Prevalence of Risk Factors and Lifestyle Choices Associated with Increased Cancer in Participants in Trinidad and Tobago

In the Caribbean, cancer has been identified as the second leading cause of death and has created an immense challenge for healthcare services and expenses throughout the region. According to the World Health Organization (WHO), cancer incidence will increase by 58%, from 2015 to 2035, and cancer mortality throughout this period will increase by 67%. This research project outlined the socio-demographic risk factors and lifestyle choices known to increase the risk of developing various forms of cancer that are present in the population of Trinidad & Tobago. Knowledge of these risk factors will allow members of the public to evaluate their lifestyles. Subsequently, they can determine if they are putting themselves at risk for certain malignancies, since different types of cancers have specific socio- demographic factors and lifestyle choices associated with them.

Epidemiology, risk factors and histopathologic characteristics of the common cancers in Trinidad

Cancer is a leading cause of death worldwide and in Trinidad and Tobago occurring due to genetic factors, or certain external factors (carcinogens) including chemicals, radiation, aging, hormones and other endogenous and exogenous elements. A mutation causes by these elements in solid tissue may result in a tumor. The site of the developed tumor is used to classify the types of cancer. This project was undertaken to shed light on the prevalence of cancer, its risk factors and those of the population who are most susceptible.

A review of the health risk behaviours among adolescents in the Englishspeaking Caribbean: 2006 to 2020

• Adolescents comprise around 25% of the Caribbean population. Past studies report that the challenges faced by this target group include substance use, mental health, violence, high risk sexual behaviours such as HIV, juvenile delinquency, obesity, accidents and injuries, among others. • Through the understanding of the adolescent health risk behaviours, challenges, their health risks and protective factors, can we then comprehend and generate solutions to the challenges faced by youth in the Caribbean. This review will focus on the years 2006-2020, where we will determine what has or has not changed from the last review (from 1985-2005) and what solutions can be implemented.

A two-year hospital based study of Lung Cancer with reference to Histological subtypes, Demograhpics, risk factors and presentng stage

Lung cancer is one of the most common cause of mortality, highly attributed to an increase in tobacco use/ cigarette smoking. It ranks amongst the top 3 causes of cancer in Trinidad and Tobagonian men. The objective of this study is to the investigate the prevalence of Lung cancer in Trinidad and Tobago, its histological subtypes, demographics, predisposing risk factors and presenting stage. Additionally, comparison is made between current Lung cancer trends and those identified from previous studies. Our current findings is a more accurate representation of local trends, which can now provide foundational data that can be used to implement better approaches in the improvement of Lung cancer care in Trinidad and Tobago.

FEAR: A fall epidemiological analysis and risk factor assessment

Objective: To determine the prevalence of falls among older adults and to determine the risk factors associated with falls. Design and Methodology: In this cross-sectional study, a sample of 416 participants from four distinct geographic regions completed an interviewer administered demographic questionnaire. Participants also answered questions on factors known to be related to fall risk in addition to performing functional tests of gait and balance. Data was analysed using SPSS Ver 23.0. Person Chi-squared test was used to identify factors associated with falls at a significance level of p<0.05. Results: There were 331 females (79.6%) and 85 males (20.4 %) with a mean age of 66.3 years (SD +/- 4.2) and a mean Body Mass Index (BMI) of 24.1 kg/m2 (SD +/- 3.5). The prevalence of falls was 43% and the significant factors associated with falls included age, hypertension, glaucoma, and poly -pharmacy (> 4 drugs). Low scores in the functional tests, the use of walking aids and living alone were also significantly associated with the risk of falling. Conclusions: Falls are very common in older persons, in this study the prevalence was found to be 43%. The significant risk factors for falls correlate with regional and international studies. Fall prevention measures should focus resources on this vulnerable group.

