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1.
West Indian med. j ; 50(Suppl 7): 23, Dec. 2001.
Artigo em Inglês | MedCarib | ID: med-77

RESUMO

Emphatic communication is a critical aspect of medical interviewing. While there are a number of theoretical perspectives on empathy, in the medical context Feignhny (1995) describes, empathy as, "a physician's cognitive capacity to understand a patient's needs, an affective sensitivity to a patient's feelings, and a behavioural ability to convey empathy to a patient". From this definition, the most direct and valid assessment of empathetic concern is likely to come from the patients own perspective. The development of empathy in students is critical in the provision of quality undergraduate medical attention. At the St. Augustine Campus of the Faculty of Medical Sciences, the skills laboratory programme has the responsibility for developing basic clinical competencies in medical students in years 1 to 3, including empathetic concern. However, as yet, there are no formal intervention programmes. A standardized patient (SP) programme is maintained in which a core of volunteers is trained to work with the students and to perform in the role of patient at the annual OSCE at the end of year 3. In the 1999 OSCE, the SPs were asked to assess the quality of the interpersonal communication of students. These ratings were compared with those of experts raters at key stations. In the 2000 OSCE, the study was expanded to include an assessment of empathy using the Adjective Check List. The key research questions for the study focused on the relationship between empathy and student individual characteristics and performance in traditional assessments. It was found that empathetic communication as practised in the OSCE and as assessed by the SPs was related to gender but unrelated to performance in traditional assessments in the Phase examinations and admission scores. There was evidence that students with high admission scores were likely to score lower in some aspects of empathy as perceived by the SPs. Recommendations for the development and assessment of attitudes are provided. Issues centring on design intervention programmes for developing empathetic concern in students are discussed. (AU)


Assuntos
Humanos , Estudantes de Medicina , Empatia , Comunicação , Relações Interpessoais , Meio Ambiente , Estudos Longitudinais
2.
West Indian med. j ; 50(Suppl 7): 22, Dec. 2001.
Artigo em Inglês | MedCarib | ID: med-79

RESUMO

St. George's University School of Medicine matriculates two separate classes of 250 students each year. Clinical interviewing and communication skills are taught in "small groups" of 9-11 students by experienced physician educators using standardized simulated patients. During each 90-minute session, a student acts as the interviewer and receives feedback from both physician and patient as well as also observing interviews by colleagues. Nine such sessions occur over a 9-month period. There is evidence of overall efficacy of the Clincial Skills course from an OSCE administered at the end of the two-year course in Basic Sciences, but this study attempts to define the efficacy of these small group sessions. The study compares, by means of videotaped recordings, the skills of volunteer freshmen medical students before and after 3 small group sessions, and compares this group to a similar group of students who had completed all 9 sessions. These recordings were rated by two independent observers, unaware of the students experience, using a new interview rating scale derived from a combination of three previously validated scales. The characteristics of this scaleproved to be reliable and valid within the limits of this study. Student performance improved significantly after three sessions in terms of interview content, non-verbal communication and interpersonal skills. Further improvement occured in the first two at the end of the course, but there appeared to be a deterioration in interpersonal skills. This was similar to the results in previous studies. The focussed small group course in interviewing and communication skills at St. George's University is effective in improving student skills, but continuing efforts are needed to ensure that their interpersonal skills are optimized and maintained. (AU)


Assuntos
Humanos , Estudantes de Medicina , /normas , Métodos de Comunicação Total , Granada , Estudos Longitudinais , Relações Interpessoais , Competência Clínica
3.
West Indian med. j ; 50(Suppl 5): 22-3, Nov. 2001.
Artigo em Inglês | MedCarib | ID: med-189

