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.

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.

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.

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.

Microbial quality of local and imported brands of bottled water in Trinidad [abstract]

A cross-sectional study was conducted to determine the microbial quality of local and imported brands of bottled water available in supermarkets, groceries, and parlours in Trinidad. A sample size of 344 bottles of water was determined by using a precision rate of 2 percent and a Type 1 error of 5 percent. These bottles were purchased from six geographical regions in Trinidad which represented the whole island. The membrane filter technique was used with cultures made on endo agar and Fc agar for total coliforms and faecal coliforms, respectively. Total aerobic plate count (TAPC) was determined on nutrient agar, Pseudomonas aeruginosa and Salmonella spp were assayed using standard methods. Of the 344 water samples tested, 239 (69.5 percent) and 105 (30.5 percent) were local brands and imported brands, respectively. Eighteen (5.2 percent) of 344 samples were contaminated by coliforms with a mean count of 0.88 2 ñ 6.38 coliforms per 100 ml while 5(1.5 percent) samples were contained Escherichia coli. The prevalence of total coliforms in local brands of bottled water was 7.5 percent (18 of 239) compared with 0.0 percent (0 of 105) detected in imported brands. The difference was statistically significant (p= 0.004). Similarly, the prevalence of aerobic bacteria in local brands of bottled water (34.7 percent) was significantly (p= 0.001) higher than that found in imported brands (17.1 percent). Among local brands, the prevalence of total coliforms ranged from 0.0 percent to 13.8 percent but the difference was not statistically significant (p= 0.121). However, the prevalence of aerobic bacteria among these local brands ranged from 5.0 percent to 88.5 percent and the difference was significant (p< 0.0001). All water samples tested were negative for faecal coliforms, Salmonella spp and P aeruginosa. It was concluded that based on the recommended zero tolerance for coliforms in potable water, 5 percent of bottled water sold in Trinidad could be considered unfit for human consumption. The need to implement national standards for bottled water in Trinidad cannot be over-emphasized. (AU)

Predictors of mortality in patients with left ventricular failure [abstract]

We retrospectively reviewed the clinical presentation and five-year mortality of 64 consecutive adults who underwent echocardiography at the Eric Williams Medical Sciences Complex between January 1992 and December 1994 with a left ventricular ejection fraction < 40 percent. The mean age was 60ñ12 years and 68 percent of patients were male. The prevalence of diabetes mellitus and hypertension was 40 percent and 46 percent, respectively. The mean left ventricle ejection fraction was 30ñ9 percent. The most common primary cost of left ventricular failure was coronary artery disease (CAD) in 47 percent, idiopathic dilated cardiomyopathy (9 percent), hypertensive heart disease (9 percent), alcohol related dilated cardiomyopathy (8 percent) and valvular heart disease (6 percent). Angiotensin converting enzyme inhibitors were prescribed in 85 percent of cases, diuretics (82 percent), digoxin (61 percent), warfarin (18 percent), beta blockers (10 percent), and amiodarone (8 percent). Survival data were available for 84 percent. Mortality was 53 percent at 5 years. Independent predictors of mortality were age, the use of beta blockers and left ventricular internal diameter. In conclusion, CAD was the most common cause of left ventricular failure. Five-year mortality was high, particularly in elderly patients with marked ventricular dilatation. (AU)

Two-Year Mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.(AU)

Two-year mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.

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)

Knowledge, beliefs and practices of breastfeeding among adults in Tobago East: preliminary findings - Poster abstract

OBJECTIVES: To evaluate the knowledge, beliefs and practices of breastfeeding among adults in Tobago East. DESIGN AND METHODS: A cross-sectional survey was conducted on adults aged > 18 years residing in Tobago East. All participants were interviewed using structured questionnaires. RESULTS: The study comprised 509 persons of who 312 (61 percent) were females. Ninety-five percent (95 percent), 69 percent and 48 percent of the respondents indicated that a baby should be exclusively breastfed at birth, 3 months and 6 months, respectively. The main source of information about breastfeeding was obtained from the health center (53 percent). The mother (50 percent) and both parents (29 percent) were thought to be responsible for making the decision to breastfeed. Sixty-three percent (63 percent) and 80 percent of the respondents did not know about "expressed breast milk and cup-feeding' of a new-born while 82 percent and 47 percent believed that the breastfed baby should be given water and that breastfeeding caused a woman's breast to sag. In addition, 23 percent and 44 percent felt that breastfeeding should be terminated <6 months of age and between 6 and 12 months, respectively. The respondents believed that inadequate maternal nutrition (35 percent) and maternal employment (26 percent) were the principal factors affecting breastfeeding. CONCLUSION: There is a low level of awareness among the respondents regarding the value of exclusive breastfeeding for the first six months. These findings can be used to guide the development and implementation of interventions to promote exclusive breastfeeding in Tobago.(AU)

