PubMed Health⌕ Search

Biomedical subjects

L A Sargeant

Publications and source records attributed to L A Sargeant.

At least 19 recordsLinked to original sources
PubMed2006

Anticardiolipin antibodies in Jamaican primiparae.

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.

Adolescent↗
PubMed2004

Energetic determinants of glucose tolerance status in Jamaican adults.

As type 2 diabetes mellitus (DM2), obesity and sedentary lifestyles are increasing in developing countries, this observational study investigated the role of physical activity on DM2 in Jamaica. Anthropometry, body composition (by bioelectrical impedance analysis) and glucose tolerance status was assessed in 722 adults in 1993 and 1997. Energy expenditure was estimated in a subset using measured resting energy expenditure in combination with self-reported activity recalls. The rates of impaired glucose tolerance (IGT) were 23.7 and 27.3%, and DM2 were 16.3 and 23.7% among men and women, respectively. After adjusting for body composition, a one-unit increase in physical activity significantly reduced the odds of having diabetes (OR = 0.05; 95% CI: 0.004, 0.66), but not IGT. Hence, decreased physical activity is a significant independent contributor to the high rates of glucose intolerance in Jamaica. Efforts must be directed at minimizing obesity and increasing physical activity in developing countries.

Adult↗
PubMed2004

Features of isolated post-challenge hyperglycaemia in Jamaican adults.

Isolated post-challenge hyperglycaemia (IPH) can be defined as a two-hour plasma glucose concentration > or = 11.1 mmol/L with a fasting plasma glucose concentration < 7.0 mmol/L. The aim of this prospective study was to determine the prevalence of IPH in a cohort of Jamaican individuals, and to determine if simple clinical features may predict the presence and subsequent diagnosis of IPH. A cohort of 1694 adults aged 25-74 years without physician-diagnosed diabetes mellitus was randomly selected. An oral glucose tolerance test (OGTT) was performed. Anthropometry, blood pressure and lipid profiles were measured. The prevalence of undiagnosed diabetes mellitus by the 1999 World Health Organization criteria was 6.4%. IPH accounted for 24% of these cases and 1.4% of the entire population. Individuals with IPH were significantly older, with greater body mass index, waist-hip ratio, systolic blood pressure, fasting blood glucose, total cholesterol and LDL-cholesterol than individuals with normal glucose tolerance. Individuals with IPH were not significantly different from individuals with fasting plasma glucose levels > or = 7 mmol/L (i.e. fasting hyperglycaemia) in anthropometry or blood pressure. However, total cholesterol and LDL-C were significantly elevated in the IPH group. OGTT screening of individuals with impaired fasting glucose (i.e. 6.1-6.9 mmol/l) could reduce the IPH group by 50%. Reducing the threshold for fasting glucose to 5.6 mmol/L would correctly classify 87% of the population. We concluded that individuals with IPH have features of the metabolic syndrome, which can aid in selection for screening. OGTT screening of individuals with fasting glucose values of 5.6-6.9 mmol/l is needed to identify IPH.

Adult↗
PubMed2004

A survey of chronic renal failure in Jamaica.

The prevalence of chronic renal failure (CRF)/end stage renal disease and the accessibility of long term renal replacement therapy in Jamaica were evaluated. The study was conducted at six Jamaican healthcare facilities between July 1998 and December 1999 and included 605 patients with CRF. Men with CRF (57% of patients, mean age of 56.7 years) were significantly older than women (mean age 53.2 years). Hypertension was the most commonly associated medical condition (60.8% of patients) followed by diabetes mellitus (31.4% of patients). The estimated crude point prevalence of CRF in persons 20 years and over at the end of 1999 was 327 per million population. More than one-third of patients with CRF (39%) were receiving renal replacement therapy, the most common modality being haemodialysis, and only 1.8% of patients had received kidney transplantation. The prevalence of chronic renal failure was not increased in areas known to have high soil cadmium levels. Chronic renal failure is a significant public health problem in Jamaica and is placing an increasing financial burden on the healthcare sector.

Adult↗
PubMed2003

Severity of systemic lupus erythematosus with diffuse proliferative glomerulonephritis and the ineffectiveness of standard pulse intravenous cyclophosphamide therapy in Jamaican patients.