RESUMO

OBJECTIVE: To examine the relationships of Body Mass Index (BMI) to obesity indices derived from anthropometry and to determine tracking of obesity between late childhood and early adolescence. We also compared identification of over-weight children using the International Obesity Task Force (IOTF) BMI cut points with skinfolds. METHODS: Three hundred and six children were examined at 7-8 years and at 11-12 years. Triceps (TSF) and subscapular (SSF) skin folds, height, and weight were measured. The sum of the skinfolds (sum SF), BMI, and fat mass (FM) were calculated. Pubertal stage was assessed at 11-12 years. RESULTS: At age 7-8 years, 11 children were overweight compared with 29 at 11-12 years. BMI was better correlated with the other indices of adiposity in girls than in boys and in the older age group than in the 7-8-year-olds. In regression analysis, BMI predicted FM best and explained 52 percent and 61 percent of the variance in FM among boys and girls at 7-8 years. Using the IOTF cut points, BMI had low sensitivity to identify children >85th percentile of the NHANES references for SSF. The sensitivity for those assessed by TSF and sum SF was higher but between 14 percent and 30 percent of the children were misclassified. The specificity of BMI was high. CONCLUSION: Adiposity increased between mid-childhood and early adolescence but the children remained realtively lean. Girls were fatter than boys, reflecting adult obesity patterns. Children identified as overweight by the IOTF BMI cut points are likley to have high body fatness. However, the concern would be that the BMI cut points may not identify many children with high body fatness. (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Índice de Massa Corporal , Obesidade/epidemiologia , Adipócitos/fisiologia , Estudos Longitudinais , Jamaica , Antropometria , Afro-Americanos
4.
West Indian med. j ; 50(Suppl 5): 19, Nov. 2001.
Artigo em Inglês | MedCarib | ID: med-196

RESUMO

OBJECTIVE: We used data for a one-year period from the Violence-related Injury (VRI) Surveillance System at the Kingston Regional Hospital (KRH) in Jamaica to describe the patterns of non-fatal VRIs. We also carried out simulation analysis to estimate rates of hospital admission under various injury-reduction scenarios, and the potential savings that could be realized by reducing violent crimes and the hospital care associated with them. METHOD: Data used were for the one-year period, August 1, 1998 to July 31, 1999. In this period there were 6107 registered violence-related visits to the Accident and Emergency Department (AED) of the KRH, representing 11.5 percent of all recorded visits. Questions on the form included age, gender, circumstance and method of injury, victim-perpatrator relationship, and admission status. cases are non-fatal violence-related injuries resulting from threatened or actual use of physical force with the intent to cause harm, and do not include accidental or self-inflicted injuries. Simulation results are based on predicted values of admission status following maximum likelihood multiple regression models and the appropriate manipulation of relevant independent variables. RESULTS: 16.6 percent (1001) of subjects were admitted. The most common method of inflicting injury was by stabbing, accounting for 52.1 percent of injuries. Bodily force or blunt objects accounted for another 37.9 percent, while gunshot wounds accounted 7.3 percent of injuries. Multivariate analyses indicated gumshot injuries, stab injuries, being male, between the ages of 15 and 44 years, receiving the injury in November or December, and being injured by a stranger or unknown assailant, to be significant correlates of probability of admission ranging from 12 percent to 44 percent, with estimated savings of up to 20 percent of the annual budget of KRH. CONCLUSIONS: Non-fatal VRIs compromise a significant proportion of admissions to KRH. There are predicatble correlates of the likelihood of admission, and educational drives aimed at reducing specific risk factors can lead to large savings of limited resources. (AU)


Assuntos
Adulto , Humanos , Masculino , Adolescente , Ferimentos e Lesões , Violência/prevenção & controle , Custos Hospitalares , Admissão do Paciente/estatística & dados numéricos , Jamaica , Estudos Longitudinais
5.
West Indian med. j ; 50(3): 218-21, Sept. 2001. tab
Artigo em Inglês | MedCarib | ID: med-291

RESUMO

Malignant soft tissue tumours are uncommon and the diagnosis is often difficult to make. This study of fifty-nine cases represents a pathological perspective of our experience with these tumors over a 10-year period. Malignant fibrous histiocytoma was the most frequent diagnosis made (36 percent) and the Majority of these occurred in the lower limbs. In 11 (19 percent) cases, the sarcomas could not be further classified along histogenetic lines. We consider some of the reasons for this and discuss these findings in the light of an increasing trend towards the use of smaller samples for diagnosis. (AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Idoso , Neoplasias de Tecidos Moles/patologia , Sarcoma/patologia , Estudos Longitudinais , Jamaica , Biópsia , Idoso de 80 Anos ou mais
6.
West Indian med. j ; 50(3): 209-13, Sept. 2001. tab
Artigo em Inglês | MedCarib | ID: med-300

