Perceived barriers to seeking medical care among middle-aged and older men and women in the British Virgin Islands

OBJECTIVE: This paper seeks to identify the perceived barriers to seeking medical care among middle-aged and older people in the British Virgin Islands. DESIGN AND METHODS: The data for this study were taken from 244 middle-aged and older men (44.3%) and women (55.7%) who were recruited and interviewed for a study on the situation of ageing in the BVIs. Exploratory factor analysis (EFA) using principal component analysis (PCA) with varimax rotation was used to identify the underlying factor structure in perceived barriers to care. RESULTS: A 3-factor model was extracted (service acceptability; geographic accessibility and service affordability/availability) accounting for approximately 65% of the variance in responses. CONCLUSION: On the demand-side, there was need for a study accessing unmet needs for medical services. On the supply-side, there was a need to investigate the barriers faced by the government in providing needed services and supplies.

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.

HIV/AIDS surveillance in the British Virgin Islands (BVI): a critical assessment

OBJECTIVE: To conduct an assessment of HIV/AIDS surveillance data in the British Virgin Islands. DESIGN AND METHODS: Existing HIV/AIDS surveillance data were examined and a literature review on HIV/AIDS in the British Virgin Islands was conducted. RESULTS: Since 1985, there have been 117 cases reported to the Ministry of Health & Social Development. However, there is a paucity of knowledge about the socio-cultural, demographic, ideological and behavioural factors driving the epidemic in this dependent micro-state. CONCLUSION: HIV/AIDS surveillance was not consistent with best international and regional practices.

Attitude toward older people taking the HIV-test among a sample of middle-aged and older people in the British Virgin Islands

OBJECTIVE: This study focuses on middle-aged and older people’s attitude toward older people taking the HIV-test by examining the effect of sociodemographic and HIV-related factors on their agreement with the statement “There is no reason for older people to take the HIV-test because younger ones are more likely to be infected than older ones”. DESIGN AND METHODS: Descriptive, bivariate and multivariate statistics were used to analyse the data. Binary logistic regression analysis was used to examine the effect of sociodemographic and HIV/AIDS related factors on attitude toward older people taking the HIV-test. RESULTS: 64.4% of the participants were born in the Virgin Islands; the average age is 65.3 years; 49.7% had at least a secondary level education; 62.5% were married or in a cohabiting relationship; 63.8% lived in male-headed households. 54.8% strongly disagreed with the notion that older people do not have to be tested because younger ones are more at risk for infection. Bivariate examination showed a significant association between attitude toward older people taking the HIV-test and place of birth; age; education; age of head of the household; religious participation, type of relationship; employment status and number of children; as well as HIV/AIDS-related factors. In binary logistic regression analysis, the two most important influences in attitude toward older people taking the HIV-test were education and agreement with the idea that HV can be prevented by always using condoms with a person who is not your spouse. CONCLUSION: There may be a need to scale up HIV services for the older adult.

History of medicine in the Caribbean region: a medical association perspective (1938-2008)

Two thousand and eight (2008) remains a landmark in the history of the Medical Association. We celebrate seventy years (70) of publication of the Caribbean Medical Journal (CMJ), first published in 1938 by the government printery under the editorship of the indefatigable Dr. James Waterman. It was indeed an arduous task in sifting through the pages of 70 years of publications, but this was sustained and motivated by the genius, enthusiasm, eloquence and debates of the medical men of the West Indies who in the early years outshined their colonial counterparts in every possible way. Past independence we have witnessed a fall out in medical interests as we became more insular in our practice. More recently, there has been a resurgence of interests in medical matters as we battle a vindictive government in a failing health system promulgating draconian legislations in health care to cover their inefficiencies. A review of our history indicates that doctors have survived the wrath of the imposing British Empire and no government present or future will have the ability to superimpose their will on learned men of multimodal distinctions. A limitation of this review is that many volumes of the journals are lost or packed away in boxes in some obscure, darkened, termite ridden room at Xavier Street. This is indeed a loss of the most valuable treasure of the Association. This may have resulted in the omission of important historical occurrences in the Association's history. It is hoped that this review will serve as a landmark for the Association to further build upon, as we continue to document our trials and tribulations, hopes and aspirations in an ever changing environment.

