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TRAMIL ethnomedicinal survey in Jamaica

Journal of Ethnopharmacology
Available online 27 April 2015
In Press, Uncorrected Proof — Note to users

TRAMIL ethnomedicinal survey in Jamaica


doi:10.1016/j.jep.2015.04.027
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Abstract

Ethnopharmacological relevance

A survey was undertaken in Jamaica to document medicinal plants frequently used in the treatment or prophylaxis of illness and trends in their use, following the methodology established by the TRAMIL network. TRAMIL, a Caribbean-wide applied research programme, scientifically evaluates and documents the efficacy and safety of medicinal plant remedies used for primary health care. Initial results from this survey, on an aspect of safety, focusing on the concomitant use and prevalence of medicinal plant use in combination with pharmaceutical drugs in Jamaica, were published in an earlier paper in 2011. This paper now reports survey results on the ethnobotanical use of medicinal plants by Jamaicans.

Materials and methods

A survey using a structured and modified TRAMIL questionnaire was administered to 407 adults selected randomly from systematically selected households within randomly selected clusters. The clusters were selected from each of the three areas that were purposefully selected.

Key findings

Respondents identified their use of 107 botanically identified medicinal plants distributed in 51 plant families to treat illnesses or maintain health in the previous twelve months. Fourteen plants, with significant use equal to or greater than 20% for a specified health issue were shortlisted, representing Jamaica׳s first submission to the TRAMIL database. Andrographis paniculata (Burm. f.) Nees (Rice Bitters) was reported as a plant remedy with significant use for the first time in a TRAMIL survey. Informant consensus factor (ICF) values were high for a number of health issues such as mental health (nerves, insomnia, etc.), respiratory system (cold/flu/cough etc.) and for health maintenance with tonics (washout and blood cleanse), indicating strong cultural coherence in medicinal plant selection for these categories. Forty two per cent (113/270) of medicinal plant users utilised mixtures, combining more than one plant. Leaf material was the most commonly used plant part (69%), with fresh material (98%) most commonly prepared as a tea for internal use by decoction (87%). The majority of medicinal plant respondents sourced plants from their backyards (75%) and cited grandmothers (33%) and mothers (32%) as their main sources of information. Jamaicans reported limited use of complementary and alternative medicine (CAM), supporting the assertion that a significant number of citizens in developing countries continue to rely on the use of medicinal plants for primary healthcare.

Conclusions

Medicinal plant use continues to play an important role in primary healthcare in Jamaica. Fourteen plant remedies with significant use are reported, five previously reported elsewhere and recommended (REC) for the same health condition. Eight plant remedies, including one Jamaican endemic, are reported for different health issues for the first time to TRAMIL and will be investigated (INV) for the new health conditions, together with one plant remedy reported for the first time. This latest survey will be followed by literature reviews, appropriate laboratory screens (TRIG) and community outreach activities (TRADIF) in Jamaica.

Graphical abstract

Jel classification

  • Ethnomedicinal field studies;
  • Quality traditional medicines

Keywords

  • Biodiversity hotspot;
  • Ethnomedicine;
  • Informant consensus factor;
  • Jamaica;
  • TRAMIL;
  • Traditional knowledge

1. Introduction

The World Health Organisation (WHO) defines Traditional Medicine (TM) as “the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illnesses” (World Health Organisation (WHO), 2002, 2013).
The practices of TM continue to be widely used internationally with those demonstrating safety, efficacy and quality playing a significant role in achieving equitable access to healthcare (World Health Organisation (WHO), 2002, WHO, 2013, Cordell, 2011 and Cordell and Colvard, 2012). In many countries TM is the main, or in some cases the only, source of healthcare. However, its use is not restricted solely to those countries with limited conventional healthcare provision but continues to be used in countries where conventional medicine is predominant in the national healthcare system (Cordell, 2011). Equitable healthcare access is being negatively affected by a narrowing of pharmaceutical drug development programmes, with a contemporary focus on antivirals, central nervous system ailments, inflammatory diseases, metabolism and oncology, whilst the health requirements of over one billion people include the need for treatments for ascariasis, Chagas׳ disease, dengue fever, diarrheal diseases, hepatitis C, leishmaniasis, leprosy, lymphatic filariasis, malaria, necatoriasis, onchocerciasis, rabies, schistosomiasis, trypanosomiasis, tuberculosis and yaws (Jarvis, 2010; Cordell et al., 2012). At a time when a number of countries continue to face severe austerity, TM is accessible, affordable and trusted by a large number of people. TM, enhanced by evidence-based research, also offers longer term opportunities to help address the increase in non-communicable diseases that now affect most developing and middle income countries, and to help address the significant mismatch between global health requirements and contemporary drug development programmes (WHO, 2002, 2013; Jarvis, 2010, Cordell, 2011 and Mitchell, 2011a; Cordell et al., 2012; Newman and Cragg, 2012 and Luciano-Montalvo et al., 2013).
Addressing issues of safety, efficacy and quality are key aspects of the WHO strategy to establish a strong evidence base for TM, a fundamental precursor to its development as a reliable source of primary health care, and subsequent integration into national healthcare systems. Additionally, sustainable use and cultivation of medicinal plants is a critical aspect of ensuring equitable access to healthcare (WHO, 2002, 2013; Cordell, 2011). In some regions the growing market for medicinal plants poses a significant threat to biodiversity, with excessive wildcrafting rather than cultivation, increasing the extinction of endangered species, together with destruction of natural habitats and resources (Cordell, 2011, 2012).
In the Caribbean region, the Traditional Medicines in the Islands network (TRAMIL) has undertaken approximately 50 TRAMIL surveys to date, in countries including: Antigua, Belize, Barbados, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Granada, Guadeloupe, Guatemala, Haiti, Honduras, Martinique, Mexico, Nicaragua, Panama, Puerto Rico, Saint Lucia, Saint Martin, Saint Vincent, Tobago and Venezuela (Weniger et al., 1986, Giron et al., 1991, Robineau, 1991, Germosén-Robineau and Soejarto, 1996, Longuefosse and Nossin, 1996, Germosén-Robineau et al., 2005, Alvarado-Guzman et al., 2009, Volpato et al., 2009, Boulogne et al., 2011, Gomez-Estrada et al., 2011 and TRAMIL, 2014).
A key aspect of the TRAMIL program is the documentation and conservation of traditional knowledge and biodiversity, using ethnomedicinal surveys. TM in the Caribbean follows an oral rather than a written tradition, a practice that is coming under increasing pressure with the widely reported loss of biodiversity-based traditional knowledge (Ramirez, 2007, Alvarado-Guzman et al., 2009, Boulogne et al., 2011 and Vandebroek and Balick, 2012). In addition, the Caribbean region is one of 25 global biodiversity hotspots characterized by very high concentrations of endemic species which are experiencing exceptional habitat losses (Myers et al., 2000).
Following a TRAMIL survey, plant remedies are shortlisted that are shown to have significant levels of use (SIG). Investigations (TRIGS – TRAMIL investigations) are ordered to validate each popular use, testing for toxicity and efficacy of the specific plant extracts corresponding to the documented traditional use, and the remedies are said to be under investigation (INV). With this information, TRAMIL collaborators promote the use of specific plant remedies, which have been deemed effective for specific conditions which can be treated at home (REC) and discourage the use of others which are shown to be toxic (TOX). Recommended (REC) recipes are placed in the Caribbean pharmacopeia, through which TRAMIL communicates ethnopharmacological information on medicinal plants to local doctors, pharmacists and other health care professionals. TRAMIL also organizes community outreach programs, TRAMIL diffusion (TRADIF), aimed at communicating the results of the surveys, and subsequent investigations, to the communities that participated. To date, over 90 medicinal plant remedies, evaluated by TRAMIL, have been recognized as safe and effective treatments and incorporated into primary healthcare programs in Cuba, Dominican Republic, Honduras, Nicaragua and Panama (Farnsworth et al., 1985, Robineau, 1991, Germosén-Robineau and Soejarto, 1996, Hoareau and DaSilva, 1999, Martin, 2004, Alvarado-Guzman et al., 2009, Boulogne et al., 2011 and TRAMIL, 2014).
The Jamaican TRAMIL survey was undertaken between 2008 and 2009 with the aim of identifying the significant traditional uses of plant species and to learn more about TM use in communities of three areas in Jamaica, representative, respectively, of urban and rural dwellers on the island, according to the TRAMIL methodology. We hypothesized that TM use continues to be highly prevalent in primary healthcare in Jamaica.
Whilst undertaking the Jamaican TRAMIL survey, additional information was gathered on the concomitant use of pharmaceutical drugs with medicinal plants, a key aspect of medicinal plant safety. The results and analysis of such concomitant use was published, together with details of the socioeconomic and demographic profiles of medicinal plant and medicinal plant concomitant drug users in 2011 (Picking et al., 2011). Following detailed analysis, this paper now reports for the first time, the ethnomedicinal plants shortlisted for inclusion in the TRAMIL database (TRAMIL, 2014), use of medicinal plant mixtures, preparation methods, sources of plant material, reasons for use, sources of information, contraindications, side effects, use of other forms of complementary and alternative medicine (CAM), and a list of all botanically identified medicinal plants used by Jamaicans sampled in the survey.

2. Material and methods

2.1. TRAMIL methodology

TRAMIL has a distinct and unique methodology comprising surveys, bibliographic researches and experimental laboratory studies, following both a quantitative and qualitative approach to the popular uses of medicinal plants. The methodology begins with an ethnopharmacological participative survey where questions are asked first about how the health condition was treated and not the plants used (Martin, 2004, Boulogne et al., 2011 and TRAMIL, 2014).
The frequency of plant remedy use mentioned by respondents, for a given health condition, is then calculated using the following formula:
Freq.=Ni/Np×100
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where Freq. is the frequency (%), Ni is the number of respondents that used that plant remedy to treat a particular health condition or to maintain health, Np is the overall number of respondents who used plant remedies to treat that particular health condition or approach to maintaining health ( Martin, 2004, Boulogne et al., 2011 and TRAMIL, 2014).
Medicinal plant remedies, identified in a survey, are shortlisted for inclusion in the TRAMIL database, when the calculated frequency (Freq.) is 20% or higher. In addition, a minimum value of five was set for the Ni and Np values, in consultation with TRAMIL. The TRAMIL group chose this minimum frequency to exclude anecdotal use ( Martin, 2004, Boulogne et al., 2011 and TRAMIL, 2014). The shortlisted plants are then documented by their scientific name, family and local name. Frequency, health issue, voucher number, plant part used, preparation mode and means of administration, are included. The shortlisted plant remedies are classified as significant use plant remedies (SIG) ( TRAMIL, 2014).