Health status and risk factors for dementia in the middle old in Trinidad: Findings from a nationally representative survey

Objective: To investigate self-reported health status and risk factors for dementia in middle old (75-84 years) individuals. Design and Methodology: This study used the validated 10/66 door- to-door interview protocols. All individuals (836 persons) 75-84 years old were approached. The modified 10/66 dementia algorithm produced output in 811 (97%). Dementia diagnosis was made according to 10/66 criteria from: (1) cognitive tests, the Community Screening Instrument for Dementia (CSI'D), (2) EURO-D depression scale (3) informant interview. Demographic data included information on accommodation, social network, level of impairment and instrumental activities of daily living. Data were analyzed using multilevel logistic regression models. Results: Of the 811 participants, 55% were females. The mean age was 78.9±6.3 years and dementia was present in 198 (24.4%). High level of education, professional employment and having no comorbidities were significant protective factors. In multivariate analyses those with stroke were nearly 5 times more likely (OR=4.81, 95% CI: 2.72, 8.53) to have dementia, and those with diabetes were 2.5 times (OR=2.55; 95% CI: 1.71-3.78) more likely to have dementia than those without these comorbities. Impairment in climbing stairs walking and sight was more common in the dementia group than the non-demented. Individuals with dementia were more likely to be unable to perform all seven instrumental activities of daily living (IADL) and were less active compared with their non-demented counterparts. Conclusion: In the middle old population in Trinidad having diabetes and stroke with varying levels of impairment as well as a sedentary lifestyle puts an individual at increased risk of dementia.

Prevalence and risk factors of Sexually Transmitted Infections (STI) among persons living with HIV attending the STI Clinic in Trinidad

Objective: To determine the prevalence and risk factors for sexually transmitted infections (STIs) among persons living with HIV (PLHIV) attending the STI Clinic in Trinidad. Design and Methodology: A cross-sectional study of STI prevalence among PLHIV attending the STI Clinic in Trinidad was conducted during the period April-September 2014. A questionnaire was administered to obtain socio-demographic data and risk factors for STI infections, a physical examination was carried out and patients were screened for STIs. Data were analysed using SPSS Version 22. Results: A total of 210 HIV infected patients (138 males [65.7%] and 72 females [34.3%]) were enrolled; age range 17-68 years, mean age 36.4 years. Of these, 68 (32.4%) were newly HIV diagnosed and 142 (67.6%) had a known history of HIV infection. Seventy-eight (37.1%) of the 210 patients were concurrently diagnosed with a STI. Homosexual/ bisexual study patients were more likely to be diagnosed with a STI (OR, 3.56; 95% CI, 1.94- 6.51) and more likely to be diagnosed with syphilis (OR, 4.84; 95% CI, 2.40-9.77). Multivariate analysis using binary multiple regression showed that risk factors for STIs included male sex (OR, 2.46; 95% CI, 1.06-5.73), homosexual/bisexual sexual orientation (OR, 2.26; 95% CI, 1.06-4.80) and multiple sex partners within the past 12 months (OR, 1.99; 95% CI, 1.03-3.86). Conclusion: There is a high prevalence of STIs among PLHIV in this study, especially among homosexual/ bisexual sexual males in whom the most commonly diagnosed STI was syphilis. Hence targeted HIV/STI prevention efforts are urgently needed in these patients.

ST elevation Myocardial Infarctions at a rural Emergency Department ­ 4 year experience in South Trinidad

Background: ST elevation Myocardial Infarctions (STEMIs) are one of the most common treatable causes of death and morbidity in Trinidad & Tobago. Bodies such as the American Heart Association (AHA) have recognised that early identification and treatment using thrombolytics or Primary Coronary Intervention (PCI) of STEMIs is crucial to improving patient outcomes, and have made recommendations for ideal critical actions in the management of STEMIs. Data on the performance of Emergency Departments to deliver these actions is poor in many developing countries, but at the same time, are important to measure in order to drive improvement in patient care. Objectives & Methods: We aimed to determine the quality metrics and six (6) month mortality outcomes in STEMI patients who presented to the Emergency Department, Siparia District Health Facility. Medical records for all patients receiving thrombolytic therapy were obtained over the period January 2011 ­ December 2014. Data was extracted and reviewed and 6 month telephone follow-up via was performed for these patients. Descriptive analysis was undertaken using Microsoft Excel. Results: Seventy- seven (77) patients received thrombolysis but only sixty-one (61) had complete documentation. There were almost 4 times as many men than women (77.8% of males and 20.3% of females), with the mean ages being 58.8 years and 66.1 years respectively. The most common risk factor was hypertension, followed by diabetes mellitus. The most common type of STEMI was of the inferior wall. The median Door to ECG time was 10 minutes with 52.5% of patients achieving a Door to ECG time of less than 10 minutes. The median Door to Needle time was 70 minutes with only 8.2% of patients having a Door to needle time of less than 30 minutes. Approximately half of all patients thrombolysed showed greater than 50% ECG resolution. 94.3% of patients were alive at 6 months. Conclusions: Although the AHA recommended standards for thrombolysis were not met fully, these results show that despite the limitations of practice in a rural developing world setting, the majority of patients received timely and appropriate care. Although showing better performance than other local centers, changes within the system are still required to meet first world standards, improve patient care and potentially improve mortality. Hypertension and Diabetes are major risk factors in our population.

