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.

The prevention of COPD exacerbations by salmeterol/fluticasone propionate or tiotropium bromide.

Rationale: Exacerbations are key drivers of morbidity and mortality in chronicobstructive pulmonary disease (COPD).Objectives: We compared the relative efficacy of the long-acting inhaledbronchodilator/anti-inflammatory combination (salmeterol/fluticasone propionate) 50/500mcg bd and the long-acting bronchodilator (tiotropium) 18mcg od in preventing exacerbations and related outcomes in moderate severe COPD Methods: 1323 patients (mean age 64yr, forced expiratory volume in 1sec 39 per cent predicted) were randomized in 2-year, double blind, double-dummy, parallel study.Measurements and Main Results: Primary endpoint was healthcare utilization exacerbation rate. Other endpoints included health status measured by St. Georges Respiratory Questionnaire (SGRQ), mortality, adverse events and study withdrawal.Probability of withdrawing from the study was 29 per cent greater with tiotropium than salmeterol/fluticasone propionate (p=0.005). The modelled annual exacerbation rate was 1.28 in the salmeterol/fluticasone propionate group and 1.32 in the tiotropium group (rate ratio 0.967 [95 per cent CI: 0.836 to 1.119]; p=0.656). The SGRQ total score was statistically significantly lower at 2 years on salmeterol/fluticasone propionateversus tiotropium (difference 2.1 units, 95 per cent CI: 0.1 to 4.0, p=0.038). Mortality was significantly lower in the salmeterol/fluticasone propionate group; 21 (3 per cent of patients in this group died compared to 38 (6 per cent) in the tiotropium group (p=0.032). Morepneumonias were reported in the salmeterol/fluticasone propionate group relative to tiotropium (p=0.008).Conclusions: We found no difference in exacerbation rate between salmeterol/fluticasone propionate and tiotropium. More patients failed to complete the study receiving tiotropium. A small statistically significant beneficial effect was found on health status, with an unexpected finding of lower deaths in salmeterol/fluticasone propionate treated patients.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

COPD exacerbations: defining their cause and prevention.

Exacerbations of chronic obstructive pulmonary disease (COPD) are episodes of worsening of symptoms, leading to substantial morbidity and mortality. COPD exacerbations are associated with increased airway and systemic inflammation and physiological changes, especially the development of hyperinflation. They are triggered mainly by respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation. Some patients are particularly susceptible to exacerbations, and show worse health status and faster disease progression than those who have infrequent exacerbations. Several pharmacological interventions are effective for the reduction of exacerbation frequency and severity in COPD such as inhaled steroids, long-acting bronchodilators, and their combinations. Non-pharmacological therapies such as pulmonary rehabilitation, self-management, and home ventilatory support are becoming increasingly important, but still need to be studied in controlled trials. The future of exacerbation prevention is in assessment of optimum combinations of pharmacological and non-pharmacological therapies that will result in improvement of health status, and reduction of hospital admission and mortality associated with COPD.

Autoinforme de salud general en adultos mayores de America Latina y el Caribe: su utilidad como indicador / Self-reported general health in older adults in Latin America and the Caribbean: usefulness of the indicator

OBJECTIVES. To evaluate self-reported general health (SRGH) as a health indicator and to analyze its covariates in people 60 years old or older living in private homes in seven cities of Latin American and the Caribbean.METHODS. This cross-sectional descriptive study was based on data from the Health, Well-Being, and Aging survey (Salud, Bienestar y Envejecimiento, or "SABE survey"), which was carried out in 1999 and 2000 in Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; and Sao Paulo, Brazil. The survey looked at the demographic and socioeconomic characteristics of the participants, several health indicators (self-reported chronic diseases, depression, and cognitivefeatures), the social and family suport network, the use of health services, reported and observed functionality, the respondent's income, and the durable consumer goods in the household. In probit regression models, self-reported fair or poor health was used as the dependent variable. The marginal effect of each categorical explanatory variable was used to indicate the difference between the probability of reporting poor health by persons who did or did not have a given characteristic. RESULTS. In all the cities studied the self-reporting of "excellent" health was very low (6 percent or less). The results of the multivariate analysis of the relationships between SRGH and covariates showed: (1) the relative importance of several health indicators as covariates of SRGH, (2) the association between sociodemographic characteristics and SRGH, and (3) the differences or similarities found among the seven cities with respect to the relationships studied. The level of self-rated good health was highest in Buenos Aires and Montevideo (60 percent), followed by Bridgetown and Sao Paulo (around 50 percent) and Havana, Santiago, and Mexico City (between 30 percent and 40 percent). The respondents evaluation of their memory was the factor that was most strongly related to SRGH, followed by satisfaction with nutritional status and satisfaction with life.CONCLUSIONS. The SRGH captured multiple facets of the health of the older adults, such as suffering from chronic diseases, the degree of satisfaction with the level of nutrition and with life, perception of memory, and any functional problems .... (AU)

Historical and current predictors of self-reported health status among elderly persons in Barbados

