Socio-demographic and clinical determinants of dementia in the oldest old: National survey of ageing and cognition in Trinidad

Objective: To determine social and clinical factors associated with dementia in the oldest old (>85 years). Design and Methodology: A survey in a nationally representative sample of people aged 85 years and older using household enumeration was undertaken. Dementia status was ascertained using standardized interviews and algorithms from the 10/66 schedule. Information was also obtained on age, gender, level of education, ethnicity and previous occupation. Self-report on the presence of angina, heart disease, stroke, diabetes, high cholesterol, and hypertension was elicited and corroborated. Results: Of the participants 61.5% were females. The mean age was 89.0 years and dementia was present in 47.2 % persons. Dementia was significantly associated with age >95 (OR=2.02; 95%CI: 0.86- 4.69), female gender (OR=1.31; 95%CI: 0.85- 2.02), East Indian ethnicity (OR=1.45; 95%CI: 0.81-2.60), being widowed (OR=2.05; 95%CI: 0.59-7), Hindu religion (OR=2.10; 95%CI: 1.23- 3.58), history of working in the agricultural sector (OR=3.20; 95%CI: 1.59-6.48). Level of education (OR=0.14; 95%CI: 0.04-0.45), taking vitamins (OR=0.61; 95% CI: 0.37-0.97) and being of mixed ethnicity (African and East Indian) were protective factors. Of the self-reported disease conditions, those with greater than 3 medical co-morbidities were 2 times (OR=2.21; 95%CI: 0.48-9.94) more likely to have dementia than those with0-2 medical comorbidities. Dementia was not more likely to occur in diabetes (OR= 1.03; 95% CI: 0.65-1.64) and hypertension (OR= 0.67; 95% CI: 0.41-1.08). Conclusion: Our study, the first of its kind in Trinidad, supports more tailored policy and better planning of services for a rapidly expanding older population.

Health status and risk factors for dementia in the middle old in Trinidad: Findings from a nationally representative survey

Objective: To investigate self-reported health status and risk factors for dementia in middle old (75-84 years) individuals. Design and Methodology: This study used the validated 10/66 door- to-door interview protocols. All individuals (836 persons) 75-84 years old were approached. The modified 10/66 dementia algorithm produced output in 811 (97%). Dementia diagnosis was made according to 10/66 criteria from: (1) cognitive tests, the Community Screening Instrument for Dementia (CSI'D), (2) EURO-D depression scale (3) informant interview. Demographic data included information on accommodation, social network, level of impairment and instrumental activities of daily living. Data were analyzed using multilevel logistic regression models. Results: Of the 811 participants, 55% were females. The mean age was 78.9±6.3 years and dementia was present in 198 (24.4%). High level of education, professional employment and having no comorbidities were significant protective factors. In multivariate analyses those with stroke were nearly 5 times more likely (OR=4.81, 95% CI: 2.72, 8.53) to have dementia, and those with diabetes were 2.5 times (OR=2.55; 95% CI: 1.71-3.78) more likely to have dementia than those without these comorbities. Impairment in climbing stairs walking and sight was more common in the dementia group than the non-demented. Individuals with dementia were more likely to be unable to perform all seven instrumental activities of daily living (IADL) and were less active compared with their non-demented counterparts. Conclusion: In the middle old population in Trinidad having diabetes and stroke with varying levels of impairment as well as a sedentary lifestyle puts an individual at increased risk of dementia.

Exploring emotional intelligence in a Caribbean medical school.

OBJECTIVE: To explore the emotional intelligence (EI) in medical students in a Caribbean medical school and investigate its association with gender, age, year of study and ethnicity. DESIGN AND METHODS: A cross-sectional design using convenient sampling of 304 years two to five undergraduate medical students at the School of Medicine, the University of the West Indies (UWI), St Augustine campus, was conducted. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT-V2.0) was administered to test four branches of EI: perceiving emotions, facilitating thought, understanding emotions and managing emotions. Data were analysed using SPSS version 19. T-test, analysis of variance (ANOVA) and r (product moment correlation) were calculated to establish the effects of selected variables (gender, age, year of study and ethnicity) on total and sub-scales EI scores and tested against 0.05 and 0.01 significance levels. RESULTS: The total mean score for EI fell within the average according to MSCEIT standards. Gender analysis showed significantly higher scores for males and for younger age groups (< 25 years). Year of study and ethnicity did not yield any significant effect. CONCLUSIONS: These findings of higher EI scores in males and younger students are unusual, given the well-publicized stereotype of the Caribbean male and the perception that advancing age brings maturity and emotional stability. It would be valuable to widen this study by including other UWI campuses and offshore medical schools in the Caribbean. This preliminary study examined a sample of medical students from a well-established Caribbean medical school. Since EI is considered to be important in the assessment and training of medical undergraduates, consideration should be given to introducing interventions aimed at increasing EI.

