Prevalence and risk factors of airflow obstruction in a Caribbean population.

SETTING: The prevalence of airflow obstruction (AO) in the Caribbean population is unknown.OBJECTIVE: To measure the prevalence of and risk factors for AO (post-bronchodilator ratio of forced expiratory volume in 1 sec to forced vital capacity of <0.7) in the Trinidad and Tobago general population using the Burden of Obstructive Lung Disease methodology.DESIGN: National cross-sectional, stratified, cluster sampling of adults aged ≥40 years.RESULTS: AO prevalence was 9.5% among 1104 participants, most of whom were unaware of this. Compared to those aged 40-49 years, the adjusted odds ratio of AO by age group was 2.73 (60-69 years) and 3.30 (≥70 years). Risk factors for AO were unemployment (OR 4.31), being retired (OR 2.17), smoking ≥20 pack-years (OR 1.88) and exposure to dusty jobs for more than 1 year (OR 2.06). Related symptoms were history of wheezing, unscheduled visits to the doctor or admission to hospital for breathing problems and in subjects with at least one respiratory symptom (OR 1.90), at least one risk factor (OR 2.81), either symptoms or risk factors (OR 3.71) and both symptoms and risk factors (OR 5.78) (P < 0.05 in all cases).CONCLUSION: AO prevalence in the general population of Trinidad and Tobago aged ≥40 years was 9.5%, almost all of which was undiagnosed. AO was associated with smoking, age >59 years, lack of employment and working in a dusty job.

Occupational dust exposure is independently associated with Chronic Obstructive Pulmonary Disease (COPD) in Trinidad and Tobago population

Objective: COPD is a leading cause of mortality and morbidity worldwide. Although cigarette smoking is a well-known risk factor for COPD, nonsmokers may account for one fourth to half of all cases. The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study objective was to measure the COPD prevalence and its risk factors in the local population aged 40 years and older. Design and Methodology: In this cross-sectional survey participants were selected using two-stage stratified-cluster sampling to represent the national population in terms of gender, age and ethnic distributions. Quality assured spirometry and questionnaires were administered. Results: Among the 1,104 participants, 36% reported occupational dust exposure for more than one year and about 40% of them were never-smokers. Overall 9.5% (95% CI: 7.78 to 11.23%) of the studied population showed COPD, accounting for an estimated 49,170 persons (95% CI = 40,267; 58,124) in Trinidad and Tobago. The majority (60%) of the diagnosed COPD was attributable to non-smoking causes, and more than half of them reported occupational dust exposure. Multiple logistic regression analysis confirmed COPD's independent association with working in a dusty job (OR 2.05; 95% CI=1.26, 3.35). Conclusions: Risk of COPD in the Trinidad and Tobago general population is significantly associated with occupational dust exposure which is probably contributing about one-third of current COPD burden. International studies showed that only about 15% of overall COPD could be ascribed to occupational risk factors. The higher occupational related COPD risk in the local population should be further studied prospectively.

Public perception of deceased organ donation in Trinidad

Objective: To investigate person's knowledge, attitude and practice (KAP) toward Deceased Organ Donation (DOD) in Trinidad. Design and Methodology: A cross-sectional study of patients attending four randomly selected health centres in Trinidad was conducted using a using quota sampling, to obtain equal numbers of males and females. Data was collected using a 41-item questionnaire, which was structured to test knowledge, attitude and practices. Chis-sq analysis was conducted using SPSS Version-23. Results: 273 respondents completed the questionnaire; 50.5% females; mean age 39.5 (SD15.1) years; 50.2% Indo-Caribbean and 24.5% African, 47.8% completed secondary education; and majority Christian (48.4%) or Hindu (31.5%). 81.3% had heard of the term organ donation". Respondents believed the most frequently reported organs for deceased organ transplant in Trinidad were kidney (76.1%), heart (48.2%) and liver (33.3%). When asked about their attitudes toward DOD, 52.3% of the respondents stated that they would donate their organs, 79% had not heard about the National Organ Transplant Unit (NOTU) and no respondent reported ever donating an organ, nor enquired about donor cards (80%), nor heard about support groups (68%). Conclusion: Most participants, though knowledgeable on the term DOD, were not familiar with the practice nor the major organ donation groups in Trinidad such as NOTU and the Kidney Recipients Support Group. However, participants were positive toward DOD, thus, raising greater awareness can lead to major cost-benefits for the public health system.

