RESUMEN
BACKGROUND: There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. METHOD: In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. RESULTS: Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. CONCLUSION: Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.
Asunto(s)
Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/fisiopatología , Esquizofrenia/epidemiología , Esquizofrenia/fisiopatología , Adolescente , Adulto , Áreas de Influencia de Salud , Estudios Epidemiológicos , Monitoreo Epidemiológico , Estudios de Factibilidad , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Trinidad y Tobago/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To investigate the factors that influence non-fatal suicidal behaviour. DESIGN AND METHODS: A cross sectional study was undertaken and data were collected from a review of medical records of patients in addition to structured interviews with patients using the Columbia Suicide Severity rating scale. RESULTS: The survey findings (n=20) revealed that one-quarter of patients had more than one attempt. More than one third of the patients began having suicidal thoughts years ago (n=9, 45%). Half of the responders had thoughts ranging from twice a week to many times a day and the thoughts lasted from one to four hours a day to most of the day in 60% of responders. Six patients told someone of their plan. While females used the method of overdosing on pills, males tended to drink a poisonous substance or use more lethal means of attempting suicide. From the case note review (n=42), more females (n=31, 74%) attempted suicide compared to males (n=11, 26%). CONCLUSION: These findings suggest there were factors that may highlight at-risk persons e.g. those with past attempts, and those who confide in others about their plans. It appears persons have suicidal thoughts for several years and the majority think about these on most days and these thoughts last at least 1-4 hours a day. There is therefore a role for health education to the public who need to be aware of warning signs and how to handle the situation if they are told about a planned attempt.
Asunto(s)
Intento de Suicidio , Factores de Riesgo , Estudios Transversales , Trinidad y TobagoRESUMEN
OBJECTIVE: This study investigated whether 1) correlations exist among homicide rates, life expectancy and interpersonal trust among 38 countries between 2000-2012; and (2) whether correlations exist between life expectancy and homicide rates in 14 Caribbean countries between 2000-2012. DESIGN AND METHODS: An ecological study using an aggregated data analysis design was constructed using publicly available data. Interpersonal trust data were gathered from wave 6 (2010-2014) of the world values survey. Life expectancy data (2000-2012) were gathered from the World Bank; homicide rates were provided by the global homicide report published by the United Nations Office on Drugs and Crime (UNODC) in 2013. Data was analyzed in SPSS version 16. RESULTS: Spearman correlation testing indicated that interpersonal trust and homicide rates were significantly correlated (p<.05). Homicide rates and life expectancy were also significantly correlated between the years of 2005-2012 (p<.05). Trust and life expectancy were not significantly correlated. Spearman correlation analysis of homicide and life expectancy in selected Caribbean countries revealed no significant correlation. CONCLUSIONS: The significant correlation between trust and homicide rates suggests that there may be a cultural connection between interpersonal trust and violence at a global level. The consistent correlation between homicide rates and life expectancy between the years of 2005-2012 also implies that population level longevity is detrimentally affected by this connection between interpersonal trust and country level homicide rates. Interpersonal trust presents a potential avenue of public health intervention that may affect rates of crime and increase years of population life expectancy over time.
Asunto(s)
Homicidio , Esperanza de Vida , Confianza , Región del CaribeRESUMEN
AIM: To provide information on the possible influence of cultural practices in perpetuating child sexual abuse and to examine documented examples of these cultural influences. METHODS: A computer literature search was done of Medline, Science Direct, PSYCInfo, Embase and PubMed for keywords. There were also manual searches in the library of journals that are not accessible online. Keywords for searches included: sexual abuse, child abuse, psychopathology, name of countries (eg Jordan, China and Morocco), culture and cultural practices. RESULTS: There is documented evidence of cultural practices that continue to fuel the persistently high level of child sexual abuse across the globe. The definition has evolved to now include simple genital-genital and non-genital contact such as oral-genital contacts, exhibitionism and pornography. CONCLUSIONS: Cultural practices are no longer restricted to one geographical collection of people due to migratory influence, as these practices may also spread to different groups who intermingle. There are few empirical studies of child sexual abuse in the Caribbean, but one factor that could be used as a proxy is age of first sexual activity. The World Bank reports that this age is youngest in the Caribbean and is likely to be significantly influenced by child sexual abuse.