RESUMO

A one-year longitudal study was undertaken in kingston, Jamaica, to examine (i) the experience of side effects among female contraceptives users, (ii) the role of side effects. The study consisted of 463 women who utilized public health centres in Kingston and were either new users of contraceptives or who were switching contraceptive methods. They were recruited over a two-month period in 1998 and followed up for one year. All follow-up, interviews were done at women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, cotraceptive history, servive factors, experience with method and length of use. Forty eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side efects were irregular bleeding/no period, headaches, nausea; dizziness and weight gain/loss. These side effects occurred mainly among pill and injection users. The occurrence of side effects had a negative impact on continuation rates. Forty seven per cent of the women stated that they had received counselling regarding side effects. The level and impact of side effects among family planning acceptors at public health centres in Jamaica is of significance to the family planning programme. Method options need to be widened and counselling needs to be improved to ensure that women fully understand the issue of side efects and make informed choices about contraception. (AU)


Assuntos
Feminino , Humanos , Serviços de Planejamento Familiar/normas , Instituições de Assistência Ambulatorial , Anticoncepção/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Estudos Longitudinais , Jamaica , Anticoncepção/métodos , Aconselhamento , Análise de Regressão
7.
Arch Ophthalmol ; 119(1): 89-95, Jan. 2001. tab, gra
Artigo em Inglês | MedCarib | ID: med-112

RESUMO

OBJECTIVE: To measure the 4-year risk of open-angle glaucoma (OAG) in a black population. DESIGN: Population-based cohort study with 4 years of follow up. SETTING: Simple random sample of residents of Barbados, West Indies, aged 40 years or older. PARTICIPANTS: A total of 3427 members of the cohort (85 percent of those eligible). MAIN OUTCOME MEASURE: Development of glaucoma visual field defects and optic disc damage, confirmed by automated perimetry, independent fundus photographic gradings, and standardized opthalmologic examinations. RESULTS: The 4-year risk of OAG in black participants was 2.2 percent (95 percent confidence interval, 1.7 percent-2.8 percent), based on 67 newly developed cases of OAG. Incidence rates increased from 1.2 percent at ages 40 to 49 years to 4.2 percent at ages of 70 years or more, tending to be higher in men than women (2.7 percent vs 1.9 percent). About half of the incident cases were undiagnosed previously, and the rest were receiving OAG treatment. Of the 67 new cases of OAG, 32 had intraocular pressure of 21 mm HG or less at baseline (1.2 percent incidence) and 35 had higher pressures (9 percent incidence). Risk was the highest among persons classified as having suspect OAG at baseline (26.1 percent), followed by those with ocular hypertension (4.9 percent and lowest in the remining population (0.8 percent). CONCLUSIONS: This longitudinal study provides new information on OAG risk, as well as the first incidence measurement in a black population. Although intraocular pressure increased risk, about half of the new cases had baseline pressures of 21 mm Hg or less. Results substantiate the high OAG risk in the population of African origin, especially in older adults; the relative role of intraocular pressure; and the considerable underdetecion of new disease after 4 years of follow-up. (AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Masculino , Glaucoma de Ângulo Aberto/etnologia , Barbados/etnologia , Estudos Longitudinais , Estudos de Coortes , Seguimentos , Transtornos da Visão/etnologia , Disco Óptico/patologia , Doenças do Nervo Óptico/etnologia , Fatores de Risco , Distribuição Aleatória , Testes de Campo Visual , Distribuição por Idade , Idoso de 80 Anos ou mais , Incidência
8.
Revista da Sociedade Brasileira de Medicina Tropical ; 34(1): 29-35, Jan.-Feb. 2001. tab
Artigo em Inglês | MedCarib | ID: med-17780

RESUMO

A longitudinal study was conducted on selected livestock farms to determine the prevalence of enteropathogens in diarrhoeic and non-diarrhoeic animals. The enteropathogens assayed from faecal samples and rectal swabs were bacteria (Escherichia coli, Campylobacter spp. Salmonella spp. and Yersinia enterocolitica), parasites (coccidia, gastrointestinal nematodes and Cryptosporidium spp.) and viruses (group A rotavirus and parvovirus). The prevalence of the enteropathogens in various animal species was related to age and month of the year. Generally, younger animals presented a higher prevalence of infection by enteropathogens than older animals while most infections occurred between the months of January and April.