Childhood sexual abuse among outpatients attending adult psychiatric outpatient clinics: a case-control study.

UNLABELLED: Only a few studies have focussed on the importance of routine investigation of childhood sexual abuse in outpatients attending adult psychiatric outpatient clinics. The aim of this study is to explore the association between having a history of childhood sexual abuse (CSA) and attending adult Psychiatric Outpatient Clinics in Trinidad. METHODS: This was a case-control study conducted in twelve psychiatric outpatient clinics located throughout Trinidad A questionnaire covering demographic, social, and sexual abuse components was administered by semi-structured interview to 566 participants, of whom 242 were cases, 239 were controls and 85 had incomplete questionnaires. The cases were 242 patients attending psychiatric outpatient clinics in Trinidad and the controls were 239 non-physician staffmembers at the clinics. Results were analyzed using the Stastistical Package for the Social Sciences (SPSS) version 10. RESULTS: Chi-square analyses revealed several significant differences between the cases and control group. Sixty-three (26%) cases and 29 (12.1%) controls experienced CSA (p < 0.000). Twenty-five (39.7%) of the CSA cases had their experiences between the ages of 4 to 8 years and 13 (44.8%) of the CSA controls had their experiences between the ages of 9 to 12 (p < 0.01). Twenty-six (41.3%) of the cases and 3 (10.3%) of the controls had been abused at least 5 times (p < 0.000). Seventeen (58.6%) abused CSA controls reported having been sexually abused as a child only once. CSA with both force and manipulation was reported by 30 (47.6%) CSA cases while 6 (20.7%) CSA controls experienced CSA with force and manipulation (p < 0. 025). The abused CSA cases reported having a smaller social network of 2 persons compared to the abused CSA controls who had a social network of more than 4 persons (p < 0. 05). Of the 92 abused participants, 73.9% were women, and only 52.2% had told someone about the CSA. For the majority of CSA cases and CSA controls, the abuse involved one abuser. CONCLUSION: A positive correlation was established between earlier onset of CSA, repeated abuse (occurring more than 5 times), a limited social network in patients who had CSA and attending adult psychiatric outpatient clinics. Identifying CSA in psychiatric outpatients may lead to early intervention and aid patient management.

Childhood sexual abuse among outpatients attending adult psychiatric outpatient clinics: a case-control study / Abuso sexual infantil entre los pacientes externos que asisten a las clínicas psiquiátricas ambulatorias para adultos: un estudio de caso-control

Only a few studies have focussed on the importance of routine investigation of childhood sexual abuse in outpatients attending adult psychiatric outpatient clinics. The aim of this study is to explore the association between having a history of childhood sexual abuse (CSA) and attending adult Psychiatric Outpatient Clinics in Trinidad. METHODS: This was a case-control study conducted in twelve psychiatric outpatient clinics located throughout Trinidad A questionnaire covering demographic, social, and sexual abuse components was administered by semi-structured interview to 566 participants, of whom 242 were cases, 239 were controls and 85 had incomplete questionnaires. The cases were 242 patients attending psychiatric outpatient clinics in Trinidad and the controls were 239 non-physician staffmembers at the clinics. Results were analyzed using the Stastistical Package for the Social Sciences (SPSS) version 10. RESULTS: Chi-square analyses revealed several significant differences between the cases and control group. Sixty-three (26%) cases and 29 (12.1%) controls experienced CSA (p < 0.000). Twenty-five (39.7%) of the CSA cases had their experiences between the ages of 4 to 8 years and 13 (44.8%) of the CSA controls had their experiences between the ages of 9 to 12 (p < 0.01). Twenty-six (41.3%) of the cases and 3 (10.3%) of the controls had been abused at least 5 times (p < 0.000). Seventeen (58.6%) abused CSA controls reported having been sexually abused as a child only once. CSA with both force and manipulation was reported by 30 (47.6%) CSA cases while 6 (20.7%) CSA controls experienced CSA with force and manipulation (p < 0. 025). The abused CSA cases reported having a smaller social network of 2 persons compared to the abused CSA controls who had a social network of more than 4 persons (p < 0. 05). Of the 92 abused participants, 73.9% were women, and only 52.2% had told someone about the CSA. For the majority of CSA cases and CSA controls, the abuse involved one abuser. CONCLUSION: A positive correlation was established between earlier onset of CSA, repeated abuse (occurring more than 5 times), a limited social network in patients who had CSA and attending adult psychiatric outpatient clinics. Identifying CSA in psychiatric outpatients may lead to early intervention and aid patient management.

