Living in the end of days: risk, anxiety, subjectivity and the devil in a Trinidadian village.

Drawing on ethnographic fieldwork in Trinidad, this paper examines how the framing of a particular apocalyptic future provided a moral commentary and model for wellbeing in contemporary everyday life. Changing social, political, and economic circumstances and relations had brought a range of new risks and anxieties into daily life. These more recent problems originating from beyond the village (such as climate change, criminality, inequality, pollution, neglect by the State) could not be resolved through working with obeah spirits as might have been used previously for more local issues, or through the long-established Catholic and Anglican churches. Instead evangelical Christian cosmology and practices gave a means of making sense of such issues and for protecting oneself. The development of a strong individual relationship with God connected individuals to a greater power and a global community, framing such problems not only as the work of the Devil but as evidence of the coming of the End of Days. Political protest or attempts at wider change were futile therefore; individuals should focus on their own practices to develop a strong relationship with God. Health and wellbeing relied on an individualised and deep relationship with the Holy Spirit. This was developed through practices that both drew on, and helped create, a type of neoliberal logic and global subjectivity to understand and live within current times, evangelical Christianity promoting ways of living without anxiety in the present through understandings of an apocalyptic future.

Risk factors for poor asthma control and impaired quality of life in a Caribbean population.

OBJECTIVE: Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life. METHODS: A multicentre cross-sectional survey of asthma patients, 18 years and older, was conducted in Trinidad. Asthma Control Test (ACT) and the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) were used to assess the disease control and quality of life, respectively. Data were analyzed using the Chi-square test and multivariable logistic regression controlling for gender. RESULTS: Of a total of 428 patients included, asthma was uncontrolled in 72.4% and asthma related quality of life was moderate to severely impaired in 86% of the studied population. In the multivariate regression models, poorly controlled asthma was associated with obesity (OR 2.25; 95% CI 1.30-3.39), late-onset asthma (OR 1.72; 95% CI 1.04-2.84), features of sleep apnea (OR 1.77; 95% CI 1.01-3.07) and depression (OR 2.01; 95% CI 1.04-3.86). Impaired quality of life was associated with Indo-Caribbean ethnicity (OR 3.19; 95% CI = 1.68-6.06). CONCLUSIONS: In this Caribbean population, uncontrolled asthma was independently associated with obesity, late-onset disease, and comorbidities of sleep apnea and depression. Poor asthma-related quality of life was independently associated with Indo-Caribbean ethnicity.

Caribbean Diaspora Healthy Nutrition Outreach Project (CDHNOP): A Qualitative and Quantitative Approach to Caribbean Health.

Background: Obesity prevention and its associated co-morbidities such as diabetes require a multi-tiered, culturally sensitive, population-based approach. South Florida's tri-county area is home to approximately 75% of Florida's total Caribbean immigrant population. This project is the first Caribbean-focused intervention using the Go-Slow-Whoa or GSW format which designates whether a food or beverage should be chosen frequently (Go - green), less often (Slow - yellow), or rarely (Whoa - red) based on the content of nutrients, sodium, fat, and sugar. Specific Aims: 1. To create and evaluate culturally appropriate nutrition materials for the Caribbean diaspora population in Broward County (i.e. tailor existing GSW evidence-based materials for this population). 2. To quantify which social determinants of health are most relevant to this population. Methods: Mixed methods were utilized in this study. The qualitative, exploratory arm consisted of semi-structured focus groups that included 38 subjects from five Caribbean countries most represented in South Florida: Jamaica, Haiti, Trinidad and Tobago, Cuba and Dominican Republic. The quantitative arm employed descriptive and inferential statistics to analyze social determinants of health (SDOH) obtained from a modified National Association of Community Health Centers' PRAPARE survey. Intercept survey data was also collected from a convenience sample of 24 Caribbean immigrants in Broward County. Findings: Analysis revealed a lack of culturally appropriate foods and exercise examples in the current GSW materials. At 92% and 82% respectively, an overwhelming majority of our intercept surveys indicated that our revised, culturally appropriate materials were helpful in making positive food and beverage choices. Further study is required to determine which SDOH variables are relevant to this population. Conclusions: Health disparities and inequity in the healthy living education of our Caribbean subpopulation are best addressed using an inclusive research frame that captures the cultural essence and preferences of this understudied community.

