The Bustamante Hospital for Children’s (BHC) paediatric renal unit has been in operation for more than five years without the use of peritoneal dialysis (PD) machines. As such, the medical staff has had to do without the use of the critical...

THE BRAIN is a very important organ as it is the control centre of your body and it allows you to move, think, feel, breathe and more. As the brain has such a big job, it is imperative that we provide it with an abundance of fuel and nutrients to...

El cansancio y las náuseas de su marido fueron tan intensas que no fue a trabajar por tres días. Pero bebió agua con lima en lugar de ir al médico porque no tienen seguro médico. “A mucha gente le pasa esto”, agregó.

No existen normas federales para proteger a los trabajadores como los García cuando los días son excesivamente calurosos. Y sin el apoyo bipartidista del Congreso, incluso con la atención urgente de la administración Biden, es posible que el alivio no llegue en años.

El presidente Joe Biden encargó en 2021 a la Administración de Seguridad y Salud Ocupacional (OSHA) la elaboración de normas para prevenir los accidentes y las enfermedades causados por el calor.

Pero ese proceso de 46 pasos puede llevar más de una década y podría estancarse si un republicano es elegido presidente en 2024, porque el Partido Republicano se ha opuesto generalmente a las regulaciones de salud laboral en los últimos 20 años.

Estas normas podrían obligar a los empleadores a proporcionar abundante agua potable, descansos y un espacio para refrescarse a la sombra o con aire acondicionado cuando las temperaturas superen un determinado umbral.

El 7 de septiembre, OSHA comenzó reuniones con propietarios de pequeñas empresas para discutir sus propuestas, incluidas las medidas que deberían adoptar las empresas cuando las temperaturas llegan a los 90 grados.

Como este verano se han batido récords de calor, la congresista Judy Chu (demócrata de California) y otros miembros del Congreso han impulsado una legislación que aceleraría el proceso de elaboración de normas de OSHA.

El proyecto de ley lleva el nombre de Asunción Valdivia, una trabajadora agrícola que se desmayó mientras recogía uvas en California en un día de 105 grados en 2004. Su hijo la recogió del campo y Valdivia murió de un golpe de calor en el trayecto a su casa.

“Ya sea en una granja, conduciendo un camión o trabajando en un almacén, los trabajadores como Asunción mantienen nuestro país en funcionamiento mientras soportan algunas de las condiciones más difíciles”, dijo Chu en declaraciones en julio en la que instaba al Congreso a aprobar el proyecto de ley.

Las organizaciones profesionales que representan a los empresarios se han opuesto a las normas, calificándolas de “exageradas”. También afirman que faltan datos que justifiquen regulaciones generales, dada la diversidad de trabajadores y lugares de trabajo, desde restaurantes de comida rápida hasta granjas.

La Cámara de Comercio de Estados Unidos, uno de los grupos de presión más poderosos de Washington, argumentó que tales medidas carecen de sentido “porque cada empleado experimenta el calor de forma diferente”. Además, según la Cámara, normas como los ciclos de trabajo-descanso “amenazan con perjudicar directa y sustancialmente… la productividad de los empleados y, por lo tanto, la viabilidad económica de su empleador”.

“Muchos de los problemas relacionados con el calor no son consecuencia del trabajo agrícola ni de la mala gestión del empresario, sino del moderno estilo de vida de los empleados”, escribió el Consejo Nacional del Algodón en su respuesta a la legislación propuesta.

Por ejemplo, el aire acondicionado hace más difícil que las personas se adapten a un ambiente caluroso después de haber estado en una vivienda o un vehículo fríos, y señaló que “los trabajadores más jóvenes, más acostumbrados a un estilo de vida más sedentario, no pueden aguantar un día trabajando al aire libre”.

La Asociación de Recursos Forestales, que representa a los propietarios de terrenos forestales, la industria maderera y los aserraderos, agregó que “las enfermedades y muertes relacionadas con el calor no figuran entre los riesgos laborales más graves a los que se enfrentan los trabajadores”. Citaron cifras de OSHA: la agencia documentó 789 hospitalizaciones y 54 muertes relacionadas con el calor a través de investigaciones e infracciones de 2018 a 2021.

