Cancer control in the Caribbean island countries and territories: some progress but the journey continues.

Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.

Reduced forced vital capacity is independently associated with ethnicity, metabolic factors and respiratory symptoms in a Caribbean population: a cross-sectional study.

BACKGROUND: Relationships between low forced vital capacity (FVC), and morbidity have previously been studied but there are no data available for the Caribbean population. This study assessed the association of low FVC with risk factors, health variables and socioeconomic status in a community-based study of the Trinidad and Tobago population. METHODS: A cross-sectional survey was conducted using the Burden of Obstructive Lung Disease (BOLD) study protocol. Participants aged 40 years and above were selected using a two-stage stratified cluster sampling. Generalized linear models were used to examine associations between FVC and risk factors. RESULTS: Among the 1104 participants studied a lower post-bronchodilator FVC was independently associated with a large waist circumference (- 172 ml; 95% CI, - 66 to - 278), Indo-Caribbean ethnicity (- 180 ml; 95% CI, - 90 to - 269) and being underweight (- 185 ml; 95% CI, - 40 to - 330). A higher FVC was associated with smoking cannabis (+ 155 ml; 95% CI, + 27 to + 282). Separate analyses to examine associations with health variables indicated that participants with diabetes (p = 0∙041), history of breathlessness (p = 0∙007), and wheeze in the past 12 months (p = 0∙040) also exhibited lower post-bronchodilator FVC. CONCLUSION: These findings suggest that low FVC in this Caribbean population is associated with ethnicity, low body mass index (BMI), large waist circumference, chronic respiratory symptoms, and diabetes.

Urgent need to strengthen and expand screening and other cancer control programs in the CARICOM Caribbean.

PURPOSE: With high mortality in breast, cervical, prostate, and colorectal cancers in Caribbean Community (CARICOM) countries, we examined cancer control initiatives including screening as well as the implementation of relevant international and regional mandates. METHODS: Secondary data were used to examine cancer control initiatives, which included the presence of national policies, programs, and screening services as well as the implementation of international and regional mandates. To identify the data, an on-line search was conducted using Google/Google Scholar. RESULTS: Data were available for 14 of the 15 full members of CARICOM. Although only six countries had distinct cancer control policies, strategies or action plans, all 14 had key elements of cancer control programs. Screening services were available in the 14 countries for cervical, in 12 countries for breast and in 11 for colorectal cancer. However, only four countries had screening policies. In addition, screening guidelines were available for cervical cancer in nine countries, in one country for breast and in none for colorectal cancer. Selected tobacco control policies were present in the 14 countries and immunization policies for human papillomavirus (HPV) in 13. Treatment services included chemotherapy in 10 countries and radiotherapy in six. Nine countries had palliative care services for patients with advanced disease. The countries were at different stages of implementation/compliance with international and regional mandates and frameworks. CONCLUSIONS: There is an urgent need to develop and implement comprehensive and customized cancer control policies addressing screening programs, treatment and palliative care.

Breast Carcinoma Receptor Expression in a Caribbean Population.

Trinidad and Tobago are islands in the Southern Caribbean with a unique mix of races within the population consisting of East Indian (EI) (37.6%), Afro-Caribbean (AC) (36.3%), mixed (24.2%), and Caucasian, Chinese, Lebanese, Syrian, Amerindian, and Spanish groups accounting for 1.9%. It makes it suitable for a comparison of breast carcinoma receptor expression within a fixed environment. This study included 257 women with an age range of 28 to 93 years (mean = 57.2, standard deviation = 15.0), peak age group of 51 to 60 consisting of 105 EI, 119 AC, and 33 mixed descent. Invasive ductal carcinoma accounted for 88%, invasive lobular 9.7%, and ductal carcinoma in situ 2.3%. The triple-negative rates were 24.8, 33.6, and 30.3% for EI, AC, and mixed races, respectively, with the Pearson's chi-square test revealing statistical significance for the AC versus EI ( p < 0.001); AC versus mixed ( p < 0.001); and EI versus mixed ( p = 0.014) groups. The overall estrogen (ER), progesterone (PR), and human epidermal growth receptor (HER) expression negative rates were 52, 64, and 79%, respectively. Chi-square test of the following combinations: ER +/PR +/HER + ; ER +/PR +/HER - ; ER -/PR -/HER + ; ER +/PR -/HER + ; ER +/PR -/HER - ; ER -/PR +/HER + ; ER -/PR +/HER- revealed no statistical differences ( p = 0.689).

No person left behind: Mapping the health policy landscape for genomics research in the Caribbean.

The Caribbean has long been an under-represented geographical region in the field of genomics research. Such under-representation may result in Caribbean people being underserved by precision medicine and other public health benefits of genomics. A collaboration among regional and international researchers aims to address this issue through the H3ECaribbean project (Human Heredity, Environment, and Health in the Caribbean), which builds on the lessons and success of H3Africa. The Caribbean project aims to target issues of social justice by encouraging the inclusion of diverse Caribbean communities in genomics research. This paper explores a framework for the ethical and socially acceptable conduct of genomics research in the Caribbean, taking account of the cultural peculiarities of the region. This is done in part by exploring research ethics issues identified in indigenous communities in North America, Small Island Developing States, and similar endeavours from the African continent. The framework provides guidance for interacting with local community leaders, as well as detailing steps for obtaining informed consent of all participants. Specifically, the authors outline the methods to ensure effective interaction and enforce full transparency with study participants to combat historical neglect when working with under-represented communities in the Caribbean.

