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1.
BMC Public Health ; 20(1): 188, 2020 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-32028917

RESUMEN

BACKGROUND: Partner concurrency, (having sexual partnerships overlapping in time), especially when condoms are not used, can facilitate sexually transmitted infections (STI) transmission. In Britain, STI diagnoses rates and the reporting of concurrency are higher among black Caribbeans than other ethnic groups. We explored attitudes towards, drivers, characteristics, and contexts of concurrent partnerships, and their implications for STI risk among black Caribbeans in England. METHODS: Purposive sampling, by sex and age-groups, was used to recruit participants (overall n = 59) from five sexual health clinics and community settings in London and Birmingham, England. Audio-recorded four focus group discussions (n = 28 participants), and in-depth interviews (n = 31) were conducted (June 2014-December 2015). Transcribed data were thematically analysed using Framework Analysis. RESULTS: 'Main plus' and 'non-main' concurrency were identified in this population. Main plus concurrency involves an individual having a main partner with whom s/he has a "relationship" with, and the individual and/or their partner secretly or explicitly have other non-main partners. In contrast, non-main concurrency entails having multiple, non-committed partners overlapping in time, where concurrency is usually taken as a given, making disclosure to partners irrelevant. While main partnerships were usually long-term, non-main partnerships ranged in duration from a single event through to encounters lasting several months/years. Condomless sex was common with ex/long-term/married/cohabiting partners; whereas condoms were typically used with non-main partners. However, condom use declined with partnership duration and familiarity with partners. Awareness of partners' concurrency facilitated condom use, STI-testing, and partner notification. While unresolved feelings, or sharing children with ex-partners, usually facilitated main plus concurrency; non-main concurrency was common among young, and single people. Gender norms, notions of masculinity, and sexual desires influenced concurrency. Black Caribbean popular music, social media, peer pressure, and relationship norms among black Caribbeans were also perceived to encourage concurrency, especially among men and young people. CONCLUSIONS: Concurrency among black Caribbeans is shaped by a complex interaction between emotional/psychological, interpersonal, sociocultural, and structural factors. Concurrency type, its duration, and awareness influence sexual health choices, and thus STI risk in this population. Collecting these data during clinic consultations could facilitate offering partner notification methods tailored to concurrency type. Gender- and age-specific, culturally-sensitive interventions addressing STI risks associated with concurrency are needed.


Asunto(s)
Grupo de Ascendencia Continental Africana/psicología , Actitud/etnología , Conducta Sexual/etnología , Parejas Sexuales/psicología , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Región del Caribe/etnología , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Enfermedades de Transmisión Sexual/etnología , Adulto Joven
2.
J Relig Health ; 59(1): 431-451, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31828596

RESUMEN

Religion, a prominent factor among Black diasporic communities, influences their health outcomes. Given the increase in Black Caribbeans living in the United States, it is important to understand how religion's function among different ethnic groups of Black Americans. We systematically reviewed four databases and included articles of any study design if they (a) focused on the religious experiences of emerging adults (18-29 years) identifying as Black Caribbean in the United States, in light of medical, public health, or mental health outcomes, and (b) were published before November 30, 2018. Study results contribute to future studies' conceptualization and measurement of religion among Black Caribbean emerging adults.


Asunto(s)
Grupo de Ascendencia Continental Africana , Estado de Salud , Religión , Espiritualidad , Adulto , Afroamericanos , Región del Caribe/etnología , Emigración e Inmigración , Femenino , Humanos , Masculino , Salud Mental/etnología , Estados Unidos
3.
Prostate ; 80(4): 329-335, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31868959