Beliefs that contribute to delays in diagnosis of prostate cancer among Afro-Caribbean men in Trinidad and Tobago.

OBJECTIVE: The aim of this study was to explore Trinidad and Tobago (TT) men's prediagnosis experiences of prostate cancer (PCa). This study is part of a wider project that examined men and their partners' experiences of routes to diagnosis for PCa in TT. METHODS: Men (n = 51) were voluntarily recruited to semi-structured interviews from four centres. Data were analysed following principles of grounded theory. RESULTS: Major barriers to medical help seeking were highlighted as lack of knowledge and awareness of the prostate gland and symptoms of PCa, the digital rectal exam (DRE), prostate-specific antigen (PSA), cultural and religious beliefs, and hegemonic masculinity norms and nonreporting of bodily changes to GPs. Fear of DRE, distrust in providers, and misinterpretation of bodily changes as related to ageing and diabetes mellitus also contributed to delays towards seeking medical help. Men's interactions with pharmacists and traditional healers lengthened the time taken to consult with health care providers for prostate concerns. CONCLUSIONS: TT men's PCa prediagnosis experiences are important to unearth barriers and facilitators to care along routes to diagnosis for this disease. This can help target specific health promotion strategies to motivate men to seek medical care for symptoms in a timely manner.

Action research improves services for child sexual abuse in one Caribbean nation: An example of good practice.

BACKGROUND: Child sexual abuse (CSA) is a multi-dimensional problem. The search for best practice must consider the complexities surrounding CSA and its management in any particular society. OBJECTIVE: Data previously gathered from service providers on CSA service provision in Trinidad and Tobago identified key deficient issues in policy and practice. In this paper, researchers aimed to bridge the gaps identified, and effect changes to improve services for CSA using an action research methodology. PARTICIPANTS AND SETTING: Service providers from all sectors in governmental and non-governmental organizations in Trinidad and Tobago, who work with children at risk of CSA were involved in the process. METHODS: Researchers led the service providers into an awareness of their own practice through critical discussion of, and reflection on, the key deficient issues. The new knowledge generated, with guided input from evidenced-based best practice, led to the development of guidelines for management. Discussion of the practicability of the guidelines by service providers in multiple sectors generated more new knowledge that refined the management approach. RESULTS: The contextual knowledge obtained from service providers resulted in best practice guidelines for service providers that were culturally relevant and context-sensitive, adaptive and implementable, and allowed a seamless multidisciplinary response to CSA in Trinidad and Tobago within prevailing constraints. CONCLUSIONS: Action research offers an effective approach to improve services for CSA through mobilization of service providers and changes in policy and practice. It is applicable in any setting and likely to be effective in any socio-cultural context.

ESRD among Immigrants to Ontario, Canada: A Population-Based Study.

Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.

Gynecologic cancer mortality in Trinidad and Tobago and comparisons of mortality-to-incidence rate ratios across global regions.

PURPOSE: To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries. METHODS: Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries). RESULTS: Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region. CONCLUSIONS: Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.

Associations among ancestry, geography and breast cancer incidence, mortality, and survival in Trinidad and Tobago.

UNLABELLED: Breast cancer (BC) is the most common newly diagnosed cancer among women in Trinidad and Tobago (TT) and BC mortality rates are among the highest in the world. Globally, racial/ethnic trends in BC incidence, mortality and survival have been reported. However, such investigations have not been conducted in TT, which has been noted for its rich diversity. In this study, we investigated associations among ancestry, geography and BC incidence, mortality and survival in TT. Data on 3767 incident BC cases, reported to the National Cancer Registry of TT, from 1995 to 2007, were analyzed in this study. Women of African ancestry had significantly higher BC incidence and mortality rates ( INCIDENCE: 66.96; MORTALITY: 30.82 per 100,000) compared to women of East Indian ( INCIDENCE: 41.04, MORTALITY: 14.19 per 100,000) or mixed ancestry ( INCIDENCE: 36.72, MORTALITY: 13.80 per 100,000). Geographically, women residing in the North West Regional Health Authority (RHA) catchment area followed by the North Central RHA exhibited the highest incidence and mortality rates. Notable ancestral differences in survival were also observed. Women of East Indian and mixed ancestry experienced significantly longer survival than those of African ancestry. Differences in survival by geography were not observed. In TT, ancestry and geographical residence seem to be strong predictors of BC incidence and mortality rates. Additionally, disparities in survival by ancestry were found. These data should be considered in the design and implementation of strategies to reduce BC incidence and mortality rates in TT.

