RESUMO
OBJECTIVES: Explore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control. DESIGN: Cross-sectional study. SETTING: Data from the Chilean Health National Survey 2009-2010. PARTICIPANTS: Regular users of primary care services aged 15 or older. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression. RESULTS: 3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8-12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients. CONCLUSIONS: Continuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.
Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Hipertensão/terapia , Atenção Primária à Saúde , Fatores Etários , Idoso , Chile , Estudos Transversais , Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Escolaridade , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Exame Físico , Fatores SexuaisRESUMO
OBJECTIVE: We investigated whether experienced food insecurity was associated with weight control behaviour of adolescents. DESIGN: A national survey of 16-year-old students with the six-item food security scale, questions concerning intentions of trying to change weight, physical activity patterns, and measurement of height and weight. SETTING: Representative sample of 29 schools in Trinidad, West Indies. SUBJECTS: Data analysed for 1903 subjects including 1484 who were food-secure and 419 who were food-insecure. RESULTS: In the whole sample, food security status did not vary by body mass index (BMI) category. 'Trying to gain weight' and 'spending most free time in activities involving little physical effort' were each associated with lower BMI. 'Trying to gain weight' was more frequent in food-insecure subjects (135, 32%) than in food-secure subjects (369, 25%, P = 0.012). After adjustment for BMI, age, sex, ethnicity and socio-economic variables, the adjusted odds ratio (OR) of 'trying to gain weight' for food-insecure subjects was 1.39 (95% confidence interval (CI) 1.07-1.82, P = 0.014). Food-insecure subjects (197, 47%) were more likely than food-secure subjects (575, 39%) to report that most of their free time was spent doing things that involved little physical effort (P = 0.003). This association was not explained by adjustment for BMI, age, sex and ethnicity (OR = 1.41, 95% CI 1.13-1.76, P = 0.002) or additional socio-economic variables (OR = 1.27, 95% CI 1.02-1.57, P = 0.033). CONCLUSIONS: Adolescents who experience food insecurity are more likely to intend to gain weight but engage in less physical activity than food-secure subjects with the same BMI.
Assuntos
Fenômenos Fisiológicos da Nutrição do Adolescente , Peso Corporal/fisiologia , Ingestão de Energia/fisiologia , Exercício Físico/fisiologia , Abastecimento de Alimentos , Adolescente , Índice de Massa Corporal , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Razão de Chances , Fatores Socioeconômicos , Inquéritos e Questionários , Índias OcidentaisRESUMO
BACKGROUND: We tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country. METHODS: Survey of primary school children in Trinidad and Tobago. Parents completed the HFSS. Responses were analysed for the 10 adult-referenced items and the eight child-referenced items. Item response theory models were fitted. Item calibrations and subject scores from a one-parameter logistic (1PL) model were compared with those from either two-parameter logistic model (2PL) or a model for differential item functioning (DIF) by ethnicity. RESULTS: There were 5219 eligible with 3858 (74%) completing at least one food security item. Adult item calibrations (standard error) in the 1PL model ranged from -4.082 (0.019) for the 'worried food would run out' item to 3.023 (0.042) for 'adults often do not eat for a whole day'. Child item calibrations ranged from -3.715 (0.025) for 'relied on a few kinds of low cost food' to 3.088 (0.039) for 'child didn't eat for a whole day'. Fitting either a 2PL model, which allowed discrimination parameters to vary between items, or a differential item functioning model, which allowed item calibrations to vary between ethnic groups, had little influence on interpretation. The classification based on the adult-referenced items showed that there were 19% of respondents who were food insecure without hunger, 10% food insecure with moderate hunger and 6% food insecure with severe hunger. The classification based on the child-referenced items showed that there were 23% of children who were food insecure without hunger and 9% food insecure with hunger. In both children and adults food insecurity showed a strong, graded association with lower monthly household income (P < 0.001). CONCLUSION: These results support the use of 18 HFSS items to classify food security status of adults or children in an English-speaking country where food insecurity and hunger are more frequent overall than in the US.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Abastecimento de Alimentos/estatística & dados numéricos , Inquéritos Epidemiológicos , Fome , Adolescente , Adulto , Ansiedade , Região do Caribe , Criança , Estudos Transversais , Etnicidade , Características da Família , Feminino , Abastecimento de Alimentos/economia , Humanos , Renda , Masculino , Modelos Estatísticos , Instituições Acadêmicas , Estudantes , Inquéritos e Questionários , Trinidad e TobagoRESUMO
