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1.
Recurso na Internet em Inglês | LIS - Localizador de Informação em Saúde | ID: lis-47275

RESUMO

Since onset of the Novel Coronavirus (COVID-19) the Pan American Health Organization/World Health Organization (PAHO/WHO) Office for Barbados and Eastern Caribbean Countries (ECC) has actively assisted countries to prepare and respond to the virus.


Assuntos
Barbados/epidemiologia , Kit de Reagentes para Diagnóstico/normas , Betacoronavirus , Capacitação em Serviço/métodos
2.
Recurso na Internet em Inglês, Espanhol | LIS - Localizador de Informação em Saúde | ID: lis-47140

RESUMO

La Organización Panamericana de la Salud (OPS) está implementando un plan integral para apoyar los esfuerzos de preparación de Barbados para el brote asociado con la enfermedad por el coronavirus 2019 (COVID-19). Este plan incluye establecer y fortalecer la capacidad de laboratorio para la detección temprana del virus a través de las redes de salud pública y laboratorios de referencia en las Américas


Assuntos
Infecções por Coronavirus/diagnóstico , Barbados/epidemiologia , Betacoronavirus , Capacitação Profissional , Infecções por Coronavirus/prevenção & controle
3.
Am J Trop Med Hyg ; 103(1): 149-156, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32342853

RESUMO

Dengue fever and other febrile mosquito-borne diseases place considerable health and economic burdens on small island nations in the Caribbean. Here, we used two methods of cluster detection to find potential hotspots of transmission of dengue and chikungunya in Barbados, and to assess the impact of input surveillance data and methodology on observed patterns of risk. Using Moran's I and spatial scan statistics, we analyzed the geospatial and temporal distribution of disease cases and rates across Barbados for dengue fever in 2013-2016, and a chikungunya outbreak in 2014. During years with high numbers of dengue cases, hotspots for cases were found with Moran's I in the south and central regions in 2013 and 2016, respectively. Using smoothed disease rates, clustering was detected in all years for dengue. Hotspots suggesting higher rates were not detected via spatial scan statistics, but coldspots suggesting lower than expected rates of disease activity were found in southwestern Barbados during high case years of dengue. No significant spatiotemporal structure was found in cases during the chikungunya outbreak. Spatial analysis of surveillance data is useful in identifying outbreak hotspots, potentially complementing existing early warning systems. We caution that these methods should be used in a manner appropriate to available data and reflecting explicit public health goals-managing for overall case numbers or targeting anomalous rates for further investigation.


Assuntos
Febre de Chikungunya/epidemiologia , Vírus Chikungunya/patogenicidade , Vírus da Dengue/patogenicidade , Dengue/epidemiologia , Surtos de Doenças , Análise Espaço-Temporal , Aedes/virologia , Animais , Barbados/epidemiologia , Febre de Chikungunya/transmissão , Febre de Chikungunya/virologia , Vírus Chikungunya/fisiologia , Análise por Conglomerados , Dengue/transmissão , Dengue/virologia , Vírus da Dengue/fisiologia , Doenças Endêmicas/estatística & dados numéricos , Monitoramento Epidemiológico , Humanos , Incidência , Mosquitos Vetores/virologia , Saúde Pública , Risco
4.
PLoS One ; 14(4): e0215392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995272

RESUMO

BACKGROUND: Although most countries face increasing population levels of obesity and diabetes their effect on coronary heart disease (CHD) mortality has not been often studied in small island developing states (SIDs) where obesity rates are among the highest in the world. We estimated the relative contributions of treatments and cardiovascular risk factors to the decline in CHD mortality from 1990 to 2012 in the Caribbean island, Barbados. METHODS: We used the IMPACT CHD mortality model to estimate the effect of increased coverage of effective medical/surgical treatments and changes in major CHD risk factors on mortality trends in 2012 compared with 1990. We calculated deaths prevented or postponed (DPPs) for each model risk factor and treatment group. We obtained data from WHO Mortality database, population denominators from the Barbados Statistical Service stratified by 10-year age group (ages 25-34 up to 85 plus), population-based risk factor surveys, Global Burden of Disease and Barbados' national myocardial infarction registry. Monte Carlo probabilistic sensitivity analysis was performed. RESULTS: In 1990 the age-standardized CHD mortality rate was 109.5 per 100,000 falling to 55.3 in 2012. Implementation of effective treatment accounted for 56% DPPs (95% (Uncertainty Interval (UI) 46%, 68%), mostly due to the introduction of treatments immediately after acute myocardial infarction (AMI) (14%) and unstable angina (14%). Overall, risk factors contributed 19% DPPs (95% UI 6% to 34%) mostly attributed to decline in cholesterol (18% DPPs, 95% UI 12%, 26%). Adverse trends in diabetes: 14% additional deaths(ADs) 95% UI 8% to 21% ADs) and BMI (2% ADs 95%UI 0 to 5% ADs) limited potential for risk factor gains. CONCLUSIONS: Given the significant negative impact of obesity/diabetes on mortality in this analysis, research that explores factors affecting implementation of evidenced-based preventive strategies is needed. The fact that most of the decline in CHD mortality in Barbados was due to treatment provides an example for SIDs about the advantages of universal access to care and treatment.