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.

Adolescent↗
PubMed2002

Cross-sectional association between total level and type of alcohol consumption and glycosylated haemoglobin level: the EPIC-Norfolk Study.

OBJECTIVE: To investigate the association between total level and type of alcohol consumed and glycaemia. DESIGN: Cross-sectional study. SETTING: The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. SUBJECTS AND METHODS: Non-diabetic men (n=2842) and women (n=3572), aged 40-78 y. Alcohol intake was assessed by self-reported questionnaire, and glycaemia measured by glycosylated haemoglobin (HbA(1c)). RESULTS: Ten percent of men and 18% of women reported drinking no alcohol. Among drinkers, median alcohol intake was 8 units/week for men and 3 units/week for women. In analyses stratified by sex and adjusted for age, total energy intake, education, fruit and vegetable intake, smoking, family history of diabetes, physical activity, body mass index and waist:hip ratio, alcohol intake was inversely associated with HbA(1c) in men and women, although the association was stronger in women. A 1 unit/week increase in alcohol intake was associated with 0.0049% (s.e.=0.00223; P-value=0.028) and 0.017% (s.e.=0.00343; P-value <0.001) reduction in HbA(1c) in men and women respectively. In similar multivariate analyses, wine intake was inversely associated with HbA(1c) in men, and wine, spirits and beer intake were inversely associated with HbA(1c) in women. When also adjusted for total alcohol intake, only the association between wine intake and HbA(1c) in men remained significant. CONCLUSION: Alcohol intake was associated with lower HbA(1c) level, an association not explained by confounding. The distinction between type of alcohol consumed was particularly important in men.

Adult↗
PubMed2002

Clinicopathological features of prostate cancer in Jamaican men.

OBJECTIVE: To document the clinicopathological features of prostate cancer in a cohort of Jamaican men, and to determine which of these features are of prognostic significance in this population. PATIENTS AND METHODS: The clinical and pathological findings in 99 patients with prostate cancer (diagnosed consecutively after biopsy, in the Department of Pathology at the University of the West Indies) between 1993 and 1997 were reviewed retrospectively. Biopsy specimens included 74 needle biopsies and 25 transurethral resection (TUR) specimens. RESULTS: The mean age at diagnosis was 72.3 years and 79 patients (80%) were symptomatic. The median (range, interquartile range) serum prostate-specific antigen (PSA) value at diagnosis was 37 (1-2100, 2-750) ng/mL; 63% of the patients had clinical stage T1 or T2 disease. Most (60%) of the cancers had a Gleason score of 8-10. Perineural invasion was present in a third of cases overall; high-grade prostatic intraepithelial neoplasia and periprostatic involvement were present in 18% and 8% of biopsies, respectively. The median percentage involvement of all biopsy samples was 37%, that for needle biopsies 47% and for TUR specimens 14%. Of the 90 patients with complete follow-up data, 37 (41%) died; the cause was progressive disease in 19 (51%). The mean (sd, range) survival was 41.3 (19.7, 1-73) months. On univariate analysis, age, PSA level, tumour stage, Gleason score, perineural involvement and periprostatic involvement were significantly associated with an increased risk of dying from prostatic cancer; in a multivariate model, PSA and tumour stage (4 vs. 1) were the only independent factors. CONCLUSIONS: The mean PSA values at the time of diagnosis, the median percentage of biopsy involvement by cancer and the number of patients with tumours of high histological grade were comparatively high, probably reflecting the patients' relatively late clinical presentation. Established prognostic markers were predictive of the risk of death from prostate cancer.

Aged↗
PubMed2002

Histopathological findings in women with postmenopausal bleeding in Jamaica.

