The Prevalence of Negative Coping Mechanisms and Its Association with The HealthRelated Quality of Life of University Students: Impact of the COVID-19 Pandemic

Mental health of young adults has become a relevant matter amidst the COVID-19 pandemic. Individuals employ various coping mechanisms to deal with their stresses and mental health challenges. The type of coping strategy determines the outcomes of their Health-related Quality of Life (HRQo). This study investigated the stressors of students at the University of the West Indies, St Augustine Campus (UWI-STA) and how their coping mechanisms influenced their HRQoL during the COVID-19 pandemic

Effects of PCOS on the quality of life of women ages 18-45: A Systematic Review

Polycystic ovary syndrome (PCOS) is a common hormonal disorder with an unknown aetiology that manifests in women of reproductive age. ➢ Excessive insulin levels, genetic predisposition, inflammation, and excessive androgen levels are involved in its development. ➢ PCOS can affect the quality of life (QoL) of women through characteristics like amenorrhea, excess androgens, polycystic ovaries, infertility, hirsutism, acne, and drastic weight gain. ➢ Associated complications like endometrial cancer, abnormal uterine bleeding, miscarriages, gestational diabetes, type 2 diabetes, hypertension, eating disorders, and depression may also arise, which can further lower QoL.

Health-related quality of life (HRQoL) during the COVID-19 pandemic on undergraduate students at the University of the West Indies, St. Augustine

▪ During the COVID-19 pandemic, the shift to online education led to behavioural/lifestyle changes, whichcan affect health-related quality of life (HRQoL). ▪ HRQoL is an individual's perceived physical and mental health over time, and highlights how these changes can impact health.

High prevalence of diabetes mellitus in a cohort of Trinidadian patients with chronic obstructive pulmonary disease

OBJECTIVE: To define the prevalence of diabetes mellitus (DM) in a cohort of Trinidadian chronic obstructive pulmonary disease (COPD) patients, and investigate its relationship to lung function, quality of life, and depression. DESIGN AND METHODS: Anthropometric and spirometric data were obtained from 108 COPD (91 males) patients from Trinidad chest clinics, who also had HbA1c test results. Questionnaires on quality of life St. George’s Respiratory questionnaire ({SGRQ} and COPD Assessment Test {CAT}) and depression (Center for Epidemiologic Studies Depression Scale {CES-D & CESD-R}) were administered, and an interview conducted. RESULTS: Mean (SD) age: 67.4 (11.0) years. Median (IQR) HbA1c: 6.1 (5.7, 6.7) %. HbA1c values were obtained for 105 patients of whom 40% had diabetes, and 40% pre-diabetes. Diabetics had a greater (p=0.001) median (IQR) BMI [27.3 (24.1, 30.4)] than non-diabetics [24.2 (21.2, 27.2)]. Patients with at least one chest infection/exacerbation in the past year had increasing CAT & SGRQ Total (p<0.001), and CES-D & CESD-R (p≤0.013) scores. CAT and SGRQ total scores were negatively related to lung function and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages (p<0.001). All lung function parameters, except Forced expiratory volume/Forced vital capacity (FEV1/FVC), decreased with increasing CES-D and CESD-R scores (p<0.05). CAT & SGRQ correlated well with CES-D & CESD-R scores (p<0.001). Intravenous corticosteroid use was positively associated with HbA1c (p=0.043). Dosage of inhaled corticosteroids was associated with lower FEV1 (p=0.034) and higher SGRQ & CAT (p≤0.048). FVC % predicted was negatively related to HbA1c (p=0.033). CONCLUSION: The prevalence of DM in the COPD patients was 40%; however no significant correlations of DM to outcome measures were observed. Patients with worse quality of life due poor lung function were more depressed.