Assuntos
Bovinos , Animais , Research Support, Non-U.S. Gov't , Fatores Etários , Animais Domésticos , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/veterinária , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/veterinária , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/veterinária , Estudos Longitudinais , Prevalência , Salmonelose Animal/epidemiologia , Ovinos , Suínos , Trinidad e Tobago/epidemiologia
9.
West Indian med. j ; 49(suppl.4): 11, Nov. 9, 2000.
Artigo em Inglês | MedCarib | ID: med-402

RESUMO

OBJECTIVES: To examine factors associated with low birth weight (LBW) in term infants as part of a longitudinal study on the effects of term LBW. METHODS: Term LBW and normal birth weight (NBW) infants were recruited from the Victoria Jubliee Hospital, Kingston, Jamaica, between March and October, 1999. All LBW infants meeting the recruitment criteria were enrolled. The next eligible NBW infant of the same gender was enrolled for two of every three LBW infants. Gestational age was determined by the Dubowitz method. Anthropometric measurements were made and a questionnaire administered to determine maternal characteristics and antenatal history. Maternal height was measured and socioeconomic status assessed at home one week later. RESULTS: A total of 234 term infants (140 LBW and 94 NBW) were enrolled. There were no significant differences between the groups in maternal age, height, education, occupation or socioeconomic status. Mothers who reported alcohol consumption during pregnancy were more likely to have a LBW infant (Odds Ratio (OR) 2.26; 95 percent CI 1.01, 5.05) LBW infants were more likely to be first born (OR 1.73; 95 percent CI 1.01, 2.97). Mothers who had a previous LBW infant were at increased risk of having another LBW infant (OR 4.89; 95 percent CI 2.21, 10.84). CONCLUSION: Socioeconomic factors did not distinguish mothers at the Victoria Jubliee Hospital, who were likely to have a term LBW infant. Primiparous mothers and mothers who have given birth to a previous LBW infant are at risk of having a LBW infant and need special attention during the antenatal period.(Au)


Assuntos
Feminino , Gravidez , Recém-Nascido , Humanos , Estudo Comparativo , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido/fisiologia , Estudos Longitudinais , Coleta de Dados , Fatores Socioeconômicos
10.
West Indian med. j ; 49(2): 148-53, Jun. 2000. tab, gra
Artigo em Inglês | MedCarib | ID: med-805

RESUMO

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.(AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Adolescente , Síndrome de Imunodeficiência Adquirida/mortalidade , Inibidores de Proteases/uso terapêutico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Guadalupe/epidemiologia , Infecções por HIV/epidemiologia , Estudos Longitudinais , Prognóstico , Modelos de Riscos Proporcionais , Inibidores de Proteases/uso terapêutico , Comportamento Sexual , Análise de Sobrevida , Carga Viral
11.
Journal of wildlife diseases ; 36(2): 284-293, Apr. 2000. tab
Artigo em Inglês | MedCarib | ID: med-17778

RESUMO

Morbidity and mortality of captive wildlife at the Emperor Valley Zoo, Trinidad from 1993 to 1996 were analysed to determine involvement of Salmonella spp. A 6 mo longitudinal study was conducted to determine the frequency of isolation of Salmonella spp. from apparently healthy, sick and dead wild mammals, birds, and reptiles. The antibiograms of Salmonella isolates were determined using the disc diffusion method. Fecal samples randomly selected from animal enclosures and cloacal swabs of snakes were cultured for Salmonella spp. following enrichment in tetrathionate and selenite cystine broths. For the 1993-96 period, Salmonella spp. was implicated in 17 (12%) of 141 sick or dead animals and the predominant serotype was S. typhimurium. During the 6 mo prospective study in a mean animal population of 1,186, there were 20 (2%) and 14 (1%) animals that were sick and died respectively; Salmonella spp. was implicated in only one mortality. Overall, of 1,012 samples from apparently healthy wildlife cultured, 66 (7%) yielded 24 serotypes of Salmonella. The predominant serotype were S. seigburg (16 isolates), S. gaminara (6 isolates), and S. thompson (6 isolates). None of the samples yielded S. typhimurium. The frequency of isolation of Salmonella spp. in reptiles (14%) was significantly higher than found in either mammals (7%) or birds (3%). Sixty-five (99%) of 66 Salmonella spp. isolates exhibited resistance to one or more of the nine antimicrobial agents tested. Resistance was high to cephalothin (92%), moderate to streptomycin (35%) and tetracycline (29%), but significantly low to gentamicin (2%), chloramphenicol (0%), and sulphamethoxazole/trimethoprim (0%). The prevalence of asymptomatic infections by Salmonella spp. in zoo animals was high and the very high prevalence of antimicrobial resistance could be a problem when treating salmonellosis.


