Maternal hypertensive disorders during pregnancy (HDP) have been suggested to contribute to the development of offspring cardiovascular disease later in life, but empirical evidence remains inconsistent. This study was aimed to assess the association of maternal overall and type-specific HDPs with diabetes in offspring from childhood to early adulthood.

Using Danish national health registers, a total of 2,448,753 individuals born in Denmark from 1978 to 2018 were included in this study. Maternal HDP included chronic hypertension, gestational hypertension, and preeclampsia. The outcome of interest was diabetes in offspring (including type 1, type 2, and gestational diabetes). The follow-up of offspring started at birth and ended at the first diagnosis of diabetes, emigration from Denmark, death, or time end on 31 December 2018, whichever came first. Cox proportional hazards regression was used to evaluate the hazard ratios (HRs) with 95% confidence intervals (CIs) of the association between maternal HDP and diabetes (including type 1, type 2, and gestational diabetes) in offspring from birth to young adulthood (up to 41 years), with the offspring’s age as the time scale.

Results

• During a follow-up of up to 41 (median: 19.3) years, 1247 offspring born to mothers with HDP and 23,645 offspring born to mothers without HDP were diagnosed with diabetes. Compared with offspring born to mothers without HDP, those born to mothers with HDP had an increased risk for overall diabetes, as well as for type 2 diabetes and gestational diabetes Researchers did not observe obvious increased risk for type 1 diabetes

• Offspring of mothers with gestational hypertension or preeclampsia had higher risks of type 2 diabetes.

• The strongest association was observed for severe preeclampsia, with a 2-fold risk of type 2 diabetes

• The association between maternal HDP and type 1 diabetes did not reach statistical significance, except for maternal gestational hypertension

• In addition, we found that offspring born to mothers with any subtypes of maternal HDP had higher risk of gestational diabetes, and the corresponding HRs (95%CIs) for chronic hypertension, gestational hypertension, and preeclampsia were 1.60, 1.29, and 1.38, respectively.

• They also observed stronger associations among offspring of mothers with HDP and comorbid diabetes than offspring of mothers with HDP or diabetes alone.

Offspring of mothers with HDP, especially mothers with comorbid diabetes, had an increased risk of diabetes later in their life. Our findings suggest that timely and effective prevention of HDP in women of childbearing age should be taken into consideration as diabetes prevention and control strategies for their generations.

Reference:

Yang, L., Huang, C., Zhao, M. et al. Maternal hypertensive disorders during pregnancy and the risk of offspring diabetes mellitus in childhood, adolescence, and early adulthood: a nationwide population-based cohort study. BMC Med 21, 59 (2023). https://doi.org/10.1186/s12916-023-02762-5

MARCH is Colon Cancer Awareness Month and colon cancer is the third most commonly diagnosed cancer in both males and females in Jamaica and the third leading cause of cancer deaths locally.

According to the International Agency for Research on Cancer, Jamaica recorded 796 new cancer cases in 2020 which represented 11 per cent of new cancer cases.

The Ministry of Health has a goal to reduce cancer mortality by 25 per cent by 2025, and an integral part of this must be to reduce the prevalence of cancer by means of primary prevention.

This includes identifying risk factors that can be modified such as increasing physical activity, keeping a healthy weight, limiting alcohol consumption, and avoiding tobacco.

Screening is imperative given that 60 to 70 per cent of Jamaican colon cancer patients present with advanced metastatic disease. Screening can take the form of occult blood testing in stools or colonoscopy. For most Jamaicans, access to colonoscopy is prohibitive due to the absence of health insurance. Also, the service is also not readily available due to limited geographic distribution centres.

For that reason, Windsor Wellness Limited will be introducing to the Jamaican public occult blood testing using faecal immunochemical testing (FIT), which is both sensitive and specific for cancers and polyps and will allow for better use of endoscopic interventions. This screening modality is used globally in population screening programmes. The key benefits are that it requires no preparation, it is not invasive and the results are immediate.

