Sign language in dental education-A new nexus.

FOCUS: The introduction of the landmark mandatory teaching of sign language to undergraduate dental students at the University of the West Indies (UWI), Mona Campus in Kingston, Jamaica, to bridge the communication gap between dentists and their patients is reviewed. LITERATURE REVIEW: A review of over 90 Doctor of Dental Surgery and Doctor of Dental Medicine curricula in North America, the United Kingdom, parts of Europe and Australia showed no inclusion of sign language in those curricula as a mandatory component. HISTORY OF SIGN LANGUAGE IN DENTAL EDUCATION: In Jamaica, the government's training school for dental auxiliaries served as the forerunner to the UWI's introduction of formal training of sign language in 2012. Outside of the UWI, a couple of dental schools have sign language courses, but none have a mandatory programme as the one at the UWI. PROGRAMME RATIONALE: Dentists the world over have had to rely on interpreters to sign with their deaf patients. The deaf in Jamaica have not appreciated the fact that dentists cannot sign and they have felt insulted and only go to the dentist in emergency situations. The mandatory inclusion of sign language in the Undergraduate Dental Programme curriculum at The University of the West Indies, Mona Campus, sought to establish a direct communication channel to formally bridge this gap. PROGRAMME DEVELOPMENT: The programme of two sign language courses and a direct clinical competency requirement was developed during the second year of the first cohort of the newly introduced undergraduate dental programme through a collaborating partnership between two faculties on the Mona Campus. IMPLEMENTATION: The programme was introduced in 2012 in the third year of the 5-year undergraduate dental programme. PROGRAMME REVIEW & OUTCOMES: To date, two cohorts have completed the programme, and the preliminary findings from an ongoing clinical study have shown a positive impact on dental care access and dental treatment for deaf patients at the UWI Mona Dental Polyclinic. IMPLICATIONS: The development of a direct communication channel between dental students and the deaf that has led to increased dental access and treatment for the deaf can be extended to dentists and to other dental students globally. The vision is that similar courses will be introduced in other health training programmes at the UWI, and conceivably, in other institutions. LIMITATIONS: The small sample size allows for informative, but not definitive, conclusions to be drawn. CONCLUSION: The mandatory inclusion of sign language and Deaf culture in the dental curricula has not just removed a communication barrier, but has assisted in the empathetic and ethical development of the dental student.

Use of Jamaican Sign language in the provision of dental health care.

The United Nations Development Assistance Framework for Jamaica 2012-2016 identifies as an outcome increased access to improved quality health and education services for socially excluded and at risk populations. The Deaf Jamaican population can be categorised as a socially excluded population. The communication barrier resulting from their deafness often leads to difficulties in accessing healthcare. The Faculty of Medical Sciences at The University of the West Indies, Mona Campus, implemented a programme aimed at overcoming this communication barrier and improving direct communication between Deaf patients and health professionals treating them. Competence in Jamaican Sign Language is integrated into the curricula of programmes offered by the faculty and mandated in the dentistry programme, and extends to the clinical training at the dental polyclinic where Deaf patients are seen by student dentists who can communicate with them in Jamaican sign language. This paper outlines the policies and systems employed worldwide for interacting with and treating Deaf patients at dental health care facilities, and focuses on the policies and practices governing the dental care of Deaf patients at the Mona Dental Polyclinic with a view to providing a model for government facilities locally and regionally. Public health competencies: Communication, management.

Depression among adolescents, aged 13-19 years, attending secondary schools in Trinidad prevalence and associated factors / Depresión entre adolescentes de 13 a 19 años, que asisten a las escuelas secundarias en Trinidad prevalencia y factores asociados

OBJECTIVE: To determine the prevalence of depression and psychosocial factors associated with depression in secondary school students in Trinidad. METHODS: This was a cross-sectional study of a stratified random sample of public secondary schools utilizing a modified pre-tested self-administered Beck Depression Inventory (BDI) to detect depression in students aged 13-19 years in Trinidad. RESULTS: In this study, 1290 students participated, a response rate of 79.6%; 43% were aged 13-15 years; 53.6 % were Indo-Trinidadians; 82.5% were attending co-educational schools and 70.6% lived with both parents. The prevalence of depression was 25.3% ± 2.37%. Chi-square analysis revealed statistically significant associations between depression and the categories of age, gender, living arrangements and school type. Similar findings were observed for respondents who admitted to cigarette and alcohol use or to being afraid of, or being injured by their parent (p < 0.05). Logistic regression indicated that females were 1.7 times as likely to be depressed when compared with males; respondents not living with both parents were 1.5 times as likely to be depressed as those who were. Respondents reporting that they were afraid of parents or of being injured by parents were three times as likely to be depressed as respondents who had not had those experiences. CONCLUSIONS: One out of every four secondary school students in Trinidad was found to have significant depression. There were strong associations between depression and age, gender, school type and family structure. This study identifies that many adolescents experience violence in the home and those who did were more likely to be depressed.

