A randomised controlled trial of compression therapies for the treatment of venous leg ulcers (VenUS 6): study protocol for a pragmatic, multicentre, parallel-group, three-arm randomised controlled trial.

BACKGROUND: Venous leg ulcer(s) are common, recurring, open wounds on the lower leg, resulting from diseased or damaged leg veins impairing blood flow. Wound healing is the primary treatment aim for venous leg ulceration, alongside the management of pain, wound exudate and infection. Full (high) compression therapy delivering 40 mmHg of pressure at the ankle is the recommended first-line treatment for venous leg ulcers. There are several different forms of compression therapy available including wraps, two-layer hosiery, and two-layer or four-layer bandages. There is good evidence for the clinical and cost-effectiveness of four-layer bandage and two-layer hosiery but more limited evidence for other treatments (two-layer bandage and compression wraps). Robust evidence is required to compare clinical and cost-effectiveness of these and to investigate which is the best compression treatment for reducing time to healing of venous leg ulcers whilst offering value for money. VenUS 6 will therefore investigate the clinical and cost-effectiveness of evidence-based compression, two-layer bandage and compression wraps for time to healing of venous leg ulcers. METHODS: VenUS 6 is a pragmatic, multi-centre, three-arm, parallel-group, randomised controlled trial. Adult patients with a venous leg ulcer will be randomised to receive (1) compression wraps, (2) two-layer bandage or (3) evidence-based compression (two-layer hosiery or four-layer bandage). Participants will be followed up for between 4 and 12 months. The primary outcome will be time to healing (full epithelial cover in the absence of a scab) in days since randomisation. Secondary outcomes will include key clinical events (e.g. healing of the reference leg, ulcer recurrence, ulcer/skin deterioration, amputation, admission/discharge, surgery to close/remove incompetent superficial veins, infection or death), treatment changes, adherence and ease of use, ulcer related pain, health-related quality of life and resource use. DISCUSSION: VenUS 6 will provide robust evidence on the clinical and cost-effectiveness of the different forms of compression therapies for venous leg ulceration. VenUS 6 opened to recruitment in January 2021 and is currently recruiting across 30 participating centres. TRIAL REGISTRATION: ISRCTN67321719 . Prospectively registered on 14 September 2020.

The Impact of Visual Impairment on the Quality of Life of Diabetic Patients Attending the University Hospital of the West Indies

ABSTRACT Objective: To assess the impact of visual impairment on the quality of life (QOL) of patients with diabetic retinopathy attending the Retina Eye Clinic at the University Hospital of the West Indies (UHWI). Method: A questionnaire modelled from the National Eye Institute Visual Function Questionnaire (NEIVFQ-25) was administered to 150 patients with diabetic retinopathy. The questions ranged from concern with their vision, health and social problems to functional ability. The associations between an overall QOL score and level of visual impairment among other variables were assessed using chi-square test and the t test in the SPSS software. Results: The mean age was 56 ± 10 years. Sixty-six percent were females. Type 2 diabetes was more common in 63% and 79% of the females and males, respectively. There were significant negative associations between QOL and increased duration of diabetes mellitus (DM) (p = 0.016), reduced vision (left eye; p < 0.049), reduced monthly income (p = 0.008), lack of compliance with exercise (p = 0.021), and a special diet (p = 0.01). There were no significant relationships between QOL and age (p = 0.495), marital status (p = 0.318) and DM type (p = 0.651). Conclusion: Poorer QOL was associated with decreased left eye visual acuity, lower income and lack of compliance with exercise and special diet among patients with diabetic retinopathy at UHWI.

The Quality and Completeness of 2008 Perinatal and Under-five Mortality Data from Vital Registration, Jamaica.

OBJECTIVE: To evaluate the completeness and timeliness of registration of stillbirths and under-five deaths and the validity of the certification and coding process. SUBJECTS AND METHODS: Registered stillbirths and under-five deaths occurring in 2008 were compared to hospital, police, forensic pathologist and coroner's records. Missed cases and new information such as birthweight, gestation and date of birth were added to the database. A 10% random sample was evaluated to measure the quality of certification and coding. RESULTS: Of 646 stillbirths [≥ 1000 g] and 933 under-five deaths, 69% and 79%, respectively were registered by December 31, 2009, for inclusion in the 2008 final demographic returns. Non-reporting of stillbirths was associated with infant gender, region and place of death (seven of 21 public hospitals accounted for 96% of unregistered stillbirths). Among under-five deaths, age at death, region, place and cause of death were important. Injury and community deaths increased with age. Registration delays including non-registration were associated with coroner's inquests. Most [80%] stillbirth certificates lacked usable cause of death data. Neonatal deaths due to prematurity and perinatal asphyxia were often misclassified by coders. The stillbirth [≥ 1000 g], infant and under-five mortality rates were 15, 20 and 22/1000 births/live births, respectively. CONCLUSIONS: While registration of stillbirths and under-five deaths improved between 1998 and 2008, persistent under-reporting reduced official rates by 20-31%. A new perinatal death certificate documenting maternal and fetal causes of death and risk factors such as birthweight, gestation and age at death would improve stillbirth and neonatal death (0-28 days) data quality.

