Evaluative Research on Pharmacist-managed Diabetes Care: Focus on Self-Monitoring of Blood Glucose / Investigación Evaluativa sobre Atención a la Diabetes Gestionada por los Farmacéuticos: Enfoque del Automonitoreo de la Glucosa en Sangre

ABSTRACT Objective: Pharmacists have not demonstrated the ability to manage chronic diseases such as Type 2 Diabetes Mellitus, which is an ongoing problem in Trinidad and Tobago. The primary objective was to demonstrate that pharmacists can assist patients to achieve at least a 1% decrease in glycosylated haemoglobin (HbA1c). Methods: A randomized, controlled Pharmacist Evaluative Research Study compared the efficacy of pharmacist-managed care (the intervention), and routine standard management (control) of poorly controlled (abnormal HbA1c, blood pressure, blood glucose and lipid panel) adult diabetic patients. Participants in the intervention group met with the pharmacist at their respective primary care sites on a regular basis for an assessment of adherence to medications, barriers to adherence and education. Control group participants consisted of patients receiving routine care by their primary physician but with no direct intervention by the pharmacist except for the filling of prescriptions. Results: Seventy-five patients were initially recruited. Of these, 48 (20 intervention and 28 control) met the inclusion criteria. It was only possible to analyse the result from 20 patients: 14 (70%) intervention and 6 (21.4%) control because of incomplete collected data. A minimum decrease of at least 1% HbA1c was obtained by 8 (57%) intervention participants compared to 2 (33%) in the control group; while HbA1c remained unchanged for two participants, each in the intervention and control groups (14% and 33%, respectively). Conclusion: We could not conclude any statistical or clinical significance in the paper as the data could only be analysed using descriptive methods. Building a culture of research among pharmacists may promote the use of pharmacists as adjunctive healthcare practitioners to achieve better patient outcomes.

RESUMEN Objetivo: Los farmacéuticos no han demostrado ser capaces de manejar el tratamiento de enfermedades crónicas como el tipo 2 Diabetes mellitus, que es un problema actual en Trinidad y Tobago. El objetivo principal fue demostrar que los farmacéuticos pueden ayudar a los pacientes a lograr al menos una disminución del 1% en hemoglobina (Hba1C). Métodos: Un Estudio de Investigación Evaluativa Farmacéutico controlado aleatorio, comparó la eficacia de la atención gestionada por los farmacéuticos (intervención) y el manejo estándar de rutina (control) de pacientes diabéticos adultos con pobre control (niveles anormales de hemoglobina glicosilada, presión arterial, glucosa en sangre, y perfil lipídico). Los participantes en el grupo de intervención se reunieron de manera regular con el farmacéutico en sus respectivos centros de atención primaria para evaluar el cumplimiento con los medicamentos, así como los obstáculos a la observancia y la educación. Los participantes del grupo de control eran pacientes que recibían atención de rutina de parte de su médico primario, pero sin intervención directa del farmacéutico, excepto para el llenado de prescripciones. Resultados: Setenta-cinco pacientes fueron reclutados inicialmente. De estos, 48 (20 de intervención y 28 de control) cumplían los criterios de inclusión. Debido a que los datos recopilados estaban incompletos, sólo fue posible analizar el resultado de 20 pacientes: 14 (70%) de intervención y 6 (21.4%) de control. Una disminución mínima de al menos 1% de HbA1C fue obtenida por 8 (57%) participantes de intervención en comparación con 2 (33%) en el grupo de control, mientras que el HbA1C permaneció inalterado para 2 participantes, cada uno en los grupos de intervención y control (14% y 33%, respectivamente). Conclusión: Los datos apoyan la hipótesis de que la gestión de los farmacéuticos como profesionales complementarios de la salud, posibilita lograr mejores resultados en los pacientes, a diferencia de lo que ocurre en ausencia de tal gestión.

