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2.
Public Health Nutr ; 22(11): 1979-1989, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30846016

RESUMO

OBJECTIVE: We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed. DESIGN: In a cross-sectional survey, the Diet Quality Index-International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9-10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed. SETTING: Barbados.ParticipantsPrimary-school children in Barbados. RESULTS: Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI. CONCLUSIONS: Children's diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

3.
J Clin Anesth ; 35: 176-189, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27871517

RESUMO

STUDY OBJECTIVE: We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. DESIGN: A prospective study. SETTING: Queen Elizabeth Hospital, Barbados. PATIENTS: Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required. INTERVENTION: Introduction of formal guidelines for preoperative investigations. MEASUREMENTS: The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments. MAIN RESULTS: For younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications. CONCLUSION: Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety.


Assuntos
Anestesia/normas , Análise Custo-Benefício , Testes Diagnósticos de Rotina/normas , Procedimentos Cirúrgicos Eletivos/normas , Fidelidade a Diretrizes/economia , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Pré-Operatórios/normas , Adulto , Idoso , Anestesia/economia , Anestesia/métodos , Testes Diagnósticos de Rotina/economia , Procedimentos Cirúrgicos Eletivos/economia , Feminino , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/economia , Estudos Prospectivos , Adulto Jovem
4.
Public Health Nutr ; 18(17): 3070-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26228380

RESUMO

OBJECTIVE: To examine overweight and obesity (OWOB), changes in prevalence and potential risk factors in Barbadian children. DESIGN: A cross-section of students were weighed and measured. The WHO BMI-for-age growth references (BAZ), the International Obesity Task Force cut-offs and the US Centers for Disease Control and Prevention growth percentiles were used to determine OWOB prevalence. Harvard weight-for-height-for-age growth standards were used to estimate differences in OWOB prevalence from 1981 to 2010. Samples of parents and students were interviewed to describe correlates of OWOB. SETTING: Barbados. SUBJECTS: Public-school students (n 580) in class 3. RESULTS: Based on WHO BAZ, the overall prevalence of OWOB was 34·8 % (95 % CI 30·9, 38·7 %). A trend of higher OWOB prevalence was seen for girls across cut-offs, with significant sex differences noted using the International Obesity Task Force cut-offs. According to Harvard growth standards, OWOB has increased dramatically, from 8·52 % to 32·5 %. Children were more likely to be OWOB when annual household income was below BBD 9000 (OR=2·69; 95 % CI 1·21, 5·99). Eating dinner with the family every night was associated with a lower prevalence of OWOB (OR=0·56; 95 % CI 0·36, 0·87). CONCLUSIONS: The sharp increase of OWOB rates in Barbados warrants attention. Sex disparities in OWOB prevalence may emerge at a young age. Promoting family meals may be a feasible option for OWOB prevention. Understanding familial and sociodemographic factors influencing OWOB will be useful in planning successful intervention or prevention programmes in Barbados.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Transição Epidemiológica , Estado Nutricional , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Atividades Cotidianas , Barbados/epidemiologia , Índice de Massa Corporal , Criança , Estudos Transversais , Família , Feminino , Humanos , Masculino , Refeições , Inquéritos Nutricionais , Sobrepeso/diagnóstico , Sobrepeso/prevenção & controle , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/prevenção & controle , Pobreza , Guias de Prática Clínica como Assunto , Prevalência , Fatores de Risco , Instituições Acadêmicas , Fatores Sexuais
5.
PLoS One ; 10(3): e0121107, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25815726