Pocos estudios han centrado su atención en la importancia de la investigación de rutina en relación con el abuso sexual infantil en pacientes externos que asisten a las clínicas psiquiátricas ambulatorias para adultos. El objetivo del presente estudio es explorar la relación que existe entre poseer una historia de abuso sexual infantil (ASI) y asistir a las clínicas psiquiátricas ambulatorias para adultos en Trinidad. MÉTODOS: Se trató de un estudio de caso-control realizado en doce clínicas psiquiátricas para pacientes externos, diseminadas por toda Trinidad. Se administró un cuestionario que abarcaba componentes demográficos, sociales y sexuales, mediante entrevistas semi-estructuradas, a 566 participantes, de los cuales 242 fueron casos, 239 fueron controles, y 85 dejaron sus cuestionarios incompletos. Los casos fueron 242 pacientes que asistían a las clínicas externas de psiquiatría, y los controles fueron 239 miembros no médicos del personal en las clínicas. Los resultados fueron analizados usando la versión 10 del Paquete Estadístico para las Ciencias Sociales (SPSS). RESULTADOS: Los análisis de chi-cuadrado revelaron varias diferencias significativas entre los casos y el grupo de control. Sesenta y tres (26%) casos y 29 (12.1%) controles habían experimentado ASI (p < 0.000). Veinticinco (39.7%) de los casos de ASI tuvieron sus experiencias entre las edades de 4 a 18 años y 13 (44.8%) de los controles de ASI tuvieron sus experiencias entre las edades de 9–12 ( p < 0.01). Veintiséis (41.3%) de los casos y 3 (10.3%) de los controles habían sido víctimas de abuso por lo menos 5 veces (p < 0.000). Diecisiete (58.6%) de los controles víctimas de ASI, reportaron haber sido abusados sexualmente cuando niños, una sola vez. ASI con fuerza y manipulación, fue reportado por 30 (47.6%) casos de ASI mientras que 6 (20.7%) controles de ASi, experimentaron ASI con fuerza y manipulación (p < 0.025). Los casos de abuso de ASI, reportaron haber tenido una red social más pequeña de 2 personas, en comparación con los controles de abuso de ASI, que tenían una red social de más de 4 personas (p < 0.05). De los 92 participantes víctimas de abuso, 73.9% eran mujeres, y sólo 52.2% le habían contado a alguien sobre el ASI. Para la mayor parte de los casos de ASI y controles de ASI, en el abuso hubo un solo abusador implicado. CONCLUSIÓN: Se estableció una correlación positiva entre el comienzo más temprano del ASI, la repetición del abuso (que ocurría más de cinco veces), y una limitada red social en pacientes que fueron víctimas de ASI y asistían a las clínicas psiquiátricas ambulatorias. La identificación de ASI en pacientes psiquiátricos externos, puede conducir a una temprana intervención y tratamiento de ayuda al paciente.

Gender and ethnic differences in urban and rural first-contact schizophrenia outpatients in Trinidad.

UNLABELLED: This study investigated gender and ethnic differences in the rate of first contact outpatients with schizophrenia in the setting of a more-urban region (MUR) and a less-urban region (LUR) in Trinidad. In a prospective study, 134 first-contact patients with a diagnosis of schizophrenia were selected from two ecologically different regions. RESULTS: Of this population, 56.7% were of African origin and 32.1% were of Indian descent. Gender differences were significant, with males accounting for 66.4% (n=89) of patients with schizophrenia (chi2 = 14.45, d.f. = 1, p = 0.0001). Further analysis by age categories revealed a significant male predominance at ages 20-24 (p = 0.0001) and 25-29 (p = 0.002). Young African males (15-19 y, p = 0.049) predominated in MUR compared with LUR. The results showed a marked presence of Afro-Trinidadian males in both outpatient clinics (p < 0.05). We conclude that gender and ethnicity are important variables in the presentation of schizophrenia in Trinidad, whereas neither rural nor urban environments appeared to influence the expression of schizophrenia.

