Características y resultados del tratamiento aplicado a los pacientes con cáncer de páncreas / Rejuvenation Surgery with High-Superficial Musculoaponeurotic System Flap

Introducción: El cáncer de páncreas mantiene un pronóstico ominoso a pesar de los avances en técnicas quirúrgicas y cuidados perioperatorios. Objetivo: Caracterizar los resultados del tratamiento aplicado a los pacientes con cáncer de páncreas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de una serie de 70 pacientes con diagnóstico de cáncer de páncreas. Se estudiaron las variables: localización, tamaño del tumor, procedimiento quirúrgico, estadificación preoperatoria, diagnóstico histológico, estancia hospitalaria, complicaciones posoperatorias y estado al egreso, mediante el análisis de frecuencias absolutas, relativas y la media así como la prueba de ji al cuadrado y el IC 95 por ciento. Resultados: El procedimiento quirúrgico más frecuente fue derivativo en 47 enfermos (67,1 por ciento). La operación de Whipple se realizó en 10 pacientes (14,3 por ciento) con tumores localizados en la cabeza del páncreas y la pancreatectomía corporocaudal en 11 (15,7 por ciento) con tumores de cuerpo y cola del páncreas. La mayoría correspondió a los estadios III y IV. El 47,1 por ciento de los pacientes presentó un adenocarcinoma poco diferenciado. La estadía fluctuó entre 15 y 30 días en el 54,3 por ciento de la serie. Las complicaciones se presentaron en 19 enfermos (27,1 por ciento). Fallecieron 15 pacientes (21,4 por ciento) del total. Conclusiones: El tratamiento debe ser individualizado mediante equipos multidisciplinarios, con protocolos de actuación uniformes en cada institución que permita realizar estudios multicéntricos, con el objetivo de obtener estadísticas propias en aras de disminuir la morbilidad y la mortalidad, así como aumentar la calidad de vida de estos pacientes(AU)

Introduction: Facial rhytidectomy is the technique for correcting facial aging features, but they are becoming increasingly complex due to the incorporation of deeper planes in the process. The superficial musculoaponeurotic system techniques have the advantage of providing a greater degree of naturalness and permanence in time. Objective: To evaluate the effectiveness of the high-superficial musculoaponeurotic system technique for facial rejuvenation. Methods: A prospective and longitudinal case series study was carried out in the plastic surgery service of Hospital General Universitario "Vladimir Ilich Lenin" with patients who requested facial rejuvenation and were treated with the high-superficial musculoaponeurotic system technique, from January 1, 2018 to June 30, 2020. The variables age, sex, skin type, degree of aging, operative complications, patient satisfaction and aesthetic outcomes were studied. Results: The female sex predominated, together with the age group 50-59 years, the degrees of aging II and III, as well as white and light brown skin colors, while the most frequent operative complication was wound dehiscence of the suture line at the auricle root. The patients' satisfaction with the aesthetic outcomes of the surgical intervention was verified and the aesthetic outcomes was assessed as favorable in 100 percent of the cases for the used surgical technique. Conclusions: The high-superficial musculoaponeurotic system surgical technique for rhytidectomy offers harmonic, long-lasting outcomes with a low percentage of complications, making it a valuable alternative for patients(AU)

Knowledge, Attitude, and Practices of Dentists in Caribbean Countries during the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

Background: The COVID-19 pandemic has affected dentists globally, both financially and mentally. This study aimed to determine the knowledge, attitude, and practices of dentists in Caribbean countries during the COVID-19 pandemic. Methods: A non-probability sample was obtained from dentists in more than ten different Caribbean countries. They were invited to complete a self-reported questionnaire, which was conducted from December 2020 to March 2021. Ethics approval was sought and an exemption was received from the UWI ethics committee. Results: One hundred and fifty-two dentists responded. More than one-third (38.8%) were in the >35­45 age group, and 58.6% were females. Most (84.9%) were general dentists and 75% were stressed by the COVID-19 situation with 80.9% being affected financially. The majority, 94.7%, believed that the highest risk of transmission of COVID-19 was via aerosol-generating procedures and 87.5% were worried about contracting it clinically. The majority (69.1%) were willing to receive the vaccine, the main reason reported for vaccine hesitancy was due to the possible side effects (35.3%). Most (75%) consumed alcohol. When the locus of control was determined, 54.6% felt they were in control of protecting themselves while 52% felt that external factors controlled their lives. Conclusions: The findings suggest that most dentists in the Caribbean were knowledgeable about COVID-19 and followed current guidelines in their practice and were willing to receive the vaccine.