Short- term impact of educational interventions on disease knowledge, illness perception and quality of life among Jamaican adolescents with sickle cell disease

OBJECTIVES: To assess the effect of educational interventions on disease knowledge, illness perception (IP) and quality of life (QOL) of adolescents with sickle cell disease (SCD) in Kingston, Jamaica. METHODS: A randomized controlled intervention study was conducted among 150 adolescents (ages 13-19 years) attending for routine visits. Baseline disease knowledge, IP and QOL were assessed prior to randomization to 3 groups (Group A: routine care; B: educational booklet; C: booklet + formal counselling) and all measures were repeated 3 months later. Changes in outcomes were analysed using random effects analysis of variance models. RESULTS: There were 76 girls and 74 boys (Mean age 16.1ñ1.9 years; 77% had homozygous SS disease), of whom 63.3% were reviewed at three months. Baseline knowledge was higher: with age (p value: 0.007) and in girls (p value: 0.024). Teen QOL was lower in girls (p value: 0.038) and lower in severe disease (p value< 0.001). Post-intervention knowledge scores were significantly higher within all 3 groups (increase of 1.68 in group A, 2.03 in B and 2.88 in C), but there was nil effect of interventions. There were no changes in QOL or IPs either. Adolescents who had higher knowledge scores had better understanding that their illness was long lasting (Coef: 0.22; p value: 0.008), and they perceived better personal control (Coef: 0.30; p value<0.001), as well as the effect of treatment (Coef: 0.12; p value: 0.01), in managing their illness. CONCLUSIONS: Participation in the study was associated with improved knowledge scores, but interventions per say appeared to have no effects.

Landscaping employment services for the mentally ill

OBJECTIVE: This project was intended to compare the quality of life of rehabilitees engaged in the Landscaping Employment Services programme with an unemployed group of rehabilitees. DESIGN AND METHODS: A total of 26 rehabilitees were invited to participate in the study with a diagnosis of schizophrenia, schizoaffective disorder, and bipolar disorder. An experimental group of 13 rehabilitees was assigned to the Landscaping Employment Services for Rehabilitees, and a control group of 13 rehabilitees were also evaluated. The landscaping programme consisted of seven days of activity. The effects were measured using a ‘Quality of Life Inventory’ applied to rehabilitees. Patients' knowledge and performance of the specific materials taught in the Landscaping Employment Services for Rehabilitees programme was ascertained through assessments conducted before and after training. RESULTS: Results indicated that participants of the Landscaping Employment Services for Rehabilitees programme significantly improved their knowledge, performance of the skills and their quality of life. CONCLUSIONS: Not only can patients learn relatively complex material, but they can also meaningfully improve the continuity of their employment capability by participating in a brief and highly structured employment training programme.

Burden of caregivers of adult patients with schizophrenia attending public health clinics in Jamaica

OBJECTIVE: To determine the extent and socio-demographic determinants of burden of care of caregivers of adult schizophrenic patients. DESIGN AND METHODS: Cross-sectional study of 115 dyads of schizophrenic patients-caregivers attending public mental health clinics, March 24 – April 4, 2014 were consecutively recruited. Burden of care was evaluated using the 22-item Zarit Burden Scale (maximum score, 88). Multiple linear regression model explored factors associated with caregiver burden. RESULTS. Caregivers were predominantly females (75.7%) and were on average 50.8 ñ 15.0 years. Most schizophrenic patients were males (65.2%) and were on average 43.6 ñ 17.2 years old. Caregivers showed on average, mild to moderate burden (score, 30.0 ñ 14.7; median, 28.0). There was a tendency for caregivers of patients who were parents or spouses to have higher levels of burden. In multivariable analyses, higher burden of caregiving was associated with inability to perform self-care, closer kinship and higher numbers of psychotic episodes in the previous year. CONCLUSIONS: Functional and social factors were important determinants of caregiver burden. Further investigations are needed which consider factors such as health status and health expenditures as predictor variables of caregiver burden.

An evaluation of the burden of diabetes in Grenada

OBJECTIVE: To assess the burden of diabetes in Grenada in terms of changes in quality of life and trends of incidence, amputation and gender. DESIGN AND METHODS: A mixed methods approach was used in which statistical retrospective analysis determined trends of diabetic related amputations based on secondary data for the period 2008-2012. A qualitative approach was also used to assess perceptions of quality of life of diabetic related amputees using interviews. RESULTS: There were no statistically significant differences or trends (relationships) found between number of amputations and incidences of diabetes with respect to time. The quality of life of diabetics decreased after receiving an amputation surgery as a result of multifactorial issues such as feelings of loneliness and financial instability. CONCLUSION: The decreasing trend of diabetes in Grenada was found to be statistically insignificant while quality of life of amputees was shown to be lowered. Decreasing the incidence of amputations should involve focus on the role of peripheral neuropathy. Policy development to increase benefits to disabled citizens is recommended to improve quality of life of Grenadians.

The prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas

OBJECTIVE: To determine the prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas. DESIGN AND METHODS: This study used a cross-sectional design with consecutive sampling. Data about sociodemographic characteristics, depression, and quality of life were collected using a sociodemographic questionnaire, the Beck Depression Inventory BDI-II, and the Short Form36 (SF 36) respectively. Data were analyzed using the Statistical Package for Social Sciences (SPSS). RESULT: 305 individuals (CMI: 106; Dialysis: 199) participated, 22 refused; 50.2% were males, 49.8% were female; mean age was 53.44 (ñ14.44); 45.9% were married; and 32.8% were unemployed for more than 2 years. The prevalence of depression was 43.7% for dialysis patients and 36.8% for CMI patients. Age of patients was associated with marital status, occupational status, ethnicity, and educational level. Hemodialysis patients were shown to have a lower quality of life than CMI patients. Linear regression analysis found that eight quality of life items were statistically significant predictor factors of the Beck score for the CMI and dialysis groups, and accounted for 45.5% of the variance. CONCLUSION: Although, these results did not necessarily demonstrate causality, patients receiving hemodialysis were as likely to be depressed as patients with chronic medical illness. Having to be on hemodialysis detracts significantly from patients’ quality of life.

The quality of life of Hansen's disease clients with disabilities compared to clients without disabilities in Trinidad and Tobago

OBJECTIVE: This study aims to assess the quality of life of persons who have Hansen’s disease-related disabilities in Trinidad and Tobago, compared to persons with the disease who do not have a disability. DESIGN AND METHODS: The study was quantitative, cross-sectional, comparative in design, conducted in the Hansen’s Disease Dermatology Clinics of Trinidad and Tobago, between February 2014 and April 2014. It was a convenience sample of the 122 respondents, 26 were Hansen’s Disease clients with disabilities, 51 had the disease but without disabilities, while 45 were clients with other Dermatological conditions. The WGO Quality of Life (WHOQOL-BREF) questionnaire was interviewer-administered after consent. RESULTS: The largest group of persons who rated their quality of life as good or very good was the persons with Hansen’s Disease that had no disability (30%), only 12% of persons with Hansen’s Disease-related disability rated their quality of life as good or very good. The mean quality of life scores (and standard deviations) for Hansen’s Disease clients without disability was 78.61 (9.6), Non-Hansen’s clients was 72.23 (11.8) and Hansen’s Disease clients with disability was 67.40 (13.9). CONCLUSIONS: The quality of life of the Hansen’s Disease clients with disabilities was found to be lower than the other two groups of clients.

Quality of life before and after laparoscopic Heller procedures-a Caribbean perspective

BACKGROUND: The aim of this study was to compare the symptoms and quality of life before and after laparoscopic Heller myotomy within a Caribbean population. METHOD: Sixteen patients who were treated by the same surgeon were polled. The procedure was laparoscopic Heller myotomy with or without concomitant fundoplication. A specifically constructed questionnaire that assessed symptomatology and the quality of life (via social and emotional functioning scores) was administered. RESULTS: The mean age of the patients was 38.4 years; 11 were female and 5 were male. The mean preoperative duration of symptoms was 5.5 years (range, 1-13). All patients complained of dysphagia (liquids and solids), odynophagia, and preoperative regurgitation. Follow-up was completed with a mean postoperative duration of 16.7 months. Overall, symptoms improved by an average of 71.2%; social and emotional functioning improved by an average of 42.2% (p < .001). CONCLUSION: Laparoscopic Heller myotomy is extremely effective in improving the overall quality of life among achalasia patients within the Caribbean.

Physical activity and health

In this final issue of Nayam News in this physical activity series we attempt to collate the main evidence for the various health indicators. Clearly, physical activity is positively related to health. However to reap maximum benefits from physical activity, individuals (2yrs and older) are recommended to participate in a minimum of 30 minutes or more on most or all the days of the week. Health can be defined as a state of physical, emotional, social and psychological well-being. In promoting health, one must take into consideration the importance of psychological well-being. It can therefore be assumed that , in an effort to improve health and wellness, physical activity is of major imortance.

