Hormone replacement therapy. Knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad.

A questionnaire was used to assess the knowledge, attitudes, and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaecology Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate principally because they regarded the menopause as a natural process (p = 0.023). Only 24% of postmenopausal women were practicing some form of HRT. A minority (7%) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69%) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.

Hormone replacement therapy. Knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad

A questionnaire was used to assess the knowledge, attitudes, and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaecology Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate principally because they regarded the menopause as a natural process (p = 0.023). Only 24 of postmenopausal women were practicing some form of HRT. A minority (7) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.

Hormone replacement therapy - knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad

A questionnaire was used to assess the knowledge, attitudes and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaec Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate prinicpally because they regarded the menopause as a natural process (p = 0.023). Only 24 percent of postmenopausal women were practicing some from of HRT. A minority (7 percent) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69 percent) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.(Au)

Microbial quality of water in rural communities of Trinidad.

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0%), fecal coliforms in 102 (61.1%), and E. coli in 111 (66.5%). There were significant differences among the towns in the proportion of the samples contaminated with coliforms (P < 0.001) and E. coli (P < 0.001). Of 253 strains of E. coli studied, 4 (1.6%) were mucoid, 9 (3.6%) were hemolytic, and 37 (14.6%) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5%) were verocytotoxigenic. Twenty-eight (14.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1%) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3%), while 48 households (28.7%) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coliform contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2% of samples) than was water stored in tanks (53.3% of samples), even after controlling for water source (P = 0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9% versus 88.8%, P < 0.001) and fecal coliforms (41.2% versus 69.8%, P < 0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage.

Bacteriological quality of raw oysters in Trinidad and the attitudes, knowledge and perceptions of the public about its consumption.

In Trinidad and Tobago, raw oyster cocktails are a delicacy, but they are generally believed to be responsible for illness in the consumer. The microbial loads of raw oysters, condiments/spices and ready-to-consume oyster cocktails were determined in four sampling areas. Questionnaires were also administered to 72 oyster vendors to determine practices that affect the bacteriological quality of the products. Three hundred members of the public were interviewed to determine the attitudes, knowledge and perceptions of the public about raw oyster consumption. The mean total aerobic plate count (TAPC) per g of 50 samples each, of raw oysters, condiments/spices and ready-to-consume raw oyster cocktails averaged from 1.0 x 10(7)+/-4.3 x 10(7) to 1.4 x 10(8)+/-6.4 x 10(8), 2.0 x 10(5)+/-1.0 x 10(6) to 2.0 x 10(7)+/-1.4 x 10(8), and 4.3 x 10(5)+/-1.0 x 10(6) to 2.2 x 10(6)+/-1.0 x 10(7), respectively. The difference for each product among the four areas was statistically significant (P < or = 0.05; chi2). Using a recommended maximum standard of TAPC per g of 5.0 x 10(5), 115 (57.5%), 27 (13.5%) and 51 (25.5%) of 200 samples each, of raw oysters, condiments/spices and oyster cocktails, respectively, were considered unfit for human consumption. Amongst vendor practices, source of oyster harvest and length of time between separation of oyster meat from shell and sale, significantly affected the mean TAPC per g and the prevalence of unfit oyster cocktail samples. Consumption of raw oyster cocktails was more prevalent amongst males (73.6%) than females (26.4%) (P < 0.002), East Indians (63.2%) as compared with other respondents (36.8%) (P < 0.001), individuals < or = 40 years old (82.1%) than in individuals > 40 years of age (17.9%) (P < 0.01), and in individuals who were aware that raw oysters are considered to be a sexual enhancer (86.8%) as compared to those who did not have this perception (11.3%) (P < 0.03). Fear of falling ill prevented 44 (37.9%) of 116 non-consumers from eating oyster cocktails, while 13 of 106 consumers (12.3%) reported having experienced an oyster-borne illness. The rather high prevalence of raw oyster cocktails found to be unfit for human consumption, coupled with the perceptions and attitudes of the consumers about the product, pose a significant health risk to the public.

Knowledge, attitudes and practices of anabolic steroid usage among gym users in Trinidad.