RESUMEN

BACKGROUND: Several studies in the Caucasian population have shown that patients with Gleason 6 prostate cancer, based on surgical specimens, have low or no risk of metastasis. However, there is no data for men of African ancestry. The objective of this study was to estimate the overall, specific, and metastasis-free survival (MFS) of patients with a Gleason 6 score, based on the surgical specimen. PATIENTS AND METHODS: This was a monocentric retrospective study that included 723 consecutive patients treated by radical prostatectomy between 1 January 1 2000 and 31 March 2018, with a Gleason score of 6 based on the surgical specimen. Specific survival (SS) was defined as the time elapsed between surgery and death attributed to prostate cancer. Overall survival was defined as the time elapsed between surgery and death from all causes. The causes of death were verified in the medical records. Survival analyses without biochemical recurrence (BCR) and without salvage treatment were performed according to the Kaplan-Meier method. The Cox model was used for univariate and multivariate analyses. RESULTS: In total, 691 patients were included because 32 were excluded for missing data. Overall 5- and 10-year survival was 94.2% and 87.1%, respectively. SS and MFS were 100%, with a median follow-up of 8.5 years. The BCR rate was 16.5%, with a median time to BCR of 5.1 years. The frequency of salvage treatment was 13.0%, with a median time to surgery of 7.3 years. In univariate analysis, PSA, pathological stage, seminal vesicle invasion, positive margins, and lymph node dissection were significantly associated with an increased risk of BCR and salvage treatment, but only PSA and positive margins were significantly associated by multivariate analysis. DISCUSSION/CONCLUSION: No metastasis or disease-specific deaths were observed for men with Gleason score ≤6 prostate cancer at radical prostatectomy, in particular, men of African ancestry.


Asunto(s)
Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/mortalidad , Anciano , Región del Caribe/etnología , Estudios de Cohortes , Guadalupe/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Tasa de Supervivencia
4.
BMC Public Health ; 19(1): 1646, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31805909

RESUMEN

BACKGROUND: Sub-Saharan and Caribbean immigrants are particularly affected by HIV in Europe, and recent evidence shows that a large portion of them acquired HIV after arrival. There is a need for efficient interventions that can reduce immigrants' exposure to HIV. We describe the pilot phase of a community-based empowerment outreach intervention among sub-Saharan and Caribbean immigrants in the greater Paris area aimed at 1) constructing the intervention, 2) assessing its feasibility, and 3) assessing the feasibility of its evaluation based on a stepped-wedge approach. METHODS: 1) To develop the intervention, a literature review was conducted on existing interventions and participatory approaches developed, including the constitution of peer groups. 2) To assess the intervention's feasibility, a pilot was conducted between April 2018 and December 2018. A daily register was used to collect data on sociodemographic characteristics of all persons who visited the mobile team to assess eligibility and acceptability. 3) To assess the feasibility of performing a stepped-wedge trial to evaluate the intervention, we compared eligibility, enrolment and retention at 3 months in two arms (immediate vs deferred). Chi-squared tests were used to compare reach and retention between the two arms. RESULTS: Intervention development. The Makasi intervention was designed as an outreach intervention that starts with the persons' capacities and helps them appropriate existing resources and information and obtain knowledge about sexual health, based upon motivational interviewing techniques. Intervention Feasibility. Between April 2018 and December 2018, a total of 485 persons were identified as eligible. Participation in the intervention was proposed to 79% of eligible persons. When proposed, the persons enrolled in the intervention with a response rate of 69%. Some were lost to follow-up, and 188 persons were finally included. Evaluation Feasibility. The proportions of eligible (45 and 42%) individuals and of enrolled individuals (65 and 74%) were similar and not significantly different in the immediate and deferred arms, respectively. CONCLUSIONS: A community-based outreach intervention aimed at improving sub-Saharan and Caribbean immigrants' empowerment in sexual health is feasible. The pilot phase was key to identifying challenges, designing a relevant intervention and validating the stepped-wedge protocol for evaluation.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Relaciones Comunidad-Institución , Emigrantes e Inmigrantes/psicología , Empoderamiento , Salud Sexual , Adulto , África del Sur del Sahara/etnología , Región del Caribe/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Paris , Proyectos Piloto
5.
Int J Equity Health ; 18(1): 158, 2019 10 16.
Artículo en Inglés | MEDLINE | ID: mdl-31619244

