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.

Depression and the nature of Trinidadian family practice: a cross-sectional study.

BACKGROUND: Depression is the most common mental disorder; in an ambulatory-care setting 5 to 10 per cent of patients meet the criteria for major depression. Despite extensive documentation in primary care internationally, Trinidadian studies published on depression have been primarily hospital-based and focussed on suicide. The objectives of this study were to determine the prevalence of depression, the variables associated with depression and the commonest reason for the encounter (RFE) among adult patients attending Trinidadian fee-for-service family practice? METHODS: This was a cross-sectional descriptive survey of consecutive patients taken from a stratified random sample of family practices in the north-west region of Trinidad. To measure depression the Zung scale was modified for use as a brief diagnostic tool. This modified Zung scale, when tested against a psychiatric interview, revealed that at a cut off point of 60, the scale had a specificity of 94 per cent (95 per cent CI 87-100), a sensitivity of 60 per cent (95 per cent CI 45-75), and a likelihood ratio for a positive test result of 10 (95 per cent CI 6-42). RESULTS: 508 patients from 28 practices participated; a response rate of 85 per cent. Participants were primarily younger 18-49 years (66.7 per cent), female (69.5 per cent), and educated, with 72.8 per cent having received a secondary school, technical school or university education. Sixty-five (12.8 per cent) of the respondents (95 per cent CI 9.9-15.7) were determined to be depressed. Chi-square analysis revealed no statistically significant association between depression and age, ethnicity, education levels, occupation or marital status (p > 0.05).

Erectile dysfunction in Trinidadian general practice

DISCUSSION: Erectile dysfunction (ED) is common, and the observed rate was 53 per cent, in men over 40 years of age attending Trinidadian GP. There were statistically significant associations between the patient's age and ethnicity, and the presence of diabetes mellitus and ED. The presence of ED is also associated with the patient's overall diminished satisfaction with life. This has a direct impact on the approach to male patients in the consultation. Many males are hesitant to discuss, and many physicians ignore asking about ED. However as this study suggests doing so can impact on the patient's overall quality of life, especially as we now have safe and effective treatments for ED. It was interesting that we could determine an association between ED and the presence of diabetes mellitus but not between the number of years the patient had diabetes and ED. This suggests that we may be making the diagnosis of diabetes very late when neurological injury is already significant. One result stands out, that is the increased ED among the afro-Trinidadian population. This is not easy to explain since it is the indo-Trinidadian that historically bears the burden of diabetes and early heart disease, the result of vascular disease. One might expect to find an ethnic association favouring the indo-Trinidadian with respect to ED. It is not clear whether this is a true difference or the observation was because of ethnic differences in help-seeking behaviour. Further research, such as a community-based survey would help to clarify any true association between ethnicity and ED ...

Referrals in family practice: a retrospective study of referrals - abstract

This study took a retrospective look at referrals from a primary care physician to secondary and tertiary institutions during three years of post-graduate training, July 1988 to September 1991. The aims were to assess the types of referrals made, their outcome and the degree of communication that existed between the specialities. Of the 151 referrals made, 41 (27.15 percent) were males and 110 (72.85 percent) were females; a male : female ratio of 1 : 2.7. The age of referral followed the population distribution with the majority 37.77 per cent in the reproductive age group 15 - 44 years. Most of the referrals went to the departments of Surgery, Accident and Emergency, Opthalmology and to the Nutritionist. The surgical disciplines received 37.75 per cent of the referrals while 5.96 per cent went to the medical disciplines. Compliance with referrals was found to be 78.15 per cent, with 13.25 per cent of the patients requiring admission to hospital at the time of referral. Emergency management on referral was required in 19.21 per cent of cases, whilst 63.58 per cent of the patients had an out patient follow-up appointment. Resolution of the problem occurred in 42.38 per cent of patients. Ninety-five per cent [95.36] of the patients returned to the primary care setting after referral, although communication from the specialties was documented in only 11.92 per cent of the referrals. The remainder of information on referral outcome was verbal in 69.54 per cent while in 18.54 per cent of cases there was no documentation on referral outcome (AU)

The general practitioner and the diabetic eye - abstract

Diabetic patients are 25 times more likely to suffer blindness than non-diabetics. General practitioners form the first link in the clinical care of diabetic patients, and their role as screeners is extremely important. An early detection and a prompt control of the disease can greatly minimize the disabilities and the associated psychological and social consequences. The aim of the therapy is to prevent the development, or at least to reduce the severity, of retinopathy, nephropathy, neuropathy and macro-vascular disease. It may not be possible to adequately control this non-specific vascular disease, but the risk factors like hypertension, hyperlipidaemia and obesity can be fully controlled by using simple measures to reduce the morbidity. A good control of diabetes mellitus certainly decreases the incidence as well as the severity of retinopathy. It is well accepted now that the lower the mean blood glucose level, the lower are the micro-vascular complications, and the younger the patient the tighter should be the glycaemic control. The quality of glycaemic control can be assessed more accurately nowadays by the levels of glycated haemoglobin. Primary care physicians must be particularly thorough when examining these patients and look for abnormalities in other systems also. The rising incidence of morbidity is related to increased longevity and an inability to detect and prevent the various complications. A regular observation for an early recognition of retinal complications is essential. Non-insulin-dependent diabetics should be examined by an opthalmologist at the time of diagnosis and insulin-dependent diabetics should be seen once every year. A diabetic patient should be encouraged to actively participate in the self-management of the disease with proper education and motivation with a frequent review of compliance. A general practitioner may not have sufficient experience in recognizing the ocular complications of diabetes mellitus. Their screening performance can be greatly improved by short courses of instruction in opthalmology departments at various institutions (AU)

Child and family law in Trinidad and Tobago

This represents a comprehensive compilation and classification of child and family law in Trinidad and Tobago. (AU)

Geriatrics in practice

In this article the author examines the specialty of geriatrics, the lack of trained staff in this field and in general the 'problem of the aged' arising directly from the arithmetic of demography. The rate of occupancy of hospital beds by the elderly in Barbados and the attitude of medical and support staff to this group of people are also examined. Diseases of the elderly and their use of drugs are also discussed

General practice in St. Eustatius: II. Results - abstract

During the 1-year period, September 1, 1987 to August 31, 1988, the only 2 general practioners (GP) on the island of St. Eustatius recorded patient-based and episode-oriented data concerning 7,222 encounters with patients. The average population was 1,996 persons and the average encounter rate was 3.6 per person. The lower the social class of the patient the higher was the average encounter rate. Thirty-five per cent of the population was not seen at all. The special clinics for children, pregnant women and prostitutes, district calls and the 18-bed hospital accounted for 22 per cent, and the open morning clinic, 66 per cent of all encounters. Patients frequently visited the GP after hours (11 per cent). The most frequent patient-initiated reasons for encounter were of 2 kinds; requests for bloodpressure check (5 per cent), for contraception (3 per cent), for complaints such as cough (4 per cent), headache (3 per cent), fever, abdominal pain, injuries and tiredness (2 per cent each). "No disease" was an important diagnostic rubric (5 per cent). Other frequently occurring episodes were upper respiratory tract infection, influenza, other viral diseases and acute bronchitis (3 per cent each). Chronic diseases occurring frequently were uncomplicated hypertension (2 per cent, prevalence, 60/1,000 persons) and diabetes (1 per cent, prevalence, 36/1,000 persons). An average of 3.2 interventions per encounter was recorded, mainly partial examination (36 per cent), medication (25 per cent) and advice (23 per cent). In 3 per cent of encounters, a patient was referred to a specialist. Patient-based and episode-based morbidity recording provide useful data that describes the content of general practice on a small Caribbean island (AU)

General practice in St. Eustatius: I. Tools and methods - abstract

The Transition Project comprises a network of 25 family practioners (FP), including two on the island of St. Eustatius, the Netherland Antilles. These doctors register all encounters with all patients during at least one year. The aim of the Project is to construct an episode-oriented epidemiology of family practice. During each encounter, the patient's reasons for the encounter, the FP's diagnostic interpretation and the diagnostic and therapeutic interventions are recorded. Classification and coding are done by the FPs themselves, using the International Classification of Primary Care (ICPC) which is a two-axial classification system specially designed for use in primary care medicine. Problem-oriented encounter forms were used, copies of which were sent to Amsterdam for data entry. In the period September 1, 1987 to August 31, 1988, the 2 FPs recorded 7,222 encounters. Two sources of error, by the coding FP and during the data entry process were assessed. In a random sample of 3 per cent of encounters, the data stored in the computer were compared with the coded information and the hand written notations of the FP on the original form. It was estimated that 4.3 per cent of all episodes had an incorrect title, mainly due to coding errors made by the FP, and 4 of every 100 episodes were missing, most of which were lost during transport of forms. It was concluded that the data collected were valid and had minimal methodological sources of error (AU)

Non-psychotic psychiatric morbidity in general practice: implications for service delivery and training

Utilizing the 30 item version of the GHQ developed by Goldberg and validated in a Jamaican population by Harding, a sample of 98 respondents drawn from a general practice were analyzed. Thirty two percent (32 percent) were found to be "potential cases". Males and females had similar scores. Some implications of this finding for service delivery and training are discussed (AU)

The development of family medicine in Barbados - abstract

This paper outlines some of the changes in general medical practice in Barbados over the past 25 years, from the general practitioner/visiting surgeon type of doctor, to today's fully trained family physician. Some of the research done in general practice from 1969 to 1980, including results of unwanted pregnancy, use of family planning, attitudes to abortion and morbidity data in general practice will be mentioned. Changes towards family medicine development came from the people themselves and were spurred on by both the UWI curriculum change and the development of a postgraduate programme in family medicine. Since 1981 medical students in the final year have done a five-week clerkship in Family Medicine, and graduates in their search for a career could choose a four-year rotating residency programme leading to the DM (F.M.S.) UWI. Continuing Medical Education (CME) has for the past 10 years been a major objective of the UWI and The Barbados Association of Medical Practitioners (BAMP). The recent birth of a Caribbean College of Family Physicians will complement existing CME as college members maintain their membership and teach each other with the aim of being more competent, informed doctors (AU)

Concepts of obesity in family practice

In this study, 502 adults (409 women, 93 men) attending a group teaching family practice were weighed, their heights were measured and they were then interviewed on their concepts and beliefs about obesity. The results confirmed other reports that the prevalence of obesity is high; 46 percent of women and 17 percent men were found to have body mass indices greater than 27.0 and 27.4 respectively. Of the obese respondents, only 94 (47 percent) considered themselves to be fat, while self-image in the non-obese was more realistic with 176 (59 percent) thinking that they were the right size; 18.7 percent of respondents though that obesity was associated with good health, 29.9 percent associated obesity with wealth and 36.3 percent associated obesity with happiness. Two hundred and four respondents (40.6 percent) believed that men preferred their women to be fat, female respondents being more often of this view. Concepts as to the cause of obesity were found to differ from medical teaching with 195 (39 percent) respondents believing obesity to be hereditary and only 215 (42.8 percent) associating obesity with overeating. These views should be appreciated by health-care providers, who should try to change them, if necessary, before making efforts to prevent and treat obesity (AU)

Patient care in Barbadian family practice

A survey was conducted in Barbados to determine the various practices and services the physicians in government and private practice provided for the population. Nineteen physicians, seven of whom worked in government general medical clinics, recorded information on the practice procedures they used at 7,303 encounters over a four-week period. The results demonstrated the profile of attendance by age and sex, with more attendances in the reproductive (44.0 percent) and childhood (24.2 percent) years. People of the lower socio-economic classes attended in large numbers both the government (83.9 percent) and private facilities (66.7 percent). Prescribing was the most frequently used procedure (75.7 percent), but the number of prescriptions written per doctor was much less than reported from developed countries. Only 13 percent of prescriptions were for long-term medication. Counselling occurred in 40 percent of encounters, but only 7.1 percent were what physicians perceived as psycho-therapeutic care. Other services provided included minor operative procedures (16.2 percent), and certification (9.4 percent) (AU)

An evaluation of the referral-consultation process between primary and secondary/tertiary care physicians in Jamaica

This study seeks to: (1) Describe qualitatively and quantitatively the problems found to exist with the referral-consultation process. (2) Highlight factors already in place which serve to promote an effective referral-consultation process. (3) Identify areas seen as needing improvement in order to promote an effective referral-consultation process. (4) Identify, based on conclusions drawn from the study, how problems may best be redressed and improvement made. Fifty general practitioners volunteered to participate in part one of the study. These physicians recorded over a ten-week period of time, relevant details of all referrals made. In part two of the study a questionnaire was administered to 25 specialty consultants chosen by stratified random sampling techniques. The results reveal that general practitioner referral patterns in Jamaica concur closely with general practitioner referral patterns in Britain and North America with about 45 percent of all referrals being made to specialties of surgery, obstetrics and gynaecology, opthalmology and orthopaedics. Findings in this study indicate that at the present time the referral-consultation process functions poorly. There is a lack of awareness of the value of a functioning referral-consultation process among physicians and this situation is worsened by economic constraints and time limitations. A need exists to establish a permanent forum for general practitioner-consultant interaction which would serve through discussion to remedy some of the existing problems. One important finding is that where levels of interaction are increased between referring physicians and consultants and a more personal relationship is forged the functioning of the referral process improves. The author hopes that some of the findings and recommendations of this study will provide a basis for further discussions and investigations on this important topic (AU)