RESUMEN

OBJECTIVES: To assess the attitude towards voluntary non-remunerated blood donation among blood donors in Trinidad and Tobago (TRT). BACKGROUND: Blood donors in TRT are either family replacement (F/R, 87%) or remunerated (13%). There is chronic blood shortage and high seroreactivity for transfusion-transmissible infections (TTI) in donors. Converting existing to voluntary non-remunerated donors (VNRD) reduces the need to recruit news donors in achieving 100% VNRD. METHODS: A questionnaire-based, cross-sectional survey was conducted at two blood collection centres at an interval of 8 years. Donors were surveyed for sociodemographic characteristics, awareness of the blood shortage, previous donation behaviour, donor-beneficiary linkage if F/R, willingness to become VNRD and choice of motivators for converting to VNRD. RESULTS: A total of 400 and 595 donors respectively participated in Surveys 1 and 2, of whom 92·8 and 86·3% were F/R (P < 0·001), respectively. In both surveys, 52% of participants were unaware of an existing blood shortage (P = 0·983). Only 9·8 and 9·1% of participants expressed unwillingness to become VNRD (P = 0·720). The main motivators to convert to VNRD were reminders from the centre (84%) and extended opening hours (78%) in Survey 1 as compared to confidence that donated blood was used properly (73%) and shortened waiting times to donate (73%) in Survey 2. CONCLUSION: Despite low awareness of blood shortage, willingness to become VNRD was high among existing donors. Accountability and donor convenience underpinned the main motivators for converting to VNRD.

Asunto(s)

Actitud , Donantes de Sangre/psicología , Encuestas y Cuestionarios , Estudios Transversales , Femenino , Humanos , Masculino , Trinidad y Tobago

RESUMEN

OBJECTIVE: To assess whether the Modified Checklist for Autism in Toddlers (M-CHAT) was easily administered in a Guyanese clinic setting and how the findings in Guyana compared to international studies. DESIGN AND METHODS: The M-CHAT was used to screen for Autism Spectrum Disorder (ASD) at 9 Health Centres in Guyana over 1 month. An information session aimed at raising Autism awareness in the community and to inform the parents/guardians attending well child clinic of the purpose of the study was conducted every morning at each clinic. A questionnaire was administered for demographic data and the family’s socioeconomic status was determined using the parent’s education level, occupations and household income. The M-CHAT results were compared to child sex, parental age, parental ethnicity, socioeconomic status, birth order of the child and the child’s age on the date of administration of the test. RESULTS: Data from 415 respondents (parents/guardians) was used for analysis of the children under study (M 210, F 205). 10.6% of the children failed the M-CHAT (M 10.5%, F 10.7% p = 0.93) with 2.3% of these being high risk and 97.7% medium risk for ASD. Of the parameters tested, maternal ethnicity (Afro-Guyanese, p = 0.03) and paternal education (low, p = 0.001) were found to be significant. CONCLUSION: While we were unable to re-test the population to confirm ASD, the trends observed for the M-CHAT were similar to those found in international studies.

Asunto(s)

Cribado de Líquidos , Trastorno Autístico , Guyana

RESUMEN

Hypertension, defined as diastolic pressure ≥ 90 mmHg and systolic pressure ≥ 140 mmHg, is a major cause of morbidity and mortality among black populations globally. Several studies have shown that prolonged consumption of cocoa or cocoa containing products leads to decreased blood pressure (BP) in hypertensives. In this study, we investigated the flavonoid content of the top selling cocoa/cocoa based products in Trinidad and Tobago and attempted to determine if consumption of cocoa had any immediate impact on blood pressure levels. The flavonoid content of three 100% cocoa powder products and four cocoa based formulas was measured using a modified Folin-Ciocalteu procedure. The brand with the highest flavonoid content, 372 gallic acid equivalents, was selected to evaluate the short-term impact of cocoa consumption on blood pressure. Thirty-six participants comprising nineteen hypertensives and seventeen persons with normal blood pressure had their blood pressure recorded on three separate days using ambulatory blood pressure monitors; the blood pressure was recorded every half hour for eight hours. On the first day, the participants received no intervention but on the second and third days, they received either the intervention (5 g cocoa in 125 ml water) or a placebo, in any order. Statistical analysis conducted using t-test statistic and a 95% confidence interval revealed that whether participants regularly took antihypertensive medication or not, a single intervention of cocoa induced decreases in both the diastolic and systolic BPs that were significant (p = 0.0001). Mean decreases of between 8 mmHg and 18 mmHg were observed.