RESUMEN

BACKGROUND: There has been an increasing number of refugee women globally; yet, there is little recent data describing the health profile of refugee women by region of origin in the United States. It is important to monitor the health status of women by region of origin to provide needed targeted interventions. METHODS: We analyzed the Refugee Health Electronic Information System (RHEIS), a population-based dataset that included 14,060 female refugees who entered California between October 3, 2013 and February 15, 2017. We assessed differences in health status by region of origin. RESULTS: Almost one out of three women experienced a traumatic event. Women from Africa and Latin America and the Caribbean experienced higher levels of trauma compared to other regions, including sexual assault, physical, and weapon assault. More than half of women and girls (56.6%) reported experiences of persecution, with Southeast Asians reporting the highest levels. Among women of reproductive age, 7.0% of women were currently pregnant at the time of arrival to the US, 19.0% ever had a spontaneous abortion, and 8.6% reported ever having an abortion. One in three women from Africa reported female genital cutting. Moreover, 80.0% of women reported needing language assistance at the time of their health assessment. CONCLUSIONS: Refugee women and girls experience high levels of trauma and persecution, suggesting the need for trauma-informed care. Those working with refugee women, such as resettlement agencies and health providers, should be equipped with information about antenatal care, nutrition, and pregnancy to newly arrived women. Lastly, differences in health status by region of origin indicate a need for tailored interventions and linguistically appropriate health information.


Asunto(s)
Estado de Salud , Refugiados/estadística & datos numéricos , Salud de la Mujer/estadística & datos numéricos , Adolescente , Adulto , África/etnología , California , Región del Caribe/etnología , Conjuntos de Datos como Asunto , Femenino , Humanos , América Latina/etnología , Embarazo , Adulto Joven
6.
J Youth Adolesc ; 48(11): 2271-2291, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31587176

RESUMEN

Adolescents are connected to multiple and interrelated settings (e.g., family, school), which interact to influence their development. Using the National Survey of American Life-Adolescent (NSAL-A), a nationally representative cross-sectional survey, this study examined patterns of social connection and Black adolescents' wellbeing and whether social connection-wellbeing links differed by ethnicity and gender. The sample included 1170 Black adolescents ages 13-17 (69% African American, 31% Caribbean Black, 52% female, mean age 15). Latent profile analysis was used to identify profiles of adolescent connections across family, peer, school, religion, and neighborhood settings. Four profiles of social connection emerged: unconnected, minimal connection, high family connection, and well-connected. The profiles differed in life satisfaction, self-esteem, mastery, coping, perceived stress, and depressive symptoms. The well-connected profile, characterized by connection to all five settings, had significantly higher life satisfaction, self-esteem, mastery, and coping, and lower perceived stress compared to the unconnected and minimal connection profiles and lower depressive symptoms than the unconnected profile. The well-connected profile also had better self-esteem and coping compared to the high family connection profile. The youth in the unconnected profile had significantly lower self-esteem and mastery and significantly higher depressive symptoms than the minimally connected youth. Moderation analyses showed no differences by ethnicity. However, differences by gender were observed for the association between connectedness and life satisfaction. The results support the critical need to examine connectedness across multiple settings and within group heterogeneity among Black youth to develop strategies to promote their psychosocial wellbeing.


Asunto(s)
Afroamericanos/psicología , Depresión/psicología , Autoimagen , Identificación Social , Red Social , Adolescente , Grupo de Ascendencia Continental Africana/psicología , Región del Caribe/etnología , Estudios Transversales , Depresión/etnología , Femenino , Humanos , Masculino , Grupo Paritario , Instituciones Académicas
7.
BMC Health Serv Res ; 19(1): 668, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533716

RESUMEN

BACKGROUND: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS: BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud Sexual , Adolescente , Adulto , Grupo de Ascendencia Continental Africana/etnología , Anciano , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Región del Caribe/etnología , Estudios Transversales , Inglaterra/epidemiología , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Asunción de Riesgos , Factores Sexuales , Conducta Sexual/etnología , Parejas Sexuales , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/etnología , Encuestas y Cuestionarios , Adulto Joven
8.
AIDS Behav ; 23(9): 2514-2521, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31520239