2.2. Jamaica TRAMIL survey

The survey was conducted in Jamaica, between 2008 and 2009, through collaboration between the Natural Products Institute and the Biotechnology Centre, both at the University of the West Indies, Mona Campus, Kingston.
Following the TRAMIL methodology (TRAMIL, 2014) a list of the health conditions most impacting the Jamaican population, using data from the Ministry of Health (MOH, 2005), were incorporated within the questionnaire. After obtaining prior informed consent, survey respondents were asked to identify conditions treated in the previous twelve month period, to minimize recall bias. In addition, respondent׳s details were collected in such a way as to guarantee anonymity, following the guidelines set forth by the University of the West Indies. For each health condition identified, respondents were then asked about their use of medicinal plants. Full details of the questionnaire are detailed in the previous paper, reporting the concomitant use of medicinal plants with pharmaceutical drugs (Picking et al., 2011).
Based upon previous surveys conducted by the Natural Products Institute in 2004 (Delgoda et al., 2004) and 2006 (Delgoda et al., 2010) a minimum sample size of 256 participants was established. A sample size of at least 256 participants adequately estimates 80% prevalence of medicinal plant use with a margin of error of 5% based upon a 95% confidence interval (CI). This figure was then inflated by 40%, to approximately 360, to accommodate for the effect of cluster sampling on the variation of parameter (prevalence) estimates. The survey team set out to conduct 400 interviews.
In previous TRAMIL surveys the person interviewed has been the mother, who is traditionally seen as the gatekeeper of family health (Longuefosse and Nossin, 1996, Boulogne et al., 2011 and TRAMIL, 2014). However, for the Jamaican survey, the decision was made to randomise the choice of adult respondent in each household based upon the experience of previous Jamaican surveys (Mitchell, 2011b) in which men were also found to be active participants in medicinal plant use.

2.3. Survey area

Jamaica, at 11,000 sq km (4411 sq  mi), is the third largest by area and the largest English speaking island in the Caribbean Sea, located at latitude of 18°15′N and longitude 77°30′W, 145 km (90 miles) south of Cuba (Watts, 1987, Lee, 2006 and UWI, 2012).
The island measures 230 km from east to west and varies in width between 35 and 82 km (Evelyn and Camirand, 2003). A mountain range runs through the interior from east to west, with the highest point reaching 2256 m (7402 ft) at Blue Mountain Peak (Watts, 1987 and Lee, 2006). Over half the country is above 305 m (1000 ft) (Asprey and Thornton, 1953 and GofJ, 2003) with narrow coastal plains surrounding the mountain range comprising 20% of the land area (Lee, 2006).
Jamaica experiences a maritime tropical climate with a hurricane season from June through November and two rainy seasons in May and October/November. Average temperatures are 28 °C (82.4 °F) at sea level and 15 °C (59 °F) at 2000 m (Lee, 2006).
Jamaica׳s varied topography, geology and hydrology supports a diverse range of ecosystems (Tole, 2001 and Dougal et al., 2006). Jamaica has a wealth of flora and fauna with a high proportion of endemic species of flora, ranking it fifth among the world׳s islands (Killmer et al., 2006 and Lee, 2006). Such a high level of endemism represents an important gene pool, with significant potential medicinal, horticultural and genetic value, much of which has yet to be explored (GofJ, 1989; UNFAO, 1989, Mitchell and Ahmad, 2006 and Mitchell, 2011a). Indigenous plants include guava (Psidium guajava L.), papaya (Carica papaya L.), pimento (Pimenta dioica (L.) Merr.) and pineapple (Ananas comosus (L.) Merr.) ( Lee, 2006 and McGlashan et al., 2008). Many plants have been introduced following colonization in the sixteenth century with plants from countries including Africa, China, India and the United Kingdom. Introduced plants include ackee (Blighia sapida K.D. Koenig), breadfruit (Artocarpus altilis (Parkinson) Fosberg), coconut (Cocos nucifera L.), mango (Mangifera indica L.), banana and plantain (Musa spp.) and marijuana (Cannabis sativa L.) ( Lee, 2006 and McGlashan et al., 2008).
A Government of Jamaica report in 2004 estimated that the island had 30% forest coverage (GofJ, 2004). A significant proportion of the island׳s tropical limestone forests are to be found along the Cockpit Country, a range of karst terrain (egg-box shaped hills and valleys with many caves, formed as limestone was dissolved by acidic rain and ground water), on the western part of the island, while, located in the north, secondary forest cover the Dry Harbour Mountains (Tole, 2001). The Cockpit Country is particularly noted for its high level of endemism with over one hundred species of endemic plants identified to date (Lee, 2006).
Jamaica is made up of 14 parishes: Clarendon, Hanover, Kingston, Manchester, Portland, Saint Andrew, Saint Ann, Saint Catherine, Saint Elizabeth, Saint James, Saint Mary, Saint Thomas, Trelawny and Westmoreland (Fig. 1) (PIOJ, 2005 and STATIN, 2010).
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Fig. 1. 
Map of Jamaican parishes indicating the study areas (PIOJ, 2005): insert A, Flagstaff, Cockpit Country; insert B, Dallas; insert C, Inner city community, Kingston.
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The current population is 2,889,187 (2012 estimate) (STATIN, 2010 and UWI, 2012), with approximately 54% living in urban areas (Killmer et al., 2006 and UN, 2007), with half of these urban dwellers concentrated in the capital, Kingston. The Kingston Metropolitan Area overlaps three parishes (Kingston, Saint Andrew and Saint Catherine), with a population of 700,000 and a population density of approximately 1528 persons per sq km (JRC, 2004). Overcrowding characterizes the composition of Jamaica׳s urban centres, with urban slums comprising approximately 36% percentof all urban centres on the island (UN, 2007).
English is the official language spoken and written in Jamaica. However Jamaica has its own unique language, known locally as patois, spoken widely throughout the island and internationally across the Jamaican diaspora. Some linguists refer to patois as Jamaican creole, which is defined as an English creole language with a mix of Central and West African tribal languages that adopted some of the English vernacular of the 17th and 18th century during the period of slavery between 1655 and 1838 (Devonish and Harry, 2004, Harry, 2006 and UWI, 2012).
The Jamaican population is made up of a number of different ethnic groups, 92% black, 6.06% mixed, 0.75% East Indian, 0.19% Chinese, 0.16% white, 0.07% other, 0.65% not reported (STATIN, 2012).
As previously reported (Picking et al., 2011), this cross-sectional study was undertaken across three locations, one urban, Kingston, the capital city of Jamaica and two rural, Dallas in St. Andrew and Flagstaff in St. James (Cockpit Country) (Fig. 1). Communities in urban areas were selected to provide a broad demographic profile from wealthier ‘uptown’ to less wealthy and poor ‘garrison’ and ‘downtown’ communities. Those in the rural areas were selected to provide demographic profiles of two rural communities, one relatively close to an urban area and non-maroon, the second, deeply rural, located within the Cockpit Country, a documented biodiversity hotspot (Lee, 2006) and home to a Maroon community (Campbell, 1988).
The 14 parishes in Jamaica are sub-divided into enumeration districts (EDs). Five ED׳s (clusters) were chosen within each location. The number of interviews to be conducted in each location, the sampling fraction, was established in proportion to the population size of that location. This was achieved by dividing the required number of interviews (400) by the total number of households in the sample frame (2576) and multiplying this number by the number of households at each location: Kingston (907), Dallas (1037) and Flagstaff (632). For each location, the sampling fraction was then divided by the number of ED׳s to give the required number of interviews per ED. In each ED, households were selected systematically by dividing the number of households in that ED by the number of interviews required, providing a skip pattern. One adult per household was selected randomly and interviewed. All maps and population statistics were provided by the Statistical Institute of Jamaica (STATIN) (STATIN, 2010 and Picking et al., 2011). Further details of the survey are given in our earlier publication (Picking et al., 2011)

2.4. Ethnobotanical data collection

All plant material, gathered during the survey, was submitted to the Herbarium at the University of the West Indies, Mona, Jamaica, for identification by Mr. Patrick Lewis, Botanist and Herbarium Curator.

2.5. Data analysis

Survey data was documented utilizing Epidata version 3.1. Categorical data analysis was performed with the statistical package STATA version 10 (StataCorp, 2010) to provide association between variables and measures of frequency (using chi-squared test and Fisher׳s exact test as appropriate), which, together with the TRAMIL methodology, was used to identify the significant traditional uses of plant species, and to learn more about the traditional medicine of the country.

2.6. Informant consensus factor (ICF)

The informant consensus factor (ICF), is a widely used method for analysing quantitative data in ethnomedicinal field studies based on the works of Trotter and Logan (1986). The ICF gives information about the consensus or consistency of the informants for the treatment of specific illness categories (Heinrich et al., 2009).
The ICF indicates if the surveys׳ information is homogenous. ICF values close to zero indicate that plants are chosen randomly or that there is significant disagreement between respondents on the choice of plants used for the treatmentof particular health conditions, body systems or maintenance of health. Values close to one indicate that plants are collectively used by a significant proportion of respondents. This factor provides an indication of the cultural coherence of a community in selecting a set of medicinal plant remedies used in the treatmentof a certain illness category but no indication about the importance of individual plant remedies used (Trotter and Logan, 1986, Heinrich et al., 2009 and Boulogne et al., 2011).
The ICF is calculated using the following formula:
ICF=Nur–Nt/Nur−1
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where Nur is the number of citations of use in each category and Nt, the number of species used ( Trotter and Logan, 1986, Heinrich et al., 2009 and Boulogne et al., 2011).
The two methods of analysis, frequency of citation (TRAMIL) and ICF, together provide a critical and quantitative understanding of local plant use (Heinrich et al., 2009).

3. Results

3.1. Socioeconomic and demographic profiles of medicinal plant users

Details of the socioeconomic and demographic profiles of medicinal plant users are reported in our earlier paper, together with an analysis of the use of medicinal plants in combination with pharmaceutical drugs. In this earlier paper, we identified that 72.6% (270/372) of respondents used medicinal plants to treat illness and/orto maintain health in the previous twelve months (Picking et al., 2011).

