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BACKGROUND: Little was known about the population coverage and causes of sight impairment (SI) registration within the Caribbean, or the extent to which register studies offer insights into population eye health. METHODS: We compared causes of SI registration in the Trinidad and Tobago Blind Welfare Association (TTBWA) register with findings from the 2014 National Eye Survey of Trinidad and Tobago (NESTT), and estimated registration coverage. Cross-sectional validation studies of registered clients included interviews, visual function and cause ascertainment in July 2013, and interviews and visual function in July 2016. RESULTS: The TTBWA register included 863 people (all ages, 48.1%(n = 415) male) registered between 1951 and 2015. The NESTT identified 1.1%(75/7158) people aged ≥5years eligible for partial or severe SI registration, of whom 49.3%(n = 37) were male. Registration coverage was approximately 7% of the eligible population of Trinidad. Nevertheless, there was close agreement in the causes of SI comparing the register and population-representative survey. Glaucoma was the leading cause in both the register (26.1%,n = 225) and population-based survey (26.1%, 18/69 adults), followed by cataract and diabetic retinopathy. In the validation studies combined, 62.6%(93/151) clients had severe SI, 28.5%(43/151) had partial SI and 9.9%(15/151) did not meet SI eligibility criteria. SI was potentially avoidable in at least 58%(n = 36/62) adults and 50%(n = 7/14) children. CONCLUSION: We report very low register coverage of the SI population, but close agreement in causes of SI to a contemporaneous national population-based eye survey, half of which resulted from preventable or treatable eye disease.
Assuntos
Sistema de Registros , Humanos , Trinidad e Tobago/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Adulto , Adolescente , Idoso , Criança , Cegueira/epidemiologia , Pré-Escolar , Inquéritos Epidemiológicos , Adulto Jovem , Pessoas com Deficiência Visual/estatística & dados numéricos , Idoso de 80 Anos ou mais , LactenteRESUMO
Background: To create a strip test to monitor blood sugar levels in diabetics using tears. For most diabetics, the current available methods for testing blood glucose are either invasive, inconvenient or both. A test such as glucose tear strip would improve patient compliance and disease control. Methods: 50 diabetic and 50 non-diabetic subjects, participated in this study. A sample of tears was collected from each subject's right eye using a glass microcapillary tube. Following tear collection, the blood glucose level of each subject was tested and recorded. At the end of sample collection 100 samples of tears were tested for glucose concentration. The results were examined to determine the correlation of glucose in tears to that in blood. Results: Based on this study conducted, the average TG concentration in non-diabetics was found to be 1.89 0.54 mg/dL and in diabetics, 3.10 0.55 mg/dL, whilst the PPBG concentration in non-diabetics and diabetics was found to be 118.60 4.67 mg/dL and 233.98 16.21 mg/dL respectively. Conclusion: There was a significant difference in between the glucose concentration in tears and the glucose concentration in blood. There was a weak correlation between the two variables. The development of a non-invasive, convenient and patient-friendly method of monitoring glucose concentration may not be possible but with advancements in technology, a strips sensitive to low concentrations of glucose present in tears can be developed.
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Humanos , Trinidad e Tobago , Glicemia , LágrimasRESUMO
AIM: To estimate the prevalence, causes and risk factors for presenting distance and near vision impairment (VI) in Trinidad and Tobago. METHODS: This is a national, population-based survey using multistage, cluster random sampling in 120 clusters with probability-proportionate-to-size methods. Stage 1 included standardised, community-based measurement of visual acuity. Stage 2 invited all 4263 people aged ≥40 years for comprehensive clinic-based assessment. The Moorfields Eye Hospital Reading Centre graded fundus photographs and optical coherence tomography images independently. RESULTS: The response rates were 84.2% (n=3589) (stage 1) and 65.4% (n=2790) (stage 2), including 97.1% with VI. The mean age was 57.2 (SD 11.9) years, 54.5% were female, 42.6% were of African descent and 39.0% were of South Asian descent. 11.88% (95% CI 10.88 to 12.97, n=468) had distance VI (logarithm of the minimum angle of resolution [logMAR] >0.30), including blindness (logMAR >1.30) in 0.73% (95% CI 0.48 to 0.97, n=31), after adjustment for study design, non-response, age, sex and municipality. The leading causes of blindness included glaucoma (31.7%, 95% CI 18.7 to 44.8), cataract (28.8%, 95% CI 12.6 to 45.1) and diabetic retinopathy (19.1%, 95% CI 4.2 to 34.0). The leading cause of distance VI was uncorrected refractive error (47.4%, 95% CI 43.4 to 51.3). Potentially avoidable VI accounted for 86.1% (95% CI 82.88 to 88.81), an estimated 176 323 cases in the national population aged ≥40 years. 22.3% (95% CI 20.7 to 23.8, n=695) had uncorrected near VI (logMAR >0.30 at 40 cm with distance acuity <0.30). Significant independent associations with distance VI included increasing age, diagnosed diabetes and unemployment. Significant independent associations with near VI included male sex, no health insurance and unemployment. CONCLUSIONS: Trinidad and Tobago's burden of avoidable VI exceeds that of other high-income countries. Population and health system priorities are identified to help close the gap.