Self-administered questionnaires were completed by 1062 gym-users in 14 gyms in Trinidad from February 1997 to July 1997 to determine the knowledge, attitudes and practices regarding anabolic steroids (AS). Five hundred and sixty (52.7%) females and 502 (48.3%) males completed the questionnaire. Half of the total sample were individuals in the 20 to 29 year age group. From the 17 questions that tested knowledge about AS, the median number of correct responses was 7 with a mode of 8. Increased muscle mass was correctly identified as one of the effects of AS by 841 respondents (79.2%), while 249 (23.6%) of the total sample thought asthma was treated with AS. Most (872 or 82.1%) felt that their knowledge about AS was inadequate and 700 (66.0%) were of the opinion that AS should be banned from use in competitive sports. Similarly, 733 (70.0%) of the gym-users thought AS should only be available by prescription. Thirty respondents reported having used AS (2.9%, 95% CI 2.0-4.1). The prevalence of AS use was higher among males than females (p < 0.001). Improvement of physical appearance and not competitive advantage in sport was the main reason cited for AS use. Anabolic steroid users knew more about the adverse effects of AS than non-AS users but the therapeutic uses of AS were comparatively less well known. This study demonstrated a general lack of knowledge concerning AS use and that a small but significant proportion of persons using gyms admitted to abusing AS.

Does signed consent for a research study constitute informed consent amongst sexually disease (STD) clinic attendees in Port-of-Spain, Trinidad?

OBJECTIVES: To determine if signed consent for a research project constitutes informed consent in sexually transmitted diseases (STD) clinic attendees who understood the voluntary nature of confidentiality outlined in the consent form. DESIGN AND METHODS: A sexual behaviour research project was conducted by researchers from local institutions in association with investigators from a university in Alabama. This present study was a cross-sectional survey using a 34-item questionnaire administered to a consecutive sample of STD clinic attendees in Port-of-Spain, Trinidad, who had been invited to participate in the sexual behaviour research project. RESULTS: Of the 102 participants, 48 (47.1 percent) persons had read the entire consent form in the sexual behaviour survey. Thirty-eight (37.3 percent) persons reported that they thought the health care they received would be worse if they declined to participate in that study. Subjects with less education were significantly more likely to believe their health care would be negatively affected if they refused to participate (p<0.001). Thirty-nine (38.2 percent) persons believed that they had to complete the sexual behaviour questionnaire in order to be treated at the clinic. Almost two-thirds of respondents thought that their answers to the sexual behaviour questionnaire could be traced back to them by persons other than the interviewers and researchers. CONCLUSIONS: The findings clearly indicate that amongst this population a signed consent form does not constitute informed consent. The process of obtaining truly informed consent for research conducted in this setting requires review.(Au)

Knowledge, attitudes and practices of anabolic steroid usage among gym users in Trinidad

Self-administered questionnaires were completed by 1062 gym-users in 14 gyms in Trinidad from February 1997 to July 1997 to determine the knowledge, attitudes and practices regarding anabolic steroids (AS). Five hundred and sixty (52.7 percent) females and 502 (48.3 percent) males completed the questionnaire. Half of the total sample were individuals in the 20 to 29 year age group. From the 17 questions that tested knowledge about AS, the median number of correct responses was 7 with a mode of 8. Increased muscle mass was correctly identified as one of the effects of AS by 841 respondents (79.2 percent), while 249 (23.6 percent) of the total sample thought asthma was treated with AS. Most (872 or 82.1 percent) felt that their knowledge about AS was inadequate and 700 (66.0 percent) were of the opinion that AS should be banned from use in competitive sports. Similarly, 733 (70.0 percent) of the gym-users thought AS should only be available by prescription. Thirty respondents reported having used AS (2.9 percent CI 2.0-4.1). The prevalence of AS use was higher among males than females (p<0.001). Improvement of physical appearance and not competitive advantage in sport was the main reason cited for AS use. Anabolic steroid users knew more about the adverse effects of AS than non-AS users but the therapeutic uses of AS were comparatively less well-known. This study demonstrated a general lack of knowledge concerning AS use and that a small but significant proportion of persons using gyms admitted to abusing AS.

