Reducing re-admissions at St. Ann’s psychiatric hospital

OBJECTIVE: This study addressed the psychoeducational approach to understand mental illness, illness self-management and social skills. It evaluated the effects of a structured-mannualized psychoeducation programme that taught inpatients about their illness and how to maintain remission after discharge and avoid re-admissions. DESIGN AND METHODS: A total of 505 inpatients admitted with mental disorders were randomly assigned to either an experimental group or control group. The psychoeducation programme consisted of six teaching modules distributed in 219 sessions of 45-minute-sessions in each of 5 wards, on a continuous, five-day-a-week schedule. The effects were measured reviewing the records of admissions and re-admissions after discharge. RESULTS: Results indicated that inpatients of the experimental group significantly improved their knowledge and performance of the skills taught in sessions, compared with the control group who did not participate in the educational group sessions. Re-admissions of participants of the experimental group were significantly less than the control group (2.1 percent versus 16.6 percent). CONCLUSIONS: Not only can patients learn relatively complex material during a typical inpatient stay despite the acuteness of their illness, but they can also meaningfully improve the continuity of their own care by participating in brief and highly structured teaching programmes in inpatient and outpatient settings.

Investigating the impact of the local health care system in controlling blood glucose levels and preventing complications in patients with type 2 diabetes

OBJECTIVES: To determine if the local health-care system controls blood glucose levels and prevents complications in Trinidadian type 2 diabetic subjects. This study also focused on assessing the structures that are established to monitor blood glucose levels of type 2 diabetics in the public health facilities. DESIGN AND METHODS: This study was a cross-sectional retrospective study of 388 adult type 2 diabetic participants. Participants were taken from all four Regional Health Authorities (RHAs) in Trinidad. RESULTS: The mean and SD of fasting blood glucose of participants, over the 3 year monitoring period, was 197ñ61.67 and a standard error of ñ3.13. The blood glucose levels of the participants did not change significantly (p = 0.848). Results showed that the higher the fasting blood sugar values, the more complications a patient presented. Fasting blood sugar values were the standard for monitoring blood glucose levels, however HbA1c and other measures mandated under protocol were absent. CONCLUSIONS: Across all Regional Health Authorities in Trinidad, fasting blood sugar values were found to be out of control and remained high. It was noted that the higher a patient’s fasting blood sugar values, the more complications they presented.

Adherence to chronic disease management among diabetic and hypertensive patients in Trinidad

OBJECTIVES: Adherence to treatment strategies is critical for disease control and long-term clinical outcomes in patients with chronic diseases, such as diabetes and hypertension. Noncompliance is strongly correlated with lack of disease control and progression to life-threatening outcomes, including end-organ damage such as kidney failure. This study sought to determine the extent of adherence to disease management strategies, including drug compliance and lifestyle modification, among diabetic and hypertensive patients in Trinidad. DESIGN AND METHODS: A cross-sectional survey was conducted using an interviewer-administered pilot-tested de novo questionnaire during the period June to August 2013 at 22 randomly selected primary health centers throughout Trinidad. Data was analyzed using χ 2 and binary logistic regression. RESULTS: Four hundred and thirty-nine patients (439) were recruited; 179 were hypertensive only, 89 were diabetic only, and 171 had both conditions. Mean age and BMI were 61.2 + 10.7 years and 29.2 + 5.99 kg/m2 respectively. One hundred and six out of 350 hypertensive patients (or 30.1%) were controlled, whilst 108 out of 260 diabetic patients (or 41.5%) were controlled. Age (p = 0.015) and body mass index (BMI) (p = 0.028) were the only significant predictors for blood pressure control. Factors such as forgetfulness, adverse drug reactions, and symptoms negatively impacted adherence to drug therapy. CONCLUSIONS: Most hypertensive and diabetic patients attending primary healthcare facilities in Trinidad were not well controlled, which has serious implications for their long-term clinical outcomes. An approach is urgently needed to ensure higher rates of disease control to prevent progression to irreversible end-organ damage.

