Investigation of syphilis immunology and Treponema pallidum subsp. pallidum biology to improve clinical management and design a broadly protective vaccine: study protocol.

BACKGROUND: The syphilis epidemic continues to cause substantial morbidity and mortality worldwide, particularly in low- and middle-income countries, despite several recent disease control initiatives. Though our understanding of the pathogenesis of this disease and the biology of the syphilis agent, Treponema pallidum subsp. pallidum has improved over the last two decades, further research is necessary to improve clinical diagnosis and disease management protocols. Additionally, such research efforts could contribute to the identification of possible targets for the development of an effective vaccine to stem syphilis spread. METHODS: This study will recruit two cohorts of participants with active syphilis infection, one with de novo infection, one with repeat infection. Whole blood specimens will be collected from each study participant at baseline, 4, 12, 24, 36, and 48 weeks, to track specific markers of their immunological response, as well as to compare humoral reactivity to Treponema pallidum antigens between the two groups. Additionally, we will use serum specimens to look for unique cytokine patterns in participants with early syphilis. Oral and blood samples, as well as samples from any syphilitic lesions present, will also be collected to sequence any Treponema pallidum DNA found. DISCUSSION: By furthering our understanding of syphilis pathogenesis and human host immune response to Treponema pallidum, we will provide important data that will help in development of new point-of-care tests that could better identify active infection, leading to improved syphilis diagnosis and management. Findings could also contribute to vaccine development efforts.

Ethnicity, body image perception and weight-related behaviour among adolescent Females attending secondary school in Trinidad / Etnicidad, percepción de la imagen del cuerpo y comportamiento respecto al peso entre las adolescentes que asisten a la escuela secundaría en trinidad

OBJECTIVE: The correlates of body image perception among an ethnically diverse group of adolescent females attending secondary school in Trinidad were investigated. METHODS: A cross-sectional survey was carried out among adolescent females from selected secondary schools in Trinidad. Participants completed a self-administered questionnaire consisting of sociodemographic items and standardized psychometric instruments. RESULTS: Two hundred and fifty-one students participated in the survey with an ethnic composition as follows: Indo-Trinidadian (35.9), Afro-Trinidadian (28.7), Indo-Afro mixed Trinidadian (21.9) and other (13.5). The results suggest that 2.4of the participants reported having a medical diagnosis for an eating disorder Indo-Trinidadians had significantly greater body dissatisfaction than Indo-Afro-mixed Trinidadians but not more than Afro-Trinidadians (p = 0.04). Also, a significantly higher proportion of Indo-Trinidadians engaged in binge eating behaviour compared to the other ethnic groups (p < 0.001). Afro-Trinidadians were more likely to use vomiting as a mean of weight control compared to Indo- and Indo-Afro-mixed Trinidadian (p < 0. 05). Fifty-one per cent of participants had a negative body image perception. Altered body image perception was associated with a significant higher mean Body Shape Questionnaire BSQ 16 score (p < 0.001) and increased likelihood of reporting being diagnosed with an eating disorder (OR = 2.03, 95CI: 1.78, 2.31; p = 0.01) compared to non-altered body image state. Eating Attitude Test (EAT-26) score was positively correlated with Drive-for-Thinness (p < 0.001) and BSQ16 (p < 0.001) scores and inversely correlated with the Rosenberg self-esteem score (p = 0.012). CONCLUSION: In this group of adolescents, there are ethnic differences in the level of concern over body image and associated eating, and weight-related behaviour.

Ethnicity, body image perception and weight-related behaviour among adolescent Females attending secondary school in Trinidad.

OBJECTIVE: The correlates of body image perception among an ethnically diverse group of adolescent females attending secondary school in Trinidad were investigated. METHODS: A cross-sectional survey was carried out among adolescent females from selected secondary schools in Trinidad. Participants completed a self-administered questionnaire consisting of sociodemographic items and standardized psychometric instruments. RESULTS: Two hundred and fifty-one students participated in the survey with an ethnic composition as follows: Indo-Trinidadian (35.9%), Afro-Trinidadian (28.7%), Indo-Afro mixed Trinidadian (21.9%) and other (13.5%). The results suggest that 2.4% of the participants reported having a medical diagnosis for an eating disorder Indo-Trinidadians had significantly greater body dissatisfaction than Indo-Afro-mixed Trinidadians but not more than Afro-Trinidadians (p = 0.04). Also, a significantly higher proportion of Indo-Trinidadians engaged in binge eating behaviour compared to the other ethnic groups (p < 0.001). Afro-Trinidadians were more likely to use vomiting as a mean of weight control compared to Indo- and Indo-Afro-mixed Trinidadian (p < 0. 05). Fifty-one per cent of participants had a negative body image perception. Altered body image perception was associated with a significant higher mean Body Shape Questionnaire BSQ 16 score (p < 0.001) and increased likelihood of reporting being diagnosed with an eating disorder (OR = 2.03, 95% CI: 1.78, 2.31; p = 0.01) compared to non-altered body image state. Eating Attitude Test (EAT-26) score was positively correlated with Drive-for-Thinness (p < 0.001) and BSQ16 (p < 0.001) scores and inversely correlated with the Rosenberg self-esteem score (p = 0.012). CONCLUSION: In this group of adolescents, there are ethnic differences in the level of concern over body image and associated eating, and weight-related behaviour.

