Feasibility study of mobile phone photography as a possible outcome measure of systemic sclerosis-related digital lesions.

Objective: Clinical trials assessing systemic sclerosis (SSc)-related digital ulcers have been hampered by a lack of reliable outcome measures of healing. Our objective was to assess the feasibility of patients collecting high-quality mobile phone images of their digital lesions as a first step in developing a smartphone-based outcome measure. Methods: Patients with SSc-related digital (finger) lesions photographed one or more lesions each day for 30 days using their smartphone and uploaded the images to a secure Dropbox folder. Image quality was assessed using six criteria: blurriness, shadow, uniformity of lighting, dot location, dot angle and central positioning of the lesion. Patients completed a feedback questionnaire. Results: Twelve patients returned 332 photographs of 18 lesions. Each patient sent a median of 29.5 photographs [interquartile range (IQR) 15-33.5], with a median of 15 photographs per lesion (IQR 6-32). Twenty-two photographs were duplicates. Of the remaining 310 images, 256 (77%) were sufficiently in focus; 268 (81%) had some shadow; lighting was even in 56 (17%); dot location was acceptable in 233 (70%); dot angle was ideal in 107 (32%); and the lesion was centred in 255 (77%). Patient feedback suggested that 6 of 10 would be willing to record images daily in future studies, and 9 of 10 at least one to three times per week. Conclusion: Taking smartphone photographs of digital lesions was feasible for most patients, with most lesions in focus and central in the image. These promising results will inform the next research phase (to develop a smartphone monitoring application incorporating photographs and symptom tracking).

Reverse-Transcription Loop-Mediated Isothermal Amplification Has High Accuracy for Detecting Severe Acute Respiratory Syndrome Coronavirus 2 in Saliva and Nasopharyngeal/Oropharyngeal Swabs from Asymptomatic and Symptomatic Individuals.

Previous studies have described reverse-transcription loop-mediated isothermal amplification (RT-LAMP) for the rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal/oropharyngeal swab and saliva samples. This multisite clinical evaluation describes the validation of an improved sample preparation method for extraction-free RT-LAMP and reports clinical performance of four RT-LAMP assay formats for SARS-CoV-2 detection. Direct RT-LAMP was performed on 559 swabs and 86,760 saliva samples and RNA RT-LAMP on extracted RNA from 12,619 swabs and 12,521 saliva samples from asymptomatic and symptomatic individuals across health care and community settings. For direct RT-LAMP, overall diagnostic sensitivity (DSe) was 70.35% (95% CI, 63.48%-76.60%) on swabs and 84.62% (95% CI, 79.50%-88.88%) on saliva, with diagnostic specificity of 100% (95% CI, 98.98%-100.00%) on swabs and 100% (95% CI, 99.72%-100.00%) on saliva, compared with quantitative RT-PCR (RT-qPCR); analyzing samples with RT-qPCR ORF1ab CT values of ≤25 and ≤33, DSe values were 100% (95% CI, 96.34%-100%) and 77.78% (95% CI, 70.99%-83.62%) for swabs, and 99.01% (95% CI, 94.61%-99.97%) and 87.61% (95% CI, 82.69%-91.54%) for saliva, respectively. For RNA RT-LAMP, overall DSe and diagnostic specificity were 96.06% (95% CI, 92.88%-98.12%) and 99.99% (95% CI, 99.95%-100%) for swabs, and 80.65% (95% CI, 73.54%-86.54%) and 99.99% (95% CI, 99.95%-100%) for saliva, respectively. These findings demonstrate that RT-LAMP is applicable to a variety of use cases, including frequent, interval-based direct RT-LAMP of saliva from asymptomatic individuals who may otherwise be missed using symptomatic testing alone.

A highly effective reverse-transcription loop-mediated isothermal amplification (RT-LAMP) assay for the rapid detection of SARS-CoV-2 infection.

The COVID-19 pandemic has illustrated the importance of simple, rapid and accurate diagnostic testing. This study describes the validation of a new rapid SARS-CoV-2 RT-LAMP assay for use on extracted RNA or directly from swab offering an alternative diagnostic pathway that does not rely on traditional reagents that are often in short supply during a pandemic. Analytical specificity (ASp) of this new RT-LAMP assay was 100% and analytical sensitivity (ASe) was between 1 × 101 and 1 × 102 copies per reaction when using a synthetic DNA target. The overall diagnostic sensitivity (DSe) and specificity (DSp) of RNA RT-LAMP was 97% and 99% respectively, relative to the standard of care rRT-PCR. When a CT cut-off of 33 was employed, above which increasingly evidence suggests there is a low risk of patients shedding infectious virus, the diagnostic sensitivity was 100%. The DSe and DSp of Direct RT-LAMP (that does not require RNA extraction) was 67% and 97%, respectively. When setting CT cut-offs of ≤33 and ≤25, the DSe increased to 75% and 100%, respectively, time from swab-to-result, CT < 25, was < 15 min. We propose that RNA RT-LAMP could replace rRT-PCR where there is a need for increased sample throughput and Direct RT-LAMP as a near-patient screening tool to rapidly identify highly contagious individuals within emergency departments and care homes during times of increased disease prevalence ensuring negative results still get laboratory confirmation.

