Longitudinal changes in the nature, severity and frequency of COPD exacerbations

Exacerbations are an important feature and outcome measure in chronic obstructive pulmonary disease (COPD), but little is known about changes in their severity, recovery, symptom composition or frequency over time. In this study 132 patients (91 male; median age 68.4 yrs and median forced expiratory volume in one second (FEV1) 38.4% predicted) recorded daily symptoms and morning peak expiratory flow. Patients were monitored for a median of 918 days and 1,111 exacerbations were identified. Patients with severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) category III, n=38) had an annual exacerbation frequency of 3.43·yr–1, 0.75·yr–1 higher than those with moderate COPD (GOLD II, n=94). Exacerbation frequency did not change significantly during the study. At exacerbation onset, symptom count increased to 2.23, relative to a baseline of 0.36 set 8–14 days previously, and this increase rose by 0.05·yr–1. Recovery to baseline levels in symptoms and FEV1 took longer (0.32 and 0.55 days·yr–1). Sputum purulence at exacerbation became more prevalent over time by 4.1%·yr–1 from an initial value of 17%. The results of this study suggest that over time, individual patients have more symptoms during exacerbations, with an increased chance of sputum purulence and longer recovery times.

Quantification of microvascular resistance in patients with diabetes mellitus [abstract]

Near Infrared Photoplethysmography (NIRP) is a non-invasive technique that has the potential to be used to assess the state of the peripheral nerves and microcirculation. However, the parameters that reflect the state of the microvascular system have not been established. Therefore, we tested the hypothesis that the resistance of the blood vessels in the microcirculation can be determined by analyzing the temporal components of the photoplethysmographic trace. NIRP incorporates two light-emitting diodes and a photodetector. The emergent light enters the skin and penetrates to the level of the dermis, is backscattered, collected by the photodetector and converted to a recordable trace. This trace consists of a series of pulses synchronous with the heart period, Th. It is possible to divide each pulse into a rise time from baseline to peak, Tg, and fall time from peak to baseline, Ta. All NIRP recordings were taken from the right index finger with the person in the supine position. In a first study involving five healthy male volunteers, the subjects right arm was cuffed approximately three minutes during which he exercised the fingers to increase a buildup of tissue metabolites; this was done in order to decrease microvascular resistance. In a second study, the above parameters (Th, Tg and Ta) were measured in 31 patients with chronic diabetes mellitus (diabetic group, DG) and compared to those of 29 healthy normal persons (healthy group, HG). In the first study, the ratio of the rise time to the heart period (Tg/Th) or of the rise time of the fall time (Tg/Ta) was increased, whereas that to the fall time of the heart period (Ta/Th) was decreased. In the second study, the mean for the Tg/Th was 0.235 ñ 0.008 (mean ñ sem) for the HG and 0.292 ñ 0.007 for the DG; the increase was highly significant, p< 0.001 (one-tail unpaired t-test). The mean for the Tg/Ta was 0.312 ñ 0.013 for the HG and 0.413 ñ 0.012 for the DG; this increase was also highly significant, p< 0.001. The mean for the Ta/Th was 0.765 ñ 0.008 for the HG and 0.711 ñ 0.006 for the DG; the decrease was highly significant, p< 0.001. In conclusion, an increase in microvascular resistance was reflected in an increase in the rise time and a decrease in the fall time. Thus this system appears to be a useful one in quantifying the increase in microvascvular resistance in diabetics. (AU)

Glucose-6-phosphate dehydrogenase activity in diabetes in Trinidad and Tobago [abstract]

