Development of the Emergency Medical Services in Barbados - abstract

Pre-hospital and emergency department care have improved immensely over the past 15 years in Barbados. In 1976, a medical unit was formed by the Barbados Regiment to assist primarily as responders in a mass casualty/disaster situation. Within 3 weeks of its existence, it was tested during the Air Cubana crash. Today, if requested, the unit is capable of responding urgently to disasters in neighbouring OECS islands. Previous responses include hurricane David in Dominica - 1979, Hugo in Montserrat - 1988, and the volcanic erruption in St, Vincent - 1980. In 1984, the Emergency Ambulance Service was completely reorganized. Among the staff are 45 EMTs trained to the basic level in pre-hospital care. The service deals with about 1,100 cases monthly, 60 per cent of which originate in the St. Michael area. Response times range from about 10 minutes in St. Michael to about 30 minutes in the most distant Parish of St. Lucy. Improved service offered by the Accident and Emergency Department of the Queen Elizabeth has been the most recent development. In July 1990, a modern 22-bed unit was opened, coinciding with the introduction of a post-graduate course in Accident and Emergency Medicine at the Cave Hill Campus of the UWI. The department is equipped with an X-ray unit and modern commuication devices. A computer tracking system will asist in monitoring patient flow and provide, on a regular basis, statistics necessary for Quality Assurance exercises (AU)

Use of the log book in a quality assurance exercise in an hospital emergency department in Barbados - abstract

Patients with bronchial asthma account for about 13 per cent of all patients attending the Accident and Emergency Department, Queen Elizabeth Hospital, Barbados. They are given high priority and departmental policy requires that they should be admitted within 4-6 hours if improvement is unsatisfactory. During the period January to March, 1989, all patients with a final diagnosis of asthmatic attack had recorded in a log book personal identification data, date and time of arrival, and times when seen, discharged or transferred, and the results were analysed by computer. The aim of this retrospective study was to monitor how closely departmental policy was adhered to with respect to these patients. A total of 1,792 visits were made by 1,079 asthmatic patients, 57 per cent males and 43 per cent females. Sixty per cent of patients were less than 15 years of age and 11 per cent did not have their ages recorded. In only 13 per cent of cases was the time the patient was seen recorded and the average waiting time for these patients was 36 minutes. Thirty-two percent of cases were discharged or admitted within 3 hours; 31 per cent between 3 and 6 hours; 15 per cent between 6 and 9 hours; and 22 per cent waited for more than 9 hours for final disposal. It is concluded that the objectives set out for care of asthmatics were mostly not met, greater effort is required to ensure that patients' ages and time when seen by attending staff are recorded and that the log book is a useful tool to monitor a quality assurance programme (AU)

Pre-hospital care in Barbados - abstract

Pre-hospital care in Barbados was completely re-organised in 1984 with international assistance. Training included a three-month course for 45 emergency medical technicians (EMTs) to the basic EMT level. The aim of this study was to review the operations of the Emergency Ambulance Service (EAS), now in its seventh year of operation. During the three-month period July - September 1991, the following information was taken from each call: time and allocation, time of arrival at the scene and the chief complaint. The EAS responded monthly to 1,142 calls from the various parishes. Distribution of calls closely followed that of the population. The majority of calls (66.4 percent) were genuine emergencies, with only 1.2 percent being crank calls. Emergency included asthmatics (12.5 percent), accidents (9.3 percent), violent injuries (6.1 percent), comatose patients (7.3 percent), seizures (5.1 percent) and 14 (0.4 percent) patients with cardiac arrest. The average response time for all calls was 20 minutes. This ranged from 13 minutes in the central parish of St. Michael, to 39 minutes in the northern district of St. Lucy, and 30 minutes in the eastern area of St. Philip. These findings highlight the need for satellite stations in the northern and eastern sides of the island. The wide range of emergencies identified also provides a useful base for reviewing the curriculum and introducing new protocols for pre-hospital care (AU)

