Risk factors for urinary tract calculi in Trinidad

OBJECTIVE: To identify risk factors for urinary tract stones in Trinidad and Tobago. METHODS: A consecutive series of patients presenting to institutions in Trinidad for the management of proven urinary tract calculi was interviewed by questionnaires designed to obtain data on age, gender, ethnicity, occupation, stone location, a family history of stone disease, a past history of certain medical diseases and a semiquantitative estimate of the magnesium intake in food, 'over the counter' drugs and drinking water. An equivalent number of patients attending the same institutions for follow-up and verified from hospital records as having a previous radiological diagnosis of urinary tract stones, as well as a group of asymptomatic members of the community working in the same area, underwent the same interview. Chi-square, anova and Kruskal-Wallis tests were used to examine differences between the groups. Multiple logistic regression analysis was used to determine persistence of the significance of these differences after controlling for confounding variables. RESULTS: Data sufficient for analysis were obtained for 122 previous and 102 prospective patients and 102 controls. The mean age of the patients was 32 years. The ratio of males to females was 0.9-1.8:1 for the affected groups, but significantly more males than females had calculi in the lower urinary tract (19% vs. 6%; P = 0.004). More patients (30%) than controls (7%) gave a positive family history of urinary tract stone disease (P < 0.001). Affected persons had a lower dietary magnesium intake (P = 0.003), which accounted for a significantly lower total magnesium intake (P = 0.02). Logistic regression analysis of the variables studied indicated that independent predictors of the disease were a positive family history (P = 0.001), total magnesium intake (P = 0.001) and age (P < 0.001). CONCLUSION: A low magnesium intake and a positive family history are highly predictive of urinary tract calculi in this population

Understanding and use of inhaler medication by asthmatics in specialty care in Trinidad: a study following development of Caribbean guidelines for asthma management and prevention

STUDY OBJECTIVES: Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies. SETTING: Chest Clinic, Ministry of Health, Trinidad. PARTICIPANTS: Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000. MEASUREMENTS AND RESULTS: A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%). CONCLUSIONS: Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.

Erectile dysfunction in Trinidadian general practice

DISCUSSION: Erectile dysfunction (ED) is common, and the observed rate was 53 per cent, in men over 40 years of age attending Trinidadian GP. There were statistically significant associations between the patient's age and ethnicity, and the presence of diabetes mellitus and ED. The presence of ED is also associated with the patient's overall diminished satisfaction with life. This has a direct impact on the approach to male patients in the consultation. Many males are hesitant to discuss, and many physicians ignore asking about ED. However as this study suggests doing so can impact on the patient's overall quality of life, especially as we now have safe and effective treatments for ED. It was interesting that we could determine an association between ED and the presence of diabetes mellitus but not between the number of years the patient had diabetes and ED. This suggests that we may be making the diagnosis of diabetes very late when neurological injury is already significant. One result stands out, that is the increased ED among the afro-Trinidadian population. This is not easy to explain since it is the indo-Trinidadian that historically bears the burden of diabetes and early heart disease, the result of vascular disease. One might expect to find an ethnic association favouring the indo-Trinidadian with respect to ED. It is not clear whether this is a true difference or the observation was because of ethnic differences in help-seeking behaviour. Further research, such as a community-based survey would help to clarify any true association between ethnicity and ED ...

Microbial quality of "doubles" sold in Trinidad

A cross-sectional study was conducted to determine the prevalence and characteristics of Escherichia coli, Staphylococcus aureus, Bacillus spp. and Salmonella spp. in "bara", "channa", condiments/spices and ready-to-eat "doubles" sold by vendors in the St. George and Caroni counties of Trinidad. Of 196 samples of each of "bara", "channa", condiments/spices and ready-to-eat "doubles" examined, E. coli was detected in 0 (0.0 per cent), 14 (7.1 per cent), 96 (49.0 per cent) and 67 (34.2 per cent), respectively; Staphylococci were isolated from 104 (53.1 per cent), 71 (36.2 per cent), 129 (65.8 per cent) and 123 (62.8 per cent) samples, respectively; and Bacillus spp. were recovered from 22 (11.2 per cent), 85 (43.4 per cent), 100 (51.0 per cent) and 88 (44.9 per cent) samples, respectively. Salmonella spp. were not isolated from any sample. Of the 177 isolates of E. coli recovered from all sources, 9 (5.1 per cent), 7 (4.0 per cent) and 47 (26.6 per cent) were mucoid, haemolytic and non-sorbitol fermenters (NSF), respectively, but none agglutinated with O157 antiserum. Of 427 staphylococcal isolates, 130 (30.4 per cent) were confirmed as S. aureus of which 20 (15.4 per cent) were haemolytic and 84 (64.6 per cent) pigmented, while 17 (20.7 per cent) of 82 strains of S. aureus tested produced enterotoxins. Ready-to-eat "doubles", a popular food in Trinidad, therefore pose a potential health risk to consumers due to the high level of contamination with bacteria.