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)

Health and the quality of life

It is perhaps intuitively obvious that health and life are inseparable and therefore, that matters of health must enter into any conceptualization of quality of life. However, the ethical and policy dimensions of the relationship between health and the quality of life are not that straightforward. There is constant debate as to whether these miracles of modern medicine are making it possible for persons to be biologically alive and still ceases to be functional in other domains encompassed in the descriptions of quality of life. Societies are being called upon to examine whether they can afford the cost of maintaining life at any cost. Resources are limited in every society. The expenditure on prolonging life that is perhaps of dubious quality means that there are fewer resources to be spent on other things (AU)

Coronary artery bypass graft outcome: the Trinidad and Tobago experience

The study is a retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in hospital and intermediate term follow up results. The mean age of patients was 59 ñ 10 years and 78 percent male. Sixty-four percent were of East Indian descent, whereas, 16 percnt were of Africian descent. Forty-eight percent of the patients were hypertensive, 46 percent were diabetic, 33 percent had hyperlipidaemia, 20 percent had a recent history of cigarette smoking and 16 percent were obese. Sixty-five percent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5 percent of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 ñ 15 percent. Wall motion abnormalities were seen in 67 pecent of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91 percent, 78 percent, 54 percent and 5 percent, respectively. Many patients (67 percent) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 ñ 0.8 days. In hospital mortality was 3.9 percent (8/205). THe most frequent post operative complicaton was haemorrhage (2.6 percent). Acute renal failure occurred in 2.1 percent; pulmonary collapse, 1.6 percent; 1 percent and cardiac arrest , 1 percent. Both sternal wound infections and systemic sepsis occurred in 0.5 percent. Intermediate term follow-up data were obtained for 92 percent (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow up period, 7 patients (3.4 percent) died. Angina severity was reduced from a mean CCS score of 2.61 ñ 0.95 before CABG ot 1.22 ñ 0.55 at the time of follow up (p<0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.(Au)

The grass is not always greener on the other side [abstract]

Too often one hears the comment that `you in the first world live a better life and make a lot more than us who live in the third world'. This statement is unfortunate, as I believe it is not true. I will try to discuss the pros and the cons of living in the `first world' and at the end suggest to you that you could be better off in most respects by staying where you are. Do not be in too much of a hurry to trade places with me because `the grass is not always greener on the other side'. (AU)

Quality of life in children with sickle cell disease in Amsterdam area

OBJECTIVE: To determine the differences in quality of life between children with sickle cell disease and healthy immigrant children. DESIGN: Descriptive, comparative. METHOD: The quality of life of children with sickle cell disease between 5 and 15 years old being treated in the Emma Children's Hospital AMC in Amsterdam, the Netherlands, was assessed by using a questionnaire for parents (TNO-AZL Children's Quality of Life Questionnaire (TACQOL) parent form) if the child was between 8 and 15 years old. The study period was April-October 1998. The questionnaires were completed by 45 (parents of) patients. The results were compared with a healthy reference group of immigrant children. Statistical analysis was performed using the Student t-Test. RESULTS: Children with sickle cell disease as well as their parents scored signifcantly lower on the items general physical, motor and independent daily functioning and on occurrence of negative emotions. No significance was observed for the items cognitive functioning and school performance nor for social functioning or occurrence of positive emotions. CONCLUSIONS: In children, sickle cell disease leads to compromised physical and possibly also psychological wellbeing, as well as the experience of decreased independence in daily functioning, but not to compromised cognitive or social aspects of the quality of life. (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)

Epidemiology, etiology, and impact of traveler's diarrhea in Jamaica

CONTEXT: Traveler's diarrhea (TD) can incapacitate travelers. Characteristics of TD could be helpful in identifying individuals who might benefit from a vaccine against TD. OBJECTIVE: To determine epidemiology, etiology, and impact of TD in Jamaica. DESIGN: Two-armed, cross-sectional survey conducted between March 1996 and May 1997. SETTING: To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples. MAIN OUTCOME MEASURES: Attack and incidence rates of reported diarrhea and of classically defined TD (> or = 3 unformed stool samples in 24 hours and > or = 1 accompanying symptom), incapacity, risk factors, and etiology. RESULTS: The attack rate for diarrhea was 23.6 percent overall, with 11.7 percent having classically defined TD. For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9 percent (all TD) and 10.0 percent (classic TD). Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3 percent of all travelers avoided potentially high-risk food and beverages. The most frequently detected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Salmonella species. CONCLUSIONS: A realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal (Au)