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.

Tuberculosis in Suriname: trends in epidemiology, diagnostics and treatment

This thesis describes the epidemiology of tuberculosis in multi-ethnic Suriname, as well as progress in diagnosis and treatment trends of tuberculosis(TB) in Suriname.

Post­World War II epidemiological transitions in Caribbean Societies: Interpretive insights based on age-associated mortality profiles

Objective: Life expectancy at birth is a robust indicator of the mortality profile in any spatial unit. The paper draws on age-associated life expectancy estimates from six Caribbean nations between 1950 and 2015 to assess variable gain in longevity of life at various stages of human lifespan and make claims about the variable impact of nation-specific sociomedical interventions as well as likely lessons to be learned. Design and Methodology: Using Mixed Methodology, secondary data are drawn from the United Nations Population Databases that reflect mortality profiles at national and regional levels. The data relate to six Caribbean nations ­ Cuba, Barbados, Jamaica, Trinidad and Tobago, Guyana and Haiti and permit the detection of changes in age-associated life expectancy over 20-year intervals including four time points ­ 1955, 1975, 1995 and 2015. Descriptive statistics are used to discern variable national trends that could be understood drawing on qualitative evidence obtained from documentary research and elite interviews. Results: Three distinct mortality profiles emerge with the most favourable being in Cuba and Barbados, the least favourable in Guyana and Haiti, and Jamaica and Trinidad and Tobago being located between the two extremes. The timing and magnitude of gains in infant, child, adult and geriatric health states can be discerned from the results. Conclusion: The paper is heuristic and constitutes a basis comparing the effectiveness of primary, secondary and tertiary health care in promoting human resilience to mortality. As such, the paper provides important ameliorative lessons that have implications for critically informing the administration of health policies.

Epidemiology and management trends of patients with severe sepsis and septic shock in Trinidadian Intensive Care Units: A prospective multicenter trial

Objectives: To investigate the epidemiology, management and predictors of mortality in severe sepsis. Design and Methodology: Prospective observational study in 4 Trinidadian Intensive Care Units (ICU) over a one year period August 2017-August 2018. Physiologic and treatment data was collected on admission to ICU and patients were followed up until ICU discharge and then at 28 days to determine mortality. Results: 163 patients fit the criteria for severe sepsis and were enrolled. Twenty-eight day and ICU mortality rate were 42% (68) and 34 % (56) respectively. Case distribution by the various hospitals were San Fernando General Hospital 62% (101), Port of Spain General Hospital 16% (26), Eric Williams Medical Sciences Complex 12.3% (20) and Sangre Grande Hospital 9.8% (16). The most common source of sepsis was pulmonary (54%) followed by abdominal (17%) and urological sepsis (14%). Acute Kidney Injury (AKI) was present in 71% (115) patients and 43% (46) of patients with stage 2 and above AKI received Renal Replacement Therapy (RRT) in the ICU. In the regression model, the only factors that were found to predict both 28 day and ICU mortality were stage 2 AKI [OR 6.2 (95% CI 1.7- 23.1, p = .007)], stage 3 AKI [OR 7.2 (95% CI, 2.1-24.0, p=.001)] , mean arterial pressure of < 60mmHg in the first 24 hours [OR 10.8 (95% CI 1.7-68.1, p= .001)], presence of either moderate-severe Acute Respiratory Distress Syndrome [OR 4.1 (95% CI 1.8 ­ 9.2, p = .002)] and Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score [OR 1.08 (95% CI, 1.0-1.2, p=.039)]. Conclusion: Severe sepsis is associated with a high hospital mortality rate and this sepsis burden varies according to region. Limited access to RRT remains a problem in certain centers.

Vitals: A quarterly report of the Ministry of Health April 2017

This document looks at health trends and statistics in Jamaica. This issue focuses on data collected in the October to December 2016 quarter along with annual comparisons. Data, utilization of the health services and complaints to the Ministry are included.

Zika in Suriname: Emerging virus ­ Established vector

This Power Point presentation by the Suriname Director of Health, addresses the Zika outbreak in Suriname, the progression of the spread of the virus and the response of the Surinamese government with respect to containing the spread of the disease. The presentation outlines steps taken in preparation for an outbreak of Zika, after the virus' first appearance in Brazil in 2015. Strategies adopted at the entomological, epidemiological, surveillance and vector control levels in Suriname are outlined. The presentation also addresses prenatal consultation and monitoring, antenatal monitoring of Zika positive pregnancies, and updating of Aedes material to include Zika-V information for use in schools and other training. Finally, the presentation addresses the drafting of new risk communication strategies and Zika response strategies at the national level, the lessons learned, and the challenges associated with the Zika virus.

The Caribbean Regional Field Epidemiology and Laboratory Training Programme (CR-FELTP): a new resource for building public health capacity

OBJECTIVE: To describe the process of developing and implementing the CR-FELTP. DESIGN AND METHODS: Caribbean countries have articulated a longstanding need for comprehensive training in applied and integrated epidemiology. Implementation of the International Health Regulations (IHR) (2005) illustrated public health capacity gaps in the region. The design of a regional FELTP was based on global FETP/FELTP curriculum standards, and the model of a 3-tiered regional FETP in Central America. CR-FELTP Level I reflects the “Tier 1” competencies for applied epidemiologists in governmental agencies, and includes training and field projects in 9 subject areas. RESULTS: A Level I curriculum including Mentor orientation, training materials, programme guide and evaluation framework, was developed and disseminated to countries, along with basic computer equipment for training. In 2014, the CR-FELTP was successfully launched in 6 Caribbean countries: Barbados, Suriname, Grenada, St Vincent and the Grenadines, the Bahamas and St Lucia. Along with a coordinator in each implementing country, 48 Mentors were recruited. A total of 71 Trainees have participated in Level I, yielding a 1.5 trainee : mentor ratio. CONCLUSIONS: FETP/FELTPs worldwide have demonstrated that they are an important and ongoing source of skilled public health professionals who contribute to strengthening surveillance systems and the public health workforce. The CR-FELTP shares these goals, but faces many challenges. With external fiscal support ending in 2015, maintaining momentum will require aggressive resource mobilisation, organisational commitment from CARPHA and its partners, and continued interest and commitment from member states.

Epidemiology of tetanus in Jamaica, 1993–2010

BACKGROUND: Although tetanus is still endemic in Jamaica, the epidemiologic profile has not been evaluated. METHODS: Admission registers at the main tertiary referral hospital were accessed to identify all patients diagnosed with tetanus from 1 January 1993 to 1 December 2010. RESULTS: There were 26 cases of tetanus (annual incidence of 0.57 cases per 1,000,000 population). Tetanus was more common in men (5.2:1) at a mean age of 59 ± 18.1 years. Persons in high-risk occupations (farmers, gardeners and construction workers) accounted for 52% of cases. CONCLUSION: Tetanus remains endemic in Jamaica, occurring more commonly in elderly men. Doctors should be educated about the importance of a high index of suspicion, an immunisation history and promoting booster shots in high-risk groups.

Epidemiology, risk analysis and clinical outcomes of acute myocardial infarction in Trinidad

Cardiovascular (CVS) disease is a global phenomenon and in Trinidad and Tobago, a small island developing country, remains the leading cause of death since the 1940's. It accounts for a proportional mortality of 25%.The main contributors are ischemic heart disease and stroke (1). Because CVS disease has global implications, the evaluation of the diverse outcomes of acute myocardial infarction (AMI) using population based hospital discharge databases is an important activity. The aim of this study is to describe the epidemiological features of acute myocardial infarction (AMI) and outcomes in patients admitted for tertiary care in Trinidad.

Epidemiology of human leptospirosis in Trinidad and Tobago, 1996-2007: a retrospective study.

A retrospective study to describe the epidemiology of human leptospirosis in Trinidad and Tobago during 1996–2007 was conducted. All confirmed cases of leptospirosis was analyzed according to age, sex, seasonality and geographic distribution. A total of 278 cases were recorded, with an average annual incidence rate of 1.84 per 100,000 population. Seventy-five percent of the cases occurred during the wet season, with the highest number of cases recorded in November. A positive correlation was found between number of cases and rainfall. Males constituted 80% of all cases, and the overall male:female ratio was 4.6:1. The total case fatality rate was 5.8 per cent, with deaths among males four times more common than in females. Clinical leptospirosis was greatest in the 10–19 age group and lowest in the 0–9 age group. The total prevalence was 22 per 100,000 population, with the highest prevalence 41 per 100,000 recorded in the regional corporation of Sangre Grande and the lowest (6 per 100,000) in the city of Port of Spain. The lack of important information and active surveillance showed that the level of awareness of the disease is low in the country. The disease is still under-reported, and is considered to be of significant public health importance.

First insight into Mycobacterium tuberculosis epidemiology and genetic diversity in Trinidad and Tobago.

This report is based on a 1-year recruitment of all of the culture-positive Mycobacterium tuberculosis cases in Trinidad and Tobago (n = 132). The study population was characterized by a high male-to-female sex ratio of 4 and a human immunodeficiency virus-tuberculosis (TB) coinfection rate of 30 per cent. It mainly occurred among African descendants, who represent 37.5 per cent of the total population but 69.7 per cent of all TB cases (P < 0.001). Spoligotyping resulted in 25 different patterns and 12 clusters (2 to 74 strains per cluster), with the predominance of a highly conserved spoligotype international type clone, SIT566.

Epidemiology of obesity in the Western Hemisphere.

CONTEXT: Obesity has emerged as a global public health challenge. The objective of this review was to examine epidemiological aspects of obesity in the Western Hemisphere. EVIDENCE ACQUISITION: Using PubMed, we searched for publications about obesity (prevalence, trends, correlates, economic costs) in countries in North America, Central America, South America, and the Caribbean. To the extent possible, we focused on studies that were primarily population based in design and on four countries in the Western Hemisphere: Brazil, Canada, Mexico, and the United States. EVIDENCE SYNTHESIS: Data compiled by the International Obesity Task Force show a substantial level of obesity in all of or selected areas of the Bahamas, Barbados, Canada, Chile, Guyana, Mexico, Panama, Paraguay, Peru, St. Lucia, Trinidad and Tobago, the United States, and Venezuela. Furthermore, countries such as Brazil, Canada, Mexico, and the United States have experienced increases in the prevalence of obesity. In many countries, the prevalence of obesity is higher among women than men and in urban areas than in rural areas. The relationship between socioeconomic status and obesity depends on the stage of economic transition. Early in the transition, the prevalence of obesity is positively related to income whereas at some point during the transition the prevalence becomes inversely related to income. CONCLUSIONS: Like other countries in the Western Hemisphere, the four countries that we focused on have experienced a rising tide of obesity. The high and increasing prevalence of obesity and its attendant comorbidities are likely to pose a serious challenge to the public health and medical care systems in these countries.

Characterization of invasive isolates of S. pneumoniae, H. influenzae, and N. meningitidis in Latin America and the Caribbean: SIREVA II, 2000-2005

OBJECTIVES: To analyze the phenotypical characteristics and the susceptibility to antibiotics of the circulating strains of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis circulating in Latin America and the Caribbean from 2000-2005. Potential coverage by conjugate vaccines was evaluated. METHODS: Conventional methods were used to study the distribution of the serotypes or serogroups of 17 303 strains of S. pneumoniae, 2 782 strains of H. influenzae, and 6 955 strains of N. meningitidis isolated from cases of pneumonia, meningitis, sepsis, bacteriemias, and other invasive processes. The antimicrobial susceptibilities of the study strains were evaluated. The isolates came from 453 sentinel surveillance sites in 19 countries in Latin America and four in the Caribbean, as part of the SIREVA II (Network Surveillance System for the Bacterial Agents Responsible for Pneumonia and Meningitis) project. RESULTS: S. pneumoniae serotype 14 was the most frequently isolated (21.1 percent), especially in children under 6 years of age (29.1 percent). The potential coverages by hepta-, nona-, deca-, and trideca-valent antipneumonia conjugate vaccines were 59.0 percent, 73.4 percent, 76.5 percent, and 85.9 percent, respectively. Of the isolates, 63.3 percent were sensitive to penicillin. H. influenzae serotype b was present in 72.2 percent of the isolations from children under 2 years of age, whereas 8.6 percent produced serotypes a, c, d, e, and f, and 19.2 percent could not be serotyped. The rate of H. influenzae beta-lactamase-producing strains isolated from children under 2 years of age was 16.3 percent. The most frequent N. meningitidis serogroups were B (69.0 percent) and C (25.7 percent); 65.8 percent and 99.2 percent of the strains were susceptible to penicillin and rifampicin, respectively. CONCLUSIONS: These results highlight the importance of comprehensive epidemiological surveillance of S. pneumoniae, H. influenzae and N. meningitidis in Latin America and the Caribbean. The great heterogeneity found in the distribution of S. pneumoniae serotypes among the countries studied could reduce immunization coverage. Conducting a specific analysis of each country to adjust the introduction of new conjugate vaccines and determine the best immunization plan is recommended

HIV risk behaviors of Latin American and Caribbean men who have sex with men in Miami, Florida, USA

OBJECTIVE: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS: Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS: In the previous 6 months, 44 percent of the sample engaged in UAI, and 41 percent used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSIONS: Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.

Sero-epidemiology of Canine Leptospirosis in Trinidad: serovars, implications for vaccination and Public Health

A sero-epidemiological study on canine leptospirosis was conducted in house, stray, farm and hunting dogs, as well as in suspect cases of clinical canine leptospirosis. Serum samples were collected from apparently healthy (vaccinated and non-vaccinated), house dogs. A questionnaire was administered to the owners to elicit information on risk factors for leptospirosis. The microscopic agglutination test was used to screen for leptospirosis using 17 international serovars. Reciprocal titres of between 100 and <800 were considered as evidence of past exposure while reciprocal titres of 800 or greater were classified as suggestive of acute/current infection. Of a total of 419 serum samples tested, 61 (14.6%) were seropositive for Leptospira agglutinins, 23 (5.5%) had mixed infections and 16 (3.8%) had current infection. Amongst 50 suspected cases of clinical leptospirosis, 24 (48.0%) were seropositive and only 13 (26.0%) had current infection compared with 10 (6.3%) and three (1.9%) of 160 apparently healthy house dogs respectively. The difference was statistically significant (P < 0.05; chi2). Twelve (25.5%) of 47 hunting dogs, 10 (20.4%) of 49 farm dogs and five (4.4%) of 113 stray dogs were seropositive (P < 0.05; chi2). Overall, a total of nine serovars were detected with serovars mankarso, icterohaemorrhagiae RGA, autumnalis and copenhageni being involved in 29 (47.5%), 20 (32.8%), 25 (41.0%) and 10 (16.4%) respectively in 61 seropositive dogs (P < 0.05; chi2). Serovar mankarso was most predominant in seropositive apparently healthy dogs, 37.8% (14/37), suspected clinical cases of leptospirosis, 62.5% (15/24) compared with serovar icterohaemorrhagiae with a frequency of 21.6% (8/37) and 50.0% (12/24), the difference being statistically significant (P < 0.05; chi2).

Kenneth Harrison Uttley (1901-1972). Historian to the diseases of Antigua, British West Indies

Dr. Kenneth Uttley (1901-1972) served as Chief Medical Officer in Antigua, British West Indies, from 1955 until 1966. During this time, Dr. Uttley personally reviewed and tabulated an island-wide governmental demographic database of all births, deaths and causes of death during the preceeding 100 years. This database was the result of a Compulsory Birth and Death Registration Ordinance enacted as one of several Colonial Poor Laws in 1856. His efforts resulted in the publication of a total of 30 papers in American and British medical journals. Many of these papers reviewed historical demographic trends in births, fertility rates, neonatal deaths, infant mortality and early childhood mortality rates. Others focused on the historical epidemiology of specific diseases such as neonatal tetanus, leprosy, tuberculosis and malaria. This is the first complete bibliographical account of Uttley's contributions to the history of diseases in the West Indies in general and Antigua in particular. Dr. Uttley also served as an ordained priest in the Anglican Church and, upon retirement from the Colonial Medical Services, returned to England to serve as the Vicar of Purton, Oxfordshire. (AU)