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BACKGROUND: Trinidad is an island that not only has a population at high vascular risk but also one that is in epidemiological transition with high dementia prevalence. The aim of the study was to investigate modifiable risk factors associated with dementia in middle-old (75-84 years) individuals. METHODS: As part of a large national community survey of dementia prevalence in Trinidad, 811 people aged 75-84 years were evaluated for dementia using the 10/66 short algorithm. Demographic data collected included information on age, gender, ethnicity, religion, education, occupation, living accommodation, smoking, alcohol consumption, self-reported medical conditions, impairments and ability to do instrumental activities of daily living (IADL). Data were analysed using multivariable logistic regression models. RESULTS: Of the 811 participants, nearly 55% were female. The mean age was 78.8 (SD = 2.8) years and dementia was present in 198 (24.4%). Having less than ten years of education, being an agricultural worker, skilled labourer or housewife and having more than four co-morbidities were significantly associated with dementia. The odds ratio for dementia for those having self-reported stroke was 4.93 (95% CI [2.64-9.23]) and for diabetes was 1.76 (95% CI [1.17-2.65]) adjusting for age, age2, gender, ethnicity, religion, education and occupation. Impairment in eyesight, hearing, climbing stairs, and walking were also more common in the group with dementia. Ability to perform IADLs was linked with dementia. Individuals with dementia were more likely to be unable to perform any of the eight IADLs. Those who did not exercise at all (OR 6.95, 95% CI [2.02-23.90]) and those who did low exercise (OR 1.83, 95% CI [1.07-3.13]) compared to those who did moderate to high exercise were also more likely to have dementia. CONCLUSION: In the middle-old population in Trinidad having diabetes and stroke, low IADL score, and no exercise were more common in people with dementia.
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BACKGROUND: This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients' demographics, comorbidities, and cardiovascular medications with depressive symptoms. METHODS: In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher's exact test, Chi-square test, and multivariate logistic regression. RESULTS: The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414-2.797), OR 1.847 (CI 1.251-2.728), OR 1.872 (CI 1.207-2.902) and OR 1.703 (CI 1.009-2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). CONCLUSIONS: Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03863262 . This trial was retrospectively registered on 20th February 2019.
Assuntos
Depressão , Questionário de Saúde do Paciente , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
OBJECTIVE: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS: The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION: The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.
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Escolaridade , Renda/estatística & dados numéricos , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Morbidade , Fatores Sexuais , Fumar/epidemiologia , Trinidad e TobagoRESUMO
OBJECTIVE: Culture plays a significant role in determining family responsibilities and possibly influences the caregiver burden associated with providing care for a relative with dementia. This study was carried out to determine the elements of caregiver burden in Trinidadians regarding which interventions will provide the most benefit. METHODS: Seventy-five caregivers of patients diagnosed with dementia participated in this investigation. Demographic data were recorded for each caregiver and patient. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), and the General Health Questionnaire (GHQ) was used as a measure of psychiatric morbidity. Statistical analyses were performed using Stata and SPSS software. Associations between individual ZBI items and GHQ-28 scores in caregivers were analyzed in logistic regression models; the above-median GHQ-28 scores were used a binary dependent variable, and individual ZBI item scores were entered as 5-point ordinal independent variables. RESULTS: The caregiver sample was composed of 61 females and 14 males. Caregiver burden was significantly associated with the participant being male; there was heterogeneity by ethnic group, and a higher burden on female caregivers was detected at borderline levels of significance. Upon examining the associations between different ZBI items and the above-median GHQ-28 scores in caregivers, the strongest associations were found with domains reflecting the caregiver's health having suffered, the caregiver not having sufficient time for him/herself, the caregiver's social life suffering, and the caregiver admitting to feeling stressed due to caregiving and meeting other responsibilities. CONCLUSIONS: In this sample, with a majority of female caregivers, the factors of the person with dementia being male and belonging to a minority ethnic group were associated with a greater degree of caregiver burden. The information obtained through the association of individual ZBI items and above-median GHQ-28 scores is a helpful guide for profiling Trinidadian caregiver burden.