The chronic disease passport: an assessment of its effectiveness in improving hypertension control in Jamaicans

OBJECTIVE: To assess whether the Chronic Disease Passport (CDP) was effective in improving blood pressure control in patients in Montego Bay, Jamaica. DESIGN AND METHODS: A retrospective cohort study was conducted on a convenient sample of 264 patients aged 18-74 years with hypertension (HPT) who attended the Type 5 Health Centre in Montego Bay between May and July 2014. Blood pressure control was assessed at baseline and one year post exposure, using data from medical records. Knowledge, attitude and behaviour towards HPT and the CDP were gathered through an interviewer-administered questionnaire. In-depth semi-structured interviews were conducted with 6 persons who had received the CDP. RESULTS: Seventy-seven percent of respondents (n=204) were exposed to the CDP. At baseline HPT control was significantly better in the exposed group (20.7%), versus the non-exposed group (5.0%) (p<0.01). At the one year follow-up endpoint, there was no significant association between exposure to the CDP and HPT control with the relative risk of having a controlled SBP being significantly lower in the exposed group (RR = 0.44, 95% CI: 0.24, 0.81). Control of HPT among the exposed group also worsened by 17.3% (p<0.001), but remained unchanged for the non-exposed group. Participants cited medication supply as an issue of concern. CONCLUSION: Exposure to the CDP was not associated with better control of HPT. More research is needed to explore other impacting factors, including issues surrounding medication supply.

The management of acute stroke on Montserrat

OBJECTIVE: To assess the management of acute stroke on Montserrat over a sixteen (16) year period in order to highlight areas in which the quality of the service provided can be improved.DESIGN AND METHODS: Forty five patients were studied from a sample frame of 117. Mean age 70 (range 38-100) of whom 29 (64%) were male. A data collection sheet was designed. Information was collected on areas of patient management. Logrank and Cox regression methods were used to test association between survival after stroke and other independent factors. RESULTS: Only 7% of patients (3) had a CT scan. All 3 had the scan within 24 hours. 49% of patients received Aspirin without a CT Diagnosis. Having Glasgow Coma Scale (GCS) <13 (p <0.001), papilledema or neck stiffness (p = 0.003), receiving oxygen for having an oxygen saturation <95% (p = 0.041) and having a swallow assessment (p<0.001) were negatively associated with survival. The estimated median survival time was 1.1 years. CONCLUSION: Access to CT scanning was a problem for patients with acute stroke on Montserrat. Providing CT scanning locally would allow for long term cost reductions and is likely to reduce morbidity and mortality from stroke. This, in combination with Stoke-unit quality ward care, may improve the median survival time.

An assessment of the renal patient’s level of nutritional knowledge at the Hemodialysis Unit at the Cornwall Regional Hospital (CRH)

OBJECTIVE: Little is known about hemodialysis patients’ nutrition knowledge level concerning the management of their disease. The aim of the research was to determine the level of nutrition knowledge related to renal disease, nutritional status and usual dietary patterns of hemodialysis patient at Cornwall Regional Hospital (CRH). DESIGN AND METHODS: A twenty six (26) item structured questionnaire consisting of closed ended questions were used to record anthropometry, biochemical markers, usual dietary patterns. The sample size was 106 patients and data were collected quantitatively. Data were analysed using Microsoft Excel. RESULTS: One half (49%) of respondents had a misconception of high potassium foods, while 38.5 % had a lack of knowledge of high or low sodium food sources. The usual dietary intake revealed 46% ate foods from animals 2 times daily; 36% once daily and 16% 3 times daily. Only 34% of the participants were knowledgeable about the correct amount of Foods from Animals (FFA) that should be consumed daily according to their weight. Albumin level below 35g/L was found in 34% of the sample; while 12% of the sample population had a Body Mass Index below 18.5 kg/m2 (underweight); 70% had a high phosphorus level and 17% had a high potassium level. CONCLUSION: Nutrition knowledge level deficit was observed which affected the patients’ nutritional status. Multidisciplinary approaches including educational interventions are needed to improve patient care outcome.