Human papillomavirus prevalence of high-risk types correlated with cervical pre-cancer and invasive cancer, sexual and reproductive health

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) high-risk types; the prevalence of pre-cancer and cervical cancer and its correlation with HPV high-risk serotypes and sexual and reproductive health risk factors; and the HPV vaccine acceptability by the persons interviewed in St Kitts and Nevis. SUBJECTS AND METHODS: A cross-sectional study of 500 eligible women 30 years and older was conducted from February to November 2014. Each participant was interviewed from a validated questionnaire followed by a gynaecological examination that included specimens collected for a Papanicolaou test and an HPV DNA highrisk screening test. Typing for specific high-risk HPV types was done on the cervical specimens that tested positive on the HPV DNA high-risk screening test. RESULTS: The prevalence of HPV high-risk genotype was 25.2%. Overall, HPV high-risk genotypes 52, 35, 51, 31and 45 were the most prevalent in descending order. Women with abnormal smears were twice as likely to have high-risk HPV types (RR = 1.94; [1.31, 2.88]) and younger women were nearly twice more likely to have a high-risk HPV infection (RR = 1.94; [1.33, 2.85]). Nearly all of the participants indicated that they wanted to be vaccinated against HPV and if they had daughters, they would also want their daughters vaccinated. CONCLUSION: High-risk HPV is prevalent in St Kitts and Nevis and women are very interested in receiving HPV vaccine for themselves and their daughters. This finding is very positive for the introduction of the HPV vaccine.

Social determinants of prostate cancer in the Caribbean: A systematic review and meta-analysis

OBJECTIVE: To determine what is known of the distribution by social determinants of health of the risk factors,occurrence and outcomes of prostate cancer among Caribbean populations. DESIGN AND METHODS: MEDLINE, EMBASE, SciELO,CINAHL, CUMED, LILACS and IBECS were searched for observational studies examining social determinants and dietary calcium, disease incidence/prevalence and disease stage/grade/recurrence/survival/mortality. Caribbean studies published from 2004–2014 with samples > 50 were eligible. Independent reviewing and data abstraction was conducted according to STROBE and Cochrane guidelines. Random-effects meta-analyses were conducted. FINDINGS: From 444 unique citations, 15 articles from 12 studies were included, of which five were appropriate for meta-analysis. Weak evidence showed higher dietary calcium in higher socio-economic position (SEP) and urban-dwelling children; prostate cancer incidence was higher in men of African descent and men with less education, and mortality was higher in men with less education, rural-dwelling men and men of lower SEP. Two meta-analyses showed that men with primary or less education were more likely to have prostate cancer (OR1.50, 95%CI 1.14, 1.96, I2 0%) and married men were less likely to have prostate cancer (OR 0.67, 95%CI 0.45, 0.99,I2 0%). CONCLUSIONS: Caribbean men of lower SEP were found to have a higher incidence and mortality from prostate cancer. Further work is needed to address potential confounding, particularly between ethnicity and other social determinants, and whether case fatality differs by SEP, such as through later diagnosis and poorer access to healthcare. This paper provides a benchmark for future research into social determinants of prostate cancer in the Caribbean.

The social determinants of diabetes and cardiovascular disease risk factors in Barbados: findings from the health of the nation study