3.2. Plant families

In our previous paper we reported that survey respondents identified their use of 116 medicinal plants in the previous twelve months (Picking et al., 2011). We now report the botanical identification of 107 (92%) of these 116 medicinal plants (Appendix A, Table A7). These plants are distributed in fifty one plant families with the more frequent plant families, in order, being, Fabaceae, Lamiaceae, Asteraceae, Malvaceae and Piperaceae. Fig. 2 identifies the top 25 of the 51 plant families identified.
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Fig. 2. 
Distribution of botanically identified medicinal plant species (n=107) by plant family showing the top 25 of 51 families identified.
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The species of Fabaceae most frequently cited was Gliricidia sepium Kunth (Maranga), a widespread and fast growing shade tree ( Adams, 1972). The most frequently cited species of Lamiaceae was Clerodendrum thomsoniae Balf. (Rice and Peas), a climbing shrub native of West Africa ( Adams, 1972). The species of Asteraceae most frequently cited was Eupatorium odoratum L. (Jack-in-the-Bush), a common glabrate shrub ( Adams, 1972). The Malvaceae most cited was Cola acuminata (P. Beauv.) Schott and Endl. (Bissy), a native tree of tropical West Africa ( Adams, 1972) and the most cited Piperaceae was Piper amalagoL. (Jointer), a glabrous shrub or tree ( Adams, 1972).
Eight of the 107 plants botanically identified are endemic or occur as endemic varieties, Boehmeria jamaicensis Urb. (Doctor Johnson), Bidens reptans (L.) G. Don (var. tomentosa O.E. Schulz) (McKatty Weed), Oryctanthus occidentalis(L.) Eichler (Godbush), Peperomia amplexicaulis (Sw.) A. Dietr. (Jackie׳s Saddle), Pilea microphylla (L.) Liebm. (var. microphylla) (Baby Puzzle), Piper amalagoL. (var. nigrinodum) (Black Jointer), Rhytidophyllum tomentosum (L.)Mart.(Search-mi-Heart) and Smilax balbisiana Kunth (Chainy Root) (Appendix A).

3.3. TRAMIL results

Table 1 identifies those ethnomedicinal plant species of 20% or higher that were shortlisted and submitted to the TRAMIL database for further evaluation. A total of 14 plants are included in the shortlist, which details the specific health issue treated, together with plant parts used and methods of preparation and administration.
Table 1. TRAMIL Shortlist: medicinal plant use where the level of use (Freq.) is equal to or greater 20% for a specific health issue (plants listed alphabetically).
Scientific nameFamilyLocal nameVoucherHealth issuePart useda(F or D)b
PreparationcAdmindFreqe%
Allium sativum L.AmaryllidaceaeGarlicn/vHypertensionClove (F)Decoct/naturalOral28
Aloe vera (L.) Burm. f.XanthorrhoeaceaeSinkle Bible35468WashoutLf/gel (F)Blend/decoct/infuseOral54
Blood-cleanseLf/gel (F)Blend/decoctOral33
Andrographis paniculata (Burm. f.) NeesAcanthaceaeRice Bitters35372Blood cleanseAer/Wh (F,D)DecoctOral21
Annona muricata L.AnnonaceaeSoursop35467NervesLf (F,D)Decoct/infuseOral83
Bryophyllum pinnatum (Lam.) OkenCrassulaceaeLeaf of Life35466ColdLf (F)Decoct/juiceOral51
Chenopodium ambrosioides L.AmaranthaceaeSemicontract35476Intestinal wormsWh/Lf&St/Lf (F,D)Decoct/infuse/juiceOral73
Cymbopogon citratus (DC.) StapfPoaceaeFever Grass35474FeverLf (F,D)Infuse/decoctOral70
Eupatorium odoratum L.AsteraceaeJack-in-the-bush35475ColdLf/Lf&ST (F,D)DecoctOral33
Momordica charantia L.CucurbitaceaeCerasee35477Blood-cleanseAer (F,D)DecoctOral67
Bellyache/gasAer (F,D)DecoctOral44
TonicAer (F,D)DecoctOral40
WashoutAer (F,DDecoctOral22
Opuntia cochenillifera (L.) Mill.CactaceaeTuna35479BackacheLf (F)MacerateOral50
Piper amalago L.PiperaceaeJointer35464Bellyache/gasLf&St/Wh/Rt (F,D)DecoctOral21
Petiveria alliacea L.PhytolaccaceaeGuinea Hen Weed35469HeadacheRt/Lf&St (F)Crush/compressInhale/ext23
Rivina humilis L.PhytolaccaceaeDogblood35470Painful periodsWh (F)DecoctOral67
Zingiber officinale RoscoeZingiberaceaeGingern/vBellyache/gasRhiz (F)DecoctOral25
a
Aer: aerial; Gel: jelly like substance; Lf: leaf; Rhiz: rhizome; Rt: root; St: stem; Wh: whole.
b
F: fresh and D: dried.
c
Decoct: actively boil plant material for several minutes; natural: no preparation; infuse: pour boiling water onto plant material and steep; macerate: soften by soaking in a liquid.
d
Ext: external use n/v: not vouchered (commonly sourced from supermarkets, markets and health stores).
e
Freq.=Ni/Np×100, where Ni is the number of respondents that used that specific plant remedy to treat a particular health condition or to maintain health; Np is the overall number of respondents who used plant remedies to treat that particular health condition or approach to maintaining health. For example: Bryophyllum pinnatum Ni =82, Np=160, therefore Freq.=82/160×100=51.3%.
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The aerial and whole plant of Andrographis paniculata, prepared as a decoction and used as a blood cleanser in Jamaica, is identified as a significant use for the first time by a TRAMIL survey.
Specimens, for each of the TRAMIL shortlisted plants,were collected and submitted to the Herbarium (Fig. 3). Photos for each plant were taken and submitted to TRAMIL and botanical nomenclature checked in Tropicos, an international botanical database maintained by the Missouri Botanical Garden (Tropicos, 2012).
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Fig. 3. 
Voucher samples submitted to the University of the West Indies Herbarium for four of the TRAMIL shortlisted plants: (A) Annona muricata (Soursop) (35467); (B) Chenopodium ambrosioides (Semicontract) (35476); (C) Cymbopogon citratus (Fever Grass) (35474); (D) Momordica charantia (Cerasee) (35477).
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3.4. Informants consensus factor (ICF)

ICF values varied between 0.0 and 0.88. The highest ICF was recorded for mental health issues(nerves, insomnia, depression), indicating the highest level of cultural coherence for the selection of medicinal plant remediesused to treatthis illness category, whilst the lowest ICF values were reported for the cardiovascular system, eyes,prostate problems and teeth (Table 2).
Table 2. Informants consensus factor (ICF) of the plants used in the treatment of specific health issues by medicinal plant respondents.
Health conditionICF value
Nerves/insomnia/depression0.88
Cold/cough/flu0.87
Blood cleanse0.84
Constipation0.80
Bellyache/gas0.77
Fever0.73
Washout0.71
Worms0.70
Skin problems0.59
Backache0.58
Diarrhoea0.55
Headache/migraine0.50
Painful periods0.50
Hypertension0.44
Tonic0.40
Vomiting/food poisoning0.38
Arthritis0.36
Diabetes0.33
Sinusitis0.27
Asthma0.26
Cut/wound0.22
Prostate problems0.00
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3.5. Use of medicinal plant mixtures

In this study, 42% (113/270) of medicinal plant users, used at least one combination of plants, or mixtures, to treat specific health conditions or maintain health, compared to 58% (157/270) who used only an individual plant in their medicinal recipe.
Medicinal plant users (270) identified a total of 350 recipes using single plants or two or more plants in combination: 186 recipes comprised of single plants (53.2%), 145 comprised two to three plants (41.4%), 18 recipes comprised of four to five plants (5.1%) and one comprised of six or more plants (0.3%) (Fig. 4).
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Fig. 4. 
Prevalence (%) of medicinal plant recipes - composed of one plant, two or three plants, four or five plants, or more than six plants (n=350).
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3.6. Medicinal plant parts used

Leaves were the most commonly used part in preparing medicinal plant remedies, used by 69% of respondents. Other plant parts most frequently used were aerial, 50%, branch, 41%and whole plant, 26% (Fig. 5).
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Fig. 5. 
Plant partsused by medicinal plant users (n=270).
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3.7. Preparation methods

Respondents used a number of methods to prepare medicinal plant material for both internal and external use. The most common method of preparing medicinal plant remedies was from fresh plant material (Fig. 6) decocted and taken as a tea for internal use (Fig. 7) and rubbing for external use (Fig. 8).
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Fig. 6. 
Dry, fresh or quailed (partially dried) use of plant material by medicinal plant users (n=270) ranked by prevalence.
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Fig. 7. 
Preparation methods employed by medicinal plant users (n=270) ranked by prevalence for internal use.
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Fig. 8. 
Preparation methods employed by medicinal plant users (n=270) ranked by prevalence for external use.
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3.8. Medicinal plant sources

Three quarters of medicinal plant users sourced plants from their own yards (Fig. 9).
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Fig. 9. 
Source of plants used by medicinal plant users (n=270), ranked by prevalence.
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3.9. Reasons cited for self-medicating with medicinal plants

The most frequently cited reason for using a medicinal plant to treat an illness or maintain health was simply that the remedy worked (Fig. 10).
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Fig. 10. 
Reasons for using herbal medicine (n=270), ranked by prevalence.
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3.10. Sources of information and knowledge

Information on the use of medicinal plants was predominantly sourced from grandmothers (33%) and mothers (32%). Interestingly fathers (10%) and grandfathers (6%) were also a prominent source of information. Doctors (0.7%) and radio/TV (0.7%) were the least cited sources of information (Fig. 11).
Full-size image (16 K)
Fig. 11. 
Information source for medicinal plant users (n=270), ranked by prevalence.
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3.11. Contraindications and reported side-effects

