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INTRODUCTION: Peripheral arterial disease (PAD) indicates generalised atherosclerotic disease but is often asymptomatic. The prevalence and potential risk factors of PAD were studied in ECHORN cohort study participants. METHODS: Representative samples of community-dwelling people ≥40 years of age residing in Barbados, Puerto Rico, Trinidad, and the USVI were recruited. The survey included questions on diabetes, hypertension, heart disease and smoking status. Body Mass Index, HbA1c, blood glucose and lipids were determined. Ankle brachial index (ABI) was evaluated in one leg. An oscillometric device measured arm and leg systolic BP simultaneously. ABI classifications were PAD ≤0.90, borderline 0.91 to 0.99, normal 1.00 to 1.40, and non-compressible >0.40. Multivariable logistic regression tested associations of potential risk factors with PAD. RESULTS: Of 2772 participants (mean age 57.3, 65.2% female), 35.8% were overweight, 38.1% obese, 32.4% had diabetes, 60% hypertension, and 15.4% reported heart. ABI prevalence (95% CI) by category was PAD 4.4% (3.6%, 5.1%), borderline 5.2% (4.4%, 6.1%), normal 87.0% (85.8%, 88.3%) and noncompressible 3.4% (2.7%, 4.0%). Female sex (OR 1.72, 95% CI 1.07 to 2.77), diabetes (OR 2.23, 95% CI 1.47 to 3.4), heart disease history (OR 1.74, 95% CI 1.07 to 2.83) and less than high school education vs having a university degree (OR 2.49, 95% CI 1.19 to 5.22) were independently associated with PAD. CONCLUSIONS: Testing one leg only would underestimate PAD prevalence. Increasing the ABI cutoff for identifying PAD to <1.0 when using oscillometric devices is suggested by some studies but would more than double the estimated prevalence. Guidelines need to address this issue. Female sex and lower educational attainment are important considerations when screening. While diabetes and a history of heart disease were confirmed as risk factors, the lack of association of increasing age and cigarette smoking with PAD was unexpected.
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Enfermedad Arterial Periférica , Humanos , Femenino , Masculino , Enfermedad Arterial Periférica/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Prevalencia , Anciano , Estudios de Cohortes , Índice Tobillo Braquial , Adulto , Región del Caribe/epidemiología , Hipertensión/epidemiologíaRESUMEN
BACKGROUND: Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS: Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS: Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION: We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.
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Trastornos Relacionados con Alcohol , Alcoholismo , Consumo Excesivo de Bebidas Alcohólicas , Humanos , Femenino , Anciano , Persona de Mediana Edad , Masculino , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Consumo Excesivo de Bebidas Alcohólicas/psicología , Estudios de Cohortes , Prevalencia , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Alcoholismo/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Puerto Rico/epidemiologíaRESUMEN
Background: Globally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort. Methods: A cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses. Results: More than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women. Discussion: The prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort.