OSHA admite que sus datos son cuestionables. Ha dicho que sus cifras “sobre enfermedades, accidentes y muertes relacionadas con el calor en el trabajo son probablemente grandes subestimaciones”.

Los accidentes y enfermedades no siempre se registran, las muertes provocadas por las altas temperaturas no siempre se atribuyen al calor, y los daños relacionados con el calor pueden ser acumulativos, provocando infartos, insuficiencia renal y otras dolencias después de que la persona haya abandonado su lugar de trabajo.

El efecto de la temperatura

Para establecer normas, OSHA debe conocer los efectos del calor en los que trabajan en interiores y al aire libre. La justificación es una parte necesaria del proceso, porque las normativas aumentarán los costos para los empresarios que necesiten instalar sistemas de aire acondicionado y ventilación en el interior, y para aquellos cuya productividad pueda bajar si se permite a los que trabajan a la intemperie tomar descansos o reducir las jornadas cuando suban las temperaturas.

Lo ideal sería que los empresarios tomaran medidas para proteger a los trabajadores del calor independientemente de las normas, afirmó Georges Benjamin, director ejecutivo de la Asociación Americana de Salud Pública. “Tenemos que hacer un mejor trabajo para convencer a los empresarios de que hay una compensación entre la eficiencia y los trabajadores enfermos”, dijo.

García y su marido sufrieron los síntomas del golpe de calor: vómitos, náuseas y fatiga. Pero sus casos forman parte de los miles que no se contabilizan cuando la gente no va al hospital ni presenta denuncias por miedo a perder su empleo o estatus migratorio.

Los trabajadores agrícolas están notoriamente subrepresentados en las estadísticas oficiales sobre accidentes y enfermedades laborales, según David Michaels, epidemiólogo de la Universidad George Washington y ex administrador de OSHA.

Investigadores que encuestaron a trabajadores agrícolas de Carolina del Norte y Georgia encontraron que más de un tercio presentaba síntomas de enfermedad por calor durante los veranos analizados, una cifra muy superior a la registrada por OSHA. En particular, el estudio de Georgia reveló que el 34% de los trabajadores agrícolas no tenía descansos regulares, y una cuarta parte no tenía acceso a espacios con sombra.

Incluso los casos en los que los trabajadores son hospitalizados pueden no atribuirse al calor si los médicos no documentan la conexión. Muchos estudios relacionan los accidentes laborales con el estrés térmico, que puede causar fatiga, deshidratación y vértigo.

En un estudio realizado en el estado de Washington, se observó que los trabajadores agrícolas se caían de las escaleras con más frecuencia en junio y julio, unos de los meses más calurosos y húmedos. Y en un informe de 2021, investigadores calcularon que las temperaturas más cálidas causaron aproximadamente 20,000 accidentes laborales al año en California entre 2001 y 2018, según los reclamos de compensación de los trabajadores.

Las lesiones renales por calor también aparecen en la base de datos de OSHA de trabajadores lesionados gravemente en el trabajo, como el caso de un empleado de una planta de procesamiento de carne hospitalizado por deshidratación y lesión renal aguda en un caluroso día de junio en Arkansas.

Sin embargo, la investigación revela que el daño renal provocado por el calor también puede ser gradual. Un estudio de trabajadores de la construcción que estuvieron durante un verano en Arabia Saudita reveló que el 18% presentaba signos de lesión renal, lo que los ponía en riesgo de insuficiencia renal futura.

Además de cuantificar las lesiones y muertes causadas por el calor, OSHA trata de atribuirles un costo para poder calcular el ahorro potencial derivado de la prevención. “Hay que medir las cosas, como ¿cuánto vale una vida?”, afirmó Michaels.