Detecting alcoholism in primary care among Trinidadians: using the CAGE and AUDIT-C screening tools

OBJECTIVES: To measure the proportion of attendees in a primary care setting consuming alcohol at levels which put them at risk of alcohol-related harm using the CAGE and AUDIT-C Screening tools. DESIGN AND METHODS: A cross-sectional study was used. The population consisted of all adults ≥18 years in a primary care setting. The CAGE and Alcohol Use Disorders Identification Test (AUDIT-C) screening tools were administered to 865 randomly selected participants. RESULTS: Of the 865 participants entered into this study, 514 participants drank alcoholic beverages. Furthermore, 142 (27.6%) were found to be CAGE positive (≥2) where more men (100, 11.5%) than women (42, 4.9%) were CAGE positive. A larger proportion of South-East Asians 60 (11.7%) were found to be CAGE positive than Africans 51 (9.9%) (ρ = 0.6221). For the AUDIT-C, 460 individuals participated with a response rate of 89.5%. With the score ≥ 4 in men, among the male drinkers 150 (32.6%) of the AUDIT-C screens were positive. For women, with the score ≥ 4, 100 (21.7%) of those who drank alcohol, screened positive. A larger proportion of South East Asians 101 (39.2%) were found to be AUDIT-C positive than Africans 105 (42%) (ρ = 0.7893). The Cronbach Alpha values for AUDIT-C and CAGE were 0.792 and 0.636 respectively. CONCLUSION: The CAGE screening tool identified 27.6% of the participants attending primary care facilities to be at risk of developing alcohol related disorders (ARDS). AUDIT-C identified 48.6% of participants to be at risk of developing an ARDS.

National alcohol survey of households in Trinidad and Tobago (NASHTT): the impact of alcohol on households

OBJECTIVE: To determine the distribution of alcohol use among households (HHs) in Trinidad and Tobago (T&T) and, whether the HHs where alcohol was used were more likely to suffer negative psychological, social or physical events. DESIGN AND METHODS: A cross-sectional convenience sample of HHs was surveyed from a random sample of enumeration districts (ED). The interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after literature review and consultation. RESULTS: 1695 HHs (from 53 EDs) responded with a response rate (RR) of 92%. Sixty-two (62%) percent of HHs consumed alcohol, distributed with 1-2 users (46%), 3-4+ users (16%). Viewpoints and experiences about alcohol included: 'alcohol consumption at family gatherings is a normal occurrence' (70%). 29% of HHs consumed alcohol in the presence of children. HHs that consumed alcohol were significantly more likely to report in the last 12 months HHs members falling sick, experiencing lifestyle related illnesses, having relationship problems between partners, having strained relationships within the HH, HH members calling in sick to work, behavioural problems of children at home, anti-social problems of children at home/school and violent behaviour by a member of the HH (p

The national alcohol survey of households in Trinidad and Tobago (NASHTT): willingness to support changes in policy, laws and regulations

OBJECTIVE: This study set out to determine what proportion of Trinidad and Tobago (T&T) households (HHs) were willing to support changes in specific policies, laws and regulations in a national alcohol campaign. DESIGN AND METHODS: A cross-sectional convenience sample of HHs were surveyed from a random sample of enumeration districts (ED) in T&T. The interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after extensive literature review and consultation. Many of the WHO 'best buys' were included. RESULTS: 1695 HHs (from 53 ED) responded from a total of 1837 HHs approached, a response rate (RR) of 92%. In a national campaign the following proportions of HHs would support: setting the legal age for drinking at 21 years (82.4%); restricting (73.1%), banning (54.4%) alcohol advertising on TV and other media; banning all alcohol advertising at sports and cultural events (64.8%); banning radio stations playing songs with reference to alcohol use (71.3%); holding sellers of alcohol responsible for the amount of alcohol sold (79.5%); advocating that proof of age to be shown by persons buying alcohol (87.4%); placing more prominent warning labels on products displaying alcohol content (87.2%); placing more prominent warning labels on products showing harmful effects (88.5% ); increasing taxes on alcohol sales (87.7% ). CONCLUSIONS: HHs in T&T were willing to support changes in policies around alcohol, including many of the policies shown by the WHO to be effective in reducing the harmful consumption of alcohol.