A point prevalence survey of health associated infections and antimicrobial use in a public health institution in Trinidad

Objective: The point prevalence survey is a validated tool for measuring the quality of prescribing in the hospital setting. The objectives were to estimate the prevalence of hospital acquired infections, to assess the antimicrobial agent prescribed and determine if prescribers followed existing evidence-based antimicrobial policies subsequent to diagnosis of infection in patients. Design and Methodology: Day-of-survey records of patients in the intensive care unit and medical/surgical wards were examined at the institution, retrospectively. The extracted clinical data were recorded on the standardized data collection instruments (hospital, ward and patient forms) and analysed. Results: Of the 130 patients surveyed, 30 had an infection which occurred within 48 hours of admission. The most commonly reported infection type was urinary tract infections, evident in 9 (30.0%) patients, caused by Escherichia coli in 7 patients and Klebsiella pneumonia in 2 patients. Out of the 30 patients, 10 (33.3%) were awaiting laboratory reports at the time of the survey. Resistance was noted for Staphylococcus aureus and Escherichia coli, both of which were seen in 2 patients and Enterococcus spp. in 1 patient. The antimicrobial agent selected to treat these microorganisms should have been queried. Conclusions: Results of this survey imply that public health surveillance and prevention activities should be implemented to address appropriate treatment of hospital acquired infections. Recommendations to minimize the risk of resistance include: improving the availability of alcohol-based hand rub, the provision of single room and isolation capacity, antimicrobial guidelines for treatment of infection, judicious prescribing and proper surveillance of prescribed antimicrobials.

Risk factors for first-time acute myocardial infarction patients in Trinidad.

BACKGROUND: The relative importance of coronary artery disease (CAD) risk varies globally. The aim of this study was to determine CAD risk factors for acute myocardial infarction (AMI) among patients in public health care institutions in Trinidad using a case-control type study design. METHODS: The sample comprised 251 AMI patients hospitalized between March 1, 2011 and April 30, 2012 and 464 age- and sex-matched non-AMI patients with no terminal or life-threatening illness and who did not undergo treatment for CAD. SPSS version 19 was used for data analysis that included chi-square tests, unadjusted and adjusted odds ratios (OR) and conditional multiple binary logistic regression. RESULTS: There was no difference in age between AMI and non-AMI patients (p = 0.551). Chi-square test revealed that clinical and lifestyle variables including stressful life, diabetes, hypertension, hypercholesterolaemia, ischaemic heart disease (IHD), a family history of IHD (p ≤ 0.001), smoking (p = 0.007) and alcohol consumption (p = 0.013) were associated with AMI; sex (p = 0.441), ethnicity (p = 0.366), age group (p = 0.826) and renal failure (p = 0.487) were not. Both unadjusted and adjusted (for age) ORs showed that the odds of hypertension, IHD and alcohol consumption were greater among AMI patients than among non-AMI patients for males; diabetes and IHD for females; and that the odds of a stressful life was greater among non-AMI patients and were the same for both groups with respect to sex, age > 45 years, hypercholesterolemia, renal insufficiency, and family history of IHD. Conditional multiple logistic regression showed that smoking [OR: 0.274, p ≤ 0.001, 95% CI for OR (0.140, 0.537)], a stressful life [OR: 2.697, p ≤ 0.001, 95% CI for OR (1.585, 4.587)], diabetes [OR: 0.530, p = 0.020, 95% CI for OR (0.310, 0.905)], hypertension [OR: 0.48, p = 0.10. 95% CI for OR (0.275, 0.837)] and IHD [OR: 0.111, p ≤ 0.001, 95% CI for OR (0.057, 0.218)] were the only useful AMI predictors. CONCLUSIONS: Smoking, diabetes, hypertension, IHD and decrease stress are useful AMI predictors.

Blood donors' attitudes towards voluntary non-remunerated donation in Trinidad and Tobago.