Para los trabajadores y sus familias, el sufrimiento tiene consecuencias de largo alcance que son difíciles de enumerar. Los gastos médicos son más obvios. Por ejemplo, OSHA calcula que el costo directo de la postración por calor (sobrecalentamiento debido a insolación o hipertermia), es de casi $80,000 en costos directos e indirectos por caso.

Si esto parece elevado, hay que pensar en un trabajador de la construcción de Nueva York que perdió el conocimiento en un día caluroso y se cayó de una plataforma, y sufrió una laceración renal, fracturas faciales y varias costillas rotas.

El precio de los golpes de calor

Investigadores también han intentado determinar el costo que supone para los empresarios la pérdida de productividad. El trabajo es menos eficiente cuando suben las temperaturas, y si los trabajadores se ausentan por enfermedad y tienen que ser reemplazados, la producción disminuye mientras se entrena a nuevos trabajadores.

Cullen Page, cocinero de Austin, Texas, y miembro del sindicato Restaurant Workers United, trabaja durante horas frente a un horno de pizza, donde, según dijo, las temperaturas oscilaron entre los 90 y los 100 grados cuando las olas de calor golpeaban la ciudad en agosto.

“Es brutal. Afecta tu forma de pensar. Estás confundido”, dijo. “Me dio un sarpullido por calor que no se me quitaba”. Como hace tanto calor, agregó, el restaurante tiene un alto índice de rotación de empleados. Una campana extractora adecuada sobre los hornos y un mejor aire acondicionado ayudarían, pero los propietarios aún no han hecho las mejoras, dijo.

Via 313, la cadena de pizzerías en la que trabaja Page, no respondió al pedido de comentario.

Page no es el único. Una organización que representa a los empleados de restaurantes, Restaurant Opportunities Centers United, encuestó a miles de trabajadores, muchos de los cuales informaron de condiciones inseguras por el calor: el 24% de los trabajadores de Houston, por ejemplo, y el 37% de los de Philadelphia.

“Los trabajadores estuvieron expuestos a temperaturas de hasta 100 grados después de que se rompieron los aparatos de aire acondicionado y los ventiladores de las cocinas, lo que les dificultaba respirar”, escribió el Sindicato Internacional de Empleados de Servicios, que incluye a trabajadores del sector de comida rápida, en una nota a OSHA. “No hay razón para retrasar más la creación de una norma cuando conocemos la magnitud del problema y sabemos cómo proteger a los trabajadores”, dijeron.

Investigadores del Atlantic Council calculan que Estados Unidos perderá una media de $100,000 millones anuales por la baja de la productividad laboral inducida por el calor a medida que el clima se vuelve más cálido. “A los empresarios les cuesta mucho dinero no proteger a sus trabajadores”, afirmó Juley Fulcher, defensora de salud y  seguridad de los trabajadores de Public Citizen, organización de Washington D.C. que aboga por que el proyecto de ley Asunción Valdivia permita a OSHA promulgar normas el año que viene.

Como modelo, Fulcher sugirió fijarse en California, Maryland, Nevada, Oregon y Washington, los únicos estados con normas que obligan a que todos los trabajadores al aire libre tengan acceso a agua, descanso y sombra.

Aunque las normas no siempre se hacen cumplir, parece que surten efecto. Después de que California instaurara la suya en 2005, se registraron menos accidentes en los reclamos de indemnización de los trabajadores cuando las temperaturas superaban los 85 grados.

Michaels afirmó que OSHA ha demostrado que puede actuar con más rapidez de lo habitual cuando el Congreso se lo permite.

En los primeros días de la epidemia de VIH/SIDA, la agencia aprobó rápidamente normas para evitar que médicos, enfermeras y dentistas se infectaran accidentalmente con agujas. Ahora existe una urgencia similar, dijo. “Dada la crisis climática y la prolongación de los períodos de calor extremo”, señaló, “es imperativo que el Congreso apruebe una legislación que permita a OSHA promulgar rápidamente una norma que salve vidas”.

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“Current weather models indicate relatively high temperatures (above 31.7℃), light winds and low rainfall at least for the next 3 days”

View the full post Heatwave advisory message to parents/guardians on NOW Grenada.

