Preventing and reversing a deadly life-style - abstract

One of the highest priorities of the Barbados Cancer Society since it was founded in December, 1980 has been controlling and reducing tobacco consumption. This is because smoking is the single most common and important preventable cause of cancer and it generates more diseases, disabilities and deaths in all developed countries and many developing countries than all other causes put together. Since it was founded, the most notable success of the Barbados Cancer Society has been a significant reduction in tobacco consumption. The Society is the only organization in Barbados which has consistently and systematically disseminated information about the health risks of tobacco smoking. It has used two strategies for tobacco control: first, public education in the media (press, radiio, TV) and second, a smoking cessation programme for smokers desiring to quit. The results achieved have been encouraging: there was a 32 percent decline in tobacco consumption between Janaury, 1982 and December, 1993. The success rate (i.e., abstinence without relapse for 1 to 4 years) for smokers using the Smoking Cessation Programme was 50 percent. Other strategies besides education are needed for tobacco control, most of which require Government intervention. These include explicit warnings on all tobacco products; teaching the skills of health education in teacher training colleges and all medical, dental and nursing schools; banning advertising and sponsorship by the tobacco in public places and work places; providing tobacco cessation classes in hospitals and other health institutions and at the international level, co-operating in agreements to discontinue generous subsidies to tobacco production (AU)

Why you should never start smoking and how to stop if you do

The diseases, disabilities and deaths caused by tobacco smoking in descending order of importance are (a) heart disease, cancer and stroke. These cause 70 percent of deaths in Europe and North America and 60 percent of deaths in Barbados (b) chronic bronchitis and emphysema (c) occlusive disease of the peripheral circulation (d) diseases and disabilities of the reproductive system (e) increased incidence of disease and disability in the children of parents who smoke (f) those persons hypersensitive to nicotine there is the risk of partial or complete visual loss (g) tobacco smoking aggravates stomach and duodenal ulcers. To stop smoking there must first be a strong desire to quit and be very conscious and knowledgeable of all the diseases, disabilities and deaths caused by tobacco smoking. Methods of quitting discussed include: cold turkey, tapering off and postponing

Managing severe pains that persist - abstract

One of the commonest examples of severe pain that persists long after the injury or disease initiating it has ceased to be active is the neuralgia complicating herpes-zoster. A large variety of treatments have been used to treat acute herpetic and post-herpetic neuralgia, with disappointing results. The treatment of choice should have a low risk of damaging the patient and should relieve acute herpetic neuralgia of all grades of severity, prevent post-herpetic neuralgia and effectively relieve neuralgia at all sites in all patients. In this study, 40 patients with acute herpetic neuralgia and 15 patients with post-herpetic neuralgia were treated with sympathetic blocks (SB). It was possible to follow up 30 (66.6 percent) of the patients with neuralgia treated in the acute stage and 12 (80 percent) of the patients with post-herpetic neuralgia for one or more years after treatment. Effective and permanent relief was achieved in all patients if SBs were given within 3 weeks of the onset of the neuralgia in the acute stage of the disease. In patients with post-herpetic neuralgia of 6 months' duration or less, SBs gave complete relief to 41.6 percent and partial relief to 41.7 percent. The results of this study justify the conclusion that SBs satisfy the criteria necessary for treating acute herpetic neuralgia effectively. The rate of success of SBs in treating post-herpetic neuralgia is high enough to make them the preferred method of treatment in this neuralgia (AU)

The sero-epidemiology of subclinical leptospirosis in Barbados - abstract

In an investigation of the relationship between serogroup, titre and age in subclinical leptospirosis, a further analysis was made of some of the data from three published surveys. Altogether, the records of 336 seropositive subjects were re-examined. The previously noted increase in seropositivity prevalence with age was found to be due mainly to a sharp increase in the prevalence of antibodies to serogroup Autumnalis; the prevalence of antibodies to serogroup Panama was found to decline. Similarly, despite the previously noted increase in titre with age, titres to serogroup Panama were found to fall. Panama is the serogroup most commonly recorded in children. The steep rise in the prevalence of Autumnalis with age, and the increasing, titres, suggest an anamnestic response to re-exposure, both to Autumnalis and to related serogroups. The Leptospira serovar producing antibodies in Barbadian subjects may be a semi-saprophytic form (AU)

Leptospiral antibodies in patients from a Barbadian general practice.