Glucose-6-phosphate dehydrogenase (G6PD D- Glucose 6 Phosphate NADP oxiderductase E.C.1.1.1.49) is ubiquitous enzyme catalyzing the first and rate limiting reaction in the pentose phosphate pathway. In erythrocytes, the role of this pathway becomes more essential since it is the soul source of reduced nicotinamide adenine dinucleotide phosphate (NADPH). There are over 100 genetic variants of G6PD deficiency, each presenting varying deficient levels. The enzymopathy has been found to be associated with a number of diseases. Previous studies on the relationship between the deficiency and diabetes mellitus have revealed that persons with diabetes mellitus exhibit a higher prevalence of G6PD deficiency than non-diabetic persons. This report deals with preliminary results of a study of the relationship between G6PD deficiency and diabetes mellitus in 71 known diabetic patients of African descent. In addition to the assay for G6PD activity, the level of glycated haemoglobin (HbA1c) was determined, since a number of studies have suggested that G6PD deficiency is most prevalent in instances of prolonged hyperglycaemia. Of these 71 patients, 46 (64.8 percent) showed varying levels of deficiency (p= 0.018). The G6PD status did not appear to be affected by age, duration of the disease, or the treatment undergone. However, a higher percentage of the elevated HbA1c level was found among the deficient diabetic patients (14.6 percent) than among the non-deficient diabetic patients (4.4 percent). These findings indicate that in addition to there being some positive relationship between diabetes mellitus and G6PD deficiency, it appears that the G6PD-deficient diabetic patients do not cope with the disease as well as those diabetic patients that are not G6PD-deficient. (AU)

Suicide in Jamaica: some socio-demographic findings [abstract]

The objective of this study was to examine trends in suicide in Jamaica from 1974 to 2000; socio-demographic variables for suicide over the past 5 years and specific aspects of in the year 2000 were examined. Figures for suicide in Jamaica over the period 1974-2000, provided by the Police Computing Centre, were examined. The trends in respect of suicide methods used, and socio-demographic factors: age, gender, location (urban/rural), over the period 1996 to date were identified, and additionally, 57 cases (51 males, 6 females) of suicide in 2000, to date, were examined via month/ quarter of occurrence, and possible precipitating factors, including mental disorder, stressful life events, and larger social issues. The ages of the suicide cases ranged from 15 to 78 years with a mean age of 40 years. The data were analyzed at the Department of Administrative Computing. The SPSS package was used. There was a marked increase in suicide from 1992. Linear regression indicated a continued increase in suicide over the following three years unless there was appropriate intervention. Hanging emerged as the most commonly used method of suicide by both men (80.4 percent, (n= 41) and women (66.7 percent, (n= 4). Chi-square analysis showed no significant difference between the genders, both choosing hanging over all other methods. Regarding age and method, 100 percent of cases in age groups 20 to 29 years (n= 13) and 70 to 79 years (n= 6) used hanging, while 80 percent of cases in age group 50 to 59 years (n= 5) chose methods other than hanging, including shooting, setting self on fire, drowning, jumping from a height, throat and wrist slashing, and ingestion of poisonous liquids (levels of significance, p= 0.006). (AU)

Social class and pathways to care among psychiatric clinic referrals at the University Hospital of the West Indies [abstract]

OBJECTIVE: To determine the effects of social class on the pathways to outpatient psychiatric care at the University Hospital of the West Indies. METHODS: This was a prospective cohort study of patients attending the psychiatric screening clinic of the University Hospital of the West Indies. Demographic, clinical and outcome variables were collected over the period February to July 2001. RESULTS: The cohort consisted of 306 patients of whom 150 were male, 156 were female and 85.4 percent were from social classes III to V. Most of the patients came from urban St.Andrew (57 percent). More than half (51 percent) took the bus, 61 percent were brought by family members, 31.8 percent came alone. More than three-quarters (76.4 percent) were seen in the emergency outpatient department prior to being referred. Most (66.4 percent) patients presented within six months of onset symptoms. Once seen, 47.3 percent (142) were referred the government community mental health service while an equal number was distributed within the psychiatric service of the hospital. There was a statistically significant relationship between social class and method of transportation (p= 0.001). No association was found with social class and any other variable. CONCLUSIONS: For the majority of these patients, with the exception of the method of transportation to the clinic, there is no effect of social class on all the variables studied. The transporattion variable, which was significant, was not related to the services offered. (AU)

A psychosocial profile of absconders from a psychiatric unit of a general hospital [abstract]