Subjective response to alcohol and ADH polymorphisms in a select sample of young adult male East Indians and Africans in Trinidad and Tobago.

OBJECTIVE: Level of response to alcohol has been associated with risk of alcohol dependence in a number of ethnic groups. In the present study, subjective and objective responses to alcohol were evaluated in Indo-Trinidadians (Indo-T) and Afro-Trinidadians (Afro-T). Associations of alcohol dehydrogenase polymorphisms with response to alcohol, using the Subjective High Assessment Scale (SHAS), and breath alcohol concentrations (BrAC) were tested. METHOD: Regular male drinkers without alcohol dependence (n = 112) ages 18-25 years participated in alcohol challenge sessions consisting of placebo and two doses of alcohol (target BrAC: 0 g/dl for placebo, .04 g/dl low dose, and .08 g/dl high dose) and genotyped for variants in ADH1B*3 and ADH1C*2. RESULTS: Indo-T had significantly higher BrAC, pulse rates, and cortisol levels when compared with Afro-T but did not have significantly higher SHAS values. Higher responses on the SHAS items muddle/confused and nauseated were significantly associated with the presence of at least one ADH1B*3 allele following the high dose of alcohol in Afro-T. Indo-T with at least one ADH1C*2 allele displayed significantly different Drug × Time interactions for the SHAS item effects of alcohol at the low dose and for the SHAS items clumsy, muddle/confused, effects of alcohol, floating, drunk, and total at the high dose from Indo-T with two ADH1C*1 alleles. CONCLUSIONS: This is the first study that has investigated individual sensitivity to alcohol in a Caribbean population and in people of East Indian descent. Indo-T with at least one ADH1C*2 allele may be at higher risk for heavy drinking by feeling less of the effects of alcohol, including nausea. In Afro-T, having at least one ADH1B*3 allele appears to exert a protective effect by enhancing the unpleasant effects of alcohol, such as nausea and confusion.

Correlates of adiposity in a Caribbean pre-school population.

OBJECTIVE: To evaluate ethnic and anthropometric correlates of adiposity among a nationally representative, multi-ethnic, Trinidadian pre-school population. DESIGN: Cross-sectional study conducted between June 2008 and July 2009. SETTING: Government and privately owned Early Childhood Care and Education Centres in Trinidad. SUBJECTS: A total of 596 pre-school children (aged 31-73 months) from thirty-four schools had their weight, height, mid-upper arm circumference, waist circumference, biceps and triceps skinfold thicknesses measured by a registered dietitian using standard procedures. Percentage body fat was estimated using a foot-to-foot bioelectric impedance analyser (Tanita 531, Tokyo, Japan). Date of birth, religion and ethnicity were extracted from school records and pre-schoolers' ethnicity was categorized as East Indian, African, Mixed (a combination of two or more ethnicities), Chinese or Caucasian. RESULTS: Anthropometric variables explained significantly more of the variance in adiposity among girls (67·4-88·1 %) than boys (24·4-39·2 %; P < 0·0 0 1). Pre-schoolers of African descent were significantly taller, heavier and had higher abdominal fat and mid-upper arm circumference than their East Indian and Mixed counterparts (all P < 0·001). The overall prevalence of excess adiposity (≥25 % body fat) as determined by bioelectrical impedance was 14·6 %, while 2·9 % of the children were undernourished according to WHO weight-for-age criteria. Differences in anthropometry were non-existent between children attending government and private pre-schools. CONCLUSIONS: Gender, ethnicity and anthropometry all explained excess adiposity in these pre-schoolers. These findings highlight the need to elucidate the mechanisms that may be involved in explaining these differences, particularly those of ethnic origin.