Sera from 1,419 patients who attended a Barbadian general practice for a variety of complaints between 1 April 1984 and 30 April 1988 were examined for leptospiral agglutinins by the microscopic agglutination test (MAT). Sera from the 42 patients with pyrexia of unknown origin, jaundice or kidney involvement, and the 26 patients with titres greater than or equal to 1:400 in the MAT, were also examined by the ELISA for IgM and IgG antibodies. Current or recent mild leptospiral infection was diagnosed in four of the patients, but some mild cases may have been missed. Two further cases of leptospirosis were recorded after the study period ended; both were very ill but responded well to doxycycline therapy. Altogether 177 of the 1,419 patients (12.5%) had agglutination titres greater than or equal to 1:50. These were 104/739 males (14%) and 73/680 females (11%). Seropositivity tended to increase with age (p less than 0.01), and the highest rates were in agricultural workers (35%), labourers (24%) and non-manual outdoor workers (19%). The difference in seropositivity between the main occupational groups was highly significant (p less than 0.001). The serogroups most commonly recorded among the seropositive patients were Autumnalis (31%), Panama (26%), Australis (24%) and Pyrogenes (20%). Autumnalis predominated in each of the main occupational groups except indoor non-manual workers where Panama, Pyrogenes and Australis occurred more frequently. 95% of the positive titres ranged between 1:50 and 1:400. Titres tended to increase with age, but there was no obvious association between higher titres and particular occupations.(ABSTRACT TRUNCATED AT 250 WORDS)

A serological survey for leptospiral agglutinins among patients in a Barbadian general practice - abstract

Sera from 1,419 patients who attended a Barbadian general practice for a variety of complaints between 1st April and 30th April 1988 were examined for leptospiral agglutinins by the microscopic agglutination test. Sera from patients presenting with pyrexia of unknown origin, jaundice or kidney complaints, and from those whose titre was > 1:400, were also examined by the ELISA for IgM and IgG antibodies. Only one patient was diagnosed clinically as possibly having mild leptospirosis, but three others had been recently infected and some mild cases may have been missed. Altogether, 177 of the patients (12.5 percent) were positive at titres> 1:50. These were 104 of the 739 males (14 percent) and 73 of the 680 females (11 percent) (no statistically significant difference). Seropositivity tended to increase with age (p<0.01), and the highest rates were in agricultural workers (35 percent), labourers (24 percent) and non-manual outdoor workers (19 percent). The difference in seropositivity between the various indoor and outdoor occupational groups was highly significant (p<0.005). Autumnalis (31 percent of the sero postives), Panama (15 percent), Australia (14 percent) and Pyrogenes (11 percent) were the serogroups most commonly recorded among the seropositive patients. Autumnalis predominated in each of the main occupational groups except indoor non-manual workers where Panama, Pyrogenes and Australis occurred more frequently. Ninety-five per cent of the positive titres ranged between 1:50 and 1:400. Titres tended to increase with age, but there was no obvious association between higher titres and particular occupations (AU)

Morbidity in general practice in Barbados

From September 1977, 11 general practitioners took part in a survey of 12 months' duration in which they recorded morbidity at every doctor-patient encounter. 35,143 patients made 53,094 encounters and a total of 62,932 problems were identified. The most common reason for going to the doctor was for examination with no disease detected. Acute upper respiratory tract infections, hypertension and pregnancy were the 3 most common specific problems with which the doctors dealt. The results demonstrated some features of general practice such as the abundance of the common diseases, the need to be alert to the infrequent occurrence of wide range major disease, pre-symptomatic screening of the healthy "at risk" patient and the problems of the ill-defined conditions. Comparisons with other surveys show some similarities in general practice morbidity, but also important differences that can be related to prevailing local conditions (AU)