Warning signs of colon cancer includes blood or mucus in the stool, change in bowel movements, loss of appetite, unintentional weight loss, unexplained anaemia or low blood count.

Charlie Balentine, managing partner at Pinnacle Labs, manufacturers of the FIT, told Your Health Your Wealth said he was happy to form the partnership with Windsor to remove colonoscopies as the primary screening tool for colon cancer, given barriers such as cost and cultural beliefs.

"Colonoscopies requires a three-day fast. It requires three samples, which means day one, day two, day three, and it's very subjective. We came up with a brand new biomarker, so we took the biomarker of blood and we isolated a B positive protein in haemoglobin. If you think back to seventh grade science, 85 per cent of blood is haemoglobin, haemoglobin is the oxygen transport mechanism throughout your body. 'Haem' is the Latin word for iron and 'globin' is the Latin word for protein. We isolate that protein and use the cut off level of 15 nanograms per millilitre. Any time someone takes the test and gets a reading of more than 15 nanograms per millilitre, it elicits a positive result and a positive result means you need to be scoped," Balentine said.

Further, he said when it comes to colon cancer in Jamaica, he has realised that majority of the population are "prisoners of hope".

"'We just hope we don't get it' and that's not necessary any more because we certainly don't have the infrastructure to screen everyone on the island with a colonoscopy. Even with that, we are only talking about the elite who would even think of something like that, much less have it done. So what can we do about that? The answer is a population-based screening test that is fast — results in five minutes. At the point of care in five minutes, I can have you screened for colon cancer with the second generation FIT ," Balentine said.

He added: "After prostate cancer, colon cancer is the second most lethal cancer on the island. It kills more people than breast cancer, it kills more people than lung cancer but I drive all over this island all the time. I see billboards for prostate cancer, I see billboards for HIV, I see billboards for breast cancer. We don't talk about colon cancer but this disease has no symptoms — none. If you have symptoms that's incredibly problematic. The only way to eradicate the disease is early detection through screening."

The FIT detects cancer with a 98 per cent sensitivity rate and a 96 per cent specificity rate and includes a tube filled with a sodium iodide buffer solution, which suspends the sample for a period of up to two weeks at room temperature and three weeks if frozen. It does not require dietary restrictions.

"Let's say you're 45 and at 45 you should screen for colorectal cancer. To do so, I need you to tale this tube home, unscrew it and after a spontaneously passed stool, use the wipe method to get a little sample of faecal matter — just enough to fill up the grooves on the test — and then cap it and bring it back to the collection site where you picked it up," Baletine said.

"This idea of colonoscopy screening tests as the primary screening method is absurd in this day and age. We can do better, better is out there, available and incredibly inexpensive. The goal is to get these tubes in everyone's hands. You can do more screening in one day with the FIT than you can do in one week with the colonoscopy."

Going forward Balentine hopes that the test will become population-based and available in the public sector for every Jamaican. Also through US not-profit organisation Black Health, there will be a major public education campaign around colorectal cancer and screening using FIT as a preventative tool.

In the meantime, founder/CEO of Windsor Wellness Centre Dr Alfred Dawes said the FIT has the potential to cut colon cancer cancer rates in half.

"The test detects the presence of blood in the stool,which is a reliable indicator of polyps — the growth that can eventually turn into cancer. If you can find and remove half of the polyps in population, just through screening more, you pick up earlier colon cancers and can cut the rates in half. Seventy per cent of the colon cancers in Jamaica are detected at late stage, which is more difficult and more expensive to treat, with higher death rates than early colon cancer. The FIT will pick up earlier cancers that have a higher cure rate and are easier to treat, so we will move from diagnosing advanced cancers to earlier detection of colon cancers."

WITH the International Myeloma Foundation (IMF) at the forefront, Myeloma Awareness/Action Month is held every year for the whole month of March to encourage individuals and groups to take actions that positively impact the myeloma community.

