RESUMO
OBJECTIVE: To evaluate standards of preventive medical care for Type 2 diabetes in the context of high prevalence and limited resources. METHODS: Surveys of records for diabetic subjects attending 23 government primary care health centres in Trinidad and Tobago in 2003 and 1998 and nine health centres in 1993. Records were compared by study year for blood glucose and blood pressure, surveillance for complications, appropriate management advice and drug prescriptions. Relevant interventions included new clinical guidelines, training workshops for clinical staff and reports to the Ministry of Health. During this time, investment in primary care increased in the context of health sector reform policies and a favourable macroeconomic environment. RESULTS: Comparing 1993 with 2003, the proportion with a blood glucose test in the past 12 months increased from 33% to 91%, urea or creatinine ever recorded increased from 14% to 61%, diet advice recorded in the first 12 months of follow-up from 35% to 67%, exercise advice from 3% to 61%. The proportion prescribed metformin increased from 25% to 65%, while chlorpropamide decreased from 48% to 0%. The proportion of all subjects treated with antihypertensive drugs increased from 49% to 70%, and the proportion of treated patients prescribed angiotensin-converting enzyme inhibitors increased from 8% to 72%. Most recent ever records of blood glucose, blood pressure and body weight showed no decrease. CONCLUSIONS: Repeated surveillance of processes of care provided information to stimulate and plan change. Process changes were associated with intervention at several levels and increased availability of resources.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Atenção Primária à Saúde/tendências , Atitude do Pessoal de Saúde , Estudos Transversais , Atenção à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Trinidad e TobagoRESUMO
AIMS: We evaluated the relationship between diabetes, health status, household income and expenditure on health care in the general population in Trinidad. METHODS: Multistage sampling of 300 households was used to select a sample of 548 adults aged > or = 25 years. There were 64 (12%) who reported a diagnosis of diabetes. Comparison was made with 128 non-diabetic controls who were frequency matched for age and sex. RESULTS: Subjects with diabetes had lower income levels than non-diabetic controls [income < or = US dollars 533 per month for 66% diabetes cases and 48% controls, test for trend P = 0.007]. Compared with controls, subjects with diabetes were less likely to have good or very good self-rated health (diabetes 32%, controls 67%; P < 0.001), and more frequently reported long-standing illness, limitation of activities, visual impairment, or self-reported history of high blood pressure, angina or heart attack. Subjects with diabetes (11%) were less likely than controls (30%) to have private health insurance (P = 0.005). Diabetic subjects (35%) were more likely than controls (16%) to have incurred expenditure on doctors' services in the last 4 weeks (P = 0.021). CONCLUSIONS: Diabetes is associated with worse health status and more frequent expenditure on medical services but greater financial barriers to access in terms of low income and lack of health insurance. Policies for diabetes should specifically address the problem of income-related variations in risk of diabetes, health care needs and barriers to uptake of preventive and treatment services, otherwise inequalities in health from this condition may increase.
Assuntos
Diabetes Mellitus/epidemiologia , Acessibilidade aos Serviços de Saúde/economia , Nível de Saúde , Renda , Adulto , Idoso , Complicações do Diabetes , Diabetes Mellitus/economia , Escolaridade , Feminino , Financiamento Pessoal/economia , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População/métodos , Prevalência , Autoavaliação (Psicologia) , Trinidad e Tobago/epidemiologiaRESUMO
We evaluated income- and education-related inequalities in blood pressure, hypertension and hypertension treatment in the general population of Trinidad and Tobago. The design included survey of 300 households in north central Trinidad, including 631 adults in 2001. Measurements of blood pressure, weight, height, waist and hip circumferences, and educational attainment, household income and alcohol intake by questionnaire. The slope index of inequality (SII) was used to estimate the difference in blood pressure between those with highest, as compared to lowest, socioeconomic status. Complete measurements and questionnaires were obtained for 461 (73%) including 202 men and 259 women. In women, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -12.6, 95% confidence interval -22.6 to -2.6 mmHg (P=0.013); and -10.8 (-21.4 to -0.2) mmHg (P=0.045) by educational attainment. After additionally adjusting for body mass index, waist-hip circumference ratio and self-reported diabetes, the SII for income was -7.3 (-16.5 to 1.9) mmHg (P=0.120) and for educational attainment was -3.0 (-13.0 to 6.9) mmHg (P=0.551). In men, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -4.3 (-15.4 to 6.8) mmHg (P=0.447) and for education -8.1 (-19.0 to 2.8) (P=0.145). There is a negative association of systolic blood pressure with increasing income or education in women. This is associated with body mass index, abdominal obesity and diabetes. There is no consistent association between education or income and blood pressure in men.
Assuntos
Escolaridade , Hipertensão/epidemiologia , Renda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/economia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
OBJECTIVE: The aim of the study was to report the association of socio-economic factors with child's height. DESIGN: Cross-sectional study based on a representative national sample of government schools. SETTING: Trinidad and Tobago in 1999. SUBJECTS: A total of 2608 boys and girls mean age 5.8 y, range 4.38-6.99 y and 3080 mean age 8.6 y, range 7.00-10.44 y olds. OUTCOME: Measurement of height and a questionnaire completed by parents. In the analysis height was expressed as standard deviation scores (s.d.s.) based on the British height curves (1990) or height below -1.5 s.d.s. RESULTS: Ethnicity, parental heights, birthweight, maternal age at child's birth and number of children in the family were the main factors associated with children's height. Lack of piped water supply in the home was the only socio-economic factor consistently associated with height (mean difference in s.d.s. adjusted only for age group, gender and ethnicity -0.192, 95% CI -0.257 to -0.127 and in addition adjusted for the variables listed above -0.080, 95% CI -0.141 to -0.019). Parental education, household overcrowding and employment status were weakly associated with height in the partially adjusted model only. Analysis of severe growth failure gave similar results. CONCLUSION: The impact of socio-economic factors on height is marginal in Trinidad and Tobago. As socio-economic factors may have an impact on a broad range of health indicators, height and rates of undernutrition should not be used as sole criteria for assessing progress in decreasing health differentials caused by social inequalities.
Assuntos
Estatura , Classe Social , Abastecimento de Água , Peso ao Nascer , Criança , Pré-Escolar , Estudos Transversais , Etnicidade , Características da Família , Feminino , Humanos , Masculino , Idade Materna , Fatores Socioeconômicos , Inquéritos e Questionários , Trinidad e TobagoRESUMO
OBJECTIVE: To evaluate the provision of free school meals in Trinidad and Tobago in relation to children's social and nutritional status. DESIGN AND METHODS: Cross-sectional survey of a nationally representative sample of 66 government schools, including children in the admissions classes (aged 4 to 7 years) and classes for 'rising nines' (aged 7-10 years). Data included questionnaire details of free school meals and children's social background, and measurements of children's heights, weights and skinfold thicknesses. RESULTS: Of 6731 eligible children, data were analysed for 5688 (85%). There were 2386 (42%) children receiving free meals provided at school. At different schools the proportion of all children receiving free meals ranged from 20% to 100%, Receipt of free meals was associated with larger family size (one child, 32% received free meals; > or =6 children, 63%), lower paternal educational attainment (primary, 52% free; university, 30%), father's employment (employed, 39% free meals; unemployed >12 months, 59%) as well as maternal education and employment and household amenities. After adjusting for age, sex and ethnic group, children who received free meals were shorter (mean difference in height standard deviation score (SDS) -0.12, 95% confidence interval (CI) -0.17 to -0.06), lighter (body mass index SDS -0.21, -0.28 to -0.14) and thinner (subscapular skinfold SDS -0.13, -0.18 to -0.09). CONCLUSIONS: Free school meals were widely available, with some targeting of provision to children with less favourable social and nutritional status. Greater universality would reduce inequity, but more stringent targeting and reduction of school-level variation would increase efficiency.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Serviços de Alimentação/economia , Estado Nutricional , Instituições Acadêmicas , Classe Social , Estatura , Peso Corporal , Criança , Pré-Escolar , Estudos Transversais , Escolaridade , Emprego , Características da Família , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Dobras Cutâneas , Inquéritos e Questionários , Trinidad e TobagoRESUMO
BACKGROUND: To evaluate distribution of body mass index (BMI) and subcutaneous fat in children of African or Indian subcontinent descent living in Trinidad and Tobago. METHODS: A cross-sectional survey was carried out in a nationally representative sample of 66 government schools. Measurements were made of children's heights, weights, triceps and subscapular skinfold thicknesses. Data were analysed by sex and ethnic group and comparison was made with international standards for overweight and obesity and with British (1990) reference curves for BMI. RESULTS: Data were analysed for 5688/6731 (85%) eligible children including 1934 Afro-Trinidadian, 1689 Indo-Trinidadian, and 1794 of mixed ethnicity. Afro-Trinidadian and mixed children were taller, but Indo-Trinidadian children were shorter than reference. Values for BMI were lower than reference: mean standard deviation score (SDS), (95% confidence interval) Afro-Trinidadian -0.34 (-0.39 to -0.28), Indo-Trinidadian -1.32 (-1.39 to -1.25), mixed -0.67 (-0.74 to -0.61). Overall 486 (8.5%, 7.8 to 9.3%) of children were overweight and 138 (2.4%, 2.0 to 2.9%) were obese. Triceps skinfold thickness values were lower than reference (-0.45, -0.48 to -0.42 SDS) but subscapular skinfold thicknesses were higher (0.45, 0.43 to 0.47 SDS). Higher BMI were associated with higher BMI in the child's parents, higher reported birthweight, older age of the child's mother, smaller family size, and with higher maternal educational attainment. CONCLUSIONS: Overweight was prevalent and distribution of subcutaneous fat was central. Work is needed to determine whether these findings are associated with adult patterns of fat distribution and metabolic abnormalities.
Assuntos
População Negra , Obesidade/etnologia , População Branca , África/etnologia , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia/etnologia , Masculino , Dobras Cutâneas , Trinidad e Tobago/epidemiologiaRESUMO
BACKGROUND: To evaluate distribution of body mass index (BMI) and subcutaneous fat in children of African or Indian subcontinent descent living in Trinidad and Tobago. METHODS: A cross-sectional survey was carried out in a nationally representative sample of 66 government schools. Measurements were made of children's heights, weights, triceps and subscapular skinfold thicknesses. Data were analysed by sex and ethnic group and comparison was made with international standards for overweight and obesity and with British (1990) reference curves for BMI. RESULTS: Data were analysed for 5688/6731 (85%) eligible children including 1934 Afro-Trinidadian, 1689 Indo-Trinidadian, and 1794 of mixed ethnicity. Afro-Trinidadian and mixed children were taller, but Indo-Trinidadian children were shorter than reference. Values for BMI were lower than reference: mean standard deviation score (SDS), (95% confidence interval) Afro-Trinidadian -0.34 (-0.39 to -0.28), Indo-Trinidadian -1.32 (-1.39 to -1.25), mixed -0.67 (-0.74 to -0.61). Overall 486 (8.5%, 7.8 to 9.3%) of children were overweight and 138 (2.4%, 2.0 to 2.9%) were obese. Triceps skinfold thickness values were lower than reference (-0.45, -0.48 to -0.42 SDS) but subscapular skinfold thicknesses were higher (0.45, 0.43 to 0.47 SDS). Higher BMI were associated with higher BMI in the child's parents, higher reported birthweight, older age of the child's mother, smaller family size, and with higher maternal educational attainment. CONCLUSIONS: Overweight was prevalent and distribution of subcutaneous fat was central. Work is needed to determine whether these findings are associated with adult patterns of fat distribution and metabolic abnormalities.
Assuntos
Criança , Humanos , Masculino , Feminino , África/etnologia , População Negra , Pré-Escolar , Estudos Transversais , População Branca , Índia/etnologia , Obesidade/etiologia , Dobras Cutâneas , Trinidad e Tobago/epidemiologiaRESUMO
Private health care provision is important in most middle-income countries but factors influencing the demand for private care have not been well defined. This paper evaluated the relationships of health status and socio-economic variables with utilisation of private care by public primary care clinic attenders. The sample included 2117 randomly selected subjects with clinical diabetes attending 35 government health centres in Trinidad and Tobago. Measures included attendance at a private doctor, the type 2 Diabetes Symptom Checklist, the SF36 questionnaire, and indicators of socio-economic status. Of the sample, 1256 (59%) reported attending a private doctor, 577 (27%) attended a private doctor for diabetes, and 378 (18%) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 scores. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81, 95% confidence interval 0.72-0.91. After adjusting for demographic and social factors the relative odds were 0.89, 0.80 to 1.00. After allowing for differences in health status, the relative odds of attending for private care for those without a pipe borne water supply in the home, compared with those with water in the home, were 0.77, 0.63-0.94. Those living alone were less likely to attend a private doctor than those living with their children and partner (odds ratio 0.60, 0.43-0.83). Among people attending public clinics, the decision to utilise private care is sensitive to health status. After adjusting for health status, there was evidence for horizontal inequity in access to private care in relation to household amenities and composition.
Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Diabetes Mellitus Tipo 2/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Prática Privada/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Adulto , Idoso , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Necessidades e Demandas de Serviços de Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
We evaluated variations in medical care for diabetes among government health centres in Trinidad and Tobago. Data were analysed for 1579 subjects with clinical diabetes attending 23 health centres concerning 12 processes of care and six case-mix or outcome variables. Random effects models were used for analysis. Health centre level variation was appreciable. Intraclass correlations ranged from 0.025 to 0.316 for process of care variables and 0.000 to 0.056 for case-mix variables. Compared with health centres with only one nurse, patients attending those with three or more nurses received 1.18 (95% confidence interval 0.27 to 2.09) more processes of care. Delivery of medical care varied among the health centres and those with higher staffing levels provided more processes of care.
Assuntos
Diabetes Mellitus/terapia , Programas Nacionais de Saúde/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Padrões de Prática Médica , Atenção Primária à Saúde/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trinidad e TobagoRESUMO
OBJECTIVES: To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13%) of diabetes. METHODS: During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"). The patients' median age ranged from 56 years at SPMC and PRMC to 63 years at PUBMC. Median follow-up had been 6.0 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10% of the patients were controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46%), compared to 7% each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40% of the patients had satisfactory blood glucose control (< 8 mmol/L fasting or < 10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P = 0.26). A blood glucose measurement had been recorded in the preceding year in 84% of the patients at SPMC, 79% at PRMC, and 67% at PUBMC. Glycosylated hemoglobin was infrequently measured: 16% at SPMC, 10% at PRMC, and 0% at PUBMC. Overall, 96% of patients had had surveillance for hypertension, and 81% had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinic records most commonly at SPMC (14% for foot complications, and 13% for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. CONCLUSIONS: The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes.
Assuntos
Diabetes Mellitus/terapia , Adulto , Idoso , Glicemia/análise , Pressão Sanguínea , Complicações do Diabetes , Diabetes Mellitus/fisiopatologia , Dieta para Diabéticos , Feminino , Hospitais Públicos , Humanos , Jamaica , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prática PrivadaRESUMO
AIMS: To evaluate an intervention to improve diabetes care in government-run heath centres in Trinidad and Tobago over 5 years. METHODS: A cross-sectional survey of 690 subjects with clinical diabetes attending nine health centres was carried out in 1993. The intervention was: reports to the Ministry of Health, dissemination of management guidelines and annual training workshops for healthcare staff. Re-evaluation was through a survey of 1579 subjects with diabetes, attending 23 health centres in 1998. RESULTS: Comparing 1993 with 1998, foot examinations in the previous year increased from 38 (6%) to 346 (22%) and fundoscopy from 6 (1%) to 139 (9%). For subjects attending for 1 year or less, 34/96 (35%) had dietary advice recorded in 1993 compared with 77/143 (54%) in 1998. Exercise advice was recorded for 3/96 (3%) in 1993 and 48/143 (34%) in 1998. In 1993, 329 (48%) were taking chlorpropamide but this fell to 57 (4%) in 1998. Glibenclamide use increased from 214 (31%) to 856 (54%) and gliclazide from four (1%) to 205 (13%). In 1993, 198/338 (56%) of hypertensive subjects were taking Brinerdin, this fell to 56/829 (7%) in 1998 while use of thiazide diuretics, methyldopa and angiotensin-converting enzyme (ACE) inhibitors increased. There were no changes in indicators of metabolic control, blood pressure control or body weight. CONCLUSIONS: Use of audit data to inform health policy and practice, linked with educational interventions, may modify patterns of care in government-run primary care health centres in a middle-income country with a high prevalence of diabetes.
Assuntos
Diabetes Mellitus/terapia , Anti-Hipertensivos/uso terapêutico , Centros Comunitários de Saúde/organização & administração , Centros Comunitários de Saúde/normas , Estudos Transversais , Atenção à Saúde/normas , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Angiopatias Diabéticas/terapia , Feminino , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Inquéritos e Questionários , Trinidad e TobagoRESUMO
This paper reports a 4-year evaluation of government primary care services in Trinidad and Tobago. The sample included 16 primary care health centres in Trinidad and Tobago with cross-sectional surveys of adult attenders in 1994 and 1998. Data were obtained from clinic records including details of processes of care, drug utilisation and blood pressure (BP) control. Intervention following the initial survey was by means of reports to the Ministry of Health and annual training workshops for medical officers. Data were analysed for 1759 adult attenders at study clinics (981 in 1994 and 778 in 1998). Most attenders had blood pressure recorded (96% in 1994 and 98% in 1998). Among 1176 subjects with hypertension (BP > or =160/95 mm Hg or treated with drugs) the proportion with dietary advice ever recorded increased from .139/662 (21%) in 1994 to 185/514 (36%) in 1998, and recording of exercise advice increased from 36 (5%) in 1994 to 99 (19%) in 1998. Among subjects treated with drugs, use of Brinerdin decreased from 191/625 (31%) in 1994 to 29/486 (6%) in 1998, while use of diuretics, beta-blockers, calcium antagonists and ACE inhibitors increased. The proportion of patients with blood pressure adequately controlled (<160/95 mm Hg) was 338 (51%) in 1994 and 297 (58%) in 1998 (odds ratio 1.39, 95% confidence interval 0.96 to 2.00). An audit study used to inform health care policy, staff training and clinical practice may contribute to improving processes of hypertension management in a middle-income country like Trinidad and Tobago.
Assuntos
Hipertensão/terapia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Estudos Transversais , Atenção à Saúde , Estudos de Avaliação como Assunto , Terapia por Exercício , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/dietoterapia , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Fatores de Tempo , Trinidad e TobagoRESUMO
Our objective was to estimate the effect of greater symptom severity in diabetes mellitus on measures of health-related quality of life in a cross-sectional design in 35 government primary care health centres in Trinidad. Data were gathered on 2,117 subjects with clinical diabetes and analysed for 1,880 (89%). For each scale of the short form 36 (SF-36) questionnaire (a generic measure of health-related quality of life), scores were presented by quartile of symptom severity, measured using the Diabetes Symptom Checklist. Mean (SD) SF-36 scores were 44 (10) for the physical component score (PCS) and 45 (12) for the mental component score (MCS). Greater severity of diabetic symptoms was associated with lower scores on each of the subscales of the SF-36. Comparing lowest and highest quartiles of DSC score, the adjusted difference in PCS was -11 (95% confidence interval -12 to -9) and for MCS -16 (-18 to -14). Our results provide standardised data for health related quality of life in relation to severity of illness from diabetes, these might be used to aid the evaluation of relevant interventions.
Assuntos
Diabetes Mellitus/classificação , Qualidade de Vida , Adulto , Idoso , Centros Comunitários de Saúde , Estudos Transversais , Diabetes Mellitus/epidemiologia , Escolaridade , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição Aleatória , Índice de Gravidade de Doença , Fatores Sexuais , Perfil de Impacto da Doença , Fatores Socioeconômicos , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
SETTING: Accident and emergency department, General Hospital, Port of Spain, Trinidad and Tobago. OBJECTIVE: To measure the occurrence and clinical management of acute severe asthma. DESIGN: Data collected prospectively for consecutive attendees with asthma over a period of 3 months. RESULTS: Asthma accounted for 8.8% of attendances. Treatment for the acute attack included nebulised salbutamol in 1031 (85%) and nebulised atrovent in 769 (63%). Systemic corticosteroids were given to 623 (51%) patients. Only 247 (20%) had planned follow-up arrangements recorded. Usual maintenance treatment included inhaled salbutamol in 767 (63%) and inhaled corticosteroid in 286 (24%). Inhaled corticosteroids were more often used by patients aged > or =15 years or who had had previous hospital admissions for asthma. CONCLUSION: The survey identified deficiencies in the clinical management of acute asthma attacks and in longterm asthma care. Caribbean guidelines for asthma care have subsequently been published, and follow-up surveys should be carried out to evaluate their implementation.
Assuntos
Asma/epidemiologia , Adulto , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Trinidad e Tobago/epidemiologiaRESUMO
Associations between socio-economic status and non-communicable diseases in middle income countries have received little study. We conducted an interview survey to evaluate the associations of morbidity with social conditions among people attending government primary care health centres with diabetes mellitus in Trinidad. Data collected included morbidity from hyperglycaemia, foot problems, visual problems and cardiovascular disease, as well as social and demographic variables. Of 622 subjects, 35% were aged > or = 65 years, 54% were Indo-Trinidadian, 13% had no schooling, only 11% were in full-time employment, and 33% had no piped drinking water supply in the home. Prevalent symptoms included itching, reported by 215 (35%), nocturia in 315 (51%), burning or numbness in the feet in 350 (56%), and difficulty with eyesight in 363 (58%). A morbidity summary score was used as dependent variable in regression analyses. Comparing those with no schooling with those with secondary education, the mean difference in morbidity score was 1.77 (95% CI 1.15-2.39), attenuated to 0.71 (0.06-1.37) after adjusting for age, gender, ethnic group and diabetes duration. The equivalent differences for those with no piped water supply in the house, compared with those with, were 0.53 (0.17-0.88) and 0.57 (0.24-0.89). For the unemployed, compared with those in full-time jobs, at ages 15-59 years the differences were 0.85 (0.14-1.56) and 0.58 (-0.11-1.27). We conclude that morbidity in persons with diabetes is associated with indicators of lower socio-economic status and that this association is partly explained by confounding with older age, female gender, longer duration of diabetes and Indo-Trinidadian ethnic group. A negative association between socio-economic status and morbidity from diabetes contributes to a justification for investment of public health resources in the control of diabetes and other non-communicable diseases.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Etnicidade , Pobreza , Adulto , Idoso , Diabetes Mellitus Tipo 2/complicações , Educação , Emprego , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Trinidad e Tobago/epidemiologia , Abastecimento de ÁguaRESUMO
This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1,105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9,478 bed days per annum. The hospital admission fatality rate was 29%. Among surviving patients, 437 (56%) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95% CI: 83 to 145) per 100,000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 to 186). Among patients with first strokes, 348/531 (66%) reported physician-diagnosed hypertension, but only 226 (65%) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.
Assuntos
Transtornos Cerebrovasculares/epidemiologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/economia , Demografia , Avaliação da Deficiência , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
We surveyed 161 medical practitioners in Trinidad and Tobago (124 reporting private sector practice and 37 describing government health centre practice) for their views on blood pressure (BP) management. 96% of the respondents agreed that BP should be measured on all adults seen and 90% agreed that diastolic pressure should be recorded as the disappearance of sounds. There was disagreement over the level of diastolic BP at which drug treatment should be initiated: 63% would treat diastolic BP less than 100 mm Hg, but 35% would only treat diastolic BP of 110 mm Hg or higher. In private practice 31% preferred angiotensin converting enzyme (ACE) inhibitors as treatment for an African Caribbean man with diastolic BP 110 mm Hg, but in public clinics 41% preferred thiazide diuretics. ACE inhibitors were most often preferred as treatment for an Indo-Caribbean man with diabetes and diastolic BP 110 mm Hg in both public and private practice. Doctors considered that noncompliance (66%), lack of education (34%) and unhealthy lifestyles (25%) were important obstacles to BP control. In private practice doctors considered patients' financial constraints to be an obstacle (58%), whereas in the public sector limited availability of drugs (57%) was felt to be more important. Less costly and, possibly, more appropriate drugs were used in public clinics.
Assuntos
Atitude do Pessoal de Saúde , Hipertensão/terapia , Adulto , Pressão Sanguínea , Humanos , Masculino , Trinidad e TobagoRESUMO
BACKGROUND: This study aimed to identify social characteristics associated with higher levels of morbidity from diabetes and their relationship to health care utilization. METHODS: During a 6-month period 1149/1447 (79%) subjects admitted to Port of Spain Hospital, Trinidad with diabetes responded to a structured interview. Data collection included social factors, diabetes-related morbidity and health care utilization. Analyses were adjusted for age, sex, ethnic group and self-reported diabetes duration. RESULTS: Of 12 indicators of morbidity, nine were more frequent in subjects with no schooling compared with those with secondary education. At ages 15-59 years, nine morbidity indicators were less frequent among subjects in full-time jobs compared with those not in employment. The association of educational attainment was explained by confounding with age, sex, ethnic group and diabetes duration but five morbidity indicators were associated with employment status after adjusting for confounding. The type of water supply in the home was generally not associated with morbidity. Each of the indicators of lower socioeconomic status was associated with less use of private doctors and with more use of government health centres. CONCLUSIONS: Morbidity from diabetes was greater in groups with lower socioeconomic status. While morbidity associated with lower educational attainment was mostly explained by older age; the results suggested the possibility that diabetes may contribute to unemployment of those in the labour force. Private care was less accessible to social groups with higher levels of morbidity and the availability of government funded health services was important for reducing inequalities in health care utilization.
Assuntos
Diabetes Mellitus/epidemiologia , Serviços de Saúde/estatística & dados numéricos , Classe Social , Adolescente , Adulto , África/etnologia , Idoso , Distribuição de Qui-Quadrado , Intervalos de Confiança , Fatores de Confusão Epidemiológicos , Estudos Transversais , Diabetes Mellitus/etnologia , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Serviços de Saúde/normas , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Razão de Chances , Trinidad e Tobago/epidemiologia , Abastecimento de ÁguaRESUMO
Use of herbal remedies from medicinal plants (bush medicines) was studied in 622 people with diabetes mellitus attending 17 government health centers on the island of Trinidad, Trinidad and Tobago. Bush medicines were used by 42% of patients surveyed and were used for diabetes by 24%. Bush medicine use was more frequent in Afro-Trinidadians and in those of mixed ethnicity than in Indo-Trinidadians, and was also more prevalent in those with lower educational attainment. Most patients using bush medicines (214/264, or 81%) reported gathering the plants themselves, and 107/264 (41%) took them more frequently than once a week. Patients taking bush medicines mentioned 103 different plants used in remedies. Among the 12 most frequently mentioned, caraili, aloes, olive-bush, and seed-under-leaf were preferentially used for diabetes. Vervine, chandilay, soursop, fever grass, and orange peel were preferentially used for other indications. Patients who reported burning or numbness in the feet or feelings of tiredness, weakness, giddiness, or dizziness used bush medicines for diabetes more frequently than did patients who reported a range of other diabetes-related symptoms. Insulin-treated patients were less frequent users of bush medicines. It is concluded that bush medicines are taken regularly by many patients with diabetes in Trinidad. Plants most frequently used as remedies for diabetes have recognized hypoglycemic activity. Patients' culture, educational background, type of symptoms, and formal medical treatment may also influence the selection and use of bush medicines.
Assuntos
Diabetes Mellitus/terapia , Medicina Tradicional , Plantas Medicinais , Adulto , Idoso , Educação , Etnicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Trinidad e TobagoRESUMO
Use of herbal remedies from medicinal plants (bush medicines) was studied in 622 people with diabetes mellitus attending 17 government health centers on the island of Trinidad, Trinidad and Tobago. Bush medicines were used by 42 percent of patients surveyed and were used for diabetes by 24 percent. Bush medicine use was more frequent in Afro-Trinidadians and in those of mixed ethnicity than in Indo-Trinidadians, and was also more prevalent in those with lower educational attainment. Most patients using bush medicines (214/264, or 81 percent) reported gathering the plants themselves, and 107/264 (41 percent) took them more frequently than once a week. Patients taking bush medicines mentioned 103 different plants used in remedies. Among the 12 most frequently mentioned, caraili, aloes, olive-bush, and seed-under-leaf were preferentially used for diabetes. Vervine, chandilay, soursop, fever grass, and orange peel were preferentially used for other indications. Patients who reported burning or numbness in the feet or feelings of tiredness, weakness, giddiness or dizziness, used bush medicines for diabetes more frequently than did patients who reported a range of other diabetes-related sympthoms. Insulin-treated patients were less frequent users of bush medicines. It is concluded that bush medicines are taken regularly by many patients with diabetes in Trinidad. Plants most frequently as remedies for diabetes have recognised hypoglycemic activity. Patients' culture, educational background, type of sympthoms, and formal medical treatment may also influence the selection and use of bush medicines (AU)