RESUMEN

To inform the development of interventions to increase uptake and adherence to antiretroviral therapy (ART), we explored perceptions of ART in semi-structured interviews with 52 men and women from UK black African and black Caribbean communities. Verbatim transcripts were analyzed using framework analysis. Perceptions of ART could be grouped into two categories: doubts about the personal necessity for ART and concerns about potential adverse effects. Doubts about necessity stemmed from feeling well, doubts about the efficacy of ART, religious beliefs and the belief that treatment was futile because it could not cure HIV. Concerns about adverse effects included the fear that attending HIV services and taking treatment would lead to disclosure of HIV, feeling overwhelmed at the prospect of starting treatment soon after diagnosis, fears about side effects and potential long-term effects, and physical repulsion. The findings will facilitate the development of interventions to increase uptake and adherence to ART.


Asunto(s)
Grupo de Ascendencia Continental Africana/psicología , Miedo , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Adulto , África del Sur del Sahara/etnología , Grupo de Ascendencia Continental Africana/etnología , Región del Caribe/etnología , Estudios Transversales , Revelación , Femenino , Infecciones por VIH/psicología , Humanos , Entrevistas como Asunto , Masculino , Cumplimiento de la Medicación/etnología , Persona de Mediana Edad , Percepción , Investigación Cualitativa , Religión , Estigma Social , Reino Unido/epidemiología
10.
BMC Public Health ; 19(1): 1146, 2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31429735

RESUMEN

BACKGROUND: UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COM-B framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. METHODS: An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COM-B framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. RESULTS: Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques. CONCLUSION: Use of COM-B and the BCW highlighted the need for an intervention to address motivational and social opportunity barriers to engaging in healthful behaviours, as well as addressing key gaps in knowledge. This framework facilitated the linkage of theoretical behaviour constructs with evidence-based behaviour change techniques, which will enable us to evaluate operationalisation of our chosen BCTs and their impact on behaviour change in a future feasibility study.


Asunto(s)
Terapia Conductista/educación , Asistencia Sanitaria Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/etnología , Dieta para Diabéticos/métodos , Educación del Paciente como Asunto/métodos , Automanejo/educación , Adulto , Grupo de Ascendencia Continental Africana/educación , Terapia Conductista/métodos , Región del Caribe/etnología , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos/etnología , Dieta Saludable/etnología , Dieta Saludable/métodos , Ejercicio Físico , Femenino , Grupos Focales , Conductas Relacionadas con la Salud/etnología , Estilo de Vida Saludable , Humanos , Masculino , Persona de Mediana Edad , Motivación , Evaluación de Programas y Proyectos de Salud , Automanejo/métodos , Apoyo Social , Reino Unido
11.
J Relig Health ; 58(5): 1857-1871, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31313108

RESUMEN

Florida has the highest number of PLWH in the USA, with the highest incidence being among young African-Americans. The purpose of this qualitative inquiry was to gain an understanding of the knowledge and attitudes to HIV/AIDS among Afro-Caribbean adolescents. Using a faith-based community, we conducted four focus group sessions with 40 Afro-Caribbean teens. Descriptive content and thematic analyses were used to examine the data. Themes identified include awareness gap, temptation everywhere, testing anxiety and stigma. Recommendations include continued exploration and interventions to address stigma in faith-based communities. Implications are discussed.


