Overweight and obesity among Grenadian adolescents: rural and urban differences in social determinants

OBJECTIVE: To examine the prevalence of overweight and obesity (OW/OB) among Grenadian adolescents and to determine associations with social determinants on urban and rural adolescents. DESIGN AND METHODS: A national sample of Form1 students (n = 689) aged 11 to 14 years, from all 23 secondary schools in Grenada were assessed as part of the Grenada School Nutrition Study (GSNS). Body Mass Index (BMI) was assessed using standard measures and standardized BMI percentile. Urban (n = 13) and rural (n = 10) schools were determined by location. Exposure to fast food outlets and shops which sold sugar sweetened beverages, candy, or highly processed foods was measured within a .75 km buffer surrounding each school and major transportation hub, between school and home. RESULTS: Overall, Grenadian adolescents had low rates of overweight (17.6%) and obesity (7.6%) compared to Grenadian adults. Girls, however, had nearly twice the rate of overweight compared to boys (i.e., 22.7% versus 12.2%). There were significant differences between rural and urban students for access to cars (40.7% versus 53.3%), computer access (61.6% versus 73.5%), and snacking after school (83.6% versus 90.5%) respectively. The rural school environment also had a lower mean density of snack shops (1.53 versus 3.39 shops/square km) and mean fast food outlet density (0 versus 1.17 outlets/square km). CONCLUSIONS: Grenadian adolescents demonstrate low rates of OW/OB compared to both Grenadian adults and their US counterparts. The low rates of OW/OB suggest Grenadian adolescents have not yet been affected by social determinants of the obesity epidemic.

Factors that contribute to readmission of paediatric asthmatic patients to the Eric Williams Medical Sciences Complex [abstract]

Asthma is the commonest respiratory disease of the paediatric population and its prevalence is increasing in all parts of the world. Repeated readmission to hospital often leads to poorer school attendance, disruption of family life and increased cost to the state. Thus, global recommendations stress preventive strategies. Previous studies of readmissions of paediatric cases in developed countries have highlighted non-compliance with preventive medication and lack of parental and patient education as some of the factors that contribute to the re-admission. The purpose of this study was to determine the factors that contribute to the readmission of paediatric patients to hospitals in Trinidad. The method adopted was a descriptive survey using a questionnaire instrument. The study population consisted of 23 consecutive parents or guardians of children, aged 3-12 years, who had two or more admissions in the last year to the Emergency Room (ER) department at the Eric Williams Medical Sciences Complex for the treatment of acute bronchial asthma. The survey was conducted over a three-day period in May 2000. We found that 74 percent of the patients were less than 8 years of age with a male predominance (57 percent). Seventy-eight percent had at least four acute asthmatic attacks in the year prior to the survey and 74 percent had visited the ER at least three times during this period with 39 percent having to be warded for further management between attacks. This may have been due to a lack of education about the disease; 65 percent of parents/guardians had received no teaching about asthma. Seventy-seven of these children missed school at least once as a result of their illness in the two months prior to the survey. In a few instances, the patients' physical activities were being curtailed by parents who thought that this would prevent the child's asthma. The parents/guardians of paediatric asthma patients with frequent re-admissions to hospital have limited knowledge of their children's disorder, despite recurrent contact with healthcare professionals during their children's ER and ward admissions. Most of these children have not received adequate preventative care between attacks. Failure of the healthcare staff to follow-up these patients in clinic and educate parents and guardians about asthma may contribute to frequent hospital admissions and poor school attendance. (AU)

Morbidity pattern of emergency room patients in Jamaica

OBJECTIVE: This study documents the morbidity pattern of diseases in patients presenting to the Accident and Emergency (A&E) Unit at the University Hospital of the West Indies in Jamaica. DESIGN and METHODS: Data were retrieved from a log book kept by the nursing staff in the A&E Unit at the UHWI. This SPSS software package was used to select 100 random days in 1997. All cases treated in the A&E Unit on those days were included in the study. Data collected included demographic data, discharge diagnosis and disposal. Diagnosis were coded and classified using the International Classification of Diseases - 9th edition coding system. RESULTS: In 1997, 16,798 patients were treated in the A&E Unit during the 100 random days selected, 4611 of these were seen. Twelve cases were excluded, as the diagnoses were unknown. Some patient had more than one diagnosis and therefore, 4762 diagnoses were made in 4599 patients. The mean age was 34ñ 24 (SD) years. The male to female ratio was 1.8:1. Injuries and poisoning accounted for 31 per cent of cases. Respiratory diseases were the next most prevalent (16.2 percent). Cardiovascular and digestive diseases accounted for 5.8 and 10.5 per cent of cases, respectively. Infectious diseases accounted for only 1.75 per cent of cases; 71.7 per cent of patients were discharged home, 23.5 per cent admitted and 4.2 per cent transferred to another institution. The mortality rate was 0.6 per cent. CONCLUSIONS: The pattern of diseases seen in this study demonstrates epidemiologic transition where injuries, cardiovascular and other chronic diseases are evolving as the most prevalent conditions seen. This is now seen frequently in the Caribbean and other developing countries. (Au)

Controlling Hypertension among African-Caribbean patients

The older age groups of African-Caribbean people are at particular risk of hypertension and stroke, and comprise the original migrant group who came to the UK in the 1955's and 1960's as young adults. This raises questions of the significance of traditional cultural beliefs and practices for health behaviours and medication use. AIMS: to examine 1) the cultural beliefs and medication practices of African-Caribbean and "white" hypertensive patients treated by general practices in Lambeth and 2) GPs awareness of the beliefs of African-Caribbean patients. METHODS: Case note review and semi-structured interviews with 60 hypertensive patients treated by general practices in Lambeth, and with 22 GPs from the study practices. RESULTS: Most African-Caribbean patients were aware of the risk of high blood pressure, although often adopting a fatalistic attitude. They had high levels of uncontrolled blood pressure and reported low levels of adherence with the prescribed medication (16/30 regularly "left off" the medication or took a reduced dose). Major reasons were concerns about possible present or future side-effects, fears of becoming "addicted" or "dependent" on the drugs, worries about mixing tablets with alcohol, and questioning their needs for the drugs. Familiarity with traditional herbal remedies increased worries about power of prescribed drugs and formed an alternative resource for managing illness. "Cerasee"(Momordica charantia) obtained from the local market was often taken for blood pressure problems and perceived as "natural" and less harmful than prescribed drugs. GPs were not aware of African-Caribbean patients' beliefs and medication practices, with implications both for prescribing and patients's interpretation of the information provided for their own self management. Feedback of the study findings was helpful to GPs in reducing cultural barriers to communication and managing this patient group. CONCLUSIONS: Low levels of compliance with treatment is likely to contribute to uncontrolled blood pressures among African-Caribbean population, while health promotion strategies require to take account of cultural beliefs and practices prevalent among the older generation of African-Caribbean people. Further work is planned (with Kings) to examine the use of herbal remedies among larger population samples, the phytochemical properties of Momordica charantia obtained from different outlets and its possible hypotensive effects. (AU)

Adrenal cortical activity in the tropics

Evidence is presented from both the literature and personal observation supporting the thesis that adrenal cortical activity in the tropics is `abnormal' by existing standards. The current programme, designed to investigate the influence of the dominant variables (racial factors and environmental conditions), is outlined, with discussion of some preliminary trends (AU)