Attitudes towards dog ownership on St. Kitts, West Indies.

A structured face-to- face interview was held with 64 arbitrarily selected local people attending a vegetable market in the capital of St. Kitts on a Saturday morning. Most (67%) respondents liked dogs and many (57%) owned one (41%) or two (29%) for protection (67%) and as a pet (65%). The main reason people disliked dogs were because they feared them (56%) and because they created a mess (50%). Generally people had purebred (40%) male (56%) dogs which were always outside (50%), in fenced yards (43%), on chains (34%) or running free (22%). All owners fed their dogs, mainly on table scraps (44%) or commercial dog food (39%). Only 16% of animals were neutered and many had puppies (range 3-11) and there was a high mortality rate (>2 puppies in 73% of litters). Only 24% of the dogs were over 4 years. Relatively few owners (55%) took their dogs to the veterinarian, principally for vaccination and checkups (85%) but when their animal was ill (24%). Most people (54%) used insecticides for external parasites on their dogs and some (44%) dewormed their animals. Many people (24%) had been bitten by a dog but 64% did not believe people could acquire diseases from dogs. Only 6% of respondents thought there were too many dogs on the island.

Attitudes towards dog ownership on St. Kitts, West Indies.

A structured face-to- face interview was held with 64 arbitrarily selected local people attending a vegetable market in the capital of St. Kitts on a Saturday morning. Most (67%) respondents liked dogs and many (57%) owned one (41%) or two (29%) for protection (67%) and as a pet (65%). The main reason people disliked dogs were because they feared them (56%) and because they created a mess (50%). Generally people had purebred (40%) male (56%) dogs which were always outside (50%), in fenced yards (43%), on chains (34%) or running free (22%). All owners fed their dogs, mainly on table scraps (44%) or commercial dog food (39%). Only 16% of animals were neutered and many had puppies (range 3-11) and there was a high mortality rate (>2 puppies in 73% of litters). Only 24% of the dogs were over 4 years. Relatively few owners (55%) took their dogs to the veterinarian, principally for vaccination and checkups (85%) but when their animal was ill (24%). Most people (54%) used insecticides for external parasites on their dogs and some (44%) dewormed their animals. Many people (24%) had been bitten by a dog but 64% did not believe people could acquire diseases from dogs. Only 6% of respondents thought there were too many dogs on the island.

Evaluation of methods for rapid detection of resistance to isoniazid and rifampin in Mycobacterium tuberculosis isolates collected in the Caribbean.

The rapid identification of drug-resistant strains of Mycobacterium tuberculosis is crucial for the timely initiation of appropriate antituberculosis therapy. The performance of the Genotype MTBDRplus assay was compared with that of the Bactec 460 TB system, a "gold standard" culture-based method. The Genotype MTBDRplus assay was quicker and more cost-effective for the detection of rifampin resistance, but it was not as good for the detection of isoniazid-resistant strains in our setting.

Oral and dental conditions presenting to medical practitioners in Trinidad and Tobago.

OBJECTIVES: To describe the type and frequency of oral and dental conditions presenting to medical practitioners in Trinidad and Tobago, type of management, and interest in continuing education in oral diseases. METHOD: Cross sectional survey of registered medical practitioners in Trinidad. 20-item self-reported questionnaire. RESULTS: 103 medical practitioners participated in the study (response rate 69 per cent). Mean age 33 years. Mean years since qualifying was 8 years and 72 per cent worked mainly in hospital service or private practice (19 per cent); 67 per cent had seen patients with a dental problems, with 69% of those at least as frequently as once a month. Most frequently seen problems were dental abscess (72.5 per cent) and toothache (59.4 per cent). In the case of dental abscess and oral mucosal infection 31.9 per cent and 63.8 per cent respectively, diagnosed and treated before referring. 84 per cent expressed interest in receiving continuing education in oral diseases. CONCLUSIONS: In the context of access to oral care in Trinidad and Tobago, medical practitioners appear to be important providers and may benefit from further training in the diagnosis and management of oral diseases.