Assuntos
Doença das Coronárias/mortalidade , Complicações do Diabetes/mortalidade , Modelos Cardiovasculares , Obesidade/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
5.
BMJ Open ; 9(1): e025977, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30696685

RESUMO

OBJECTIVES: In Barbados, high case fatality rates have been reported after myocardial infarction (MI) with higher rates in women than men. To explore this inequality, we examined documented pharmacological interventions for ST-segment elevated myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable and chronic angina in women and men. DESIGN: Prospective cohort registry data for STEMI and NSTEMI and retrospective chart review for unstable and chronic angina. SETTING: Tertiary care (acute coronary syndromes) and primary care (chronic angina) centres in Barbados. PARTICIPANTS: For the years 2009-2016, a total of 1018 patients with STEMI or NSTEMI were identified via the prospective study. For unstable and chronic angina, 136 and 272 notes were reviewed respectively for the years 2010-2014. OUTCOME MEASURES: The proportions of patients prescribed recommended medication during the first 24 hours after an acute event, at discharge and for chronic care were calculated. Prescribed proportions were analysed by gender after adjustment for age. RESULTS: Between 2009 and 2016, for the acute management of patients with NSTEMI and STEMI, only two (aspirin and clopidogrel) of six drugs had documented prescription rates of 80% or more. Patients with STEMI (n=552) had higher prescription rates than NSTEMI (n=466), with gender differences being more pronounced in the former. Among patients with STEMI, after adjustment for age, diabetes, hypertension and smoking, men were more likely to receive fibrinolytics acutely, OR 2.28 (95% CI 1.24 to 4.21). Compared with men, a higher proportion of women were discharged on all recommended treatments; this was only statistically significant for beta-blockers: age-adjusted OR 1.87 (95% CI 1.16 to 3.00). There were no statistically significant differences in documented prescription of drugs for chronic angina. CONCLUSION: Following acute MI in Barbados, the proportion of patients with documented recommended treatment is relatively low. Although women were less likely to receive appropriate acute care than men, by discharge gender differences were reversed.


Assuntos
Síndrome Coronariana Aguda/terapia , Angina Instável/terapia , Disparidades nos Níveis de Saúde , Infarto do Miocárdio/terapia , Prevenção Secundária/métodos , Fatores Sexuais , Síndrome Coronariana Aguda/epidemiologia , Fatores Etários , Idoso , Angina Instável/epidemiologia , Barbados/epidemiologia , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Sistema de Registros
6.
Artigo em Inglês | MEDLINE | ID: mdl-31892174

RESUMO

Despite widespread awareness of the rise of non-communicable diseases (NCDs) and the growing threat of climate change, little research has explored future health outcomes that will occur at the intersection of these challenges. Ten Barbadian health professionals were interviewed to assess their knowledge of health risks of climate change as it relates to NCDs in Barbados as a case study of a small island state at risk. There is widespread concern among health professionals about the current and future prevalence of non-communicable diseases among Barbadians. There is less concern about the future burden of NCDs in the context of a changing climate, largely because of a lack of knowledge among the majority of the health experts interviewed. Those knowledgeable about potential connections noted the difficulty that climate change would pose to the prevention and management of NCDs, given the impacts of climate stressors to food security, the built environment, and physiological and psychosocial health impacts. Lack of awareness among health professionals of the risk climate change poses to NCD prevalence and impact is reflective of the country's health priorities that fail to recognize the risk of climate change. We recommend efforts to disseminate information about climate change to stakeholders in the health sector to increase awareness.