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Inseguridad Alimentaria , Abastecimiento de Alimentos , Masculino , Adulto , Humanos , Femenino , Factores Socioeconómicos , Estudios Transversales , Estudios de Cohortes , Estudios Longitudinales , Factores de Riesgo , Puerto Rico/epidemiologíaRESUMEN
BACKGROUND: Preconception care (PCC) is the term used for activities and interventions designed to address and prevent problems related to pregnancy, the neonatal period and childhood. This study assessed maternal health status prior to conception in Trinidad by means of a screening tool, physical measurements, and laboratory samples. METHODS: A cross-sectional study was conducted among women aged 18-45 years at a primary care centre in Arima, Trinidad. A de novo PCC screening tool was used to assess 13 domains of high-risk pregnancy in participants. These domains included dietary details, gynaecological and obstetric histories, and genetic and vaccination histories, among others. Blood pressure, weight, height, and waist circumference were recorded, and a capillary blood sample was used to determine random blood glucose and HbA1c levels. All data were coded and entered into SPSS ver. 21. RESULTS: A total of 400 nongravid participants were recruited, of whom 366 were included in the final analysis. Most (96.7%) had one or more risk factors for adverse pregnancy outcomes. These included overweight (27%), obesity (35%), central obesity (69.4%), and impaired glucose tolerance/diabetes mellitus (IGT/DM) (26.2%). Additionally, a sedentary lifestyle and diet high in processed food/fats were self-reported by 74.9% and 88.8% of participants, respectively. Only 13.1% had planned to conceive, and of those who had no immediate plans to conceive, 76.4% were currently sexually active, and many (60.7%) did not use birth control techniques. More than half (57.1%) had never had a pap smear. On the other hand, 86.3% knew their HIV status. Self-reported percentages for vaccination were as follows: MMR (100%), tetanus (17.5%), hepatitis B (11.5%) and influenza (2.7%). The majority (82.8%) of participants had not visited the dentist in the past year, with 35.9% of these individuals reporting symptoms of periodontitis. Segments of the population had multiple risk factors; for example, 23.7% of participants were overweight or obese and had an elevated HbA1c level. CONCLUSIONS: Unexpectedly, most participants had a risk factor for an adverse pregnancy outcome, and many had multiple risk factors. There is a strong case for enhanced preconception care for women in Trinidad.
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Sobrepeso , Atención Preconceptiva , Adulto , Persona de Mediana Edad , Adulto Joven , Estudios Transversales , Hemoglobina Glucada , Obesidad/epidemiología , Trinidad y Tobago/epidemiología , Humanos , FemeninoRESUMEN
BACKGROUND: The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement. METHOD: A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12. RESULTS: There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025). CONCLUSION: Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.
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Enfermedades no Transmisibles , Humanos , Femenino , Anciano , Masculino , Estudios Transversales , Trinidad y Tobago/epidemiología , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Satisfacción del Paciente , Derivación y Consulta , Atención Primaria de Salud , Atención Dirigida al PacienteRESUMEN
OBJECTIVE: Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean. DESIGN: SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations. SETTING: Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis. PARTICIPANTS: Participants (n 1701) enrolled in the ECS. RESULTS: Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)). CONCLUSIONS: Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean.
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Diabetes Mellitus Tipo 2 , Bebidas Azucaradas , Masculino , Humanos , Bebidas Azucaradas/efectos adversos , Estudios de Cohortes , Bebidas Gaseosas , Azúcares , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etiología , Puerto Rico/epidemiologíaRESUMEN
Noncommunicable diseases (NCDs) account for a higher proportion of mortality and morbidity in the Caribbean and US territories-majority-minority communities-than in the United States or Canada. Strategies to address this disparity include enhancing data collection efforts among racial/ethnic communities. The ECHORN Cohort Study (ECS), a regional adult cohort study, estimates prevalence and assesses risk factors for NCDs in two United States territories and two Caribbean islands. Here, we describe the cohort study approach, sampling methods, data components, and demographic makeup for wave one participants. We enrolled ECS participants from each participating island using random and probability sampling frames. Data components include a clinical examination, laboratory tests, a brief clinical questionnaire, and a self-administered health survey. A subset of ECS participants provided a blood sample to biobank for future studies. Approximately 2961 participants were enrolled in wave one of the ECS. On average, participants are 57 years of age, and the majority self-identify as female. Data from the ECS allow for comparisons of NCD outcomes among racial/ethnic populations in the US territories and the US and evaluations of the impact of COVID-19 on NCD management and will help highlight opportunities for new research.
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Enfermedades no Transmisibles , Adulto , Femenino , Humanos , Región del Caribe/epidemiología , Estudios de Cohortes , Evaluación de Resultado en la Atención de Salud , Encuestas y Cuestionarios , Estados Unidos , Indias Occidentales , Masculino , Persona de Mediana EdadRESUMEN
AIMS: To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS: Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS: Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION: There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.