An epidemiological overview of geohelminths and schistosomiasis in the Caribbean

The purpose of this publication is to provide a historical review of articles published on schistosomiasis and geohelminth infections in the Caribbean region. This is not an extensive overview of the entire region but rather one, which focuses on those nations and territories that have recent publications available. Efforts will be made in future revisions to examine countries and territories omitted from this review paper. The disease burden created by geohelminths as well as global prevalences will be discussed in this publication. In addition, various control and treatment methods will be explored. A summary of the data will be provided at the end of the publication (AU)

Management of the dry eye

Dry eye is a common presenting symptom. It may be either the causative factor of disease or an aggravating condition. This paper deals with the causes of the dry eye and its management, both medical and surgical.(AU)

The ocular surface

The ocular surface comprises the bulbar and palpebral conjunctival epithelium, the corneal epithelium, the corneal epithelium, the tear film and the eyelid margins. The recent recognition by anterior segment practitioners that these structures function as a unit has stimulated new approaches to the management of diseases of the ocular surfaces. An overview of the anatomy, physiology and pathology of the ocular surface is presented.(AU)

Vector control for public health in the Caribbean

Despite the successful elimination of malaria from the Caribbean islands (except Hispaniola) by 1958-61, vector- borne diseases (VBDs) continue to challenge the health and wellbeing of Caribbean people. In addition during the last few years, we have witnessed the emergence or re-emergence of certain VBDs, which have a lasting impact on our health and also on our economies given the tourism-dependent nature of the Caribbean. Virtually all Caribbean countries have been affected by one or more of these emergent diseases in the past year, be it dengue/dengue haemorrhagic fever (DHF), malaria, Chagas' disease, cutaneous leishmaniasis, lymphatic filariasis, Venezuelan and Eastern equine encephalitis (VEE & EEE), the threat of yellow fever, or infection by other viruses (such as Mayaro) which may go undiagnosed. Dengue and malaria are of particular concern (AU)

An assessment of some aspects of management by teritary prevention of diabetes by doctors at the primary care level

Diabetes Mellitus is among the top five leading causes of morbidity and mortality in Jamaica. This islandwide cross-sectional study examined the knowledge, attitudes and practice of primary care physicians concerning assessment of glycemic control and monitoring for long-term complications in diabetes. A total of 152 physicians completed a structured questionnaire. Exit interviews with 15 patients were also conducted to gain further insights in the physicians' management of diabetes. Data was analysed using Epi-Info version 6.04. The results showed that only 41 percent of respondents were familiar with PAHO guidelines for management of diabetes. Only 44 percent had correct knowledge about the concept of tertiary prevention of diabetes. The majority of physicians correctly identified the long-term complications of diabetes mellitus. A greater percentage of those who graduated in the 1980's and 1990's had correct knowledge of 4 or more of 6 tertiary prevention screening strategies identified, when compared with graduates of previous decades. Most physicians had positive attitudes towards use and usefulness of practice guidelines, educating their patients and the clinical management as recommended by regional and international organizations. Female physicians had higher attitude scores than their male counterparts. In general, only a small majority of physicians were influenced by cost of laboratory investigation when deciding to order them. The self-reported practice of physicians regarding monitoring for long-term complications by using certain screening strategies, revealed that they did NOT demonstrate a high degree of compliance with recommended practice guidelines. For example, dilated eye examinations, foot examinations for neurological deficits; glycosylated haemoglobin and microalbuminuria/24-hr. urinary albumin excretion rates were being monitored less frequently than recommended. The main exceptions were blood pressure and blood glucose monitoring for short-term glycemic control, where over 90 percent of physicians reported monitioring these frequently and on most patients. In conclusion, the result underscore the importance of continuing medical education and suggest that more proactive efforts should be instituted to ensure acceptable and optimal levels of control of diabetic patients (AU)

