The Impact of Online Schooling due to the Covid-19 Pandemic on the Mental and Socioeconomic Well-being of Parents and Guardians of Primary School Students

• COVID-19 caused extensive economic recession and Trinidad is no exception. Whilst lockdown slowed the spread of COVID-19, it also resulted in the closure of schools and retrenchment of workers. • Therefore, it was imperative that the parental population be investigated to determine the impact of this pandemic on their livelihood, since challenges they encountered impacted the quality of education received by their children. • Many families faced financial constraints in purchasing electronic devices and internet connectivity to facilitate their children's online learning. This overwhelming stress coupled with lack of technological competence had the possibility of increasing the prevalence of psychiatric disorders such as generalized anxiety and depression

Impact of COVID-19 Pandemic on Medical Students' clinical training, their learning behaviours, perceived stress and performance as future medical professionals

The COVID-19 pandemic led to a global lockdown of all levels and types of educational institutions, prompting the implementation of online education worldwide. Undoubtedly, the traditional delivery of medical education was directly affected by this development. Challenges created compromised the proper delivery of clinical training as face-to-face teaching was restricted due to social distancing measures. Inevitably, this sudden change affected the learning behaviours and stress levels of medical students in their penultimate years, as well as the standard of their clinical training and their perception of their performance as future medical professionals.

Demographic and Lifestyle Factors that affect HbA1c awareness amongst type II diabetic patients in Trinidad

• Trinidad and Tobago is amongst the countries with the greatest burden of type II diabetes in the western hemisphere • Educating type II diabetic patients in controlling their glycosylated hemoglobin (HbA1c) are recommended as measures to reduce morbidity and mortality associated with type II diabetic complications • Measurement of HbA1c in type II diabetic patients represents their glycemic history for the former 8 ­ 12 weeks and should be tested every 3 months to monitor patients' metabolic control • This study is aimed at measuring HbA1c awareness amongst T2D population in Trinidad and making recommendations based on results

Investigating the Correlation between Proliferative Diabetic Retinopathy (PDR) and the duration of diabetes mellitus

The objective of this study is to determine the correlation between proliferative diabetic and duration retinopathy and duration of diabetes mellitus. This study was conducted using a total of one hundred (100) diabetic patients from Trinidad Eye Hospital Diabetic Retinopathy Screening Program (DESP). An efficient screening along with fundus photographs was done prior to collection of data. All data received from TEH database were entered into IBM SPSS statistical software (version 6). Tests such as One-Way ANOVA as well as Chi square test was used to determine the correlation between duration of diabetes and progression of diabetic retinopathy through grading of photographs. From the results obtained in this study, there was a correlation between duration of diabetic retinopathy and the grade obtained therefore the objective of the study was answered. In conclusion, it can be stated that a longer duration of diabetes mellitus relates to an increase in the progression of diabetic retinopathy. Additionally, there was no associated correlation between ethnicity and the progression of diabetic retinopathy indicating that ethnicity is not a definite risk factor for the progression of the condition.

An investigation on the knowledge, attitudes and practice towards vaginal candidiasis amongst women of reproductive age attending the University of the West Indies, St. Augustine Campus

From 20th century, our views, understanding and treatment of pathogenic infections have drastically changed. Pathogenic organisms were discovered, classified and treatments were subsequently implemented. Candidiasis spp. was discovered and linked to the condition; Vulvovaginal Candidiasis (VVC), commonly known as yeast infection, which affects the female lower genital tract, vulva and vagina. Symtoms of such an infection include itching, burning, soreness and a creamy vaginal discharge. Given the nature, location and symptoms of such an infection, individuals are often self-conscious and hesitant to discus it or seek medical attention until symptoms become unbearable. VVC is one of the most common infections in reproductive age females with 75% of women experiencing infection at least once in their lives. Due to the qualitative gap in literature toward women affected by VVC in our country, this study aimed to highlight the knowledge, attitudes and practices towards VVC among reproductive age in Trinidad and Tobago.