Sex differences in math performance: The role of children's approach to schoolwork.

This research examined whether the tendency for girls to outperform boys in the classroom is due to differences in how girls and boys approach schoolwork. In 5th grade and then again in 7th grade, children (N=518) reported on how they approach schoolwork (i.e., achievement goals and classroom behavior), their learning strategies, and their self-efficacy in math; math grades and achievement test scores were also collected. Girls were more likely than boys to hold mastery over performance goals and to refrain from disruptive classroom behavior, which predicted girls' greater effortful learning over time. The sex difference in learning strategies accounted for girls' edge over boys in terms of grades. Girls did not do better on achievement tests, possibly because self-efficacy, for which there was also no sex difference, was the central predictor of performance on achievement tests.

Community needs in mental health

A cross-sectional survey using a probability sample of 6,727 adults, (> 15 years) was conducted in Trinidad and Tobago from November 1994 to April 1995. General and mental well-being (assessed with Goldberg's GHQ 12), socio-economic status, alcohol use, disability and utilization patterns were assessed. There were few demographic differences between the sample and the census population and between males and females. On the GHQ 12, 11.5 percent of males and 14.3 percent of females had a severe problem. These results were comparable to international data published by Goldberg. Seeking help varied with severity. Only 8 per 1,000 of the sample population sought help from a primary care provider. This is much lower than the rates from comparable datasets from the UK and The Netherlands. Persons with emotional problems used significantly more general health care than persons without. Forty-nine per cent of persons with an emotional problem had received a prescription during the past year, indicating contact with the health service. It is concluded that (a) the prevalence of mental health problems in the population is comparable to that in other populations; (b) up to 25 percent of these persons seek help and (c) 49 percent were in a position to receive help as judged by their ability to access a prescription. It would appear that there is scope for training primary care providers in the early identification, basic care and efficient referral of these persons, thus improving the quality of life of approximately 20 percent of the population (AU)

Investigation of an hepatitis A outbreak in a rural squatting community associated with a contaminated water-source in County St. George East, Trinidad - abstract

Following a report of a confirmed case of Hepatitis A in a child, a cross sectional epidemiological and an environmental survey were done on the total population ( about 90 households) of a village adjacent to the Arima river from April to September, 1989. The residents had no legal claim to the land and there was no pipe-bourne water supply or scavenging service to the area. Cases of Hepatitis A were identified based on clinical signs and symptoms, and a case control analysis was done using affected and non-affected households. Based on case definition criteria, the attack rate was 22 per cent and 30 cases were found. The age distribution was typical of Hepatitis A, and an epidemic curve had some features of both a common source and a propagated source epidemic. Highly significant were exposures related to using the river as a water source, using a spring and a household size > 4. It was concluded that there was an Hepatitis A outbreak, and the initial source was a river which collected waste from the nearby town and the effluent from a water treatment plant. This outbreak serves as a useful indicator of declining socio-economic conditions and deteriorating environmental standards (AU)

A Strategy for directing public health action in Trinidad and Tobago, 1995 - 2015 - abstract

Trinidad and Tobago is embarking on a national health reform programme driven by a decline in the value of the dollar and a need to decentralize its management structures. In order to focus the efforts of its five regions and the central policy formulating body, it is proposing to identify key priority areas and measurable goals and targets. This paper reviews the epidemiological information that was used to select those priority areas, presents three possible models for choosing its goals and targets, and recommends a model for use in Trinidad and Tobago. Demographic changes over the next 20 years will produce a doubling of the population of adults (45 - 64 years old). The expected number of deaths in this age group will increase from 1,895 to 4,020. It will therefore be necessary to focus on preventing some of these deaths, most of which will be from circulatory diseases, diabetes and cancer. Other problems which may increase in numbers but at a more moderate rate are injury and the STDs. Mental illness has also been selected as a priority area because of the perception that it is a serious and growing problem, uses a large proportion of resources and is an area which has been neglected in the past. The model chosen for describing our goals and targets comes from Australia because it best fits the current concepts of coordinated public health action on a number of fronts. This model selects 5 or 6 priority areas and then orders detailed objectives under the headings: preventive mortality and morbidity, health literacy and lifeskills, healthy lifestyles and healthy environments (AU)