Indo-Caribbean population has lower vital capacities than Afro-Caribbean population in Trinidad and Tobago

Objective: Low forced vital capacity (FVC) is a good predictor of mortality and morbidity including cardiovascular disease, diabetes and chronic kidney disease in the general population. Objective of the current post-hoc analysis was to compare the FVCs among the major ethnic groups of Trinidad and Tobago. Design and Methodology: The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study was conducted to measure the COPD prevalence and its risk factors in the local population of 40 years and older by using questionnaires and quality assured spirometry. The participants were selected using two-stage stratified, cluster sampling to represent the national population in terms of gender, age and ethnic distributions. To avoid the influence of contentious international spirometry predictive values, FVC was used as a continuous variable after adjusting for age, gender, height and height square. Results: Among the 1,104 participants, 42% were Indo- Caribbeans, and 36% were Afro-Caribbeans. Indo- Caribbeans had a similar prevalence of abnormal waist circumference (57.0% vs. 58.7%; p=0.751), a lower prevalence of obesity (30.0% vs. 41.8%; p=0.008), but a higher prevalence of abnormal waist-hip ratio (74.1% vs. 57.5%; p<0.001) and diabetes (21% vs. 10%; p<0.001) than the Afro- Caribbeans. Multiple regression analysis indicated that FVC was independently associated with ethnicity and revealed lower volumes in Indo- Caribbean participants than Afro-Caribbeans (-180ml; 95%CI:-90ml,-269ml; p<0.001). Conclusions: The Indo-Caribbean population has a lower FVC than the Afro-Caribbean population which was independent of age, gender, and height. Healthrelated consequences of low FVC among local ethnic groups warrant further research using longitudinal studies.

Sex and social class inequities in physical and mental health: an analysis using data from the Burden of Obstructive Lung Disease Trinidad and Tobago (BOLD-TT) study

Objectives: To examine sex and social class differences in physical and mental health in the Trinidad and Tobago population aged ≥40 years. Design and Methodology: Data from the BOLD-TT study, which included a stratified cluster sample of 1104 persons, were analysed. The Veteran Rand (VR)-12 instrument assessed physical (general health, physical functioning and role playing and bodily pain) and mental health (vitality, role-emotional, mental health and social functioning); using a physical health component (PCS) and mental health component (MCS) scores. Highest level of education attained, and employment status were used as measures of social class. General Linear Models were used to examine differences in PCS and MCS by sex, education and employment, controlling for age. Results: Mean age of the participants was 54.1 (SD10.8) years; 59.9% were females; 47% had no/primary education; 56% were employed. Mean PCS and MCS (SEM) scores were 47.8 (0.3) and 54.7 (0.3). Females had lower mean PCS and MCS than males (p<.001 in each case). There were significant mean differences in PCS (p<.001) and MCS (p=.04) by employment status. Persons who were not working had lower mean PCS (p<.001) and MCS (p=.002) than those employed. There were differences in PCS by education (p=.019); persons with no/primary education had lower PCS than those with post-secondary and university education. Multiple regression identified employment (p<.001) and education (p=.097) as independent predictors of PCS while sex (p=.002) and employment (p=.021) predicted MCS. Conclusion: The VR-12 provided initial results indicating health inequities i.e. poorer health status among females, the unemployed and uneducated.