I used to have painful periods in my teens and 20s, but nowadays there is no pain at all, and I hardly notice that it's there. It still lasts between two to three days, with the same flow as I've always had. I'm just wondering why the pain and discomfort would have stopped, and if there's anything to be concerned about. I am 45, mother of two, and had my tubes tied.

The absence of pain with your monthly period may be an early sign that you do not ovulate as you used to when you were younger. Women who ovulate tend to have some amount of painful discomfort on the first one to two days of the period. This can range from mild cramping discomfort which can usually warn you that the period is about to start, but can be severe enough to warrant the need for pain medication.

The change in your monthly cycle from painful to painless could also be a sign that you are entering the perimenopausal phase of life. These changes can start at any time after 40 years old. The pain associated with the menstrual period is caused by prostaglandin which is increased in production when you ovulate. This causes the muscles of the uterus to contract and results in the pain during the menstrual period.

There are other factors that can cause or change your ovulation pattern and result in painless menstrual periods. These include changes in your body weight, strenuous excessive exercise, and stressful factors.

In some women there can be changes in ovulation and menstrual period after a tubal ligation. This can result in less painful periods because the ovulation pattern changes and is less frequent. The fact that you did a tubal ligation suggests that you have completed your childbearing desires.

The absence of pain with the menstrual period is really nothing to be worried about. You could consult your doctor and have your hormone profile including a test of your thyroid function, as thyroid problems can sometimes result in changes in your ovulation and absence of the period or painless periods. But the fact that your period is still regular makes this less likely to be the cause. Other symptoms of the perimenopause include hot flashes, mood swings, irritability and sleep disturbances.

Experiencing an absence of pain with the menstrual cycles is a welcome change accepted by most women with previously disabling painful periods, as it is seen as a significant improvement in their quality of life.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

IN the realm of women's wellness, the topic of sexual and reproductive health is often seen as taboo, being discussed in hushed tones if it's ever spoken about at all.

As things and times change, women are becoming more responsible with their health, and gone are the days when they have to sit in discomfort when it comes to intimacy.

Medical experts have now found a way to explore a transformative approach to restoring vitality, and that includes exploring the role of testosterone.

While this hormone is traditionally associated with men, testosterone also plays a vital role in women's well-being. Ovaries produce both oestrogen and testosterone, making it a naturally occurring hormone in a woman's body. With the help of the adrenal glands, the ovaries release small amounts of testosterone into the bloodstream helping to maintain muscle mass, bone density, energy levels and a healthy libido. However, as we age, the levels of testosterone in both men and women can gradually decline and when its levels drop, can lead to fatigue, decreased sexual desire and significant changes in mood.

In order to restore the natural order of things in the body, medical practitioners now suggest the use of testosterone cream, which has the potential to be a game-changer for women's intimate wellness. This alternative is becoming more popular than ever as a proven solution and is now readily available here in Jamaica. If used as directed by a physician, testosterone cream can replenish the levels of the hormone that may have declined over time.

Testosterone cream serves as a promising ally for women experiencing a decrease in sex drive during menopause. By delivering a controlled dose, women and their medical doctors can work to counterbalance the hormonal shifts that affect desire, arousal and satisfaction. While a low sex drive isn't always cause for concern in terms of physical health, it can have emotional and relational implications. The cream seeks to address this by potentially alleviating a range of symptoms, including reduced sexual thoughts, diminished pleasure and decreased energy contributing to a holistic improvement in a woman's intimate well-being.

Testosterone cream is typically applied directly to the skin and is best used on shoulders, upper arms or inner thighs so it can be quickly absorbed into the bloodstream.

While the use of testosterone cream offers promise, it's essential to approach it under the guidance of a health-care professional. Hormone levels need careful monitoring to ensure the treatment is tailored to each woman's unique needs and regular assessments and discussions with a medical provider can help ensure its effectiveness while minimising any potential risks. Using testosterone cream is a journey and results may vary, but with consistent use, women often report improved quality of life, both physically and emotionally.