Asunto(s)
Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Afroamericanos/psicología , Región del Caribe/etnología , Florida/epidemiología , Grupos Focales , Infecciones por VIH/etnología , Humanos , Investigación Cualitativa
12.
Psychooncology ; 28(8): 1712-1720, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31216078

RESUMEN

OBJECTIVE: Evidence suggests that treatment side-effects of prostate cancer (CaP) substantially affect the psychosocial well-being of affected men and their partners. However, this phenomenon is poorly understood among high risk (1 in 4) Black African (BA)/Black Caribbean (BC) men and their partners, as they are currently under-represented in global research on CaP survivorship. This study explored the psychosocial experiences of BA/BC men with CaP and their partners in the United Kingdom as they lived through the side effects of CaP treatment within their own sociocultural and marital contexts. METHODS: Using constructivist grounded theory methodology, interviews and focus groups were conducted with eligible men (n = 25), partners (n = 11), and health care professionals (HCPs) (n = 11) recruited in England. Data were iteratively analysed using constant comparison following the key stages of initial, focused, and theoretical coding until saturation was achieved. RESULTS: Data analysis culminated in the development of a substantive theory "man in the driving seat," which describes the experiences of BA/BC men with CaP and their partners within their context. Culturally informed gender roles and identities influenced how men and partners responded and coped with the side effects of CaP treatment. There was a hierarchy of power within the BA/BC relationship, in which men were dominantly positioned as leaders, whilst partners mostly operated from a supportive but "accepting" position. CONCLUSION: Inclusive and culturally sensitive individual and couple-focused psychosocial support, which is devoid of stereotyping and recognises the experiences of both BA/BC men and their partners is recommended.


Asunto(s)
Grupo de Ascendencia Continental Africana , Conocimientos, Actitudes y Práctica en Salud , Masculinidad , Neoplasias de la Próstata , Esposos , Adulto , Grupo de Ascendencia Continental Africana/etnología , Grupo de Ascendencia Continental Africana/psicología , Anciano , Región del Caribe/etnología , Grupos Focales , Teoría Fundamentada , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/psicología , Neoplasias de la Próstata/terapia , Investigación Cualitativa , Esposos/etnología , Esposos/psicología , Reino Unido/etnología
13.
Psychooncology ; 28(6): 1321-1327, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30953381

RESUMEN

OBJECTIVE: The aim of this study was to explore Trinidad and Tobago (TT) men's prediagnosis experiences of prostate cancer (PCa). This study is part of a wider project that examined men and their partners' experiences of routes to diagnosis for PCa in TT. METHODS: Men (n = 51) were voluntarily recruited to semi-structured interviews from four centres. Data were analysed following principles of grounded theory. RESULTS: Major barriers to medical help seeking were highlighted as lack of knowledge and awareness of the prostate gland and symptoms of PCa, the digital rectal exam (DRE), prostate-specific antigen (PSA), cultural and religious beliefs, and hegemonic masculinity norms and nonreporting of bodily changes to GPs. Fear of DRE, distrust in providers, and misinterpretation of bodily changes as related to ageing and diabetes mellitus also contributed to delays towards seeking medical help. Men's interactions with pharmacists and traditional healers lengthened the time taken to consult with health care providers for prostate concerns. CONCLUSIONS: TT men's PCa prediagnosis experiences are important to unearth barriers and facilitators to care along routes to diagnosis for this disease. This can help target specific health promotion strategies to motivate men to seek medical care for symptoms in a timely manner.


Asunto(s)
Grupo de Ascendencia Continental Africana/etnología , Detección Precoz del Cáncer/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Neoplasias de la Próstata/diagnóstico , Adulto , Anciano , Región del Caribe/etnología , Humanos , Masculino , Persona de Mediana Edad , Trinidad y Tobago/etnología
14.
BMJ Open ; 9(2): e023733, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30826792