Non-fatal suicidal behaviour: associated factors

OBJECTIVE: To investigate the factors that influence non-fatal suicidal behaviour. DESIGN AND METHODS: A cross sectional study was undertaken and data were collected from a review of medical records of patients in addition to structured interviews with patients using the Columbia Suicide Severity rating scale. RESULTS: The survey findings (n=20) revealed that one-quarter of patients had more than one attempt. More than one third of the patients began having suicidal thoughts years ago (n=9, 45%). Half of the responders had thoughts ranging from twice a week to many times a day and the thoughts lasted from one to four hours a day to most of the day in 60% of responders. Six patients told someone of their plan. While females used the method of overdosing on pills, males tended to drink a poisonous substance or use more lethal means of attempting suicide. From the case note review (n=42), more females (n=31, 74%) attempted suicide compared to males (n=11, 26%). CONCLUSION: These findings suggest there were factors that may highlight at-risk persons e.g. those with past attempts, and those who confide in others about their plans. It appears persons have suicidal thoughts for several years and the majority think about these on most days and these thoughts last at least 1-4 hours a day. There is therefore a role for health education to the public who need to be aware of warning signs and how to handle the situation if they are told about a planned attempt.

Epidemiological risk factors, knowledge and attitudes concerning osteoporosis among women in a primary care setting in Nassau, Bahamas

OBJECTIVE: To determine perimenopausal and post menopausal women’s epidemiological risk factors (including the calculated ten year fracture probability of obtaining an osteoporotic fracture), knowledge and attitudes toward osteoporosis in the Bahamas, in a specialist Family Medicine practice setting. DESIGN AND METHODS: Using a cross-sectional survey design, researchers determined epidemiological risk factors, knowledge and attitudes concerning osteoporosis among Bahamian perimenopausal and postmenopausal women and calculated their Fracture Risk Assessment Tool (FRAX) scores for a major osteoporotic and hip fracture. Informed consent was obtained from all participants. The study took place in the Family Medicine clinic of the Public Hospital Authority and selected Public Health Clinics. Data was collected using questionnaires and analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The 347 enrolled female participants mean age was 57.91 (ñ 8.98) years and 76.9% knew what osteoporosis was but had less accurate knowledge about the risk factors. 47.6% was not sure menopause was a contributing factor. 93.1% did not know the recommended daily calcium amount and 34% consumed calcium rich meals daily. 88.3% knew and practiced walking as a preventative method. Attitudes were mainly positive as 82% thought it should be discussed with their physician. FRAX scores were relatively low with only 20% requiring a bone density scan. CONCLUSION: Overall, low FRAX scores indicated low fracture risk among Bahamian women. However, limited knowledge about related risk factors was also evident. Increasing awareness through public education campaigns, addressing modifiable risk factor and involving younger women as well can avoid major complications from osteoporosis in the future.

Correlates of vigorous physical activity in adolescents in five secondary schools in Trinidad

OBJECTIVE: To determine the correlates of vigorous physical activity in adolescents in Trinidad. DESIGN AND METHODS: Adolescents (n = 344) between 11-15 years from five secondary schools in North-central Trinidad were cross-sectionally surveyed. Behavioural risk factors: alcohol and smoking use, physical activity and diet were obtained by a pilot tested interviewer administered questionnaire. In addition, anthropometric measures were obtained on site at school. Multivariate logistical regression was used to analyze correlates of vigorous physical activity by sex. RESULTS: Fruit and vegetable intake (p < 0.001) and religion (p = 0.034) were correlated with vigorous physical activity in females. Lower waist circumference (p = 0.014), age (p = 0.046) and diastolic blood pressure (p < 0.01) were correlated with vigorous physical activity in males. Body mass index (BMI) for age data indicated that 41.3% of the children were overweight or obese. However, vigorous physical activity did not correlate with BMI for age in either sex. In the final logistic regression models, higher vigorous physical activity was associated with lower diastolic blood pressure in males (p < 0.05) and an increased daily intake of fruit and vegetables in females (p < 0.001). CONCLUSION: Increased dietary intake of fruits and vegetables in females and lower diastolic blood pressure in males were associated with higher vigorous physical activity. Prospective studies are required to determine and clarify the relative importance of diet and physical activity in overweight adolescents and their risk of chronic metabolic disease.