A multilevel analysis of the role of parental and community variables on young children's health.

OBJECTIVE: The purpose of this study was to examine the associations among community characteristics, family economic adversity, parents' health beliefs, and parents' and children's health using cross-level mediation analyses. METHODS: Survey data were collected from a nationally representative sample of 1,337 families with children between 3 and 6 years nested within 45 Trinidad and Tobago community clusters. RESULTS: At the individual level, parents' health belief of internality was a significant mediator between family economic adversity, adult health, and children's health. In the cross-level mediation analyses, health belief of internality was a significant mediator between community health problems and children's health. There were between-community variations in the relationship between adult health, health belief of powerful others, and children's health. CONCLUSIONS: There is strong evidence of the role of community and family influences on children's health. Findings indicate the need to use a multilevel analytical approach in studies of children's health.

Socio-behavioural factors and early childhood caries: a cross-sectional study of preschool children in central Trinidad.

BACKGROUND: Early childhood caries (ECC) is a public health problem due to its impact on children's health, development and well being. Little is known about early childhood oral health in the West Indies or the influence of social and behavioural factors on the prevalence and severity of early childhood caries in this preschool population. The aims of this study were to describe the prevalence and severity of ECC in preschool children in a region of central Trinidad and to explore its relationship with social and behavioural factors. METHOD: A cross-sectional survey was undertaken on children aged 3-5 years-old from a random sample of preschools in central Trinidad. Oral health examinations were conducted for children for whom parental consent was given, using WHO criteria (visual diagnosis / cavitation at d3). A self-reported questionnaire was distributed to all parents and caregivers. Variables included socio-demographics, oral health knowledge, attitudes and behaviours, visible caries experience and treatment need. RESULTS: 251 children were examined, 50.2% were male with a mean age of 3.7 years (SD 0.67) and 71% were of Indian ethnicity. The prevalence of ECC was 29.1% and the prevalence of severe early childhood caries (S-ECC) was 17.5%. 29.9% of children had some treatment need, with 12% in need of urgent care or referral. Poisson generalized linear mixed model analysis found a higher rate of visible caries experience for children who ate sweet snacks more than twice a day (p < 0.001), had poorer parental dental health ratings (p < 0.0001), a previous dental visit (p < 0.0001) and difficulty finding dental care (p < 0.001). CONCLUSION: The prevalence and severity of ECC in central Trinidad was related to oral health behaviours and access to dental care. Oral health promotion should include more supportive and practical advice for parents and caregivers of preschool children along with improved access to dental care to enable primary prevention and management of ECC.

West Indian interventions at the heart of the cultural establishment: Edric Connor, Pearl Connor, and the BBC.

The history of New Commonwealth migration to Great Britain and its impact on British national identity have been the subjects of growing scholarly interest, but they are often viewed overwhelmingly in terms of racial tension and conflict, a perspective reinforced by the tendency to trace this history as a succession of crisis moments marked by violence and immigration restriction. This article instead focuses on an instance of cultural collaboration between two Trinidadian settler-artists, Edric and Pearl Connor, and Britain's premier cultural institution, the BBC. The BBC careers of these two individuals suggest that the Connors used their professional opportunities to integrate West Indian history, culture, and talent into BBC programming in an effort to formulate and promote an inclusive conception of British culture, one that embraced the imperial connections between the colonies and the 'mother country' and involved the growing West Indian and New Commonwealth communities in Britain itself. Furthermore, their success highlights a moment, between roughly 1945 and 1965, when the BBC was open to the Connors' progressive vision of a British culture 6f the future. Only when the cultural priorities of the Connors and the Corporation diverged in the 1960s did the disillusionment so characteristic of later generations of 'black British' artists become pronounced.

The association of serum 25-hydroxyvitamin D with indicators of bone quality in men of Caucasian and African ancestry.