Knowledge, attitudes and practices of anabolic steroid usage among gym users in Trinidad

Self-administered questionnaires were completed by 1062 gym-users in 14 gyms in Trinidad from February 1997 to July 1997 to determine the knowledge, attitudes and practices regarding anabolic steroids (AS). Five hundred and sixty (52.7 percent) females and 502 (48.3 percent) males completed the questionnaire. Half of the total sample were individuals in the 20 to 29 year age group. From the 17 questions that tested knowledge about AS, the median number of correct responses was 7 with a mode of 8. Increased muscle mass was correctly identified as one of the effects of AS by 841 respondents (79.2 percent), while 249 (23.6 percent) of the total sample thought asthma was treated with AS. Most (872 or 82.1 percent) felt that their knowledge about AS was inadequate and 700 (66.0 percent) were of the opinion that AS should be banned from use in competitive sports. Similarly, 733 (70.0 percent) of the gym-users thought AS should only be available by prescription. Thirty respondents reported having used AS (2.9 percent CI 2.0-4.1). The prevalence of AS use was higher among males than females (p<0.001). Improvement of physical appearance and not competitive advantage in sport was the main reason cited for AS use. Anabolic steroid users knew more about the adverse effects of AS than non-AS users but the therapeutic uses of AS were comparatively less well-known. This study demonstrated a general lack of knowledge concerning AS use and that a small but significant proportion of persons using gyms admitted to abusing AS.(Au)

Microbial quality of oysters sold in Western Trinidad and potential health risk to consumers.

The prevalence and characteristics of Escherichia coli and Salmonella spp. as well as counts of E. coli in raw oysters, condiments/spices, and raw oyster cocktails sampled from 72 vendors across Western Trinidad were determined. The microbial quality of the water used in the preparation of raw oysters was also investigated. Of 200 samples each of raw oysters, condiments/spices and oyster cocktails tested, 154 (77.0%), 89 (44.5%) and 154 (77.0%) respectively yielded E. coli. The differences were statistically significant (P = < 0.001; chi square = 62.91). The mean E. coli count per g in the ready-to-eat oyster cocktail ranged from 1.5 x 10(3) +/- 2.7 x 10(3) in Couva to 8.7x10(6) +/- 4.9x10(7) in San Fernando. One hundred and forty-six (73.0%) oyster cocktails contaminated with E. coli had counts that exceeded the recommended standard of 16 per g. Of a total of 590 E. coli isolates from various sources tested, 24 (4.1%), 20 (3.4%) and 69 (11.7%) were mucoid, haemolytic and non-sorbitol fermenters respectively. Twelve (2.0%) isolates of E. coli were O157 strains, while 92 (46.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Ninety (45.0%) and 73 (36.5%) of 200 water samples contained total coliforms and faecal coliforms respectively, with counts that exceeded 2.2 coliforms per 100 ml. Salmonella spp. were isolated from 7 (3.5%), 1 (0.5%) and 2 (1.0%) of 200 samples each, of raw oysters, condiments/spices and oyster cocktails respectively. Oysters pose a health risk to consumers in Trinidad, particularly from colibacillosis and salmonellosis, and the need for increased public awareness of this hazard cannot be over-emphasized.

Prediction of over-response to ovarian stimulation in an intrauterine insemination programme.

Prediction of poor-response is of equal importance to prediction of over-response in intrauterine insemination programmes. The gonadotrophin-releasing hormone agonist (GnRHa) stimulation test (GAST) was assessed as a predictor of over-response to ovarian stimulation in 81 patients. Blood samples were taken on cycle day 2 (before and 24 h after starting the GnRHa). Day 2 and 3 samples were assayed for oestradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH). Linear and logistic regression analyses were used to assess age, day 2 FSH, day 2 FSH/LH, oestradiol ratio (oestradiol on day 3/oestradiol on day 2) and FSH ratio (FSH on day 3/FSH on day 2) as predictors of the number of follicles (total and > or = 14 mm), oestradiol on HCG day, and clinical pregnancy rate as appropriate. Several parameters were also compared between the patients who produced < or = 3 (> or = 14 mm) follicles (group A) and those who produced >3 (> or = 14 mm) follicles (group B). The mean +/- SEM age of the patients in the study was 32 +/- 0.4 years. The mean total dose of recombinant FSH was 800 +/- 20 IU and the mean duration of stimulation was 7.6 +/- 0.2 days. Nine (11%) and 12 (15%) patients were cancelled for poor and over-response respectively. The oestradiol ratio was significantly positively correlated with oestradiol on HCG day (P < 0.001), and with the number of mature follicles (> or = 14 mm) (P = 0.01). Age, day 2 FSH and FSH ratio were not significantly correlated with oestradiol on HCG day, total follicles and follicles > or = 14 mm. None of the above-mentioned variables was correlated with clinical pregnancy rate. Group A had significantly lower oestradiol ratio (P = 0.007), longer duration of stimulation (P = 0.002), higher total FSH dose (P = 0.001), and lower oestradiol on HCG day (P = 0.001). GAST is therefore useful in predicting the high responders to gonadotrophin stimulation.