We investigated the histopathological findings in women presenting with postmenopausal bleeding in a population predominantly of African descent by conducting a six-year retrospective study of 716 gynaecological surgical specimens from 629 women accessed in the Department of Pathology, The University of the West Indies, Jamaica. Histopathological diagnoses were correlated with patients age, specimen volume, duration of bleeding and length of postmenopausal interval at presentation using t-tests and linear regression models. The mean (SD) age was 63.6 (9.3) years. The frequency of the main causes of postmenopausal bleeding was: endometrial hyperplasia (22.3%); endometrial atrophy (21.3%); non-diagnostic (19.9%); endometrial carcinoma (9.5%); cervical carcinoma (6.8%); cervical polyps (4.5%); endometrial sarcoma (3.5%); proliferative endometrium (3.2%). Mean (SD) duration of bleeding was 6.9 (12.7) months. The percentage of women with malignant lesions was two to three times greater than those reported in the United States of America and Europe subsequent to 1980. The delay between the onset of bleeding and presentation is worrisome and suggests the need for public education.

Aged↗
PubMed2001

Fruit and vegetable intake and population glycosylated haemoglobin levels: the EPIC-Norfolk Study.

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 fibre and plasma vitamin C. CONCLUSION: These findings support the hypothesis that high intake of fruit and green leafy vegetables may influence glucose metabolism independent of dietary fibre or vitamin C alone and that increased consumption may contribute to the prevention of diabetes.

Aged↗
PubMed2001

Cigarette smoking and glycaemia: the EPIC-Norfolk Study. European Prospective Investigation into Cancer.

BACKGROUND: Previous prospective studies have suggested that cigarette smoking may be associated with an increased risk of type 2 diabetes, but the possibility of confounding, particularly by dietary factors has not been fully examined. METHODS: Cross-sectional analysis of the association between cigarette smoking and HbA(1C), a marker of long-term glucose homeostasis in 2704 men and 3385 women, aged 45--74 years who were recruited to a population-based study of diet and chronic disease. RESULTS: Twelve per cent of men and 11% of women reported being current smokers. Mean HbA(1C) was lowest in never smokers, intermediate in former smokers and highest in current smokers. There was a dose-response relationship between HbA(1C) levels and number of cigarettes smoked per day and a positive association with total smoking exposure as measured by pack-years. The unadjusted increase in HbA(1C) for 20 pack-years of smoking was 0.12% (95% CI : 0.09--0.16) in men and 0.12% (95% CI : 0.08--0.17) in women. After adjustment for possible confounders including dietary variables, the values were 0.08% (95% CI : 0.04--0.12) and 0.07% (95% CI : 0.02--0.12) for men and women, respectively. Mean HbA(1C) was inversely related to time since quitting smoking in men. CONCLUSIONS: These results add support to the hypothesis that smoking has long-term effects on glucose homeostasis, an association that cannot be explained by confounding by dietary factors as measured in this study.

Aged↗
PubMed2001

Anticardiolipin antibodies and risk of thromboembolic disease in young Jamaican women.

BACKGROUND: 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. STUDY DESIGN: Case--control study METHODS: 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. RESULTS: 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. CONCLUSION: aCL are a risk factor for thromboembolic disease in young Jamaican women. They confer a strong independent risk for venous thromboembolism.

Adolescent↗
PubMed2001

Management of diabetes mellitus in three settings in Jamaica.

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 patients' median age ranged from 56 years at SPMC and PRMC to 63 years at PUBMC. Median follow-up had been 6.0 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10% of the patients were controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46%), compared to 7% each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40% of the patients had satisfactory blood glucose control (< 8 mmol/L fasting or < 10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P = 0.26). A blood glucose measurement had been recorded in the preceding year in 84% of the patients at SPMC, 79% at PRMC, and 67% at PUBMC. Glycosylated hemoglobin was infrequently measured: 16% at SPMC, 10% at PRMC, and 0% at PUBMC. Overall, 96% of patients had had surveillance for hypertension, and 81% had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinic records most commonly at SPMC (14% for foot complications, and 13% for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. CONCLUSIONS: The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes.

Adult↗
PubMed2001

Fat consumption and HbA(1c) levels: the EPIC-Norfolk study.