Where respondents indicated their use of medicinal plants, they were asked if there were times when it would not be appropriate or safe to use the remedy. Only two percent of medicinal plant users identified possible contraindications with two percent stating that a particular medicinal plant should be avoided during pregnancy (Table 3) with Rivina humilis L. (Dogblood), Momordica charantia L. (Cerasee), Aloe vera (L.) Burm.f. (Sinkle Bible) and Boehmeria jamaicensis Urb. (Doctor Johnson) being the plants cited by respondents. In addition, one respondent stated that Momordica charantia L. (Cerasee) was contraindicated in diabetics prior to blood tests to avoid interfering with, or ‘masking’ test results.
Table 3. Stated contraindications for the medicinal plants used by respondents in decreasing order of frequency (n=270), ranked by prevalence.
Contraindicationsn%
Pregnancya51.9
Prior to blood sugar testb10.4
a
Medicinal plants identified were: Aloe vera (L.) Burm. f. (Sinkle Bible); Momordica charantia L. (Cerasee); Rivina humilis L. (Dogblood); Boehmeria jamaicensis Urb. (Doctor Johnson).
b
Medicinal plant identified to avoid before taking a blood sugar test: Momordica charantia L. (Cerasee).
Table options
Only four percent of respondents reported experiencing any side effect when taking medicinal plants in the previous twelve months (Table 4).
Table 4. Reported incidence of side effects by medicinal plant users (n=270), ranked by prevalence.
Side effectsn%
No26096.3
Yes104.1
Table options
Of those respondents who did experience some type of side effect, bellyache/gas and vomiting were the most reported. The medicinal plants associated with the reported side effects are listed in Table 5.
Table 5. Reported side effects by medicinal plant users (n=270), ranked by prevalence.
Reported side effectsn%
Bellyache/gas31.1
Vomiting31.1
Diarrhea20.7
Hypotension (BP too low)20.7
N.B. Medicinal plants linked to reported side effects.
Bellyache/gas: Aloe vera (L.) Burm. f. (Sinkle Bible) (2); Bryophyllum pinnatum (Lam.) Oken (Leaf of Life) (1).
Vomiting: Picramnia antidesma Sw. (Majoe Bitter) (2); Helicteres jamaicensis Jacq. (Corkscrew) (1).
Diarrhea: Aloe vera (L.) Burm. f. (Sinkle Bible) (2).
Hypotension: Ocimum micranthum Willd. (Barsley) (1); Artocarpus altilis (Parkinson) Fosberg (Breadfruit) (1).
Table options

3.12. Complementary and alternative medicine (CAM) use

Respondents were asked if, in addition to using medicinal plants as home remedies, they had used any other forms of complementary and alternative medicine (CAM) in the last twelve months. Massage and reflexology were the only two CAM modalities identified by a small number of respondents (Table 6).
Table 6. Reported use of other Complementary and Alternative Medicine (CAM) modalities by medicinal plant users (n=270), ranked by prevalence.
CAM modalityn%
Massage20.7
Reflexology10.4
Aromatherapy00.0
Acupuncture00.0
Ayurvedic medicine00.0
Chinese medicinal plants00.0
Diet/nutritional therapy00.0
Homeopathy00.0
Naturopathy00.0
Osteopathy/chiropractic00.0
Shiatsu00.0
Spa/hydrotherapy00.0
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4. Discussion

This survey represents the first Jamaican study to statistically follow the TRAMIL methodology (TRAMIL, 2014) and to contribute to the Caribbean wide TRAMILdatabase. Results from this survey build on knowledge from previously published studies, on the use of medicinal plants by Jamaicans (Asprey and Thornton, 1953, Asprey and Thornton, 1954, Asprey and Thornton, 1955a, Asprey and Thornton, 1955b, Landman and Hall, 1983, Michie, 1992, Sobo, 1996, Gardner et al., 2000, Delgoda et al., 2004, Delgoda et al., 2010, Mitchell and Ahmad, 2006 and Mitchell, 2011b), and sets out to contribute information not previously documented.
Following a similar approach to that taken in a previous survey by Gardner et al., (2000), areas were purposefully selected with similar demographic characteristics to urban and rural Jamaica in consultation with STATIN (STATIN, 2010). It is therefore likely that these findings are representative of the use of medicinal plants by all Jamaicans.
The distribution of plant families by medicinal plant users is similar to the most recent TRAMIL survey in Guadeloupe (Boulogne et al., 2011) in which the five most frequent plant families cited were Fabaceae, Lamiaceae, Euphorbiaceae, Malvaceae and Asteraceae compared to Fabaceae, Lamiaceae, Asteraceae, Malvaceae and Piperaceae in the Jamaican survey (Fig. 3). It is interesting to note that only two of the top five plant families are represented in the TRAMIL shortlist (Table 1), Asteraceae (Eupatorium odoratum L.) and Piperaceae (Piper amalago L.) and that the top five families do not include the top three plants most cited by respondents, Momordica charantia L. (Cucurbitaceae), Bryophyllum pinnatum(Lam.) Oken(Crassulaceae) and Aloe vera(L.) Burm.f.(Xanthorrhoeaceae) (Appendix A) ( Picking et al., 2011).
Of the 107 botanically identified medicinal plants (Appendix A), eight are endemic (7.5%) and one of these, Piper amalagoL.(var.nigrinodum), is shortlisted for its notable medicinal use, according to the TRAMIL methodology ( Martin, 2004 and TRAMIL, 2014). Piper amalago L. var.nigrinodum) and a second of the endemics, Rhytidophyllum tomentosum (L.) Mart., have undergone some form of screening at the University of the West Indies (UWI) Mona campus in Jamaica and found to exhibit significant medicinal or agricultural bioactivity ( Durand et al., 1962, Williams and Mansingh, 1993, Mansingh and Williams, 1998, Seeram, 1998, Facey et al., 1999, Jacobs et al., 1999 and Mitchell and Ahmad, 2006). In a review of medicinal plant research undertaken at UWI, Mona between 1948 and 2001, nine percent of the plants screened were identified as endemic. Whilst the proportion of endemics was relatively low, those endemics screened demonstrated a significant level of bioactivity, 23% for endemics compared to 11% for non-endemics ( Mitchell and Ahmad, 2006).
Following the TRAMIL methodology (Martin, 2004 and TRAMIL, 2014) respondents identified fourteen plants distributed in thirteen plant families as medicinal plants with significant uses and these fourteen plants have been shortlisted and included in the Caribbean-wide TRAMIL database (Table 1). Comparing the Jamaican shortlist with several other TRAMIL surveys, respondents in Martinique identified 94 plants with significant uses (Longuefosse and Nossin, 1996), Puerto Ricans identified six (Alvarado-Guzman et al., 2009), Guatemalans 12 (Giron et al., 1991), and residents of two islands in Guadeloupe identified 22 and 18 plants respectively (Boulogne et al., 2011).
The shortlisted TRAMIL plants represent culturally significant species which are likely to be more effective, used for a more common disease or prophylactically, easily available or have special cultural significance (Heinrich et al., 2009). Plant species that did not make the TRAMIL shortlist are more likely to be ineffective for the condition(s) reported, be used for less prevalent diseases, have become less popular due to cultural change, to have been incorrectly identified during interview, have become rare species and difficult to source or belong to cultural fringe knowledge (Heinrich et al., 2009).
Six of the 14 shortlisted TRAMIL plants are cited for their use in predominantly self-limiting conditions of the respiratory system and gastrointestinal tract and three plants for their use as tonics to maintain health (Table 1). In the first report from this survey (Picking et al., 2011), the popular use ‘tonics’ grouped plants, said to act as blood cleansers, plants used as laxatives for ‘washout’, and plants said to have aphrodisiac properties. In Jamaica, these tonics, made from local plants (Mitchell, 2011b), are traditionally taken on a regular basis to maintain health and strengthen the body and have been well documented elsewhere (Asprey and Thornton, 1953, Asprey and Thornton, 1954, Asprey and Thornton, 1955a, Asprey and Thornton, 1955b, Robertson, 1982, Robertson, 1990, Lowe et al., 2001, Austin and Thomas, 2003, Payne-Jackson and Alleyne, 2004, Warner, 2007, Austin and Thomas, 2010, Mitchell, 2011a and van Andel et al., 2012). It is interesting to note that Momordica charantia L., is included on the TRAMIL shortlist as both a tonic and a treatment for GI tract problems.
Andrographis paniculata (Burm. f.) Nees (Rice Bitters) is reported as a plant remedy with significant use for the first time in a TRAMIL survey ( TRAMIL, 2014). This seems surprising, given its long history of traditional use in a number of countries and broad range of bioactivities, identified through extensive published research, including: anti-tumor; anti-angiogenic; antidiabetic; antiinflammatory; anti-HIV; anti-hepatitis; antitussive; anti-venom; cerebroprotective; hypoglycemic; anti-ulcer; hypolipidemic; immunostimulant; inhibiting the progression of diabetic nephropathy; nootropic; NF-κB inhibitor ( Kuhn and Winston, 2001, Sheeja et al., 2007, Pekthong, 2008, Pekthong et al., 2008, Shi et al., 2008, Saranya et al., 2011, Kumar et al., 2012, Lu et al., 2012, Nugroho et al., 2012, Radhika et al., 2012, Uttekar et al., 2012, Xu et al., 2012, Yang et al., 2012, Kale et al., 2013, Nugroho et al., 2013, Chen et al., 2014, Kou et al., 2014, Lee et al., 2014, Lin et al., 2014, Nosalova et al., 2014, Nugroho et al., 2014 and Suriyo et al., 2014).
Five of the medicinal plant remedies listed (Table 1) are recommended by TRAMIL (REC) for the same health issue and using the same plant part and preparation method, based upon previous surveys, literature reviews and laboratory screens. These are Bryophyllum pinnatum(Lam.) Oken (Leaf of Life) for cold, Chenopodium ambrosioides L. (Semicontract) for intestinal parasites, Cymbopogon citratus (DC.) Stapf (Fever Grass) for fever, Petiveria alliacea L. (Guinea Hen Weed) for headache, and Zingiber officinale Roscoe (Ginger) for flatulence and stomach pain ( TRAMIL, 2014). With the exception of Andrographis paniculata (Burm. f.) Nees (Rice Bitters), the remaining eight plant remedies have previously been reported as plants with significant uses, but not for the same health condition, or using the same plant part or preparation method, and are therefore classified as under investigation (INV), until literature reviews and appropriate laboratory screens have been completed.
The informants consensus factor (ICF) values reported were relatively high for a number of health issues, body systems and for health maintenance (Table 2) (mental health with 0.88, respiratory system with 0.86, tonic with 0.82, GI tract 0.79). These figures indicate strong cultural coherence in the selection of medicinal plants used in the treatment of these health conditions and body systems, and in the case of tonics, in the maintenance of health (Heinrich et al., 2009 and Boulogne et al., 2011).
Medicinal plant safety, through the identification of potentially toxic plant remedies, is a key aspect of the TRAMIL methodology (TRAMIL, 2014). Gardner et al. (2000) previously noted the absence of two plants, Crotalaria fulva Roxb. (Consumption Weed) and the endemic Senecio discolor Desf. (Whiteback), previously associated with reported cases of veno-occlusive disease (VOD) in the Jamaican population ( Bras et al., 1954, Bras et al., 1961, McLean et al., 1964, Nelson et al., 2007 and Paul and Seaforth, 2011). Reassuringly neither plant is reported in this latest survey, and neither plant appears to have been reported across the Caribbean region in other TRAMIL surveys ( TRAMIL, 2014).
The use of medicinal plant mixtures (combining more than one plant) is an area that is poorly reported in ethnobotanical studies, and the botanical and phytochemical aspects of these complex combinations has received limited attention in the Caribbean region (Cano and Volpato, 2004). However, some studies have taken place, for example in Cuba (Cano and Volpato, 2004 and Volpato et al., 2009), the Dominican Republic (Vandebroek et al., 2010), Martinique (Longuefosse and Nossin, 1996) and Trinidad (Clement et al., 2005) and in a parallel study of bitter tonic use in West Africa and the Caribbean (van Andel et al., 2012). In Jamaica, reference to the use of medicinal plant mixtures, predominantly by traditional healers, has been documented by several authors (Robertson, 1982, Robertson, 1990, Zampieron and Kahmhi, 1999, Lowe et al., 2001, Austin and Thomas, 2003, Austin and Thomas, 2010, Payne-Jackson and Alleyne, 2004, Warner, 2007, Harris, 2011 and Mitchell, 2011b). The use of root tonics is an important aspect of Jamaica׳s ethnomedical heritage, with utilisation of these medicinal plant mixtures by community members and commercial entities (Warner, 2007, McGlashan et al., 2008, Mitchell et al., 2008 and Mitchell, 2011b). Vandebroek et al., (2010) note that root tonics have a history of use by specialists, such as traditional healers, in the treatment of more serious health conditions and as such, tend to fall outside the use of medicinal plants by self-medicating households. In this latest survey, we identify that 42% of medicinal plant users utilise medicinal plant mixtures made up of two or more plants compared to 58% who only reported using single plant recipes. A little over 50% of recipes comprised single plants (Fig. 4), with very few respondents using more than six plants, compared to an average of 13 plants used in root tonics (Mitchell, 2011b). The use of medicinal plant mixtures is an important and understudied aspect of traditional medicine use which justifies further research (Vandebroek et al., 2010).
Decoction was by far the most cited preparation method for internal use (Fig. 7) and it is interesting to note that the plant material most used was leaves (Fig. 5). In many traditional medical systems, decocting or boiling is reserved for hard and woody plant material, whilst infusion is used for softer material, and in particular material with known volatile content (Mills and Bone, 2000 and Hoffman, 2003). It should be noted that the majority of respondents identified their use of decoction in which the plant material is boiled for not more than ten minutes. This is in contrast to the practice of deep decoction utilised in the preparation of root tonics in which root, bark and leaf material is actively boiled for one to two hours or until the water level is reduced to half (Mitchell, 2011b).
The standard TRAMIL methodology (TRAMIL, 2014) recommends the interviewing of women and preferably the mother of the household. However, it was decided for this survey to randomise the choice of respondent in each household. We report that the primary source of information was grandmothers and mothers, 65%, with a secondary choice being grandfathers and fathers, 16%, thus justifying their inclusion in this study, and making it clear that knowledge continues, predominantly, to be passed down from generation to generation through an oral tradition. A key goal of TRAMIL is to ensure that such traditional knowledge is recorded and safeguarded for future generations (TRAMIL, 2014).
Very few respondents identified contraindications for the medicinal plants used (Table 3). A review of the literature indicates that several of the medicinal plants cited have known contraindications. For example, the most popular medicinal plant, Momordica charantia L. (Cerasee), has traditionally been used as an abortifacient ( Sobo, 1996) and various parts of the plant have weak uterine stimulant activity, and its use in pregnancy is therefore not recommended. Its active constituents can be transferred through breast milk, and it is therefore not recommended for use in breast feeding mothers. All parts of cerasee are proven to lower blood sugar levels and it is therefore not recommended in persons with hypoglycemia ( Kuhn and Winston, 2001, Taylor, 2005 and Alternative-Medicine-Review, 2007).
The reported level of side effects was low (Table 4 and Table 5),and though not quantified, there was a general perception amongst respondents, that as natural products, medicinal plants are generally considered to be safe.
As far as the authors are aware, this represents the first time an attempt has been made to quantify the use of CAM modalities across a representative sample of the Jamaican population. As can be seen from the results (Table 6), levels of CAM use, other than medicinal plant use,are very low, with most respondents having little knowledge or access to other CAM practices. Internationally, CAM use is increasingly popular, with reports of use as high as 80% in rural Japan (one year prevalence) (Shumer et al., 2014). In a systematic review of UK CAM surveys, carried out between 2000 and 2011, an average 41% of respondents reported their use of CAM in the previous year (Posadzki et al., 2013). A systematic review of German surveys, undertaken since 1993, reported CAM levels of between 40% and 62% (one year prevalence) (Linde et al., 2014). The types of CAM practices most commonly reported include herbal medicine, homeopathy, acupuncture, dietary supplements and manual therapies (van Andel et al., 2013). Previous reviews have indicated that, for many industrialized countries, 50% of the population regularly choose a broad range of CAM treatments, whilst citizens in developing countries have fewer options to choose from, other than the use of medicinal plants (Bodeker and Kronenberg, 2002 and van Andel and Carvalheiro, 2013).