OBJETIVO: Determinar la prevalencia de la depresión y los factores psicológicos asociados con la depresión en estudiantes de las escuelas secundarias de Trinidad. MÉTODOS: El presente trabajo constituye un estudio transversal con muestreo aleatorio estratificado de escuelas secundarias públicas, utilizando un Inventario de Depresión de Beck modificado, auto-administrado y pre-probado, con el objeto de detectar depresión en estudiantes de 13 a 19 años de edad en Trinidad. RESULTADOS: En este estudio, participaron 1290 estudiantes, lo cual constituye una tasa de respuesta de 79.6%; 43% tenían de 13 a 15 años; 53.6% eran indo-trinidenses; 82.5% asistían a escuelas co-educacionales y 70.6% vivían con el padre y la madre. La prevalencia de la depresión fue 25.3% ± 2.37%. El análisis de chi-cuadrado reveló asociaciones estadísticamente significativas entre la depresión y las categorías de edad, género, ordenamiento de la vida y tipo de escuela. Hallazgos similares se observaron en encuestados que admitieron el uso del alcohol y cigarrillos, o tener miedo de sus padres, o haber sido herido por sus padres (p < 0.05). La regresión logística indicó que las hembras tenían una tendencia a deprimirse 1.7 veces mayor en comparación con los varones; los encuestados que no vivían con el padre y la madre presentaban una probabilidad de deprimirse 1.5 veces mayor que aquellos que vivían con ambos progenitores. Los encuestados que reportaron tener miedo de sus padres o haber sido físicamente lastimados por sus padres, presentaban una tendencia tres veces mayor a deprimirse que los encuestados que no habían pasado por esas experiencias. CONCLUSIONES: Se halló que uno de cada cuatro estudiantes de escuelas secundarias en Trinidad tenía una depresión significativa. Hubo fuerte asociaciones entre la depresión y la edad, el género, el tipo de escuela y la estructura de la familia. Este estudio identifica que muchos adolescentes experimentan violencia en sus hogares y los que tuvieron esa experiencia tenían una probabilidad mayor de sentirse deprimidos.

Depression among adolescents, aged 13-19 years, attending secondary schools in Trinidad: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of depression and psychosocial factors associated with depression in secondary school students in Trinidad METHODS: This was a cross-sectional study of a stratified random sample of public secondary schools utilizing a modified pre-tested self-administered Beck Depression Inventory (BDI) to detect depression in students aged 13-19 years in Trinidad. RESULTS: In this study, 1290 students participated, a response rate of 79.6%; 43% were aged 13-15 years; 53.6% were Indo-Trinidadians; 82.5% were attending co-educational schools and 70.6% lived with both parents. The prevalence of depression was 25.3% +/- 2.37%. Chi-square analysis revealed statistically significant associations between depression and the categories of age, gender, living arrangements and school type. Similar findings were observed for respondents who admitted to cigarette and alcohol use or to being afraid of or being injured by their parent (p < 0.05). Logistic regression indicated that females were 1.7 times as likely to be depressed when compared with males; respondents not living with both parents were 1.5 times as likely to be depressed as those who were. Respondents reporting that they were afraid of parents or of being injured by parents were three times as likely to be depressed as respondents who had not had those experiences. CONCLUSIONS: One out of every four secondary school students in Trinidad was found to have significant depression. There were strong associations between depression and age, gender, school type and family structure. This study identifies that many adolescents experience violence in the home and those who did were more likely to be depressed.

An analysis of skin involvement in lupus erythematosus - abstract

Of 105 patients diagnosed as lupus erythematosus at the Port-of-Spain General Hospital between 1981 and 1986, 86 satisfied the ARA criteria for the classification of SLE, whilst 19 were clinically and histologically DLE. Fifty-eight SLE patients were of African origin, 24 of Asian origin and 4 were mixed. The ages of onset varied from 14 to 64 years, the majority presented in the 15 to 24-year age group. Of the SLE group, 55 percent had malar rash and 21 percent discoid lesions; this is higher than in the Jamaican study (32 percent and 14 percent respectively). Photosensitivity in the Trinidadian patients (20 percent) and the Jamaican patients (12 percent) was lower than that reported in temperate zones. These differences may be due to genetic and environmental factors. Direct immunofluorrescence (DIF) on 32 biopsies of non-sun esxposed (NSE) skin was characteristic of SLE in 80 percent cases compared to 30 percent by histology. Deposits of IgG, IgA and complement in the NSE skin are associated with a poor prognosis. IgM deposits were found in the NSE skin of 4 DLE patients; this probably represents a transitional phase to SLE, a benign state or a distinct subset of lupus erythematosus. This study confirms that DIF is a far more reliable and sensitive diagnostic tool than histology in the differential diagnosis of SLE and DLE, and in the early detection of SLE (AU)