An analysis of the functioning of the Hospital Emergency Department in Barbados - abstract

Hospital emergency departments throughout the Caribbean are confronted with problems which may be best solved by examining data relating to their individual functions. On arrival at the Emergency Department of the Queen Elizabeth Hospital, patients are divided into one of the following categories: Grade I - life threatening, requiring immediate care; Grade II - seriously ill, needing to be seen as soon as possible; Grade III - others except Grade IV; and, Grade IV - review patients. The patient's clinical grade, age sex, address, the necessity of a consultation with an in-house registrar, the use of X-ray, laboratory or social services, and the final diagnosis were gathered during the 3-month period July to September, 1987. A total of 13, 769 patients were seen; 51.9 percent came from the parish of St. Michael, where the hospital is sited. This is a larger percentage than of the national population (43.1 percent). Each of the other parishes had a smaller percentage when similar comparisons were made. About 80 percent of cases presented as Grade I (7.7 percent) or II (72.5 percent); 7.5 percent were Grade IV, no grade was recorded in 5.6 percent of cases; 6.3 percent of patients were referred to the department by physicians. A variety of conditions were seen. Bronchial asthma alone represented 13.1 percent of all illnesses. An in-house registrar was consulted in 16 percent of the cases, another 16 percent required X-rays and 13 percent needed laboratory investigations; 33 patients were referred to the social service department, and 17.3 percent were admitted, 32.4 percent of whom were males and 67.6 percent females. This study has shown that the majority of patients visiting the department are genuinely ill. Asthmatics pose a special problem. Proximity to the department may furthermore influence the decision to seek help there. The dependency on other in-house staff and departments emphasizes the need for a good communication network (AU)

After-hour calls in family practice in Barbados

The demand by the people in the community at the Caribbean for medical care after hours is largely unknown, and most of this is provided by casualty departments of general hospitals and by family physicians. This six-month study in a section of Barbadian Family Practice has revealed a visiting rate of 53/1000 patients/year with an increase in the workload at weekends and a sharp decrease during the late night. The illness managed was relevant to the patient's well-being, and resulted in 16.8 percent referrals to the hospital. The workload can be adequately covered by family practitioners in group practice and by the co-operation of neighbouring "solo" practitioners (AU)

`Plenty children got the wheeze these days': lay knowledge, beliefs and stated behaviours related to asthma in Barbados - abstract

Knowledge, beliefs, and practices related to the management of asthma were assessed among 143 parents of asthmatic children in Barbados. Nearly 54 per cent of the informants verbalized that the child could die during an asthmatic attack, and informants ranked asthma as the fourth most serious disease compared to 13 other illnesses. Preferred modes of treatment were compared for a sample of parents without asthmatic children (N = 34); parents of asthmatics were more likely to believe that asthma could be managed in the physician's office and at home with prescribed medications than parents without asthmatic children (t = 1.78; df = 67.0, equal variance; p = 0.08). Wealthy parents of asthmatics were more likely to use a private physician than poorer parents of asthmatics (F = 8.50; df = 3; p < 0.0001). Fewer than 10 per cent of the sample used traditional home remedies for asthma. Less than 76 per cent of the children with prescribed inhalers possessed them at all times. Minimal reliance on traditional home remedies, preference for treatment by professional physicians, and preference for a private physician when socio-economics allow, suggest that asthma is viewed as a contemporary illness best treated by professional health care deliverers. Findings from the disease ranking suggest that multi-media campaigns are effective in increasing community awareness and concern for managing specific illness (e.g. leptospirosis, cholera). Possession of a prescribed inhaler at all times by less than three-quarters of the sample population, in the face of a steady increase in asthma-related morbidity, emphasises the need for more aggressive patient and community education for the management of asthma (AU)