OBJECTIVE: To describe the relationship between total dietary fat and the pattern of fat intake and HbA(1c). 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 HbA(1c) level was negatively associated with the polyunsaturated fat-to-saturated fat ratio (P:S ratio) of the diet (beta = -0.0338 HbA(1c)% per SD change in P:S ratio; P < 0.001) and positively associated with the total level of fat intake (beta = 0.0620 HbA(1c)% 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, beta = -0.0200 HbA(1c)% per SD change in P:S ratio, P = 0.013; for total fat, beta = 0.420% HbA(1c)% per SD change in total fat intake, P < 0.001). The benefits from a high P:S ratio were attributed to a lower saturated fat intake. CONCLUSIONS: These findings demonstrate independent associations between HbA(1c) concentration across the normal range of HbA(1c) and both total fat intake and the pattern of dietary fat intake. They provide further support to efforts promoting modifications in the intake of dietary fat.

Adult↗
PubMed2001

Chronic diseases--facing a public health challenge.

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 major contributors to the epidemic. In populations of similar genetic stock, living in significantly different socio-economic circumstances, the impact of increased dietary salt, increasing obesity and decreased physical activity on the prevalence of hypertension, diabetes mellitus and lipid disorders is unequivocal. Data from the developed world, which has already been through this epidemic of chronic diseases, have shown that increasing technological advances in medical care is an inefficient way to respond to the situation. A multi-sectoral approach is required to tackle this epidemic, including the provision of incentives for healthy eating and widespread opportunities for increased exercise and other physical activities. Continued research into the evolution of the epidemic, including reliable estimates via surveillance methods is a necessary component of our response. The problems and the solutions are not only the responsibilities of the health officials but must involve education, agriculture and other sectors of the economy.

Caribbean Region↗
PubMed2000

Interaction of vitamin C with the relation between smoking and obstructive airways disease in EPIC Norfolk. European Prospective Investigation into Cancer and Nutrition.

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). This question was investigated in a cross-sectional analysis of a population-based study of 3,714 males and 4,256 females aged 45-74 yrs. Undiagnosed OAD was defined as a forced expiratory volume in one second (FEV1) of <80% of the predicted value and FEV1/forced vital capacity of <70% without self-reported OAD. An increase of 20 micromol x L(-1) (or 1 SD) in plasma vitamin C concentration was associated with a 13% reduction in the risk of having OAD (adjusted odds ratio (OR) (95% confidence interval) 0.87 (0.77-0.98)). The OR for current smokers relative to never smokers within the lowest quintile of plasma vitamin C concentration was 5.93 (3.03-11.61). The risk in the upper four quintiles was 2.84 (1.92-4.19). Within the lowest quintile of plasma vitamin C concentration, the risk in former smokers was strongly related to the time since quitting (interaction significant, p=0.001). These findings support a protective role for vitamin C against the risk of obstructive airways disease and support the hypothesis that vitamin C may be an effect modifier for the adverse effects of smoking on the risk of obstructive airways disease.

Aged↗
PubMed2000

Family history of diabetes identifies a group at increased risk for the metabolic consequences of obesity and physical inactivity in EPIC-Norfolk: a population-based study. The European Prospective Investigation into Cancer.

OBJECTIVE: To investigate the interaction of a family history of diabetes with obesity and physical inactivity on diabetes prevalence in middle-aged and elderly men and women. DESIGN: A cross-sectional population-based study. SUBJECTS: 2,912 men and 3,561 women, aged 45-74y. MEASUREMENTS: Body mass index (BMI), HbA1C, self-administered questionnaire including questions on occupational physical activity and personal and family history of diabetes as part of the Norfolk arm of the European Prospective Investigation into Cancer (EPIC-Norfolk). RESULTS: The prevalence of diabetes increased in a dose-response relationship with increasing BMI. There was an interaction between family history and obesity on diabetes risk in subjects with a BMI of greater than 27.5kg/m2 (P= 0.049). Crude prevalence in individuals without a family history and BMI of 22.5-24.9 kg/m2 was 2.2% compared to 33.3% in those with a family history and BMI over 35 kg/m2. Thirty-eight percent of the excess risk of diabetes in people with a family history could be avoided if their BMI did not exceed 30 kg/m2. Individuals who reported sedentary occupations were at greater risk of diabetes compared to those reporting more active occupations. There was a synergistic effect of family history and self-reported occupational physical activity on diabetes risk. CONCLUSION: Individuals with a family history of diabetes are at increased risk for the metabolic consequences of obesity and form an easily identifiable group who may benefit from targeted intervention to prevent the development of obesity through increased physical activity.

Aged↗