BACKGROUND: We tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country. METHODS: Survey of primary school children in Trinidad and Tobago. Parents completed the HFSS. Responses were analysed for the 10 adult-referenced items and the eight child-referenced items. Item response theory models were fitted. Item calibrations and subject scores from a one-parameter logistic (1PL) model were compared with those from either two-parameter logistic model (2PL) or a model for differential item functioning (DIF) by ethnicity. RESULTS: There were 5219 eligible with 3858 (74%) completing at least one food security item. Adult item calibrations (standard error) in the 1PL model ranged from -4.082 (0.019) for the 'worried food would run out' item to 3.023 (0.042) for 'adults often do not eat for a whole day'. Child item calibrations ranged from -3.715 (0.025) for 'relied on a few kinds of low cost food' to 3.088 (0.039) for 'child didn't eat for a whole day'. Fitting either a 2PL model, which allowed discrimination parameters to vary between items, or a differential item functioning model, which allowed item calibrations to vary between ethnic groups, had little influence on interpretation. The classification based on the adult-referenced items showed that there were 19% of respondents who were food insecure without hunger, 10% food insecure with moderate hunger and 6% food insecure with severe hunger. The classification based on the child-referenced items showed that there were 23% of children who were food insecure without hunger and 9% food insecure with hunger. In both children and adults food insecurity showed a strong, graded association with lower monthly household income (P < 0.001). CONCLUSION: These results support the use of 18 HFSS items to classify food security status of adults or children in an English-speaking country where food insecurity and hunger are more frequent overall than in the US.
Assuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Feminino , Alimentos , Abastecimento de Alimentos , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/estatística & dados numéricos , Trinidad e Tobago , Região do CaribeRESUMO
OBJECTIVE: To evaluate the reliability and validity of a six-item food security scale when self-administered by adolescents. DESIGN: Cross-sectional questionnaire survey including the six-item food security measure, socio-economic variables and a food-frequency questionnaire. SETTING: Representative sample of 29 schools in Trinidad. SUBJECTS: In total 1903 students aged approximately 16 years. RESULTS: Item affirmatives ranged from 514 (27%) for the 'balanced meal' item to 128 (7%) for the 'skipped or cut meals often' item and 141 (7%) for the 'hungry' item. Item-score correlations ranged from 0.444 to 0.580. Cronbach's alpha was 0.77. Relative item severities from the Rasch model ranged from -1.622 (standard error 0.043) for the 'balanced meal' item to 1.103 (0.068) for the 'skipped or cut meals often' item and 0.944 (0.062) for the 'hungry' item. The 'hungry' item gave a slightly lower relative severity in boys than girls. Food insecurity was associated with household overcrowding (adjusted odds ratio comparing highest and lowest quartiles 2.61, 95% confidence interval 1.75 to 3.91), lack of pipe-borne water in the home, low paternal education or paternal unemployment. After adjusting for socio-economic variables, food insecurity was associated with less frequent consumption of fruit (0.75, 0.60 to 0.94) or fish (0.72, 0.58 to 0.88) but more frequent consumption of biscuits or cakes (1.47, 1.02 to 2.11). CONCLUSIONS: The food security scale provides a valid, reliable measure in adolescents, although young people report being hungry but not eating relatively more frequently than adults. Food-insecure adolescents have low socio-economic position and may eat less healthy diets.
Assuntos
Abastecimento de Alimentos , Avaliação Nutricional , Classe Social , Estudantes/psicologia , Inquéritos e Questionários/normas , Adolescente , Escolaridade , Características da Família , Feminino , Privação de Alimentos , Humanos , Fome , Masculino , Pobreza , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Trinidad e Tobago , Incerteza , DesempregoRESUMO
BACKGROUND: We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed. METHODS: The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity. RESULTS: Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96). CONCLUSIONS: The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.
