RESUMO
OBJECTIVE: Healthcare professionals in the Caribbean today know very little about these drug-herb interactions of the popular West Indian medicinal herb practices linked to the immigrants from West Africa and India, and to the indigenous Amerindians. It is the intent of this project to produce a database which comprehensively summarizes indications and possible drug-herb interactions of these plants. METHOD: Using the database programme Epi Info 3.5.1, one hundred and eighty-three herbs used in the Caribbean as medicine by locals have been entered into the West Indian Drug Herb Interaction Database version 0.06 (WIDHID 0.06). RESULTS: A range of one to three common names have been entered with the family and scientific name of each herb, in addition to a range of one to six conditions/illnesses for which a particular plant was to be used as a medicinal herb. One to four bioactive compounds have been made to correlate with the typical herbal preparation methods and toxicity. Thirty of the most common and popular herbs have been researched for their drug herb interactions. CONCLUSION: West Indian Drug Herb Interaction Database version 0.06 for the first time allows easy access to Caribbean ethno-medicinal plant cures with their possible drug-herb interactions reference sources, a feature often absent although so important. In addition, WIDHID 0.06 will support pharmaco-epidemiological studies in the field. It will also ensure future public access to ethno-medicinal information through developed web pages or programmes.
Assuntos
Bases de Dados Factuais , Extratos Vegetais/efeitos adversos , Plantas Medicinais/efeitos adversos , Região do Caribe , Interações Medicamentosas , Extratos Vegetais/uso terapêuticoRESUMO
The luteinizing hormone (LH) receptor is fundamental for the regulation of the corpus luteum (CL) in women and non-human primates. Its ligands, LH and human chorionic gonadotropin (hCG), have key roles in the regulation of tissue and vascular remodeling associated with luteal formation and regression. However this remodeling involves the regulation of cells that do not express LH receptors including endothelial cells, pericytes, fibroblasts and macrophages. We have taken a candidate molecule approach to identify important LH/hCG-regulated paracrine molecules and their receptors in CL and assess the effects of their manipulation in vivo and in vitro. Vascular endothelial growth factor (VEGF) acts on endothelial cells and is a major paracrine regulator of luteal angiogenesis and vasculature maintenance. Luteolysis is associated with increased SLIT/ROBO, connective tissue growth factor (CTGF) and matrix metalloproteinase (MMP) expression in luteal fibroblasts. Investigation of the inhibition of these changes by hCG has identified activin A as a novel paracrine luteolysin and locally generated cortisol as a novel paracrine luteotropin. The molecular regulation of luteal function in the primate is complex and the paracrine regulation of luteal function is still not fully understood. Locally, the luteolytic activities of SLIT/ROBO and activin-A are inhibited by hCG and the luteotropic activities of VEGF and cortisol are stimulated by hCG.
Assuntos
Feminino , Animais , Fator A de Crescimento do Endotélio Vascular/fisiologia , Gonadotropina Coriônica/efeitos adversos , Gravidez/fisiologia , Luteinização/fisiologia , Receptores do LH/metabolismo , Hormônio Luteinizante/fisiologia , Luteólise/fisiologia , Neovascularização Fisiológica/fisiologiaRESUMO
The luteinizing hormone (LH) receptor is fundamental for the regulation of the corpus luteum (CL) in women and non-human primates. Its ligands, LH and human chorionic gonadotropin (hCG), have key roles in the regulation of tissue and vascular remodeling associated with luteal formation and regression. However this remodeling involves the regulation of cells that do not express LH receptors including endothelial cells, pericytes, fibroblasts and macrophages. We have taken a candidate molecule approach to identify important LH/hCG-regulated paracrine molecules and their receptors in CL and assess the effects of their manipulation in vivo and in vitro. Vascular endothelial growth factor (VEGF) acts on endothelial cells and is a major paracrine regulator of luteal angiogenesis and vasculature maintenance. Luteolysis is associated with increased SLIT/ROBO, connective tissue growth factor (CTGF) and matrix metalloproteinase (MMP) expression in luteal fibroblasts. Investigation of the inhibition of these changes by hCG has identified activin A as a novel paracrine luteolysin and locally generated cortisol as a novel paracrine luteotropin. The molecular regulation of luteal function in the primate is complex and the paracrine regulation of luteal function is still not fully understood. Locally, the luteolytic activities of SLIT/ROBO and activin-A are inhibited by hCG and the luteotropic activities of VEGF and cortisol are stimulated by hCG.(AU)