Trends in asthma visits to accident and emergency centres in Trinidad during 1997 and associations with climate variables

OBJECTIVES: To describe trends in asthma visits to Accident and Emergency (A&E) facilities during 1997 and to examine their associations with climatic conditions. DESIGN AND METHODS: A census of patients with asthma, defined as those who required brochodilator nebulization, was taken at five A&E facilities in Trinidad. Data on patients' age, gender and date of visit were obtained from the A&E records and, climate variables, including rainfall, temperature, relative humidity, and wind speed, were obtained from the Meteorological Office. RESULTS: There was a total of 27,848 asthma visits to the five facilities during 1997, of which the paediatric population(<16 years) accounted for 43 percent. There were steady increases in adult and elderly visits from January to December. A sharp increase in paediatric visits was observed in September, which coincided with the start of the school year. The results of multiple regression analysis indicated that paediatric visits to the A&E were positively associated with temperature and wind speed, while adults' visits were positively associated with temperature and relative humidity. None of the climatic variables predicted asthma visits in the elderly. CONCLUSION: There is a need for further research to explain the increase in paediatric visits at the start of the school year as well as to elucidate the mechanism for the observed associations between climate and asthma visits. (Au)

Motivation for and concerns about entering a medical programme: a Caribbean perspective

OBJECTIVE: To determine the motivation for and concerns about studying medicine, and future career plans of students of Faculty of Medical Sciences, University of the West Indies (UWI). DESIGN AND METHODS: A cross-sectional survey that included year 1 medical students at both the Mona and St. Augustine medical schools of the UWI was conducted. A self-administered questionaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences held by students at entrance into the course of study, was used to collect the data. RESULTS: A total of 228 students took part in the study, 103 from Mona and 125 from St. Augustine. Seventy-three percent of the students were between 18 and 22 years of age with 61 percent being females and 39 percent males. The students gave the highest rating to those motives best described as people-oriented. These included interest in relations between health, well-being and society and caring for and working with people. The female students scored significantly higher than the males for most of those motives. However, males rate the social prestige/status motive significantly higher than females. The greatest concern of the students was fear of failure. Surgical specialities (43 percent), family medicine (38 percent) and paediatrics (34 percent) were the top choices of the students for future specialty. However, significantly more males chose surgery while more females chose obstetrics.(AU)

Desirable body size associated factors in Trinidadian adolescents

OBJECTIVES: To determine body size considered desirable by adolescents in Trinidad and to identify factors associated with it. DESIGN AND METHODS: A random sample of 1,139 adolescents, aged 14-17 years and attending secondary schools in Trinidad were selected for the study. Silhouettes of different body sizes were used to determine what was considered desirable body size. Weights and heights were measured to determine actual body size. RESULTS: 1,090 (96 percent) students participated, 512 males and 578 females. The calculated BMI indicated that 15 percent were underweight, 73 percent were normal and 13 percent were overweight. There was a significant gender difference in desirable body size (p<0.001). The majority of females (83 percent) wanted to be normal while 13 percent wanted to be underweight. In contrast, 66 percent of males wanted to be normal and 31 percent overweight. In males, sports personalities (55 percent) and movie stars (31 percent) were most important in influencing desirable body size while movie stars (44 percent) and fashion models (43 percent) were most important for females. There was no association between actual and desirable body size in females but the association was significant in males (p=0.004). More overweight males chose the overweight figure (45 percent) compared with normal (31 percent) or underweight (23 percent) males. Although 41 percent of adolescents said that they would like to remain the same size, more females (37 percent) than males (20 percent) said that they wanted to lose weight while more males (38 percent) than females (3 percent) wanted to gain weight (p<0.001). CONCLUSION: It is important that appropriate intervention be implemented to address this desire by adolescent males to be overweight.(Au)

Chlamydia trachomatis antibody and DNA determination in ectopic pregnancy in Trinidad

OBJECTIVE: To determine the prevalence of C. trachomatis in ectopic pregnancy by serum IgG and IgM antibody and by chlamydia DNA in endometrial, Fallopian tube and ovarian tissues. DESIGN AND METHODS: A cross-sectional study included 32 women presenting with tubal ectopic pregnancy and 94 fertile controls. Methods employed were ELISA for IgG and IgM and Polymerase Chain Reaction (PCR) and in situ hybridization (ISH) for DNA. RESULTS: Chlamydial IgG and IgM antibody detection was higher in the ectopic than the control groups (IgG, p<0.01; IgM, p<0.01). A similar finding was also noted for chlamydia DNA by PCR (p<0.05). DNA detection was also significantly higher at each site in the upper genital tract (endometrium p<0.01, Fallopian tube p<0.05, ovary p<0.05). CONCLUSION: By antibody detection, this study confirms the role played by genital tract C. trachoma infection and subsequently ectopic pregnancy, but more importantly, identifies chlamydial DNA in upper genital tract tissues. These results support allocation of resources towards screening programmes for C. trachomatis.(Au)