Suicide in Trinidad and Tobago: associations with measures of social distress

Using national statistics for the period 1978-1992, associations were examined between suicide rates and measures of social distress in Trinidad and Tobago. The latter included unemployment, serious crimes, emigration rates and admissions to the country's psychiatric hospital. There was a 319% increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in 1992. Although there were fluctuations in the rate for females, it remained below 8/100,000. Over the 15-year period examined, there was a 51% increase in serious crime while male and female unemployment increased by 89% and 33% respectively. There was a 63% fall in the rate of permanent emigration while male and female admissions to the psychiatric hospital fell by 28% and 19% respectively. There were significant positive associations between male suicide and serious crimes as well as with male and female unemployment (p < 0.01). Male suicide rates were also negatively associated with the male admissions to the psychiatric hospital (p < 0.01). Female suicide rates were positively associated with serious crime and male unemployment (p < 0.01). Although it is not possible to determine whether the observed associations were causal, the results suggest that social distress may be an important contributor to the suicide rate in Trinidad and Tobago, particularly among men. The organisation of preventive strategies for suicidal behaviour must therefore include measures to counter the experience of social distress in this setting.

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago

We investigated the rate of HIV infection in patients at the St. Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9 percent) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75 percent. Among the high-risk group tested, being positive for HIV was associated with age (p=0.01) and ethnicity (p=0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p<0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p<0.001). These findings indicate that psychiatric patients are at greater average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.(AU)

Suicide in Trinidad and Tobago: associations with measures of social distress

Using national statistics for the period 1978-1992, associations were examined between suicide rates and measures of social distress in Trinidad and Tobago. The latter included unemployment, serious crimes, emigration rates and admissions to the country's psychiatric hospital. There was a 319 percent increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in male suicide in 1992. Although there were fluctuations in the rate for females, it remained below 8/100,000. Over the 15 year period examined, there was a 51 percent increase in serious crime while male and female unemployment increase by 89 percent and 33 percent respectively. There was a 63 percent fall in the rate of permanent emigration while male and female admissions to the psychiatric hospital fell by 28 percent and 19 percent respectively. There were significant positive associations between male suicide and serious crimes as well as with male and female employment (p < 0.01). Male suicide rates were also negatively associated with male admissions to the psychiatric hospital (p < 0.01). Female suicide rates were positively associated with serious crime and male unemployment (p < 0.01). Although it is not possible to determine whether the observed associations were causal, the results suggest that social distress may be an important contributor to the suicide rate in Trinidad and Tobago, particularly among men. The organisation of preventive strategies for suicidal behaviour must therefore include measures to counter the experience of social distress in this setting(AU)

Acute respiratory disorders in the newborn: a survey at the Mt Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital (MHWH) from January 1 to December 31, 1994. The study also examined the relationship between incidence rates and maternal and neonatal parameters. Hyaline membrane disease (HMD), transient tachypnoea of the newborn (TTN), meconium spiration syndrome (MAS), persistent foetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5,062 live newborns using standard diagnostic criteria. Overall, 174/5062 neonates were diagnosed with ARD to give an incidence of 3.4 percent (104 males and 70 females). The commenest ARD was PI (39 percent) followed by HMD (29 percent). The incidence of ARD in preterm infants was 20.6 percent (100/486) and 1.1 percent (48/4363) in full term neonates. HMD occurred mainly in the preterm and low birth weight babies. TTN and PI were found in all gestational age groups. Asphyxia was present in 9.8 percent (17/174) at 1 minute and in 10.9 percent (19/174) at 5 minutes. It was more common in babies who developed HMD and PFC. Forty one percent of babies with ARD required assisted ventilation. There were 58 (33 percent) deaths. More than half of those ventilated died (55 percent), 2/3 of those with airleaks, and all those with IVH died Mortality was significantly associated with asphyxia at both 1 and 5 minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs.(AU)