5. Conclusion

Fourteen medicinal plants met the criteria set by TRAMIL for inclusion in the TRAMIL database and represent the first submission by Jamaica.
Andrographis paniculata (Burm. f.) Nees (Rice Bitters) is reported as a plant remedy with significant use (SIG) for the first time in a TRAMIL survey. Five of the plant remedies have previously been recommended by TRAMIL (REC) for the same health issue, using the same plant part and preparation method. Eight of the plant remedies, including one Jamaican endemic, are classified as under investigation (INV), requiring literature reviews and appropriate laboratory screens.
Informant consensus factor (ICF) values were high for a number of body systems, health issues and for health maintenance, e.g. mental health (insomnia/nerves/depression) and tonics, indicating strong cultural coherence in medicinal plant selection for these categories.
The majority of respondents stated that they used medicinal plants because they work, cited their mothers and grandmothers as their main source of knowledge, prepared fresh leaf material by decoction for internal use, from plant material sourced from their own backyards.
A significant percentage of respondents identified their use of medicinal plant mixtures, an aspect of traditional medicine poorly reported in the literature, warranting further research.
Jamaicans reported limited use of CAM, which, together with the previously reported us of medicinal plants by 72.6% of Jamaicans, reported in Picking et al., (2011), lends further support to the assertion that a significant number citizens in developing countries continue to rely on the use of medicinal plants for their primary healthcare.
The results of the survey are being followed by ongoing scientific validation and toxicity studies, and plans for outreach activities (TRADIF) in Jamaica. In addition, the results of the survey, together with the results focusing on the concomitant use of medicinal plants with pharmaceutical drugs (Picking et al., 2011), are being communicated to local doctors, pharmacists and other health care professionals.

Acknowledgements

We thank the Commonwealth Scholarship Commission, the University of the West Indies Postgraduate Research Fund, the Environmental Foundation of Jamaica, the Forest Conservation Fund and the International Foundation for Science (Sweden) for funding support. The authors express their gratitude to respondents who so graciously gave their time and generously shared their traditional knowledge during the survey. We thank and acknowledge the hard work and dedication of Devon Lindsay who helped coordinate and manage the survey across the three areas. Thanks also to community leaders and others for facilitating the surveys, guidance in their areas and botanical collection: Kelvin Clarke, Mike Grizzle the late Mr. Black, Melinda Brown, Dolphy Powell, Mr. Dallas and Garfield McNaughton, Shanti. We also thank Mr. Patrick Lewis, Botanist and Herbarium Curator at the University of the West Indies for his advice and identification of all botanical samples.