Anaemia and kidney dysfunction in Caribbean type 2 diabetic patients.

BACKGROUND: Anaemia has been shown in previous studies to be a risk factor for cardiovascular disease in diabetic patients with chronic kidney disorder. This study was aimed to assess the prevalence of anaemia and kidney dysfunction in Caribbean type 2 diabetic patients that have been previously shown to have a high prevalence of the metabolic syndrome. METHODS: 155 type 2 diabetic patients and 51 non-diabetic subjects of African origin were studied. Anthropometric parameters were measured and fasting blood samples were collected for glucose, creatinine, glycated hemoglobin and complete blood count. Anaemia was defined as haemoglobin < 12 g/dl (F) or < 13 g/dl (M). Kidney function was assessed using glomerular filtration rate (GFR) as estimated by the four-variable Modification of Diet in Renal Disease (MDRD) study equation. Subjects were considered to have chronic kidney disease when the estimated GFR was < 60 ml/min per 1.73 m2. Comparisons for within- and between-gender, between diabetic and non-diabetic subjects were performed using Student's t-test while chi-square test was employed for categorical variables. RESULTS: The diabetic patients were older than the non-diabetic subjects. While male non-diabetic subjects had significantly higher red blood cell count (RBC), haemoglobin and hematocrit concentrations than non-diabetic female subjects (p < 0.001), the RBC and hematocrit concentrations were similar in male and female diabetic patients. Furthermore, irrespective of gender, diabetic patients had significantly higher prevalence rate of anemia than non-diabetic subjects (p < 0.05). Anaemic diabetes patients had significantly lower GFR (67.1 +/- 3.0 vs. 87.9 +/- 5.4 ml/min per 1.73 m2, p < 0.001) than non-anaemic patients. CONCLUSION: A high prevalence of anaemia was identified in this group of type 2 diabetic patients previously shown to have a high prevalence of the metabolic syndrome.

Neutropenia in 6 ethnic groups from the Caribbean and the U.S.

BACKGROUND: Low white blood cell counts (WBC) or absolute neutrophil counts (ANC) may delay or prevent the completion of appropriate chemotherapy, especially among women receiving adjuvant therapy for breast and colon cancer, and affect cancer survival. Because race/ethnicity is also associated with survival, the authors compared WBC and ANC in healthy American-born women of African descent and European descent, and women from Barbados/Trinidad-Tobago, the Dominican Republic, Haiti, and Jamaica. METHODS: Blood samples from 261 healthy women ages 20 to 70 years were tested for WBC with differential, cytokine and growth factor levels, and ancestry informative and neutrophil elastase polymorphisms. The authors analyzed the association between neutropenia and serum WBC growth factor levels, cytokine levels, and neutrophil elastase c199a polymorphism. RESULTS: The median WBC and ANC differed among the 6 groups (P < .01 for WBC and P < .0001 for ANC). Dominicans were found to have higher median WBC and ANC than all other groups (P < .03). Neutropenia (ANC < 1500 cu/mm) was observed among 2.7% to 12.5% of the groups of predominantly African descent; no other groups were found to have neutropenia (P < .05). Granulocyte-colony-stimulating factor was found to be lower in white women, but tumor necrosis factor-alpha and C-reactive protein were not found to be correlated with ethnicity. Women of African origin were more likely to have polymorphisms of African ancestry (P < .001) and c199a alleles (P < .0001), which were also associated with low ANC levels. CONCLUSIONS: In the current study, the authors observed a strong association between neutropenia and African descent among asymptomatic women from the U.S. and the Caribbean. Among women of African descent who develop a malignancy, this association may contribute to racial disparities in treatment and outcomes.