Immunopathological studies in a mixture of pemphigus and pemphigoid - abstract

This is the first report from the Commonwealth Caribbean of a mixture of two rare forms of vesiculobullous diseases. A mixture of both bullous pemphigoid and pemphigus vulgaris was present in a 61 year-old East Indian man. He presented at the Dermatology Clinic of the Port-of-Spain Hospital with vesiculobullous lesions of both the tense and flaccid types extending throughout his trunk, limbs and face. Skin biopsies showed both immunoglobulin and complement at the intercellular spaces of the epidermis of the flaccid bulla and at the basement membrane zone (BMZ) from the tense bulla supporting the existence of both pemphigus and pemphigoid but the fourth confirmed the above findings. This patient gave a favourable clinical response to corticosteroid therapy with the disappearance of pemphigus antibodies but the anti-BMZ antibodies (typical of pemphigoid) persisted, as expected. It is clear from these findings that immunopathological investigations are not only essential in the early diagnosis of these rare bullous forms but also in prognosis (AU)

Blood alcohol concentrations of motor vehicle accident victims at the Port-of-Spain General Hospital Casualty Department, December 1984: a preliminary report - abstract

Hospital admission figures, cirrhosis death rates, per capita alcohol consumption rates and other indices have for many years indicated a high prevalence of alcoholism in Trinidad and Tobago. A six-month survey of the Medical wards, Port-of-SPain General Hospital by Prasad in 1979 showed that 47 percent of male admissions and 5 percent of female admissions were alcohol-related. Beaubrun (1978)) demonstrated a close inverse relationship (r = -0.978) between total motor vehicle and the real price of rum, i.e. the price relative to average personal income. Trinidad and Tobago has one of the highest per capita motor vehicle accident rates anywhere, even higher than the United States and very much higher than Europe. It is well established that alcohol is the single most important factor yet identified in traffic accidents wherever this has been studied. Nevertheless, there has been some reluctance to enact B.A.C. laws and to introduce the Breathalyser and other controls until more specific local research has been done to establish clearly the relationship between alcohol and such accidents. For these reasons a survey was carried out in December 1984 to determine the blood alcohol concentrations of all persons seen at the Casualty Department of the Port-of-Spain General Hospital as a result of traffic accidents. PROCEDURE: A pilot study was carried out first to refine the schedule for use in the study and to test its feasibility. A one-month survey was then carried out. Blood specimens were taken of all victims and a schedule filled out. Venous blood specimens were taken in Fluoride Oxalate and analyzed by a staff member of the Department of Pathology. Thirty-eight (38) accident victims were seen. More than 68 percent had blood alcohol concentrations higher than 0.05 percent (50mg. per 100 ml) and 55 percent had concentrations higher than 0.08 percent (80 mg per 100 ml) which is the legal limit in the United Kingdom. Blood specimens from three (3) controls, i.e. not involved in accidents, showed levels of between .002 percent (2mg percent) and .011 percent (11 mg percent). Many of the accident victims had B.A.Cs well over 0.1 percent (100 mg/100ml), and some were over 0.2 percent (200mg/100ml), levels of 0.2 percent could only be tolerated by habitual excessive drinkers who have developed considerable tolerance. The findings of this preliminary study point to an urgent need for B.A.C. legislation and the introduction of the breathalyser and other preventive strategies aimed at reducing the drinking/driving hazard (AU)

Some characteristics of Trinidad and Tobago kidney stone formers - abstract

During the period June 1983 to June 1985, 79 kidney stone formers of Trinidad and Tobago were evaluated by the ambulatory protocol of Pak, and their acid loading and urine citrate levels measured. Patient receiving medications that could affect the metabolism of calcium, uric acid or oxalate were asked to discontinue their use before and throughout the period of evalution. Forty-five males and 34 females were examined. Mean age of males was 43 years and of females 43 years. Males passed 3.4 ñ 4.4 stones in the previous 3 years and retained 1.0 ñ 2.2 stones. Females passed 1.9 ñ 2.7 stones in the previous 3 years and retained 1.7 ñ 2.9. Mean 24 hr urine volumes were as follows: females: 1,464 ñ 786 ml; Males: 1,369 ñ 585 ml. Renal hypercalciuria was found in three, absorptiive hyperuricosuria in one and hyperparathyroidism in one person. One person had renal tubular acidosis; seven had hyperuricosuria. Ten persons had high urine calcium levels because of a high dietary calcium intake. Hypocitraturia was found in 38 out of 50 respondents examined. A metabolic abnormality was found in 77 percent of the patients (AU)

Characterisation of mixed connective tissue disease - abstract

Of sixteen patients with MCTD, 10 62 percent) presented with the clinical features of systemic lupus erythematosus (SLE) and 6 (37 percent) with SLE-scleroderma. Ninety-four per cent had a speckled antinuclear factor pattern and 100 percent had IgG deposits in a speckled pattern within the epidermal cell nuclei of the skin. Seventy per cent of these patients had nRNP antibodies. These characteristics are more typical of the mixed connective tissue syndrome than of SLE or scleroderma. The low incidence of Raynaud's phenomenon in our group of patients (18 percent) with MCTD is probably due to the tropical climate. The IgM deposits in the skin of a significant number (67 percent) of the patients with the clinical picture of SLE-scleroderma probably represent an early stage in the development of the disease. The significance of high serum IgA in the clinically diagnosed SLE group is not understood and is now being further investigated. This study strongly suggests that laboratory investigations are of primary importance in distinguishing MCTD from SLE and other forms of collagen vascular diseases (AU)