OBJECTIVES: To assess the attitude towards voluntary non-remunerated blood donation among blood donors in Trinidad and Tobago (TRT). BACKGROUND: Blood donors in TRT are either family replacement (F/R, 87%) or remunerated (13%). There is chronic blood shortage and high seroreactivity for transfusion-transmissible infections (TTI) in donors. Converting existing to voluntary non-remunerated donors (VNRD) reduces the need to recruit news donors in achieving 100% VNRD. METHODS: A questionnaire-based, cross-sectional survey was conducted at two blood collection centres at an interval of 8 years. Donors were surveyed for sociodemographic characteristics, awareness of the blood shortage, previous donation behaviour, donor-beneficiary linkage if F/R, willingness to become VNRD and choice of motivators for converting to VNRD. RESULTS: A total of 400 and 595 donors respectively participated in Surveys 1 and 2, of whom 92·8 and 86·3% were F/R (P < 0·001), respectively. In both surveys, 52% of participants were unaware of an existing blood shortage (P = 0·983). Only 9·8 and 9·1% of participants expressed unwillingness to become VNRD (P = 0·720). The main motivators to convert to VNRD were reminders from the centre (84%) and extended opening hours (78%) in Survey 1 as compared to confidence that donated blood was used properly (73%) and shortened waiting times to donate (73%) in Survey 2. CONCLUSION: Despite low awareness of blood shortage, willingness to become VNRD was high among existing donors. Accountability and donor convenience underpinned the main motivators for converting to VNRD.

National Alcohol Survey of households in Trinidad and Tobago (NASHTT): Alcohol use in households.

BACKGROUND: To determine the patterns of alcohol use among households in Trinidad and Tobago (T&T) and to estimate the association between alcohol use and negative psychological, social, or physical events experienced by the household. METHODS: A convenience sample of 1837 households across T&T. We identified bivariate correlates of alcohol use, and heavy episodic drinking using chi-square and t-test analyses and used multivariable logistic regression to estimate adjusted associations between household alcohol use and experiences within the past 12 months adjusted for sociodemographic covariates. RESULTS: One thousand five hundred two households had complete data for all variables (82% response rate). Nearly two thirds (64%) of households included alcohol users; 57% of household that consumed alcohol also reported heavy episodic drinking. Households that reported alcohol consumption were significantly more likely to report illnesses within the households, relationship problems, and behavioral and antisocial problems with children. Among households where a member was employed, those who consumed alcohol were nearly twice as likely (OR = 1.98; 95% confidence interval (CI) 1.03, 3.82) to have a household member call in sick to work and 2.9 times as likely (OR = 2.9; CI 1.19, 7.04) to have a household member suffer work related problems compared with households who reported not consuming alcohol. CONCLUSIONS: Approximately two thirds of households in T&T reported using alcohol. These households were more likely to report psychological, physical, and social problems. These findings would support efforts to enforce current policies, laws, and regulations as well as new strategies to reduce the impact of harmful alcohol consumption on households in T&T.

A cross-sectional study of dentine sensitivity in periodontitis patients in Trinidad and Tobago.

OBJECTIVE: This cross-sectional study aimed to determine the prevalence, distribution and associated factors of dentine sensitivity (DS) among periodontitis patients in Trinidad. METHODS: Sequential patients meeting the periodontitis criteria (BPE 4/4*) were included and completed a questionnaire on DS prior to a full periodontal examination. Clinically elicited symptoms of DS and presence of cervical tooth wear were recorded. RESULTS: DS prevalence was 73.1% (n = 130; mean age 50 years). Mean number of sensitive teeth increased with increased severity of gingival recession. Most common initiating factors of DS were cold stimuli (70.5%), brushing (25.3%) and sour food (11.6%). Correlations were obtained for DS and race, toothbrush texture hardness, cervical tooth wear and gingival recession severity (P < 0.05; binary logistic regression). Cervical tooth wear was recorded in 46.3% of DS patients. Full-mouth plaque scores (FMPS) and full-mouth bleeding scores (FMBS) were statistically significantly (P < 0.05; Mann-Whitney U) test lower for DS versus non-DS patients. Patients reported a low usage (27.4%) and satisfaction (53.8%) rating for desensitizing agents. CONCLUSIONS: The high prevalence of DS was comparable to other studies on periodontitis patients. Progressive periodontal disease and toothbrush abrasion were possible aetiological factors for DS in this study. Knowledge of local dietary practices and the role of acidic (sour) foods in eliciting DS may aid in management. The high prevalence of cervical tooth wear and the lower FMPS and FMBS among DS patients may reflect more aggressive tooth brushing. DS does not seem to be a limitation to plaque control in DS versus non-DS patients in this study.