A strategy for genetic improvement of Barbados Blackbelly sheep in the Caribbean in the context of small flock sizes.

This paper points out that several breeds of prolific sheep in the world possess a major gene for prolificacy. However, the existence of such a major gene in the prolific breeds of hair sheep in the Caribbean remains to be researched. This paper assumes that this gene (F) exists in the Barbados Blackbelly sheep and goes on to outline a strategy to exploit it for the benefit of the small farmer as well as the large private producer. The strategy aims at developing one type of sheep for the small farmer by selective reduction in the frequency of the F gene thereby reducing the frequency of multiple births. The development of another type of highly prolific sheep is suggested for use by the large producer through selective increase in the frequency of the F gene. Large producer is expected to employ high levels of feeding and management including artificial rearing of lambs so as to minimise mortality of multiplets. The paper further discusses within breed selection for genetic improvement in general fitness of hair sheep. In this connection, the development of an open nucleus flock is suggested involving cooperation among participant smallholders.

Investigation of skin diseases in non- domestic animals.

The skin is a readily accessible organ and dermatological disorders are commonly seen in a wide variety of species. In order to investigate skin diseases of non-domestic animals, the veterinarian must have some understanding of their varied biology and natural history. Sample- taking may require anaesthesia and techniques must be appropriate to the type of lesion and the species in question. Processing of samples is usually carried out in a similar way to those from domestic animals. Interpretation of the findings need caution. The establishment of databases will help in the progression of comparative dermatology in the West Indies and elsewhere.

A strategy for genetic improvement of Barbados Blackbelly sheep in the Caribbean in the context of small flock sizes.

This paper points out that several breeds of prolific sheep in the world possess a major gene for prolificacy. However, the existence of such a major gene in the prolific breeds of hair sheep in the Caribbean remains to be researched. This paper assumes that this gene (F) exists in the Barbados Blackbelly sheep and goes on to outline a strategy to exploit it for the benefit of the small farmer as well as the large private producer. The strategy aims at developing one type of sheep for the small farmer by selective reduction in the frequency of the F gene thereby reducing the frequency of multiple births. The development of another type of highly prolific sheep is suggested for use by the large producer through selective increase in the frequency of the F gene. Large producer is expected to employ high levels of feeding and management including artificial rearing of lambs so as to minimise mortality of multiplets. The paper further discusses within breed selection for genetic improvement in general fitness of hair sheep. In this connection, the development of an open nucleus flock is suggested involving cooperation among participant smallholders.

Investigation of skin diseases in non- domestic animals.

The skin is a readily accessible organ and dermatological disorders are commonly seen in a wide variety of species. In order to investigate skin diseases of non-domestic animals, the veterinarian must have some understanding of their varied biology and natural history. Sample- taking may require anaesthesia and techniques must be appropriate to the type of lesion and the species in question. Processing of samples is usually carried out in a similar way to those from domestic animals. Interpretation of the findings need caution. The establishment of databases will help in the progression of comparative dermatology in the West Indies and elsewhere.

Glycaemic responses after ingestion of 3 local carbohydrate-based foods in West Indian patients with type-2 diabetes mellitus