Assuntos
Animais , Animais de Zoológico , Antibacterianos/farmacologia , Aves , Mamíferos , Répteis , Salmonelose Animal/epidemiologia , Salmonelose Animal/mortalidade , Resistência Microbiana a Medicamentos , Estudos Longitudinais , Morbidade , Prevalência , Estudos Retrospectivos , Salmonella/classificação , Salmonella/efeitos dos fármacos , Salmonella/isolamento & purificação , Sorotipagem/veterinária , Trinidad e Tobago/epidemiologia
12.
West Indian med. j ; 49(Suppl 2): 16, Apr. 2000.
Artigo em Inglês | MedCarib | ID: med-1009

RESUMO

OBJECTIVE: To ascertain blood pressure and echocardiographic measurements in Tobagonian children and to determine possible inter-relationships. DESIGN AND METHODS: Over the period 1994-1995, based on data from school enrolment in the area, we evaluated all the school children of Plymouth and Blackrock (n=338, 174 boys, 164 girls; age range 5-13 years). Anthropometric and blood pressure measurements were taken using WHO guidelines, and echocardiographic measurements of heart size were obtained according to the recommendations of the American Society of Echocardiography and the data were analysed. RESULTS: Echocardiographic indices of left heart size varied as a function of blood pressure levels. Male subjects demonstrated significantly higher adjusted left ventricular mass, left ventricular wall thickness, and left ventricular chamber size. After adjustment for body size, blood pressure correlated with left ventricular wall stress (p<0.001). Systolic blood pressure correlated with left ventricular mass (p<0.05), and height correlated with both systolic and diastolic blood pressure (p<0.01). CONCLUSIONS: Our data demonstrated that blood pressure in healthy Tobagonian children correlated with several measures of left ventricular size. Longitudinal studies are indicated.(Au)


Assuntos
Criança , Feminino , Humanos , Masculino , Pressão Arterial , Ecocardiografia , Antropometria , Trinidad e Tobago , Estudos Longitudinais
13.
West Indian med. j ; 49(1): 47-51, Mar. 2000. tab
Artigo em Inglês | MedCarib | ID: med-1076

RESUMO

The results of this study indicated that patients aged 3-13 years who had a history of previous hospitalization appeared to be significantly more distressed than patients without such previous history (p<0.05). Previously hospitalized children were more uncooperative and displayed anxious, immature behaviour patterns. Children who were hospitalized for more than a month were also interviewed about their concerns and response to hospitalization. The study highlighted the need for hospitalized children to be better prepared for hospitalization, to have greater parental involvement in the management of their behaviour and to have efficiently run programmes geared at addressing their educational and emotional needs.(Au)


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adolescente , Criança Hospitalizada/psicologia , Jamaica , Adaptação Psicológica , Fatores Etários , Comportamento Infantil , Hospitalização , Hospitais Universitários , Estudos Longitudinais
14.
Hypertension ; 35(2): 662-7, Feb. 2000.
Artigo em Inglês | MedCarib | ID: med-864

RESUMO

The objective of this study was to determine whether maternal nutrition and fetal and placental size program blood pressure. A longitudinal study linking the maternal anthropometric measurements of the first antenatal visit, ultrasound data of placental and fetal size, anthropometry at birth, and childhood growth and blood pressure was performed. The subjects were 428 women who attended the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, and their children, who were subsequently followed up. Systolic blood pressure at ages 1, 2, 2.5, 3, and 3.5 years was the main outcome measure. Pooling the data across ages, systolic blood pressure fell by 1.4 mm Hg for every 1-kg increase in birth weight (95 percent CI 0.2 to 2.7, P=0.02) and by 1.2 mm Hg for every 100 mL increase in placental volume at 20 weeks of gestation (95 percent CI 0.4 to 2.0, P=0.004). Blood pressure was also negatively associated with placental volume at 17 weeks and fetal abdominal circumference at 20 weeks. Measures of maternal nutritional status were strongly related to birth weight and placental volume but not directly to childhood blood pressure at these young ages. In conclusion, blood pressure is associated with fetal size in this population, as previously described among Europeans. We found associations between placental volume and abdominal circumference in the second trimester and childhood blood pressure, suggesting that the initiating events of blood pressure programming occur early in pregnancy. Measures of maternal nutritional status were not directly related to childhood blood pressure at these young ages but were strong predictors of both birth weight and placental volume, suggesting an indirect relation.(Au)