Factors associated with quality of life impairment among asthma patients attending specialty clinics in Trinidad

Objectives: To examine factors associated with asthma related quality of life impairment (AQLI) among patient attending asthma clinics in Trinidad. Design and Methodology: A consecutive sample of 428 patients, ≥18 years, attending asthma clinics in Trinidad were recruited. Data were collected using intervieweradministered questionnaires which captured demography, comorbidities, triggers, hospital admissions and emergency department (ED) visits. AQLI was evaluated using the Juniper Mini AQL questionnaire to capture both the physical and emotional impact of the disease. The data were analysed using Chi-square test and multivariable logistic regression (SPSS Version 25). Results: Majority of patients were female (81%), ≥40 years (80.4%), of Indo-Caribbean descent (61.9%), and overweight (71.7%). The most commonly reported health conditions were gastrooesophageal reflux (53.0%), hypertension (47.2%), allergic rhinitis (45.1%), anxiety (42.8%), sleep apnoea (35.0%), and depression (32.5%). Environmental allergens (73.8%) were the most commonly reported trigger factor. The prevalence of moderate to severe AQLI was 60% and significantly associated variables were: age group (p=.0003), ethnicity (p<.0001), trigger factors (p=.013), sleep apnoea (OR=3.07, p=.001), gastrooesophageal reflux (OR=2, p=.014), depression (OR=3.59, p=.001) and anxiety (OR=2.52, p=.003), frequent (two or more) exacerbations (OR=4.07, p<.001) and having ever visited the ED (OR=4.78, p<.001) in the last 12 months. Independent predictors of AQLI were age, ethnicity, sleep apnoea and ED visits (Nagelkerke's pseudo R2=41%). Conclusion: Asthmatics demonstrate a high prevalence of moderate to severe quality of life impairment associated with demography and co-morbidities. Understanding these factors may improve doctor patient interactions, treatment and management.

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.

Climatic variables are associated with seasonal acute asthma admissions to accident and emergency room facilities in Trinidad, West Indies.

OBJECTIVES: To determine if there is seasonal variation in acute asthmatic visits to accident and emergency (A&E) facilities in Trinidad and to identify the climatic variables associated with such visits. DESIGN AND METHODS: A retrospective census of patients with asthma, defined as those who required emergency bronchodilator nebulization, was taken at two A&E facilities in Trinidad from 1 January 1997 to 31 December 1999. The study included patients aged 64 years and under. Patient demographic data were obtained from the A&E records. Climate variables were taken from the island's sole Meteorological Office. Multiple regression was used to identify climate variables that were independent predictors of A&E asthma visits. RESULTS: There were a total of 45 842 asthma admissions to the two facilities during the study period. Visits exhibited a cyclic pattern over the 3 years that varied according to the island's dry (January-May) and wet (June-December) seasons. There were more visits during the wet season than the dry (40 [SD=2] vs. 32 [SD=2] visits/day; P<0.001). The results of multiple regression indicated that season (P<0.001), barometric pressure (P<0.001), temperature difference (P<0.001), minimum temperature2 (P<0.001) and wind speed2 (P=0.032) were predictors of paediatric visits. Independent predictors of adult visits were season (P<0.001), relative humidity (P<0.001), minimum temperature (P=0.01), temperature difference2 (P<0.001) and minimum temperature2 (P=0.004). Season and climatic variables explained 18% of the variance of the total A&E asthma admissions. CONCLUSION: There is seasonal variation in acute asthma visits to A&E facilities in Trinidad, which remains significant after controlling for climate variables. However, while climate has a role, there are other factors that may also be responsible for increased visits during the wet season. More research is needed to identify these factors.