Summary - BACKGROUND & AIM: Previous studies suggest that inadequate glycaemic control in diabetic patients might be related to the type of carbohydrates the patients consume regularly. Thus, we aimed to assess glucose and insulin responses after diabetic and non-diabetic subjects ingested 3 commonly consumed carbohydrate-based foods. METHODS: Thirty-eight type-2 diabetic and 27 non-diabetic subjects were studied in 3 different occasions of 7 days apart. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed bread, roti or rice within 10 min. Subsequently 7 ml of venous blood samples were collected at 60, 90, 120 and 150 min for determination of glucose and insulin responses. RESULTS: Although the diabetic patients were older than the healthy subjects (P < 0.05), both subjects had similar weight, body mass index and waist and hip circumferences (P > 0.05). The mean fasting and post meal plasma glucose concentrations for the 3 test foods were higher in diabetic patients than the corresponding values for the healthy subjects (all; P < 0.001). Generally, roti elicited the highest total incremental glucose responses in the diabetic patients irrespective of ethnic group (P < 0.05). CONCLUSION: There were variations in glucose and insulin responses to the 3 test foods. However, roti elicited the highest postprandial hyperglycaemia and should therefore be discouraged in regular dietary plan of diabetic patients.

Epidemiology of early childhood caries (ECC) in Anguilla, British West Indies, 2000 [abstract]

The study was conducted to estimate the prevalence and severity of Early Childhood Caries (ECC) in infants aged 2 to 5 years. The teeth of 523 children aged between 24 and 71 months from all 18 primary and pre-schools (census) were assessed by one calibrated examiner (AA) following parental consent. Tooth-surfaced based data were collected for each child using the NIDCR diagnostic and scoring criteria and the WHO codes for teeth with non-cavitated lesions. A 15-item questionnaire on flouride exposure as well as the use of feeding bottles and pacifiers was completed by parents and gaurdians. The overall prevalence of ECC and Severe-ECC was 46 percent and 35 percent, respectively. It decreased with age and did not differ significantly with gender. Early childhood Caries prevalence was determined with and without non-cavitated lesions and by sextant. The mean dmft of infants without non-cavitated lesions was 1.68 (SD= 3.22) of which 1.08 teeth (SD= 2.01) were molars. The mean dmft with non-cavitated lesions was 2.57 (SD= 3.86) of which 60 percent represented untreated decayed teeth. The ECC prevalence was highest in the molar (32.5 percent) followed by upper (17.4 percent) and lower anterior (4.4 percent) sextants, respectively. A slightly higher proportion of children with ECC (55 percent) did not have non-cavitated lesions while 51 percent had non-cavitated lesions based on the affected molars. The highest site-specific prevalance (53.43 percent) occurred in the molar teeth of children aged 60 to 71 months. Children aged 48 to 59 months and the highest site-specific caries prevalence in the upper and lower anterior sextants (34.84 percent and 10.83 percent) for those with and without non-cavitated lesions. This is the first ever population-based study using the NIDCR criteria developed in 1998. The prevalence and severity of ECC in Anguilla is high. A high proportion of children had maxillary anteriors and molars as the only affected teeth. Oral health promotion programmes should be extended to preschools. Flouride exposure in 2 to 5-year-old children should be augmented in order to reduce the high prevalence of ECC. (AU)

Medical Library - then and now

The paper traces the Medical Library's growth, development and its relationship with the Faculty of Medical Sciences (FMS), researchers and other users pursuing their teaching, research and patient care. The information is analyzed, synthesized and organized from the annual reports of the Vice Chancellor, Principal, Libraries, various Departments in the Faculty of Medical Sciences, Office of Planning, Institutional Research, and the Web Pages of the University of the West Indies, Mona, Jamaica (AU)

An evaluation of medical school education in musculoskeletal medicine at the University of the West Indies, Barbados

At the University of the West Indies, Cave Hill campus, the Freedman and Bernstein musculoskeletal competency examination was administered to 22 medical students during the last month of their final year. Eighty two percent (82 percent) of the students failed to score above the passing score of 73.1 percent. Nineteen of the twenty-two students had taken an orthopaedic elective or rotation during their final two years. The questions were also categorized as anatomy, Trauma and general Orthopaedics. All students failed to score above the passing score in Anatomy. Sixty-four per cent (64 per cent) failed in general Orthopaedics. This study suggests that inadequacies in medical school preparation do exist at this campus of the University of the West Indies and the findings mirror those at medical schools in the United States of America. (AU)