Assuntos
Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/epidemiologia , Cegueira/etiologia , Cegueira/fisiopatologia , Catarata/complicações , Catarata/epidemiologia , Estudos Transversais , Retinopatia Diabética/complicações , Retinopatia Diabética/epidemiologia , Glaucoma/complicações , Glaucoma/epidemiologia , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Prevalência , Erros de Refração/complicações , Erros de Refração/epidemiologia , Fatores de Risco , Trinidad e Tobago/epidemiologia , Baixa Visão/etiologia , Baixa Visão/fisiopatologia , Acuidade VisualRESUMO
Avoidable blindness is an important global public health concern. This study aimed to assess Trinidad and Tobago's progress towards achieving the Pan American Health Organization, 'Strategic Framework for Vision 2020: The Right to Sight-Caribbean Region,' indicators through comprehensive review of the eyecare system, in order to facilitate health system priority setting. We administered structured surveys to six stakeholder groups, including eyecare providers, patients and older adult participants in the National Eye Survey of Trinidad and Tobago. We reviewed reports, registers and policy documents, and used a health system dynamics framework to synthesize data. In 2014, the population of 1.3 million were served by a pluralistic eyecare system, which had achieved 14 out of 27 Strategic Framework indicators. The Government provided free primary, secondary and emergency eyecare services, through 108 health centres and 5 hospitals (0.26 ophthalmologists and 1.32 ophthalmologists-in-training per 50 000 population). Private sector optometrists (4.37 per 50 000 population), and ophthalmologists (0.93 per 50 000 population) provided 80% of all eyecare. Only 19.3% of the adult population had private health insurance, revealing significant out-of-pocket expenditure. We identified potential weaknesses in the eyecare system where investment might reduce avoidable blindness. These included a need for more ophthalmic equipment and maintenance in the public sector, national screening programmes for diabetic retinopathy, retinopathy of prematurity and neonatal eye defects, and pathways to ensure timely and equitable access to subspecialized surgery. Eyecare for older adults was responsible for an estimated 9.5% (US$22.6 million) of annual health expenditure. This study used the health system dynamics framework and new data to identify priorities for eyecare system strengthening. We recommend this approach for exploring potential health system barriers to addressing avoidable blindness, and other important public health problems.
Assuntos
Oftalmologia/organização & administração , Análise de Sistemas , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/prevenção & controle , Oftalmopatias/epidemiologia , Oftalmopatias/cirurgia , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmologistas/estatística & dados numéricos , Oftalmologia/economia , Oftalmologia/instrumentação , Optometristas/estatística & dados numéricos , Pacientes Ambulatoriais , Inquéritos e Questionários , Trinidad e Tobago , Recursos HumanosRESUMO
PURPOSE: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. METHODS: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. RESULTS: The fieldwork was conducted over 13 months in 2013-2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. CONCLUSION: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older.
Assuntos
Cegueira/epidemiologia , Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Cegueira/economia , Criança , Pré-Escolar , Análise por Conglomerados , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Fatores de Risco , Distribuição por Sexo , Trinidad e Tobago/epidemiologia , Baixa Visão/economia , Adulto JovemRESUMO
BACKGROUND: The conduct of international collaborative genomics research raises distinct ethical challenges that require special consideration, especially if conducted in settings that are research-naïve or resource-limited. Although there is considerable literature on these issues, there is a dearth of literature chronicling approaches taken to address these issues in the field. Additionally no previous ethical guidelines have been developed to support similar research in Trinidad and Tobago. METHODS: A literature review was undertaken to identify strategies used to address common ethical issues relevant to human genetics and genomics research in research-naïve or resource-limited settings. Strategies identified were combined with novel approaches to develop a culturally appropriate, multifaceted strategy to address potential challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT). RESULTS: Regarding the protection of study participants, we report a decision to exclude children as participants; the use of a Community Engagement and Sensitization Strategy to increase the genetic literacy of the target population; the involvement of local expertise to ensure cultural sensitivity and to address potential comprehension barriers in informed consent; and an audit of the informed consent process to ensure valid consent. Concerning the regulation of the research, we report on ethics approvals from relevant authorities; a Materials Transfer Agreement to guide sample ownership and export; and a Sample Governance Committee to oversee data use and data access. Finally regarding the protection of the interests of scientists from the host country, we report on capacity building efforts to ensure that local scientists have access to data collected through the project and appropriate recognition of their contributions in future publications. CONCLUSION: This paper outlines an ethical framework for the conduct of population-based genetics and genomics research in Trinidad and Tobago; highlights common issues arising in the field and strategies to address these.