Assuntos
Comportamento Alimentar/etnologia , Abastecimento de Alimentos/classificação , Psicometria/instrumentação , Inquéritos e Questionários , Adulto , População Negra/psicologia , Região do Caribe , Características da Família , Comportamento Alimentar/classificação , Privação de Alimentos , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/normas , Humanos , Fome/classificação , Pessoa de Meia-Idade , Pobreza/classificação , Pobreza/etnologia , Psicometria/métodos , Reprodutibilidade dos Testes , Classe Social , Trinidad e Tobago , Incerteza , Estados Unidos , Verduras , População Branca/psicologiaRESUMO
BACKGROUND: We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed. METHODS: The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity. RESULTS: Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96). CONCLUSIONS: The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.
Assuntos
Adulto , Humanos , População Negra/psicologia , Região do Caribe , Características da Família , Privação de Alimentos , Comportamento Alimentar/classificação , Comportamento Alimentar/etnologia , Abastecimento de Alimentos/classificação , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/normas , Pobreza/classificação , Pobreza/etnologia , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Classe Social , Trinidad e Tobago , Incerteza , VerdurasRESUMO
BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.
Assuntos
Países em Desenvolvimento , Dieta , Alimentos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comportamento de Escolha , Estudos Transversais , Etnicidade , Exercício Físico , Feminino , Privação de Alimentos , Abastecimento de Alimentos , Nível de Saúde , Humanos , Masculino , Desnutrição/etnologia , Desnutrição/etiologia , Desnutrição/psicologia , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade/etiologia , Obesidade/psicologia , Fatores Socioeconômicos , Trinidad e TobagoRESUMO
BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.
Assuntos
Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Feminino , Índice de Massa Corporal , Comportamento de Escolha , Estudos Transversais , Dieta , Etnicidade , Exercício Físico , Alimentos , Privação de Alimentos , Abastecimento de Alimentos , Nível de Saúde , Desnutrição/etnologia , Desnutrição/etiologia , Desnutrição/psicologia , Obesidade/etnologia , Obesidade/etiologia , Obesidade/psicologia , Fatores Socioeconômicos , Trinidad e TobagoRESUMO
We estimated the prevalence of foot symptoms and disease and evaluated foot care practices in a primary care based sample including 2106 people with diabetes in Trinidad. Symptoms of neuropathy were reported by 1030 (49%), previous foot ulceration by 257 (12%), and amputation by 92 (4%). Previous foot ulceration was associated with longer duration of diabetes (odds ratio 1.05, (95% CI 1.04-1.06) per year) and greater severity of neuropathy symptoms (1.17 (1.10-1.24) per unit increase in score). A history of foot ulceration gave relative odds of amputation of 16.3 (8.1-32.9). In those with previous foot ulceration, 120 (47%) went barefoot in the home, and 44 (17%) went barefoot outside the house. Overall, 1491 (71%) subjects reported they cut their toenails themselves, help was provided by a friend or relative to 584 (28%) and by a nurse or chiropodist to 13 ( < 1%). Most patients (1320, 63%) reported that they would treat a cut or blister on the foot themselves, while only 650 (31%) would attend for health care. Diabetic foot disease is common but care practices predispose to foot injury. Implementation of a strategy to improve care of the feet is needed.