Prevalence of bacteriuria in pregnant women attending antenatal clinics of Trinidad and Tobago

Urinary tract infection (UTIs) are one of the most common infectious diseases ranking next to upper respiratory tract infection and are often linked with significant morbidity and mortality. They are caused by the colonization of pathogenic microbes along urinary tract as well as tissue invasion of any part of the urinary tract. Microbes that cause UTIs include bacteria, fungi, parasites, protozoa and viruses. Bacteriuria is a problem among the pregnant women. The UTI's in pregnancy has been associated with morbidities such as cystitis, pyelonephrities, pre-eclampsia, polyhydramnios, pre-term birth and low birth weight. This research was undertaken to determine the prevalence of bacteriuria among the pregnant women of Trinidad.

Men's Perspectives on 'Male Sensitive' Health Services

Men, in general, are more likely to hold negative views and be unwilling to access health services (Hawkes and Buse, 2013) except in circumstances when they view their lives qas being imperilled (Novak, et al., 2019). However, this is associated with the social constructionof masculinity an the expectations of how masculinity should be performed (Novak, et al 2019.) Being concerned about one's health is perceived as a female concern and creates cognitive dissonance for men in deciding whether they should behave as though they don't care or should care for their health (Robertson and Williams, 2010, Elliott. 2015, Bonhomme, Brott and Fadich, 2017, Novak, et al., 2019). In spite of the growing body of literature on masculinity and health; addressing issues of men's health is challening since there is an absence of agreement on what constitutes 'men's health', in spite of attempts to do so (Bardehle, Dinges and Whitw, 2016). Although a number of studies have been conducted on men in the Caribbean, there is a dearth of literature on men and their perceptions of 'male sensitive' health services among men between the ages of 18 yeas to 65 years in Trinidad and Tobago. The research questions was: What are men's perceptions about masculinity and its implications for 'male sensitive' health services?

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.

Knowledge levels, attitude and beliefs of men towards the Digital Rectal Examinations (DRE): A study in Trinidad

Objective: To determine knowledge levels, attitudes and beliefs of men 40 years and over regarding Digital Rectal Examination (DRE). The investigators considered this crucial following the scourge of prostate cancer in Trinidad and Tobago, and seeming lack of the use of the DRE, a noted method of screening for the condition for early detection. Design and Methodology: A cross-sectional descriptive study was undertaken using all men totaling 216, who were 40 years and over, and who gave their informed consent, attending a central mall in Trinidad in the month of April 2018. Data was collected using researchers'- designed self-administered questionnaire. Data was collected and collated manually but analysed with the aid of the SPSS version 20. Result: Results indicate that the men (a) were knowledgeable (95.8%) about DRE, (b) had positive belief (96.3%) about DRE and its medical significance, and (c) had good attitudes (73.6%) towards DRE. Further, men's knowledge levels and beliefs were not significantly associated with their selected demography, namely age, religion, educational level, marital status and ethnicity (p>0.05. However, their attitudes were associated with their ethnicity only (p<0.03). Conclusion: Results suggest that perhaps the attitudes and beliefs are better predictors of intentions than knowledge. This needs to be explored further given the need to curb the prevalence of prostate cancer among men in Trinidad and Tobago.

Polypharmacy and the risk of potentially inappropriate medications among the elderly in Trinidad and Tobago

Objective: The primary objective of this study was to assess the frequency, extent and complications of polypharmacy in elderly patients using Beer's criteria. Design and Methodology; A cross-sectional study was conducted at the outpatient pharmacy of the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago. Interviewer ­ administered questionnaires were used to collect data from 120 participants aged 65 years and above. The questionnaire was specifically designed to gather information regarding the participants' demographics, medical information and the various medications the participants were using at the time of the study. The data collected was entered in SPSS for analyses. Result: The results of the study have shown that the occurrence of polypharmacy was 54.2%, while the use of potentially inappropriate medications was (24.2%) among the study population. It was also shown that age, ethnicity and the number of doctors visited by participants had a significant effect on the occurrence of polypharmacy (with p values of 0.003, 0.003 & <0.001 respectively). Also, it was observed that polypharmacy was a main factor associated with potentially inappropriate medications (p value 0.012). Conclusion: The results of this study indicated a high prevalence of polypharmacy and potentially inappropriate medication use among the study population.