HIV infection in a psychiatric hospital - abstract

This study sought to identify the characteristics of HIV positive patients in a psychiatric hospital in Trinidad and Tobago. HIV testing is done on patients admitted to the hospital who were at potentially high risk for HIV infections as identified by their behavioural history and clinical examination. Of the patients tested, 6.9 percent were HIV positive. There were no significant gender differences between positive and negative patients but there was an association with age. The highest prevalence was in the 35-44 year age group (9.7 percent) and the 15-24 year age group (8.3 percent). This was statistically significant (p=0.01). East Indians were significantly less likely to be HIV positive (p=0.003) when compared to Africans and those of patients of mixed descent. The prevalence of HIV infection was highest among those patients with a diagnosis of cocaine abuse or dependence (12.4 percent) compared with schizophrenia (3.3 percent), depression (3.9 percent) and dementia (8.1 percent) (p<0.001). These findings illustrate that among psychiatric patients, HIV infection may be associated with cocaine abuse and is more likely to be seen in patients of African and mixed descent. (AU)

Factors associated with having general medical "check ups" in a Caribbean country

OBJECTIVES: To determine the extent to which general `check ups' were sought by adult Jamaicans and to identify the demographic and health factors that would characterise individuals who utilized this service. DESIGN and METHODS: A national survey was conducted comprising Jamaicans age 15-50 years. Subjects were selected using a random sampling technique and respondents were interviewed using a structured questionnaire that included a number of demographic, health and behaviour variables. Multiple regression analyses were used to identify the independent predictors of having general 'check-ups'. RESULTS: Of the 3001 persons identified for study, 2580 persons were interviewed (86 percent). Nine hundred and twenty-six (926) (35.9 percent; 95 percent C1, 34.1-37.8 percent) persons said that they had general medical `check -ups. Of those who had check-ups, 33 percent had them at least once every 6 months, 34 percent every year and 33 percent less frequently. The independent predictors of having a check-up were being well educated (p<0.001, maried (p,0.001), more religious (p<0.001), female gender (p=0.001), being satisfied with life (p=0.009) and over 20 years of age (p=0.03). CONCLUSIONS: Having general medical `check-ups' was not an uncommon behaviour in this sample. More research is needed to further characterize and understand this phenomenon since this could be a route for improved preventive medicine and health education. (Au)

Suicides in Trinidad and Tobago: associations with unemployment, crime and emigration

Death by suicide is an important public problem and efforts to identify its causes are needed so as to facilitate its prevention. Although mental illness is an established risk factor, the role of socioeconomic factors has not been explored. We, therefore, conducted an investigation to determine whether suicides in Trinidad and Tobago are related to social distress. Using national statistics for the period 1978 - 1992, associations were examined between suicide rates and unemployed, serious crimes and emigration rates. Over the 15-year period examined, there was a 319 per cent increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in 1992. The rate in females was fairly constant remaining below 8/100,000 throughout the period. Over the same period there was a 51 per cent increase in serious crime, an 89 per cent increase in male unemployment and a 33 per cent increase in female unemployment. However, there was a fall in the rate of permanent emigration. Male, female and total suicide rates were significantly associated with serious crimes and unemployment (male, female and total). However, there was no association with emigration. The results of multiple regression analyses indicated that female unemployment was an independent predictor of male suicides while crime was an independent predictor of female suicides. Because of the design, the present study could not determine whether the observed associations were causal. However, the results suggest that at least some suicides in Trinidad and Tobago, during the period examined, may have been due to social distress. Programmes to ease this distress should have a positive effect on the suicide rate (AU)

Use of food expenditure data to estimate household nutrient accessibility

The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20 percent and 9 percent of the households were less than half of requirments for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica (AU)

Energy and protein accessibility at the household level in Jamaica: results from a national survey - abstract