Assuntos
Atitude do Pessoal de Saúde , Mudança Climática , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Prioridades em Saúde/estatística & dados numéricos , Doenças não Transmissíveis/epidemiologia , Adulto , Barbados/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
7.
J Infect Dev Ctries ; 13(1): 1-10, 2019 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32032017

RESUMO

INTRODUCTION: Microbes such as Salmonella, Campylobacter and S. aureus have been implicated in Foodborne disease outbreaks (FBDOs) worldwide, yet information on their occurrence in Barbados is scanty. The purpose of this study was to determine the aetiological agents, food vehicles, locations and peak seasons of FBDOs in Barbados; assess the quality of epidemiological investigations; and identify deficiencies in food production practices and laboratory detection. METHODOLOGY: A search of FBDOs occurring in Barbados between 1998-2009 was conducted among published and unpublished literature sources and reports. The search terms included the keywords "foodborne disease," "outbreaks" and "Barbados". RESULTS: During the period 1998 to 2009, there were 24 foodborne outbreaks, 215 cases of illness, one hospitalisation and no deaths. Overall, 37.5% of outbreaks were associated with hotels/resorts. Salmonella Enteritidis phage type 8 was most commonly implicated with eggs and poultry being the primary vehicles. Three outbreak reports were available for assessment and revealed that there were deficiencies in the outbreak investigations. These reports also recorded high levels of food contamination with indicator organisms, suggesting that improvements in food hygiene and production practices were required. CONCLUSIONS: The number of FBDOs is low in comparison to developed countries. However, the data was likely affected by under-reporting and inadequacies in the outbreak investigations and laboratory detection. Improvements in these areas would lead to not only better detection and characterisation of FBDOs in Barbados but improved food safety control measures.


Assuntos
Campylobacter/isolamento & purificação , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/etiologia , Salmonella/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Barbados/epidemiologia , Campylobacter/classificação , Contaminação de Alimentos , Humanos , Salmonella/classificação , Estações do Ano , Staphylococcus aureus/classificação
8.
BMC Public Health ; 18(1): 998, 2018 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-30092782

RESUMO

BACKGROUND: High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults. METHODS: A sub-sample (n = 364; 25-64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012-13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design. RESULTS: Mean sodium excretion was 2656 (2488-2824) mg/day, with 67% (62-73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395-1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9-2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings. CONCLUSIONS: In this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Dieta/estatística & dados numéricos , Potássio/urina , Sódio/urina , Adulto , Barbados/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/urina , Estudos Transversais , Dieta/efeitos adversos , Inquéritos sobre Dietas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/análise , Prevalência , Sódio na Dieta/análise
9.
PLoS Med ; 15(7): e1002613, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30016319

RESUMO

BACKGROUND: Over the last 5 years (2013-2017), the Caribbean region has faced an unprecedented crisis of co-occurring epidemics of febrile illness due to arboviruses transmitted by the Aedes sp. mosquito (dengue, chikungunya, and Zika). Since 2013, the Caribbean island of Barbados has experienced 3 dengue outbreaks, 1 chikungunya outbreak, and 1 Zika fever outbreak. Prior studies have demonstrated that climate variability influences arbovirus transmission and vector population dynamics in the region, indicating the potential to develop public health interventions using climate information. The aim of this study is to quantify the nonlinear and delayed effects of climate indicators, such as drought and extreme rainfall, on dengue risk in Barbados from 1999 to 2016. METHODS AND FINDINGS: Distributed lag nonlinear models (DLNMs) coupled with a hierarchal mixed-model framework were used to understand the exposure-lag-response association between dengue relative risk and key climate indicators, including the standardised precipitation index (SPI) and minimum temperature (Tmin). The model parameters were estimated in a Bayesian framework to produce probabilistic predictions of exceeding an island-specific outbreak threshold. The ability of the model to successfully detect outbreaks was assessed and compared to a baseline model, representative of standard dengue surveillance practice. Drought conditions were found to positively influence dengue relative risk at long lead times of up to 5 months, while excess rainfall increased the risk at shorter lead times between 1 and 2 months. The SPI averaged over a 6-month period (SPI-6), designed to monitor drought and extreme rainfall, better explained variations in dengue risk than monthly precipitation data measured in millimetres. Tmin was found to be a better predictor than mean and maximum temperature. Furthermore, including bidimensional exposure-lag-response functions of these indicators-rather than linear effects for individual lags-more appropriately described the climate-disease associations than traditional modelling approaches. In prediction mode, the model was successfully able to distinguish outbreaks from nonoutbreaks for most years, with an overall proportion of correct predictions (hits and correct rejections) of 86% (81%:91%) compared with 64% (58%:71%) for the baseline model. The ability of the model to predict dengue outbreaks in recent years was complicated by the lack of data on the emergence of new arboviruses, including chikungunya and Zika. CONCLUSION: We present a modelling approach to infer the risk of dengue outbreaks given the cumulative effect of climate variations in the months leading up to an outbreak. By combining the dengue prediction model with climate indicators, which are routinely monitored and forecasted by the Regional Climate Centre (RCC) at the Caribbean Institute for Meteorology and Hydrology (CIMH), probabilistic dengue outlooks could be included in the Caribbean Health-Climatic Bulletin, issued on a quarterly basis to provide climate-smart decision-making guidance for Caribbean health practitioners. This flexible modelling approach could be extended to model the risk of dengue and other arboviruses in the Caribbean region.