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Cuidadores/psicologia , Efeitos Psicossociais da Doença , Demência , Transtornos Mentais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trinidad e TobagoRESUMO
OBJECTIVE: To investigate the dementia prevalence in a country with high levels of cardiovascular risk factors DESIGN AND METHODS: Older people in Trinidad are recognised to have particularly high levels of cardiovascular risk factors. We carried out a survey in a nationally representative sample of people aged ≥70 years using household enumeration. Dementia status was ascertained using standardised interviews and algorithms from the 10/66 schedule and age-specific prevalence were compared with identically defined output from the 10/66 surveys of 16 536 residents in eight other low-income and middle-income countries. RESULTS: Of 1832 participants (77.0% response rate), dementia was present in 442 (23.4%). Prevalences were 12.0% in persons aged 70-74 years, 23.5% at 75-79, 25.8% at 80-84, 41.3% at 85-89 and 54.0% in those aged ≥90 years. Prevalence ratios compared with averages from 10/66 surveys in these age groups were 2.2, 2.6, 1.6, 1.7 and 1.6, respectively, and were 2.7, 2.8, 1.7, 1.4 and 0.8, respectively, compared with previously published consensus estimates for the Latin American region. Dementia was significantly associated with reported stroke and diabetes in logistic regression models adjusted for sociodemographic status and other vascular risk factors (OR (95% CI) 4.40 (2.70 to 7.19) and 1.56 (1.20 to 2.03), respectively). Projected national numbers of people with dementia (18 206) were 70%-100% higher than those estimated using most recent regional consensus prevalences. CONCLUSION: In a nation with high levels of vascular risk, dementia prevalence is higher than expected, particularly at the lower end of the 70+ age range. International prevalence projections may need to take into account risk status as well as age structures.
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Envelhecimento/psicologia , Doenças Cardiovasculares/epidemiologia , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos Transversais , Demência/complicações , Países em Desenvolvimento , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimers and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.
Em 2003, os membros da equipe acadêmica da Faculdade de Ciências Médicas St Augustine, da Universidade de West Indies, Trinidad e Tobago, combinaram seus conhecimentos para promover avanços nas pesquisas sobre doença de Alzheimer e demência em Trinidad e Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis e Professora Amanda McRae começaram a desenvolver um projeto que tem produzido resultados significativos através da análise não só da epidemiologia da demência, mas também dos fatores de risco associados, sobrecarga do cuidador e, ultimamente, estabelecendo biomarcadores para a doença. Esta avaliação representa um relato de nossos resultados de uma década de pesquisa demência e como eles estão contribuindo para mitigar o tsunami de demência em Trinidad e Tobago.
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Humanos , Fatores Socioeconômicos , Biomarcadores , Carga de Trabalho , Cuidadores , DemênciaRESUMO
In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimer's and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.
Em 2003, os membros da equipe acadêmica da Faculdade de Ciências Médicas St Augustine, da Universidade de West Indies, Trinidad e Tobago, combinaram seus conhecimentos para promover avanços nas pesquisas sobre doença de Alzheimer e demência em Trinidad e Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis e Professora Amanda McRae começaram a desenvolver um projeto que tem produzido resultados significativos através da análise não só da epidemiologia da demência, mas também dos fatores de risco associados, sobrecarga do cuidador e, ultimamente, estabelecendo biomarcadores para a doença. Esta avaliação representa um relato de nossos resultados de uma década de pesquisa demência e como eles estão contribuindo para mitigar o tsunami de demência em Trinidad e Tobago.