Epidemic management: a Caribbean university's response to the 2009 H1N1 outbreak.

BACKGROUND: In June 2009, the World Health Organization (WHO) declared a global influenza pandemic (1). During the throes of the epidemic, the Caribbean region recorded 22 deaths and 350 hospitalizations. Jamaica reported most of the deaths in the region--7, followed by Trinidad and Tobago--5 and Barbados--3; the remaining 7 deaths occurred in other Caribbean countries (2). In June, Jamaica reported its first case (3) and some three months later in September 2009, The University of the West Indies (UWI) Mona Campus experienced an outbreak of the 2009 H1N1 virus infection. As one of the three main Campuses of the leading tertiary institution in the English-speaking Caribbean (others being in Trinidad and Tobago and Barbados in addition to an 'Open Campus' which serves the non-Campus territories), the UWI Mona Campus serves some 15 000 students. These students originate mainly from the Caribbean; North American and African students also comprise the student population. The University Health Centre provides primary care services to a community of students, staff (3000) and their dependents, retirees, visiting staff and students.

Epidemic management: a Caribbean university's response to the 2009 H1N1 outbreak / Manejo de las epidemias: una respuesta de la universidad del Caribe al brote de H1N1 de 2009

BACKGROUND: In June 2009, the World Health Organization (WHO) declared a global influenza pandemic (1). During the throes of the epidemic, the Caribbean region recorded 22 deaths and 350 hospitalizations. Jamaica reported most of the deaths in the region - 7, followed by Trinidad and Tobago -5 and Barbados - 3; the remaining 7 deaths occurred in other Caribbean countries (2). In June, Jamaica reported its first case (3) and some three months later, in September 2009, The University of the West Indies (UWI) Mona Campus experienced an outbreak of the 2009 H1N1 virus infection. As one of the three main Campuses of the leading tertiary institution in the English-speaking Caribbean (others being in Trinidad and Tobago and Barbados in addition to an 'Open Campus'which serves the non-Campus territories), the UWI Mona Campus serves some 15 000 students. These students originate mainly from the Caribbean; North American and African students also comprise the student population. The University Health Centre provides primary care services to a community of students, staff (3000) and their dependents, retirees, visiting staff and students.

Antecedentes: En junio de 2009, la Organización Mundial de la Salud (OMS) declaró una pandemia mundial de gripe (1). Durante la agonía de la epidemia, la región del Caribe registró 22 muertes y 350 hospitalizaciones. Jamaica reportó la mayor parte de las muertes en la región, 7, seguida de 5 en Trinidad y Tobago y 3 en Barbados; las restantes 7 muertes ocurrieron en otros países del Caribe (2). En junio, Jamaica reportó su primer caso (3) y unos tres meses más tarde, en septiembre de 2009, la Universidad de West Indies (UWI) Mona Campus experimentó un brote del virus H1N1 de 2009. Como uno de los tres campus principales de la principal institución terciaria en el Caribe de habla inglesa (los otros dos en Trinidad y Tobago por un lado, y Barbados por otro, además de un 'Campus abierto', que sirve a los territorios sin campus), el campus de Mona, en UWI, presta servicio a unos 15000 estudiantes. Estos proceden principalmente de la región del Caribe; Estudiantes norteamericanos y africanos comprenden también la población estudiantil. El Centro de Salud de la Universidad brinda servicios de atención primaria a la comunidad de estudiantes residentes, al personal (3000) y sus dependientes, jubilados, así como al personal y los estudiantes de visita.

Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners.

OBJECTIVE: There were two aims in this research. First, to examine the relationships between childhood sexual abuse and HIV drug and sexual risk taking behaviors among female prisoners, and second, to examine the relationship between a marginal adult living context and HIV drug and sexual risk taking behavior among female prisoners. METHOD: The data were collected through face-to-face interviews with a random sample of 500 women at admission to prison in 1994. Differences between women who were sexually abused while growing up (n = 130) were compared to women who reported no sexual abuse (n = 370) along various demographic, and HIV drug and sexual risk taking dimensions. RESULTS: A history of sexual abuse while growing up was associated with increased sexual risk taking behaviors in adulthood. A marginal adult living situation also emerged as an important factor increasing the risk for HIV infection. Examining the co-occurrence of both childhood sexual abuse and adult marginal living context revealed a strong relationship between these two factors and HIV risk taking activities. CONCLUSIONS: The findings indicate that childhood sexual abuse may be a predictor for HIV sexual risk taking behaviors among incarcerated women. The marginal and chaotic adult living style of these women was also associated the extent of their HIV drug and sexual risk taking behaviors. Our research suggests that the co-occurrence of sexual victimization and marginality is a stronger predictor of HIV risk than each variable alone.