OBJECTIVE: To identify the significant psychosocial variables in a cohort of absconders from a psychiatric unit of a general hospital. METHOD: This study looked at the demographic and clinical aspects of patients who absconded from a psychiatric unit (Ward 21, University Hospital of the West Indies) over an 18-month period from January 2000 to June 2001. The variables observed were age, gender, diagnosis, period of time between admission to the ward and absconding, substance abuse and rate of absconding for each month during the 18-month period. The rate of patients absconding from the unit was calculated as the number of patients who absconded divided by the total number of patients admitted for that month. RESULTS: The monthly rate of absconding for the overall period observed was 2.98 percent. Of the patients who absconded, 95 percent were male, 71 percent were within the age range 15-34 years, 52.4 percent were frequent users of marijuana, 52.4 percent absconded within the first 6 days of admission and the most common diagnosis in the cohort was substance induced psychosis (33.3 percent). CONCLUSION: Patients who absconded from Ward 21 were mainly young males who were marijuana substance abusers who absconded early in their admission to the ward. This profile has guided the design of more efficient therapeutic management programmes on the unit. (AU)

Utilization of liaison psychiatric services in a general hospital in Jamaica [abstract]

OBJECTIVE: To identify the pattern and characteristics of Liaison Psychiatry refferals in the University Hospital of the West Indies over a six-month period. METHOD: A prospective cohort analysis was conducted on patients referred to the Liaison Psychiatry service between November 28, 2000 and May 28, 2001. Clinical and sociodemographic data were gathered by individual interviews and mental status examination and a DSM IV diagnosis made. RESULTS: Fifty-nine patients were referred with 28 (47.5 percent) males, and with a mean ñ Standard Deviation age of 39.42 ñ 15.92 years. Significantly more patients were referred from the medical wards (37, 62.5 percent) than from the surgical wards (14, 23.7 percent) or the gynaecological wards (8, 13.6 percent) (x2= 16.803, 2df, p<0.005). The main reason for referral was "strange behaviour" (31, 52.5 percent) and depression (13, 22 percent). There was no statistically significant difference between the referring wards and the reason for referral or diagnostic pattern. An equal number of patients were diagnosed with a psychotic disorder and unipolar depressive disorder (33.9 percent each). CONCLUSION: The medical wards of the University Hospital of the West Indies are the main agents of referral to the Liaison Psychiatric service with the majority of patients presenting with the majority of patients unipolar depressive or psychotic disorders. (AU)

Psychological autopsy as a method of investigating suicide in Jamaica [Abstract]

OBJECTIVE: To assess the usefulness of the psychological autopsy in the Jamaican setting for investigating the characteristics of suicides in respect of psychiatric diagnoses and stressful life events. METHODS: The study was conducted in the parishes of Kingston, St.Andrew and St.Catherine, Jamaica. All suicide cases occuring between January 1 and December 31, 1998, were identified on the basis of police records. After obtaining informed consent the autopsy process initiated by interviewing key informants identified by relatives. Semi-structured interviews to assess mental state and stressful life events were conducted by a psychiatrist and supplemented by a review of case notes. A structured questionnaire was used to assess sociodemographic characteristics. An assessment of mental status prior to death was done and DSM IV criteria used to classify psychiatric disorders. Thiry-two suicides were studied using the psychological autopsy method. There was overwhelming willingness among key informants to be interviewed. RESULTS: The approach was fairly time consuming; interviews ranged from forty-five minutes to four hours (mean of 2 hours) having to be extended at times to allow for expression of emotions by informants. The method allowed for fairly easy retrospective formulation of psychiatric diagnosis (90 percent of victims) and for the elucidation of comorbidity. Substancial levels of stressful life events were also exposed. Many relatives expressed relief at being able to discuss these deaths with a neutral person. CONCLUSIONS: The psychological autopsy approach has provided valuable insights into the epidemiological and psychosocial context of suicide occurrence in these three Jamaican parishes. It has potential for ongoing surveillance and in the planning of prevention programmes. Its use among community mental health professionals should be evaluated. (AU)

Obstetric complications and autism in Jamaican children [abstract]