Assuntos
Aedes/virologia , Clima , Vírus da Dengue/patogenicidade , Dengue/epidemiologia , Surtos de Doenças , Vetores de Doenças , Tempo (Meteorologia) , Animais , Barbados/epidemiologia , Teorema de Bayes , Dengue/diagnóstico , Dengue/transmissão , Dengue/virologia , Secas , Inundações , Temperatura Alta/efeitos adversos , Humanos , Dinâmica não Linear , Chuva , Medição de Risco , Fatores de Risco , Fatores de Tempo
10.
Am J Trop Med Hyg ; 98(6): 1857-1859, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29637883

RESUMO

Barbados is a Caribbean island country of approximately 285,000 people, with a thriving tourism industry. In 2015, Zika spread rapidly throughout the Americas, and its proliferation through the Caribbean islands followed suit. Barbados reported its first confirmed autochthonous Zika transmission to the Pan American Health Organization in January 2016, a month before the global public health emergency was declared. After detection of suspected Zika cases on Barbados in 2015, 926 individuals were described as suspected cases, and 147 laboratory-confirmed cases were reported through December 2016, the end of the most recent epidemiological year. In this short report, we describe the epidemiological characteristics of 926 clinical case records that were originally suspected as cases of Zika, and which were subsequently sent for testing and confirmation; 147 were found positive for Zika, using reverse transcription-polymerase chain reaction methods, another 276 tested negative, and the remaining 503 were either pending results or still in the suspected category. Women were represented at about twice the rate of men in case records where gender was reported (71.9%), and confirmed cases (78.2%), and 19 of the confirmed positive cases were children under the age of 10.


Assuntos
Surtos de Doenças , Saúde Global , Infecção por Zika virus/epidemiologia , Zika virus/fisiologia , Adolescente , Adulto , Barbados/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Adulto Jovem , Infecção por Zika virus/virologia
11.
Epidemiol Infect ; 146(8): 1048-1055, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29655390

RESUMO

Using the dengue surveillance program, we prospectively collected data on all the suspected and confirmed cases of dengue in Barbados from 2006 to 2015. Data were analysed for demographic, seasonal and temporal dynamics of this disease in this country. The overall mean annual incidence rate of suspected and confirmed dengue over the study period was 0.49% (range 0.15%-0.99%) and 0.16% (range 0.05%-0.48%), respectively. There was a significant correlation between the mean monthly number of confirmed cases, the mean monthly rainfall and the mean monthly relative humidity percentage. Dengue in this population is predominantly an infection affecting children and young adults. The median age of the patients with both, suspected and confirmed dengue was 25 years and the highest proportion of cases was seen in the age group 0-15 years. The annual incidence rates of both the suspected and the confirmed cases showed an upward trend during the study period and this upward trend was more pronounced among children.


Assuntos
Dengue/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Criança , Pré-Escolar , Dengue/virologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estações do Ano , Adulto Jovem
12.
Asian Pac J Cancer Prev ; 19(S1): 45-50, 2018 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-29682920