Assuntos
Animais , Feminino , Receptores do LH/metabolismo , Luteinização/fisiologia , Gonadotropina Coriônica/efeitos adversos , Fator A de Crescimento do Endotélio Vascular/fisiologia , Gravidez/fisiologia , Hormônio Luteinizante/fisiologia , Luteólise/fisiologia , Neovascularização Fisiológica/fisiologiaRESUMO
SETTING: One hundred and twenty-six public health centers and laboratories in Lima, Peru, without internet. BACKGROUND: We have previously shown that a personal digital assistant (PDA) based system reduces data collection delays and errors for tuberculosis (TB) laboratory results when compared to a paper system. OBJECTIVE: To assess the data collection efficiency of each system and the resources required to develop, implement and transfer the PDA-based system to a resource-poor setting. DESIGN: Time-motion study of data collectors using the PDA-based and paper systems. Cost analysis of developing, implementing and transferring the PDA-based system to a local organization and their redeployment of the system. RESULTS: Work hours spent collecting and processing results decreased by 60% (P < 0.001). Users perceived this decrease to be 70% and had no technical problems they failed to fix. The total cost and time to develop and implement the intervention was US$26092 and 22 weeks. The cost to extend the system to cover nine more districts was $1125 and to implement collecting patient weights was $4107. CONCLUSION: A PDA-based system drastically reduced the effort required to collect TB laboratory results from remote locations. With the framework described, open-source software and local development, organizations in resource-poor settings could reap the benefits of this technology.
Assuntos
Computadores de Mão/economia , Coleta de Dados/economia , Coleta de Dados/métodos , Tuberculose/diagnóstico , Custos e Análise de Custo , Países Desenvolvidos , Humanos , PeruRESUMO
Health and Human Resources (HHR) are very important issues to be considered in healthcare services. While various factors may be of greater significance in one area depending on resources, priorities and stage of economic development, a robust HHR plan is important in all cases. There are many factors such as demographic shifts, changing delivery models, consumer expectations, global shortages and financial restraints that must be considered in proper HHR planning. This manuscript summarizes some of the factors that should be considered and some of the short comings of current HHR planning approaches. Based on our review and experience, we developed a framework for HHR planning and apply the framework to Barbados to try to identify the existing challenges and issues and potential areas for staff and training investments.
Assuntos
Recursos em Saúde/organização & administração , Modelos Organizacionais , Barbados , Canadá , Planejamento em Saúde Comunitária , Economia , Mão de Obra em Saúde/organização & administração , Humanos , Médicos/estatística & dados numéricos , Índias OcidentaisRESUMO
The University of the West Indies was founded at Mona, Jamaica, in 1948. After fifty-two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper.
Assuntos
Humanos , Avaliação Educacional/métodos , Avaliação Educacional/normas , Competência Clínica , Faculdades de Medicina , Índias OcidentaisRESUMO
The University of the West Indies has had a major impact on the provision of health care and the health of Caribbean nations over the last 50 years, through undergraduate, postgraduate and continuing medical education, research, outreach and public service. These roles are fully accepted, and the Faculties of Medical Sciences and School of Clinical Medicine and Research have provided most of the doctors now serving the English-speaking Caribbean, including academic leaders and chief medical officers. The design of a curriculum to produce doctors "designed" for the region has been a well-articulated goal, and the need to carry out relevant and essential national health research is now accepted. But the broader roles of ensuring translation of research into policy and practice, and developing effective ways of promoting on-going continuing training and behaviour change are far from understood or seriously attempted. Communication of research findings and evidence-based practice is crucial. The West Indian Medical Journal clearly has a valuable role to play here and this requires expansion and support. But a multi-faceted approach to communicating research findings and translating evidence into policy, planning and care is necessary. One possible approach would be a University Unit of Health Policy Research and Development.
Assuntos
Faculdades de Medicina/tendências , Pesquisa sobre Serviços de Saúde/tendências , Política de Saúde , Política de Saúde/tendências , Atenção à Saúde/tendências , Educação Médica/tendências , Faculdades de Medicina/organização & administração , Índias OcidentaisRESUMO
OBJECTIVE: To determine if 1) Afro-Caribbean women prefer large body sizes, 2) the body size preference of Afro-Caribbean men and women are associated, 3) women's preferences are associated with increased risk of obesity or with weight management behaviors. DESIGN: Population samples of 314 and 487 women, ages 20-55 years, were recruited on Barbados and Dominica with response rates of 74% and 77%, respectively. Body size preferences, stress related variables, and demographic data were ascertained by questionnaire. Height and weight were also measured. On Barbados, body preference data were collected from male partners of participants, and data on intentions to perform weight management behaviors were collected from 175 women. RESULTS: Most women preferred body sizes within normal limits, although women on Dominica had a slightly larger ideal body size (IBS) than did Barbadian women (P<.05). On both islands, the size that women thought men preferred was related to their IBS (P<.0001). Likewise, IBS was associated with increased odds of being overweight (P<.001), however most overweight women (>75%) wanted to be smaller. IBS was not related to the intention to exercise or to eat high fat foods. CONCLUSIONS: It is unlikely that body size preference poses a barrier to intervention efforts to reduce the prevalence of overweight in Afro-Caribbean women.
Assuntos
Constituição Corporal/etnologia , Promoção da Saúde , Obesidade/epidemiologia , Adulto , África/etnologia , Barbados/epidemiologia , Imagem Corporal , Índice de Massa Corporal , Dominica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Parceiros Sexuais , Redução de PesoRESUMO
The University of the West Indies has had a major impact on the provision of health care and the health of Caribbean nations over the last 50 years, through undergraduate, postgraduate and continuing medical education, research, outreach and public service. These roles are fully accepted, and the Faculties of Medical Sciences and School of Clinical Medicine and Research have provided most of the doctors now serving the English-speaking Caribbean, including academic leaders and chief medical officers. The design of a curriculum to produce doctors "designed" for the region has been a well-articulated goal, and the need to carry out relevant and essential national health research is now accepted. But the broader roles of ensuring translation of research into policy and practice, and developing effective ways of promoting on-going continuing training and behaviour change are far from understood or seriously attempted. Communication of research findings and evidence-based practice is crucial. The West Indian Medical Journal clearly has a valuable role to play here and this requires expansion and support. But a multi-faceted approach to communicating research findings and translating evidence into policy, planning and care is necessary. One possible approach would be a University Unit of Health Policy Research and Development.
Assuntos
Atenção à Saúde/tendências , Política de Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Faculdades de Medicina/tendências , Educação Médica/tendências , Faculdades de Medicina/organização & administração , Índias OcidentaisRESUMO
The University of the West Indies was founded at Mona, Jamaica, in 1948. After fifty-two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper.
Assuntos
Avaliação Educacional/métodos , Competência Clínica , Avaliação Educacional/normas , Humanos , Faculdades de Medicina , Índias OcidentaisRESUMO
BACKGROUND: Waist circumferences (WC) >/=94 cm for men and >/=80 cm for women (action level I) and >/=102 cm for men and >/=88 cm for women (action level II) have been suggested as limits for health promotion purposes to alert the general public to the need for weight loss. In this analysis we examined the ability of the above cut-off points to correctly identify subjects with or without hypertension in Nigeria, Cameroon, Jamaica, St Lucia and Barbados. We also determined population- and gender-specific abdominal adiposity cut-off points for epidemiological identification of risk of hypertension. METHODS: Waist measurement was made at the narrowest part of the torso as seen from the front or at midpoint between the bottom of the rib cage and 2 cm above the top of the iliac crest. Sensitivity and specificity of the established WC cut-off points for hypertension were compared across sites. With receiver operating characteristics (ROC), population- and gender-specific cut-off points associated with risk of hypertension were determined over the entire range of WC values. RESULTS: Predictive abilities of the established WC cut-off points for hypertension were poor compared to the specific cut-off points estimated for each population. Different values of WC were associated with increased risk of hypertension in these populations. In men, WC cut-off points of 76, 81, 80, 83 and 87 cm provided the highest sensitivity for identifying hypertensives in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, respectively. The analogous cut-off points in women were 72, 82, 85, 86 and 88 cm. CONCLUSIONS: The waist cut-off points from this study represent values for epidemiological identification of risk of hypertension. For the purpose of health promotion, the decision on what cut-off points to use must be made by considering other additional factors including overall impact on health due to intervention (e.g. weight reduction) and potential burden on health services if a low cut-off point is employed. There is a need to develop abdominal adiposity cut-off points associated with increased risks for cardiovascular diseases in different societies, especially for those populations where the distribution of obesity and associated risk factors tends to be very different from those of the technologically advanced nations. International Journal of Obesity (2000) 24, 180-186
Assuntos
População Negra , Composição Corporal , Doenças Cardiovasculares/genética , Promoção da Saúde , Hipertensão/genética , Obesidade/genética , Abdome , Adulto , África Ocidental/epidemiologia , Distribuição por Idade , Idoso , Antropometria , Área Sob a Curva , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/prevenção & controle , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Distribuição por Sexo , Índias Ocidentais/epidemiologiaRESUMO
Racism is associated with increased psychosocial stress and blood pressure in blacks. However, little is known of the relationship of racism to other features of insulin resistance syndrome. This study examined the relationship of internalized racism to abdominal obesity and elevated blood pressure in a population of black Caribbean women aged 20-55 years. One hundred thirty-three randomly selected women from the island of Barbados comprised the study sample. Data collected included anthropometric and blood pressure measurements, and information about internalized racism, anxiety, and depression. The stress measures including anxiety, depression, and internalized racism were significantly correlated with waist circumference (r = .25, r = .21, and r = .25). After adjusting for age, education, anxiety, and depression, internalized racism remained significantly correlated with waist circumference. The odds ratio associated with development of abdominal obesity among those with high internalized racism (OR = 2.4 [95% CI, 1.1,5.3]) was significant (P < .05) after adjusting for age, education, and body mass index. Blood pressure was not independently related to internalized racism. Studies comparing black-white differences in diseases for which abdominal obesity is a risk factor (eg, diabetes and cardiovascular disease) should take into account the potential role of internalized racism in defining the differences between ethnic groups.
Assuntos
População Negra , Hipertensão/etnologia , Hipertensão/fisiopatologia , Obesidade/etnologia , Obesidade/fisiopatologia , Preconceito , Estresse Psicológico/fisiopatologia , Abdome , Adulto , Ansiedade/epidemiologia , Ansiedade/fisiopatologia , Barbados/epidemiologia , Índice de Massa Corporal , Depressão/epidemiologia , Depressão/fisiopatologia , Feminino , Humanos , Hipertensão/epidemiologia , Modelos Logísticos , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estresse Psicológico/epidemiologiaRESUMO
This paper reports on neurological and neurosurgical referrals overseas from the Queen Elizabeth Hospital (QEH) for the period November 1987 to November 1996, and is a follow up to an earlier report for the period January 1984 to November 1987. It outlines the pattern of referral, diagnoses, referral centres and costs based on examination of the files of all QEH patients transferred overseas under a government aided scheme. There were 203 transfers of 191 patients (69 males, 122 females) including 10 patients who were transferred twice and one patient who was transferred three times. Patients' ages ranged from 1 to 80 years (mean 37 years). Twenty overseas centres were used during the period but most patients were transferred to Brooklyn Hospital, New York in 1988, Mount Sinai Medical Center, New York, between 1989 and 1994, and Hospital de Clinicas Caracas, Venezuela (1992 to 1996). 65% of the referrals were for neurosurgery and 25% were for magnetic resonance imaging scans for diagnosis. The largest diagnostic categories were central nervous system tumors (40%) and subarachnoid haemorrhage (25%). Estimated costs reached almost BDS$11 million, but the mean actual cost was BDS$63,916 based on information from 123 patient transfers. Thus, the actual total government expenditure was probably closer to BDS$13 million. This study demonstrates the urgent need to establish a neurosurgical service at the QEH and the cost effectiveness of doing so.
Assuntos
Neurologia/estatística & dados numéricos , Neurocirurgia/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Barbados , Análise Custo-Benefício , Feminino , Gastos em Saúde/estatística & dados numéricos , Hospitais Gerais/economia , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , Neurologia/economia , Neurocirurgia/economia , Transferência de Pacientes/economia , Encaminhamento e Consulta/economiaRESUMO
This paper reports on neurological and neurosurgical referrals overseas from the Queen Elizabeth Hospital (QEH) for the period November 1987 to November 1996, and is a follow up to an earlier report for the period January 1984 to November 1987. It outlines the pattern of referral, diagnoses, referral centres and costs based on examination of the files of all QEH patients transferred overseas under a government aided scheme. There were 203 transfers of 191 patients (69 males, 122 females) including 10 patients who were transferred twice and one patient who was transferred three times. Patients' ages ranged from 1 to 80 years (mean 37 years). Twenty overseas centres were used during the period but most patients were transferred to Brooklyn Hospital, New York in 1988, Mount Sinai Medical Center, New York, between 1989 and 1994, and Hospital de Clinicas Caracas, Venezuela (1992 to 1996). 65of the referrals were for neurosurgery and 25were for magnetic resonance imaging scans for diagnosis. The largest diagnostic categories were central nervous system tumors (40) and subarachnoid haemorrhage (25). Estimated costs reached almost BDS$11 million, but the mean actual cost was BDS$63,916 based on information from 123 patient transfers. Thus, the actual total government expenditure was probably closer to BDS$13 million. This study demonstrates the urgent need to establish a neurosurgical service at the QEH and the cost effectiveness of doing so.
Assuntos
Humanos , Masculino , Feminino , Neurocirurgia/estatística & dados numéricos , Neurologia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Análise Custo-Benefício , Barbados , Gastos em Saúde/estatística & dados numéricos , Hospitais Gerais/economia , Hospitais Gerais/estatística & dados numéricos , Neurocirurgia/economia , Neurologia/economia , Encaminhamento e Consulta/economia , Transferência de Pacientes/economiaRESUMO
OBJECTIVE: Rates of non-insulin-dependent diabetes mellitus have risen sharply in recent years among blacks in the U.S. and the U.K. Increases in risk have likewise been observed in the island nations of the Caribbean and in urban West Africa. To date, however, no systematic comparison of the geographic variation of NIDDM among black populations has been undertaken. RESEARCH DESIGN AND METHODS: In the course of an international collaborative study on cardiovascular disease, we used a standardized protocol to determine the rates of NIDDM and associated risk factors in populations of the African diaspora. Representative samples were drawn from sites in Nigeria, St. Lucia, Barbados, Jamaica, the United States, and the United Kingdom. A total of 4,823 individuals aged 25-74 years were recruited, all sites combined. RESULTS: In sharp contrast to a prevalence of 2% in Nigeria, age-adjusted prevalences of self-reported NIDDM were 9% in the Caribbean and 11% in the U.S. and the U.K. Mean BMI ranged from 22 kg/m2 among men in West Africa to 31 kg/m2 in women in the U.S. Disease prevalence across sites was essentially collinear with obesity, pointing to site differences in the balance between energy intake and expenditure as the primary determinant of differential NIDDM risk among these populations. CONCLUSIONS: In ethnic groups sharing a common genetic ancestry, these comparative data demonstrate the determining influence of changes in living conditions on the population risk of NIDDM.