Screening for chronic kidney disease in East Trinidad using the National Kidney Foundation guidelines

OBJECTIVE: To screen high risk patients ≥ 45 years attending primary care facilities who have undiagnosed chronic kidney disease (CKD) and identify this group for further intervention. DESIGN AND METHODS: A cross-sectional study design was used, the population consisted of all adults 45 years and older in a primary care setting. A validated questionnaire was administered to all eligible participants. RESULTS: A total of 227 participants were recruited to the study. No participant refused to participate resulting in a 100% response rate. One hundred and five participants (105, 46.3%) were classified as normal and one hundred and twenty two (122, 53.7%) were classified as having Stages 1-3 CKD. Further, 22 (18.0%) participants were found to be in Stage 3 of CKD. CONCLUSION: We provide evidence that screening can detect as much as 18.0% of asymptomatic individuals with Stage 3 CKD.

Parenting styles: a critical predictor of youth offending

OBJECTIVE: To assess the relationship between parenting styles and youth offending. DESIGN AND METHODS: A cross-sectional design was used to collected data from youth in two secondary schools in east Trinidad, and from two penal institutions that housed male and female adolescents respectively. Independent variables were parenting styles, age, gender, area of residence, the amount of children in the home, and educational level of the parents. The dependent variable was offending status. Multiple logistic regression was conducted to determine predictors of offending. RESULTS: Of 182 participants, 120 (65.9%) were non-offenders, and 62 (34.1%) were offenders. Among non-offenders there were more females (52.5%), whereas in the offenders group there were more males (87.1%). Overall, offenders were older (16.7ñ1.0 vs 15.2ñ1.4 yrs) and for every year increase in age the risk of offending increased by 126%. Every additional child in the household increased the risk of offending by 33%. Participants from the North/West part of the Island were 4.47 times more likely to engage in offending. Participants from the South/Central part of the Island were 7.66 times more likely to be offenders. Non-offenders had more parents attaining tertiary level education. CONCLUSION: The data gathered established an association between parenting styles and youth offending. There was also an association between age of the adolescent, gender, area of residence, number of children in the home and the educational level of the parents with offending.

A ten year retrospective analysis of motor vehicle accidents in Grenada

OBJECTIVE: To assess the burden of Motor Vehicular Accidents in Grenada during the period 2000-2009. DESIGN AND METHODS: A cross-sectional study of secondary data in the form of vehicular accident records were sourced from the Royal Grenada Police for the period 2000-2009. Detailed records of the number of motor vehicle accidents per month and per year were sourced including the type of vehicle, the number of passengers, time and location of the accident and the gender and age of the drivers were not considered to be important. The adverse health outcomes of the accidents were also determined as either minor or major depending on fatalities and extent of injuries sustained. RESULTS: There has been an increase in the total number of fatalities during the period of study occurring from motor vehicle accidents from 4.1 in 2000 to 11.9 in 2009 per 100,000. The average increase in the number of total road accidents also rose by 8.9% in the stated period. In addition, the number of major and minor road accidents had steadily increased together with an increase in the number of vehicles registered. The burden of injuries varied across different periods of time over the course of review. Conclusion: From 2000-2009, there was steady increase in the total number of motor vehicle accidents, and fatal road accidents in Grenada.