OBJECTIVE. To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. METHODS. The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated the determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. RESULTS. Historical determinants of health status accounted for 5.2 percent of the variation in reported health status, and this was reduced to 2.0 percent when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1 percent of the variation in reported health status, lifestyle risk factors for 7.1 percent, and current disease indicators for 33.5 percent. CONCLUSIONS. Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly (AU)

Enfermedades cronicas y limitacion funcional en adultos mayores: estudio comparitivo en siete ciudades de America Latina y el Caribe / Chronic diseases and functional limitation in older adults: a comparative study in seven cities of Latin America and the Caribbean

OBJECTIVE. To identify the relationship between selected chronic diseases and the presence of disability in inhabitants 60 years old or older in seven cities of Latin America and the Caribbean. METHODS. In 2000 and 2001 a descriptive cross-sectional study was conducted with a sample of 10 891 persons 60 or older in seven cities: Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; and Sao Paulo, Brazil. This research was part of the Salud, Bienstar y Envejecimiento (Health , Well-Being, and Aging) project (known as the "SABE project"). The dependent variables in the study were difficulty in performing basic activities of daily living, and difficulty in performing instrumental activities of daily living. Compiled from self-reports, the independent variables were : age, sex, educational level, living alone or with other person (s), self-assesed health, and the presence or not of hypertension, diabetes mellitus, cancer, chronic obstructive pilmonary disease, ischemic heart disease, cerebrovascular diseases, and osteoarthritis. The presence of depression and cognitive impairment in the participants was evaluated, and body mass index was also calculated. To compare the degree of influence of the different variables on disability, a standardized coefficient for each association was calculated. RESULTS. In the seven cities studied, the variables that showed a direct association with difficulty in carrying out basic activities of daily living and instrumental activities of daily living were: suffering from a higher number of noncommunicable diseases, from cerebrovascular diseases, from osteoarthritis, or from depression; being older; being female; rating one's own health as bad, and the presence of cerebrovascular diseases, osteoarthritis, or cognitive impairment. CONCLUSIONS. Our research provides the first systematized description of the associations between disability and chronic noncommunicable diseases in older adults in Latin America and the Caribbean. Difficulties that older adults have in carrying out instrumental activities of daily living are the first ones to appear. Therefore, follow-up mechanisms should be established that make possible the early detection of this disability (AU)

Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago

BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.

Overview of social inequalities in health in the Region of the Americas, using various methodological approaches

Over the past decade, according to several important indicators, health conditions have improved in the Region of the Americas. However, inequalities persist among the countries of the Region. This article has two primary objectives: 1) to provide some unbiased evidence on health inequalities among countries of the Region of the Americas and 2) to illustrate the application of some of the more frequently used methods for measuring inequalities, including effect measurements, population attributable risk, the slope index of inequality, the relative index of inequality, and the concentration index. Analyses have shown that there are great health disparities in the Region of the Americas. For example, residents of the poorest countries of the region live nearly 10 years less, on average, than do residents of the richest countries. If the other countries of the Americas had the same incidence of tuberculosis as does the subregion of North America (Bermuda, Canada, and the United States of America), there would be 76 percent fewer cases of this disease in the region. In the Americas, nearly 35 percent of deaths of infants under 1 year old are concentrated in the 20 percent of live births that occur in the group with the lowest income. As for maternal mortality in the Americas, fewer than 2 percent of maternal deaths occur in association with the 20 percent of live births in the group with the highest income. The analyses of health inequalities based on the use of various methods highlight the existence of important disparities among subregions and countries of the Americas that are not readily seen when using only the more-traditional methods for analyzing mortality and morbidity. There is also a need to incorporate the concepts of distribution and socioeconomic dimensions of health when interpreting a given situation. Using this approach will allow decisionmakers to target areas and populations that are in less-favorable conditions. A considerable body of aggregate data at the regional and country levels from routine information systems is already available-especially on morbidity, mortality, and other health-related factors-that can be used on a regular basis to analyze health inequalities. These kinds of analyses may be regarded as a first step toward the identification of health inequalities (AU)

Using household surveys and other information sources to study health equity in Latin America and the Caribbean

There are many types of household surveys. The discussion that follows will focus on what is know as "general-purpose household surveys." Such surveys were devised to study household expenditures (and/or income), job and occupational conditions, education of the members of the household (both highest level of attainment and current enrollment), conditions of the dwelling, and access to and utilization of services, including health services. The surveys usually also include a few questions on self-assesment of health status and the presence of health problems. Some of the surveys also include modules for special population groups such as children and women of reproductive age. The modules may cover such topics as immunizations, prevalence of diarrhea, upper respiratory tract illnesses in children, complete birth histories for women, and women's use of contraceptive methods. While they almost never have information on expenditures or income, they do include data about conditions of the dwelling, education, crowding, and other characteristics. These data allow some limited analyses of the relationships that health-seeking behaviors, health outcomes, and access to and utilization of some types of health care services have some aspects of the social and economic determinants of inequalities (AU)

Measuring and analyzing activities of daily living and quality of life in community elderly residents [abstract]

The rapid growth of the elderly population as well as the ongoing change in family structure is of public health concern in Japan. Before one can attempt to solve the problem of providing support to the elderly community residents, some assessment of their health status must be undertaken. We measured the activities of daily living (ADL), quality of life (QOL) and SF-36 score of about 716 elderly residents aged 65 years and over by interviewing them at home. The items of our survey included ADL, QOL (PGC), SF-36 scores, the elderly health-awareness, attitude, daily activities and other related subjects. Comparisons were then conducted in regard to the scores on the individual subscales of the SF-36 of residents with each of the diseases and the national-norm scores for Japan. ADL of the people who responded, "go out very often", was 99.9, followed by 98.6 for "occasionally", 87.4 for "seldom". ADL of the people who responded, "able to do shopping for daily necessities", was 99.7 while for "unable" it was 81.1. QOL of the people who resonded that their health status was "excellent" was 98.6, followed by 12.7 for "very good", 11.4 for "good", 8.3 for "not very good" and 7.1 for "not good". About the differences in SF-36 scores standardized with the national-normscores for Japan, only "role limitations due to physical problems" was -0.17 in males; "role limitations due to physical problems" was-0.19, "pain" was -0.10, and "mental health" was -0.01 in females. The survey revealed the prevalence of poor health among those ADL (QOL) showing 8090 (78). From this it may be concluded that ADL, QOL and SF-36 scores are very useful indices for us to rate the elderly patients' health status level, thus enabling us to consider what support is required by them. (AU)

The Saba health study: methodology and main results

'The Saba Health Study' is the first large scale health interview survey of the island. This book presents the main results of the study. It discusses the population's health status, use of health services, and satisfaction with health care. Known health risks, such as smoking, alcohol consumption, and overweight are evaluated and compared with situations on the sister island of Curacao and in western countries. Attention is focused on the identification of risk groups in need of specific policy interventions and health promotion programs (AU)

Relationship of health-related quality of life to symptom severity in diabetes mellitus: a study in Trinidad and Tobago

Our objective was to estimate the effect of greater symptom severity in diabetes mellitus on measures of health-related quality of life in a cross-sectional design in 35 government primary care health centres in Trinidad. Data were gathered on 2,117 subjects with clinical diabetes and analysed for 1,880 (89 percent). For each scale of the short form 36 (SF-36) questionnaire (a generic measure of health-related quality of life), scores were presented by quartile of symptom severity, measured using the Diabetes Symptom Checklist. Mean (SD) SF-36 scores were 44 (10) for the physical component score (PCS) and 45 (12) for the mental component score (MCS). Greater severity of diabetic symptoms was associated with lower scores on each of the subscales of the SF-36. Comparing lowest and highest quartiles of DSC score, the adjusted difference in PCS was -11 (95 percent confidence interval -12 to -9) and for MCS -16 (-18 to -14). Our results provide standardised data for health related quality of life in relation to severity of illness from diabetes, these might be used to aid the evaluation of relevant interventions.(Au)

Health status of the elderly in the Marigot Health District, Dominica

The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires: collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20 percent were dependent on care. 74 percent were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40 percent of the study population were known to be hypertensive, and another 13 percent had an elevated blood pressure on examination. Diabetes mellitus was present in 15 percent. 20 percent had a visual acuity of 0.1 or below, and 10 percent had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50 percent of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We suggest the development of a programme oriented approach of primary health care for the elderly to support this.(AU)

Ministry of Health Annual Report 1998

This publication looks at the Minister of Health's Presentation to the Sectoral Debate 1998-1999 outlining its challenges and achievements. It also looks at epidemiologic profile, service delivery, reproductive health status, child health and wellbeing, health status of adults, policy, organization and management, emerging issues and strategy for the future. It contains tables that gives usage and performance data in the Public Health Sector. It includes trends in hospital utilization for the period 1995-1998

An assessment of the health status and needs of the Watermount All-Age School in St. Catherine, Jamaica

It should be the goal of every school to be healthy. An healthy environment creates healthy students and healthy students should perform well academically. "Investment in our children, our most precious resource, is the wisest of all investments, for today's children" (UNICEF Pamphlet). This study analyzed data obtained from 99 students who attend the Watermount All-Age School during the period stated. Interview sheets, check list and focus group discussions were used to collect the data. The age distribution ranged from 7 - 15 years with the mean age being 11 years. The main findings revealed that the school environment needs to be enhanced: effective dialogue needs to take place to heighten vendors awareness about nutrition; it is clear that the school does not fully meet the WHO Criteria for a healthy school; students need to get more information about conditions of the physical plant including prevention of soil erosion; proper partitioning of classrooms. The study recommends that a programme be embarked on to improve: the vendors knowledge about nutrition; assist in helping the school fulfill the WHO Criteria for a healthy school; incorporate more health information through integration of subjects; work be done to improve the physical structure of the school.(Au)