Development of tolerance in mice to the sedative effects of the neuroactive steroid minaxolone following chronic exposure.

Minaxolone is a potent ligand for the neurosteroid binding site of the GABAA, receptor. In radioligand binding studies to rat brain membranes, minaxolone caused a 69% increase in [3H]muscimol binding and a 25% increase in [3H]flunitrazepam binding and inhibited the binding of [3H]TBOB with an IC50 of 1 microM. In mice, minaxolone (100 mg/kg, orally) had marked sedative effects as indicated by a reduction in locomotor activity. Chronic dosing with minaxolone (100 mg/kg, orally, once daily for 7 days) resulted in a loss of sedative response to an acute dose of the drug, indicating development of tolerance. Chronic dosing with temazepam (10 mg/kg, orally, once daily for 7 days) resulted in the development of tolerance to an acute dose of temazepam; however, the two drugs did not appear to be cross-tolerant, indicating that they may have a different mechanism of action at the level of the GABAA receptor.

Growth monitoring: the role of community health volunteers.

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine its effectiveness. The results of the evaluation indicated that almost all (95.6%) of the children were covered by the CHVs. In addition the participation rate was high (78.5%). However, only 50% of the children were adequately covered. Nonetheless, 81% of them gained adequate weight. Indeed, malnutrition levels declined by 34.5%. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries.

PIP: In May 1990 in Jamaica, a nutrition program was established in the isolated and low economic level community of Freemans Hall (population, about 1400; altitude, 1000-1300 m; rainfall, 2000-2000 mm) in Southern Trelawny parish. Community health volunteers (CHVs) monitored the growth of children younger than 36 months. A committee of representatives from the local health team and parent- teachers' association selected four CHVs. One CHV covered about 22 children. Two public health nurses and two nutritionists conducted a one-week training course for the CHVs. Topics included malnutrition, young child feeding and weaning, nutrition during pregnancy, management of diarrhea, family planning, immunization, community weighing and growth monitoring, organization of a health district, and home visiting. The CHVs weighed and measured the height of all children under 36 months old monthly, provided nutritional advice to mothers, and referred malnourished children to a nutrition clinic. They received US$150 as an incentive, which they used to set up income-generating projects (e.g., goat rearing). An evaluation of the process and outcome of the CHV nutrition program during May 1990-April 1992 was conducted. None of the CHVs had stopped their duties. 95.6% of eligible children were registered in the program. 78.5% of the children participated. 50% of the children received adequate coverage. 85.7% of identified malnourished children were adequately covered. The CHVs referred all of the malnourished children to the nutrition clinic. The total cost of the program (nutrition clinics and food supplements) was US$2740. Overall cost/child was US$31.1. The cost for growth monitoring only was US$6.2. Growth monitoring accounted for 42.7% of annual costs. Malnutrition decreased from 17.1% to 11.2% (a 34.5% reduction). 81% of all children gained adequate weight. These findings show that CHVs can contribute significantly to primary health care programs in developing countries.

Growth monitoring: the role of community health volunteers

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine effectiveness. The results of the evaluation indicated that almost all (95.6 percent) of the children were covered by the CHVs. In addition the participation rate was high (78.5 percent). However, only 50 percent of the children were adequately covered. Nonetheless, 81 percent of them gained adequate weight. Indeed, malnutrition levels declined by 34.5 percent. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries(AU)

Risk factors associated with malnutrition in rural Jamaica.

Risk factors associated with malnutrition were examined in rural Jamaica. Socioeconomic data were obtained on 63 well-nourished and 14 malnourished children. Risk factors associated with malnutrition were birth weight less than 2.5 kg (P < 0.01), maternal age equal to or greater than 25 years (P < 0.05) and landlessness (P < 0.05). Interventions aimed at reducing these factors can go a long way in reducing the malnutrition problem in developing countries.

Risk factors associated with malnutrition in rural Jamaica

Risk factors associated with malnutrition were examined in Jamaica. Socio-economic data were obtained on 63 well-nourished and 14 malnourished children. Risk factors associated with malnutrition were birth weight less than 2.5kg (P < 0.01), maternal age equal to or greater than 25 years (P < 0.05) and landlessness (P < 0.05). Intervention aimed at reducing these factors can go a long way in reducing the malnutrition problem in developing countries (AU)