National alcohol survey of households in Trinidad and Tobago (NASHTT): the impact of alcohol on households

OBJECTIVE: To determine the distribution of alcohol use among households (HHs) in Trinidad and Tobago (T&T) and, whether the HHs where alcohol was used were more likely to suffer negative psychological, social or physical events. DESIGN AND METHODS: A cross-sectional convenience sample of HHs was surveyed from a random sample of enumeration districts (ED). The interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after literature review and consultation. RESULTS: 1695 HHs (from 53 EDs) responded with a response rate (RR) of 92%. Sixty-two (62%) percent of HHs consumed alcohol, distributed with 1-2 users (46%), 3-4+ users (16%). Viewpoints and experiences about alcohol included: 'alcohol consumption at family gatherings is a normal occurrence' (70%). 29% of HHs consumed alcohol in the presence of children. HHs that consumed alcohol were significantly more likely to report in the last 12 months HHs members falling sick, experiencing lifestyle related illnesses, having relationship problems between partners, having strained relationships within the HH, HH members calling in sick to work, behavioural problems of children at home, anti-social problems of children at home/school and violent behaviour by a member of the HH (p

The national alcohol survey of households in Trinidad and Tobago (NASHTT): willingness to support changes in policy, laws and regulations

OBJECTIVE: This study set out to determine what proportion of Trinidad and Tobago (T&T) households (HHs) were willing to support changes in specific policies, laws and regulations in a national alcohol campaign. DESIGN AND METHODS: A cross-sectional convenience sample of HHs were surveyed from a random sample of enumeration districts (ED) in T&T. The interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after extensive literature review and consultation. Many of the WHO 'best buys' were included. RESULTS: 1695 HHs (from 53 ED) responded from a total of 1837 HHs approached, a response rate (RR) of 92%. In a national campaign the following proportions of HHs would support: setting the legal age for drinking at 21 years (82.4%); restricting (73.1%), banning (54.4%) alcohol advertising on TV and other media; banning all alcohol advertising at sports and cultural events (64.8%); banning radio stations playing songs with reference to alcohol use (71.3%); holding sellers of alcohol responsible for the amount of alcohol sold (79.5%); advocating that proof of age to be shown by persons buying alcohol (87.4%); placing more prominent warning labels on products displaying alcohol content (87.2%); placing more prominent warning labels on products showing harmful effects (88.5% ); increasing taxes on alcohol sales (87.7% ). CONCLUSIONS: HHs in T&T were willing to support changes in policies around alcohol, including many of the policies shown by the WHO to be effective in reducing the harmful consumption of alcohol.

Knowledge, awareness and attitudes of guardians in the community towards distribution of the HPV vaccine to primary and secondary school children in Trinidad

OBJECTIVE: To investigate the knowledge, awareness and attitudes of guardians towards the distribution of Gardasil to school children in the North Central Regional Health Authority jurisdiction of Trinidad. DESIGN AND METHODS: A cross sectional study utilizing a questionnaire was employed to collect data from 368 participants who reside in the North Central division of Trinidad. The statistical analysis included chi square tests and logistical regression. RESULTS: There was an increase in the approval rate of Human Papillomavirus (HPV) vaccine (32.4%) after the participants received further education. Guardians preferred the 12-14 (24.2%) and 9-11 (23.1%) age groups for vaccination. Religion did not influence the decision to vaccinate. About half (49.2%) of parents believed vaccination would not cause promiscuity. Women were more likely to approve of the vaccine (p=0.023). Most participants did not talk to a doctor about the vaccine (70.7%). The general opinion (44.9%) was that insufficient information was imparted for an informed decision to be made. CONCLUSION: There was approval of the HPV vaccine despite risks and lack of knowledge. A more effective vaccination program requires prolonged sensitization of the public on the HPV vaccine.

Relationship of fasting total homocysteine, high sensitivity C-reactive protein and features of the metabolic syndrome in Trinidadian subjects.

