal function at final review. Six patients developed end stage renal disease (ESRD). The risk (95% confidence interval) of developing ESRD at one year was 16.2% (CI, 6.4-37.6) and at two years was 23.2% (CI, 10.0-48.5). There were three deaths, two from sepsis and one from heart failure. The one-year mortality (95% CI) was 8% (CI, 2.0-28.5), the two-year mortality was 15.6% (CI, 4.9-43.5) and the five-year mortality was also 15.6% (CI, 4.9-43.5). Intravenous pulse cyclophosphamide for Jamaican patients with SLE and diffuse proliferative glomerulonephritis is an ineffective form of treatment.

Journal of Public Health, 2007

Journal of Obstetrics & Gynaecology, 2006

A prevalence survey of anticardiolipin antibodies (aCL) was done among 924 primiparae. aCL were m... more A prevalence survey of anticardiolipin antibodies (aCL) was done among 924 primiparae. aCL were measured in serum by the standardised anticardiolipin enzyme linked immunosorbent assays (ELISA) and beta(2)-glycoprotein 1 assays to determine the seroprevalence of both beta(2) glycoprotein 1 dependent aCL and beta(2)-glycoprotein 1 independent aCL in Jamaican primiparae, to determine whether aCL are associated with abnormal pregnancy outcomes and if treatment with aspirin had any effect on pregnancy outcome in aCL positive primiparae. The prevalence of aCL was (32/671) 4.8% (95%CI 3.2-6.4) in women who were tested twice. A total of 49 of 924 primiparae or 5.3% (95%CI 3.9-6.7) were positive for aCL on at least one occasion. Only three of the 32 primiparae 3/32 (9.4%) who were positive for aCL on two occasions were positive for beta(2)-glycoprotein 1 dependent aCL. Pregnancy outcome did not differ significantly with respect to aCL status. Aspirin therapy did not influence pregnancy outcome in the 49 aCL positive primiparae studied.

International Journal of Epidemiology, 2001

European Respiratory Journal, 2000

Previous studies have reported an association between plasma vitamin C levels and respiratory fun... more Previous studies have reported an association between plasma vitamin C levels and respiratory function, but have not examined the role of vitamin C as an effect modifier of the relation between cigarette smoking and obstructive airways disease (OAD).

The West Indian medical journal, 1999

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to t... more A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7% of total admissions to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62% were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7% of admissions, the commonest being renal and/or hepatic impairment; anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35% of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).

Revista Panamericana de Salud Pública, 2001

Objectives. To evaluate the quality of diabetic care in three clinics (one of them private and th... more Objectives. To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13%) of diabetes. Methods. During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"

The Lancet, 2013

Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Po... more Background The increasing prevalence of type 2 diabetes poses a major public health challenge. Population-based screening and early treatment for type 2 diabetes could reduce this growing burden. However, uncertainty persists around the benefi ts of screening for type 2 diabetes. We assessed the eff ect of a population-based stepwise screening programme on mortality. Methods In a pragmatic parallel group, cluster-randomised trial, 33 general practices in eastern England were randomly assigned by the method of minimisation in an unbalanced design to: screening followed by intensive multifactorial treatment for people diagnosed with diabetes (n=15); screening plus routine care of diabetes according to national guidelines (n=13); and a no-screening control group (n=5). The study population consisted of 20 184 individuals aged 40-69 years (mean 58 years), at high risk of prevalent undiagnosed diabetes, on the basis of a previously validated risk score. In screening practices, individuals were invited to a stepwise programme including random capillary blood glucose and glycated haemoglobin (HbA 1c) tests, a fasting capillary blood glucose test, and a confi rmatory oral glucose tolerance test. The primary outcome was all-cause mortality. All participants were fl agged for mortality surveillance by the England and Wales Offi ce of National Statistics. Analysis was by intention-toscreen and compared all-cause mortality rates between screening and control groups. This study is registered, number ISRCTN86769081. Findings Of 16 047 high-risk individuals in screening practices, 15 089 (94%) were invited for screening during 2001-06, 11 737 (73%) attended, and 466 (3%) were diagnosed with diabetes. 4137 control individuals were followed up. During 184 057 person-years of follow up (median duration 9•6 years [IQR 8•9-9•9]), there were 1532 deaths in the screening practices and 377 in control practices (mortality hazard ratio [HR] 1•06, 95% CI 0•90-1•25). We noted no signifi cant reduction in cardiovascular (HR 1•02, 95% CI 0•75-1•38), cancer (1•08, 0•90-1•30), or diabetes-related mortality (1•26, 0•75-2•10) associated with invitation to screening. Interpretation In this large UK sample, screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause, cardiovascular, or diabetes-related mortality within 10 years. The benefi ts of screening might be smaller than expected and restricted to individuals with detectable disease.