RESUMEN
The current study investigated the prevalence of depressive symptoms in persons with self-reported cardiovascular disease and the interactions of depressive symptoms, reported cardiovascular disease and gender in a Trinidadian population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Center for Epidemiologic Studies Depression Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-seven per cent of the self-reported cardiovascular disease participants were identified as having high depressive symptoms as compared to 32% of those who did not report having a cardiovascular illness. The odds ratio indicated that high depressive symptoms are more likely to occur in individuals with reported cardiovascular disease. The Mann-Whitney test revealed females had significantly higher levels of depressive symptoms than males. Previous studies suggest that depression is a risk factor for adverse prognosis in a cardiac population, therefore future research examining the link between depression and cardiovascular disease is warranted.
El presente estudio investigó la prevalencia de síntomas depresivos en personas con enfermedad cardiovascular autoreportadas y las interacciones de los síntomas depresivos, las enfermedades cardiovasculares reportadas y el género en una población de Trinidad y Tobago. Entre junio y agosto de 2009, 425 participantes fueron reclutados de la Clínica Cardiológica del Complejo de Ciencias Médicas Eric Williams (EWMSC), todos los participantes respondieron la Escala de Depresión del Centro de Estadios Epidemiológicos, y se obtuvieron las variables demográficas y clínicas del cuestionario sociodemográfico. Cuarenta y siete por ciento de los participantes con enfermedades cardiovasculares autoreportadas fueron identificados con síntomas depresivos altos en comparación con el 32% de aquellos que no reportaron tener enfermedad cardiovascular. El cociente de probabilidades (OR) indicó que los síntomas depresivos altos tienen mayor probabilidad de ocurrir en individuos con enfermedades cardiovasculares reportadas. La prueba de Mann-Whitney reveló que las hembras presentaban niveles significativamente mayores de síntomas depresivos que los varones. Los estudios previos sugieren que la depresión es un factor de riesgo para un pronóstico adverso en una población cardiaca. Por lo tanto, es un hecho que la investigación futura necesita examinar el vínculo entre depresión y enfermedad cardiovascular.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Trinidad y Tobago/epidemiología , Oportunidad Relativa , Factores Sexuales , Prevalencia , AutoinformeRESUMEN
The current study investigated the prevalence of depressive symptoms in persons with self-reported cardiovascular disease and the interactions of depressive symptoms, reported cardiovascular disease and gender in a Trinidadian population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Center for Epidemiologic Studies Depression Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-seven per cent of the self-reported cardiovascular disease participants were identified as having high depressive symptoms as compared to 32% of those who did not report having a cardiovascular illness. The odds ratio indicated that high depressive symptoms are more likely to occur in individuals with reported cardiovascular disease. The Mann-Whitney test revealed females had significantly higher levels of depressive symptoms than males. Previous studies suggest that depression is a risk factor for adverse prognosis in a cardiac population, therefore future research examining the link between depression and cardiovascular disease is warranted.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Autoinforme , Factores Sexuales , Trinidad y Tobago/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The current study investigated the prevalence of Type D personality in persons with self-reported cardiovascular disease and the interactions of Type D personality, reported cardiovascular disease and gender in a Trinidadian cardiac population. METHODS: Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Type D Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. RESULTS: Forty-two per cent of participants with self-reported cardiovascular disease were identified as Type D as compared to 26% of participants who did not report having a cardiovascular illness. The odds ratio indicated individuals identified with Type D personality are 2.0 times more likely to report having cardiovascular disease and females with cardiac disease are 1.6 times more likely to be identified with Type D personality as compared to males. CONCLUSIONS: Previous studies suggest Type D personality is a risk factor for adverse prognosis in the cardiac population, therefore future research examining the link between Type D personality and cardiovascular disease is warranted.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Personalidad Tipo D , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Trinidad y Tobago/epidemiologíaRESUMEN
OBJECTIVE: The current study investigated the prevalence of Type D personality in persons with selfreported cardiovascular disease and the interactions of Type D personality, reported cardiovascular disease and gender in a Trinidadian cardiac population. METHODS: Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Type D Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. RESULTS: Forty-two per cent of participants with self-reported cardiovascular disease were identified as Type D as compared to 26% of participants who did not report having a cardiovascular illness. The odds ratio indicated individuals identified with Type D personality are 2.0 times more likely to report having cardiovascular disease and females with cardiac disease are 1.6 times more likely to be identified with Type D personality as compared to males. CONCLUSIONS: Previous studies suggest Type D personality is a risk factor for adverse prognosis in the cardiac population, therefore future research examining the link between Type D personality and cardiovascular disease is warranted.