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Enfermedades Cardiovasculares , Diabetes Mellitus , Adulto , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Estudios de Cohortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Control Glucémico , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Evaluación de Resultado en la Atención de Salud , Puerto Rico , Factores de RiesgoRESUMEN
Little has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.
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COVID-19 , Certificación , Educación de Postgrado en Medicina/organización & administración , Evaluación Educacional , Medicina Familiar y Comunitaria/educación , Médicos de Familia/normas , Rendimiento Académico , COVID-19/epidemiología , COVID-19/prevención & control , Certificación/métodos , Certificación/normas , Evaluación Educacional/métodos , Evaluación Educacional/estadística & datos numéricos , Escolaridad , Tecnología Educacional/métodos , Humanos , Evaluación de Necesidades , SARS-CoV-2 , Enseñanza/normas , Enseñanza/tendencias , Indias OccidentalesRESUMEN
BACKGROUND: Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. METHODS: Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. RESULTS: Mean age (SD) of participants (n = 1617) was 56.6 years (±10.2), 64% were women, 74% were overweight/obese, and 24% had an ASCVD risk score above 10%. Elevated body mass index (BMI, > 30 kg/m2) and waist circumference were not associated with CVD risk. Elevated waist-to-hip ratio (WHR, > 0.9 men, > 0.85 women) and elevated waist-to-height ratio (> 0.5) were associated with all three categories of CVD risk. Area under the receiver curve was highest for WHR for each category of CVD risk. Elevated WHR demonstrated odds of 2.39, 2.58, and 3.32 (p < 0.0001) for CVD risk of > 7.5, > 10 and > 20% respectively. CONCLUSION: Findings suggest that WHR is a better indicator than BMI of obesity-related CVD risk and should be used to target adults in the Caribbean, and of Caribbean-descent, for interventions.
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Enfermedades Cardiovasculares , Adulto , Barbados , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Evaluación de Resultado en la Atención de Salud , Puerto Rico , Factores de Riesgo , Trinidad y Tobago , Circunferencia de la Cintura , Relación Cintura-CaderaRESUMEN
BACKGROUND: Palliative care is in its infancy in most of the developing world. We set out to explore the lived experiences of families and caregivers of recently deceased cancer patients in Trinidad and Tobago and to determine the unmet needs of the patients and what recommendations could be derived to improve the current services. METHODS: A phenomenological approach with purposeful sampling was used. Participants were referred by key health professionals. Face-to-face interviews were conducted. Interviews were transcribed verbatim, with analysis and data collection occurring concurrently. Thematic content analysis was used to determine common domains, themes and sub-themes. RESULTS: Interviews were completed with 15 caregivers. All were spouses or children of the deceased. Ages of the deceased ranged from 43 to 93, the average being 65.5 years. The deceased experienced a variety of cancers including lung, colorectal and oesophageal. Unmet needs were identified under 4 domains of institutions, community, the family unit and the wider society. Institutional unmet needs were delayed diagnosis and treatment and poor inter-institution coordination. Medical and nursing care failed in the areas of health care providers' attitudes, pain management and communication. The family unit lacked physical and psychosocial support for the caregiver and financial aid for the family unit. Societal needs were for public education to address myths and cultural beliefs around cancer. CONCLUSION: There is need for systemic interventions to improve the care of those dying from cancer in Trinidad and Tobago. Stakeholders need to commit to palliative care as a public health priority, implementing education, planning services and mobilizing community resources.