RESUMEN

The study is a retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in hospital and intermediate term follow up results. The mean age of patients was 59 ñ 10 years and 78 percent male. Sixty-four percent were of East Indian descent, whereas, 16 percnt were of Africian descent. Forty-eight percent of the patients were hypertensive, 46 percent were diabetic, 33 percent had hyperlipidaemia, 20 percent had a recent history of cigarette smoking and 16 percent were obese. Sixty-five percent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5 percent of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 ñ 15 percent. Wall motion abnormalities were seen in 67 pecent of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91 percent, 78 percent, 54 percent and 5 percent, respectively. Many patients (67 percent) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 ñ 0.8 days. In hospital mortality was 3.9 percent (8/205). THe most frequent post operative complicaton was haemorrhage (2.6 percent). Acute renal failure occurred in 2.1 percent; pulmonary collapse, 1.6 percent; 1 percent and cardiac arrest , 1 percent. Both sternal wound infections and systemic sepsis occurred in 0.5 percent. Intermediate term follow-up data were obtained for 92 percent (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow up period, 7 patients (3.4 percent) died. Angina severity was reduced from a mean CCS score of 2.61 ñ 0.95 before CABG ot 1.22 ñ 0.55 at the time of follow up (p<0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.(Au)

Asunto(s)

Femenino , Humanos , Masculino , Persona de Mediana Edad , Puente de Arteria Coronaria/estadística & datos numéricos , Enfermedad Coronaria/cirugía , Trinidad y Tobago/epidemiología , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/etnología , Enfermedad Coronaria/clasificación , Enfermedad Coronaria/mortalidad , Estudios Retrospectivos , Diabetes Mellitus Tipo 2/metabolismo , Mortalidad Hospitalaria , Complicaciones Posoperatorias , Calidad de Vida , Angina de Pecho/clasificación , Angina de Pecho/cirugía , Angiografía Coronaria , Puente Cardiopulmonar/instrumentación , Estudios de Seguimiento , Unidades de Cuidados Intensivos , Factores de Riesgo , Tasa de Supervivencia

RESUMEN

The study is retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in-hospital and intermediate-term follow-up results. The mean age of patients was 59 +/- 10 years and 78 were male. Sixty-four per cent were of East Indian descent, whereas 16 were of African descent. Forty-eight per cent of the patients were hypertensive, 46 were diabetic, 33 had hyperlipidaemia, 20 had a recent history of cigarette smoking and 16 were obese. Sixty-five per cent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5 of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 +/- 15. Wall motion abnormalities were seen in 67 of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91, 78, 54 and 5, respectively. Many patients (67) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 +/- 0.8 days. In-hospital mortality was 3.9 (8/205). The most frequent post-operative complication was haemorrhage (2.6). Acute renal failure occurred in 2.1; pulmonary collapse, 1.6; stroke, 1 and cardiac arrest, 1. Both sternal wound infections and systemic sepsis occurred in 0.5. Intermediate-term follow-up data were obtained for 92 (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow-up period, 7 patients (3.4) died. Angina severity was reduced from a mean CCS score of 2.61 +/- 0.95 before CABG to 1.22 +/- 0.55 at the time of follow-up (p < 0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Coronaria , Puente de Arteria Coronaria/estadística & datos numéricos , Calidad de Vida , Trinidad y Tobago , Puente Cardiopulmonar , Estudios Retrospectivos , Factores de Riesgo , Estudios de Seguimiento , Mortalidad Hospitalaria , Enfermedad Coronaria , Unidades de Cuidados Intensivos , Angina de Pecho , Angiografía Coronaria , Complicaciones Posoperatorias , Puente de Arteria Coronaria/mortalidad , Tasa de Supervivencia

RESUMEN

OBJECTIVE: To determine whether Coronary artery bypass grafting (CABG) in Trinidad influenced morbidity and mortality. METHOD: Retrospective review of the demographic, clinical and angiographic data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex, Trinidad, between November 1993 and December 1997. RESULTS: The mean age was 59 ñ 10 years and 74 percent were males. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 69 percent of patients had class 3 or 4 angina (CCS). The mean ejection fraction was 63 ñ 13 percent. Many patients (64 percent) had severe diffuse disease on angiography. The in-hospital mortality was 8/205 (3.9 percent). Follow-up data were obtained for 189/205 (92 percent). The duration of follow-up ranged from 1 to 5 years. During the follow-up period, 7/189 patients. (3.4 percent) died. Angina severity before and after surgery was determined in 174 surviving patients. Angina severity was reduced from a mean CCS score of 2.61 ñ 0.95 before CABG to 1.22 ñ 0.55 after CABG (p<0.0001). CONCLUSION: Overal 4-year mortality compared favourably with data from international studies. Amongst survivors, quality of life improved as evidenced by the reduction in the mean angina score.(AU)

Asunto(s)

Adulto , Persona de Mediana Edad , Anciano , Humanos , Puente de Arteria Coronaria/mortalidad , Angiografía Coronaria/mortalidad , Estudios Retrospectivos , Trinidad y Tobago , Estudios de Seguimiento