Bodies change over time and it's time for women to feel more comfortable about exploring options that can enhance what we've already grown to know and love. If you've been feeling less vibrant or noticing changes in your energy and mood, testosterone cream could be a valuable tool in your wellness arsenal.

Dr Charles Rockhead is a consultant obstetrician gynaecologist at Amadeo Medical Group and Andrews Memorial Hospital. He can be contacted at 876-361-2355 or via email: drrockhead@gmail.com . Follow him on Instagram @amadeomedicalgroup and @oshuncosmeticservice

It estimated that by 2022 more than $1 billion of these devices would be in use worldwide. These devices allow the measurement of a variety of physiological data that was once confined to medical or research settings. Examples of these devices include the smart watch (eg, the Apple Watch, Samsung Galaxy watches, Garmin forerunner devices), heart rate monitors worn during exercise and a host of rings and bracelets with the ability to measure heart rate, assess sleep quality and duration, the amount and intensity of exercise and oxygen saturation.

With the increased frequency of use among the general population, our patients often turn to us for an explanation of the data obtained particularly when abnormal findings are seen. From the physician perspective, for a variety of reasons that we will discuss, it can be difficult to assess the clinical importance of these findings. For many types of data there are inadequate definitions of what is normal for a population or an individual. There are often real-world factors that can reduce device accuracy and each company can have propriety algorithms for generation of data that have not been tested against a gold standard.

Heart rate

There are several ways that heart rate can be obtained from a CWD. The two most common are the use of a chest strap to obtain a single lead ECG or the use of plethysmography in which light is used to penetrate the skin and subcutaneous blood vessels. This light is reflected to the device from the blood cells. The intensity and frequency of those reflections is used to generate a heart rate. Most watches, rings and bracelets use the second method to measure heart rate, although some watches can generate a single lead ECG that is user activated. When evaluated in research settings both methods give reasonable approximations of the heart rate when compared to a gold standard ECG; however, in "the real world" the accuracy tends to be less. A chest strap is generally more accurate than devices using plethysmography; however, a chest strap can be affected by motion causing artefact. It can also be affected by the type of exercise, for example, cycling vs running because of transient loss of contact with the skin or challenges with Bluetooth connection. A watch is generally more sensitive to motion resulting in lower accuracy. An important consideration for our population when using plethysmography devices is skin colour with higher doses of melanin as seen in black populations reducing the accuracy of some of these devices.

Most of our patients who follow their heart rates do so in the setting of exercise, where the heart rate is a reasonable proxy for the intensity of exercise, with higher heart rates being associated with more intense exercise. For runners or cyclists who want to exercise aerobically "so-called fat burning zone" using the heart rate to avoid going too hard is easily achievable. A common concern of our patients is the finding of a heart rate that they think is too fast or too slow. It is important to remember that the heart rate over 24 hours is not a number but is a range. On average the heart rate at rest ie, when sitting quietly is 60-100 beats per minute. This, however, can vary with several factors including age, sex, and level of fitness. A very well-trained endurance athlete can have a resting heart rate that is in the 30s as a normal finding. A normal heart rate will vary with activity and with emotional stress so that a rise in heart rate when walking, climbing stairs, being anxious or arguing with a friend or loved one is normal. It is also important to know that the heart rate can fall quite significantly with sleeping given the loss of activation of the "flight or fight" system with heart rates in the 30s being seen in some individuals.

When should we be concerned about the heart rate? Speaking anecdotally, most abnormalities that bring patients to see a cardiologist are found either to be normal findings or an inaccurate measurement by the CWD. If abnormalities in heart rate are associated with symptoms, then these are of more concern. Very slow heart rates and very fast heart rates (particularly at rest) should always be evaluated recognising that most times no significant abnormality will be found. Some CWDs can generate and record a single lead ECG, and these can be useful in trying to ascertain the clinical importance of heart rate abnormalities seen on these devices. Many of these patients will need medical grade rhythm assessment with electrocardiography or prolonged outpatient rhythm monitoring.