OBJETIVO: El presente estudio investigó la prevalencia de la personalidad tipo D en personas con enfermedades cardiovasculares autoreportadas, así como las interacciones de la personalidad de tipo D, las enfermedades cardiovasculares reportadas, y el género en una población cardíaca de Trinidad y Tobago. MÉTODOS: Entre junio y agosto de 2009, 425 participantes fueron reclutados de la Clínica Cardiológica del complejo de Ciencias Médicas Eric Williams (EWMSC), y todos los participantes llenaron el cuestionario de la Escala de Tipo D. Las variables demográficas y clínicas fueron obtenidas del cuestionario sociodemográfico. RESULTADOS: Cuarenta y dos por ciento de los participantes con enfermedad cardiovascular autoreportada, fueron identificados como tipo D, en comparación con el 26% de los participantes que no reportó tener una enfermedad cardiovascular. El cociente de probabilidades (odds-ratio) indicó que los individuos identificados con personalidad de tipo D son 2.0 veces más propensos a reportar su enfermedad cardiovascular, y las mujeres con enfermedad cardiaca presentan 1.6 veces más probabilidades de ser identificadas con personalidad tipo D en comparación con los varones. CONCLUSIONES: Estudios previos sugieren que la personalidad de tipo D es un factor de riesgo que apunta a una prognosis adversa en la población cardiaca. Por lo tanto, las investigaciones futuras que examinen el vínculo entre la personalidad de tipo D y las enfermedades cardiovasculares tienen un lugar asegurado.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/psicología , Personalidad Tipo D , Trinidad y Tobago/epidemiología , Enfermedades Cardiovasculares/epidemiología , Prevalencia , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.
Asunto(s)
Trastornos Mentales/terapia , Colonialismo , Emigración e Inmigración , Historia del Siglo XX , Humanos , Trastornos Mentales/historia , Salud Mental , Trastornos de la Personalidad/terapia , Resiliencia Psicológica , Indias OccidentalesRESUMEN
The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.
La exploración intelectual del descubrimiento fenomenológico y psiquiátrico que ha florecido en el Caribe en el periodo de independencia política de la colonización británica, es un reflejo de la erudición surgida del cultivo académico de la Universidad de West Indies. La pujante migración de personas del Caribe a Inglaterra en el siglo 20, ha traído como consecuencia reportes de altas tasas de psicosis en relación con esta población de emigrantes. La investigación caribeña de esta condición ha revelado la existencia de retos producidos por la hostilidad racial y ambiental en Gran Bretaña, que han tenido un profundo efecto en la salud mental de los emigrantes afrocaribeños. Estos resultados han desplazado significativamente el péndulo de la comprensión de la etiología de esta condición, desde una posición genética a una posición biopsicosocial. La investigación también ha revelado la presencia de efectos psicopatológicos pertinaces provenientes de la esclavitud y el colonialismo en el Caribe. Se trata de efectos significativamente negativos y a largo plazo, sobre la salud mental de muchos dentro de la población caribeña. La investigación actual sugiere que hay una necesidad de fomentar estrategias de protección a fin de mejorar la resiliencia y el capital social, que asegurarían el bienestar y la continuación de la supervivencia de las personas del Caribe, a pesar de los muchos desafíos a que se enfrentan.
Asunto(s)
Historia del Siglo XX , Humanos , Trastornos Mentales/terapia , Colonialismo , Emigración e Inmigración , Trastornos Mentales/historia , Salud Mental , Trastornos de la Personalidad/terapia , Resiliencia Psicológica , Indias OccidentalesRESUMEN
BACKGROUND: African-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients. METHOD: We obtained dual-echo (proton density/T2-weighted) images from a sample of 75 first-episode psychosis patients and 68 healthy controls. We used high resolution magnetic resonance imaging and voxel-based methods of image analysis. Two separate analyses were conducted: (1) 34 white British patients were compared with 33 white British controls; (2) 41 African-Caribbean and black African patients were compared with 35 African-Caribbean and black African controls. RESULTS: White British patients and African-Caribbean/black African patients had ventricular enlargement and increased lenticular nucleus volume compared with their respective ethnic controls. The African-Caribbean/black African patients also showed reduced global grey matter and increased lingual gyrus grey-matter volume. The white British patients had no regional or global grey-matter loss compared with their normal ethnic counterparts but showed increased grey matter in the left superior temporal lobe and right parahippocampal gyrus. CONCLUSIONS: We found no evidence in support of our hypothesis. Indeed, the finding of reduced global grey-matter volume in the African-Caribbean/black African patients but not in the white British patients was contrary to our prediction.
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Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Femenino , Trastornos Psicóticos , Imagen por Resonancia Magnética , Diagnóstico , Neuroanatomía , Región del CaribeRESUMEN
We are grateful to the commentators for their constructive observations on our review. We agree with Kwame McKenzie (2009) that consensus needs to be built ; the key point we attempted to make is that, to gain such a consensus, the problem of high rates of psychosis in migrant and minority ethnic populations needs to be de-coupled from the no less important issue of service provision for minority ethnic patients. In the same way that improving customer services for insurance claimants following an accident is irrelevant to reducing the rate at which such accidents occur, so reforming mental health services (important as this no doubt is) will have no impact on population rates of disorder.
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Humanos , Masculino , Femenino , Trastornos Psicóticos , Depresión , Región del CaribeRESUMEN
BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world. Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.
ANTECEDENTES: El auto-daño deliberado y el comportamiento suicida se han convertido cada vez más en una forma común de morbosidad en el mundo en vías de desarrollo. El comportamiento suicida es un serio problema de salud pública en Trinidad, como país que tiene la tasa más alta de suicidios efectuados en el Caribe anglófono. Los objetivos de este estudio fueron determinar la epidemiología del suicidio efectuado y el auto-daño en un lugar específico (el Hospital General de Puerto España) y compararla con estudios previos realizados en el mismo lugar. SUJETOS Y MÉTODOS: Esto fue investigado mediante una revisión de los ingresados de un año al Hospital General de Puerto España por comportamiento suicida. La incidencia fue comparada con un estudio previo terminado en este sitio y reportado en 1974. La comparación de las características demográficas de la muestra con la del estudio previo se llevó a cabo usando un análisis de chi-cuadrado y pruebas de significatividad mediante el uso de tests t. RESULTADOS: Se produjeron un total de 368 casos referidos por intento de suicidio o auto-daño deliberado en el período en cuestión, lo cual indica que la incidencia de esta conducta aumentó en cuatro veces, con un mayor incremento entre los varones, y una disminución de la proporción hembras-varones de 4:1 a 2:1; p < 0.001); la edad promedio de los varones fue 34 años en comparación con la de las hembras, 22 (p < 0.0001). Los varones mostraron una tendencia mayor a usar medios violentos en comparación con las hembras, entre las que había una mayor probabilidad de ingerir tabletas o lejía. Las dificultades en las relaciones constituyeron la explicación más comúnmente dada como causa del intento, tanto por los varones como por las hembras. Hubo tendencia a una mayor propensión a este comportamiento entre los indo-trinitenses en comparación con los afro-trinitenses, tanto en hembras como varones. CONCLUSIONES: Un número cada vez mayor de hombres se involucran en conductas auto-agresivas y están usando métodos más violentos y físicamente dañinos, lo que sugiere un grado mayor de riesgo de suicidio, mientras que las mujeres se entregan principalmente a actos de ingestión con riesgo mucho menor de muerte. La edad promedio mayor de estos hombres sugiere que sus problemas se presentan en medio de su adultez, mientras que las mujeres se entregan a estas conductas como adultos jóvenes. La conducta suicida y el auto-daño deliberado constituyen un problema principal de salud pública en Trinidad.