OBJECTIVES: To assess the relationship of homocysteine, hs-CRP, with known cardiovascular risk factors of the metabolic syndrome. METHOD: Cross sectional study comprised 182 diabetic outpatients (70 males and 112 females), attending endocrinology clinics in Trinidad. RESULTS: Both male and females showed significant linear relationships between high sensitive C-reactive protein (hs-CRP), blood pressure and diabetes (r = -0.2 < R or R > 0.2). In females hs-CRP showed significant linear relationship with HDL, triglyceride, blood pressure and diabetes mellitus (p < 0.0001). The inverse relationship of hs-CRP with HDL implies the strong association of hs-CRP with metabolic syndrome. The multivariate logistic regression analysis showed significant relation of hs-CRP, metabolic syndrome and diabetes mellitus. There was no significant relationship of tHCY to any of the features studied. CONCLUSION: Serum C-reactive protein is significantly related to features of the metabolic syndrome. Total plasma homocysteine, appears to be independent of both hs-CRP and features of the metabolic syndrome.

Relationship of biochemical parameters, BMI and blood pressure with age, gender and ethnicity of Trinidadian type 2-diabetic subjects.

OBJECTIVE: To determine the relationship of biochemical parameters, BMI and blood pressure with age, gender and ethnicity of Trinidadian type 2-diabetic subjects. METHODS: A retrospective case control study comprised of 1794 patient (740 males and 1054 females). RESULTS: The correlation was found for lipid profile with age and gender in diabetic subjects. There was a positive significant correlation in LDL-C values for all age groups. Serum creatinine concentrations significantly varied amongst ethnicity (p = 0.02). Of the known ethnicities, East Indians had the highest mean creatinine value (1.00 ± 0.47 mg/dl). The univariate general linear model showed that lipid profile had many associations with gender and ethnicity in type 2 diabetic subjects. LDL-C had significant differences between gender (p = 0.04) and diabetes (p = 0.01). CONCLUSIONS: Varied lipid profile with elevated systolic blood pressure and BMI are associated in type 2 diabetic patients with respect to age, gender and ethnicity.

Mortality trends and potential years of life lost in the English and Dutch-speaking Caribbean, 1985-2000 / Tendencias de la mortalidad y años potenciales de vida perdidos en el Caribe de habla Inglesa y Holandesa, 1985-2000

OBJECTIVE: To describe mortality trends and potential years of life lost (PYLL) due to leading causes of death in 21 Caribbean countries during 1985, 1990, 1995 and 2000. METHODS: Mortality data for 1985, 1990, 1995 and 2000 were analyzed to identify regional mortality trends using crude, age-specific and age-adjusted death rates and potential years of life lost. The variables used were age, gender and underlying cause of death. RESULTS: During 1985-2000, there was an overall 5% decrease in age-adjusted mortality rates and male mortality exceeded female mortality. Heart disease was the leading cause of death, with cancers, cerebrovascular diseases, diabetes mellitus and hypertensive disease also among the top five causes in most years. Prostate cancer and cancer of the uterus and breast were the leading causes of death due to cancers. HIV disease (AIDS) featured in the ten leading causes of death for the first time in 1995 and was the 5th leading cause in 2000. CONCLUSION: During the period 1985-2000, countries experienced an increase in mortality due to non-communicable diseases, AIDS and assaults (homicides); the latter two causes were most common among the 15-44 year age group. In 2000, AIDS, heart disease and assault (homicide) were the largest contributors to PYLL.

OBJETIVO: Describir las tendencias de la mortalidad y los años potenciales de vida perdidos (APVP) debido a las causas principales de muerte en 21 países caribeños durante 1985, 1990, 1995 y 2000. MÉTODOS: Se analizaron los datos de la mortalidad de los años 1985, 1990, 1995 y 2000, a fin de identificar tendencias de mortalidad regionales, usando tasas crudas de mortalidad ajustadas por edad y específicas por edad, así como años potenciales de vida perdidos. Las variables usadas fueron la edad, el género y la causa subyacente de muerte. RESULTADOS: Durante 1985-2000, hubo una disminución general de un 5% en las tasas de mortalidad ajustadas por edad y la mortalidad masculina excedió la mortalidad femenina. Las enfermedades cardíacas fueron la causa principal de muerte, hallándose junto a distintas formas de cáncer, las enfermedades cerebrovasculares, la diabetes mellitus, y la hipertensión, entre las cinco causas principales de muerte en la mayor parte de los años. El cáncer de próstata y el cáncer de útero y mamas, se encontraban entre las principales causas de muerte. El VIH (SIDA) se sumaba a la lista de las diez causas principales de muerte, por primera vez, en 1990, y fue la 5ta causa principal en el año 2000. CONLCUSIÓN: En el 2000, el SIDA, las enfermedades cardíacas y los asaltos (homicidios) fueron los principales contribuyentes de APVP.