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The aim of the present study was to compare the porosity characteristics of AH Plus Jet(tm) syringe-mix and the conventional hand-mixed AH Plus root canal sealers by three-dimensional quantitative high-resolution micro-computed tomography (micro-CT). Seven test specimens were prepared from each tested sealer by a single operator following the manufacturer's instructions and poured into pre-lubricated plastic split-ring moulds. Set sealer test specimens were scanned using a micro-CT device and the shadow images were reconstructed into cross-sectional slices. The evaluated parameters were (i) total pore count, (ii) total pore volume and mean pore volume, (iii) total porosity (% of pore volume in relation to total sealer volume) and (iv) mean pore distance to the sealer lateral external surface. In both groups, most pores were localized within the external sealer perimeter (0.05 mm from the external surface). Hand-mixed AH Plus specimens showed statistically significant higher mean total pore count, total pore volume and total porosity (p=0.001) than the syringe-mixed specimens. However, mean pore sizes in AH Plus syringe-mixed specimens were significantly higher (p=0.046) than the AH Plus hand-mixed counterparts. Hand-mixed AH Plus was associated with higher total mean pore count, volume and total porosity compared to syringe mixed AH Plus.
Resumo O objetivo do presente estudo foi comparar a porosidade do AH Plus Jet(tm) dotado de misturador automático com o AH Plus convencional manipulado a mão a partir de um método quantitativo de microtomografia computadorizada (micro-CT). Para cada cimento, sete espécimes foram preparados por um único operador, seguindo as instruções do fabricante, e inseridas em anéis de plástico. Após o tempo de presa, os cimentos foram escaneados utilizando o micro-CT e as imagens foram reconstruídas. Os parâmetros avaliados foram (i) contagem total de poros, (ii) volume total de poros e média dos volumes dos poros, (iii) porosidade total (% de volume de poros em relação ao volume total do cimento) e (iv) distância média dos poros em relação ao perímetro externo (0,05 mm da superfície externa). O AH Plus manipulado a mão apresentou maior número de poros, maior volume total de poros e porosidade total (p=0,001) comparado com o AH Plus com misturador. No entanto, a média de tamanho dos poros foi estatisticamente superior no AH Plus com misturador quando comparado com o AH Plus manipulado a mão (p=0,046). O AH Plus manipulado a mão foi associado com uma maior média de poros, volume e porosidade quando comparado com o AH Plus com misturador.
Assuntos
Resinas Epóxi , Porosidade , Materiais Restauradores do Canal Radicular , Seringas , Microtomografia por Raio-XRESUMO
Background. Worldwide, cataract is a major cause of blindness. The paper aims to evaluate factors associated with borderline and poor outcomes of cataract surgery at an Eastern Regional Health Authority (ERHA) hospital in Trinidad and Tobago. Materials and Methods. A hospital-based, retrospective study was done on 401 patients who had undergone cataract surgery (unilateral and bilateral) at an ERHA Hospital between March 2009 and September 2014. Data was collected on variables concerning demographic, medical history, surgical history, ocular findings and visual acuity (VA). The outcome variable of interest was Snellen's post-operative (presenting) VA which was transformed into a dichotomous variable with borderline and poor outcomes as one and good outcomes as the other. Data were analysed using univariate and multivariate logistic regression analyses. Results. Good outcome (presenting VA 6/18 or better) was seen in 350 (67%) eyes. The fitted model consisted of ocular co-morbidity (OR =2.133; 95% CI [1.346-3.380]), hypertension (OR = 0.520; 95% CI [0.381-0.928]), surgical procedure (OR = 1.56; 95% CI [1.004-2.425]), good preoperative VA (OR = 0.388, 95% CI [0.211-0.714]), borderline preoperative VA (OR = 0.485; 95% CI = [0.278-0.843]) and year of first visit to clinic (OR = 2.243; 95% CI [1.215-4.141]). Conclusion. There is a need for community-based outreach to increase awareness of eye health and diseases. It is recommended that the general population is encouraged to take responsibility for personal management. The facilities at the Hospital should also be enhanced.
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The aim of the present study was to compare the porosity characteristics of AH Plus Jet(tm) syringe-mix and the conventional hand-mixed AH Plus root canal sealers by three-dimensional quantitative high-resolution micro-computed tomography (micro-CT). Seven test specimens were prepared from each tested sealer by a single operator following the manufacturer's instructions and poured into pre-lubricated plastic split-ring moulds. Set sealer test specimens were scanned using a micro-CT device and the shadow images were reconstructed into cross-sectional slices. The evaluated parameters were (i) total pore count, (ii) total pore volume and mean pore volume, (iii) total porosity (% of pore volume in relation to total sealer volume) and (iv) mean pore distance to the sealer lateral external surface. In both groups, most pores were localized within the external sealer perimeter (0.05 mm from the external surface). Hand-mixed AH Plus specimens showed statistically significant higher mean total pore count, total pore volume and total porosity (p=0.001) than the syringe-mixed specimens. However, mean pore sizes in AH Plus syringe-mixed specimens were significantly higher (p=0.046) than the AH Plus hand-mixed counterparts. Hand-mixed AH Plus was associated with higher total mean pore count, volume and total porosity compared to syringe mixed AH Plus.