The Onchocerciasis elimination program for the Americas: a history of partnership

The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination all morbidity from onchocerciasis from the region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal. This partnership is embodied in the Onchocerciasis Elimination Program for the Americas (OEPA), which is supported by the River Blindness Foundation (RBF) and now by the Carter Center, OEPA was conceived as a means of maintaining a regional initiative to eliminate what is otherwise a low priority disease. Since its inception in 1993, the OEPA has provided more than US$ 2 million in financial, managerial, and technical assistance to stimulate and/or support programs in Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela, so as to take full advantage of the Merck donation, Now halfways into a five-year, US$ 4 million grant provided through the Inter-American Development Bank, the OEPA's capacity to support the regional initiative is assured through 1999 (AU)

Leading Pan American Health: quadrennial report of the director, 1994-1997

The report seeks to describe the impact of our work over the past four years and to determine to what extent we have contributed to the progress in health that the countries of the Americas have made. The overeaching problem for health in the Americas continues to be inequity. It is this concern for equity that links all of our activities to the goal of Health for All, which holds equity as its essential value system. This goal has been interpreted by us as a call for social justice and a removal of those barriers that have risen to block the sun from the large numbers of humanity who most need it... (Director) The region of the Americas has scored major achievements in the area of health, as the result of the countries' collective will to tackle, together, their health challenges. This publication recounts recent progress the countries and the Organization have made in the areas of health and human development, disease prevention and control, health systems and service development, health promotion and protection, and environmental protection and development (back cover)

La eliminacion de la lepra de las mericas: situacion actual y perspectivas / Eliminating leprosy from the Americas: current situation and future perspectives

Leprosy, a disease that used to be shrouded in darkness and fear, can now be cured thanks to a multidrug treatment schedule with rifampicin, clofazimine, and dapsone which has been in use since 1981. In 1991 the World Health Assembly, encouraged by the efficacy of this treatment regimen, established the goal of eliminating the disease as a public health problem globally and nationally by the year 2000. This goal, which calls for reducing disease prevalence to less than one case per 10 000 inhabitants, should not be confused with the goal of eradicating the disease, which implies a complete interruption of its transmission. Eliminating leprosy is an attainable goal which will depend on the forceful and massive use of the multidrug treatment regimen. This paper describes and discusses the various initiatives that have been launched in Latin America for the purpose of achieving this goal and the results obtained so far. It also explores the factors that impact on the feasibility of eradicating the disease (AU) (AU)

Update: international task force for disease eradication

In 1998, a decade after the successful eradication of smallpox, the International Task Force for Disease Eradication (ITFDE) was formed to systematically evaluate the potential for global eradicability of candidate diseases, identify specific barriers to their eradication that might be sumountable, and promote eradication efforts. This group includes representatives from the World Health Organization, United Nations International Children's Emergency Fund, United Nations Development Project, the World Bank and the Rockefeller Foundation. In its first two meetings in April and October 1989, the ITFDE determined that two of eight diseases examined were eradicable and three others were candidates for elimination of transmission or clinical sympthoms. In its third and fourth meetings in August 1990 and June 1991, the ITFDE evaluated the potential eradicability of seven other diseases. This report summarizes the results of the third and fourth meetings (AU)

Measles occurrence in the Caribbean prior to the measles elimination campaign

The measles elimination campaign began in May 1991 with a measles immunization month in the Carec-member countries (some countries began in mid April). During the month it is intended to immunize all children aged 1-14 years old to interrupt any transmission. Measles is one of several diseases in the Americas targeted for elimination or eradication and has recently been considered by an International Task Force for Disease Eradication. It is timely therefore to review measles occurrence in the Caribbean before the commencement of the campaign and to predict likely future patterns of measles (AU)