Mortality trends and potential years of life lost in the English and Dutch-speaking Caribbean, 1985-2000.

OBJECTIVE: To describe mortality trends and potential years of life lost (PYLL) due to leading causes of death in 21 Caribbean countries during 1985, 1990, 1995 and 2000. METHODS: Mortality data for 1985, 1990, 1995 and 2000 were analyzed to identify regional mortality trends using crude, age-specific and age-adjusted death rates and potential years of life lost. The variables used were age, gender and underlying cause of death. RESULTS: During 1985-2000, there was an overall 5% decrease in age-adjusted mortality rates and male mortality exceeded female mortality. Heart disease was the leading cause of death, with cancers, cerebrovascular diseases, diabetes mellitus and hypertensive disease also among the top five causes in most years. Prostate cancer and cancer of the uterus and breast were the leading causes of death due to cancers. HIV disease (AIDS) featured in the ten leading causes of death for the first time in 1995 and was the 5th leading cause in 2000. CONCLUSION: During the period 1985-2000, countries experienced an increase in mortality due to non-communicable diseases, AIDS and assaults (homicides); the latter two causes were most common among the 15-44 year age group. In 2000, AIDS, heart disease and assault (homicide) were the largest contributors to PYLL.

A knowledge, attitude and practices study of the issues of climate change/variability impacts and public health in Trinidad and Tobago, and St Kitts and Nevis.

OBJECTIVE: To determine the level of understanding of the issues of climate change (CC)/variability (CV) and public health by populations of St Kitts and Nevis (SKN) and Trinidad and Tobago (T&T) and to find whether respondents would be willing to incorporate these values into strategies for dengue fever (DF) prevention. DESIGN AND METHODS: Using a cluster sampling system, representative samples of the communities of SKN (227) and T&T (650) were surveyed for responses to a questionnaire document with questions on the impact of climate variability on health, the physical environment, respondents' willingness to utilize climate issues to predict and adapt to climate variability for DF prevention. Data were analyzed by Epi Info. RESULTS: Sixty-two per cent SKN and 55% T&T of respondents showed some understanding of the concept of climate change (CC) and distinguished this from climate variability (CV). With regard to causes of CC, 48% SKN and 50% T&T attributed CC to all of green houses gases, holes in the ozone layer burning of vegetation and vehicular exhaust gases. However some 39.3% SKN and 31% (T&T) did not answer this question. In response to ranking issues of life affected by CC/CV in both countries, respondents ranked them: health > water resources > agriculture > biodiversity > coastal degradation. The major health issues identified for SKN and T&T respondents were: food-borne diseases > water-borne diseases > heat stresses; vector-borne diseases were only ranked 4th and 5th for SKN and T&T respondents respectively. There was in both countries a significant proportion of respondents (p < 0.001) who reported wet season-related increase of DF cases as a CC/CV link. Respondents identified use of environmental sanitation (ES) at appropriate times as a method of choice of using CC/CV to prevent DF outbreaks. More than 82% in both countries saw the use of the CC/CV information for DF prevention by prediction and control as strategic but only 50-51% were inclined to become personally involved. Currently, only 50% SKN and 45% T&T respondents claimed current involvement in DF vector surveillance and control in the last two days. CONCLUSION: Despite the fact that knowledge and attitudes did not always coincide with practices of using ES for DF prevention, in both countries, even with CC/CV tools of prediction being available, it seems that respondents could be persuaded to use such strategies. There is a need for demonstration of the efficacy of CC/CV information and promotion of its usefulness for community involvement in DF and possibly other disease prevention.