Microbial quality of oysters sold in Western Trinidad and potential health risk to consumers

The prevalence and characteristics of Escherichia coli and Salmonella spp. as well as counts of E. coli in raw oysters, condiments/spices, and raw oyster cocktails sampled from 72 vendors across Western Trinidad were determined. The microbial quality of the water used in the preparation of raw oysters was also investigated. Of 200 samples each of raw oysters, condiments/spices and oyster cocktails tested, 154 (77.0 percent), 89 (44.5 percent) and 154 (77.0 percent) respectively yielded E. coli. The differences were statistically significant (P= <0.001; chi square = 62.91). The mean E. coli count per g in the ready-to-eat oyster cocktail ranged from 1.5 x 10(3) +/- 2.7 x 10(3) in Couva to 8.7 x 10(6) +/- 4.9 x 10(7) in San Fernando. One hundred and forty six (73.0 percent) oyster cocktails contaminated with E. coli had counts that exceeded the recommended standard of 16 per g. Of a total of 590 E. coli isolates from various sources tested, 24 (4.1 percent0, 20 (3.4 percent) and 69 (11.7 percent) were mucoid, haemolytic and non-sorbitol fermenters respectively. Twelve (2.0 percent) isolates of E. coli were O157 strains, while 92 (46.0 percent) of 200 E.coli isolates tested belonged to enteropathogenic serogroups. Ninety (45.0 percent) and 73 (36.5 percent) of 200 water samples contained total coliforms and faecal coliforms respectively, with counts that exceeded 2.2 coliforms per 100 ml. Salmonella spp. were isolated from 7 (3.5 percent), 1 (0.5 percent) and 2 (1.0 percent) of 200 samples each, of raw oysters, condiments/spices and oyster cocktails respectively. Oysters pose a health risk to consumers in Trinidad, particularly from colibacillosis and salmonellosis, and the need for increased public awareness of this hazard cannot be over-emphasized. (AU)

Probiotics inhibit enteropathogenic E. coli adherence in vitro by inducing intestinal mucin gene expression.

Probiotic agents, live microorganisms with beneficial effects for the host, may offer an alternative to conventional antimicrobials in the treatment and prevention of enteric infections. The probiotic agents Lactobacillus plantarum 299v and Lactobacillus rhamnosus GG quantitatively inhibited the adherence of an attaching and effacing pathogenic Escherichia coli to HT-29 intestinal epithelial cells but did not inhibit adherence to nonintestinal HEp-2 cells. HT-29 cells were grown under conditions that induced high levels of either MUC2 or MUC3 mRNA, but HEp-2 cells expressed only minimal levels of MUC2 and no MUC3 mRNA. Media enriched for MUC2 and MUC3 mucin were added exogenously to binding assays and were shown to be capable of inhibiting enteropathogen adherence to HEp-2 cells. Incubation of L. plantarum 299v with HT-29 cells increased MUC2 and MUC3 mRNA expression levels. From these in vitro studies, we propose the hypothesis that the ability of probiotic agents to inhibit adherence of attaching and effacing organisms to intestinal epithelial cells is mediated through their ability to increase expression of MUC2 and MUC3 intestinal mucins.