OBJECTIVE: There has been an increased prevalence of autism worldwide. Research in developed countries has identified a number of associations, though no direct agent has been identified. Mothers of autistic children have been shown to have more obstetric complications than others. There is little information available about autistic disorder in developing countries. This study sought to determine the relationship between obstetric and perinatal history and the diagnosis of autistic disorder in Jamaican children. METHODS: Children with autistic disorder were identified from public hospital records, private paediatricians' records and from registers of special schools. Parents of 55 Jamaican children were interviewed about the pre-natal and peri-natal periods. Their experiences were compared with those of a national sample of young children for whom pre-natal and peri-natal information was already available. The same questionnare was administered to both groups of parents. RESULTS: The mean ñ Standard Deviation age of autistic children was 6.3 ñ 4.3 years. There was a male preponderance in the autistic group (79 percent), compared with the control group (forty eight percent). Families with autistic children had significantly fewer children (mean/SD 2.54 ñ 1.5) than the non-autistic control group (mean/SD4.02 ñ 2.5) (p<0.05). Mothers of autistic children had higher rates of complications during labour (30.2 percent compared with 12.8 percent) and pregnancy (30.2 percent compared with 13.4 percent), but these did not achieve statistical significance. A greater proportion of autistic children was either born prematurely or late and was admitted to the hospital but these differences were not statistically significant. Breast feeding rates were similar. CONCLUSION: This study showed that mothers of autistic children in Jamaica have a higher rate of obstetric complications, as has been found in other countries. Mothers have a significantly higher mean age at the birth of an autistic child and have significantly fewer children. Parents may opt not to have any more children once a child with a disability has been born. (AU)

Outcome of first contact schizophrenia in Jamaica

Several previous studies have identified high incidence rates, high relapse rates and poor short term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62 percent) were treated at home, and 120 (38 percent) were admitted to hospital for treatment. Two hundred and sixty four (83 percent) were still being seen after one year. The relapse rate was 13 percent (41 patients), higher for admissions (24, 20 percent) than for those treated at home (17, 9 percent; p<0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p<0.005). One hundred and thirty five (43 percent) were in gainful employment within the 12 month period of follow up, contrasted with the 40 percent unemployment rate for the 2.4 million population of the island (chi square = 39.322, p<0.001). There was a self-reported use of medication in 213 (67 percent) patients, with 142 (45 percent) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first srevice contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK. (AU)

Red cell antibodies in patients with homozygous sickle cell disease: a comparison of patients in Jamaica and the United Kingdom

The transfusion history and frequency of red cell antibodies in patients with homozygous sickle cell (SS) disease have been compared in 190 subjects from the Jamaican cohort study and 37 patients attending a sickle cell clinic in Manchester, England. The proportion of patients transfused did not differ between the groups although the number of units transfused and the frequency of red cell antibodies were significantly greater in the Manchester group. Immune antibodies occurred in three Jamaicans (2.6 percent of those transfused) and 16 UK subjects (76 percent of those transfused). Multiple antibodies occurred in 10 (63 percent) UK subjects but in no Jamaicans. Indications for transfusion also differed between the groups, Jamaican patients typically receiving 1-2 units for acute anaemia or acute chest syndrome, whereas UK patients frequently had multiple transfusions in preoperative exchange or prophylaxis programmes. The greater red cell alloimmunization among UK patients probably reflects both the greater use of transfusion and the disparity between donor and recipient populations in the UK. (AU)

Surfactant treatment in premature infants with respiratory distress syndrome in Curacao

Surfactant replacement therapy for Respiratory Distress Syndrome (RDS) in premature neonates has been established as an effective treatment, although significant mortality and morbidity remain. In Curacao, surfactant became available as a therapeutic option in 1994. A retrospective cohort study was performed to describe the results of surfactant treatment in premature newborns with RDS in Curacao between 1994 and 1998. Of 429 infants admitted to the study hospital in this period, 7.5 percent (n=32) developed RDS and were treated with surfactant. Twenty-five per cent (n=8) of these infants died, most of them in the first year of surfactant treatment. Twenty-eight per cent (n=9) developed bronchopulmonary dysplasia (BPD), the most frequently observed complication. The highest incidence of BPD (44 percent) was found in the very low birth weight infants (750-1500 g); all infants with BPD were 27-30 weeks of gestational age. The duration of ventilator dependence was significantly associated with the development of BPD (p < 0.05). No other risk factors for complications during the treatment course could be identified. The mean time between birth and the first surfactant treatment was more than nine hours. In this study, we found low incidence rates of RDS and BPD, and a considerable mortality in surfactant treated surfactant treatment newborns. This pilot study shows that surfactant treatment of premature infants is feasible in Curacao. Earlier administration of surfactant, preferably within 2-3 hrs after birth, is expected to lower the risk of death and oxygen dependence.(Au)