Assuntos
Pé Diabético/terapia , Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/epidemiologia , Neuropatias Diabéticas/epidemiologia , Feminino , Úlcera do Pé/epidemiologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Autocuidado , Trinidad e Tobago/epidemiologiaRESUMO
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 percent) 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, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10 percent of the patients wer controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46 percent), compared to 7 percent 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 percent of the patients had satisfactory blood glucose control of (<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 percent of the patients at SPMC, 79 percent at PRMC, and 67 percent at PUBMC. Glycosylated hemoglobin was infrequently measured: 16 percent at SPMC, 10 percent at PRMC, and 0 percent at PUBMC. Overall, 96 percent of patients have had surveillance for hypertension, and 81 percent had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinical records most commonly at SPMC (14 percent for foot complications, and 13 percent 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. (AU)
Assuntos
Adulto , Idoso , Estudo Comparativo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus/terapia , Glicemia/análise , Pressão Arterial , Diabetes Mellitus/complicações , Diabetes Mellitus/fisiopatologia , Pé Diabético , Hospitais Públicos , Jamaica , Estilo de Vida , Educação de Pacientes como Assunto , Prática PrivadaRESUMO
Fewer than 10 percent of the patients were controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46 percent). compared to 7 percent 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 percent of the patients had satisfactory blood glucose control (<8 mmol/L fasting or <10 mmol/L post prandial). 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 percent of the patients at SPMC, 79 percent at PRMC, and 67 percent at PUBMC. Glycosylated hemoglobin was infrequently measured: 16 percent at SPMC, 10 percent at PRMC, and 0 percent at PUBMC. Overall, 96 percent of patients had surveillance for hypertension, and 81 percent had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinic records most commonly at APMC (14 percent for foot complications, and 13 percent 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. 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 (AU)
Assuntos
Humanos , Diabetes Mellitus/complicações , Jamaica , Atenção à Saúde/métodos , Diabetes Mellitus/tratamento farmacológicoRESUMO
To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patients, aged > 30 years, attending a public general clinic (PUBMC) (n=500), a special hypertension clinic (SPMC) (n=119) and a private group general clinic (PRMC) (n=137), for more than one year, were reviewed. Duration of follow-up varied among clinics with the longest mean follow-up at PRMC (10.8 years) compared to 6.1 years and 4.7 years at the PUBMC and SPMC respectively. Mean age was greatest at the PUBMC (60 yrs) compared to 53 years in the SPMC and 50 years in the PRMC (p < 0.001). Sex distribution differed among clinics with 15 percent men in the PUBMC, 34 percent in the SPMC and 54 percent in the PRMC (p < 0.001). Over 92 percent of patients had blood pressure (BP) recorded at least once in the 12-month review period. Hypertension was defined as being prescribed antihypertensive medication in clinic records. By this definition 98 percent SPMC patients were hypertensive, compared to 87 percent PUBMC and 80 percent PRMC. Using BP < 160 / 95mmHg, the PRMC was 0.57 (0.34-0.97) compared to the other two clinics after adjustments for age, clinic type, duration of follow-up and gender. Only age was a significant covariate with older patients at greater risk of poor control. Only 18 percent of hypertensives were controlled to BP < 140 / 90mmHg with no difference among clinics. Diuretics were the commonest agent used at the PUBMC (76 percent) and SPMC (86 percent) followed by a-methyldopa, 41 percent and 27 percent, respectively. These agents were less commonly prescribed at the PRMC than at the other clinics (45 percent diuretics and 8 percent a-methyldopa, p < 0.001 for both agents compared to other clinics). PRMC used more angiotensin converting enzyme inhibitors 38 percent, compared to SPMC 23 percent and PUBMC 1 percent (p < 0.001). Between 9 percent and 15 percent of patients at the PUBMC and PRMC had recorded data on smoking and alcohol use compared to 69 percent at the SPMC. A record of body weight was found in 99 percent at SPMC compared to 82 percent at PRMC and 33 percent at PUBMC (p < 0.001). Surveillance for complications differed for proteinuria (PRMC 33 percent, PUBMC 15 percent, SPMC 15 percent) and fundoscopy (PUBMC 0 percent, PRMC 3 percent, SPMC 43 percent). These results show very limited adherence to recommended hypertension treatment guidelines in all three settings.(Au)
Assuntos
Humanos , Masculino , Feminino , Hipertensão/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde , Assistência ao Paciente/normas , Jamaica , Diabetes MellitusRESUMO
To determine quality of monitoring and control of hypertension in Jamaica, 756 records of patients, aged > 30 years, attending a public general clinic (PUBMC) (n=500), a special hypertension clinic (SPMC) (n=119) and a private group general clinic (PRMC) (n=137), for more than one year, were reviewed. Duration of follow-up varied among clinics with the longest mean follow-up at PRMC (10.8 years) compared to 6.1 years and 4.7 years at the PUBMC and SPMC respectively. Mean age was greatest at the PUBMC (60 yrs) compared to 53 years in the SPMC and 50 years in the PRMC (p < 0.001). Sex distribution differed among clinics with 15 percent men in the PUBMC, 34 percent in the SPMC and 54 percent in the PRMC (p < 0.001). Over 92 percent of patients had blood pressure (BP) recorded at least once in the 12-month review period. Hypertension was defined as being prescribed antihypertensive medication in clinic records. By this definition 98 percent SPMC patients were hypertensive, compared to 87 percent PUBMC and 80 percent PRMC. Using BP < 160 / 95mmHg, the PRMC was 0.57 (0.34-0.97) compared to the other two clinics after adjustments for age, clinic type, duration of follow-up and gender. Only age was a significant covariate with older patients at greater risk of poor control. Only 18 percent of hypertensives were controlled to BP < 140 / 90mmHg with no difference among clinics. Diuretics were the commonest agent used at the PUBMC (76 percent) and SPMC (86 percent) followed by a-methyldopa, 41 percent and 27 percent, respectively. These agents were less commonly prescribed at the PRMC than at the other clinics (45 percent diuretics and 8 percent a-methyldopa, p < 0.001 for both agents compared to other clinics). PRMC used more angiotensin converting enzyme inhibitors 38 percent, compared to SPMC 23 percent and PUBMC 1 percent (p < 0.001). Between 9 percent and 15 percent of patients at the PUBMC and PRMC had recorded data on smoking and alcohol use compared to 69 percent at the SPMC. A record of body weight was found in 99 percent at SPMC compared to 82 percent at PRMC and 33 percent at PUBMC (p < 0.001). Surveillance for complications differed for proteinuria (PRMC 33 percent, PUBMC 15 percent, SPMC 15 percent) and fundoscopy (PUBMC 0 percent, PRMC 3 percent, SPMC 43 percent). These results show very limited adherence to recommended hypertension treatment guidelines in all three settings.
Assuntos
Humanos , Masculino , Feminino , Garantia da Qualidade dos Cuidados de Saúde , Assistência ao Paciente/normas , Hipertensão/prevenção & controle , Diabetes Mellitus , JamaicaRESUMO
OBJECTIVE: To measure weight for height and skinfold thickness as indicators of overweight and obesity in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. Measurements were made of children's heights, weights, triceps and subscapular skinfold thickness. Standard deviation scores (SDS) were calculated for weight and body mass index (BMI) using age and sex specific British growth reference curves for 1990 as standard. SDS for skinfolds were calculated using English children in 1990 for reference. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values, data were analysed for 6,343 children. CONCLUSIONS: The pattern of fat distribution differed from the reference population. Although values for body mass index and triceps skinfold were lower, high subscapular skinfold values suggested excess central adiposity in this population.(Au)
Assuntos
Criança , Feminino , Humanos , Masculino , Índice de Massa Corporal , Pesos e Medidas Corporais , Dobras Cutâneas , Trinidad e Tobago/etnologia , Coleta de Dados , Interpretação Estatística de DadosRESUMO
OBJECTIVE: To measure height as an indicator of nutritional status in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. After stratifying for county, schools were sampled with probability proportional size. In each school all children were sampled from the admission class (mean age 5.8 years) and the `rising nines' (mean age 8.6 years). Measurements were made of children's heights. In order to standardize for age, standard deviation scores (SIDS or z scores) were calculated using age and sex specific British growth reference curves for 1990 as standard. In the reference population the mean (SD) SDS is 0.0 (1.0). Results were presented by sex and ethnic group. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values data were analysed for 6,343 children (3065 boys and 3278 girls). In boys the mean height SIDS in those of African descent was 0.47 (1.04), in those of Indian descent 0.24 (1.08) and in those of mixed ethnicity 0.19 (1.07). The equivalent figures for girls were 0.53 (1.10), 0.19 (1.04) and 0.29 (1.12). Height SDS were higher for children aged 5-6 years than those aged 8-9 years. CONCLUSIONS: The distribution of children's heights in Trinidad and Tobago is similar to that observed in African Caribbean and Indian origin children in Britain. Overall the results suggest that nutritional conditions are as adequate as in the reference population.(Au)