Gender and ethnic differences in urban and rural first-contact schizophrenia outpatients in Trinidad

This study investigated gender and ethnic differences in the rate of first contact outpatients with schizophrenia in the setting of a more-urban region (MUR) and a less-urban region (LUR) in Trinidad. In a prospective study, 134 first-contact patients with a diagnosis of schizophrenia were selected from two ecologically different regions. Results: Of this population, 56.7 per cent were of African origin and 32.1 per cent were of Indian descent. Gender differences were significant, with males accounting for 66.4 per cent (n=89) of patients with schizophrenia (X2 = 14.45, d.f. = 1, p = 0.0001). Further analysis by age categories revealed a significant male predominance at ages 20-24 (p= 0.0001) and 25-29 (p = 0.002). Young African males (15-19 y, p = 0.049) predominated in MUR compared with LUR. The results showed a marked presence of Afro-Trinidadian males in both outpatient clinics (p < 0.05). We conclude that gender and ethnicity are important variables in the presentation of schizophrenia in Trinidad, whereas neither rural nor urban environments appeared to influence the expression of schizophrenia.

Mental disorders in medical students at the University of the West Indies, Trinidad and Tobago. Audit at a doctor's practice.

A series of 32 consecutive students from one medical school presenting for psychiatric treatment over a two-year period between September 1997 and August 1999 is described. The author treated 31 of these students, representing 288 visits and 312 hours. On the basis of retrospective case note reviews, the author presents demographic data, the year of medical school in which the illness began, DSM IV diagnoses, treatment modalities, time absent from University as a result of mental illness and major stressors. Of the 32 subjects, 50% were male, with ages ranging from 20 to 34 years (mean 24.9 years). Ninety-four per cent were single, and 78% were Trinidadians. Thirty-one per cent were Trinidad and Tobago National Scholars. This finding achieved statistical significance. Seventy-two per cent presented during their clinical training. The most common source of referral was from members of the Faculty of Medical Sciences (31%). Relationship issues were the most commonly identified stressors in 31% of the subjects. Mood disorders and anxiety disorders were present in 59% of the students. Pharmacotherapy was used in 75% of the students. The majority (53%) of medical students with mental disorders were absent from university for less than one month. At follow-up in July 2001, 26 (81%) of the students had graduated, three (9%) were still in medical school and three (9%) had withdrawn from medical school as a result of mental illness. The study is limited in that only those seeking assistance from one doctor's practice are described. The findings would be further explored in longitudinal studies.

Mental disorders in medical students at the University of the West Indies, Trinidad and Tobago. Audit at a doctor's practice

A series of 32 consecutive students from one medical school presenting for psychiatric treatment over a two-year period between September 1997 and August 1999 is described. The author treated 31 of these students, representing 288 visits and 312 hours. On the basis of retrospective case note reviews, the author presents demographic data, the year of medical school in which the illness began, DSM IV diagnoses, treatment modalities, time absent from University as a result of mental illness and major stressors. Of the 32 subjects, 50 were male, with ages ranging from 20 to 34 years (mean 24.9 years). Ninety-four per cent were single, and 78 were Trinidadians. Thirty-one per cent were Trinidad and Tobago National Scholars. This finding achieved statistical significance. Seventy-two per cent presented during their clinical training. The most common source of referral was from members of the Faculty of Medical Sciences (31). Relationship issues were the most commonly identified stressors in 31 of the subjects. Mood disorders and anxiety disorders were present in 59 of the students. Pharmacotherapy was used in 75 of the students. The majority (53) of medical students with mental disorders were absent from university for less than one month. At follow-up in July 2001, 26 (81) of the students had graduated, three (9) were still in medical school and three (9) had withdrawn from medical school as a result of mental illness. The study is limited in that only those seeking assistance from one doctor's practice are described. The findings would be further explored in longitudinal studies.