Diabetes Care, 2007

OBJECTIVE—We examined the associations of objectively measured sedentary time and physical activi... more OBJECTIVE—We examined the associations of objectively measured sedentary time and physical activity with continuous indexes of metabolic risk in Australian adults without known diabetes. RESEARCH DESIGN AND METHODS—An accelerometer was used to derive the percentage of monitoring time spent sedentary and in light-intensity and moderate-to-vigorous–intensity activity, as well as mean activity intensity, in 169 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) participants (mean age 53.4 years). Associations with waist circumference, triglycerides, HDL cholesterol, resting blood pressure, fasting plasma glucose, and a clustered metabolic risk score were examined. RESULTS—Independent of time spent in moderate-to-vigorous–intensity activity, there were significant associations of sedentary time, light-intensity time, and mean activity intensity with waist circumference and clustered metabolic risk. Independent of waist circumference, moderate-to-vigorous–intensity activity time ...

Epidemiology and Infection

In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases o... more In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ...

I have with great interest read the article, "Proinflammatory Cytokines and Early Neurological Wo... more I have with great interest read the article, "Proinflammatory Cytokines and Early Neurological Worsening in Ischemic Stroke," by Vila et al. 1 Bearing in mind the complexities of interleukin (IL)-6 effects, I would like to ask the authors the following questions: Are the patients included in this study the same patients as in the earlier published studies 2 from the same research group concerning glutamate? If so, is there a relationship between IL-6 and glutamate that can be identified in the material?

Diabetes Care, 2001

OBJECTIVE—To describe the relationship between total dietary fat and the pattern of fat intake an... more OBJECTIVE—To describe the relationship between total dietary fat and the pattern of fat intake and HbA1c. RESEARCH DESIGN AND METHODS—In this cross-sectional study, 2,759 men and 3,464 women (40–78 years of age) without a previous diagnosis of type 2 diabetes were recruited from a population-based sampling frame. Diet was assessed using a self-reported semiquantitative food frequency questionnaire. RESULTS—The HbA1c level was negatively associated with the polyunsaturated fat–to–saturated fat ratio (P:S ratio) of the diet (β = −0.0338 HbA1c% per SD change in P:S ratio; P < 0.001) and positively associated with the total level of fat intake (β = 0.0620 HbA1c% per SD change in total fat intake; P < 0.001), adjusted for age and total energy intake. The associations remained significant when adjusted for each other and for total energy, protein, age, sex, family history of diabetes, BMI, waist-to-hip ratio, physical activity, and smoking (for P:S ratio, β = −0.0200 HbA1c% per SD c...

European Journal of Clinical Nutrition, 2001

Objective: To investigate whether self-reported frequency of fruit and vegetable consumption was ... more Objective: To investigate whether self-reported frequency of fruit and vegetable consumption was associated with HbA 1C levels in individuals not known to have diabetes, and what dietary and lifestyle factors might explain this association. Design: Cross-sectional study. Setting: The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. Subjects and methods: A total of 2678 men and 3318 women (45 ± 74 y) not known to have diabetes reported weekly consumption of fruit, green leafy vegetables and other vegetables. Results: Among men, 274 (10.2%) reported seldom or never eating fruit and 127 (4.7%) seldom or never eating green leafy vegetables. Corresponding numbers in women were 157 (4.7%) and 92 (2.8%), respectively. Participants who reported never or seldom having both fruit and green leafy vegetables had higher mean (s.d.) HbA 1C measurements (5.43% (0.71)) than those who reported more frequent consumption (5.34% (0.67); P 0.046). Differences by category of fruit or green leafy vegetable consumption were not substantially changed after adjustment for saturated fat, dietary ®bre and plasma vitamin C. Conclusion: These ®ndings support the hypothesis that high intake of fruit and green leafy vegetables may in¯uence glucose metabolism independent of dietary ®bre or vitamin C alone and that increased consumption may contribute to the prevention of diabetes.