Politics and political determinants of health policy and systems research funding in Latin America and the Caribbean.

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. METHODS: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR, based on research in eight countries, including interviews with key stakeholders (n = 42). RESULTS: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. CONCLUSION: Although HPSR is recognised as valuable for decision making and policy development, it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries. Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders.

Health Systems' Resilience: COVID-19 Response in Trinidad and Tobago.

Trinidad and Tobago, a small island developing state, has been ranked as number one in a report published by the University of Oxford that assessed responses to COVID-19 based on four of the six WHO criteria for rolling back COVID-19 "lockdown" measures. The key mitigation and containment strategies implemented by the country were evidence-informed and demonstrated an "all-of-government" approach. The COVID-19 health system response of this country demonstrates that although developing countries face many health system challenges, political will, evidence-informed decision-making, respect for science, and timely, coordinated, collaborative actions can strengthen the resilience and response of the health system during a health emergency.

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.

Hearing loss in steelband musicians.

OBJECTIVE: To determine the difference in hearing between a group of steelband musicians (pannists) and a control group. DESIGN, SETTINGS, AND SUBJECTS: We conducted a controlled cross-sectional pilot study consisting of 29 steelpan players and 30 control subjects from a steelpan orchestra (steelband) in the Otolaryngology Department of the Eric Williams Medical Sciences Complex. RESULTS: Significantly more steelpan players had a hearing loss than the control subjects at 3000 Hz, 4000 Hz, and 6000 Hz ( P < 0.01). chi 2 testing for trend demonstrated that the longer a steelpan player played his instrument the greater the hearing loss. CONCLUSION: These results indicate that pannists suffer permanent auditory damage from high-intensity sound levels and that preventative measures are required to prevent this hearing loss, particularly in younger players.

Sources of stress and psychological disturbance among dental students in the West Indies.

The aim of this study was to investigate sources of stress and psychological disturbance in dental students across the five years of undergraduate study at a dental school in Trinidad. Eighty-three percent of students completed a modified version of the Dental Environment Stress questionnaire (DES) and the Brief Symptom Inventory (BSI). On a scale ranging from 0 (not stressful) to 5 (highly stressful), overall mean DES scores for each of the five years of study were 1.58, 1.83, 2.65, 2.39, and 2.61 respectively, suggesting that levels of stress increase over the five years with a noticeable spike at the transition between the preclinical and clinical phases. Significant differences were found between specific stressors across the five years of study. Seven specific stressors and the stressor domains of Academic work and Clinical factors were more stressful for female students (t-test p < 0.05). The Global Severity Index of the BSI indicated that 54.8 percent of males and 44.2 percent of females were in the clinical range indicating significant psychological disturbance. Psychological disturbance was significantly associated with stress levels for male students (Spearmans rank correlation r = 0.56; p < 0.001), but not generally for female students. Further development is needed of dental educational programs that enhance students' psychosocial well-being.

Using a modified course experience questionnaire (CEQ) to evaluate the innovative teaching of medical communication skills.

SETTING: At the Faculty of Medical Sciences, The University of the West Indies, St Augustine first-year students take two courses in health communication. In the Centre for Medical Sciences Education students completed a course experience questionnaire. This instrument is potentially useful in evaluating innovative programmes and securing support for their development. CONTEXT: The Faculty of Medical Sciences, The University of the West Indies, St Augustine was the first of three campuses to introduce compulsory health communication courses in 1995. Using a modified form of the 25-item course experience questionnaire (CEQ25) (Broomfield & Bligh, 1998) normally employed in overall degree or course evaluation, this study developed a 30-item questionnaire (CEQ30) to test its applicability to the evaluation of medical communication skills teaching MEASURES: In 1997 - 1998 medical, dentistry, veterinary medicine and pharmacy students completed the original short form of the CEQ25 including five items specific to medical communication skills teaching. Students used a five-point Likert scale ranging from one, indicating that they strongly disagreed with the statement, to a score of five, reporting that they strongly agreed with the statement. Principal Components Analysis with Varimax rotation analysed the scale structure of the evaluation tool. RESULTS: The principal components factor analysis of responses (n = 165) broadly confirmed five of Broomfield and Bligh's six factors, but identified a sixth factor in their original instrument (appropriate assessment) that split into two, and a seventh factor, use of available materials and resources. CONCLUSION: The modified CEQ30 is a reliable instrument with which to evaluate a course in medical communication skills, and encourage reflection on teaching and course design. Its use is applicable to medical courses during overall curriculum change and innovation in a medical school.

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.

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.

Use of food expenditure data to estimate household nutrient accessibity

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

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)

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)