A one year-review of anti-epileptic drug monitoring in Trinidad

OBJECTIVE: To audit anti-epileptic drug monitoring in tertiary hospitals in Trinidad. METHODS: Epileptic patients, from hospital clinics, who were receiving maintenance therapy and were referred for plasma drug level monitoring, gave informed consent and were enrolled. Blood collection was at trough levels of drug and coded plasma samples were analysed by competitive immunoassay on the TDx Monitoring system. RESULTS: All 93 patients consented to participate. Phenytoin and carbamazepine were the two major drugs prescribed. The use of multiple drugs did not influence the occurrence of seizures in the patients; (31 percent) receiving polytherapy. Phenobarbital was the most frequent agent added to the drug regime in 24/9 patients (83 percent). Low plasma levels of drugs were detected in 58 percent and 36 percent of patients receiving polytherapy with phenytoin and carbamazepine respectively; but an association was not found between the range of drug levels and the frequency of seizures. Seventy-seven (83 percent) patients reported good compliance. Plasma drug levels were significantly below normal (p=0.004) in patients who reported poor compliance. CONCLUSIONS: Multiple drug therapy did not influence the prognosis of seizure control in this study. Suspected non-compliance, drug toxicity and failure to individualize dosing are considerations for plasma level drug monitoring in the protocol for management of epilepsy.(Au)

Experiences and socialization of Jamaican men with multiple sex partners

One of the goals of the Acquired Immunodeficiency Syndrome (AIDS) control programme in Jamaica is to encourage persons to have a single sex partner. Before this can be achieved in men, it is important to identify the demographic characteristics as well as the sexual attitudes and socialization of men who have multiples sex partners. A national survey was conducted on sexual decision-making in Jamaica in which a random sample of 3,001 persons was selected for study and 2,580 (86 percent) interviewed 979 were men. The following analyses included the 769 men who where sexually active. Thirty-four percent (34 percent), 95 percent CI, 30.6-37.4 percent) of these men said that they were currently having sex with more than one woman. Although condom use was higher in men with multiple sex partners. 33 percent of them said that they never used condoms. Independent predictors of having multiple sex partners were: not being in a stable union; being raised by fathers only; and having a secondary school education. There was no significant association with church attendance or with occupation. Compared with other males, men who had multiple sex partners started having sex at an earlier age and were more likely to engage in high-risk sex behaviours such as having sex with prostitutes and abusing drugs prior to coitus. They were also more likely to believe in the use of sex as a means to control their partners and were less likely to think that being married or involved in a long-term relationship was important. These data must be taken into considerations by the AIDS control programme in Jamaica when formulating policies to promoted monogamy. There may also be a need to implement parenting support or education programmes for single men who raise their sons.(AU)

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

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

Perceptions about mental illness among pre-clinical medical students in Trinidad and Tobago

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad and Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88 percent felt that medical treatment in hospital was the best means of treating the illness and 86 percent suggested that discharge should be conditional on regular visits to a doctor. 89 percent however opposed the patient's marrying into their families and 85 percent to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illnes (p < 0.03). Surprisingly, 25 percent believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.(AU)

High rates of paraquat-induced suicide in southern Trinidad

The suicide rate in Trinidad and Tobago is much greater than that of its English-speaking Caribbean neighbors. Many of these suicides are paraquat induced. This research reviewed the deaths due to suicide in the area with the greatest agricultural activity in Trinidad for 1996 and identified, for further demographic and etiological investigation, cases in which paraquat was ingested as the agent of suicide. Of 48 cases of suicide for the year, 39 (81.3 percent) were due to paraquat poisoning. The incidence of paraquat-induced suicide was 8.0 per 100,000. Among the males, 47.8 percent were in the age group 25-34 (p< 0.001), and among the females 50.0 percent were in the 15-4 age group (p < 0.05). Family-of-origin disputes were the most frequently cited precipitant, folllowed by marital problems. Individuals of East Indian origin accounted for 89 percent of the suicide victims (p < 0.001). When compared with suicide by other methods in the country, these findings confirm that paraquat poisoning is a significant means of suicide in Trinidad and that young East Indian individuals are particularly vulnerable.(AU)