European Journal of Cardiovascular Prevention & Rehabilitation, 2001

Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that ar... more Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that are associated with arterial and venous thrombosis. We measured aCL in women, aged 15-49 years, to determine if they are an independent risk factor for thromboembolic disease. Case--control study Fifty cases were studied including venous thromboembolism (n=29), stroke and myocardial infarction (n=21), along with 148 age-matched controls. Serum samples were assayed for aCL and anti-beta2 glycoprotein 1 antibodies using the enzyme-linked immunosorbent assay (ELISA). Information on other risk factors was obtained by a standardized questionnaire. aCL were present in 16/50 (32%) of cases compared with 25/148 (17%) of controls (P[?]=[?]0.02). Unadjusted odds ratio (OR) and 95% confidence interval (95% CI) for thromboembolic disease associated with aCL was 2.32 (1.10--4.87). Other risk factors were hypertension, 2.93 (1.20--7.17) and a history of other heart diseases, 12.78 (1.32--123.60). Adjustment for hypertension, diabetes, oral contraceptive use, smoking, alcohol use, varicose veins, a family history of cardiovascular disease and a history of other heart diseases yielded OR (95%CI) 2.99 (1.32--6.80). beta2 glycoprotein 1-dependent aCL were also an independent risk factor, OR 4.56 (1.76--17.83). Subgroup analysis was carried out separately for cases of MI and stroke and for venous thrombosis. Adjusted OR (95% CI) associated with aCL in cases of MI and stroke was 1.76 (0.46--6.73) and 3.32 (1.15--9.54) for venous thromboembolism. aCL are a risk factor for thromboembolic disease in young Jamaican women. They confer a strong independent risk for venous thromboembolism.

Preventive Medicine, 2000

Occupational medicine (Oxford, England), 2012

Work-related psychosocial stress has been hypothesized to increase the individual risk of Type 2 ... more Work-related psychosocial stress has been hypothesized to increase the individual risk of Type 2 diabetes; however, observational epidemiological studies investigating the association between work-related psychosocial stress and Type 2 diabetes have provided an inconsistent picture. To evaluate whether work-related psychosocial stress (defined by a work-related stress model or by long work hours) is associated with the risk of Type 2 diabetes. A systematic review of the literature was conducted until March 2010. Studies eligible for inclusion were published observational epidemiological studies of adult participants in community or occupational settings if they had a measure of work-related stress on a validated scale or a measure of work hours or overtime assessed prior to, or at the same time as, assessment of Type 2 diabetes status. Where possible, meta-analysis was conducted to obtain summary odds ratios of the association. We located nine studies (four prospective, one case-con...

The West Indian medical journal, 2001

Middle income countries like those in the Caribbean can feel proud of their achievements in healt... more Middle income countries like those in the Caribbean can feel proud of their achievements in health care. There has been a dramatic fall-off in infant mortality and crude mortality rates along with significant improvements in life expectancy at birth. However, these countries now find themselves grappling with the burden of chronic non-communicable diseases such as heart disease, stroke, hypertension, diabetes mellitus and cancer. There are good data to support the view that some of these diseases, in particular diabetes mellitus, have assumed epidemic proportions and there is concern that this fact may have been missed by many because of the surreptitious onset, as is the nature of the chronic diseases. The impact of this epidemic may have suffered because of the higher profile of more topical issues like HIV/AIDS even though the former makes a larger contribution to morbidity and mortality statistics. It is now obvious that despite the impact of other factors, lifestyle changes are...