OBJECTIVE: To describe the distribution of diabetes, hypertension and related behavioural and biological risk factors in adults in Barbados by sex, education and occupation. DESIGN AND METHODS: Multistage probability sampling was used to select a representative sample of the adult population (> 25 years). Participants were interviewed using standard questionnaires, underwent anthropometric and blood pressure measurements, and provided fasting blood for glucose and cholesterol measurements. Standard WHO Definitions were used. Data were weighted for sampling and non-response and age-adjusted for group comparisons. RESULTS: Study participation rate was 55%, with 764 women, 470 men. Prevalence of obesity was 33.8%, hypertension 40.6%, and diabetes 17.9%. Compared with women, men were less likely to be obese (prevalence ratio 0.53; 95%CI 0.42–0.67), diabetic (0.77; 0.61–0.98), or physically inactive (0.47; 0.39–0.57), but more likely to smoke tobacco (4.08; 2.48–6.69) and binge drink alcohol (4.53; 2.70–7.58). In women, higher educational level was significantly related to higher fruit and vegetable intake, more physical activity, less diabetes and less hypercholesterolaemia (p values: 0.01 – 0.04). In men, higher education was significantly related only to less smoking. Differences by occupational category were limited to smoking in men and hypercholesterolaemia in women. CONCLUSIONS: In this population, unlike in most high-income countries, sex appears to be a much stronger determinant of behavioural risk factors, and consequent obesity and diabetes, than education or occupation. These findings have major implications for meeting the commitments made in the 2011 Rio Political Declaration, to reduce health inequities.

The risk factors to youth violence: findings from the CARICOM youth crime and violence school survey, Bahamas

OBJECTIVES: To determine the risk factors for in-school violence among Bahamas public school students. DESIGN AND METHODS: Self-administered questionnaires were completed by students in grades 6, 8, 10, and 12 from four public schools on New Providence island, Bahamas. Questionnaire focus was on school violence. Physical fighting, weapon carrying, and bullying were tested for associations for selected risk factors, including family structure, socioeconomic status, gang membership, attitudes toward school and delinquent behaviour, and delinquent peers. Bivariate associations were tested using Pearson chi-square and Fisher’s Exact Test (p <= .05). RESULTS: Five hundred and eighty eight students completed the survey (53% female); median age was 15 years (range 10 to 19). The average household size was 4. A third (34%) lived with both parents. Most parents had at least a high school education. More than half (55%) answered favourably for most school items. Forty six percent did not have friends who committed delinquent acts, and 68% felt most delinquent acts were morally wrong. Forty percent were in a gang, 7% carried weapons, 12% bullied, and 16% physically fought and/or injured someone. Students who were in gangs, had delinquent peers, and felt that delinquent acts were not wrong were more likely to bully, fight, carry weapons, and be in a gang. School connectedness was associated with all deviant activities except gang membership. Family make-up and socioeconomic status were not associated with delinquency. CONCLUSIONS: Schools should strongly monitor gang activity. Schools can also take advantage of students’ favourability toward school with after-school programs.

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.

Health inequities in diabetes, its risk factors, and adverse outcomes in populations living in the Caribbean: a systematic review

OBJECTIVES: Following the WHO Commission on the Social Determinants of Health, Caribbean countries committed to identifying and reducing health inequities (Rio Political Declaration 2011). We undertook a systematic review to determine what is known about the social distribution of diabetes (DM), its risk factors and major complications in the Caribbean. This paper describes findings on the distribution by ethnicity, education, occupation and income. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by ethnicity, income, education and occupation of: known risk factors for type 2 DM, prevalence of DM, DM control or complications. Only quantitative studies were included; each was assessed for risk of bias. RESULTS: Out of 2796 unique records, 81 articles required full text review, and 29 articles met the inclusion criteria. Few studies examined DM, its risk factors or complications by education (4), income (2) or occupation (1). None described significant relationships but all had a high risk of bias. Statistically significant findings were described from Barbados, Cuba and Trinidad on the distribution of diabetes by ethnicity: higher in Blacks than Whites, and in South Asians in Trinidad compared to other groups (OR 1.87, 95% CI 1.14, 3.05). CONCLUSION: Published data in the Caribbean on the social distribution of diabetes, its risk factors and complications were very limited and of overall low quality. Work to better identify health inequities in the Caribbean is required if governments are to meet their commitment to addressing them.

The importance of gender as a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis

OBJECTIVES: We undertook a systematic review to determine the social distribution of diabetes (DM) its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by gender of: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models. RESULTS: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance. CONCLUSION: Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity and physical inactivity.