RESUMO

UNLABELLED: Despite complex presentation of adult hypertension and a concomitant obesity epidemic, little is known about overweight in relation to blood pressure among Caribbean children. We examined blood pressure in relation to body size in a cross-sectional study of 573 Barbadian children aged 9-10 years (2010-2011). The United States normative blood pressure percentiles were used to identify children with high (≥95th percentile) or high normal blood pressure (90th-95th percentile). The World Health Organization body mass index cut-off points were used to assess weight status. MAJOR FINDINGS: Thirty percent of children were overweight/obese. Percentage fat mass differed between girls (20.4%) and boys (17.72%) (p<0.05). Mean systolic blood pressure among girls was 106.11 (95% CI 105.05, 107.17) mmHg and 105.23 (104.09, 106.38) for boys. The percentages with high or high-normal mean systolic blood pressure were 14.38% (10.47, 18.29) for girls and 8.08% (4.74, 11.41) for boys. Height and body mass index were independent correlates of systolic and diastolic blood pressure. Mean systolic blood pressure was related to lean mass but not fat mass, while diastolic blood pressure was associated with fat mass index and overweight. PRINCIPAL CONCLUSION: One third of 9-10 year old children in Barbados were overweight/obese and 12% had elevated mean systolic blood pressure. BP was related to body size. These findings signal potential adverse trends in weight gain and BP trends for children growing up in the context of a country that has recently undergone rapid economic transition.


Assuntos
Pressão Sanguínea/fisiologia , Composição Corporal/fisiologia , Hipertensão/epidemiologia , Sobrepeso/epidemiologia , Barbados , Índice de Massa Corporal , Região do Caribe , Criança , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Sobrepeso/fisiopatologia
6.
J Environ Public Health ; 2014: 580928, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24899905

RESUMO

Previous reviews of nutritional status in children under 5 years describe the Caribbean grouped with Latin America. This paper focuses specifically on the Caribbean and the goals and targets of the Millennium Declaration that have bearing on childhood development. The results indicate that CARICOM countries have made progress in terms of child health as assessed by gross health indicators. Yet, the millennium generation experiences coexistence of undernutrition and overweight in early childhood. The associations of GNI with markers such as poverty indices are somewhat inconsistent with traditional findings and highlight a need to reassess the causes of infant mortality and low birth weight. However, a lack of systematic local data has hampered progress on an individual country basis. Interventions that deal more pointedly with country specific needs are required including those targeting obesity if the MDGs are to be attained by all member states.


Assuntos
Bem-Estar da Criança , Estado Nutricional , Obesidade Pediátrica/epidemiologia , Belize/epidemiologia , Região do Caribe/epidemiologia , Pré-Escolar , Guiana/epidemiologia , Humanos , Obesidade Pediátrica/etiologia , Obesidade Pediátrica/prevenção & controle
7.
Emerg Med Int ; 2012: 659392, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23198147

RESUMO

Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System) instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%). Nineteen (19%) percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (P = 0.01). Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made.

8.
J Nutr Metab ; 2012: 242875, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23193460

RESUMO

Objective. Barbados, a small developing state at the end of the nutrition transition, faces an obesity epidemic. Although there is hope of stemming the epidemic in childhood, no descriptions of children's dietary and physical activity (PA) patterns are available for planning purposes. We describe the food and activity preferences and adult encouragement of active and sedentary behaviors for children 9-11 years in relation to weight status and the cultural context. Design. We used data from a pilot study preceding a large-scale ongoing study on the local drivers of the obesity epidemic among preadolescent children. PA, sedentary activity, and dietary intakes were assessed from recalls. Weight and height were measured. Setting. Barbados. Subjects. Sixty-two (62), 9-11-year-old school children. Results. Sugar-sweetened beverages provided 21% of energy consumed. Energy intake significantly explained BMI. Parents selected significantly more of children's sedentary activities and encouraged mostly homework and chores (59%). Children's self-selected school-based activity was significantly related to BMI. Conclusions. Childhood obesity prevention recommendations and research should focus on culture-specific practices that promote acquired taste for excess sugar and parent-child interactions regarding PA. Child influenced by school-based activity intervention may an important area for preventive intervention research.

9.
Public Health Nutr ; 11(1): 41-8, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17572934

RESUMO

OBJECTIVES: To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality. DESIGN: A cross-sectional study. SETTING: Secondary schools in Barbados. SUBJECTS: A cohort of 400 schoolchildren, 11-16 years old, selected to study physical education practices. RESULTS: Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity. CONCLUSIONS: Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.


Assuntos
Comportamento do Adolescente/psicologia , Índice de Massa Corporal , Exercício Físico , Sobrepeso/epidemiologia , Adolescente , Barbados/epidemiologia , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Modelos Lineares , Masculino , Mães , Obesidade/epidemiologia , Sobrepeso/psicologia , Prevalência , Instituições Acadêmicas , Autoimagem , Distribuição por Sexo
10.
Public Health Nutr ; 5(3): 391-6, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12003649

RESUMO

OBJECTIVE: To determine the effects of birth weight and early childhood stunting on body mass index (BMI), body fat and fat distribution at ages 7 and 11 years, and the change from 7 to 11 years. DESIGN: Prospective cohort study SETTING: Kingston, Jamaica. SUBJECTS: One hundred and sixteen stunted children (height-for-age below two standard deviations (<-2SD) of the National Center for Health Statistics (NCHS) references) and 190 non-stunted children (height-for-age > -1SD), identified at age 9-24 months. The stunted group was divided into a previously stunted group (height-for-age at 11 years >or= -1SD) and a chronically stunted group (height-for-age < -1SD). RESULTS: Birth weight was positively related to the children's BMI but not to measures of body fat. Birth weight was negatively associated with the subscapular/triceps skinfold (SSF/TSF) ratio at age 11 years, and to the change between 7 and 11 years. Controlling for birth weight, the chronically stunted group remained significantly smaller than the non-stunted children at both ages and increased less from 7 to 11 years in all measures except the SSF/TSF ratio, which was significantly greater at age 7 years. The previously stunted group had significantly lower BMI and percentage body fat at age 7 years than the non-stunted group. Change from 7 to 11 years was not significantly different from that of the non-stunted group except for a smaller increase in TSF. At age 11 years they had significantly lower TSF and percentage body fat. CONCLUSIONS: Children stunted in early childhood had less fat and lower BMI than non-stunted children but had a more central fat distribution that was partially explained by their lower birth weights. The association between birth weight and central fat distribution developed between 7 and 11 years.


Assuntos
Peso ao Nascer/fisiologia , Composição Corporal/fisiologia , Constituição Corporal/fisiologia , Índice de Massa Corporal , Transtornos do Crescimento/fisiopatologia , Obesidade/fisiopatologia , Antropometria , Criança , Estudos de Coortes , Feminino , Humanos , Jamaica , Masculino , Estudos Prospectivos , Puberdade/fisiologia , Análise de Regressão , Pregas Cutâneas , Classe Social
11.
West Indian med. j ; 50(Suppl 5): 23, Nov. 2001.
Artigo em Inglês | MedCarib | ID: med-188

RESUMO

OBJECTIVE: To test the hypothesis that pre-existing beta cell function (BCF) and insulin resistance (IR) are related to the development of adiposity. METHOD: A sample of 493 subjects (mean age 47ñ18 yrs; 55 percent women) was selected from the Spanish Town Survey. Base-line anthropometry, blood pressure, lipid profile, oral glucose tolerance test and fasting insulin levels were done. Anthropometry was repeated 4.5 years later in 319 subjects. Baseline IR and BCF were computed using the method of homeostatic model assessment. Cross-sectional and prospective associations between measures of adiposity (body mass index, waist-hip ratio) and explanatory variables (age, gender, IR, BCF, lipids, blood pressure, glycaemia) were assessed using correlation and multiple linear regression and analyses. RESULTS: Baseline body mass index (BMI) and waist:hip ratio (WHR), folow-up BMI and WHR, change in weight and change in BMI, but not change in WHR, were correlated with IR (r=-0.120; p<0.001). BCF was correlated only with baseline WHR (r=-0.21; p<0.001). In multiple regression analyses, gender, HDL-C, LDL-C, BCF and IR were associated with baseline BMI regardless of glycaemic state. Baseline WHR was associated with the same variables and triglycerides (TG), but the association with the BCF and TG lost significance in subjects with normoglycaemia. Follow-up BMI was associated with age, IR, HDL-C and LDL-C, but not after adjustment for baseline BMI. Follow-up WHR was associated with gender, TG and HDL-C. After adjustment for baseline WHR or BMI, only gender and lipids remained significant. IR, TG and baseline BMI were associated with change in weight. Change in BMI was significantly correlated with IR, but not after adjustment for baseline BMI. Change in WHR was associated with baseline WHR and gender. CONCLUSIONS: BCF and IR are independently associated with current adiposity. IR, but not BCF, significantly explains some of the variance of future adiposity. However, this effect is ameliorated if baseline adiposity is considered. (AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Adolescente , Adipócitos/fisiologia , Sistemas de Infusão de Insulina/efeitos adversos , Resistência à Insulina , Obesidade/epidemiologia , Jamaica , Estudos Transversais , Estudos Prospectivos
12.
West Indian med. j ; 50(Suppl 5): 22-3, Nov. 2001.
Artigo em Inglês | MedCarib | ID: med-189