Assessment of risk for type 2 diabetes mellitus in a Caribbean population with high diabetes-related morbidity

Diabetes mellitus is a major cause of morbidity in Trinidad and Tobago. Screening programmes are not incorporated in the health sector and the population at risk remains unaware of the benefits of screening. We investigated the risk of developing Type 2 diabetes mellitus in office workers with one risk factor. Participants were randomly selected from the urban corporate sector in Port of Spain. Fasting capillary blood glucose and the American Diabetes Association (ADA) questionnaire for major diabetes risk factors were used to assess risk. Student pharmacists approached 482 persons, of whom 317 consented to participate (66 response rate). There were 101 (32) men and 216 (68) women, 37 (39) were of African ancestry and 28 each were of East Indian and mixed ancestry. Family history was positive in 54. Thirty per cent (95) of the volunteers were at risk of developing Type 2 diabetes mellitus (41 men; 54 women). Based on the ADA questionnaire, 82 (78) of volunteers were at high risk for developing Type 2 diabetes mellitus. The ADA risk test and Impaired Fasting Glucose were both positive in 13 (14) volunteers. In subjects at risk, Body Mass Index (BMI) was > 25 kg/m2 in 74 (78) and the waist/hip ratio was 0.85. Approximately 30 of office staff was at risk of developing diabetes mellitus. The ADA questionnaire is a useful non-invasive measure which pharmacists can use to assess risk for Type 2 diabetes mellitus. The glucometer can be used for risk assessment providing that it is associated with a quality assurance programme and that diagnosis is confirmed with laboratory testing

Assessment of risk for type 2 diabetes mellitus in a Caribbean population with high diabetes-related morbidity.

Diabetes mellitus is a major cause of morbidity in Trinidad and Tobago. Screening programmes are not incorporated in the health sector and the population at risk remains unaware of the benefits of screening. We investigated the risk of developing Type 2 diabetes mellitus in office workers with one risk factor. Participants were randomly selected from the urban corporate sector in Port of Spain. Fasting capillary blood glucose and the American Diabetes Association (ADA) questionnaire for major diabetes risk factors were used to assess risk. Student pharmacists approached 482 persons, of whom 317 consented to participate (66% response rate). There were 101 (32%) men and 216 (68%) women, 37 (39%) were of African ancestry and 28% each were of East Indian and mixed ancestry. Family history was positive in 54%. Thirty per cent (95) of the volunteers were at risk of developing Type 2 diabetes mellitus (41 men; 54 women). Based on the ADA questionnaire, 82% (78) of volunteers were at high risk for developing Type 2 diabetes mellitus. The ADA risk test and Impaired Fasting Glucose were both positive in 13 (14%) volunteers. In subjects at risk, Body Mass Index (BMI) was > 25 kg/m2 in 74% (78) and the waist/hip ratio was 0.85. Approximately 30% of office staff was at risk of developing diabetes mellitus. The ADA questionnaire is a useful non-invasive measure which pharmacists can use to assess risk for Type 2 diabetes mellitus. The glucometer can be used for risk assessment providing that it is associated with a quality assurance programme and that diagnosis is confirmed with laboratory testing.

A developmental view of the comprehensive community mental health concept.

Apprehension and doubt about the Comprehensive Community Mental Health Center (CCMHC) service programs are felt by both mental health professionals and local and state government officials who have yet to see the comprehensive center operate independent of Federal financial support and consistent with the concept of total service. Critics and pessimists must recognize that the CCMHC must initially establish and maintain itself amid a network of local social and rehabilitation agencies before the goals spelled out as essential elements of service can be achieved. It is suggested that there are critical factors that affect the evolvement from Phase 1, in which the CCMHC directs attention to its own survival, to Phase 2, when the CCMHC can begin to deal effectively with the local problems of mental health.