The assessment of postoperative delirium at the Port of Spain General Hospital

Objective: To determine the incidence of post-operative delirium at the Port of Spain General Hospital, Trinidad and Tobago. Design and Methodology: Post-operative delirium (POD) is a relatively common occurrence particularly in the elderly (>65 yr.), after prolonged surgery and after major orthopaedic surgery. It is linked to longer hospitalization and a more prolonged recovery to full functional status. This study aimed to establish the incidence of POD at the Port of Spain General Hospital during the period September 2017 to March 2018. After obtaining consent, patients were screened using the 4 'A's Test questionnaire pre- and postoperatively. Post-operative testing was done on days 0, 1 and 2 between the hours of 18:00 and 22:00. Results: Sixty-one (61) patients were recruited. A total of 42 underwent surgery and were screened using the 4AT questionnaire. Eighteen (42.8%) displayed cognitive impairment post-operatively, with 9 (21.4%) having delirium according to the 4AT score. Delirium occurred more frequently after general anaesthesia (26.7%) compared to regional anaesthesia (8.4%). Vasopressor use was associated with a higher risk of POD (66.6%). There was an association between gynaecological malignancy and POD (3/9, 33.3%). Conclusion: The incidence of POD in elderly patients at a tertiary level hospital in Trinidad was 21.4%. At risk patients were those who underwent general anaesthesia, those who received vasopressors and those with gynaecological malignancy. We recommend that the 4AT tool be modified for our population to more accurately detect delirium.

Vision standards for driving in Trinidad and Tobago

Objective: To research the licensing system with respect to vision standards, and the process of assessing vision at licensing offices. We identified areas where there may be problems, which can hinder the safety of drivers and other citizens and proposed solutions for these issues. Design and Methodology: Methods of information gathering includedconducting interviews with the head licensing officer at each licensing office branch. Data such as the types of chart, distance from the chart and room lighting were also measured and recorded at each office. Information about the vision screening process was gathered through the interviews. Results: It was found that there were no set standards in Trinidad and Tobago for assessing the vision of individuals wanting to obtain a driver's license. Individuals performing the vision assessment at the offices were not trained to do so and did not perform it on everyone. There were variations in the types of chart used, the chart distance used for testing, and room lighting, which can significantly affect the results. Conclusions: There is room for improvement in the system and methods of vision screening in Trinidad and Tobago. Other features of vision testing including peripheral vision and contrast sensitivity should be taken into consideration for a proper assessment of vision to be done. There is also a need for more extensive research to be done to aid policymakers in making sound decisions.

Health literacy in patients requiring joint replacement

Objectives: To assess the general and musculoskeletal health literacy in a group of patients requiring joint replacement at the public hospitals. To determine factors associated with both general and musculoskeletal health literacy. Design and Methodology: In this cross-sectional study, a convenience sample of 82 patients completed a demographic survey as well as the Newest Vital Sign (NVS), a general health literacy tool, and the Literacy in Musculoskeletal Problems (LiMP) which assesses musculoskeletal health literacy. Statistical analysis was performed using Stata version 15, chi-squared tests were used to determine the relationships between general and musculoskeletal health literacy and demographic variables. Results: There was 61 females and 21 male patients (74% and 26% respectively) with a mean age of 63.5 years (SD +/- 8.2) . The mean score for the NVS was 2.3 (SD +/-0.9) {> 3 indicates adequate General Health Literacy}and LiMP 3.7 (SD+/- 1.7) {>5 indicates adequate Musculoskeletal Health Literacy}. Male patients, secondary school education, being employed and previous healthcare experience were all statistically associated with higher NVS and LiMP scores. Conclusion: Inadequate general and musculoskeletal health literacy (90% and 80% respectively) was found in the majority of patients. The inability to make good decisions about health care due to insufficient health literacy is associated with poor outcomes and increased utilisation of resources. Greater emphasis should be placed on educational campaigns to improve health literacy.