This year the IMF invites YOU to take the action of storytelling.

Stories evoke empathy and foster hope. They help us better understand ourselves and others. The IMF will engage the global myeloma community by sharing stories about members of the myeloma community who live well with myeloma and by prompting others to share their stories.

Yelak Biru, president and CEO of the IMF and a 27-year myeloma survivor, shares his story to inspire others to do the same: "As a young immigrant from Ethiopia, a new husband, and a graduate student, I learned I had multiple myeloma at the age of 26. While the road of living with myeloma has not always been smooth, it has been paved with many valuable lessons along the way. One of those lessons is that we must learn to live with, and not for, myeloma. This Myeloma Action Month, I ask you — as patients, care partners, and anyone who has been touched by this incurable disease — to share how you live well with and not for myeloma."

Biru's call to action is just one example of the many ways the IMF will prompt individuals and groups to share their stories on social media with the hashtag #MYelomaSTORY.

Help the IMF spread myeloma awareness on a global scale by using the hashtag #MYelomaSTORY, on all social media channels — Twitter, Facebook, LinkedIn, and Instagram. Using the #MYelomaSTORY hashtag, all related posts will be displayed on the IMF's digital "Wall of Stories" at the Myeloma Action Month website: mam.myeloma.org.

How can you get involved in Myeloma Action Month?

Take Action

• Join the movement and take action for myeloma by using the MAM website photo uploader in mam.myeloma.org. All you need to do is upload a photo of your chosen action, put a caption to it, and then share with the community through Twitter, Facebook, Instagram, and LinkedIn. Your image will automatically include the hashtag #MYelomaSTORY in your post.

• The IMF will provide story-based infographics that share stats and facts based on first-hand experiences from patients and care partners in the myeloma community. These graphical

prompts will be on all IMF social media channels. Follow along each day at facebook.com/myeloma to respond to these prompts and share your stories.

• Visit mam.myeloma.org to watch an international video mash-up featuring members of the global myeloma community answering the question: "Tell us in one word, what is your

myeloma story?"

• Get inspired with guest blogs from patients and their care partners on the sentiment of "living with — and not for — myeloma"

• Download this Patient Action Letter from IMF Chairman and Chief Science Officer Dr Brian GM Durie, personalise it, and send it to general practitioners and internists. The letter spells out potential myeloma signs, symptoms, and diagnostic tests that can be used to educate healthcare providers who may not be as familiar with the disease.

• Find a virtual support group at myeloma.org/support-groups and join an upcoming meeting

Participate and Learn

Sign up for and participate in the IMF's scheduled virtual and/or in-person information programmes for the whole month of March.

IMF Patient and Family Seminar — Boca Raton, Florida. This free, in-person event on March 17-18, 2023, has limited seating. Register today!

Join us live on Facebook on 3/22 @ 4 pm PT / 7 pm ET

IMF Chief Medical Officer Dr Joseph Mikhael answers your questions in a special Q&A and shares his myeloma story on 3/7 @ 4 pm PT / 7 pm ET

IMF Nurse Leadership board member Dr Beth Faiman discusses living well with myeloma and shares her myeloma story.

Experience and Nurture

The IMF is excited to share with you a 31-day wellness challenge. This year during March Action Month we work together, take accountability, to increase the visibility of myeloma and take action through your #MYelomaSTORY and whole wellness within ourselves.

We at the IMF, challenge YOU to put yourself on the top of that "to-do list" and join us in this wellness challenge. Learn how to take part in the Support Group Challenge here.

We welcome new and prospective members to join the Jamaica Multiple Myeloma Support Group using any of the following contacts: e-mail: jamaica@imfsupport.org;
WhatsApp: 876-829 5507; website: myelomajamaica.org

In recognition of World Obesity Day, commemorated on March 4, the Barbados Childhood Obesity Prevention Coalition (BCOP) shared a letter of commendation to the Ministry of Education, Technological and Vocational Training for the February 15 launch of the National School Nutrition Policy. On hand to receive the letter from Dr Kia Lewis, Chairperson of the Barbados Childhood Obesity Prevention Coalition, was Deputy Chief Education Officer Joy Adamson.  