A knowledge, attitude and practices study of the issues of climate change/variability impacts and public health in Trinidad and Tobago, and St Kitts and Nevis / Un estudio de conocimientos, actitudes y prácticas (CAP) de los problemas del cambio climático/variabilidad de los impactos y salud pública en Trinidad y Tobago y St Kitts Nevis

OBJECTIVE: To determine the level of understanding of the issues of climate change (CC)/variability (CV) and public health by populations of St Kitts and Nevis (SKN) and Trinidad and Tobago (T&T) and to find whether respondents would be willing to incorporate these values into strategies for dengue fever (DF) prevention. DESIGN AND METHODS: Using a cluster sampling system, representative samples of the communities of SKN (227) and T&T (650) were surveyed for responses to a questionnaire document with questions on the impact of climate variability on health, the physical environment, respondents' willingness to utilize climate issues to predict and adapt to climate variability for DF prevention. Data were analyzed by Epi Info. RESULTS: Sixty-two per cent SKN and 55% T&T of respondents showed some understanding of the concept of climate change (CC) and distinguished this from climate variability (CV). With regard to causes of CC, 48% SKN and 50% T&T attributed CC to all of green houses gases, holes in the ozone layer burning of vegetation and vehicular exhaust gases. However some 39.3% SKN and 31% (T&T) did not answer this question. In response to ranking issues of life affected by CC/CV in both countries, respondents ranked them: health > water resources > agriculture > biodiversity > coastal degradation. The major health issues identified for SKN and T&T respondents were: food-borne diseases > water-borne diseases > heat stresses; vector-borne diseases were only ranked 4th and 5th for SKN and T&T respondents respectively. There was in both countries a significant proportion of respondents (p < 0.001) who reported wet season-related increase of DF cases as a CC/CV link. Respondents identified use of environmental sanitation (ES) at appropriate times as a method of choice of using CC/CV to prevent DF outbreaks. More than 82% in both countries saw the use of the CC/CV information for DF prevention by prediction and control as strategic but only 50-51...

OBJETIVO: Determinar los niveles de comprensión de los problemas del cambio climático (CC)/ variabilidad (CV) y salud pública por parte de las poblaciones de St Kitts y Nevis (SKN) y Trinidad y Tobago (T&T), y averiguar si los encuestados estarían dispuestos a incorporar estos valores en las estrategias para la previsión de la fiebre del dengue (FD). DISEÑO Y MÉTODOS: Usando un sistema de muestreo por conglomerados, muestras representativas de las comunidades de SKN (227) y de T&T (650) fueron encuestadas mediante un cuestionario en el que se les pedía responder preguntas sobre el impacto de la variabilidad del clima sobre la salud, el ambiente físico, y la disposición de los encuestados a aprovechar las cuestiones del clima para predecir y adaptarse a la variabilidad climática a fin de prevenir la FD. Los datos fueron analizados mediante Epi Info. RESULTADOS: Sesenta y dos por ciento de los encuestados de SKN y el 55% de los de T&T, mostraron cierta comprensión del concepto de cambio climático (CC) y fueron capaces de diferenciarlo de la variabilidad climática (CV). En relación con las causas del CC, el 48% (SKN) y el 50% (T&T) atribuyó el CC a los gases de efecto invernadero, los agujeros en la capa de ozono, la quema de la vegetación, y los gases de escape de vehículos.

A comparison of surveillance systems for the dengue vector Aedes aegypti in Port of Spain, Trinidad.

When the currently used larval surveillance system (visual inspection) for the dengue vector Aedes aegypti was compared with the surveillance for the presence of eggs by ovitrapping in Port of Spain, Trinidad, it was found that the latter (39.1%) was significantly more sensitive than the visual inspection system (10.1%). At the same time, the presence of the nuisance mosquito Culex quinquefasciatus was detected in 38.4% of the households. Both Ae. aegypti and Cx. quinquefasciatus showed preference for ovipositional attractants in ovitraps: hay infusion > yeast suspension > plain tap water. Although all the socioeconomic and geographic areas produced both mosquito species in 1996, upper middle class (UMC) areas (8.6-43.4%) produced more Ae. aegypti than did lower middle class (LMC) areas (7.8-38.8%), which produced more than working class (WC) areas (3.9-29.9%). For Cx. quinquefasciatus, the order of production was reversed with WC areas (50.1%) > LMC areas (30.0%) > UMC areas (26.0%). Change in vector surveillance strategies incorporating some ovitrapping and stratified sampling are recommended for Caribbean countries.