Appendix A

See Table A7.
Table A7. The 107 botanically identified medicinal plants identified by medicinal plant users (n=270), ranked by prevalence a.
Scientific nameFamilyLocal name(s)Vouchern% (n/270)
Momordica charantia L.CucurbitaceaeWild Cerasee, Cerasee3547711442.3
Bryophyllum pinnatum (Lam.) OkenCrassulaceaeLeaf of Life354669334.4
Aloe vera (L.) Burm. f.XanthorrhoeaceaeSinkle Bible354686825.2
Eupatorium odoratum L.AsteraceaeJack-in-the-Bush, Christmas Bush, Jackney354756122.6
Annona muricata L.AnnonaceaeSoursop354674115.2
Zingiber officinale RoscoeZingiberaceaeGingern/v3713.7
Solanum torvum Sw.SolanaceaeSusumber359643513
Allium sativum L.AmaryllidaceaeGarlicn/v3412.6
Gliricidia sepium KunthFabaceaeMaranga, Quick Stick, Never Die359622710
Piper amalagoL. (var. nigrinodum) 1PiperaceaeJointer, Black Jointer, Black Betty35464269.6
Stachytarpheta jamaicensis (L.) VahlVerbenaceaeVervine, Porter Weed35963269.6
Andrographis paniculata (Burm. f.) NeesAcanthaceaeRice Bitters35372248.9
Clerodendrum thomsoniae Balf.LamiaceaeRice and Peas23207248.9
Rivina humilis L.PhytolaccaceaeDogblood35470228.1
Morinda citrifolia L.RubiaceaeNoni, Hog Apple35295217.8
Opuntia cochenillifera (L.) Mill.CactaceaeTuna35479207.4
Polyscias guilfoylei (W. Bull) L.H. BaileyAraliaceaeAralia35961197
Cymbopogon citratus (DC.) StapfPoaceaeFever Grass35474165.9
Chenopodium ambrosioides L.AmaranthaceaeSemi Contract35479155.6
Rhytidophyllum tomentosum (L.) Mart. bGesneriaceaeSearch-mi-Heart35969155.6
Bidens reptans (L.) G. Don (var. tomentosa O.E. Schulz) bAsteraceaeMcKatty Weed, Marigold35970134.8
Petiveria alliacea L.PhytolaccaceaeGuinea Hen Weed, Gulley Root, Duppy Weed35469134.8
Desmodium canum Schinz & Thell.FabiaceaeStrong Back, Sweetheart35963114.1
Priva lappulacea (L.) Pers.VerbenaceaeFasten-pon-coat, Clammy Bur,35971114.1
Hyptis verticillata Jacq.LamiaceaeJohn Charles3547393.3
Picramnia antidesma Sw.PicramniaceaeMajoe Bitter, Macary Bitter3597293.3
Citrus aurantiifolia (Christm.) SwingleRutaceaeLime3526693.3
Cassia alata L.FabaceaeKing of the Forest, Candlestick, Ringworm Shrub3597383
Artocarpus altilis (Parkinson) FosbergMoraceaeBreadfruit3597483
Pothomorphe umbellata (L.) Miq.PiperaceaeCowfoot3596872.6
Bambusa vulgaris Schrad. ex J.C. Wendl.PoaceaeBamboo3597572.6
Picrasma excelsa (Sw.) Planch.SimaroubaceaeBitter Wood, Jamaican Quassia3525272.6
Lippia alba N.E. Br. ex Britton & P. WilsonVerbenaceaeColic Mint, Cullen Mint,3597672.6
Bidens pilosa L.AsteraceaeSpanish Needle3536662.2
Pseudelephantopus spicatus (Juss. ex Aubl.) C.F. BakerAsteraceaeDog׳s Tongue, Packy Weed3597762.2
Cassia occidentalis L.FabaceaeDandelion, Piss-a-bed, Wild Coffee, Stinking Weed3420562.2
Mentha×piperita L.LamiaceaePeppermintn/v62.2
Pimenta spp. Lindl.MyrtaceaePimento3523462.2
Smilax regelii Killip & C.V. MortonSmilacaceaeJamaican Sarsaparilla3597862.2
Mikania micrantha KunthAsteraceaeGuaco Bush, Quaco Bush, Kwaku Bush3597951.9
Terminalia catappa L.CombretaceaeAlmond3598051.9
Psidium guajava L.MyrtaceaeGuava3598151.9
Argemone mexicana L.PapaveraceaeThistle, Mexican Poppy, Yellow Thistle697951.9
Justicia pectoralis Jacq.AcanthaceaeFresh Cut3598241.5
Achyranthes indica (L.) Mill.AmaranthaceaeDevil׳s Horse-Whip3538041.5
Cordia globosa (Jacq.) KunthBoraginaceaeBlack Sage2180341.5
Tournefortia hirsutissima L.BoraginaceaeChigga Nut, Cold With, Horse bark3598341.5
Cannabis sativa L.CannabaceaeCannabis, Ganja, Marijuana, Weed3064941.5
Zebrina pendula Schnizl.CommelinaceaeRed Water Grass, Wandering Jew3598441.5
Alysicarpus vaginalis (L.) DC.FabiaceaeMedina3589741.5
Rosmarinus officinalis L.LamiaceaeRosemary (fine)3118841.5
Salvia serotina L.LamiaceaeChicken Weed, Little Woman3596641.5
Cola acuminata (P. Beauv.) Schott & Endl.MalvaceaeBissy3596541.5
Cecropia peltata L.UrticaceaeTrumpet Tree3598541.5
Annona reticulata L.AnnonaceaeCustard Apple2754531.1
Eryngium foetidum L.ApiaceaeSpirit Weed, Fit Weed, Culantro3598631.1
Symphytum officinale L.BoraginaceaeComfrey3533131.1
Hippobroma longiflora (L.) G. DonCampanulaceaeMadam Faith3598731.1
Tamarindus indica L.FabaceaeTamarind3579231.1
Thymus vulgaris L.LamiaceaeThymen/v31.1
Peperomia amplexicaulis (Sw.) A. Dietr. bPiperaceaeJackie׳s Saddle3598831.1
Prunus L. spp.RosaceaePlum3598931.1
Foeniculum vulgare Mill.ApiaceaeFennel3599020.7
Syngonium auritum (L.) SchottAraceaeFive Finger2651420.7
Cocos nucifera L.ArecaceaeCoconutn/v20.7
Tillandsia recurvata (L.) L.BromeliaceaeOld Man Beard3537420.7
Erythrina corallodendron L.FabaceaeFence Stake, Cutlass Bush, Duppy Machete3599120.7
Ocimum micranthum Willd.LamiaceaeBarsely3599220.7
Acalypha wilkesiana Müll.Arg.EuphorbiaceaeJoseph Coat3599320.7
Oryctanthus occidentalis (L.) Eichler bLoranthaceaeGodbush, Mistletoe, Scorn-the Earth3599420.7
Hibiscus sabdariffa L.MalvaceaeSorrell2780420.7
Hibiscus rosa-sinensis L.MalvaceaeShoeblack, Hibiscus3599520.7
Trophis racemosa (L.) Urb.MoraceaeRamoon3271220.7
Musa spp.MusaceaeBananan/v20.7
Peperomia pellucida (L.) KunthPiperaceaePepper Elder3536020.7
Polypodium phyllitidis L.PolypodiaceaeCow׳s Tongue770020.7
Pilea microphylla (L.) Liebm. (var. microphylla) bUrticaceaeBaby Puzzle, Lace Plant3599620.7
Allium cepa L.AmaryllidaceaeOnionn/v10.4
Anacardium occidentale L.AnarcardiaceaeCashew3373510.4
Annona squamosa L.AnnonaceaeSweetsop3373210.4
Daucus carota L.ApiaceaeCarrotn/v10.4
Catharanthus roseus (L.) G. DonApocynaceaePeriwinckle, Ram Goat Rose3575710.4
Mandevilla torosa (Jacq.) WoodsonApocynaceaeincorrectly ID׳d as Milkweed3599710.4
Bursera simaruba (L.) Sarg.BurseraceaeRed Birch3536310.4
Croton linearis Jacq.EuphorbiaceaeRock Rosemary3536510.4
Ricinus communis L.EuphorbiaceaeCastor Oil3599810.4
Abrus precatorius L.FabaceaeJohn Crow Bead, Carb׳s Eyes, Red Bead Vine3599910.4
Arachis hypogaea L.FabaceaePeanut Trashn/v10.4
Entada gigas (L.) Fawc. & RendleFabaceaeCacoon2421210.4
Moghania strobilifera (L.) J. St.-Hil. ex KuntzeFabaceaeWild Hops3600610.4
Stylosanthes hamata (L.) Taub.FabaceaeDonkeyweed, Cheesy Toes3600010.4
Ocimum basilicum L.LamiaceaeBasil3070510.4
Plectranthus amboinicus (Lour.) Spreng.LamiaceaeFrench Thyme3538210.4
Satureja brownei (Sw.) Briq.LamiaceaePenny Royal3600110.4
Persea americana Mill.LauraceaePear (Avocado)2376010.4
Ceiba pentandra (L.) Gaertn.MalvaceaeCotton Tree2745010.4
Helicteres jamaicensis Jacq.MalvaceaeScrew Trea, Corkscrew3600210.4
Turnera ulmifolia L.PassifloraceaeRamgoat Dashalong2333710.4
Plantago major L.PlantaginaceaeEnglish Plantain2909410.4
Zea mays L.PoaceaeCornsilkn/v10.4
Hydrastis canadensis L.RanunculaceaeGoldensealn/v10.4
Smilax balbisiana Kunth bSmilacaceaeChany Root3600310.4
Capsicum frutescens L.SolanaceaeBird Pepper3085710.4
Boehmeria jamaicensis Urb. bUrticaceaeDoctor Johnson3600410.4
Cissus sicyoides L.VitaceaeSnake Withe, Pudding Withe2136810.4
Vitis tiliifolia Humb. & Bonpl. ex Schult.VitaceaeWild Grape3600510.4
Curcuma longa L.ZingiberaceaeTurmericn/v10.4
a
The top 50 medicinal plants in this table are reported in Picking et al. (2011, Table 5), and the full list is provided here for completeness.
b
Endemics n/v: not vouchered (commonly sourced from supermarkets, markets and health stores).
Table options

References

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Corresponding author. Tel.: +1 876 977 1828; fax: +1 876 977 3331.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Organically vs conventionally grown winter wheat: Effects on grain yield, technological quality, and on phenolic composition and antioxidant properties of bran and refined flour

Organically vs conventionally grown winter wheat: Effects on grain yield, technological quality, and on phenolic composition and antioxidant properties of bran and refined flour

 

Food Chemistry
Volume 175, 15 May 2015, Pages 445–451

 


doi:10.1016/j.foodchem.2014.11.138
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Highlights

•
Bread-making quality and yield of organic wheat were lower than conventional wheat.
•
The cropping systems did not affect the total amounts of phenols and phenolic acids.
•
The composition and amounts of phenolics were affected by the milling fractions.
•
Organic farming can maintain or increase the health benefits of the milling products.

Abstract

Since organic food is widely assumed to have a better nutritional quality than conventional food, our aim was to study the effects of organic vs conventional cropping systems on yield and the phenolic composition of winter wheat cv. ‘Bologna’. Although organic wheat yielded less than conventional wheat, mainly due to the nitrogen shortage, and its bread-making quality was lower, the cultivation system did not affect the total amounts of phenolics and phenolic acids. Of the eight phenolic acids identified, only ferulic acid was influenced by the cultivation system. Phenolic composition and quantity were significantly affected by the milling fraction (bran or white flour): phenolics were more concentrated in the bran, which showed the highest antioxidant power. Under the conditions adopted in this study, an organic cropping system can maintain or even increase the health properties of the wheat milled products, provided a reduction in grain yield is accepted.

Keywords

  • Organic farming;
  • Winter wheat;
  • Flour;
  • Bran;
  • Total phenolics;
  • Phenolic acids;
  • Antioxidant activity;
  • DPPH and ABTS assays
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Black Cohosh May Reduce Side Effects of Clomid/Clomiphene

Black Cohosh May Reduce Side Effects of Clomid/Clomiphene - American College for Advancement in Medicine (ACAM) http://www.acam.org/blogpost/1092863/185760/Black-Cohosh-May-Reduce-Side-Effects-of-Clomid-Clomiphene#.VUP4eFPsD1g.twitter
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BMJ Awards 2015 Women’s health team of the year

BMJ Awards 2015

Women’s health team of the year

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2030 (Published 30 April 2015) Cite this as: BMJ 2015;350:h2030

  1. Nigel Hawkes, freelance journalist, London, UK
  1. nigel.hawkes1@btinternet.com
Changing expectations is the theme that links the five shortlisted entries in the Women’s Health team category of the BMJ awards, says Nigel Hawkes. Rather than dramatic breakthroughs in care, the teams succeeded by using existing knowledge better through persuasion, training, and altering entrenched attitudes. Teamwork, openness, and a willingness to share perceptions good and bad were common factors

Improving induction of labour

Induction of labour is increasingly common, says Sabrina O’Dwyer, a specialty registrar at Barts Health NHS Trust, but is “infamous” for being poorly managed, to the irritation of women and at the risk of increasing the caesarean section rate. “We have an ageing maternal population, more medical problems, more fertility treatments, more diabetes in pregnancy, and all lead to a higher induction of labour rate,” she says. “But it is elective work, it doesn’t take priority, and it can be neglected a bit. It features a lot in complaint letters.”
A study launched at Whipps Cross Hospital in north London, part of the Barts trust, found inconsistent and outdated guidelines, poor patient information, a lack of coordination, and no feedback to staff. “Caesarean rates were high—we were an outlier,” she says.
One big change was to implement outpatient induction of labour in low risk women, using Propess, a single administration prostaglandin that works over 24 hours. Strong conditions were enforced, such as insisting that women had access to a phone, good English, and the competence to remove the pessary as instructed. An induction of labour suite with a dedicated midwife was also introduced, and the programme involved effective and continued engagement of all the staff involved.
The results show a reduction in active labour from the time of admission, and a fall in the caesarean section rate from 30% to 20%, as well as improved patient satisfaction scores. “There was a big culture change,” O’Dwyer says. “We have to prioritise women’s expectations and outcomes. The idea that they could wait for ever needed to change. The challenge now is to sustain the improvements.”