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Cuidadores/psicología , Evaluación de Necesidades/normas , Neoplasias/psicología , Adulto , Anciano , Anciano de 80 o más Años , Cuidadores/tendencias , Femenino , Humanos , Entrevistas como Asunto/métodos , Persona de Mediana Edad , Evaluación de Necesidades/estadística & datos numéricos , Neoplasias/complicaciones , Neoplasias/epidemiología , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , Cuidados Paliativos/normas , Investigación Cualitativa , Apoyo Social , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: Over 60% of households (HHs) in Trinidad and Tobago (T&T) consume alcohol. These HHs were more likely to report illnesses, relationship problems, and behavioral problems with children. This study set out to determine what proportion of HHs were willing to support changes in specific policies, laws and regulations in a national alcohol campaign. METHODS: A cross-sectional convenience sample of HHs were surveyed from a random sample of enumeration districts (ED) in T&T. An interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after an extensive literature review and consultation. Many of the WHO 'best buys' recommendations were included. RESULTS: One thousand six hundred ninety-five HHs (from 53 ED) responded from a total of 1837 HHs approached (response rate 92%). In a national campaign the following proportions of HHs would support: setting the legal age for drinking at 21 years (82.4%); restricting or banning alcohol advertising on TV and other media (73.1% and 54.4% respectively); banning all alcohol advertising at sports and cultural events (64.8%); banning radio stations playing songs with reference to alcohol use (71.3%); holding sellers of alcohol responsible for the amount of alcohol sold (79.5%); advocating that proof of age to be shown by persons buying alcohol (87.4%); placing more prominent warning labels on products displaying alcohol content (87.2%); placing more prominent warning labels on products showing harmful effects (88.5%); increasing taxes on alcohol sales (87.7%). Less than 50% of HH supported restrictions in density of outlets and reduction in opening times for alcohol outlets. CONCLUSIONS: Many HHs in T&T are willing to support changes in policies around alcohol, including many of the policies shown by the WHO to be effective in reducing the harmful consumption of alcohol.
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Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Consumo de Bebidas Alcohólicas/prevención & control , Opinión Pública , Política Pública , Adulto , Publicidad/legislación & jurisprudencia , Consumo de Bebidas Alcohólicas/epidemiología , Bebidas Alcohólicas/economía , Estudios Transversales , Composición Familiar , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Impuestos/economía , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: Patients with normal weight obesity (NWO) have a normal body mass index (BMI) but elevated body fat percentage (BF%), thereby increasing their risk of cardiovascular and metabolic disorders. The purpose of this research was to determine the prevalence of NWO and its associated factors in a sample of young adults in Trinidad and Tobago (T&T). METHODS: A cross sectional study involving a convenience non-voluntary sample of participants with a normal BMI of 18.5-24.9 kg/m2 was conducted. The following information was collected: history, basic anthropometric measurements, including BF% via the Tanita Ironman Body Composition Analyzer (BC554), physical examination and basic blood investigations. Participants were divided into two groups; normal BF% (<23.1% males, <33.3% females) and elevated BF% (≥23.1% males, ≥33.3% females). RESULTS: Two hundred and thirty-six students participated, F:M (2.1:1), aged 18-28 years [Mean 21.33 (SD 2.5)], mean BMI 21.66 (SD 1.9). A response rate of 80.3%. The prevalence of NWO for this population was 19.9% [95% confidence interval (CI) 15.1-25.7]. Males 14.4% (95% CI 10.3-19.7) and females 5.5% (95% CI 3.1-9.5). Variables with a statistically significant association with NWO included gender, waist circumference, waist-to-hip ratio (WHR), systolic blood pressure (BP), the ratio of total cholesterol (TC) to high density lipoprotein and in females, the presence of polycystic ovarian syndrome (PCOS) (p<0.05). Binary logistic regression revealed that predictors of NWO were male gender and waist circumference. CONCLUSIONS: One in five of this young adult population was found to have NWO. Long-term studies are recommended to study the full implications of these findings.