RESUMEN

INTRODUCTION: Black British communities are disproportionately burdened by type 2 diabetes (T2D) and its complications. Tackling these inequalities is a priority for healthcare providers and patients. Culturally tailored diabetes education provides long-term benefits superior to standard care, but to date, such programmes have only been developed in the USA. The current programme of research aims to develop the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) culturally tailored T2D self-management programme for black British communities and to evaluate its delivery, acceptability and the feasibility of conducting a future effectiveness trial of HEAL-D. METHODS AND ANALYSIS: Informed by Medical Research Council Complex Interventions guidance, this research will rigorously develop and evaluate the implementation of the HEAL-D intervention to understand the feasibility of conducting a full-scale effectiveness trial. In phase 1, the intervention will be developed. The intervention curriculum will be based on existing evidence-based T2D guidelines for diet and lifestyle management; codesign methods will be used to foster community engagement, identify the intervention's underpinning theory, identify the optimal structure, format and delivery methods, ascertain adaptations that are needed to ensure cultural sensitivity and understand issues of implementation. In phase 2, the intervention will be delivered and compared with usual care in a feasibility trial. Process evaluation methods will evaluate the delivery and acceptability of HEAL-D. The effect size of potential primary outcomes, such as HbA1c and body weight, will be estimated. The feasibility of conducting a future effectiveness trial will also be evaluated, particularly feasibility of randomisation, recruitment, retention and contamination. ETHICS AND DISSEMINATION: This study is funded by a National Institute of Health Research Fellowship (CDF-2015-08-006) and approved by National Health Service Research Ethics Committee (17-LO-1954). Dissemination will be through national and international conferences, peer-reviewed publications and local and national clinical diabetes networks. TRIAL REGISTRATION NUMBER: NCT03531177; Pre-results.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Estilo de Vida Saludable , Automanejo , Grupo de Ascendencia Continental Africana , Región del Caribe/etnología , Asistencia Sanitaria Culturalmente Competente , Diabetes Mellitus Tipo 2/etnología , Inglaterra/epidemiología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
No convencional en Inglés | MedCarib | ID: biblio-1026221

RESUMEN

Objective: To determine the prevalence of Salmonella species during slaughtering and dressing of broiler chickens at four poultry processing plants in Trinidad using three isolation methods. Design and Methodology: In this cross-sectional study, a total of 396 samples were collected from all four commercial poultry processing plants in Trinidad. Samples collected comprised swabs of cloacae pre-slaughter, pre evisceration and post evisceration carcasses; immersion chiller water, neck skins, whole carcasses and chicken parts (final product). Isolation and identification of Salmonella spp. were performed using standard bacteriological techniques (whole carcass enrichment, whole carcass rinse and neck skin methods). Results: The overall prevalence of Salmonella spp. was 27.5% (109/396). The prevalence of Salmonella spp. was 2.2% (2/90), 55.6% (25/45), 37.8% (17/45), 27.8% (25/90), 5.6% (2/36), 44.4% (20/45) and 40.0% (18/45) for cloacal swabs, preevisceration carcasses, post evisceration carcass swabs, neck skins, immersion chiller water, whole carcass and chicken parts respectively (p<0.001). Salmonella was isolated from 52.3% (46/88), 19.3% (34/176), 11.4% (5/44) and 27.3% (24/88) of the samples from Plant A, B, C and D respectively (p<0.001). Overall, Salmonella was detected in 27.2% (49/180), 27.8% (25/90) and 39.4% (71/180) carcasses by whole carcass rinse, neck skin method and whole carcass enrichment method respectively (p= 0.028). Conclusion: Data from the study indicate the extent of contamination by Salmonella spp. throughout the various stages of broiler processing at the four plants studied and, of significance is the risk of salmonellosis posed to consumers of contaminated, undercooked chicken sold to retail outlets by these processing plants in the country.


Asunto(s)
Animales , Salmonella , Trinidad y Tobago , Región del Caribe/etnología
16.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
No convencional en Inglés | MedCarib | ID: biblio-1026239