Dengue in Trinidad: a survey of knowledge, attitudes, practices and beliefs in two communities in Trinidad, West Indies

This study was conducted to test the Health Belief Model as it relates to dengue fever in two urban communities, namely Curepe and Woodbrook, Trinidad using a knowledge, attitude, practices and beliefs questionnaire and entomological investigations. The knowledge of dengue symptomatology, its prevention and control suggested a high level of awareness about dengue and its aetiological agents among residents of both commuities, but the connection between the vector Aedes aegypti (L.) and dengue fever transmission was poorly understood. The major determinants for cues to action were demographics, prevention of water treatment and garbage collection and disposal. Data from the present study gave clear indications of the need for health education programs, defining what garbage is and the further studies using the transtheoretical model of change (Prochaska Model). With these tools a holistic approach to vector control using community participation, health education and conventional vector control strategies may be adopted for the prevention and control of dengue and its vector. Ae. aegypti, on a sustained basis in Trinidad and, possibly, the Caribbean region.(AU)

Knowledge, attitude and practice of anabolic steroid usage among gym users in Trinidad

Self-administered questionnaires were completed by 1062 gym users in 14 gyms in Trinidad from February to July. 1997 tp determine , attitude and practices regarding anabolic steroids (AS). Five hundred and sixty (53 percent) females and 502 (48 percent) males participated with half of the total sample in the 20 to 29 year age group. From the 17 questions which tested knowledge about AS, the median number of correct responses was 7 with a mode of 8. Increased muscle mass was correctly identified as one of the effects of AS by 841 respondents (79 percent), while 249 (24 percent) of the total sample thought that asthma was treated with AS. Most (872 or 82 percent) felt that their knowledge about AS was inadequate and 700 (66 percent) were of the opinion that AS should be banned from use in competition. Similarly, 733 (70 percent) of the gym users thought AS should be available only by prescription. Thirty respondents reported having used AS (2.9 percent, 95 percent CI 2.0-4.1) and the prevalence of AS use was higher among males than females (X = 13.28, p<0.001, df = 1). Improvement of physical appearance was one of the main reasons cited for AS use. AS users knew more about the adverse effects of AS than non-AS users. However, the therapeutic uses of AS were comparatively less well known amongst both AS and non-AS gym-users. This study demonstrates a lack of knowledge about AS among the gym users and a prevalence of AS use of 2.8 percent which may be an underestimation due to the self-reporting nature of the questionnaire.(AU)

Changes in circulating hormone concentrations, testes histology and testes ultrasonography during sexual maturation in beef bulls.

Nine groups of bull calves (n = 5 to 6 per group) were castrated every 5 wk from 5 to 45 wk of age, and the stages of spermatogenesis were identified histologically. Prior to castration, the testes of each calf were examined by ultrasonography, and the pixel intensities of the parenchyma were quantitated. Testis ultrasonograms were also recorded every 2 wk from 10 bull calves between 2 and 40 wk of age. Blood samples were collected at weekly intervals until castration. There was an early transient rise in circulating LH concentrations between 4 and 25 wk of age, while circulating FSH concentrations were high initially but decreased between 14 and 30 wk of age. Circulating testosterone concentrations increased gradually from 6 to 35 wk of age and then rapidly to 42 wk of age. There was a progressive increase in the more mature cell types during spermatogenesis as the animals aged, with the most dramatic changes occurring between 15 and 45 wk of age. Outer seminiferous tubule diameter increased between 10 and 45 wk of age, with the most rapid increase occurring from 30 wk of age. Inner tubule diameter increased between 30 and 35 wk of age. The echogenicity of the testes (as determined by ultrasonography) increased between 20 and 40 wk of age. From these data we conclude that testis echogenicity increased during the most active phase of growth of the seminiferous tubules as more mature germ cells were produced. Cessation of the early rise in gonadotrophin secretion immediately preceded this active phase of testicular development. Testosterone secretion rose markedly with the production of mature spermatozoa.

Scanning electron microscopy of target cells and molecular weight determination of a bacteriocin produced by Lactococcus lactis D53.

A bacteriocin, lactococcin D53, from Lactococcus lactis strain D53 was partially purified by precipitation with ammonium sulfate and dialysis against deionized water, at which time it precipitated from solution. A native molecular weight was determined by gel filtration, where bacteriocin was detected in two fractions which were measured at 104 and 6.7 kDa. A molecular weight of 7.0 kDa under denaturing conditions was determined by Tricine-SDS-polyacrylamide gel electrophoresis. The molecular weight determinations implied that lactococcin D53 complexed with other macromolecules in its native state in solution. Scanning electron micrographs of Lactobacillus D17 target cells treated with lactococcin D53 showed considerable differences from untreated control cells. The bacteriocin-treated cells had rougher, more granular-looking outer surfaces than untreated cells, which appeared smooth. Counts of viable cells in buffer solution rapidly declined by about one log in target cells treated with bacteriocin.