The association between indices of obesity and common clinical measures in adults with and without type 2 diabetes

OBJECTIVE: To determine if there are any differences in anthropometric measurements, lipid profile, blood pressure and body shape between diabetics and non-diabetics. DESIGN AND METHODS: This cross-sectional study comprised 309 subjects with 91 males and 218 females; there were 217 diabetics and 92 non-diabetics. The sample was taken from three hospitals in Trinidad. Lipid profile and blood pressure were taken from each facility’s physicians’ notes while anthropometric measurements were taken from the patients themselves. RESULTS: The diabetic group had elevated body mass index, and waist to hip ratios were significantly higher (p<0.05) when compared to non-diabetics. There was no significant difference in lipid profile and blood pressure between diabetics and non-diabetics. As age increased, the prevalence of type 2 diabetes mellitus was higher. Of the 217 diabetics, 173 were of East Indian descent. With regards to gender, more males were found to be diabetics resulting from having an android body shape as compared to females (gynoid body shape). It was deduced that waist to hip ratio was the best indicator of type 2 diabetes mellitus based on the area under the curve analysis. CONCLUSION: Of all the anthropometric measurements used, waist to hip ratio was found to be the most effective indicator of type 2 diabetes mellitus in Trinidadians, while body mass index was found to be the least.

Cardiovascular disease (CVD) risk factors: a patient’s perspective

OBJECTIVES: To identify CVD risk factors present in patients presenting with stroke; to assess knowledge of patients on risk factors for CVD; and to identify management methods employed (prior to admission) by patients to deal with these risk factors. DESIGN AND METHODS: This study used a cross-sectional, incident case design. All patients admitted to the hospital, within a 6 week period, given an initial diagnosis of stroke by the attending physician, were eligible for the study. Patients were recruited using consecutive sampling. Data on patient risk awareness and management methods were gathered using a survey. Data on risk factors present in patients were collected using patient records. RESULTS: A total of 102 patients were interviewed. The two major risk factors present in patients were hypertension (80.2%) and diabetes (57.8%). 83.3% of patients identified hypertension as a risk factor and 78.8% identified diabetes. However, 32.2% of hypertensive patients and 40.5% of diabetics reported not taking medication despite being awareness of their risk. Similarly 81.3% of patients knew lack of exercise was a risk factor, but only half were exercising frequently in the past 2 years. CONCLUSION: In this study, hypertension and diabetes were found to be the two major risk factors present in stroke patients. While patient knowledge about risk factors was high, their management of their risk factors as well as general knowledge about stroke prevention were lacking. This could be helpful in formulating public health strategy, if supported by larger population based studies.

Caffeine use and the side effects associated with its use among adolescents of Trinidad

OBJECTIVES: To determine the prevalence of the use of products containing caffeine, the side effects associated with this use and whether there was a relationship between the development of side effects and the dose of caffeine consumed among an adolescent population in Trinidad. A threshold level of daily caffeine consumption was being sought in this population to establish when there is likely to be an increase in side effects being experienced. DESIGN AND METHODS: A cross-sectional study was done using a convenience sampling strategy. A de novo questionnaire was self-administered to adolescents 18-20 years old. Questions included a one week caffeine recall for the participants, side effects and the timing of these side effects related to the use of the caffeinated products. RESULTS: The response rate was 391/412 (94.9%). The most common source of caffeine for this population was from beverages (67.5%).Significant dose dependent relationships between the dose of weekly caffeine consumed and the frequency of occurrence of palpitations (p=0.001) and the frequency of sleep disturbances (p=0.001) were observed. Doses of weekly caffeine consumption of > 428.5mg were significantly predictors for headaches, restlessness and anxiety in this population; OR (95% CI) [1.7(1.03, 2.74), 2.3(1.3, 4.0), 1.8(1.1, 2.9)] respectively. CONCLUSION: Caffeinated products mainly from beverages were commonly consumed by adolescents. Side effects like palpitations, sleep disturbances, restlessness and headaches were significantly more often reported above a threshold of 428.5mg/week. Daily caffeine intake in this adolescent population should be recommended to be less than this threshold in an attempt to reduce the occurrence of these side effects.

The timing of side effects associated with caffeine use in adolescents: acute effects or withdrawal symptoms?