Patterns of food consumption in Jamaica are of interest not only because of the increase in the food prices relative to the national minimum wage but also because the increased mortality rates from cardiovascular diseases in Jamaica may be related to dietary intakes. Data on household food expenditure were collected in the Jamaica Survey of Living Conditions and these were used to determine household energy and protein accessibility. The survey comprised a national representative sample of 3,861 households. The mean per capita daily energy and protein accessibility levels were 2,170 calories and 64 gm, respectively. This can be compared to reference requirements of 2,250 calories and 43 gm protein. The sample was divided into quintiles of total consumption with the top comprising the richest 20 per cent of the sample and the bottom quintile the poorest 20 per cent. The mean accessibility levels from the poorest quintiles were 909 calories and 24 gm protein while those of richest were 3,356 calories and 102 gm protein. The deficit in energy and protein in the poorest individuals may not be as dramatic as these figures indicate. The total energy and protein accessibility levels do not include meals consumed outside of the home, whether these were bought or received as gifts or as wages. This source of nutrients may be important to this group. In addition, the poorest households have more children which will decrease their per capita nutrient received. However, the indication is that the poorest individuals may be having intakes below those required. This would not only result in poor development of children but also may affect productivity levels in adults and hence national development (AU)

Marsupialisation of bartholins cysts and abscesses a comparison of interrupted versus continuous suturing - abstract

Bartholins cysts and abscesses are very common in the reproductive-age group. Unless these conditions are treated properly the recurrence rate is very high. Marsupialisation of lesions offers an ideal method for treating these conditions, as it is simple, cheap and effective. Interrupted sutures are used to maintain patency of the defect made at operation. This is the method described originally by Jacobson in 1960. Continuous suture has never been described but theoretically could simplify the procedure even if it is as effective as the interrupted method. A clinical trial was therefore conducted to compare the continuous and interrupted methods of marsupialisation in terms of the length of time taken, the quantity of suture used and the outcome in terms of complications and efficacy. The sample comprised 30 women with cysts or abscesses who were randomly assigned to receive continous or interrupted sutures. The continuous method was better in using less suture, (47.1 cm, vs 67.8 cm;p<0.001) and taking less operating time (226.7 secs vs 345.7 secs;p > 0.00 (AU)

Nutritional deficiencies and children's behaviour and mental development

There is an increasing amount of evidence that all the nutritional deficiencies reviewed here detrimentally affect children's concurrent mental functions. In the case of 1 and probably severe PEM in poor environments, long term effects have also been demonstrated. It is likely that Fe deficiency, and mild to moderate undernutrition, if allowed to persist for long periods may lead to developmental lags which are difficult to reverse. The long-term effects of recurrent short-term food deprivation are unknown. Considering the high prevalence of these conditions the public health implications are enormous (AU)

Effects of missing breakfast on the cognitive functions of school children of differing nutritional status

We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in influency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in digit span backwards test and wasted members of the malnourished groups were adversely affected on efficiency of problem solving and those control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children (AU)

Factor VIII:C activity in cryoprecipitate prepared at the Blood Bank, University Hospital of the West Indies, Jamaica - abstract

Cryoprecipitate is the blood product rich in factor VIII: C activity used in the treatment of haemophhlia A. The University Hospital Blood Bank makes most of this product used in Jamaica. Commercially prepared factor VIII concentrates are expensive. We examined the effect of donor variables and techniques of preparation on the potency of cryoprecipitates in order to determine the most efficient production method. Factor VIII: C activity of cryoprecipitate was measured using the activated partial thromboplastin time with a normal plasma pool being used as reference plasma. Donor age and method of freezing the plasma had no effect on potency. Blood group B had a higher yield of factor VIII: C than groups A and O. Potency was decreased by prolonged storage of blood prior to processing (p = 0.015) but was increased by increasing volumes of cryprecipitate (p<0.01). The mean potency of the factor VIII: C was 184 i.u., surprisingly higher than the usually assumed 70 i.u. used for calculating the requirements of our haemophiliacs. We recommend that plasma from fresh tested blood, frozen in - 40§C be used for preparing cryoprecipitate and that a higher value than 70 i.u. of factor VIII: C be used for each bag of cryoprecipitate (AU)

The impact of routine misoprostol (prostaglandin E1) induction on antenatal care at the University Hospital of the West Indies, Mona, Jamaica - abstract

