Impact on blood pressure control of a six month intervention project

The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies (UHWI), between January 4 and March 29, 1999, with blood pressure >140/90 mmHg (n=80), were randomly divided into Group 1, cases (n=42) and Group 2, controls (n=38). A 40-item pretested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyles and knowledge data. Group 1 attending monthly structured interventions for six months. Except for diastolic blood pressure among male controls, disatolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p < 0.01). Knowledge improved among the male patients (p < 0.01). Among the female patients, acitivity scores were significantly increased (p < 0.01), weight ( p < 0.05) and BMI (p < 0.05) were significantly reduced. There were no differences in these variables among the controls. This intervention had a benefit in blood pressure control.(Au)

Profile of Uncontrolled Hypertensive patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies

The purpose of this study was to describe the knowledge of hypertension, its management, anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension. Patients (n=80) attending the Specialist Hypertension Clinic at the University Hospital of the West Indies (UHWI) who had a baseline systolic BP> 140 mmHg and/or a diastolic BP> 90 mmHg were invited to participate in the study. Blood pressure, height, weight, waist and hip circumferences were measured. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. A pretested questionannaire with 40 items eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95 percent CI 25.7 - 29.6); mean BMI for women was 30.89 (95 percent CI 26.1 - 35.7). In men, there was an association between BMI and WHR, r = 0.62, p<0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level (r= -0.42, p<0.05). Although the majority of both men and women were classified as obese, only 12 percent of men and 7 percent of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressure in this population, the use of nonpharmacologic theraphy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.(AU)

Profile of uncontrolled hypertensive patients attending the specialist hypertension clinic, University Hospital of the West Indies

The purpose of this study was to describe the knowledge of hypertension, its management, anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension. Patients (n=80) attending the Specialist Hypertension Clinic at the University Hospital of the West Indies (UHWI) who had a baseline systolic BP> 140 mmHg and/or a diastolic BP> 90 mmHg were invited to participate in the study. Blood pressure, height, weight, waist and hip circumferences were measured. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. A pretested questionannaire with 40 items eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95 percent CI 25.7 - 29.6); mean BMI for women was 30.89 (95 percent CI 26.1 - 35.7). In men, there was an association between BMI and WHR, r = 0.62, p<0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level (r= -0.42, p<0.05). Although the majority of both men and women were classified as obese, only 12 percent of men and 7 percent of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressure in this population, the use of nonpharmacologic theraphy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.

Impact of a six-month intervention project on blood pressure control: preliminary report

OBJECTIVES: To describe the characteristics of uncontrolled hypertensive clients attending the specialist hypertension clinic at the University Hospital of the West Indies. To evaluate the effect of a six-month structured education programme on blood pressure (BP) control in these clients. METHOD: All clients attending the clinic between January 4 and March 29, 1999, with blood pressure >140/90 mmHg (n=80), were divided into Group 1, cases (n=42) and Group 2, controls (n=38). Blood pressure (BP), weight (wt), height (ht), waist (W) and hip (H) circumferences were measured and Body Mass Index (BMI) and W/H ratio calculated. Group 1 attended monthly structured interventions: BP and wt monitoring, videos, group and individual counselling for six months. A 40 item pretested questionnaire, administered to both groups, collected demographic, lifestyle, knowedge and medication data at baseline and at the end of six months. RESULTS: Mean BMI for men was 27.2 (95 percent CI, 25.7-29.6); mean BMI for women was 30.9 (95 percent CI, 26.1-35.7). Although the majority of both men and women recognized diet, inactivity and overweight as contributing to high blood pressure. Reported medication compliance was good with a mean of only 4 days missed per month. In men, there were associations between BMI and WWHR, p<0.05, BMI and diastolic BP and a negative association between BMI and activity level, p<0.05. Following the intervention, BP was reduced overall, p<0.01, except for diastolic BP in male controls. Knowledge improved among the male cases p<0.01. In the female cases activity scores were higher, p<0.001; Wt and BMI, were lower than at baseline, p<0.05. There was no difference in these variables among the controls. CONCLUSION: Structured education and monitoring interventions with personalised counselling in life style management and weight reduction may be an important part of therapy for clients.(Au)

Biochemical markers of growth in the male and female adolescents - abstract

The biochemical markers of growth, insulin-like growth factor-1 (IGF-1) and the carboxyterminal propeptide of the type 1 procollagen (PICP) have been related to anthropometric indicators of growth. We have demonstrated a relationship among plasma levels of IGF-1 and height (ht) for age and weight (wt) for age Z-scores in children 2-10 years. PICP has been associated with height (kit) velocity. We therefore looked at plasma levels of these indicators in adolscents expected to attain maximum growth velocity during the year: boys ( n=20) 13-14 years old (mean age, 13.7 years) and girls ( n=18) 11-12 years old (mean age, 11.6 years). Ht, wt, mid-upper arm circumference (MUAC), triceps and subscapular skinfold thickness were measured at baseline, then every 3 months for a year. At each visit, a venous blood sample was taken for plasma determinations of IGF - 1 and PICP by radioimmunoassay (RIA). The girls were slightly above and the boys were slightly below the NCHS references for their age with the exception of the triceps skinfold. The observed mean ht and wt velocities among the boys were 5.5 cm/year and 5.3 kg/year and the girls, 5.3 cm/year and 4.9 kg/year. The mean plasma level of IGF -1 in the adolescents were double those in the 2 - 10 year old age group with the girls (41.02 nmol/ml 95 percent CI22.0, 60.0) higher than the boys (35.39 nmol/ml 95 percent CI15.4,55.39). The difference was statistically significant. The mean plasma levels of PICP were similar for boys, (399.63 ng/ml 95 percent CI59.83, 739.43) and for the girls (398.76 ng/ml 95 percent CI 114.36, 683.16). These values were slightly higher than those in the 2-10 year-old age group. These values of IGF-1 and PIUCP are comparable to those of other populations. Mean percent body fat (PBF) increased linearly during the year in the girls, was related to the their body mass index (BMI) and was significantly higher than that in the boys. There was no association between PBF and BMI in the boys. Unlike the 2-10 year-old age group, there were no consistent relationships demonstrated among the anthropometric and the biochemical markers of growth in adolscents. This may reflect the mixed levels of maturity and the influence of the pubertal hormones in this group of adolescents. (AU)

Low plasma levels of insulin-like factor-1 among children affected by trichuris dysentery syndrome

Children with the Trichuris Dysentery Syndrome (TDS) are both stunted and wasted. Following treatment, these children show rapid gain in height and weight. Levels of insulin-like growth factor-1 (IGF-1), the main mediator of growth hormone (GH) in plasma, have been related to growth velocity. We therefore looked at the relationship between IGF-1 and the anthropometric and biochemical indices of growth in a group of 14 children (2-10 years old) affected by TDS (cases). We also looked at the same indices in 28 unaffected (control) children matched by age, gender, neighbourhood and socio-economic status. The cases were admitted to the Tropical Metabolism Research Unit (TMRU) and treated with albendazole and iron. The following series of anthropometric measurements: height (Ht), weight (Wt), head circumference (HC), mid-upper arm circumference (MCA), triceps and subscapular skinfold thicknesses were made at predetermined intervals for one year. On each measuring day, blood samples were drawn for plasma IGF-1 determination by radioimmunoassay (RIA). On admission, the mean levels of plasma IGF-1 were significantly lower in the cases than in the controls. More than half of the individual cases (57 percent) fell below the IGF-1 assay reference levels for their age and gender, the others were at the low end of the range. All of the control levels were within the reference range. Three weeks after hospital discharge (approximately 4 weeks after worm expulsion) the cases had a significant rise in levels of plasma IGF-1: mean = 13.09, SD = 2.97, SEM = 0.86, but were still significantly lower than the controls, 95 percent CI (-11.34, -2.19), p = 0.008. Three months after treatment, there was no significant difference in mean plasma IGF-1 levels between the cases and the controls. This study indicates that low circulating IGF-1 is associated with reduced collagen synthesis. Levels of plasma IGF-1 are correlated with the anthropometric indices of growth and nutrition and reflect the severity of disease in these children (AU)

Health, nutrition and socio-economic predictors of school achievement among 13- and 14-year-old Kingston girls - abstract

Poor school achievement is a major problem which seriously affects the future of many students in Jamaica. As part of a study on the health and nutrition of 13- and -14-year-old girls their nutritional status and health-related behaviours were investigated to determine whether they contribute to the poor levels of achievement. The sample was selected from all 9 All-Age and New Secondary Schools in the city of Kingston with over 40 girls enrolled in grade 8. Four hundred and fifty-two girls were selected by random sampling from the 1061 eligible girls. Each girl was given an indepth interview by 1 of 5 trained female interviewers, using a structured questionnaire to collect health-rlated behaviours and social background. The girls' heights and weights and skinfolds were measured and blood taken for the assessment of iron status. School achievement was measured, using the Wide Range Achievement Test and expressed ingrade level ratings. Mean achievement levels was poor (5.1ñ2.1). The girls' weights and heights were appropriate for their age. However, 16 per cent of them were anaemic (Haemoglobin<11.5gm/dl). Variables which made unique contributions to the variance in school achievement were identified, using stepwise multiple regression analyses. Lack of school materials, reading stimulation at home and community participation; anaemia, involvement in fights, early sexual intercourse and chores before school were associated with poor school achievement. Interventions to addresss these problems need evaluation (AU)

Sexual abuse and experience of violence among 13- and 14-year-old Kingston girls - abstract

As part of a study on health and nutrition of grade 8 girls in Kingston schools, their experience of violence and sexual harassment was investigated. Nine all-age and new secondary schools serving poor socio-economic areas in Kingston were identified. Four hundred and fifty-two girls were randomly selected from the 1,064 in grade 8, in proportion to the number enrolled in each school. Each girl was given an in-depth private interview by 1 of 5 trained female interviewers using a structured questionnaire. Nineteen girls (4 per cent) had been raped, including 3 girls raped more than once, one of whom was a victim of incest. The offenders were usually casual acquaintances. Sixteen cases were reported to an adult, 6 were reported to the police and 6 seen by a doctor. No girl received counselling. In the past year, twenty-two per cent of the sample had seen violent acts involving the use of a weapon at home, 40 per cent saw these at school and 64 per cent saw them elsewhere. While in Grade 8, 8 per cent were involved in fights at school with a weapon, and 21 per cent without any. Twenty-one per cent were afraid to come to school because of the violence in the community. Thirty-eight per cent had been beaten by an adult at home, and 57 per cent had been beaten at school with an instrument. Sexual abuse is under-reported, and few girls receive medical care or counselling. Also, there is an urgent need for remedial action to reduce the level of violence (AU)

A post Hurricane Gilbert increase in neural tube defects in Jamaica, associated with a diet comparatively low in folate, in the periconceptional period - abstract

An increase in obvious live-birth neural tube defects (NTDs), spina bifida cystica and encephalocelle, occurring in Jamaica 11-18 months post-Hurricane Gilbert and periconceptionally coinciding with a rise in megaloblastic change in sickle-cell (SS) patients, was investigated by a retrospective case-control study. A detailed health, environmental and dietary history was done on each of the 17 affected mothers (cases) and 51 controls, matched for 5 variables. The Group I (cases) reported a significantly lower mean score in dietary folate intake in the periconceptional period (154) than Group 2 (controls) (254), p < 0.0001). Trauma was high among the cases, p < 0.0005. There was no association with maternal smoking, alcohol, ganja or other substance abuse, pesticide exposure, intake of previously suspected teratogenic foods, bush teas, pica, sources of drinking water, clinic attendance, environmental or psychosocial stress, hyperemesis, hypertension, spacing of pregnancies, incestuous parenting or previous birth defects. The results show that this NTD increase was associated with maternal diets comparatively low in folate in the periconceptional period. (AU)