Assuntos
Adulto , Lactente , Pré-Escolar , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Pressão Arterial/fisiologia , Peso ao Nascer , Placenta/fisiologia , Troca Materno-Fetal/fisiologia , Avaliação Nutricional , Desenvolvimento Embrionário e Fetal , Jamaica , Estudos Longitudinais
15.
Zentralbl Veterinarmed [B] ; 46(8): 567-81, Oct. 1999.
Artigo em Inglês | MedCarib | ID: med-721

RESUMO

A 6-month longitudinal study was conducted on 30 dairy cows in early lactation and their human handlers on six farms across Trinidad. Weekly samples of bulk milk, composite milk and anterior nares and hand swabs from human handlers were collected and cultured for Staphylococcus aureus on Baird-Parker agar (BPA). The susceptibility of S. aureus strains to bacteriophages and the relatedness of strains isolated over the study period were determined. Sixty-three (51.2 percent) of 123 strains of S. aureus from bulk milk were typable compared with 111 (57.3 percent) of 194 and 82 (61.7 percent) of 133 strains isolated from composite milk and human handlers, respectively. The differences were not statistically significant (P> 0.05; chi 2). Bovine phage 42D lysed 3.3 percent (4 of 123), 16.5 percent (32 of 194) and 12.0 percent (16 of 133) of S. aureus strains isolated from bulk milk, composite milk and human handlers, respectively. The differences were statistically significant (P< 0.001; chi 2). Amongst bulk milk isolates of S. aureus, 35 (31.8 percent) of 110 exhibited relatedness in 11 groups based on their phage patterns and groups. The mean maximum interval between the first and last detection of related S. aureus strains in a group was 11.5 +/- 7.3 weeks. Amongst composite milk strains of S. aureus, 23 (46.0 percent) of 50, 25 (62.5 percent) of 40 and 22 (53.7 percent) of 41 exhibited relatedness on farms IB 2, IB 27 and IC 23, respectively, but the differences were not statistically significant (P> 0.05; chi 2). On farm IB 2, five groups of related strains of S. aureus were detected with a mean maximum interval of detection of 18.2 +/- 8.5 weeks compared to farm IB 27 where five groups of related strains were also observed but with an interval of 13.8 +/- 8.2 weeks. On farm IC 23, a total of seven groups of related S. aureus strains detected with a mean interval of 8.0 +/-5.5 weeks. For human strains of S. aureus from farm IB 2, nine (56.3 percent) of 16 strains isolated from anterior nares exhibited relatedness in three groups with a mean maximum interval of 13.3 +/- 4.7 weeks compared to four (25.0 percent) of 16 hand swab isolates which exhibited relatedness in two groups with a mean maximum interval of detection of 20.5 +/- 2.1 weeks compared to hand swab isolates, with six (50.0 percent) of 12 showing relatedness in two groups and a mean interval of 10.5 +/- 2.1 weeks. (AU)


Assuntos
Estudo Comparativo , Humanos , Feminino , 21003 , Tipagem de Bacteriófagos/veterinária , Doenças dos Bovinos/microbiologia , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/classificação , /microbiologia , Bovinos , Mãos/microbiologia , Lactação , Estudos Longitudinais , Nariz/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Trinidad e Tobago
16.
J Dent Res ; 78(3): 797-803, Mar. 1999.
Artigo em Inglês | MedCarib | ID: med-1353