Training for cultural change

Cultural change through human factors training was the key to reducing postpartum haemorrhage at Peterborough City Hospital. “In 2012 in our hospital it was very high,” says Manjula Samyraju, consultant and intrapartum care lead at the trust. “We tried very hard in 2013 to reduce it and had some success in reducing cases of massive blood loss (more than two litres) but had little effect on less severe blood loss which ought to have been avoidable.”
With the support of Maggie Boyall, practice development midwife at the trust, and others, she decided that training in the human factors that often underlie poor performance might help. A survey in September 2013 showed a defensive culture in the maternity staff, with more than half of responders saying they would not raise their concerns for fear of ruffling other people’s feathers.
With the aid of the University of Hertfordshire and support from the trust board, mandatory training days were used for human factors training. “It’s non-clinical,” she explains. “It’s about why do we make mistakes, how can we help each other and manage risks better. It’s not about systems but about how individuals can change them. At the end of the day it’s about how we come to work.”
Achieving change was difficult, but worthwhile. Blood transfusions in the postnatal ward were cut by 30%. Postpartum haemorrhage was no longer the top risk. A new staff survey showed that 85% now felt able to express their views and concerns. “Oher departments are showing an interest and may take up the same training themselves,” Samyraju says.

Essential obstetric training

In low and middle income countries with weak healthcare systems, services in obstetrics and care of the newborn struggle. This is the problem addressed by the “Making it Happen” programme from the Liverpool School of Tropical Medicine, which mobilises 300 UK based volunteers to deliver short courses of training in 11 countries across sub-Saharan Africa and South Asia, funded by the UK Department for International Development (DFID).
“We go out initially to start training and build up capacity, and then we play a quality assurance role,” says Charles Ameh, deputy head of the Centre for Maternal and Newborn Health at the school. “Most of our volunteers work full time in the NHS and take unpaid leave to carry out the training, so we make sure they are away for a maximum of two weeks at a time.” Sustaining the improvements achieved is very important so the team has set up and furnished more than 200 skills rooms in countries where they have been active to scale up training packages to regional and national levels. Outcomes show a mean reduction in maternal deaths of 50% and a 15% reduction in stillbirths.
“We’ve trained over 12 000 healthcare workers so far in phase 2 of the project and our target is 17 000,” Ameh says. “Clearly there’s a high need for this kind of training. Even within the countries we already work in there’s room to expand—in Kenya, for example, we’ve only worked in three out of eight provinces and will be expanding, and other countries such as Ethiopia, Namibia, Sudan, and Uganda have also asked us to come.” That will depend on the availability of additional funding from DFID.

Diabetes preconception website

“Women with diabetes need to plan for pregnancy, but it’s not happening,” says Valerie Holmes, senior lecturer at Queen’s University Belfast. “If they have poor glycaemic control, they risk congenital malformations and miscarriage, so it’s important to plan.” Changes such as the increasing prevalence of type 2 diabetes at younger ages, and the movement of care from secondary to primary care mean that the conversations aren’t happening, and awareness of the risks is low.
She applied for a grant from Diabetes UK to develop a DVD, which was distributed to almost 5000 women with diabetes in Northern Ireland, and subsequently converted into a website with the backing of Public Health Agency Northern Ireland. Entitled “Women with Diabetes,” the subtitle on the opening page is “Things you need to know, but maybe don’t.”
Results showed that women were significantly more likely to have had their blood glucose recorded in the six months before conception and to have planned to take folic acid supplements. The team has also targeted health professionals. Holmes says the responses from both groups have been strongly positive, stressing that the DVD filled an educational void.
To get the message out wider the team has focused on social media such as Twitter, a good tool for reaching this particular group. “Doctors find it hard to have the right conversations with women at the right time because they need to mention it before they are pregnant or maybe even planning a pregnancy. So we try to get information packs to GP surgeries and to pharmacies where women will see them.”

Day case breast cancer surgery

How long do breast cancer patients need to stay in hospital after surgery? At Wrightington Wigan and Leigh NHS Foundation Trust in 2010 it was between two and three days. But consultant breast and oncoplastic surgeon Amar Deshpande believed that for straightforward cases without reconstruction length of stay could be greatly reduced.
“It is not medically necessary to stay for two to three nights but the culture had grown up that people have to stay in,” he says. “Once we got everyone together to discuss it, it wasn’t difficult to persuade them that it would be beneficial to reduce it. Initially we were looking to send them home the next day, and then we moved to the same day. Patients weren’t hard to persuade once we had been able to reassure them that they would get good support from community nurses and that if they needed it help would be at hand or only a phone call away.”
Enlisting the support and enthusiasm of community nurses was the key. “When they realised how important it was, they got involved. In addition, because we hold clinics every week day, if patients do need to be looked at they can be brought to the hospital.”
Now breast cancer surgery is done as a day case procedure for 85% of patients, and length of stay has fallen from an average of 2.7 days to 0.8 days in 2012 and 0.6 in 2014. “We found no evidence of harm. Patients have heard of it by word of mouth and now expect to be home the same day—and it reduces their risk of deep vein thrombosis and hospital acquired infection.” As well as saving the NHS money through reduced bed days, the trust earns more through the best practice tariff designed to encourage day case surgery.

Notes

Cite this as: BMJ 2015;350:h2030

Footnotes

  • The BMJ Awards are sponsored by MDDUS. The awards ceremony takes place on 6 May at the Park Plaza, Westminster Bridge, London. To find out more go to http://thebmjawards.bmj.com.
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“America’s Doctor” Dr Oz fights back against critics


“America’s Doctor” Dr Oz fights back against critics

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2283 (Published 28 April 2015) Cite this as: BMJ 2015;350:h2283

  1. Michael McCarthy
    Author affiliations
Mehmet Oz, the popular television doctor known as Dr Oz and who has been dubbed “America’s Doctor” by the television personality Oprah Winfrey, has said that he will not be silenced by critics who have alleged that he misleads the public, promoting miracle cures of no proven value.
Last week in an opinion article in Time magazine,1 and later on his television show, Oz defended his promotion of practices that are often considered outside mainstream medical practice: “I have spent my entire career searching for ways to lessen the suffering of my patients. The best and safest paths have generally been the traditions of conventional medicine. They are tried and true, well funded, and fast. But there are other routes to healing that offer wisdom as well, so I have been willing to explore alternative routes to healing and share any wisdom that can be gathered.”1
The defense was prompted by a letter from a group of 10 physicians sent to Lee Goldman, dean of the Faculties of Health Sciences and Medicine at Columbia University in New York City, expressing dismay that Oz was allowed to remain on the university’s faculty. The letter charged that Oz had “repeatedly shown disdain for science and for evidence-based medicine” and had promoted “quack treatments and cures in the interest of personal gain.”
In his defense Oz implied that the letter’s signatories wanted to silence him for his support of consumer labeling of genetically modified foods, noting that five of the 10 signatories were associated with the American Council on Science and Health, an industry funded group that opposes compulsory labeling of genetically modified foods. “I know I’ve irritated some potential allies in our quest to make America healthy. No matter our disagreements, freedom of speech is the most fundamental right we have as Americans. And these 10 doctors are trying to silence that right,” Oz said.
On his show, Oz, who is a cardiothoracic surgeon and vice chair of Columbia University’s Department of Surgery, often features “miracle” fat burning supplements, unproven cancer preventives, and alternative medicine practitioners, including psychics.
An analysis of medical television talk shows published in The BMJ last December concluded that only 46% of the recommendations made on The Dr Oz Show were supported by evidence, that no support could be found for 39%, and that the evidence contradicted 15% of the show’s recommendations.2
The article drew several rapid responses criticizing it. Replying in The BMJ to the critics, one of the article’s coauthors, Christina Korownyk, associate professor of family medicine at the University of Alberta’s department of family medicine, defended its conclusions, writing, “Despite the authors of the letter’s assertions of their expertise and their many comments on our study, we feel they have failed to raise any valid concerns that we did not outline in the original article.
“Given all the above and at least one of the authors of the letter’s undisclosed affiliation with the aforementioned medical talk show, one may wonder if their recommendation for manuscript withdrawal may stem from something other than the methodological quality of our study.”3

Notes

Cite this as: BMJ 2015;350:h2283

References

  1. ↵
    Oz M. Exclusive: Dr Oz says “We’re not going anywhere.” Time 27 Apr 2015. http://time.com/3831926/dr-oz-criticism-answers.
  2. ↵
    Korownyk C, Kolber MR, McCormack J, Lam V, Overbo K, Cotton C, et al. Televised medical talk shows: what they recommend and the evidence to support their recommendations: a prospective observational study. BMJ2014;349:g7346.