UNLABELLED: We examined the association of serum 25-hydroxyvitamin D [25(OH)D] with indices of bone quality in older men. Positive associations for 25(OH)D and bone mineral density, content, cortical thickness, and axial and polar strength strain indices were observed among Caucasians; however, among men of African descent findings were either null or negative. INTRODUCTION: There are limited data on serum 25(OH)D and bone measures in men of African ancestry. To better understand racial differences in vitamin D status and bone health, a cross-sectional study among 446 Caucasian men in the US and 496 men of African ancestry in Tobago (age ≥ 65 years) was conducted. METHODS: Serum 25(OH)D (liquid chromatography and tandem mass spectrometry) was measured, and peripheral quantitative computed tomography scans were administered. Bone measures estimated included trabecular and cortical volumetric bone mineral density (vBMD), bone mineral content (BMC), bone geometry (cross-sectional area and cortical thickness), and polar and axial strength strain indices (SSIp and SSIx). RESULTS: Men of African ancestry had higher 25(OH)D than Caucasians (34.7 vs. 27.6 ng/ml, p < 0.01). Among Caucasians, 25(OH)D was positively (p trend < 0.05) associated with cortical vBMD, total BMC, cortical thickness, SSIp, and SSIx at the distal radius after adjustment for potential confounders. Similar patterns were observed at the distal tibia. In contrast, in men of African ancestry, there was an inverse association (p trend < 0.05) between 25(OH)D and the cross-sectional area, and SSIx. Race modified (p for interaction < 0.05) the association between 25(OH)D and total BMC, cross-sectional area, SSIp, SSIx, and trabecular vBMD of the radius. In men of African ancestry, there was evidence of a threshold effect (at approximately 18 ng/ml) for 25(OH)D on tibial total BMC and cortical thickness. CONCLUSIONS: More studies are needed to better comprehend these race differences for 25(OH)D and bone density, geometry, and indices of bone strength.

Are international nursing students disadvantaged by UK patients?

International students bring billions of pounds annually to the UK through higher education. Although nursing students may not contribute as significantly in monetary terms as traditional graduate and postgraduate learners, they do, however, bring with them other benefits in terms of wealth of experience, diversity and cultural capital, often looking after client groups sometimes marginalized by mainstream society. The reality is that many nursing homes and care homes simply would not function without internationally recruited nurses contributing to our health service and the wellbeing of society. The author of this article is a module manager for a Nursing and Midwifery Council regulated Overseas Nurses Programme, which runs up to four times per year at a large Faculty of Health, Sports and Science in South Wales. Anecdotal evidence from class disclosures by international nursing students provided the rationale for this independent enquiry. Listening to verbal accounts suggested that internationally-recruited nurses were experiencing episodes of 'unfair treatment' by patients under their care when undertaking the clinical practice component of the programme.

Knowledge of, attitudes toward, and perceptions of epilepsy among college students in Trinidad and Tobago.

Epilepsy is poorly understood by the public and has been associated with numerous myths. This, coupled with its sometimes dramatic clinical manifestations, has often resulted in stigmatization of persons with epilepsy. A questionnaire to measure knowledge of, attitudes toward, and perceptions of epilepsy (KAPE) was adapted from previous studies and administered to students of the University of the West Indies, St. Augustine, Trinidad and Tobago. The response rate was 91% (355 students). Knowledge was limited, especially with respect to epilepsy's cause, its incidence, and management of an acute emergency. Attitudes toward epilepsy were generally positive. Students who knew someone with epilepsy scored significantly higher on knowledge and attitude questions. A stigma score was calculated to assess perceived stigmatization. There were no differences between the genders, but persons from rural areas and persons of mixed ethnicity perceived less stigmatization. Hindus perceived greater stigmatization than people of other religions. Overall, students still feel persons with epilepsy are discriminated against and experience stigmatization.

Natural history and correlates of hip BMD loss with aging in men of African ancestry: the Tobago Bone Health Study.

