RESUMO
OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.
OBJETIVO:Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. MÉTODOS: Se realizó un estudio descriptivo basado en 15 entrevistas a informantes clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. RESULTADOS: La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. CONCLUSIONES: Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.
Assuntos
Saúde Pública , Coleta de Dados/estatística & dados numéricos , Observatório de Recursos Humanos em SaúdeRESUMO
Objective. To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. Methods. A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. Results. The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. Conclusions. Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.
Objetivo. Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. Métodos. Se realizó un estudio descriptivo basado en 15 entrevistas a informants clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. Resultados. La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. Conclusiones. Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.
Assuntos
Saúde Pública , Pesquisa Qualitativa , Tomada de Decisões , Coleta de Dados , Índias Ocidentais , Saúde Pública , Setor de Assistência à Saúde , Tomada de Decisões , Coleta de Dados , Trinidad e Tobago , Índias Ocidentais , Setor de Assistência à Saúde , Trinidad e TobagoRESUMO
OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.
Assuntos
Saúde Pública , Região do Caribe , Etnicidade , Política de Saúde , Humanos , Trinidad e TobagoRESUMO
Type 2 diabetes (T2DM) and its complications such as cardiomyopathy, contribute significantly to morbidity and mortality worldwide. Increased adoption of westernized diets and decreased physical activity are contributing to the obesity epidemic which, in turn, increases the risk for T2DM. Other risk factors for T2DM include insulin resistance, dyslipidemia, hypertension, metabolic syndrome, and a genetic predisposition. Risk measures for assessing these factors include family history, blood pressure, body weight, waist circumference, fasting glucose, insulin, and lipid levels, and calculated indices such as BMI, HOMA, and QUIKI. Most of these risk measures routinely done in annual check-ups, should help a primary care physician in making an early diagnosis of impending diabetic condition. The underlying mechanisms of these clinical, anthropometric and biochemical risk measures may also be involved in the etiology of diabetes and its complications. Their levels and changes over time therefore, may indeed reflect the disease process. Early and continued assessment of diabetes risk, as part of patient care, will help identify individuals most likely to develop diabetes and allow for early interventions to reduce risk factors as well as delay or may even prevent disease onset. In T2DM patients, ongoing measurement of risk markers and implementation of intervention where appropriate will improve the diabetic condition, decrease risk of cardiovascular and other complications, and decrease morbidity.
Assuntos
Cardiomiopatias/etiologia , Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/etiologia , Animais , Cardiomiopatias/prevenção & controle , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevenção & controle , Progressão da Doença , Dislipidemias/complicações , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/complicações , Resistência à Insulina , Masculino , Obesidade/complicações , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
The human leukocyte receptor complex (LRC) of Chromosome 19q13.4 encodes polymorphic and highly homologous genes that are expressed by cells of the immune system and regulate their function. There is an enormous diversity at the LRC, most particularly the variable number of killer cell immunoglobulin-like receptor (KIR) genes. KIR have been associated with several disease processes due to their interaction with polymorphic human leukocyte antigen class I molecules. We have assessed haplotype compositions, linkage disequilibrium patterns and allele frequencies in two Caucasoid population samples (n=54, n=100), using a composite of single-nucleotide polymorphism (SNP) markers and high-resolution, allele-specific molecular genotyping. Particular KIR loci segregated with SNP and other markers, forming two blocks that were separated by a region with a greater history of recombination. The KIR haplotype composition and allele frequency distributions were consistent with KIR having been subject to balancing selection (Watterson's F: P=0.001). In contrast, there was a high inter - population heterogeneity measure for the LRC-encoded leukocyte immunoglobulin-like receptor A3 (LILRA3), indicating pathogen-driven disruptive selection (Wright's FST=0.32). An assessment of seven populations representative of African, Asian and Caucasoid ethnic groups (total n=593) provided little evidence for long-range LRC haplotypes. The different natural selection pressures acting on each locus may have contributed to a lack of linkage disequilibrium between them.
Assuntos
Humanos , Células Matadoras Naturais , Seleção Genética , Trinidad e TobagoRESUMO
The enzyme glycoxalase I (glyox I) is involved in metabolic detoxification, and requires glutathione (GSH) as a cofactor. Given the low concentration of whole blood GSH in children with oedematous malnutrition, it is possible that the function of this pathway may be compromised in these children. Glyox I activity was therfore assayed in erythocytes taken from 133 severely malnourished children and 21 age-matched controls. The mean values (ñSEM) for the marasmic group (marasmus: 105 ñ 4/u/gm Hb) and the group with kwashiorkor (Kwash: 103 ñ 4/u/gm Hb) were not significantly different from controls (cont: 104 ñ 2u/gm HB)>. In the group with marasmic-kwashiorkor (M-K: 88 ñ 4u/g Hb) Glyox I activity was significantly lower in controls (p < 0.005), as well as in children with marasmus (p < 0.005), and kwashiorkor (p < 0.05). Enzyme activity was lower than normal in 45 per cent of the MK group. Seven children died subsequent to admission; in five cases Glyox I activities were exceedingly low. There was a weak positive correlation between Glyox I activity and whole blood levels of GSH (r=0.215). We conclude that Glyox I activity is relatively unaffected in malnutrition, except in those with M-K and especially those who do not survive the acutely malnourished state