RESUMEN

Objective: Angiostrongylus cantonensis or the rat lungworm can cause eosinophilic meningitis in humans. The Giant African snail has been reported to be a suitable intermediate host for this parasite. As the population of Giant African snails has recently exploded, there is an increased risk of transmission of this helminths to humans residing in this country. Therefore the objective of this study is to detect the presence of the rat lungworm in the Giant African Snails in Trinidad by conventional polymerase chain reaction (PCR). Design and Methodology: A total of 178 Giant African snails were collected from ten different locations throughout Trinidad. DNA was extracted from 25 mg of the mantle of each Giant African snail using the DNeasy® PoweSoil® Kit. Conventional PCR was performed using the primers AngioF1 and AngioR1 to amplify a 1,134bp fragment of the 18S rRNA gene of Angiostrongylus spp. The PCR reactions and conditions were are adapted from Qvarnstrom et al in 2007(1). Results: Six of the DNA extracted samples were positive for Angiostrongylus spp. by conventional PCR. Conclusion: Giant African snails in Trinidad are a suitable intermediate host for the rat lungworm and can increase transmission of these helminths to humans. Therefore Angiostrongylus cantonensis infection should be considered to be a differential for eosinophilic meningitis in humans.


Asunto(s)
Animales , Angiostrongylus cantonensis , Caracoles , Trinidad y Tobago , Región del Caribe/etnología
17.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
No convencional en Inglés | MedCarib | ID: biblio-1026242

RESUMEN

Objective: To determine the immune response of dogs by measuring the levels of cytokines tumour necrosis factor (TNF) α, interleukin (IL)-4 and interferon (IFN) γ pre- and post-vaccination with a locally produced killed whole-celled Leptospira vaccine. Design and Methodology: Three separate vaccine-challenge experiments involving 21 beagle dogs were conducted. Study 1 (duration of immunity), used 6 vaccinated and 3 non-vaccinated (control) dogs. Vaccination was done at 12 and 16 weeks of age and challenged at 12 months of age with 1-2.5 x 108 live Leptospira. Study 2 (onset of immunity) also contained the same number of dogs as study 1. Vaccination was done at 12 and 16 weeks of age and challenged at 18 weeks of age. Study 3 (onset of immunity study), as study 2, used 4 vaccinated and two control dogs but challenged with 1-2.5 X 109 live Leptospira. Blood samples were collected to measure the levels of TNF α, IL-4 and IFN γ in dogs 2 days pre-challenge and daily thereafter until day 7 post-challenge. Results: For cytokine TNF α, pre-challenge levels for Study 1, 2 and 3 were 0.0000, 0.0755 and 0.0705 pg/ml which increased to a maximum post-challenge level of 49.05 pg/ml, 0.47 pg/ml and 1.667pg/ml respectively. For cytokine IL-4 and IFN γ the level increased from 0.00 pg/ml to a maximum post-challenge level of 52.67 pg/ml, 243.34 pg/ml and 989.14 pg/ml; and 281.91 pg/ml, 1223.85 pg/ ml and 1778.95 pg/ml respectively. Conclusion: The locally produced Leptospira vaccine induced immune response post-challenge with live Leptospira.


Asunto(s)
Animales , Perros , Leptospira/patogenicidad , Trinidad y Tobago , Región del Caribe/etnología
18.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
No convencional en Inglés | MedCarib | ID: biblio-1026258

RESUMEN

Objective: To prevent severe clinical and pathological findings of leptospirosis in dogs vaccinated against L. interrogans serovar Copenhageni. Design and Methodology: Two vaccination-challenge experiments involving 22 dogs were performed using a vaccine prepared from formalin-killed cultures of L. interrogans serovar Copenhageni. The dogs were challenged by administering a suspension of 1 x 109 of a virulent strain of serovar Copenhageni (8 mL) at 2 weeks (Study 1: Onset of immunity) and 14 months (Study 2: Duration of immunity) after primary and secondary vaccinations. Each dog was observed for clinical signs of leptospirosis for five weeks post-challenge (PC). Any dog which showed irreversible clinical signs of leptospirosis was humanely euthanized, and a necropsy performed. Results: One (20.0 %) vaccinated puppy in Study 1 showed mild clinical signs (PC) which lasted for one day. Five (100.0 %) non-vaccinated (controls) puppies exhibited irreversible signs of acute severe leptospirosis PC, as well as significant postmortem lesions consistent with leptospiral infection. In Study 2, no clinical signs were exhibited by the vaccinated group of dogs PC, while two (40.0 %) non-vaccinated dogs exhibited mild clinical signs for 2 to 3 days, after which they recovered. Conclusions: The vaccine was successful in protecting vaccinated dogs against acute leptospirosis 2 weeks and 14 months after a vaccination schedule of two doses of the bacterin (primary and booster doses), since all vaccinated dogs were clinically normal after challenge with a virulent inoculum of serovar Copenhageni.