Induction of labour for obstetric problems is of great value in antenatal care. The usual method is to use oxytocin and artificial rupture of membranes. This, however, is sometimes not easily done when the patient's cervix is unripe. The use of prostaglandin reduces cervical dystocia and should therefore make induction easier with less need to resort to caesarean section. However, prostaglandin is not without risks as hyperstimulation can occur with foetal distress or demise, abruptio placetae and ruptured uterus. Since 1992, induction of labour with misoprostol, a synthetic prostaglandin E1 analogue, has become very common in the Department of Obstetrics, U.W.I., Mona. A retrospective study was done to look at certain variables two years preceeding routine prostaglandin induction (1990 and 1991) and this was compared to the two years after routine prostaglandin induction became established, 1993 - 1994. Results showed a significantly lower mean caesarean section rate - 16.3 per cent for 1990 - 1991 versus 14.4 per cent for 1993 - 1994 with the advent of increased prostaglandin inductions (p = 0.006). There was also a significant reduction in the number of oxytocin inductions as the number of prostaglandin inductions rose - total number of oxytocin inductions for 1990 - 1991 was 431 of 6192 deliveries (7.1 per cent) and for 1993 - 1994 it was 307 of 5537 deliveries (5.5 per cent; p = 0.001). The forceps rate was higher in the prostaglandin group (1.6 per cent vs 2.4 per cent; p = -0.004). The abruption rates were almost identical (0.45 per cent vs 0.46; p= 0.97). The stillbirth and neonatal death rates were not significantly different. There were no cases of ruptured uterus in either group. Prostaglandin induction may be important in reducing caesarean section rate and appears to be a safe alternative to oxytocin induction in some patients (AU)

The effects of short term fasting on the cognitive functioning of 9 and 10-year-old children of differing nutritional status - abstract

Schoolfeeding programmes may benefit children through the relief of hunger. There are no studies on the effects of hunger on the congitive function of malnourished children, who may be particularly vulnerable. We therefore, examined the effects of omitting breakfast on the cognitive functions of chronically undernourished children (n = 30). Malnourished and control subjects were admitted overnight to the ward on two occasions, on week apart. They received a standard dinner (940 Kcals) in the evening. By random assingment, half the children received a standard breakfast (590 Kcals) on the morning of their first visit and a placebo on their second visit. The treatment order was reversed for the other half. Tests of cognitive functioning were given at 11:00 a.m. Since the previously malnourished and the chronically undernourished children behaved similarly, they were combined and compared to the adequately nourished. In the fasted state, the malnourished group had lower scores in fluency but the adequately nourished were not affected (group x treatment, p < 0.05); whereas in arithmetic, the adequately nourished had better scores and the malnourished group was not affected (group x treatment, p< 0.05). When weight-for-height was considered, the wasted children (<90 percent expected weight-for-height) tended to do worse when fasted, and the non-wasted slightly better in short-term memory and problem-solving ability (group x treatment, p<0.05). Omitting breakfast appears to have a detrimental effect in poorly nourished children but not in adequately nourished ones. The former are therefore most likely to benefit from schoolfeeding programmes (AU)

Psychiatric disorder in systemic lupus erythematosus

The symptoms of systemic lupus erythematosus (SLE) may include altered mental function. The present study sought to examine whether the psychiatric disorders are due to the disease itself or to the stress of having a chronic disease. Forty-five SLE patients attending outpatient clinics at the Port of Spain General Hospital in Trinidad were compared with two control groups: patients with chronic debilitating diseases similar to SLE in terms of chronicity and treatment (n = 44) and non-diseased individuals (n = 48). The Structured Clinical Interview for DSM III-R was used to identify psychiatric disorders. Both the SLE and the chronic illness groups had more psychic illness (44 percent and 39 percent, respectively) when compared with the non-diseased controls (2 percent) (p<0.001). Major depression was the most common diagnosis among both diseased groups. However, the psychotic illnesses (schizophrenic-type psychosis and bipolar disorders) were more prevalent in the SLE group (11.1 percent vs 0 percent, p=0.02). These results indicate that major depression in SLE may be related more to the effects of a chronic illness than to SLE itself. However, the occurrence of psychotic symptoms may be related to SLE disease and needs further study. (AU)