The West Indian medical journal, 2000

To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patient... more To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patients, aged > 30 years, attending a public general clinic (PUBMC) (n = 500), a specialist hypertension clinic (SPMC) (n = 119) and a private group general clinic (PRMC) (n = 137), for more than one year, were reviewed. Duration of follow-up varied among clinics with the longest mean follow-up at PRMC (10.8 yrs) compared to 6.1 years and 4.7 years at the PUBMC and SPMC respectively. Mean age was greatest at the PUBMC (60 yrs) compared to 53 years in the SPMC and 50 years in the PRMC (p < 0.001). Sex distribution differed among clinics with 15% men in the PUBMC, 34% in the SPMC and 54% in the PRMC (p < 0.001). Over 92% of patients had blood pressure (BP) recorded at least once in the 12-month review period. Hypertension was defined as being prescribed antihypertensive medication in clinic records. By this definition 98% SPMC patients were hypertensive, compared to 87% PUBMC and 80% PR...

The West Indian medical journal, 2000

A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a ... more A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7 +/- 0.7 cm and the left 10 +/- 0.7 cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between right or left kidneys in the group as a whole or within either gender. There was a significant association between the weight of males and width of their kidneys; however, this association was not seen in females. The lone association between weight of participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the genders and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the genders. Re...

Lupus, 2003

The majority of patients seen at the renal clinic of the University Hospital of the West Indies (... more The majority of patients seen at the renal clinic of the University Hospital of the West Indies (UHWI) are of African descent. The case notes of patients with systemic lupus erythematosus (SLE) with class 4 nephritis and who were given standard pulse intravenous cyclophosphamide therapy during the period 1990-2000 were retrospectively reviewed. Primary outcomes were doubling of serum creatinine and development of end stage renal disease (ESRD). Secondary outcomes were return of proteinuria to normal and renal remission. A total of 117 patients had a renal biopsy for SLE nephritis at the UHWI between 1990 and 2000. Of the patients, 34 (29%) had diffuse proliferative glomerulonephritis (WHO class 4), of which 29 were reviewed. Twenty-two patients of 24 in whom it was measured (92%) had significant proteinuria at presentation. The 24-hour proteinuria was measured at final review in 16 patients and in 10 patients it went into complete remission. At the beginning of therapy, 24 patients (83%) had renal impairment. Of the 18 who had final creatinine values, the renal function returned to normal in eight patients (44%) and an additional six patients showed a significant improvement in renal function at final review. Six patients developed end stage renal disease (ESRD). The risk (95% confidence interval) of developing ESRD at one year was 16.2% (CI, 6.4-37.6) and at two years was 23.2% (CI, 10.0-48.5). There were three deaths, two from sepsis and one from heart failure. The one-year mortality (95% CI) was 8% (CI, 2.0-28.5), the two-year mortality was 15.6% (CI, 4.9-43.5) and the five-year mortality was also 15.6% (CI, 4.9-43.5). Intravenous pulse cyclophosphamide for Jamaican patients with SLE and diffuse proliferative glomerulonephritis is an ineffective form of treatment.

Journal of Public Health, 2007

Journal of Obstetrics & Gynaecology, 2006

A prevalence survey of anticardiolipin antibodies (aCL) was done among 924 primiparae. aCL were m... more A prevalence survey of anticardiolipin antibodies (aCL) was done among 924 primiparae. aCL were measured in serum by the standardised anticardiolipin enzyme linked immunosorbent assays (ELISA) and beta(2)-glycoprotein 1 assays to determine the seroprevalence of both beta(2) glycoprotein 1 dependent aCL and beta(2)-glycoprotein 1 independent aCL in Jamaican primiparae, to determine whether aCL are associated with abnormal pregnancy outcomes and if treatment with aspirin had any effect on pregnancy outcome in aCL positive primiparae. The prevalence of aCL was (32/671) 4.8% (95%CI 3.2-6.4) in women who were tested twice. A total of 49 of 924 primiparae or 5.3% (95%CI 3.9-6.7) were positive for aCL on at least one occasion. Only three of the 32 primiparae 3/32 (9.4%) who were positive for aCL on two occasions were positive for beta(2)-glycoprotein 1 dependent aCL. Pregnancy outcome did not differ significantly with respect to aCL status. Aspirin therapy did not influence pregnancy outcome in the 49 aCL positive primiparae studied.

International Journal of Epidemiology, 2001

European Respiratory Journal, 2000

Previous studies have reported an association between plasma vitamin C levels and respiratory fun... more Previous studies have reported an association between plasma vitamin C levels and respiratory function, but have not examined the role of vitamin C as an effect modifier of the relation between cigarette smoking and obstructive airways disease (OAD).