Entrance qualifications and student performance in a hybrid problem based and traditional medical programme

A hybrid problem based learning (PBL) and traditional medical programme was started at the Trinidad campus of the University of the West Indies in 1989. Analyses were carried out to determine the extent to which the entrance qualifications of the students were related to their performances at the examinations in the Phase I (preclinical and paraclinical) and Phase II (clinical) programmes. Students who were admitted on the basis of their results in the secondary school General Certificate of Examination (GCE), 'A' level scored higher at the Phase I, but not at the Phase II, level than those who already had university education. Among the 'A' level students, there was positive correlation between the total 'A' level scores and the examination marks in the medical programme, particularly at the Phase I level. Furthermore, multiple regression analyses indicated that the grades in 'A' level Chemistry and, to a lesser extent in Biology, had the most influence on performances at the Phase I examinations, with much less influence on performances at the Phase II examinations. These results suggest that good grades at 'A' level examinations are significant factors, but not the only important ones, that favour high achievement in the initial stages of this type of PBL/traditional medical programme.

Entrance qualifications and student performance in a hybrid problem based and traditional medical programme.

A hybrid problem based learning (PBL) and traditional medical programme was started at the Trinidad campus of the University of the West Indies in 1989. Analyses were carried out to determine the extent to which the entrance qualifications of the students were related to their performances at the examinations in the Phase I (preclinical and paraclinical) and Phase II (clinical) programmes. Students who were admitted on the basis of their results in the secondary school General Certificate of Examination (GCE), 'A' level scored higher at the Phase I, but not at the Phase II, level than those who already had university education. Among the 'A' level students, there was positive correlation between the total 'A' level scores and the examination marks in the medical programme, particularly at the Phase I level. Furthermore, multiple regression analyses indicated that the grades in 'A' level Chemistry and, to a lesser extent in Biology, had the most influence on performances at the Phase I examinations, with much less influence on performances at the Phase II examinations. These results suggest that good grades at 'A' level examinations are significant factors, but not the only important ones, that favour high achievement in the initial stages of this type of PBL/traditional medical programme.

Effect of 5-lipoxygenase inhibitors on the anti-IgE-induced contraction of passively sensitized human bronchus in vitro.

We assessed the effect of 5-lipoxygenase inhibitors on the contraction of human bronchial ring segments passively sensitized with IgE in vitro. Contraction was induced by increasing doses of anti-IgE (0.01-0.5 micrograms/ml) in the presence of the antihistamine mepyramine. Zileuton and MK-886 (10 microM) significantly inhibited the dose-related contraction to anti-IgE as compared with solvent (DMSO). At the highest dose of anti-IgE used, contraction reached 10.3 and 9.6% of the maximal carbachol contraction, respectively, as compared with 30.3% for solvent. Maximal carbachol contraction was unaffected. These results suggest a potential beneficial effect of 5-lipoxygenase inhibitors in anaphylactic reactions in man.

Carbohydrate composition of human megakaryocyte membranes in culture: identification using binding of seven lectins.

Seven tetramethylrhodamine B isothiocyanate- (TRITC) labeled lectins: lens culinaris (LCH), ulex europeus-1 (UEA-1), lycopersicon esculentum (LEA), wheat germ agglutinin (WGA), dolichos biflorus (DBA), soybean agglutinin (SBA) and erythrina cristagalli (ECA) were applied on cultured human megakaryocytes (Megs) detected by immunofluorescence. All stages of Megs (from lymphocyte-like Megs to mature Megs) and platelets were labeled by LCH, LEA, UEA-1 and WGA. ECA binds to platelets but only to some Megs. DBA did not bind to platelets but did bind to some Megs, irrespective of stage. SBA binds to all stages of Megs, but did not bind to platelets. These results indicate the presence of mannose, glucose (LCH), sialic acid (WGA), and glucosamine (UEA-1, LEA, WGA) on the surface of all cells of the Meg lineage, a variable presence of galactosamine (DBA, SBA, ECA), and a discrepancy in the presence of some galactosamine compounds between platelets and Megs (DBA, SBA).