"After-hour calls" in Barbadian family practice - abstract

The aim of this 6-month prospective study was to provide a profile on "After-hour calls". An "after-hour call" was defined as any call made during the period between 16:31 hrs. and 08:00hrs on week-days, and during the entire day on week-end and Public Holidays. Information taken included age of patient, day and time of call, the physician's response, duration, diagnosis and referral, if any. A total of 224 calls were received, with an incidence of 85 calls/1000 patients/year at the G.P Unit. The majority (33 percent) belonged to the 15 - 44 years age group. One hundred and thirty-six (60 percent) calls were made on week-ends of which 72.8 percent required an after-hour visit. Of the remainig calls received during week-days, only 36.4 percent needed a visit. During week-ends most calls occured between 08.01 and 16:30 hrs, unlike week-days, when the majority of calls were made between 16:31 and 23:00hrs. Very few calls were received between the sleeping hours of 23:01 and 06:00 hrs (11 percent week-day; 4 percent week-end). The five most common diagnoses made were acute AUTI (14.3 percent) lacerations (7.6 percent), acute intestinal infections (7.1 percent), asthma (4.9 percent) nausea/vomiting (4.5 percent). Of all after-hour visits, 73.3 percent were managed within 30 minutes, with only 3.8 percent lasting over one hour. Only 10.3 percent of all patients were referred to the hospital. This study has shown that there is a demand for an after-hour service in Family Medicine in the Caribbean. It has also identified certain features of these calls including the morbidity content. This data is useful in justifying and planning such a service, for example introducing short practice hours during week-ends, and the need to be well set up to deal with minor trauma in the after-hour period (AU)

The economics of asthma treatment in Barbados: a review of the drug cost

OBJECTIVE: To determine the annual cost of treating asthma in Barbados over a ten-year period. METHODS: The Barbados Drug Service is the central procurement agent for drugs on the Barbados National Formulary. Information on the costs of the various asthma medications, and the number of prescriptions written for these drugs, were obtained from the Barbados Drug Service records. The prescriptions written for asthma medications between 1986 and 1997 were analysed and the annual cost of the various categories of asthma calculated. RESULTS: The annual drug cost of treating asthma in Barbados increased from $293,111 in 1987 to $1,268,348 in 1996, a four-fold increase over ten years. There was a rapid rise in the cost of anti-inflammatory drugs during the study period, from $48,628 or 16.5 percent of total drug cost in 1986 to $503,092 or 39.6 percent of total drug cost in 1997. The cost of inhaled beta-2-agonists over the same period increased from $131,154 or 44.7 percent of the total drug cost in 1997. However, the cost of oral beta-2-agonists decreased over the ten-year period, reflecting the increased use of the inhaled form of the medication. With the increasing number of acute asthmatics seen in the Accident and Emergency Department at the Queen Elizabeth Hospital, the cost of nebulization solutions increased eight-fold, from $8,361 in 1986 to $69,172 in 1997. CONCLUSIONS: Asthma has been an increasing burden on the medical resources of Barbados over the past decade. The drug costs of treating asthma have increased significantly over the 10-year period 1986 to 1997 and accounted for 5.8 percent of the annual budget of the Barbados Drug Service in 1997.(Au)

The microbiological analysis of Sahara dust and its association with asthma in Barbados

Sahara or African dust originates on the African continent and its transported across the North Atlantic to Barbados and other Caribbean Islands by the North East Trade Winds. The amount of dust deposited in Barbados has shown a steady increase over the years and so has the incidence of respiratory disease and asthma. This study investigated the monthly variation of the concentration of Sahara dust in the atmosphere the presence of micro-organisms in it. It also examined whether there was any association between these and asthmatic attendances at the Asthma Bay of the Accident and Emergency Department of the Queen Elizabeth Hospital (QEH). During the one year study period, dust deposition was lowest during February and March 1996 and heaviest during April to July 1996 with the peak in April. The peak in April did not coincide with any noticeable increase in asthma attendances during that month. A total of 289 dust samples were collected and cultured. The cultures grew mainly bacillus species and fungi, including several species of Aspergillus. 43 samples (14.8 percent) grew bacilli and fungi and 5 (1.7 percent) grew organisms other than bacilli and fungi, such as micrococci. More colonies of fungi were isolated during the early part of the year and more bacilli were found during the latter part of the year when there was the peak attendance at the QEH Asthma Bay. It is concluded that the content of Sahara dust may be of greater importance to the development of asthma than the concentration of the dust.(AU)