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Hospitales Generales/estadística & datos numéricos , Conducta Autodestructiva/epidemiología , Factores de Edad , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Suicidio/estadística & datos numéricos , Trinidad y Tobago/epidemiologíaRESUMEN
OBJECTIVE: Cannabis use increases the risk for psychosis, but psychotogenic effects of cannabis may be restricted to exposure during early adolescence. METHOD: Four hundred and seventy-two participants (aged 12-23 years), randomly selected from the general population in Trinidad, completed questionnaires on past and current cannabis use and psychotic symptoms (using the Community Assessment of Psychic Experiences). RESULTS: Cannabis use increased the risk of experiencing psychotic symptoms and this effect was conditional on early exposure, defined around the mean age of onset of cannabis use. Thus, exposure before but not after the age of 14 years predicted psychotic symptoms (respectively beta: 0.71, 95% CI 0.22; 1.19, P = 0.004 and beta: -0.11, 95% CI -0.57; 0.36, P = 0.66). The developmental effect of cannabis use was independent of use of other drugs or current use of cannabis. CONCLUSION: Early adolescence may be a critical period with regard to the psychotogenic effect of cannabis across geographical settings and ethnic groups.
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Conducta del Adolescente/psicología , Abuso de Marihuana/epidemiología , Abuso de Marihuana/psicología , Fumar Marihuana/efectos adversos , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Factores de Edad , Edad de Inicio , Niño , Comorbilidad , Estudios Transversales , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Fumar Marihuana/epidemiología , Valor Predictivo de las Pruebas , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Factores de Riesgo , Autorrevelación , Encuestas y Cuestionarios , Trinidad y Tobago/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.
Asunto(s)
Hospitales Generales/estadística & datos numéricos , Conducta Autodestructiva/epidemiología , Adulto , Factores de Edad , Femenino , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Suicidio/estadística & datos numéricos , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: The prevalence of Human Immunodeficiency Virus (HIV) infection in the Caribbean is reported to be second only to sub Saharan Africa. HIV in pregnancy has become an increasingly important focus of attention in HIV research because of its role in contributing to spread of the infection. This study sought to establish the prevalence and risk factors associated with HIV infection among antenatal women in the northwest region of Trinidad. SUBJECTS AND METHODS: Using a cross-sectional survey design, interviews were conducted with each new pregnant attendee to the antenatal clinics in the county of St George West over a six-month period after informed consent was obtained. These women were all offered routine HIV testing in their antenatal assessment. Their HIV results were confirmed through the island's HIV monitoring facility. The interviews included questions on demographics, known risk factors for HIV infection, mental health history and related information on their partners. Women who had refused testing were also asked to give reasons for this. RESULTS: There was a total of 541 women attending the clinic for the first time during the six-month period Seven of them refused testing. Of the remaining 534 women, 37 were HIV positive (6.8%). Fourteen of the HIV positive women (37.8%) admitted to knowing of their status prior to becoming pregnant. Risk factors significantly associated with positive HIV status were early age of first sexual intercourse, a history of sexually transmitted disease, mental health problems and homelessness. Regression analysis established a history of sexually transmitted disease as the only independent predictor of HIV infection in this sample. CONCLUSION: These findings reveal a high rate of HIV infection among pregnant women in northwest Trinidad and suggest that having a history of sexually transmitted disease is a key determinant of this. Prevention efforts must therefore be targeted at identifying the factors which influ...
Antecedentes: Se reporta que la prevalencia de infección por VIH en el Caribe, ocupa el segundo lugar detrás del África subsaharana. Debido al papel que juega en diseminar la infección, el VIH en los embarazos se ha convertido cada vez más en foco de atención de las investigaciones de VIH. Por tal motivo, nos dimos a la tarea de establecer la prevalencia y los factores de riesgo asociados con la infección por VIH entre las mujeres que reciben cuidados antenatales en la región noroccidental de Trinidad y Tobago. Sujetos y métodos: Usando un diseño de encuesta transversal, se llevaron a cabo entrevistas con cada nueva embarazada atendida en las clínicas antenatales en el condado de Saint George West, por un período de seis meses, tras de obtener consentimiento informado. A estas mujeres se les aplicó pruebas de VIH de rutina en su valoración antenatal. Los resultados de sus pruebas de VIH fueron confirmados en la instalación de monitoreo de VIH de la isla. Las entrevistas incluyeron preguntas sobre datos demográficos, factores de riesgo conocidos en las infecciones por VIH, historia de salud mental, así como información relacionada con sus parejas. A las mujeres que rehusaron hacerse las pruebas, se les preguntó también sus motivos para el rechazo. Resultados: Hubo un total de 541 mujeres que asistieron a la clínica por primera vez durante el período de seis meses. Siete de ella rechazaron las pruebas. De las restantes 534 mujeres, 37 resultaron VIH positivas (6.8%). Catorce de las mujeres positivas al VIH (37.8%), admitieron conocer su condición antes de salir embarazadas. Los factores de riesgo...
Asunto(s)
Humanos , Femenino , Embarazo , Adolescente , Adulto , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones por VIH/epidemiología , Entrevistas como Asunto , Estudios Transversales , Factores de Riesgo , Prevalencia , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: Minor physical anomaliesare more prevalent among people withpsychosis. This supports aneurodevelopmental aetiology forpsychotic disorders, since these anomalies and the brain are both ectodermally derived. However, little is understood about the brain regions implicated in this association. AIMS: To examine the relationship between minor physical anomalies and grey matter structure in a sample of patients with first-episode psychosis. METHOD: Sixty patients underwent assessment of minor physical anomalies with the Lane scale. High-resolution magnetic resonance images and voxel-based methods of image analysis were used to investigate brain structure in these patients. RESULTS: The total anomalies score was associated with a grey matter reduction in the prefrontal cortex and precuneus and with a grey matter excess in the basal ganglia, thalamus and lingual gyrus. CONCLUSIONS: Minor physical anomalies in a sample of patients with first-episode psychosis are associated with regionalgrey matter changes. These regional changes may be important in the pathogenesis of psychotic disorder.
Asunto(s)
Humanos , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/patología , Trastornos PsicóticosRESUMEN
BACKGROUND: The prevalence of Human Immunodeficiency Virus (HIV) infection in the Caribbean is reported to be second only to sub Saharan Africa. HIV in pregnancy has become an increasingly important focus of attention in HIV research because of its role in contributing to spread of the infection. This study sought to establish the prevalence and risk factors associated with HIV infection among antenatal women in the northwest region of Trinidad. SUBJECTS AND METHODS: Using a cross-sectional survey design, interviews were conducted with each new pregnant attendee to the antenatal clinics in the county of St George West over a six-month period after informed consent was obtained. These women were all offered routine HIV testing in their antenatal assessment. Their HIV results were confirmed through the island's HIV monitoring facility. The interviews included questions on demographics, known risk factors for HIV infection, mental health history and related information on their partners. Women who had refused testing were also asked to give reasons for this. RESULTS: There was a total of 541 women attending the clinic for the first time during the six-month period Seven of them refused testing. Of the remaining 534 women, 37 were HIV positive (6.8%). Fourteen of the HIV positive women (37.8%) admitted to knowing of their status prior to becoming pregnant. Risk factors significantly associated with positive HIV status were early age of first sexual intercourse, a history of sexually transmitted disease, mental health problems and homelessness. Regression analysis established a history of sexually transmitted disease as the only independent predictor of HIV infection in this sample. CONCLUSION: These findings reveal a high rate of HIV infection among pregnant women in northwest Trinidad and suggest that having a history of sexually transmitted disease is a key determinant of this. Prevention efforts must therefore be targeted at identifying the factors which influence this and these include early sexual activity and the experience of childhood sexual abuse.
Asunto(s)
Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto , Embarazo , Prevalencia , Factores de Riesgo , Trinidad y Tobago/epidemiologíaRESUMEN
Self destructive behaviour may not occur consistently across a population. Identification of variations in homicidal and suicidal behaviour within a country can enable specific prevention and public health strategies to be adopted. This is significant because morbidity and mortality associated with these behaviour patterns is preventable and the affected population is increasingly young adults with potentially productive lives. The author sought to identify some of the associated risk factors with the behaviours in Trinidad and Tobago, a developing island-state in the English-speaking Caribbean, by disaggregating the homicide and suicide data available from Police records for distinct geographical regions. Spearman rank correlation was used to determine whether any of the variations observed could be attributed to social or demographic factors. Homicide and suicide were inversely related in many areas of the country. They were both low in Tobago. Homicide was positively associatedwith high population density, low marriage rates, African ethnicity and showed a trend toward association with school drop-out rates. For suicide, low population density, low income, East Indian ethnicity and alcohol consumption were significantly correlated. These findings underline the benefit of disaggregating national data and suggest specific interventions to diminish the occurrence of these harmful behaviour patterns in Trinidad and Tobago with possible extension to other similar developing countries.
Puede que los comportamientos auto-destructivos no ocurran de forma sistemáticamente en una población La identificación de variaciones en el comportamiento homicida y suicida dentro de un país puede hacer posible la adopción de estrategias específicas tanto con respecto a la prevención como en relación con la salud pública. Esto es significativo porque la morbosidad y la mortalidad asociadas con estos patrones de conducta son prevenibles y la población afectada consiste cada vez más de adultos jóvenes con vidas potencialmente productivas. Desagregando los datos sobre suicidios y homicidios a su disposición en los archivos de la policía en diferentes regiones geográficas, el autor se dio a la tarea de identificar algunos de los factores de riesgo asociados con los comportamientos en Trinidad-Tobago una Isla-Estado en vías de desarrollo en el Caribe anglófono. A fin de determinar si alguna de las variables observadas podía atribuirse a factores sociales o demográficos, se recurrió al coeficiente de correlación por rangos de Spearman. El homicidio y el suicidio se hallaban en relación de proporcionalidad inversa en muchas áreas del país. En Tobago, ambos resultaron ser bajos. El homicidio estuvo positivamente asociado con una alta densidad de población, tasas de matrimonio, etnicidad africana y mostró una tendencia hacia la asociación con las tasas de deserción escolar. Por su parte, el suicidio presentó una correlación significativa con una baja densidad de población, ingresos bajos, etnicidad indo-oriental, y consumo de alcohol. Estos hallazgos destacan el beneficio de desagregar los datos nacionales, y sugieren intervenciones específicas con el fin de disminuir la manifestación de estos patrones de conducta negativos en Trinidad-Tobago, con la extensión posible en otros países similares en vías de desarrollo.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Homicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Violencia/estadística & datos numéricos , Conducta Autodestructiva , Demografía , Densidad de Población , Distribución por Edad , Distribución por Sexo , Estudios Retrospectivos , Factores Socioeconómicos , Homicidio/tendencias , Incidencia , Medición de Riesgo , Países en Desarrollo , Probabilidad , Sistema de Registros , Suicidio/tendencias , Trinidad y Tobago/epidemiologíaRESUMEN
HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident.