Epidemiological transition in Trinidad and Tobago, West Indies 1953-1992

BACKGROUND: This study aimed to describe trends in age-specific mortality from diabetes mellitus, hypertension, cerebrovascular disease and ischaemic heart disease in Trinidad and Tobago between 1953 and 1992 and to relate them to earlier changes in infant mortality rates. METHODS: Average annual age-specific mortality rates per 100 000 were calculated for 5-year time periods from 1953 -1957 to 1988-1992 and plotted by mid-year of birth for cohorts born 1874-1882 to 1944-1952. Regression analyses were performed to test associations between adult mortality rates, and infant mortality rates for the same birth cohorts and period of death. RESULTS: Infant mortality declined from 180 per 1000 in 1901 to 10 per 1000 in 1992. Age-standardized mortality from diabetes mellitus increased, in men, from 60 in 1958-1962 to 278 in 1988-1992, in women the increase was from 89 to 303. Mortality from hypertension declined, in men, from 232 in 1953-1957 to 73 in 1988-1992, and in women, from 207 to 67. Cerebrovascular mortality increased, in men, from 341 in 1953-1957 to 451 in 1963-1967 before declining to 224 in 1988-1992. In women cerebrovascular mortality increased from 292 in 1953-1957 to 361 in 1963-1967 before declining to 196 in 1988-1992. There was evidence of a deceleration in cebrovascular mortality for cohorts born after 1908-1918. Ischaemic heart disease mortality remained constant. Mid-cohort infant mortality rates were not associated with adult mortality after adjusting for age and period of death. CONCLUSION: Declining infant mortality was subsequently associated with declining mortality from cerebrovascular disease and hypertensive disease and increasing mortality from diabetes mellitus but there was no association with ischaemic heart disease mortality. These relationships were confounded by secular changes associated with year of death.(AU)

Entrepreneurship and nation building: proprietary medical schools and development in the Caribbean, 1976-1990

Since the mid-1970s proprietary medical schools have spread throughout the Windward & Leeward Islands of the Caribbean. In some cases, these transnational educational corporations have made commitments to enhance education and health care resources of host countries. In all cases, the presence of hundreds of students and faculty, and the associated local spending, represents significant additional foreign exchange and employment. This dissertation seeks to learn how proprietary medical schools have affected development in Eastern Caribbean microstates, to assess what role, if any, they might play in local development, and to discern their implications for the complex array of regional agreements comprising the fourteen-nation Caribbean Community and its associated educational regime - whose institutional pinnacle is the University of the West Indies - to which all host microstates subscribe. The central focus of this study is Grenada and St. George's University School of Medicine. St. George's is the oldest such establishment, and is the archetype for all that followed in the region, Using an historical approach rooted in international political economy, public policy and area studies, this dissertation utilizes unpublished and recently declassified documents, newspapers, personal interviews, and other primary sources to reconstruct the complex relationship of school and state through four distinct political periods. At every stage of the analysis, regional events and implications were also considered. The study concludes that the incentive to allow proprietary medical schools was rooted in historic insecurities deriving from unequal power relations among member states of the educational regime, combined with ongoing perceptions of distributive bias. Host states viewed proprietary medical schools as an opportunity to augment both capital and human resources, and therefore acted alone, despite implicit norms against such independent action. The Grenadian case demonstrated that proprietary medical schools could, given sufficient encouragement, provide host microstates with certain developmental benefits affecting educational development, health care, and economy. However, the extent that these benefits are realized was found to be largely dependant on entrepreneurial awareness within the political leadership, institutionalization of collaborative/coordinating mechanisms, quality of medical school management.(AU)

Migration and mental health among the peoples of the Caribbean

Reviews the salient findings in the literature for 1948-1980 dealing with migration and mental health among the peoples of the Caribbean. Highlights some of the important theoretical problems inherent in research on migration and mental health. Increases the awareness of an array of questions that should be raised and some of the theoretical and methodological issues involved. (AU)

Environmental modification and differential health practices

The modification of social and physical environmental features of a society are hypothesized as producing changes in health status and such health related behavior as nutritional practices, perception of socialization environment. Preliminary study of two communities in Dominica, W.I. reveals such differences, generates hypotheses for later phases of the research. Some of the differences in ecology of the two communities will be regarded as intervening variables throughout this longitudinal study.(AU)