RESUMO

OBJECTIVE: To examine the relationships of Body Mass Index (BMI) to obesity indices derived from anthropometry and to determine tracking of obesity between late childhood and early adolescence. We also compared identification of over-weight children using the International Obesity Task Force (IOTF) BMI cut points with skinfolds. METHODS: Three hundred and six children were examined at 7-8 years and at 11-12 years. Triceps (TSF) and subscapular (SSF) skin folds, height, and weight were measured. The sum of the skinfolds (sum SF), BMI, and fat mass (FM) were calculated. Pubertal stage was assessed at 11-12 years. RESULTS: At age 7-8 years, 11 children were overweight compared with 29 at 11-12 years. BMI was better correlated with the other indices of adiposity in girls than in boys and in the older age group than in the 7-8-year-olds. In regression analysis, BMI predicted FM best and explained 52 percent and 61 percent of the variance in FM among boys and girls at 7-8 years. Using the IOTF cut points, BMI had low sensitivity to identify children >85th percentile of the NHANES references for SSF. The sensitivity for those assessed by TSF and sum SF was higher but between 14 percent and 30 percent of the children were misclassified. The specificity of BMI was high. CONCLUSION: Adiposity increased between mid-childhood and early adolescence but the children remained realtively lean. Girls were fatter than boys, reflecting adult obesity patterns. Children identified as overweight by the IOTF BMI cut points are likley to have high body fatness. However, the concern would be that the BMI cut points may not identify many children with high body fatness. (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Índice de Massa Corporal , Obesidade/epidemiologia , Adipócitos/fisiologia , Estudos Longitudinais , Jamaica , Antropometria , Afro-Americanos
13.
J Epidemiol Community Health ; 55(6): 394-8, Jun. 2001. tab
Artigo em Inglês | MedCarib | ID: med-114

RESUMO

STUDY OBJECTIVE: To determine the effects of birth weight and linear growth retardation (stunting) in early childhood on blood pressure at age 11-12 years. DESIGN: Prospective cohort study. SETTING: Kingston, Jamaica. Participants: 112 stunted children (height for age < -2 SD of the NCHS references) and 189 non-stunted children (height for age > -1 SD), identified at age 9-24 months by a survey of poor neighbourhoods in Kingston. MAIN RESULTS: Current weight was the strongest predictor of systolic blood pressure (beta= 4.90 mm Hg/SD weight 95 percent CI 3.97, 5.83). Birth weight predicted systolic blood pressure (beta= -1.28 mm Hg/SD change in birth weight, 95 percent CI -2.17, -0.38) after adjustment for current weight. There was a significant negative interaction between stunting in early childhood and current weight indicating a larger effect of increased current weight in children who experienced linear growth retardation in early childhood. There was no interaction between birth weight and current weight. The increase in blood pressure from age 7 to age 11-12 was greater in children with higher weigth at age 11-12 and less in children with higher birth weight and weight at age 7. CONCLUSIONS: Birth weight predicted systolic blood pressure in Jamaican children aged 11-12. Postnatal growth retardation may potentiate the relation between current weight and blood pressure. Greater weight gain between ages 7 and 11 was associated with a greater increase in systolic blood pressure. The relation between growth and later blood pressure is complex and has prenatal and postnatal components. (AU)


Assuntos
Feminino , Humanos , Masculino , Recém-Nascido , Criança , Peso ao Nascer/fisiologia , Pressão Arterial/fisiologia , Transtornos do Crescimento/fisiopatologia , Crescimento/fisiologia , Obesidade/fisiopatologia , Estudos Prospectivos , Análise de Regressão , Antropometria , Índice de Massa Corporal , Seguimentos , Ganho de Peso/fisiologia , Jamaica
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