Smoking cessation - the role of the dental team implications for the Caribbean [abstract]

There is increasing awareness that cigarette smoking not only threatens systemic health but also compromises oral health. For example, smoking can result in staining of teeth, halitosis (bad breath), altered salivary flow, predisposition to chronic and acute periodontal disease and oral candidosis, delayed wound healing, failure of dental implants, oral mucosal lesions, oral precancer and cancer. Although data from the United Kingdom show a reduction in the prevalence of smoking since the 1960s, there is an upward trend of smoking among young adults, particularly teenage girls. There are no comparable data for the Caribbean but it is plausible to assume a similar trend may exist, suggesting the need for primary prevention strategies. The dental team often treats patients in a primary care setting and, apart from an important role in early detection of smoking-related oral conditions, may also be well placed to aid in preventive strategies through the implementation of chair-side smoking cessation programmes. These programmes are based on the 4-As strategy: Ask, Advise, Assist, Arrange, and have been recently developed specifically for the dental team. There should also be close collaboration between the dental team and other primary health care professionals to improve health promotion strategies aimed at reducing the prevalence of smoking. Dental health professionals in the Caribbean must be made aware of smoking cessation programmes for their patients and research into their effectiveness, in a Caribbean population, is required. (AU)

The cost of treating acute asthma at the Queen Elizabeth Hospital, Barbados

OBJECTIVES: To determine the cost of treating acute asthma at the Queen Elizabeth Hospital (QEH) and to identify ways of reducing these costs. DESIGN AND METHODS: Case notes of all patients presenting to the Asthma Bay of the QEH during a two-week period in March 1999, were reviewed. Data, extracted included gender, arrival time, number of nebulizations, dosage of oral prednisolone and inhalers prescribed. A questionnaire was completed by a sample of these patients regarding use of inhalers, follow-up care and time lost from work and school. RESULTS: A total of 303 cases were reviewed and 75 patients completed questionnaires. The majority of asthmatics received oral prednisolone (74 percent) and/or three nebulizations (42 percent). The cost of treating each patient was determined to be approximately US $22.00, including medical and nursing salary costs. The annual cost to the QEH was estimated to be US $214,000 including the costs of admitting patients. Indirect costs included the time lost from work or school in 86 percent of patients and in 56 percent of parents taking time off to look after their sick children. The questionnaire survey revealed that 63 percent of patients with "preventer" medications were not using them and only 38 percent received follow-up care. Seventy-four percent of these patients had repeated asthmatic attacks during the preceding 3 months with 11 percent having more than six attacks. CONCLUSIONS: A significant amount of money is spent on asthma care at the QEH. However, improper understanding and use of medication coupled with lack of continuity of care lead to poor control and frequent attacks. These findings justify the need for an asthma clinic for these patients.(Au)

Obesity in food handlers

The objective of this study was to determine whether obesity is an occupational hazard in food handlers. 309 persons who presented to two Barbadian group General Practices for food handling certification were studied. The results demonstrate that a majority (55.3 percent) of food handlers had grade 1 obesity or overweight (BMI > 25 kg/sq m). The prevalence in men 67/104 (64.4 percent) was as great as in women 104/175 (59.4 percent). Overweight was high in the relatively young age groups, 30-39 (60.9 percent), 40-49 (75 percent) and 50-59 (69.7 percent). Among the food handlers it was seen more frequently in those with sedentary lifestyles (76/116; 65.5 percent) and in those who had worked more than 10 years in the food handling industry (91/140; 65 percent). No association was found between overweight and use of alcohol or tobacco, but among the food handlers studied were many who demonstrated inaccurate perception of their body image, with 74 of the 190 (39 percent) who thought their weight to be normal, actually classified as overweight. Obesity or overweight is most likely and occupational hazard in food handlers. They work in an industry that is growing rapidly in Barbados as tourism services expand and as the local population adopts the lifestyle of eating out more often. Food handlers are required by law to be certified annually as fit to work. It is important that doctors recognize the threat of obesity and use the opportunity of this annual examination to screen and intervene for this hazard.(AU)