The BCOP Chair outlined that the new policy was a brave one to protect children in Barbados. The new policy removes sugar-sweetened beverages from schools and forges a healthier school food environment from April 2023. 

The school nutrition policy has been part of the ardent fight by the Coalition since 2019 and the group stands ready to support the Ministry through vendor training, building awareness about childhood obesity with all stakeholders including teachers, students and parents, and monitoring and evaluation of the platform to ensure the policy has the power to change the health of students across Barbados.  

The theme for World Obesity Day 2023 is Changing Perspectives: Let’s Talk About Obesity. When we talk, debate and share, we can change minds, shift norms and transform health outcomes. In Barbados, the conversation has been about advocating for policies and this has brought a massive change among parents, students and government, who recognized that the trajectory of the alarming levels of childhood obesity in Barbados was putting the health of children in jeopardy. 

A societal problem like childhood obesity will require a societal response. Research shows that in Barbados, one in three children between 13 to 15 years old are obese or overweight. This is alarming and puts the health of a generation under threat. 

Adamson thanked the Coalition on behalf of the Minister of Education, Technological and Vocational Training the Hon. Kay McConney gave the assurance that the Ministry will work with the Coalition and the Ministry of Health to help reduce childhood obesity. 

(PR)

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In the letter dated February 23, 2023, the students from the Centre-run institute mentioned how the students of the college were facing trouble because of hours long daily commute or expensive rented accommodations.

Even though the former health minister had announced that the college building and the hostel facilities would be completed by 2022, the construction for the college building has not yet commenced in 2023, the students pointed out in the letter.

Atal Bihari Vajpayee Institute of Medical Sciences and Dr RMLH was established in 2019 under the special intervention of the Ministry and named after the former Primer Minister Atal Bihari Vajpayee. 

However, referring to the present condition of the college, the MBBS students stated in the letter, "At the time of the College's inception, the former health minister had assured that the college's building and hostels would be completed by 2022. Unfortunately, it is regrettable to inform you that the construction for the college building has not yet commenced in 2023."

Referring to the guidelines issued by the National Medical Commission, the apex medical education regulatory body, ABVIMS Students Council pointed out in the letter that the norms prescribe that at least 75% of students should be allotted hostels.

Also Read: No more casual wear on campus: Delhi's RML Hospital issues dress code for doctors, other staff

"However, we have observed that only 35% of students have been provided with hostel accommodations. As a result, the remaining students are facing a daily commute of 3-4 hours, making it challenging for them to concentrate on their studies. Some students have had to rent flats or PGs nearby, which is beyond their means. We believe that providing hostel accommodations would be more affordable and beneficial to the students," stated the letter.

"In addition, the college lacks adequate infrastructure. There are insufficient Lecture Theatres for students, and there is no separate reading room for undergraduate students. There is also no examination hall and no place for students to play sports. The mental health of medical students is being neglected, and we believe that appropriate arrangements should be made to address this issue," it further mentioned.

"While opening new medical colleges is crucial for improving the healthcare system, we believe that the quality of facilities of existing colleges must also be enhanced," the letter added.

Referring to the inadequate infrastructure, the students urged the Union Health Minister to expedite the construction of the college building and complete it before the 2019 batch completes their MBBS course. They have also requested the Minister to ensure that the students are provided hostels as early as possible and the infrastructure of the medical college gets improved.

While commenting on the infrastructure of the medical college, students informed Indian Express that a three-acre plot of land, where the psychiatry department is running at present, was there was college was supposed to come up.

“In 2019, when the name of the medical college was changed from PGIMER to ABVIMS and an undergraduate course was started, the then union health minister Harsh Vardhan had promised that a college will be built along with a hostel but nothing has been done so far,” a student said.