RESUMO

Background: The prevalence of alcohol use is quite high in the Caribbean region, and specifically, in Barbados. Alcohol use has been documented to negatively affect the way students behave within and outside school. This study set out to examine the role alcohol plays in students' behavioural problems at school. Methods: An analysis of crosssectional data collected during the National Secondary Schools Survey was done. Mean (and standard deviation), frequencies and percentages were computed, and differences in proportions among the groups were assessed using Pearson's Chi Square. Multivariate analysis using binary logistic regression was done to determine the association between explanatory variables and outcome variables. Results: In bivariate analysis, behavioural problems at school were significantly associated with age (p= 0.001), grade (p= 0.000), sense of belonging at school (p= 0.000), relationship with teachers (p= 0.000), and past month alcohol use (p= 0.007). In multivariate analysis, students' having frequent behavioural problems at school was significantly associated with neither past year nor past month alcohol use (AOR= 1.13, 95% CI= 0.91- 1.40, AOR= 1.02, 95% CI= 0.83- 1.24 respectively). Significant inverse associations were found between students' behavioural problems and age (11- 14 years: AOR= 0.53, 95% CI= 0.33- 0.84; AOR= 0.51, 95% CI= 0.32- 0.82 for models 1 and 2 respectively), and relationship with teachers (very good: AOR= 0.10, 95% CI= 0.07- 0.16; AOR= 0.13, 95% CI= 0.09- 0.20 for models 1 and 2 respectively). Conclusion: Neither past year nor past month alcohol consumption by students was associated with frequent behavioural problems at school. Students who were younger than 17 years, and who had a relationship with their teachers that was not very bad were significantly less likely to engage in frequent behavioural problems.


Assuntos
Comportamento do Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Comportamento Problema/psicologia , Instituições Acadêmicas , Estudantes/psicologia , Adolescente , Adulto , Barbados/epidemiologia , Criança , Estudos Transversais , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Adulto Jovem
13.
Asian Pac J Cancer Prev ; 19(S1): 57-62, 2018 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-29682922

RESUMO

Background: In Barbados and the wider Caribbean region, alcohol is widely consumed by adolescents and young people, including those in secondary schools. The high prevalence of alcohol use, and its potential adverse effects are a source of concern to policy makers and the general population, which calls for better understanding of the drivers of this problem. This study thus aimed at investigating whether parental alcohol drinking habit is a predictor of alcohol use among secondary school students in the country. Methods: The predictor variables and response variables in the study were categorical, and so descriptive, univariate analysis consisted of computation of frequencies and percentages. Bivariate analysis using Pearson's Chi Square was done to test for significant differences in the response variables among groups. Logistic regression modeling was used in multivariate analysis to determine the predictor variables that were significantly associated with the response variables. Results: Significant associations were seen between students' age, (P= 0.00), grade (P=0.00), fathers' drinking habit (P=0.00), mothers' drinking habit (P=0.00), and both past year and past month alcohol use, in bivariate analysis. Logit model shows that students whose fathers drink only on weekends, sometimes during the week, or every day, respectively, had significantly increased risk of alcohol use in the past month (AOR= 2.62, 95%CI= 1.81- 3.77; AOR= 1.85, 95%CI= 1.19- 2.85; AOR= 2.18, 95%CI= 1.49- 3.18). Students whose mothers drink only on special occasion had significantly higher risk of alcohol use in the past year and past month (AOR= 1.99, 95%CI= 1.06- 3.74; AOR= 2.30, 95%CI= 1.36- 3.89 respectively). Conclusion: Having fathers who drink only on weekend, sometimes during the week and every day were significantly positively associated with alcohol use in the past month. Having mothers who drink only on special occasion was a risk factor for past year and past month alcohol use. However, having mothers who drin


Assuntos
Comportamento do Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Pais/psicologia , Estudantes/psicologia , Adolescente , Barbados/epidemiologia , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Prevalência , Fatores de Risco , Instituições Acadêmicas
14.
Trop Doct ; 48(1): 11-16, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29099347

RESUMO

A retrospective study was conducted by examining all the medical files of all the children with sickle cell anaemia (Hb SS) admitted from 1 January 2009 to 31 December 2013. A total of 220 admission notes (59 patients aged 5 months-16 years) were analysed. Of these, 53.2% were boys; 85.8% of the patients had Hb SS. The most common reason for admission was vaso-occlusive crisis. Blood transfusions were used in 39.7% of admissions There were no deaths during the study period. We note the number of sickle cell-related admissions and morbidity has increased, along with an increase in the number of blood transfusions. The mortality rate for children with sickle cell in Barbados is low compared to other territories in the Caribbean and worldwide. The need for better comprehensive management protocols and universal screening should decrease the morbidity patterns seen in this study.