OBJECTIVES: To determine the timing of side effects related to caffeine use in adolescents. It also serves to determine adolescents’ perception as to what food product or medication they believed caused the side effects. DESIGN AND METHODS: A cross-sectional study was done using a convenience sampling strategy. A de novo questionnaire was self-administered to adolescents 18-20 years old. Questions included a one week caffeine recall for the participants, side effects, the timing of these side effects related to the use of the caffeinated products and which product the participants associated with the development of the side effects. RESULTS: The survey response rate was 391/405 (95.6%). The response rate varied from 19.5% to 45.3% for the various adverse events experienced. Headaches (68.9%), palpitations(81.4%), restlessness (67.5%), nausea/vomiting (66.7%), polyuria (84.6%), tremors (75%) and anxiety (62.5%) were reported to occur more commonly within 4 hours of consumption of caffeinated products and these symptoms were attributed to coffee, tea and chocolate beverages. Depression (66.7%) occurred more commonly between 4-24 hours after consumption and was attributed to colas and energy drinks. Sleep disturbances (55.7%) occurred within 4 hours of caffeine consumption. CONCLUSION: Side effects reported by adolescent participants: palpitations, polyuria, nausea, tremors, anxiety and restlessness were mainly due to the acute effect of caffeine. Participants attributed most of these symptoms to coffee, teas and chocolate drinks. Depression was a withdrawal symptom attributed more to colas and energy drinks by the adolescents. Sleep disturbances could have been related to both the acute and withdrawal effects of caffeine.

Local public knowledge of blood donation systems in Trinidad and Tobago and in other places

OBJECTIVE: To investigate the Trinidad and Tobago (TRT) public’s knowledge of donation procedures locally and in the United States (USA) and United Kingdom (UK) and its effect on willingness to donate blood locally. DESIGN AND METHODS: A cross sectional study was conducted on a convenience sample from adults in TRT concerning knowledge and attitudes towards blood donation. Data was collected using an interviewer-administered questionnaire. 529 responses were received. Analysis was performed using SPSS Statistics 21. Chi-squared testing was done to determine statistical significance. RESULTS: Of 529 respondents, 141 (26.7%) had donated previously, 34 (6.4%) had been excluded and 354 (66.9%) had never donated. 76.8% of those who had donated did so for a friend or family member. 53.6% of respondents rated their knowledge of TRT’s system, and 86.2% rated that of the US and UK, as ‘poor’ or ‘very poor’. Knowledge of the local system was directly correlated to willingness to donate blood in TRT (p<0.001). No relation was found concerning knowledge of the foreign systems and local willingness to donate (p=0.423). Factors deemed most ‘likely’ or ‘very likely’ to influence people to donate included: if donation was for an ill family member (87.7%) or friend (77.9%); if the blood donation system in place was a replacement system (70.9%) and if more information was given to the public about blood donation (67.3%). CONCLUSION: Public knowledge of the blood donation system of TRT affected willingness to donate while knowledge of the US and UK systems had no effect.

The quality of life of Hansen's disease clients with disabilities compared to clients without disabilities in Trinidad and Tobago

OBJECTIVE: This study aims to assess the quality of life of persons who have Hansen’s disease-related disabilities in Trinidad and Tobago, compared to persons with the disease who do not have a disability. DESIGN AND METHODS: The study was quantitative, cross-sectional, comparative in design, conducted in the Hansen’s Disease Dermatology Clinics of Trinidad and Tobago, between February 2014 and April 2014. It was a convenience sample of the 122 respondents, 26 were Hansen’s Disease clients with disabilities, 51 had the disease but without disabilities, while 45 were clients with other Dermatological conditions. The WGO Quality of Life (WHOQOL-BREF) questionnaire was interviewer-administered after consent. RESULTS: The largest group of persons who rated their quality of life as good or very good was the persons with Hansen’s Disease that had no disability (30%), only 12% of persons with Hansen’s Disease-related disability rated their quality of life as good or very good. The mean quality of life scores (and standard deviations) for Hansen’s Disease clients without disability was 78.61 (9.6), Non-Hansen’s clients was 72.23 (11.8) and Hansen’s Disease clients with disability was 67.40 (13.9). CONCLUSIONS: The quality of life of the Hansen’s Disease clients with disabilities was found to be lower than the other two groups of clients.