Socio-demographic factors impacting infant mortality in the Bahamas

OBJECTIVE: To explore the influence of various socio-demographic factors on infant mortality in The Bahamas. DESIGN AND METHODS: The 2010 Bahamas Census was used as the data source. Females who had a live birth in the past year, with accompanying demographic, social, and fertility characteristics, were examined using bivariate and logistic regression analyses (p-value <=.05). RESULTS: Overall infant mortality was 2.8% among 5,011 females. Logistic regression revealed for all females: increased parity, (OR 1.64; CI 1.36, 1.96), first child at 30 years or older (OR 1.85; CI 1.16, 2.96), 5 or more persons in household (OR .38; CI .26, .56), being married (OR 1.45; CI 1.01, 2.06), and being Bahamian (OR 2.47; CI 1.5, 4.06) were predictors of mortality. For females under 35 years, final predictors were: increased parity (OR 1.41; CI 1.14, 1.74), being married (OR 1.86; CI 1.22, 2.83), Bahamian (OR 3.58; CI 1.76, 7.31), urban residence (OR .55; CI .34, .91), 5 or more persons in household (OR .54; CI .35, .85). Females over 35 had decreased odds of infant mortality with households of 5 or more persons (OR .36; CI .19, .67) and not being the head of household (OR .46; CI .27, .76). CONCLUSIONS: Older age, smaller households, and rural residence increased risk for infant mortality. Large household size appeared to be a protective factor regardless of age. Timely access to critical care for infants in rural areas is recommended along with wider implementation of paternity leave in the work place to increase maternal support.

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.

Non-communicable disease (NCD) risk factor survey 2014 among staff at one workplace in Barbados

OBJECTIVE: To investigate the prevalence of NCD risk factors at a specified workplace in Barbados. DESIGN AND METHODS: An interviewer administered questionnaire comprised of Core and some “Expanded” questions from the validated PAHO/WHO STEPS NCD Risk Factor Survey was conducted over a three-week period in June 2014 at a specified workplace. Standardized measurements were taken for height, weight, blood pressure, and hip and waist circumference. RESULTS: There was a 57.8% (70/121) response rate; 37.1% male and 62.9% female, with a mean age of 31.7 years (SD 8.0), age range 19 – 54. It was found that 95.7% of respondent staff had at least one of the identified risk factors; 76.9% of males and 54.5% of females were either overweight or obese. Most of the staff (91.4%) ate less than 5 servings of fruit and/or vegetables on average per day (88.5% males, 93.2% females). Comparison of study population with the Barbados population shows close correlations for most of the risk factors with some exceptions like binge drinking. Almost half of respondents (44.7%) (60.9% males, 29.2% females) engaged in binge drinking when compared to 25.3% and 5.4% in Barbadian males and females respectively in 2013. CONCLUSIONS: The study confirms a similar high prevalence of NCD risk factors among staff as observed among the Barbadian population. The study reveals opportunities to increase workplace health promotion and evidence-based national standards for the management of major NCDs through a primary care approach.

Non-communicable diseases risk factors survey 2014 among University of the West Indies staff, St. Augustine Campus, Trinidad & Tobago

OBJECTIVE: To determine the prevalence of NCD risk factors among University of the West Indies staff in Trinidad and Tobago. To compare these results with the country’s 2011 NCD risk factor survey. DESIGN AND METHODS: A cross sectional prevalence survey utilizing a self-administered questionnaire conducted during April-May 2014. The target population was all staff. Standardized measurements of cardiovascular fitness, weight, height and blood pressure were taken. Data was analyzed and results were compared to the national 2011 NCD survey. RESULTS: Participation was 24.9% (522/2100), 32.4% males (n=169) and 67.6% females (n=353). Among participants, 65.7% (95% CI 58.4, 72.9) of males and 64.7% (95% CI 59.6, 69.7) of females were either overweight or obese, 86.9% (95% CI 83.9, 90.0) ate <5 fruits and vegetables/day. Smoking prevalence was 13.1% (95% CI 7.9, 18.2) and 2.8% (95% CI 1.1, 4.6) for among males vs. females respectively while 39.1% and 7.6% were binge drinkers; One fifth of the participants had blood pressures >140/90, while 6.4% had blood pressures >160/100. The results were similar to the 2011 national risk factor profile. UWI staff smoked less but drank alcohol more frequently. UWI males were more obese and UWI women had higher blood pressure and higher cholesterol compared to the general Trinidad and Tobago population. CONCLUSION: The results confirmed a high prevalence of NCD risk factors among these staff as among the Trinidad and Tobago population. The study revealed opportunities to inform policy on strategies to positively impact the risk factors.

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.