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Obesidad/epidemiología , Adolescente , Adulto , Antropometría , Presión Sanguínea , Índice de Masa Corporal , Peso Corporal , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Prevalencia , Factores de Riesgo , Distribución por Sexo , Estudiantes , Encuestas y Cuestionarios , Trinidad y Tobago/epidemiología , Universidades , Adulto JovenRESUMEN
Context and background: To describe the Family Medicine (FM) postgraduate training programme at the University of the West Indies (UWI). Actions and activities: This paper was created through a review of documents, and discussions with past and present coordinators and key stakeholders at four campuses in the English-speaking Caribbean (ESC). LESSONS LEARNED: Despite intermittent setbacks the FM programme in the ESC has grown due to: (1) The presence of an umbrella institution in the UWI. (2) The role of the Caribbean College of Family Physicians providing a unifying force of advocacy and cooperation. (3) Collaboration of staff across four sites despite large distances, differing departmental and campus structures and financial models; and varying levels of local medical and public health support. (4) The use of a modular design for academic content, which means that students have comparable learning experiences. (5) Streamlining of exit examinations, thus sharing resources in the assessment process. (6) A strong presence of FM in the undergraduate curriculum. CONCLUSIONS: Despite a variety of timelines in programme development and funding mechanisms, over 150 physicians have graduated in FM in the past five years. We identify the unifying strategies and institutions which made this possible and present this model as an option for new programmes in the developing world.
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Educación de Postgrado en Medicina/organización & administración , Educación de Postgrado en Medicina/normas , Medicina Familiar y Comunitaria/educación , Curriculum , Humanos , Facultades de Medicina/organización & administración , Facultades de Medicina/normas , Indias OccidentalesRESUMEN
BACKGROUND: To describe the prevalence of missing teeth, use of bridges and dentures and unmet dental needs among those aged 60 years and above. The associations of these conditions with socio-demographics, type 2 diabetes mellitus and depression were also studied. The work was carried out in 7 Latin American and Caribbean (LAC) cities in 1999-2000. METHODS: A secondary analysis was conducted on the Survey of Health and Well-Being of Elders (SABE) dataset. The 7 cities were Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. This survey did not employ any oral examinations. Descriptive statistics, chi-square and regression analysis were used to test for associations. RESULTS: Data for 10 902 persons were analyzed. Females made up 62% of the population. Across the SABE population, between 93.7% (Mexico City) to 99.9% (Santiago) reported missing teeth, with an average of 97.5%. Of those with missing teeth, between 55.1% (Mexico City) and 82.4% (São Paulo) reported having bridges or dentures, with an average of 70.1% across all SABE cities. The proportion of the SABE population with 'unmet dental needs' ranged from 85.8% (Santiago) to 98.4% (Havana), with an average of 94.5%. Bridgetown, São Paulo and Mexico City demonstrated a statistically significant association between aging and tooth loss. Generally a greater proportion of females (97.6%) reported tooth loss compared with males (96.8%), but in only São Paulo and Montevideo was there a statistically significant association between sex and tooth loss. Generally those with higher education reported less tooth loss, primary education (97.6% had tooth loss), secondary (96.8%) and tertiary (94.7%). All the SABE cities except Buenos Aires demonstrated a statistically significant association between tooth loss and education. CONCLUSIONS: The prevalence of missing teeth, use of bridges and dentures and unmet dental needs were high in the SABE cities in 1999-2000. In general across the SABE cities, the elderly with the most missing teeth were less educated or less likely to be a professional. They tended to be not working and were receiving a pension. Additionally they were less likely to report their health as 'excellent', were diabetic and were more likely to give responses suggestive of depression.