  3. ↵
    Korownyk C, Kolber M, McCormack J, Allan M. Re: Televised medical talk shows—what they recommend and the evidence to support their rec
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Type 2 diabetes is more common among Indians who stay in India than in those who migrate to US, study finds


Type 2 diabetes is more common among Indians who stay in India than in those who migrate to US, study finds

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2320 (Published 29 April 2015) Cite this as: BMJ 2015;350:h2320

  1. Cheryl Travasso
    Author affiliations
People of Indian origin who live in the United States have a lower prevalence of diabetes than those who live in India, a study published in Diabetes Care has found.
These differences were seen after adjusting for age, sex, systolic blood pressure, and waist circumference, indicating that other factors may be linked to the high prevalence of type 2 diabetes seen in Asian Indians.1 Previously, when the prevalence of type 2 diabetes in India was lower, studies had shown that Asian Indians had a higher risk of type 2 diabetes after immigration.
Unjali Gujral, lead author of the new study, noted that India has seen many economic and nutritional changes in recent years, along with a rapid rise in diabetes cases. The uniqueness of this study is that it looked at two genetically similar Indian populations living in different environments, she said.
The 757 US residents were participants in the Mediators of Atherosclerosis in South Asians Living in America study (MASALA; 2010-13) living in the Chicago or greater San Francisco areas, while the 2305 residents in India were participants in the Centre for Cardiometabolic Risk Reduction in South Asia study (CARRS; 2010-11) residing in Chennai. Both studies were large, population based studies whose participants had similar laboratory parameters and anthropometric measurements.
The prevalence of age adjusted type 2 diabetes was higher among Indians in the CARRS-Chennai study (38% (95% confidence interval 36 to 40)) than among those in the MASALA-US study (24% (21 to 27)). When participants were grouped by body mass index (BMI) the difference in prevalence of type 2 diabetes was significant (P<0.05) among the normal weight and overweight participants but not among those who were obese.
Conversely, the prevalence of age adjusted pre-diabetes was lower in the India residents (24% (22 to 26)) than in the US residents (33% (30 to 36)). When grouped by BMI the difference in prevalence of pre-diabetes was significant (P<0.05) only in those who had a normal BMI.
To correct for possible differences relating to region of origin the group then compared participants in the CARRS-Chennai study with only those of south Indian origin in the MASALA-US study, and they found the same observations. The authors acknowledged that, since the study looked at specific locations in the US and India, it could not be extrapolated to the countries’ entire populations. However, the prevalence in both the MASALA study and the CARRS-Chennai study aligned with other publications that have individually looked at diabetes in these two countries.
Gujral said that the higher diabetes prevalence among participants living in India could be because the disease is at an early stage of the epidemic, where people at risk would develop the disease sooner. Those living in the US were likely to have better access to healthcare and more awareness about diabetes prevention, she said; however, there was still a need to understand why migrant Indians are at a lower risk than those living in India.
Moreover, migrant Indians in the US still have a higher prevalence of diabetes than the overall US population, Gujral added, and better understanding is needed about the best treatment and prevention practices for this group.

Notes

Cite this as: BMJ 2015;350:h2320

References

  1. ↵
    Gujral UP, Narayan KM, Pradeepa RG, et al. Comparing type 2 diabetes, prediabetes, and their associated risk factors in Asian Indians in India and in the US: the CARRS and MASALA studies. Diabetes Care2015;pii:dc150032.
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Merv Wilkinson's Wildwood Ecoforest south of Nanaimo BC (Letter is NOT attached)

We are a group of citizens who have formed out of concerned for the future
of Merv Wilkinson's Wildwood Ecoforest south of Nanaimo BC.  We hope you
will sign onto our letter to prevent Wildwood from being sold. (See
attached letter).

As you may be aware, The Land Conservancy of BC (TLC) is proceeding with
plans to sell Wildwood to a private buyer, despite the fact that it was
purchased in full by public donations with the intention that TLC would
protect it forever.

To sell this property would contravene the community’s wish to protect this
legacy and, we believe, contravenes the Charitable Purposes Preservation
Act. http://www.bclaws.ca/civix/document/id/complete/statreg/04059_01

Would you be interested to sign your name to our letter to TLC?

We have also sent this letter to other forestry professionals, conservation
biologists, ecologists, university professors, citizen scientists,
advocates of wilderness preservation and environmental sustainability, as
well as members of TLC and donors to the campaign to purchase and protect
Wildwood.

If you would like to sign on, please reply to this email with your name,
credentials, and/or name of organization/department.  Also include your
phone number in case we need to clarify anything with you.  Your contact
info will *not *be included in the letter.

Sale of Wildwood is imminent so we are asking for *replies by Friday May
1st.* If you need longer to reply on behalf of your organization, please
let us know.

We have included links to further information about the sale of Wildwood
below.   Please feel free to circulate to other individuals and
organizations you believe would be interested.  If you have any questions
feel free to contact us.

Sincerely,

Glenys Wood  250 758-1287 (evenings )  and Erik Piikkila 250 924 5811
 (daytime)
On behalf of the Wildwood Protectors citizens group
savewildwood@gmail.com




*PS.  Please note we may modify paragraph #2 of the letter slightly to more
accurately reflect who has signed onto the letter once we have your
replies.Links to Further Information:*Petition to Stop the Sale of Wildwood
from Wildwood Protectors


* www.change.org/p/save-wildwood-ecoforest-don-t-let-it-be-sold*
< http://www.change.org/p/save-wildwood-ecoforest-don-t-let-it-be-sold >The
Land Conservancy of British Columbia website
< http://blog.conservancy.bc.ca/>and facebook page
< https://www.facebook.com/TLC4BC?fref=ts>

Ecoforestry Institute Society website <http://ecoforestry.ca/> and Wildwood
Ecoforest facebook page.
< https://www.facebook.com/wildwoodecoforest?fref=ts>

Press release from TLC March 11, 2015
http://blog.conservancy.bc.ca/2015/03/tlc-will-protect-the-future-of-wildwood/


Press release from EIS  Feb 2015
http://ecoforestry.ca/call-action-protect-wildwood-ecoforest-donors

Times Colonist Newspaper Article
http://www.timescolonist.com/business/society-offers-land-conservancy-600-000-for-wildwood-forest-1.1816780


Ecoforestry Institute Management Plan for Wildwood 2000
http://ecoforestry.ca/sites/default/files/attachments/Wildwood%20management%20plan.pdf


TLC Plan of Compromise and Arrangement (which states Wildwood will be sold
section 4.10 page 13)
< http://wmltrustees.com/customer/wm/trustees.nsf/lookupAttach/6109AFF332BAE44A88257DF70008A3DA/$File/Plan%20of%20%20Compromise%20&%20Arrangement%20%28Feb%2023,%202015%29.PDF?OpenElement >
http://goo.gl/Uy105r
 < http://wmltrustees.com/customer/wm/trustees.nsf/lookupAttach/6109AFF332BAE44A88257DF70008A3DA/$File/Plan%20of%20%20Compromise%20%26%20Arrangement%20(Feb%2023,%202015).PDF?OpenElement >BC
Ministry of Environment Lands and Parks - Pamphlet on Ecosystems At Risk:
Coastal Douglas-fir Ecosystem
http://www.env.gov.bc.ca/wld/documents/douglasfir.pdf
 
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Thursday, 30 April 2015

Windows 10 Home Insider Preview 10074

Around 10 am this morning I decided to upgrade to the new Build 10074 because the technicians claimed that they had missed the audio fix by one day. It downloaded in 25 minutes but it did not install until 20.40. This is supposed to be an update not a full install.  I have a 2014 budget computer that is not that great but it is not so bad that an install should take that long. Also it has 326 free GB out of 457. I haven't heard any sounds yet but since I did not delete the Korea Media Player Centre like I did for the first build I will figure out the sound issue tomorrow. This new build is midnight blue instead of Kermit green but either colour is fine. It also loaded Chrome before Firefox and  Internet Explorer also loaded (which I never use).
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See how a group of Swedish cops responded when a fight broke out on the New York subway

See how a group of Swedish cops responded when a fight broke out on the New York subway. #copwatch http://www.upworthy.com/see-how-a-group-of-swedish-police-officers-responded-when-a-fight-broke-out-on-the-new-york-subway?g=2
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cats prefer cat music

 http://www.npr.org/2015/03/07/391377916/these-tunes-are-music-to-your-cats-furry-ears


Applied Animal Behaviour Science
Volume 166, May 2015, Pages 106–111

Cats prefer species-appropriate music


doi:10.1016/j.applanim.2015.02.012
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Highlights

•
Music is often used for enrichment of animals, but results are conflicting.
•
We present a theory of species-appropriate music and test this with domestic cats.
•
Cats responded more to species-appropriate music than to human music.
•
Species-appropriate music is more likely to benefit animals than human music.

Abstract

Many studies have attempted to use music to influence the behavior of nonhuman animals; however, these studies have often led to conflicting outcomes. We have developed a theoretical framework that hypothesizes that in order for music to be effective with other species, it must be in the frequency range and with similar tempos to those used in natural communication by each species. We have used this framework to compose music that is species-appropriate for a few animal species. In this paper, we created species-appropriate music for domestic cats and tested this music in comparison with music with similar affective content composed for humans. We presented two examples of cat music in counterbalanced order with two examples of human music, and we evaluated the behavior and response latencies of cats to each piece. Cats showed a significant preference for and interest in species-appropriate music compared with human music (median (interquartile range (IQR)) 1.5 (0.5–2.0) acts for cat music, 0.25 (0.0–0.5) acts for human music, P < 0.002) and responded with significantly shorter latencies (median (IQR) 110.0 (54–138.75) s for cat music, 171.75 (151–180) s for human music (P < 0.001). Younger and older cats were more responsive to cat music than middle-aged acts (cubic trend, r2 = 0.477, P < 0.001). The results suggest novel and more appropriate ways for using music as auditory enrichment for nonhuman animals.

Keywords

  • Cats;
  • Auditory enrichment;
  • Emotions;
  • Music;
  • Species-appropriate

Corresponding author at: Department of Psychology, University of Wisconsin, 1202 West Johnson Street, Madison, WI 53706, USA. Tel.: +1 6082623974.
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Music decreases aortic stiffness and wave reflections

Atherosclerosis
Volume 240, Issue 1, May 2015, Pages 184–189

Music decreases aortic stiffness and wave reflections


doi:10.1016/j.atherosclerosis.2015.03.010
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Abstract

Objective

Music has been related to cardiovascular health and used as adjunct therapy in patients with cardiovascular disease. Aortic stiffness and wave reflections are predictors of cardiovascular risk. We investigated the short-term effect of classical and rock music on arterial stiffness and wave reflections.

Methods

Twenty healthy individuals (22.5 ± 2.5 years) were studied on three different occasions and listened to a 30-min music track compilation (classical, rock, or no music for the sham procedure).

Results

Both classical and rock music resulted in a decrease of carotid-femoral pulse wave velocity (PWV) immediately after the end of music listening (all p < 0.01). Augmentation index (AIx) decreased with either classical or rock music in a more sustained way (nadir by 6.0% and 5.8%, respectively, at time zero post-music listening, all p < 0.01). When music preference was taken into consideration, both classical and rock music had a more potent effect on PWV in classical aficionados (by 0.20 m/s, p = 0.003 and 0.13 m/s, p = 0.015, respectively), whereas there was no effect in rock aficionados (all p = NS). Regarding wave reflections, classical music led to a more potent response in classical aficionados (AIx decrease by 9.45%), whereas rock led to a more potent response to rock aficionados (by 10.7%, all p < 0.01).

Conclusions

Music, both classical and rock, decreases aortic stiffness and wave reflections. Effect on aortic stiffness lasts for as long as music is listened to, while classical music has a sustained effect on wave reflections. These findings may have important implications, extending the spectrum of lifestyle modifications that can ameliorate arterial function.

Keywords

  • Aortic stiffness;
  • Wave reflections;
  • Music;
  • Pulse wave velocity;
  • Augmentation index

Corresponding author. 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Profiti Elia 24, Athens 14575, Greece.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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