Normative values for hand grip strength in Trinidad And Tobago

Objectives: To establish normative Hand Grip Strength (HGS) data for Trinidad and Tobago and to assess factors that may influence hand grip strength within this population. Design and Methodology: A cross sectional study of participants between the ages of 18-80 years was conducted at five distinct geographic regions in Trinidad and Tobago. Demographic data was collected including hand dominance. HGS was measured using a Jamar dynamometer. Descriptive statistics were performed for all direct measurements and Pearson's correlation coefficient used to analyze the relationship between variables. All statistical analysis was performed using the Statistical Package for Social Sciences (SPSS v20) p-value < 0.05 was considered significant. Results: A total of 1354 participants took part in the study, with 121 exclusions leaving 1233 for analysis. There were 561 males (45.5%) and 672 females (54.5%). The mean age of the participants was 42.5 years (SD +/-15.5) and mean body mass index (kg/m2) 27.3 (SD +/- 6.0). The overall mean HGS for our sample was 28.4 kgs. (SD +/- 2.9) with males having a higher overall HGS compared with females. Conclusions: This study presents previously unreported normative data on HGS in a Trinidad and Tobago population. This data will allow for a more objective evaluation of hand function in patients following injury and has implications for the assessment of disability in workmen's compensation.

Asymptomatic 'normal' subjects may have a respiratory health burden as assessed by the St Georges Respiratory Questionnaire (SGRQ)

Objectives: The Burden of Obstructive Lung Disease study in Trinidad and Tobago identified subjects with obstruction and no symptoms in approximately 5% of the general population over 40 years old. We reviewed data from a previously published study involving asymptomatic subjects to determine respiratory health burden and relation to lung function. Results: Subject characteristics were: 16 (64%) males, Mean (SD) age 64.8 (6.78) years, forced expiratory volume (FEV1) 2.25 (0.77)L, forced vital capacity (FVC) 2.91 (1.02) L, FEV1/FVC 78.1 (8.31)%. Parameters assessed were FEV1 (1.21 to 3.69 L); FVC (1.32 to 4.88 L); FEV1/FVC (65.2 - 94.7%); SGRQ Total Score (0 to 20.8). Three subjects (12%) had a FEV1/FVC ratio of less than 70%. The correlations (rho, p) of total SGRQ scores were FEV1 (-0.62, 0.001), FEV1% (-0.52, 0.008); FVC (-0.69, < 0.001). Conclusion: Asymptomatic normal elderly subjects had significant respiratory health burden as measured by the SGRQ and this was worse in those with a lower FEV1%. This may apply to elderly persons in the general population.

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.

Factors associated with quality of life impairment among asthma patients attending specialty clinics in Trinidad

Objectives: To examine factors associated with asthma related quality of life impairment (AQLI) among patient attending asthma clinics in Trinidad. Design and Methodology: A consecutive sample of 428 patients, ≥18 years, attending asthma clinics in Trinidad were recruited. Data were collected using intervieweradministered questionnaires which captured demography, comorbidities, triggers, hospital admissions and emergency department (ED) visits. AQLI was evaluated using the Juniper Mini AQL questionnaire to capture both the physical and emotional impact of the disease. The data were analysed using Chi-square test and multivariable logistic regression (SPSS Version 25). Results: Majority of patients were female (81%), ≥40 years (80.4%), of Indo-Caribbean descent (61.9%), and overweight (71.7%). The most commonly reported health conditions were gastrooesophageal reflux (53.0%), hypertension (47.2%), allergic rhinitis (45.1%), anxiety (42.8%), sleep apnoea (35.0%), and depression (32.5%). Environmental allergens (73.8%) were the most commonly reported trigger factor. The prevalence of moderate to severe AQLI was 60% and significantly associated variables were: age group (p=.0003), ethnicity (p<.0001), trigger factors (p=.013), sleep apnoea (OR=3.07, p=.001), gastrooesophageal reflux (OR=2, p=.014), depression (OR=3.59, p=.001) and anxiety (OR=2.52, p=.003), frequent (two or more) exacerbations (OR=4.07, p<.001) and having ever visited the ED (OR=4.78, p<.001) in the last 12 months. Independent predictors of AQLI were age, ethnicity, sleep apnoea and ED visits (Nagelkerke's pseudo R2=41%). Conclusion: Asthmatics demonstrate a high prevalence of moderate to severe quality of life impairment associated with demography and co-morbidities. Understanding these factors may improve doctor patient interactions, treatment and management.

Does the Chronic Disease Assistance Program promote equity or increases the socioeconomic divide?