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BACKGROUND: the scientific literature is deficient in studies looking at the achievement of primary care diabetes treatment targets as stipulated by best practice guidelines in the Caribbean. AIMS: assessment of treatment goals attained by patients according to the Caribbean Health Research Council (CHRC)/Pan-American Health Organization (PAHO) guidelines for diabetes management in primary care centres in North Trinidad. The primary interest of this study was the extent to which stated intermediate outcome measures were achieved. Secondarily, process measures and adherence to specific recommendations on pharmacotherapy were evaluated. METHODS: this was a cross-sectional study where 225 patients with diabetes from five primary care centres were interviewed in October and November 2007. Data collected included age, sex, ethnicity, religious background, educational level and duration, diabetes type and duration since diagnosis, the presence of hypertension, current blood pressure, level of physical activity and current medications. Last documented serum cholesterol and HbA1c within the past year were obtained from patient records. Anthropometric measurements recorded were weight, height and waist and hip circumferences. RESULTS: of patients with available values, 49.3% achieved the target total cholesterol of less than 200 mg/dL while 56.6% had an HbA1C level of less than 6.5%. Only 47.7% attained a blood pressure target of less than or equal to 130/80 mmHg. 25.2% had a Body Mass Index (BMI) of less than 25 kg/m(2). For waist circumference measurements, 40.8% of males and 2.1% of females were within recommended limits. Only 13.5% had 20 minutes or more of at least moderate exercise daily. No patient met all recommended target values for these six parameters. CONCLUSIONS: there is poor achievement of treatment goals as set by best practice diabetes management guidelines. Results from this study may serve to inform primary care strategy revisions aimed at more widespread achievement of control targets which would ultimately abate the burden of illness in this population.
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Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Fidelidade a Diretrizes , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Antropometria , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
To investigate whether sialic acid could discriminate between healthy age matched controls and patients with dementias of the Alzheimer's type (AD), and pure vascular dementia (VaD). 27 patients and 51 controls were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of total sialic acid, total homocysteine (tHcy), and C-reactive protein (CRP). Significant differences were found between the mean MMSE scores for patients with dementia compared with controls. Sialic acid levels were significantly higher in patients with AD compared with controls and homocysteine levels were higher in VaD. Sialic acid levels discriminated between patients with dementia of the Alzheimer's type and healthy controls only. The MMSE could discriminate between controls and patients with dementia but not between the subtypes and homocysteine was significant for patients with VaD.
Assuntos
Doença de Alzheimer/sangue , Doença de Alzheimer/diagnóstico , Proteína C-Reativa/análise , Demência/sangue , Demência/diagnóstico , Homocisteína/sangue , Ácido N-Acetilneuramínico/sangue , Idoso , Doença de Alzheimer/complicações , Biomarcadores/sangue , Demência/complicações , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Biomarkers that could possibly discriminate between healthy controls and patients with dementias of the Alzheimer's type (AD) and vascular dementia (VaD) were investigated. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition TR (DSM IV TR) was used to diagnose for dementia in Trinidad. Healthy seniors greater than 60 years old were controls. All participants were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of C-reactive protein (CRP), total homocysteine (tHcy) and microglial antibodies (MgAb). Plasma tHcy was determined on the Abbot AxSym, serum CRP concentrations were measured using the Tina-Quant sCRP (Latex) high sensitive immunoturbidimetric assay and serum MgAb were examined on frozen rat brain sections. The study was carried out on 29 patients that fulfilled the inclusion criteria and 46 controls. Of the patients 65.5% had AD and 34.5% had VaD. Significant differences were found between the mean MMSE scores of the different types of dementias and controls. MgAb presence as well as tHcy were able to distinguish between controls and dementia of the AD and VaD type, respectively. The MMSE is a good discriminative tool for dementias. Serum MgAbs are a possible biomarker for Alzheimer disease pathology and tHcy is elevated in patients with vascular dementia.
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Doença de Alzheimer/diagnóstico , Demência Vascular/diagnóstico , Idoso , Doença de Alzheimer/sangue , Doença de Alzheimer/psicologia , Animais , Anticorpos/análise , Anticorpos/sangue , Biomarcadores/análise , Biomarcadores/sangue , Análise Química do Sangue , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Demência Vascular/sangue , Demência Vascular/psicologia , Diagnóstico Diferencial , Feminino , Homocisteína/análise , Homocisteína/sangue , Humanos , Masculino , Microglia/imunologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Ratos , Trinidad e TobagoRESUMO
BACKGROUND: This study was conducted to determine factors that influence career choice among 1st-year medical students. DESIGN AND METHODS: A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. RESULTS: The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). CONCLUSION: The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice.