RESUMO
BACKGROUND: The incidence of inflammatory bowel disease (IBD) may be lower among people of African descent than Caucasians. However, incidence studies among the former are uncommon and are often limited by incomplete case ascertainment or uncertainty about the size of the "at-risk" population. METHODS: We report the incidence and prevalence of IBD among people of African ancestry in Barbados from island-wide disease surveillance over a 25-year period beginning January 1980. RESULTS: The annual incidence of IBD age standardized to the world population was 1.85 per 100,000 person-years (95% confidence interval [CI] 1.53-2.22) for ulcerative colitis (UC) and 0.70 per 100,000 person-years (0.51-0.95) for Crohn's disease (CD). These incidence rates increased to 2.09 and 0.76 when standardized to the US population. The UC incidence rate increased from 1.3 in 1980-1984 to 2.3 in 1995-1999, and decreased to 1.6 in 2000-2004. The CD incidence rate followed a similar trend, rising from 0.3 in 1980-1984 to 1.3 in 1990-1994 before decreasing to 0.6. IBD prevalence in December 2004 was 44.3 per 100,000 person-years (36.7-53.0) for UC and 16.7 per 100,000 person-years (12.2-22.4) for CD. In the island-nation of Barbados, with a population in 2000 of 270,000, we expect between 4.3 and 6.1 new cases of UC and between 1.5 and 2.6 new cases of CD each year. CONCLUSIONS: The reported rates are generally lower than reported for European and North American Caucasians, and are similar to The French West Indies--the only other IBD disease register in the Caribbean.
Assuntos
População Negra/estatística & dados numéricos , Doenças Inflamatórias Intestinais/epidemiologia , Adolescente , Adulto , Idoso , Barbados/epidemiologia , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Incidência , Lactente , Doenças Inflamatórias Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Adulto JovemRESUMO
The Queen Elizabeth Hospital (QEH) is the major secondary and tertiary health care facility in Barbados, and patients who reach this hospital either present directly to the Accident and Emergency Department (A+E), or are referred by physicians. Over a six-month period all diabetic admissions to the hospital were identified, each patient was interviewed and examined, and hospital progress and outcome recorded. Of the 539 patients identified, 201 (37 percent) came directly to the A+E, while 338 (63 percent) had been referred to hospital. Three hundred and sixty-two (69 percent) had seen a physician within three months of admission. The main reasons for admission were the diabetic septic foot (33 percent), followed by heart failure (13 percent) and acute myocardial infarct 12.5 percent. Because the diabetic septic foot is considered a largely preventable problem, the high admission rate suggests that preventive care, assessment and management at the primary care level are inadequate. Patients who visited their primary care physicians within three months of admission, but nevertheless ended up in hospital, had lower mortality rates but prolonged hospital stays (AU)
Assuntos
Humanos , Diabetes Mellitus , Admissão do Paciente , Pé Diabético , Barbados/epidemiologiaRESUMO
Effective nursing practice requires being free of prejudice and bias. One's outlook is not necessarily the only proper one and there is no room for hasty judgments. The professional has health at the center of her perceptual system and often finds it difficult to view health as laymen do. If she wishes to work effectively with different groups of people, she must overcome her "trained incapacity" and learn to see health and beliefs surrounding it and disease from the patient's standpoint. It would simplify matters if personal and community health could be separated from the complexities of social existence, but this cannot be done. Health practices and ideas penetrate deeply into all domains of life. Nurses would do well to adopt a way of looking at the community that gives some coherence and depth to various cultures. This concept of culture can provide an organizing frame for those details and help the specialist assume the view of the client and family.