Prevalence of asthma and wheezing illnesses in Barbadian school children: the Barbados national asthma and allergy study

In Barbados, there has been a fourfold increase in the number of asthmatic visits to the Accident and Emergency department of the Queen Elizabeth Hospital between 1980 and 1994. However, there are no data on the prevalence of asthma in Barbados. This study was done to determine the prevalence of childhood asthma using the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaires. Questionnaires were distributed to parents of 3,894 pupils (age group 6-7 years) in all 91 primary schools in Barbados, and 3,500 questionnaires were completed by pupils (age 13-14 years) in all 46 secondary schools. The data analysis was carried out by Systems Caribbean Limited utilising SPSS. In the 6-7 years olds, the prevalence of self-reported asthma was 16.8 percent with doctor diagnosed asthma of 16.5 percent wheeze had occurred at some time in 30.7 percent and in the previous 12 months in 18.3 percent. In the 13-14 year-olds, self reported asthma was 17 percent, doctor diagnosed asthma 15.9 percent, wheeze occurring at some time was 30.1 percent and wheeze in the previous 12 months was 17.7 percent. Of the 6-7 year-olds, of those who wheezed in the previous 12 months, 78 percent had 1-3 attacks, 18.5 percent had 4-12 attacks and 3.5 percent had more than 12 attacks. In the 13-14 year-olds, 76.5 percent had 1-3 attacks in the previous 12 months, 18.2 percent had 4-12 attacks, 5.3 percent had more than 12 attacks. There was no difference in frequency of smokers in the household between those who wheezed in the previous 12 months and those who never wheezed. Overall, wheezing was more frequent in boys than in girls. The prevalence of asthma in Barbados is high for a tropical island with relatively little atmospheric pollution. The increase has coincided with increasing affluence and trend toward urbanisation and modernisation of the domestic environment.(AU)

Management of teeth requiring root canal treatment and views on continuing professional education in endodontics by dental practitioners in Trinidad and Tobago [abstract]

Many of the new materials and techniques used in endodontics (root canal treatment) require considerable practice to master and many require continuing education courses to allow formal instruction. Nothing is known regarding techniques employed and views on continuing professional education (CPE) in endodotics by dentists in Trinidad and Tobago. With the shift toward evidence-based dentistry and rising patient expectation of quality oral health care, a survey was conducted to describe these issues. A self-administered postal questionnaire was sent to all registered dentists in Trinidad and Tobago. Seventy dentists responded after two mailings. Most respondents worked primarily in private practice (85.5 percent). Years since qualification ranged from 2 to 45 years and 54.3 percent were qualified for more than 10 years. Most frequent treatment of an acute dental abcess involved opening, preparing the canal(s), dressing and prescribing antibiotics (40 percent). Forty-one respondents (58.6 percent) ocassionally completed root canal treatment in a single visit. Isolation of the tooth for molar root treatment always caused difficulty for thirty-five respondents (50 percent) and rubber dam isolation was used routinely by only nine respondents (12.9 percent). Most respondents either filed (20 percent) or reamed (18 .6 percent) for canal preparation usually using K files. Thirty-three respondents (47 percent) used sodium hypochlorite to irrigate the tooth and thirty-one (44.3 percent) used cold lateral condensation of gutta percha to obturate. Thirty-four respondents (48.6 percent) subscribed to professional journals and sixty-seven (95.7 percent) had attended some form of Continuing Professional Education. Sixty-seven (95.7 percent) of respondents would attend CPE in endodontics if available in Trinidad and Tobago, with most (72.9 percent) preferring a lecture/seminar format addressing problem-solving and new techniques. Respondents to this survey showed use of a wide range of techniques and materials but still expressed considerable interest in developing their skills in endodontics through formal CPE. (AU)