Objectives: The objective of the study was to assess the extent to which the Chronic Disease Assistance Programme (CDAP)was able to meet the needs of different risk groups within the Trinidad and Tobago population. The study sought to answer the research question how does the healthcare strategy of risk group segmentation (RGS) interact with the country context to create legitimacy for CDAP. It was hypothesised that the implementation of a RGS strategy improves CDAP's legitimacy to allocate and manage resources. Design and Methodology: A sample of 161 pharmacists were surveyed via face to face interviews and telephone calls using a convenient sampling method. The instrument determined the extent to which the six dimensions of RGS were utilized in CDAP and three performance construct were assessed. Two pharmacists from each pharmacy were interviewed to reduce common method bias. Descriptive measures such as mean, standard deviation and Pearson bivariate correlations for the purpose of simple summaries of the dominant views and relationships were done and hypothesis testing was conducted using three-stage hierarchical regression analysis. Results: RSG was seen as an empowering tool for the patients and was needed, but not addressed. It was found to be desirable but not implemented. Its non implementation reduced the socio-political legitimacy of the program. Conclusions: CDAP in its current form does not address the risk faced by various groups in Trinidad and Tobago. This has led to the socio-political legitimacy of the program being reduced. It may be inferred its ability to create true health equality is compromised.

Belize Vector and Ecology Center monthly activity report March 2018

The Belize Vector and Ecology Center has embarked on vector surveillance initiatives that will allow us to determine changes in distribution and density of vectors and obtain information about population changes. In turn, this will allows us to monitor and evaluate adequate control methods. In this report, we have outlined the various activities that we have been conducting for the month of March.The Household Container Mapping is being conducted by teams consisting of BVEC employees and Vector Control representatives. So far, we have mapped approximately 20.61% of the total structures in Orange Walk Town. Mapping data was updated for the month of March based on the amount of structures we did. Ovitrap Surveillance is being done in which 120 oviposition cups are set out to 60 pre-consented homes in Orange Walk Town. The hatch rate has been determined to be about 40% to 60%, and there is interesting variation in the number of eggs collected per zone which may also be related to the position of ovicups and climatic conditions.The BG Sentinel Surveillance is being conducted in order to collect live adult Aedes mosquitoes in the field. There are 12 BG Sentinels in the town at 12 pre-consented homes. The traps so far have collected a number of Aedes mosquitoes as well as some from the Culex species and other types of flies.The adult Aedes mosquitoes collected in the traps are then sorted, identified and stored for testing using the Dengue Antigen Kit. Tests conducted so far have turned up negative and testing will continue while working on a pooling strategy depending on the number of adult females collected in the field. Larval Resistance Testing is another key component to the surveillance which will be done in conjunction with the ovitrap surveillance initiative. Currently eggs are being pooled and hatched so that there is enough larvae to meet the standard testing methods. BVEC also does Presentations and Training sessions in which we collaborate with schools and other groups to foster community engagement.

Belize Vector and Ecology Center monthly activity report February 2018

The Belize Vector and Ecology Center has embarked on vector surveillance initiatives that will allow us to determine changes in distribution and density of vectors and obtain information about population changes. In turn, this will allows us to monitor and evaluate adequate control methods. In this report, we have outlined the various activities that we have been conducting for the month of February.The Household Container Mapping is being conducted by teams consisting of BVEC employees and Vector Control representatives. So far we have mapped approximately 19.19% of the total structures in Orange Walk Town. Mapping data was updated for the month of February based on the amount of structures we did. Ovitrap Surveillance is being done in which 120 oviposition cups are set out to 60 pre-consented homes in Orange Walk Town. The hatch rate has been determined to be about 40% to 60% and there is interesting variation in the number of eggs collected per zone which may also be related to the position of ovicups and climatic conditions. The BG Sentinel Surveillance is being conducted in order to collect live adult Aedes mosquitoes in the field. There are 12 BG Sentinels in the town at 12 pre-consented homes. The traps so far have collected a number of Aedes mosquitoes as well as some from the Culex species and other types of flies. The adult Aedes mosquitoes collected in the traps are then sorted, identified and stored for testing using the Dengue Antigen Kit. Tests conducted so far have turned up negative which is a good sign and will continue testing while working on a pooling strategy depending on the number of adult females collected in the field. Larval Resistance Testing is another key component to the surveillance which will be done in conjunction with the ovitrap surveillance initiative. Currently eggs are being pooled and hatched so that there is enough larvae to meet the standard testing methods. BVEC also does Presentations and Training sessions in which we collaborate with schools and other groups to foster community engagement.