RESUMEN

OBJECTIVES: To determine if signed consent for a research project constitutes informed consent in sexually transmitted diseases (STD) clinic attendees who understood the voluntary nature of confidentiality outlined in the consent form. DESIGN AND METHODS: A sexual behaviour research project was conducted by researchers from local institutions in association with investigators from a university in Alabama. This present study was a cross-sectional survey using a 34-item questionnaire administered to a consecutive sample of STD clinic attendees in Port-of-Spain, Trinidad, who had been invited to participate in the sexual behaviour research project. RESULTS: Of the 102 participants, 48 (47.1 percent) persons had read the entire consent form in the sexual behaviour survey. Thirty-eight (37.3 percent) persons reported that they thought the health care they received would be worse if they declined to participate in that study. Subjects with less education were significantly more likely to believe their health care would be negatively affected if they refused to participate (p<0.001). Thirty-nine (38.2 percent) persons believed that they had to complete the sexual behaviour questionnaire in order to be treated at the clinic. Almost two-thirds of respondents thought that their answers to the sexual behaviour questionnaire could be traced back to them by persons other than the interviewers and researchers. CONCLUSIONS: The findings clearly indicate that amongst this population a signed consent form does not constitute informed consent. The process of obtaining truly informed consent for research conducted in this setting requires review.(Au)

Asunto(s)

Humanos , Consentimiento Informado , Enfermedades de Transmisión Sexual , Estudios Transversales , Encuestas y Cuestionarios , Trinidad y Tobago , Investigación sobre Servicios de Salud

RESUMEN

The study is retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in-hospital and intermediate-term follow-up results. The mean age of patients was 59 +/- 10 years and 78% were male. Sixty-four per cent were of East Indian descent, whereas 16% were of African descent. Forty-eight per cent of the patients were hypertensive, 46% were diabetic, 33% had hyperlipidaemia, 20% had a recent history of cigarette smoking and 16% were obese. Sixty-five per cent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5% of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 +/- 15%. Wall motion abnormalities were seen in 67% of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91%, 78%, 54% and 5%, respectively. Many patients (67%) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 +/- 0.8 days. In-hospital mortality was 3.9% (8/205). The most frequent post-operative complication was haemorrhage (2.6%). Acute renal failure occurred in 2.1%; pulmonary collapse, 1.6%; stroke, 1% and cardiac arrest, 1%. Both sternal wound infections and systemic sepsis occurred in 0.5%. Intermediate-term follow-up data were obtained for 92% (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow-up period, 7 patients (3.4%) died. Angina severity was reduced from a mean CCS score of 2.61 +/- 0.95 before CABG to 1.22 +/- 0.55 at the time of follow-up (p < 0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.

Asunto(s)

Puente de Arteria Coronaria/estadística & datos numéricos , Enfermedad Coronaria/cirugía , Angina de Pecho/clasificación , Angina de Pecho/cirugía , Puente Cardiopulmonar/instrumentación , Angiografía Coronaria , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/clasificación , Enfermedad Coronaria/etnología , Enfermedad Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Calidad de Vida , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Trinidad y Tobago/epidemiología

RESUMEN

Coronary artery bypass grafting surgery (CABG) has been recently performed at the Eric Williams Medical Sciences Complex, for the management of patients with coronary artery disease (CAD). This is a review of the joint experience of the Eric WIlliams Medical Sciences Complex/Caribbean Heart Care Venture. Forty-one patients had CABG between November, 1993 and October, 1994. Their ages ranged from 39 to 73 years with mean age 56 years; 28 patients (83 per cent) were male and 7 (17 per cent) were female. Twenty patients (49 per cent) were hypertensive, 16 (39 per cent) were diabetic, 5 had mild pre-operative impairment of renal function, 1 had had previous bypass surgery in 1984 and pre-operatively most patients were using maximal oral therapy for angina control. The indications for surgery were: left main coronary disease (7 per cent), 3-vessel coronary disease with ejection fraction < 50 per cent (12 per cent), unstable or refractory stable angina due to 2-vessel, 3-vessel or proximal left anterior descending coronary disease with good LV function (80 per cent). Left internal mammary artery grafts were used in 68 per cent of patients and saphenous vein grafts in the rest. The mean stay in hospital post-operatively was 9.6 days. Two patients died, both in the early post-operative period. In two patients, in whom complete revascularization was not possible, mild angina occurred during the post-discharge mobilization period. All other patients have been free of angina since discharge. Complications included early re-operation (day 1) for excessive bleeding from the chest drains (1 patient), aortic dissection requiring repair (1 patient), lobar atelectasis requiring prolonged physiotherapy (4 patients), pneumonia (1 patient), severe transient post-pericardiotomy syndrome (1 patient) and peroneal nerve palsy (1 patient) (AU)

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Puente de Arteria Coronaria/estadística & datos numéricos , Resultado del Tratamiento