Acceptability of neonatal male circumcision for HIV prevention among adults in the Bahamas

OBJECTIVES: To assess parents’ knowledge of HIV and sexually transmitted infection (STI) reduction through male circumcision, determine their desire to have their newborn son circumcised, and quantify impacts of circumcision procedural awareness. DESIGN AND METHODS: A cross-sectional survey of parents attending public healthcare facilities in Nassau, Bahamas, including a subsection completed after reading a circumcision information pamphlet. RESULTS: 314 mothers and 39 fathers were included. 87.8% were Bahamian and 7.4% Haitian. 97.1% followed Christianity. 7.4% had at least one other circumcised son and 25.7% of parents reported a circumcised father. 15.7% were aware that male circumcision reduces a man’s chance of getting HIV and 29.8% knew the procedure reduces STI. 88.5% and 88.4% of Haitians were unaware of male circumcision reducing HIV and STI acquisition, while awareness was greater amongst all those with higher levels of formal education. 55.6% of parents initially opted for neonatal male circumcision - especially circumcised fathers, Bahamian and Jamaican nationals, those who completed at least high school, and those believing male circumcision reduces HIV and STI rates. Improved health, appearance, and hygiene motivated participants more than cultural and religious affiliation. Both parents felt that the decision on neonatal male circumcision should be made in unison. Acceptance rose to 68.0% after reading the information pamphlet on male circumcision. CONCLUSION: Newborn male circumcision is decided on by both parents in most cases with little influence of culture and religion. Information on neonatal male circumcision risks and benefits, including reduction of HIV and STI, lead to an increase in its acceptance.

Leprosy - knowledge, attitudes and practices among clinic attenders

OBJECTIVE: To investigate the knowledge, attitudes and practices among leprosy clinic attendees and to review the epidemiology of leprosy in Trinidad. DESIGN AND METHODS: A cross-sectional study was undertaken utilizing an interviewer administered structured questionnaire. All leprosy clinic attendees over the age of 18 years who attend 3 of the 5 leprosy clinics in Trinidad were included. Data were collected from April to July 2014. RESULTS: All 21 responders who were invited to participate agreed, giving a response rate of 100%. Fifty-two percent (52%) were unaware of how the disease is contracted. Most patients (81%) believed that educating the public would help eradicate leprosy-related stigma. Ninety percent (90%) reported that they were compliant with taking their medication and 86% reported that they attended all clinic appointments. The majority (76%) felt self-conscious about their disease and 50% have experienced negative feelings after diagnosis. CONCLUSION: Patients appear to be aware of signs and symptoms of leprosy but less so about transmission. There appears to be a need for educating patients about their illness as well as the public to reduce stigma associated with the illness. There was also a need for counselling of patients to minimize the reported distress, sadness and worry they experience after being diagnosed.

Tuberculosis – patients’ knowledge, attitudes and practices regarding their illness

OBJECTIVE: To determine tuberculosis (TB) patients’ knowledge, attitudes and practices with respect to their illness. DESIGN AND METHODS: A cross sectional study was conducted. 208 tuberculosis patients > 18 years of age who were currently receiving treatment were included. The study sample was selected from two major regional chest clinics in Trinidad. A pilot tested questionnaire was interviewer administered to each patient. RESULTS: Out of the 208 patients interviewed (response rate 65.0%), 129 were male, and 79 were female. The majority of patients had either secondary or tertiary level of education (54.8%), whereas only 43.8% had either primary level of education or none at all. Analysis revealed that TB knowledge was affected by a patient’s level of education, where persons with secondary/tertiary levels of education had a greater knowledge about TB (p<0.005). The majority (78.4%) of patients believed that they were not stigmatized; however, 191 (91.8%) patients urged for increased public awareness about TB in order to change perceptions toward the disease. The majority of patients were compliant towards their management advice, as well as taking their prescribed medications, however non- compliance was noted to be more likely in the under 50 year age group (9.8%), rather than the over 50 year age group (1.1%). CONCLUSION: Patients with at least secondary level education had better knowledge about tuberculosis than those with primary level education. Patients indicated the need for more public awareness about TB. Compliance with management (medication and attendance at clinics) was good among the majority of the patients.