The Plymouth Bethesda cardiovascular risk factor and alcohol consumption study of Tobago - alcohol consumption

The CAGE questionnaire has not been previously used in the Commonwealth Caribbean. A high prevalence of probable alcoholism in males has been found in Tobago. There is strong positive evidence based on the questionnaire that peak prevalence of probable alcoholism is in the 25-34 age group males and 20-24 females. A negative association found between alcohol consumption and ECG codes compatible with ischaemia are consistent with reports from other countries. Alcohol consumption patterns in Tobago pop-population will be further evaluated in longitudinal studies

Selected cardiovascular risk factors and electrocardiographic findings: a Tobago study

Cardiovascular risk factors and electrocardiographic findings were evaluated in a rural adult Tobago community. High amplitude R-waves, T-waves items and conduction and rhythm disturbances were the common electrocardiographic findings. Codable items suggestive of ischaemia showed no correlation with age, smoking, cholesterol levels, pulse rate or exercise, but showed a positive correlation in women with high serum uric acid levels and high fasting blood sugar levels, and a negative correlation with alcohol consumption in men (AU)

Blood sugar levels, weights and heights of Tobagonians

In Plymouth and Bethesda, in Tobago, blood sugar levels, heights and weights were measured in a censused total adult population. Diabetes mellitus appears to be common and probably of similar prevalence to that of Trinidad and Jamaica. Mean weights of females were similar to those of males. There was a progressive loss of height with age in both sexes, consistent with a better nutritional status in the younger respondents. Compared with Trinidad and Guyana, weights and Quetelet's Indices were high (AU)

Blood pressure levels and cardiothoracic ratios of a mixed African West Indian community

In Plymouth-Bethesda, Tobago, blood pressures and cardiothoracic (CT) ratios in a censused total adult population. Blood pressure levels rose across the age groups in both sexes and were similar to those of other West Indian communities and of most African studies. Most of the hypertensives were not on treatment at the time of interview. Mean CT ratios are similar to those of Jamaican and Guyanese mixed Africans and appear not to be associated with the high prevalence of ECG criteria for left ventricular hypertrophy. The latter was predominant in men and the high CT ratios in women. CT ratios increased with hypertension. For men, highest correlation for systolic and diastolic blood pressures was with Quetelet's Index. For women, highest correlations were repectively with post-load blood sugar levels and Quetelet's Index. (AU)

Predictors of all cause mortality in an island population of African descent, Tobago, West Indies, 1976-1994

The objective of this study was to evaluate the predictors of all cause mortality in a rural West Indian population. From 1976 to 1978, 92.5 percent of an adult (o 21 years) Afro-Caribbean community was examined for selected cardiovascular risk factors using a pretested questionnaire. Bloodpressure, resting ECG, fasting and 2-hour post-load blood glucose, serum uric acid and body mass index were measured. Alcohol consumption patterns were also assessed. Follow-up measurements were made over the next 18 years during return visits for medical attention and at home visits. Additional information was obtained from hospital (the only one in the island) and church records. Eighteen-year mortality studies revealed 96/482 females (19.9 percent) and 88/345 (25.5 percent) males had died. Genetic and environmental influences appear operative. Intervention to alter environmental components would reduce premature mortality (AU)

Behavioural risk factors in the adolescent and adult populations of Trinidad and Tobago, 1989 - abstract

A KAPB study on non-communicable disease conducted in Trinidad and Tobago in 1989 measured the prevalence of selected behavioural risk factors for the non-communicable diseases in the adolescent and adult populations. A two-staged sample of 1,700 households was designed to interview 4,000 adults and 33 adolescents (15 - 19 years old). A total of 1,448 (36 percent of target sample) persons, including 306 adolescents (16 - 19 years old), was interviewed; 4.8 percent of adolescent males and 14.9 percent of adult males were former or current smokers (z 100 cigarettes per lifetime). Smoking started in most cases before age 25 years. One in 3 of all smokers had attempted to stop smoking but were susceptible to advertising. Forty-two point five per cent (42.5 percent) of adolescent males, 11.3 percent of adolescent females and 21.9 percent of adult females were drinking at least once per month. Acute heavy drinking (z 5 drinks on a single occasion) was more prevalent in adolescent females than in adult females, pointing to a change in female drinking behaviour (AU)

Cardiovascular risk factors in Tobagonians: comparisons with other African populations

Comparative studies on cardiovascular risk factors in Tobagonians with other African populations show that Tobagonians had higher blood pressure levels of body bulk and obesity. T-wave inversion was also more common in Tobagonians were similar to those of two other Caribbean studies and were significantly higher than those of a white population in Wales (AU)

Alcohol consumption patterns in two Caribbean islands: the CAGE Questionnaire as a predictor of mortality

This study was undertaken to compare the alcohol consumption patterns of Tobago and Jamaica and to assess the impact of alcohol consumption and of alcoholism on mortality. In both Tobago and Jamaica the mean number of alcoholic drinks consumed is less at the extremes of youth and age, and heavy and very heavy drinking patterns were similar. Heavy and very heavy drinking patterns and percentage frequency of abstainers and light drinkers were similar in the two islands. CAGE responses consistent with alcoholism were present in 14.3 percent males and 1.1 percent females (p <0.001) in Tobago. In fitting a logistic regression model for all-cause mortality, a CAGE response of > 2 had a risk ratio of 4.56 (1.25, 16.6), higher than that of any cardiovascular risk factor evaluated (AU)

Left ventricular hypertrophy: a common finding in an adult African population in Tobago, West Indies - abstract

A total adult African population of age 16 years and over is being assessed for cardiovascular risk factors. Mean body mass index of the 303 men was 26.5 and that of the 465 females, 31.0. Hypertension was present in 19.0 per cent of women (89/465). Diabetes was present in 7.9 per cent men (24/303), 11.0 per cent women (51/465). Preliminary data reveal that ECG left ventricular hypertrophy, MACPC display using a modified Sokolow and Lyon Index (ECGLVH) is common: it is present in 27.4 per cent of men (83/303) -9.7 per cent of women (45/465). Results of echocardiograms are available on 198 men and 321 women. Males with ECGLVH had a higher mean of left ventricular wall thickness in diastole (p 0.025) and a higher mean of intraventricular septal thickness in diastole (IVSD) (p 0.05). Females with ECGLVH did not have a higher mean of LVWD or IVSD. LV mass was calculated by the criteria of Devereux and Reichek (1976). Mean left ventricular mass (LVMASS) was higher in respondents with ECGLVH both for males (p 0.05) and for females (p 0.05). Mean LV mass increased across the ten year age groups from 25 - 64 years both sexes (p 0.05). Mean blood pressures of respondents without LVH for males were 111.4/69.5, for females were 118.8/69.5. Further research into the factors affecting LV mass in this population are underway (AU)

The Tobago cardiovascular risk factor study ten-year mortality data - abstract

Out of a total adult censused population of 826 respondents, of Plymouth-Bethesda in 1976, 88 people have died. The fasting and 1-hr post glucose-load blood sugar, the serum uric acid and the systolic blood pressure levels were higher than those of the population in general and, except for systolic blood pressure, higher than those for age group 55-64 years. (Table Included) Alcohol consumption, alcoholism, ponderal index, cigarette smoking, and E.C.G. findings did not differ from those of the general population. In our study, the 1976 serum uric acid levels were significantly higher in those who died compared with those who are still alive (AU)

The Tobago leg of the Intersalt Study: urine sodium, bloodpressure and body mass index correlations - abstract

Tobago is a participant in the INTERSALT study, a multicentre study of inter-relationships between salt intake, bloodpressure and other variables. In the period 1986-1987, in Tobago, a random sample of 200 men and women, 25 in each of 8 age/sex groups, were enrolled in the study. Systolic and diastolic bloodpressure levels were measured with a Hawksley random sphygmomanometer under defined conditions, a spot urine and 24-hr. urine collection were obtained and information was obtained on cardio-vascular risk factors (questionnaire), drug schedules and alcohol intake. Overall in the INTERSALT study of 52 centres in 32 countries, increase of systolic and diastolic bloodpressure with age was significantly related to the average sodium excretion. In addition, sodium excretion (positive), body mass index (positive), heavy alcohol intake (positive) and potassium excretion (negative) were significantly related to the bloodpressure of individuals. In Tobago, prevalence of raised bloodpressure was 18 per cent. Thirteen per cent of men were heavy drinkers (>300 ml alcohol per week), and an average body mass index of 27.0 (kg/m2) and sodium/potassium ratio 2.77 were recorded (men and women combined). The results indicate above optimal values of these variables in Tobago, and suggest the potential for appropriate lifestyle changes of high bloodpressure in Tobago (AU)