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Dentadura Completa/estadística & datos numéricos , Dentadura Parcial/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Pérdida de Diente/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Región del Caribe/epidemiología , Estudios Transversales , Depresión/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Escolaridad , Empleo/estadística & datos numéricos , Femenino , Humanos , América Latina/epidemiología , Masculino , Estado Civil , Persona de Mediana Edad , Evaluación de Necesidades/estadística & datos numéricos , Ocupaciones/estadística & datos numéricos , Pensiones/estadística & datos numéricos , Factores Sexuales , Factores Socioeconómicos , Salud Urbana/estadística & datos numéricosRESUMEN
BACKGROUND: Previous studies have demonstrated poor metabolic and blood pressure control in the diabetic population in Trinidad. The aim of this study is to compare baseline and follow-up metabolic parameters and blood pressures taken within a 16-month period to ascertain if there have been improvements. METHOD: A retrospective chart review was conducted of diabetic patients at the Siparia and Erin health facilities in 2012. To be eligible, charts had to contain two point-of-care values of HbA1c, Total Cholesterol (TC), Triglycerides (TG), Low Density Lipoproteins (LDL), systolic and diastolic blood pressure (BP), and weight measurements taken within a 16-month period with at least an 8-month interval from the initial to the final testing. Comparisons were made with the Caribbean Health Research Council (CHRC) guidelines to determine clinical significance. RESULTS: 253 patients from Siparia and 68 from Erin were studied. At Siparia there was a statistically significant change in TG, LDL and diastolic BP, with TG levels actually worsening (p<0.05). At Erin there was a statistically significant change in HbA1c, LDL and diastolic BP. At neither site did these changes achieve clinical significance. There were statistically significant differences between the means of HbA1c and systolic BP by age, but not by gender or ethnicity. On comparing the outcomes between the two health facilities, there were no statistically significant differences between them. When compared with the recommendations by the CHRC, only for the TC was the guideline level achieved. CONCLUSION: Despite heavy investment in primary care centers, there continues to be little success in achieving metabolic and BP control for diabetic patients in Trinidad.
Asunto(s)
Presión Sanguínea/fisiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Trinidad y Tobago , Adulto JovenRESUMEN
BACKGROUND: Our previous work has shown that type 2 diabetes mellitus is a problem in the school-aged population of Trinidad, West Indies. The current study evaluated the prevalence in this population of selected risk factors for diabetes, viz: obesity, family history of diabetes and acanthosis nigricans. OBJECTIVE: To assess the prevalence of the following risk factors for type 2 diabetes (T2DM) in school children in Trinidad: obesity, family history of diabetes in first- or second-degree relatives and the presence of acanthosis nigricans (AN). METHODS: A cross-sectional survey was performed among school children aged 7-18 years from September 2009 to June 2010. A convenience sample was selected from a random sample of 32 schools drawn from all educational districts. A self-administered questionnaire was employed to record family history, gender and ethnicity. AN was assessed and scored clinically at the neck and obesity was measured by anthropometry and bio-impedance. RESULTS: There were 2130 participants in the study. Fifteen per cent were obese and 17% were overweight. Primary school children had a higher prevalence of obesity (22·9% vs 11·0%) and overweight (20·0% vs 15·6%) than secondary school children (P<0·05). A greater proportion of males than females had combined overweight/obesity as measured by BMI for age (35·8 vs 29·4%, P<0·05). The overall prevalence of AN was 43·4%. However, just over 18% of all school children have a degree of AN greater than grade 2, which clinically is readily recognisable. Females displayed this physical sign more commonly than males (P<0·05). The prevalences of a family history of diabetes in first- and second-degrees relatives were 11·0% and 1·1%, respectively. Forty-three per cent had one risk factor for diabetes, 23·1% had two and 2·9% had three. CONCLUSION: Risk factors for T2DM are very common among school children in Trinidad. More than 40% had at least one risk factor. Strategies aimed at reducing risk factors for T2DM, especially obesity, among Trinidadian school children are urgently warranted.