Assuntos
Criança , Feminino , Humanos , Masculino , Estudo Comparativo , Avaliação Nutricional , Inquéritos Nutricionais , Trinidad e Tobago/etnologia , Etnicidade , Estatura/etnologia , Interpretação Estatística de Dados , Coleta de Dados , Estudos TransversaisRESUMO
OBJECTIVE: We evaluated variations in care among government health centres in Trinidad and Tobago. DESIGN AND METHODS: We studied processes of care and drug prescribing for diabetes in 23 government health centres in Trinidad and Tobago. Data were abstracted from the records of 1579 subjects with clinical diabetes, related to 12 processes of care and the prescription of five hypoglycaemic drugs and six cases of anti-hypertensive drug. Health centre level variances were estimated using multilevel statistical models. RESULTS: At different health centres, the proportion of patients receiving dietary advice ranged from 6 percent ot 95 percent; blood glucose estimations ranged from 14 percent to 88 percent; and foot inspection from 3 percent to 43 percent. Using a process of care summary score ranging from zero to 12, the lowest scoring health centre achieved a mean score of 1.55 and the highest 7.45. Regression analyses showed that health centres with only one nurse or doctor at each session provided fewer processes of care. More processes of care were provided when there were more patients attending each session, or when the health centre had more items of equipment. The proportion of patients prescribed insulin ranged from 3 percent to 29 percent. Prescription of insulin was associated with younger age and male gender but not with health centre characteristics. CONCLUSIONS: Larger health centres with more staff and equipment, or with higher patient attendance rates, appeared to provide better quality care. Variations in drug utilisation were less and tended to be explained by individual patient characteristics.(Au)
Assuntos
Humanos , Níveis de Atenção à Saúde , Variações Dependentes do Observador , Trinidad e Tobago , Pesquisa sobre Serviços de Saúde , Revisão de Uso de MedicamentosRESUMO
OBJECTIVE: To evaluate associations of health status and social inequalities with consultation at a private doctor among public primary care clinic attendees. DESIGN AND METHODS: The sample included 2,117 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 social and economic status. RESULTS: Of the sample, 1,256 (59 percent) reported attending a private doctor, 577 (27 percent) attended a private doctor for diabetes, and 378 (18 percent) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 score. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81 (95 percent confidence interval 0.72 to 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, those without pipe-borne water supply in the home were less likely to attend a private doctor than those with (odds ratio 0.77, 0.63 to 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 to 0.83). CONCLUSIONS: Persons consulting doctors in the private sector had worse health status than those relying only on public care. Household rather than individual measures of lower social or economic status were associated with less access to private care in relation to need, even among those who use public sector care.(Au)
Assuntos
Humanos , Fatores Socioeconômicos , Trinidad e Tobago , Pesquisa sobre Serviços de SaúdeRESUMO
AIMS: To evaluate an intervention to improve diabetes care in government-run health 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 percent) to 346 (22 percent) and fundoscopy from 6 (1 percent) to 139 (9 percent). For subjects attending for 1 year or less, 34/96 (35 percent) had dietary advice recorded in 1993 compared with 77/143 (54 percent) in 1998. Exercise advice was recorded for 3/96 (3 percent) in 1993 and 48/143 (34 percent) in 1998. In 1993, 329 (48 percent) were taking chlorpropamide but this fell to 57 (4 percent) in 1998. Glibenclamide use increased from 214 (31 percent) to 856 (54 percent) and gliclazide from 4 (1 percent) to 205 (13 percent). In 1993, 198/338 (56 percent) of hypertensive subjects were taking Brinerdin, this fell to 56/829 (7 percent) 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. (AU)
Assuntos
Estudo Comparativo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , 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 , Hipertensão/terapia , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Inquéritos e Questionários , 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 percent). 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 percent 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.(Au)