A profile of road traffic accidents in Barbados - abstract

In many Caribbean countries, the impact of road traffic accidents cannot be adequately assessed, because of the lack of the required information. This study analyses all accidents reported to the Royal Barbados Police Force during 1992. The information recorded included the day, date and time of the accident, the number and ages of those injured or dying, the age of the driver if at fault and the type of vehicle involved in the accident. A total of 4,644 accidents were reported, of which 0.5 percent were fatal, giving a fatality rate of 11 deaths per 100,000 population and 5 per 10,000 vehicles; whilst 30.5 percent of the accidents resulted in injuries. The majority of deaths occurred in the 15-39-year-age group and in the afternoon between noon and 6:00 p.m. Motorcycles, taxis and minibuses accounted for a proportionately greater percentage of accidents and fatalities than their number in the vehicle population. In the cases where driver error was thought to be the main cause of the accident, drivers under the age of 20 (who represent only 4 percent of all licensed drivers), accounted for 18 percent of the fatal accidents. These data can be used to plan preventive programmes and identify areas in need of further research (AU)

Weather as a predictor of the frequency of asthmatic attacks in Barbados - abstract

Daily data on asthmatic patients seen in the Accident and Emergency Department of the Queen Elizabeth Hospital for the years 1983 and 1989-1991, and corresponding daily data for the meterological variables of wind speed, relative humidity (0800 hr), vapour pressure and minimum and maximum temperatures were analysed to determine the statistical relationships that might exist. The results show positive correlation between asthma attacks and relative humidity and vapour pressure, and negative correlations for the wind speed. The data also show the existence of a seasonal variation in asthmatic attacks. It is suggested that this variation is due to the transport of aero-allergens into Barbados through the trade winds (AU)

Prevalence of atopic eczema in Barbadian schoolchildren: preliminary findings from the Barbados National Asthma and Allergy Study - abstract

In 1995 and 1996 the Barbados National Asthma and Allergy Study, a questionnaire survey of all schoolchildren 6 - 7 years and aged 13 - 14 year, was conducted. The aim of the survey was to describe the prevalence and severity of asthma, rhinitis and eczema in children living in Barbados, to make meaningful comparisions with other countries (e.g Jamaica) and to obtain baseline measures for asessment of future trends in the prevalence and severity of this disease. The questionnaire sought to discover the presence of an itchy rash, persisting for more than six months, and in the typical anatomical distribution of atopic eczema. In addition, doctor diagnosed eczema was sought. Three thousand, eight hundred and ninety-four (3894) questionnaires were returned in the 6 - 7 years old age group (97 percent) and 3552 in the 13 - 14 year- old age group (88 percent). The prevalence of atopic eczema in the 6 - 7 year-old age group was 10.6 percent and in the 13 - 14 year-old age group was 10.0 percent. Diagnosis by a doctor reduced the prevalence to 6.2 percent in the primary school group and 3.6 percent in the secondary school group. This study has demonstrated for the first time in a Caribbean country the prevalence of this common childhood complaint. (AU)

Work site heart health promotion and practice: a pilot project of the Heart Foundation of Barbados