RESUMO

Habitual xylitol gum-chewing may have a long-term preventive effect by reducing the caries risk for several years after the habitual chewing has ended. The goal of this report was (1) to determine if sorbitol and sorbitol/xylitol mixture provide a long-term benefit, and (2) to determine which teeth benefit most from two-year habitual gum-chewing - those erupting before, during, or after habitual gum-chewing. Children, on average 6 years old, chewing gums sweetened with xylitol, sorbitol, or xylitol/sorbitol mixture. There was a "no gum" control group. Five years after the two-year program of habitual gum-chewing ended, 288 children were re-examined. Compared with the no-gum group, sorbitol gums had no significant long-term effect (relative risk (RR), 0.65; 95 percent confidence interval [c.i]. 0.39 to 1.07; p < 0.18). Xylitol gums and, to a lesser extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5 years after habitual gum-chewing ended, xylitol gums reduced the caries risk 59 percent (RR, 0.41; 95 percent c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums reduced the caries risk 44 percent (RR, 0.56; 95 percent c.i., 0.36 to 0.89; p < 0.02). The long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02). Teeth that erupted after 1 year of gum-chewing or after the two-year habitual gum use ended had long-term caries risk reduction of 93 percent (p < 0.0054) and 88 percent (p < 0.0004), respectively. Teeth that erupted before the gum-chewing started had no significant long-term prevention (p < 0.30). We concluded that for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt.(AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Goma de Mascar , Cárie Dentária/prevenção & controle , Belize/epidemiologia , Goma de Mascar/estatística & dados numéricos , Distribuição de Qui-Quadrado , Estudos de Coortes , Cárie Dentária/epidemiologia , Índice CPO , Incidência , Estudos Longitudinais , Risco , Sorbitol/uso terapêutico , Fatores de Tempo , Erupção Dentária , Xilitol/uso terapêutico
17.
In. University of the West Indies, Mona, Jamaica. Faculty of Medical Sciences. Eighth Annual Research Conference 1999. Kingston, s.n, 1999. p.1. (Annual Research Conference 1999, 8).
Monografia em Inglês | MedCarib | ID: med-1444

RESUMO

In planning for the training of medical personnel in a well ordered health service, it is important to determine the profile of those persons who enter the course of training and what effect, if any, this programme has on their subsequent choice of speciality. Work on this issue elsewhere indicates that the best time to begin gathering information about these factors is at the time of entry to medical school and before students are swayed by the course and by the opinions of their peers and teachers. This study was designed to explore why persons seek to become doctors and what factors influence different sub groups to select different specialities. It sets out to answer the following questions: 1) What are the motivational factors influencing the students to study medicine? 2) What demographic and family background factors are related to these motivational factors? 3) What influence do these motivational factors have on future choice of speciality? A longitudinal study of all medical students from their first year in a 5-year curriculum was begun on the Mona and St. Augustine campuses by administration of a questionnaire at the start of the first year of study. This included structured questions on demographics, the motivation for making the decision to study medicine and the present choice of speciality. Confidentiality of the information collected will be assured by using student's identification numbers. This paper reports the preliminary data from one of the campuses. It focuses on motivational factors, speciality choices and concerns of the students about pursuing the medical programme at the UWI. It is hoped that this information and the results of longitudinal follow-up will help the Faculty to shape decisions about selection criteria for entrants and for designing and implementing the new curriculum (AU)


Assuntos
Humanos , Educação Médica/normas , Jamaica , Estudos Longitudinais , Currículo
18.
Br J Nutr ; 77(2): 165-81, Feb. 1997.
Artigo em Inglês | MedCarib | ID: med-2028

RESUMO

Urea kinetics were measured in normal women aged 22-34 years at weeks 16, 24 and 32 on either their habitual protein intake (HABIT) or a controlled intake of 60 g protein/d (CONTROL), using primed-intermittent oral doses of [15N15N] urea and measurement of plateau enrichment in urinary urea over 18 h (ID) or a single oral dose of [15N15N] urea and measurement of enrichment of urea in urine over the following 48 h (SD). The intake of protein during HABIT-ID (80 g/d) was greater than that on HABIT-SD (71 g/d); urea production as a percentage of intake was significantly greater at week 16 for HABIT-ID than HABIT-SD, whereas urea hydrolysis at week 16 was greater for HABIT-SD than HABIT-ID and urea excretion at week 32 was greater for HABIT-ID than HABIT-SD . The combined results for HABIT-ID and HABIT-SD showed a significant reduction in urea production at week 32 compared with week 24. Urea excretion decreased significantly from week 16 to week 24 with no further decrease to week 32 and urea hydrolysis was significantly greater at week 24 than either week 16 or week 32. Compared with HABIT, on CONTROL there was a decrease in urea production at week 16, and urea excretion was significantly reduced at week 16. For all time periods urea production was closely related to the sum of intake plus hydrolysis. Hydrolysis was greatest at week 24 and closely related to urea production. There was a significantly inverse linear relationship overall for hydrolysis as a proportion of production and excretion as proportion of intake. The results show that on HABIT N is more effectively conserved in mid-pregnancy through an increase in urea hydrolysis and salvage, and during late pregnancy through a reduction in urea formation. Lowering protein intake at any stage of pregnancy increased the hydrolysis and salvage of urea. The staging of these changes was later than that in pregnancy in Jamaica.(AU)


Assuntos
Adulto , Feminino , Humanos , Proteínas na Dieta/metabolismo , Gravidez/metabolismo , Ureia/farmacocinética , Dieta com Restrição de Proteínas , Hidrólise , Estudos Longitudinais , Isótopos de Nitrogênio , Necessidades Nutricionais , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Ureia/urina
19.
Br J Nutr ; 77(2): 183-96, Feb. 1997.
Artigo em Inglês | MedCarib | ID: med-2029

RESUMO

Urinary 5-L-oxoproline was measured during normal pregnancies in Southampton, England and Kingston, Jamaica. The CV of 5-L-oxoproline excretion in urine, determined over 7 d in a non-pregnant woman and three pregnant women, was 10-36 percent. Compared with non-pregnant women, urinary 5-L-oxoproline increased three to four times from early pregnancy in women in Southampton, a highly significant difference, and remained elevated at similar levels during mid and late pregnancy. For women in Kingston, the excretion of 5-L-oxoproline was similar to that of Southampton women in the non-pregnant group and during early pregnancy. However, there was a progressive increase in the excretion of 5-L-oxoproline as pregnancy advanced and by late pregnancy excretion was from three to ten times greater than the average for the non-pregnant women. There was a significant difference between the women in Southampton and the women in Kingston during mid and late pregnancy, with women in Kingston excreting twice as much 5-l-oxoproline during late pregnancy. If the excretion of 5-L-oxoproline is a measure of glycine insufficiency, the results would indicate that in some pregnancies the ability of the mother to provide glycine for herself and the developing fetus is marginal or inadequate and the constraint appears more marked in Jamaica than in England.(AU)


Assuntos
Adulto , Estudo Comparativo , Feminino , Humanos , Gravidez/urina , Ácido Pirrolidonocarboxílico/urina , Estudos Transversais , Inglaterra , Glicina/metabolismo , Jamaica , Estudos Longitudinais , Gravidez/metabolismo , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez
20.
Am J Phys Anthropol ; 102(1): 33-53, Jan. 1997.
Artigo em Inglês | MedCarib | ID: med-2040

RESUMO

This study examines socioeconomic conditions, psychosocial stress, and health among 264 infants, children, adolescents, and young adults aged 2 months to 18 years residing in a rural Caribbean village in Dominica. Fieldwork was conducted over a 9 year period (1988-1996). Research methods and techniques include salivary cortisol radioimmunoassay (N = 22, 438), systematic behavioral observation, psychological questionnaires, health evaluation, medical records, informal interviews, and participant observation. Analyses of data indicate complex relations among socioeconomic conditions, stress, and health. Household income, land ownership, parental education, and other socioeconomic measures are weakly associated with child illness. There is no evidence that apparent material benefits of high socioeconomic status such as improved housing, diet, work loads, and access to private health care have important direct effects on child health in this population. However, social relationship, especially family environment, may have important effects on childhood psychosocial stress and illness. Abnormal glucocorticoid response profiles, diminished immunity, and frequent illness are associated with unstable mating relationships for parents/caretakers and household compositon. We suggest that family relationships and concomitant stress and immunosuppression are important intermediary links between socioeconomic conditions and child health.(AU)


Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estresse Psicológico/metabolismo , Fatores Socioeconômicos , Nível de Saúde , Glucocorticoides/análise , Ritmo Circadiano/fisiologia , Escolaridade , Família , Tolerância Imunológica , Interleucina-1 , Interleucina-8 , Estudos Longitudinais , Inquéritos e Questionários , Radioimunoensaio , Saliva/química , Estações do Ano , Biopterina/análogos & derivados , Biopterina/sangue
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