Asunto(s)
Animales , Perros , Leptospirosis , Trinidad y Tobago , Región del Caribe/etnología , Perros
19.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
No convencional en Inglés | MedCarib | ID: biblio-1026444

RESUMEN

Objective: Gastrointestinal nematode (GIN) infestations of sheep are considered a major constraint to sheep production in the West Indies. Sheep are semiintensively managed under tropical conditions which are favorable for the development and survival of GIN. This study was conducted to determine if there was a relationship between GIN burdens in sheep with seasonality and management practices of farmers in Trinidad and Tobago (TT). Design and Methodology: Eighteen (18) farms were visited in Trinidad and 23 in Tobago on a monthly basis between January and December 2017. A maximum of ten sheep between three to nine months of age were selected using non-random sampling at each farm. Results: A total of 3053 fecal samples were collected and analyzed using the Modified McMaster Technique. A mixed effects Poisson regression model was constructed to analyze the relationship between eggs per gram (EPG) with season, management and deworming. The standard error was adjusted for clustering according to farm. EPG decreased according to wet season vs. dry season (coef. = - 0.6, 95% CI = -1.17 - -0.03, p = 0.039). Semiintensive management system experienced higher EPG than intensive system (coef. = 1.43; 95% CI = 0.72, - 2.14; p < 0.001). EPG did not vary significantly according to whether the farmer dewormed or not over the period (p = 0.54). Conclusion: Proper management is required for reducing the occurrence of GIN in sheep of TT throughout the year. Further investigation is needed to elucidate why EPG appear to be higher in the dry season than the wet season.


Asunto(s)
Animales , Fármacos Gastrointestinales , Ovinos , Trinidad y Tobago , Región del Caribe/etnología
20.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
No convencional en Inglés | MedCarib | ID: biblio-1026460

RESUMEN

Mycobacteria have, for a long time, been suspected to be causing severe disease in ornamental and farmed fish in Trinidad and Tobago (T&T), however, up to now, these mycobacteria species have not been identified and characterised. Many piscine mycobacteria species are also known to be zoonotic, potentially affecting human health. Objective: To identify and characterize the species of mycobacteria affecting fish (and possibly man) in T&T. Design and Methodology: Homogenised internal organs were collected from a total of 13 fish showing clinical signs consistent with mycobacterial infection. Samples were analysed using Ziehl-Neelsen (acid-fast) staining and real-time Polymerase Chain Reaction (rPCR). The species of mycobacteria were further characterised using conventional PCR targeting the 16s rRNA (564 bp), rpoB (396 bp) and sod (408 bp) genes. PCR products were sequenced and the sequences were compared with those from known and recently identified mycobacteria species through phylogenetic analysis. Results: Acid-fast non-branching bacilli were detected in all samples. All samples were also positive for Mycobacterium sp. by real-time PCR. Multi-gene phylogenetic analysis revealed the presence of two distinct species of mycobacteria. One aligned closely with Mycobacterium marinum, a well known pathogen affecting fish and man, and a second aligned closely with a species also known to affect both fish and humans, Mycobacterium stomatepiae. Conclusions: Phylogenetic analysis demonstrated the presence of two mycobacterium species in organs from fish showing clinical signs of Piscine Mycobacteriosis in T&T. Further work is needed to characterise these mycobacteria species and investigate their zoonotic potential.


Asunto(s)
Enfermedades de los Peces , Mycobacterium , Trinidad y Tobago , Región del Caribe/etnología
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