Little is known about the magnitude, pattern, and determinants of bone loss with advancing age among men, particularly among those of African descent. We examined the rate of decline in hip BMD and identified factors associated with BMD loss among 1478 Afro-Caribbean men >or=40 yr of age. BMD was measured at baseline and after an average of 4.4 yr by DXA. The rate of decline in femoral neck BMD was 0.29 +/- 0.81%/yr in the total sample (p < 0.0001). However, a U-shaped relationship between advancing age and the rate of decline in BMD was observed. The rate of decline in BMD at the femoral neck was -0.38 +/- 0.77%/yr among men 40-44 yr of age, decelerated to -0.15 +/- 0.81%/yr among men 50-54 yr of age, and then accelerated to -0.52 +/- 0.90%/yr among those 75+ yr of age (all p < 0.003). Men who lost >or=5% of their body weight during follow-up had significantly greater BMD loss than those who remained weight stable or gained weight (p < 0.0001). The relationship between weight loss and BMD loss was more pronounced among men who were older and leaner at study entry (p < 0.03). We also observed a strong impact of advanced prostate cancer and its treatment with androgen deprivation on BMD loss. Men of African ancestry experience substantial BMD loss with advancing age that seems to be comparable to the rate of loss among white men in other studies. Additional studies are needed to better define the natural history and factors underlying bone loss with aging in men of African ancestry.

Parents' views on factors influencing the dental health of Trinidadian pre-school children.

OBJECTIVE: To describe parents' views on the dental health of pre-school children in Trinidad. BASIC RESEARCH DESIGN: Self-administered 22 item questionnaire by 138 parents and guardians of pre-school children. CLINICAL SETTING: University paediatric dentistry clinic. PARTICIPANTS: Consecutive parents or guardians of pre-school children attending a university paediatric dentistry clinic. MAIN OUTCOME MEASURES: Views on dental health and dental care of pre-school children, perceptions of own oral health and demographic information. RESULTS: Most participants (80%) were educated up to secondary school level and 59% were from homes where the head of the household was either in manual work or unemployed. One-half of the participants (50.7%) felt that teeth of young children should be brushed three times a day, with (75.4%) choosing a small brush. Most participants (65%) considered the position of supervised brushing of childrens' teeth from 'in front' to be the most effective method while 4.5% choose 'from behind'. Twenty seven percent did not know if their child's toothpaste contained fluoride and 82.6% did not know how much fluoride it should contain. Thirty three percent of the respondents had given their child a sweetened baby bottle or comforter at night. Fifty four percent felt a child's first dental visit should be when all baby teeth were present. Forty two percent would want a decayed baby tooth filled, 31.9% would want it extracted and 22.4% were unsure. CONCLUSION: The generally inaccurate factual knowledge and low awareness of preventive care among parents suggest the need for accurate information about factors influencing the dental health of pre-school children. These findings have significant implications for the delivery of effective health promotion strategies and the accuracy of health education messages in Trinidad and Tobago.

Genetic and environmental influences on skeletal muscle phenotypes as a function of age and sex in large, multigenerational families of African heritage

The aim of this study was to estimate the heritability of and environmental contributions to skeletal muscle phenotypes (appendicular lean mass and calf muscle cross-sectional area) in subjects of African descent and to determine whether heritability estimates are impacted by sex or age. Body composition was measured by dual-energy X-ray absorptiometry and computed tomography in 444 men and women aged 18 yr and older (mean: 43 yr) from eight large, multigenerational Afro-Caribbean families (family size range: 21-112). Using quantitative genetic methods, we estimated heritability and the association of anthropometric, lifestyle, and medical variables with skeletal muscle phenotypes. In the overall group, we estimated the heritability of lean mass and calf muscle cross-sectional area (h(2) = 0.18-0.23, P < 0.01) and contribution of environmental factors to these phenotypes (r(2) = 0.27-0.55, P < 0.05). In our age-specific analysis, the heritability of leg lean mass was lower in older vs. younger individuals (h(2) = 0.05 vs. 0.23, respectively, P = 0.1). Sex was a significant covariate in our models (P < 0.001), although sex-specific differences in heritability varied depending on the lean mass phenotype analyzed. High genetic correlations (rho(G) = 0.69-0.81; P < 0.01) between different lean mass measures suggest these traits share a large proportion of genetic components. Our results demonstrate the heritability of skeletal muscle traits in individuals of African heritage and that heritability may differ as a function of sex and age. As the loss of skeletal muscle mass is related to metabolic abnormalities, disability, and mortality in older individuals, further research is warranted to identify specific genetic loci that contribute to these traits in general and in a sex- and age-specific manner.