Asunto(s)
Acantosis Nigricans/epidemiología , Diabetes Mellitus Tipo 2/etiología , Obesidad/epidemiología , Acantosis Nigricans/complicaciones , Adolescente , Antropometría , Niño , Medicina Clínica/métodos , Estudios Transversales , Demografía , Salud de la Familia , Femenino , Humanos , Masculino , Anamnesis , Obesidad/complicaciones , Prevalencia , Distribución Aleatoria , Factores de Riesgo , Encuestas y Cuestionarios , Trinidad y Tobago/epidemiologíaRESUMEN
OBJECTIVE: The objective of the present study was to determine the knowledge and practices among Trinidad and Tobago school-attending adolescents towards energy drinks (ED), alcohol combined with energy drinks (AwED), weight-altering supplements (WAS) and vitamin/mineral supplements (VMS) and their experience of adverse effects associated with such use. DESIGN: A cross-sectional, proportionate, stratified sampling strategy was adopted using a self-administered, de novo questionnaire. SETTING: Secondary schools throughout Trinidad and Tobago. SUBJECTS: Students aged 15-19 years. RESULTS: Five hundred and sixty-one students participated, an 84% response rate; 43·0% were male, 40·5% East Indian and 34·1% mixed race. VMS, ED, WAS and anabolic steroids were used by 52·4%, 44·0%, 8·9% and 1·4% of students, respectively, with 51·6% of ED users using AwED. Predictors of use of AwED were males and students who played sport for their school (OR = 1·9; 95% CI 1·2, 3·2 and OR = 2·6; 95% CI 1·4, 4·7, respectively). Predictors of ED use were males and attendees of government secondary schools (OR = 1·7; 95% CI 1·1, 2·4 and OR = 1·7; 95% CI 1·2, 2·4, respectively). Side-effects, mainly palpitations, headaches and sleep disturbances, were reported in 20·7% of dietary supplement users. CONCLUSIONS: Many adolescent students in Trinidad and Tobago use dietary supplements, including ED and AwED, and about one-fifth of users experience side-effects. Identification of students at risk for ED, AwED and WAS use and education of students about the dangers of using dietary supplements need to be instituted to prevent potential adverse events.
Asunto(s)
Fenómenos Fisiológicos Nutricionales de los Adolescentes , Fármacos Antiobesidad/administración & dosificación , Bebidas , Suplementos Dietéticos , Ingestión de Energía , Conocimientos, Actitudes y Práctica en Salud , Micronutrientes/administración & dosificación , Adolescente , Fenómenos Fisiológicos Nutricionales de los Adolescentes/etnología , Adulto , Fármacos Antiobesidad/efectos adversos , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etnología , Arritmias Cardíacas/etiología , Atletas , Bebidas/efectos adversos , Estudios Transversales , Suplementos Dietéticos/efectos adversos , Ingestión de Energía/etnología , Femenino , Cefalea/epidemiología , Cefalea/etnología , Cefalea/etiología , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Incidencia , Masculino , Micronutrientes/efectos adversos , Encuestas Nutricionales , Instituciones Académicas , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/etnología , Trastornos del Sueño-Vigilia/etiología , Trinidad y Tobago/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Intra-lesional glucocorticosteroid (GCS) injections are used widely for painful musculoskeletal conditions in general practice. CASE: A 26 year old female, was given an intra-lesional injection of 24 mg methyl prednisolone acetate (MPA) with 15 mg lidocaine for treatment of DeQuervain's tenosynovitis. She was six weeks postpartum and predominantly breast feeding. Lactation was suppressed at approximately 30 h post injection and this persisted for a period of approximately 36 h before spontaneous resumption of milk production. Lactation returned to normal 90 h after the injection. DISCUSSION: Studies done in lactating animals have shown that injected GCS have led to a reduction of milk production, but there is limited data on these injections in lactating humans. The dose of GCS administered and the site of the GCS injection appear to contribute to this phenomenon. Very large doses of GCS have caused suppression of lactation in humans as opposed to low doses of GCS. Injections of GCS into areas of the body subjected to high activity level like the knee or wrist could lead to greater systemic absorption of GCS than GSC administered to body sites with lower physical activity like the shoulder. CONCLUSION: Local injection of MPA reversibly suppressed lactation in a young woman for a period of 24-48 h. Doctors using injectable GCS in lactating women should apprise patients of this possibility. Mothers can take precautions like expressing and storing enough breast milk to cover this period prior to receiving these injections.