The workplace has long been recognised as an important setting in which to promote the practice of healthy living since most individuals spend more than one-third of their day in such situations which might be considered a "captive environment". The Heart Foundation of Barbados, aware of the significantly high prevalence of lifestyles related illnesses and the opportunities and potential for effecting positive change in the workplace, embarked on a worksite heart pilot project aimed at determining the feasibility of establishing such a programme in Barbados and determining its impact and effect on health practices of workers in the workplace and elsewhere. The study was conducted among the staff of a local professional services firm. It consisted of risk factor screening of staff members, teaching of and certification in Cardiopulmonary Resuscitation (CPR), and facilitating regular related activities. Two years after the initiation of the project an anonymous knowledge, attitudes and practice questionnaire was administered to participants. 116 (88 percent) members of staff was taught and certified in CPR, and a further 3 persons were trained and certified as CPR instructors. Anthropometric and blood pressure measurements were performed on the 116 participants. Over the two years of the project the company developed a significantly enhanced health consciousness and profile, as evidenced by the formation of a health club, active participation in national healthy lifestyles activities and the conducting of a regular related seminars, lectures and associated and related activities. Finally, among those responding to the knowledge attitudes and practices survey 60 percent of 60 participants returning completed questionnaires reported a positive change in their lifestyle as a direct result of the programme. Among 63 percent there was an enhanced personal attitude to the company. 36 participants (60 percent), reported that they would provide assistance in an emergency situation, of which 64 percent expressed confidence in doing so, and 58 percent attributed their confidence to their involvement in the programme. Preliminary results suggest that the introduction and implementation of a work site heart health promotion and practice programme is acceptable to workers in Barbados, is feasible, and results in improvement of worker health attitudes and practices.(AU)

IgE antibodies to four mite allergens in atopics and non-atopics living in Barbados - abstract

The prevalence of specific IgE (RAST) to Blomia tropicalis (Bt) was evaluated for 64 individuals from four families residing in Barbados, with self-reported atopic asthma (AA) and/or self-reported allergic rhinitis (AR) or individuals with no reported atopic disease (NA). The presence of specific IgE antibodies that reacted with components of Chortoglyphus arcuatus (Ca), Dermatophagoides pteronyssinus (Dp) and Euroglyphus maynei (Em) was also evaluated; components from Ca, Dp and Em were separated by SDS-PAGE, transferred to nitrocellulose membranes and screened with sera from the 22 AAs, 17 ARs and 25 NAs. Total serum IgE was significantly higher in individuals with self-reported AA (logIgE = 977 ng/ml) than in individuals reporting no AA (logIgE = 323 ng/ml). There was a significant difference between the number of AAs who were Bt-positive according to RAST (68 percent) and the number of individuals without AA(p=0.002). IgE antibodies to Ch and Em were significantly higher in individuals with AA than in those without AA (p = 0.001 and p = 0.005, respectively), and there was a weak correlation between IgE antibodies to Dp and self-reported AA (p=0.05). A significant pattern of conversion of response to certain bands within families was observed (AU)

Is preventive medicine a component of the primary care service for diabetes in Barbados? - abstract

Diabetes mellitus is a chronic illness that requires continued medical care and education to prevent acute complications and to reduce the risk of long-term complications. Diabetics should receive care and treatment from a health team with interest and expertise in the management of diabetes. This study aimed to evaluate the quality of care offered to diabetics in three different clinic settings in Barbados. The case notes of 690 diabetic patients attending private practitioner offices, polyclinic general clinics and polyclinic diabetic clinics, were identified during a six-week index period, and a questionnaire was completed for each patient. Although the average number of visits annually was similar in each of the three settings (5-6 visits/year), private practitioners had the lowest percentage of patients (30.7 percent) with poor glycaemic control (defined here as a fasting blood sugar >/=8 mmol/l, or any other blood sugar >/=10 mmol/l. Overall, the glycaemic control was poor in 44.9 percent of patients. Screening for potential long-term complications such as cardiovascular complications, foot problems, eye problems and kidney problems was recorded as being done in a minority of patients, while the concomitant menace of poorly controlled hypertension, which is known to accelerate the progression of diabetic complications, was present in a significant number of patients. While recognising the limitations of the technique of case note review, these results indicate a need for clear concise guidelines for diabetic primary care, with emphasis on prevention and early detection (AU)