Observed versus indirect estimates of incidence of open-angle Glaucoma

Incidence data on open-angle glaucoma (OAG) are limited and difficult to obtain. To date, few studies have reported incidence directly measured from population-based cohorts. Other reported estimates have been derived indirectly from age-specific prevalence by using several assumptions, and their validity is unknown. To the authors' knowledge, this report presents the first comparison of observed versus indirect estimates of OAG incidence based on data from the population-based Barbados Incidence Study of Eye Diseases (1992-1997) (n= 3,427; 85 percent participation). The observed 4-year incidence of OAG was 1.2 percent (95 percent confidence interval (CI):ages 60-69 years, and 4.2 percent (95 percent CI: 2.6, 6.3 percent) in persons at ages 70 or more years. When incidence was calculated from the prevalence data, power function fitting achieved a closer approximation to observed incidence than did logistic curve fitting. Calculated incidence rate for each group were similar when assuming mortality that was equal (incidence rate= 0.7, 1.3, 2.3, and 4.8 percent) or differential (incidence rate= 0.7, 1.2, 2.4, and 4.8 percent). Other nonlogistic approaches also increased the resemblance of observed and calculated estimates. The absence of longitudinal data, reasonably valid incidence estimates of OAG were obtained from available prevalence data. These estimation techniques can be useful when OAG incidence estimates are required for research or public health purposes. (AU)

Incidence of open-angle glaucoma. The Barbados Eye studies

OBJECTIVE: To measure the 4-year risk of open-angle glaucoma (OAG) in a black population. DESIGN: Population-based cohort study with 4 years of follow up. SETTING: Simple random sample of residents of Barbados, West Indies, aged 40 years or older. PARTICIPANTS: A total of 3427 members of the cohort (85 percent of those eligible). MAIN OUTCOME MEASURE: Development of glaucoma visual field defects and optic disc damage, confirmed by automated perimetry, independent fundus photographic gradings, and standardized opthalmologic examinations. RESULTS: The 4-year risk of OAG in black participants was 2.2 percent (95 percent confidence interval, 1.7 percent-2.8 percent), based on 67 newly developed cases of OAG. Incidence rates increased from 1.2 percent at ages 40 to 49 years to 4.2 percent at ages of 70 years or more, tending to be higher in men than women (2.7 percent vs 1.9 percent). About half of the incident cases were undiagnosed previously, and the rest were receiving OAG treatment. Of the 67 new cases of OAG, 32 had intraocular pressure of 21 mm HG or less at baseline (1.2 percent incidence) and 35 had higher pressures (9 percent incidence). Risk was the highest among persons classified as having suspect OAG at baseline (26.1 percent), followed by those with ocular hypertension (4.9 percent and lowest in the remining population (0.8 percent). CONCLUSIONS: This longitudinal study provides new information on OAG risk, as well as the first incidence measurement in a black population. Although intraocular pressure increased risk, about half of the new cases had baseline pressures of 21 mm Hg or less. Results substantiate the high OAG risk in the population of African origin, especially in older adults; the relative role of intraocular pressure; and the considerable underdetecion of new disease after 4 years of follow-up. (AU)

The impact of the women's centre of Jamaica foundation programme for adolescent mothers on repeat pregnancies

A random sample (n=260) of primiparous Jamaican adolescent mothers (12-16 years old) who gave birth in 1994 in the parishes of Kingston and St Andrew, St Catherine and Manchester was selected from vital records and interviewed in 1998 for this historical cohort study. Among programme participants, the incidence of repeat pregnancy was 37 percent compared with 60 percent among non-participants. Programme participation reduced the risk of one or more repeat pregnancies by 45 percent with 95 percent confidence interval (0.22, 0.91). Programme participants were also 1.5 times (1.005, 2.347) more likely to complete high school than non-participants; however, this effect did not achieve statistical significance. The results confirmed that the WCJF Programme exerts a considerable effect on the incidence of repeat pregnancy among participants. The benefits of programme participation were greatest among residents of the Kingston Metropolitan Area from single parent, female headed households with average incomes below J$10,000, who wanted to continue their education after the first live birth.(Au)

Disorders of thyroid hormones in non-insulin-dependent diabetes mellitus

INTRODUCTION: In a previous study of patients with non-insulin-dependent diabetes mellitus (NIDDM) of less than 5 years' duration at the HCQ "Hermanos Ameijeiras", Cuba, we found abnormal values of T3 at iniitial evaluation. It was proved that the cause was an increase in the activity of the enzyme catalysing the process of peripheral deiodination of T4 to T3. OBJECTIVE: To examine these variables in a larger sample. SUBJECTS AND METHODS: One hundred and forty patients with NIDDM of 1-25 years' duration being treated by diet, and/or oral hypoglycaemic agents, were studied T3, T4, and insulin were measured by radio-immunoassay; glucose, by glucose-oxidase; cholesterol, triglycerides and HDL-cholestrol by the Trinder method; LDL and VLDL by the Ellefson formula; glycosylated haemoglobin by ion exchange chromatography, and microalbuminuria by an immuno-colorimetric semiquantitative method. The sample was divided into 5 groups: 1-2 years, 3-4 years, 5-6 years, 7-15 years, and more than 15 years' duration of diabetes mellitus. RESULTS: The results confirmed the previous findings that there was a marked increase in T3 (4.87, 4.49, 3.1, 2.8, 2.9 mmol/l, respectively) in the time of evolution but diminishing progressively as the time of evolution increases and normalizing in the 5-6 year group. There were no notable differences in T4 in the 5 groups of healthy controls (102, 113, 96, 94, 99 mmol/l). The blood glucose levels were higher than in the healthy population but a point of inflection was noted in the 5th -6th year of evolution (8.6, 8.2. 7.02, 8.4, 8.3 mmol/l). The insulin values were noted to have a greater variation between 1-2 years and 3-4 years, supposedly a treatment effect as in the 1-2 year group. There were patients who had not started treatment but the insulin in the 3-4 year group decreased with the introduction of treatment (48.7, 17.9, 32.1, 36.6, 39.5 mU/ml). Glycosylated haemoglobin showed a point of inflection in the 5th-6th year (7.2, 6.3, 8.2, 7.9, 8.5 percent). Lipid metabolism indicators, cholesterol (4.7, 5.2, 5.6, 5.74, 5.5 mmol/l), triglyceride (1.34, 2.01, 1.33, 1.95, 1.65 mmol/l) and low density lipoprotein (2.99, 3.14, 3.97, 3.95, 3.63 mmol/l) progressively increased with time of evolution. Microalbuminuria behaved the same (25, 12.4, 14.5, 33.4, 27.3 mg/l), showing a higher value at 1-2 years and diminishing between 3 and 6 years but increasing thereafter.(Au)

Incidence of open-angle glaucoma and blood pressure [abstract]

PURPOSE: The relationship of open-angle glaucoma (OAG) to blood pressure (BP) is uncertain, with inconsistent result reported. clarification is needed because vascular factor may influence OAG incidence, but only OAG prevalence between data has been available. In addition, few analyses have accounted for the correlation between BP and intraocular pressure (IOP), or for the effects of antihypertensive treatment (AHT) and IOP-lowering treatment. We describe the role of BP as a risk factor for the 4-year incidence of OAG in Barbados Incidence of Eye Disease (BISED) participants of African descent, while controlling for relevant variables. METHODS: BISED re-examined 3,427 or 85 percent of eligible members of a population-based cohort, 4 years after baseline. The protocol included two BP measurements (random zero sphygmomanometer). Applanation tonometry, Humphrey perimetry; stereo disc photos (graded at the Reading Center); an interview and an ophthalmological examination. OAG criteria required visual field and disc damage, with opthalmological confirmation. The results are reported as ajusted relative risks (RR) from logistic regression analyses. RESULTS: The 4-year OAG incidence was 2.2 percent (n=67.2989 at risk). While the RR increased markedly with IOP, it tended to decrease with systolic BP. The RR for SBP 140 mmHg at baseline, with or without AHT, was 0.5(95 percent Confidence Interval; w/AHT = 0.23, 1.08; w/o AHT = 0.26, 1.03). Hypertension (BP>140/90 mmHg or AHT) reduced OAG risk (RR = 0.48 (0.28, 0.82)). Consistent results were found evaluating perfusion pressure (PP), as persons with lower PP were at higher risk of OAG (RR:SPP<101 mmHg=2.6 (1.3,4.9); DPP<55 mmHg=3.2 (1.6, 6.6): mean PP<42=3.1 (1.6, 6.0). Results were similar when stratifying by age or IOP. CONCLUSION: The 4-year risk of OAG in the cohort was decreased by one-half in those with hypertension at baseline. Risk tended to decreased as SBP increased. Persons with lower SPP, DPP or mean PP had 2-3 times increased OAG risk. Results may have implications for OAG pathogenesis and assessment of risk. (AU)

Corneal thickness and intraocular pressure [abstract]

PURPOSE: To describe the relationship between corneal thickness and Intraocular Pressure (IOP) in a predominantly black population. METHODS: BISED II conducted a 9 year follow up of a population based cohort. The protocol involved an interview and comprehensive ophthalmologic examination including Applanation Tonometry and Pachymetry (KMI ultrasound RK500 pachymeter). RESULTS: Among the participants with pachymetry (n = 616; 1223 eyes) mean age was 63.4 years and 60 percent were female. Most individuals were of African descent (n = 582), with smaller subgroups of mixed (African and Caucasian, n=13) and Caucasian/others (n=21). The IOP was highest among those of African descent (mean= SD; 16.7= 3.8 mmHg) followed by those with mixed (15.5= 3.5 mmHg) and Caucasian/other ancestry (14.7= 3.1 mm Hg). However, the participants of African descent tended to have lower values of corneal thickness (mean= SD; 529.7= 37.0 um) than the mixed (533.6+29.8 um) and Caucasian/other participants (542.2= 43.5 um) respectively. Although sample size was small, significant correlations between corneal thickness and IOP were noted among Caucasian participants (r=-0.36,p=0.03), but no correlations were found for participants of African descent or of mixed ancestry. CONCLUSIONS: Individuals of African descent tend to have thinner cornea than Caucasian participants. Corneal thickness and IOP were positively correlated in Caucasians, but not mixed race participants or those of African descent. (AU)

Longitudinal changes in IOP and incident glaucoma in the Barbados Eye Studies

PURPOSE: There are a few longitudinal population studies describing the progression of intraocular pressure (IOP) or the risk of developing incident open-angle glaucoma (OAG). This report examines changes in IOP and measures the incidence of IOG over a 4-year period in the population of the Barbados Eye Studies. METHODS: The Barbados Incidence Study of Eye Disease (BISED) re-examined members of the Barbados Eye Study (BES) cohort, the original sample being based on a simple random sample of the country's population aged 40 - 84 years. At both visits patients had applanation tonometry, automated Humphrey perimetry, a comprehensive opthalmological examination, colour stereo fundus photography, blood pressure and anthropometric measurements and a detailed interview. RESULTS: A total of 3427 participants or 85 percent of the eligible cohort were re-examined in BISED. The IOP analyses were based on the subset of 2640 Black participants without glaucoma (OAG, or other type) or history of IOP lowering treatment at either visit. The mean age at follow-up was 55 years and 60 percent were women. Mean IOP was 17.3 mmHg (SDñ3.0, median 17.0) at baseline and increased by 2.6 mmHg (SDñ3.6 mmHg, median 2.3)(p<0.001by paired 1 test) in 4 years. Factors positively associated with longitudinal increases in IOP include age (p=0.001) and baseline hypertension (p=0.014) or high systolic blood pressure(p=0.005), while there was an inverse association with baseline IOP. Among the 2989 Black participants without OAG at baseline,the 4-year incidence of OAG was 2.2 percent (95 percent CI: 1.7 percent, 2.8 percent). Incidence was highest among persons classified as suspect OAG at baseline (26.1 percent) followed by ocular hypertensives with IOP >21 mmHg (4.9 percent) and lowest in persons with normal / other diagnoses and with IOP ó21 mmHg (0.8 percent). However, 32 of the 67 new cases of OAG (48 percent) had IOP ó21 at baseline. CONCLUSION: Significant increases in IOP were seen at 4-year follow-up in persons without glaucoma or IOP-lowering treatment history. While high IOP increases the risk of OAG, almost half of the incident cases had IOPó21mmHg at baseline. These results highlight the importance of prognostic factors, other than IOP, in determining the development of OAG.(AU)

Treatment of acute schizophrenia in open general medical wards in Jamaica

OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of thier illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More that half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and s everity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients, superior to the outcome of treatment in conventional psychiatric facilities.(Au)