Atrial fibrillation

Atrial fibrillation is the most common sustained abnormal heart rhythm and is an important cause of stroke and heart disease. Many patients who experience atrial fibrillation will have symptoms of palpitations, but for some this arrhythmia is silent and the first recognition is when the patient presents with a stroke or heart failure. The ability of a smart watch or other CWD to detect atrial fibrillation thus allows for early identification and potentially early diagnosis and treatment. Atrial fibrillation, unlike normal sinus rhythm, is irregular and if an EKG is done there is no organised activity seen from the upper chambers of the heart. By looking at these features some smart watches can detect atrial fibrillation. Several devices have been approved for the detection of atrial fibrillation by either the US Food and Drug Administration or the European Medicines Agency. These include the Apple Watch, the Samsung Galaxy watch, several Fitbit devices and the Alivecor Kardiamobile device.

There is limited data on the real-world efficacy of these devices in detecting atrial fibrillation after approval particularly since smart watches tend to be used most in younger populations as opposed to the middle aged and elderly who are at greater risk of atrial fibrillation. A recent study was published in the Clinical Electrophysiology Journal of the American College of Cardiology comparing the efficacy of five consumer wearable devices in a group of patients who were undergoing evaluation and treatment for atrial fibrillation. Two hundred and eleven patients with an average age of 65 years were provided with smart watches, instructed on how to use them, and followed for approximately one year. The highest sensitivity was found with the Apple Watch 6 and the Samsung Galaxy 3, which detected around 85 per cent of atrial fibrillation episodes. The Fitbit sense detected 79 per cent of episodes. Among all watches rhythms were detected that the device was unable to classify approximately 20 per cent of the time; however, when a recording was available for review by a cardiologist a correct determination could be made in 95 per cent of the tracings. These findings suggest a potential use for consumer wearable devices in the detection of atrial fibrillation in patients at risk particularly with those devices that have undergone validation studies.

In future articles we will look further at other aspects of consumer wearable devices.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.

A new study has been published in
The Lancet Global Health
showing that almost one in three men over the age of 15 are infected with at least one genital human papillomavirus (HPV) type, and one in five are infected with one or more of what are known as high-risk, or oncogenic, HPV types.

These estimates show that men frequently harbour genital HPV infections, and emphasise the importance of incorporating men in efforts to control HPV infection and reduce the incidence of HPV-related disease in both men and women.

The systematic review and meta-analysis assessed the prevalence of genital HPV infection in the general male population based on studies published between 1995 and 2022. The global pooled prevalence was 31 per cent for any HPV and 21 per cent for high-risk HPV. HPV-16 was the most prevalent HPV genotype (5 per cent) followed by HPV-6 (4 per cent). HPV prevalence was high in young adults, reaching a maximum between the ages of 25 years and 29 years, and stabilised or slightly decreased thereafter.

Pooled prevalence estimates were similar for the UN Sustainable Development Goal geographical regions of Europe and Northern America, sub-Saharan Africa, Latin America and the Caribbean, and Australia and New Zealand (Oceania). The estimates for Eastern and South-Eastern Asia were half that of the other regions.

The majority of HPV infections in men and women are asymptomatic but they can lead to long-term sequelae and mortality. Each year, more than 340, 000 women die of cervical cancer. In men, HPV infection tends to manifest clinically as anogenital warts, which cause significant morbidity and increase HPV transmission rates. HPV infections are also associated with penile, anal and oropharyngeal cancers, which are commonly linked to HPV type 16. The International Agency for Research on Cancer estimated that there were about 69,400 cases of cancer in men caused by HPV in 2018.

"This global study on the prevalence of genital HPV infection among men confirms how widespread HPV infection is. HPV infection with high-risk HPV types can cause genital warts and oral, penile and anal cancer in men. We must continue to look for opportunities to prevent HPV infection and to reduce the incidence of HPV-related disease in both men and women," said Dr Meg Doherty, director of WHO's Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.