Knowledge, beliefs and practices of breastfeeding among adults in Tobago East: preliminary findings - Poster abstract

OBJECTIVES: To evaluate the knowledge, beliefs and practices of breastfeeding among adults in Tobago East. DESIGN AND METHODS: A cross-sectional survey was conducted on adults aged > 18 years residing in Tobago East. All participants were interviewed using structured questionnaires. RESULTS: The study comprised 509 persons of who 312 (61 percent) were females. Ninety-five percent (95 percent), 69 percent and 48 percent of the respondents indicated that a baby should be exclusively breastfed at birth, 3 months and 6 months, respectively. The main source of information about breastfeeding was obtained from the health center (53 percent). The mother (50 percent) and both parents (29 percent) were thought to be responsible for making the decision to breastfeed. Sixty-three percent (63 percent) and 80 percent of the respondents did not know about "expressed breast milk and cup-feeding' of a new-born while 82 percent and 47 percent believed that the breastfed baby should be given water and that breastfeeding caused a woman's breast to sag. In addition, 23 percent and 44 percent felt that breastfeeding should be terminated <6 months of age and between 6 and 12 months, respectively. The respondents believed that inadequate maternal nutrition (35 percent) and maternal employment (26 percent) were the principal factors affecting breastfeeding. CONCLUSION: There is a low level of awareness among the respondents regarding the value of exclusive breastfeeding for the first six months. These findings can be used to guide the development and implementation of interventions to promote exclusive breastfeeding in Tobago.(AU)

Trends in asthma visits to accident and emergency centres in Trinidad during 1997 and associations with climate variables

OBJECTIVES: To describe trends in asthma visits to Accident and Emergency (A&E) facilities during 1997 and to examine their associations with climatic conditions. DESIGN AND METHODS: A census of patients with asthma, defined as those who required brochodilator nebulization, was taken at five A&E facilities in Trinidad. Data on patients' age, gender and date of visit were obtained from the A&E records and, climate variables, including rainfall, temperature, relative humidity, and wind speed, were obtained from the Meteorological Office. RESULTS: There was a total of 27,848 asthma visits to the five facilities during 1997, of which the paediatric population(<16 years) accounted for 43 percent. There were steady increases in adult and elderly visits from January to December. A sharp increase in paediatric visits was observed in September, which coincided with the start of the school year. The results of multiple regression analysis indicated that paediatric visits to the A&E were positively associated with temperature and wind speed, while adults' visits were positively associated with temperature and relative humidity. None of the climatic variables predicted asthma visits in the elderly. CONCLUSION: There is a need for further research to explain the increase in paediatric visits at the start of the school year as well as to elucidate the mechanism for the observed associations between climate and asthma visits. (Au)

Characterization and cloning of a nucleoside-diphosphate kinase targeted to matrix of mitochondria in pigeon.

Nucleoside-diphosphate kinase (NDP kinase) from the matrix space of mitochondria in pigeon liver was purified to homogeneity. Degenerate oligonucleotide primers to the N-terminal sequence of the purified protein and the region containing the active site histidine were used in reverse transcriptase-polymerase chain reaction to obtain a major portion of the coding sequence for the mature protein. The sequences of the C and N termini of the mature protein, and eight residues in the signal peptide, were obtained by rapid amplification of cDNA end procedures. The entire coding sequence of a cytosolic form of NDP kinase was also determined. Both isoforms, which share 53% sequence identity, possess the characteristically conserved regions of known NDP kinases. The mature mitochondrial NDP kinase protein migrates in molecular sieving columns with an apparent molecular mass of about 66 kDa. It shows very high thermal stability even though it lacks the proline residue in the killer of prune loop, and the Tyr/Glu C termini that are important in stabilizing other NDP kinases. The affinity of the mitochondrial isoform for adenine and guanine nucleotides is much higher than for pyrimidine nucleotides, but the enzyme is especially susceptible to substrate inhibition by GDP. Semi-quantitative reverse transcriptase-polymerase chain reaction showed that the relative levels of expression of the mitochondrial isoform are liver > kidney >> heart = brain > breast muscle. The cytosolic isoform is strongly and approximately equally expressed in these same five tissues. This work is the first characterization of a NDP kinase isoform that is found in the matrix space of mitochondria.