The student further mentioned, “We have three lecture rooms — two in the main building and one across the road in the psychiatry department. Whenever there is a space constraint, our lectures are conducted in the auditorium in the main building. Even the labs have space issues.”

At present, around 400 MBBS students from four years are enrolled in the college. Among them, 290 students are boys and only 80 of them have been given free hostel accommodation in a nearby dharamshala on Mandir Marg, around 1.3 km away from the campus. Only 40 out of 110 girl students have been provided with hostel accommodation on the campus.

Alleging that students coming from Noida, Gurgaon and Faridabad are required to travel long distances to the campus a student pointed out how it affects their concentration on studies and mentioned, “Many are living on rent in areas such as Rajinder Nagar and spending Rs 20,000 for a 1BHK set.”

Meanwhile, speaking about construction work of the medical college, Dr Nandini Duggal, the Director and Medical Superintendent of RML Hospital told the daily that the building has been planned at the concerned plot and currently several approval processes are ongoing. After the design gets approved, it will be presented to the Ministry for its financial approval. 

She mentioned, “The administration is well aware of the issues faced by medical students and all necessary measures are being taken to expedite the relevant projects.”

Also Read: Dr Ram Chander appointed as Dean of RML Hospital, Dr Virendra Kumar takes charge as Director of LHMC

To avoid situations like the one that occurred a decade ago when hundreds of thousands of Dominicans contracted chikungunya, the doctor understands that it is necessary to protect oneself from the bite of the Aedes aegypti.
The also director of the Robert Reid Cabral hospital warned that chikungunya could cause lesions in different body organs, such as the heart and kidneys. By way of example, he cited meningoencephalitis, myocarditis, and pericarditis, among others.

Greater danger

Children and adolescents could be at greater risk should chikungunya spread in the country as it did in 2014.
The Dominican Republic has been under epidemiological alert since the World Health Organization spoke of the presence of the disease in The Americas.

Mosquito control Authorities advise eliminating standing water where mosquitoes could lay their eggs.

Once a week, empty, scrub, turn over, cover, or throw away any items that accumulate water, such as tires, buckets, flower pots, toys, swimming pools, birdbaths, flower pot dishes, and garbage containers.
Mosquitoes lay their eggs near water.

Protecting yourself from mosquitoes

The U.S. Centers for Disease Control and Prevention (CDC) recommends controlling mosquitoes inside and outside your home. These include using window and door screens; using air conditioning if one is available; sleeping under mosquito netting if rooms don’t have air conditioning or screens on doors and windows, or if you sleep outside.

“Once a week, empty, scrub, turn over, cover or throw away any items that collect water such as tires, buckets, flower pots, toys, swimming pools, birdbaths, planter dishes and garbage containers. Check inside and outside your home. Mosquitoes lay their eggs near water.”

For children and infants, CDC recommends protecting infants and children from mosquito bites and dressing in clothing that covers the arms and legs. “When using insect repellent on children: Always follow directions when applying insect repellent to children.

Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under three years of age.”

It also urges not to apply insect repellent to children’s hands and eyes or cut or irritated skin.

The Queen Elizabeth Hospital (QEH) welcomed nine interns into the fold on Wednesday, March 1, as they began their one-year internship programme with the hospital, in partial fulfillment of the requirement to practice medicine in Barbados.

The doctors will work in the Internal Medicine, General Surgery, Obstetrics & Gynaecology and Paediatrics Departments during the next 12 months. 

In her address, Director of Medical Services Dr Chaynie Williams reminded the interns to work hard in their respective departments every day.  

Before welcoming them officially into the QEH, Dr Williams prompted the youthful doctors to utilise the assistance that is always nearby, citing that “there is always someone to call on to ask a question when needed”.  

The doctors were all smiles and appeared ready for the challenge as they proceeded to their assigned departments in the hospital. 

(QEH)

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World Obesity Day – PAHO urges countries to tackle main driver of NCDs in the Americas

Cristina Mitchell

3 Mar 2023