Assuntos
Anemia Falciforme/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Distribuição por Idade , Barbados/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Masculino , Morbidade , Estudos Retrospectivos
15.
Rev. panam. salud pública ; 42: e17, 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-961735

RESUMO

ABSTRACT Objective To understand what number and proportion of dementia cases in Barbados are attributable to modifiable lifestyle factors and what effect a reduction in these risk factors would have on future dementia prevalence. Methods This was an observational study using Levin's Attributable Risk formula, which assumes independence of risk factors, to calculate the population attributable risk (PAR) of dementia (all-cause) for six risk factors: midlife obesity, physical inactivity, smoking, low educational attainment, diabetes mellitus, and midlife hypertension in Barbados. A recently-published, modified formula was utilized to account for non-independence of risk factors using secondary data for Barbados. The number and proportion of dementia cases attributable to each risk factor and to all risk factors combined were computed, as was the effect that any reduction in these risk factors might have on future dementia prevalence. Results Accounting for the fact that risk factors do not operate independently, 50.9% (1 526 cases) were attributable to the combined effect of the six risk factors under study. According to the analysis, if each risk factor were reduced by 5% - 20% per decade, dementia prevalence could be 3.3% - 31.8% lower by 2050. Conclusion Using a largely theoretical model, the six modifiable lifestyle factors were estimated to be attributable to 50.9% of dementia cases in Barbados. Since the risk factors have much in common, any intervention that targets one of them could significantly reduce future dementia prevalence.


RESUMEN Objetivo Establecer el número y la proporción de casos de demencia en Barbados que se pueden atribuir a factores modificables relacionados con el modo de vida y el efecto que podría tener una reducción de estos factores de riesgo en la prevalencia de la demencia en el futuro. Métodos Este fue un estudio de observación en el que se usó la fórmula de riesgo atribuible de Levin, que presupone la independencia de los factores de riesgo, para calcular el riesgo de demencia (por cualquier causa) atribuible a la población (RAP) en Barbados en relación con seis factores de riesgo: obesidad en la edad madura, inactividad física, tabaquismo, nivel de escolaridad bajo, diabetes mellitus e hipertensión en la edad madura. Se utilizó una fórmula modificada de publicación reciente para incluir los factores de riesgo no independientes, sobre la base de datos secundarios para Barbados. Se computaron el número y la proporción de casos de demencia atribuibles a cada factor de riesgo y a todos los factores de riesgo combinados, al igual que el efecto de una reducción de estos factores de riesgo sobre la prevalencia de la demencia. Resultados Teniendo en cuenta el hecho de que los factores de riesgo no operan independientemente, 50,9% de los casos (1 526 casos) se podían atribuir al efecto combinado de los seis factores de riesgo en estudio. Según el análisis, si cada factor de riesgo se redujera de 5% a 20% por decenio, la prevalencia de la demencia podría ser de 3,3% a 31,8% más baja para el 2050. Conclusiones Mediante un modelo mayormente teórico, se estimó que 50,9% de los casos de demencia en Barbados eran atribuibles a seis factores modificables relacionados con el modo de vida. Como los factores de riesgo tienen mucho en común, cualquier intervención dirigida específicamente a uno de ellos podría reducir considerablemente la prevalencia de la demencia en el futuro.


RESUMO Objetivo Conhecer o número e a proporção de casos de demência em Barbados que são atribuíveis a fatores modificáveis do estilo de vida e examinar o efeito que teria uma redução desses fatores de risco na prevalência futura de demência. Métodos Estudo observacional realizado com o uso da fórmula do risco atribuível de Levin (pressuposto de independência dos fatores de risco) para calcular o risco atribuível populacional (RAP) da demência (todas as causas) em Barbados para seis fatores de risco: obesidade na meia idade, inatividade física, tabagismo, baixo grau de instrução, diabetes mellitus e hipertensão na meia idade. Uma versão modificada da fórmula recentemente publicada foi usada para representar a não independência dos fatores de risco usando dados secundários do país. O número e a proporção de casos de demência atribuíveis a cada fator de risco e a todos os fatores de risco combinados foram computados, assim como o efeito de uma redução desses fatores de risco na prevalência futura de demência. Resultados Considerando que os fatores do risco não atuam de modo independente, 50,9% (1.526 casos) foram atribuíveis ao efeito combinado dos seis fatores de risco estudados. De acordo com a análise, se cada fator de risco tivesse uma redução de 5%-20% por década, a prevalência da demência poderia cair de 3,3% a 31,8% até 2050. Conclusões De acordo com um modelo eminentemente teórico, estimou-se que os seis fatores modificáveis do estilo de vida eram atribuíveis a 50,9% dos casos de demência em Barbados. Visto que os fatores de risco têm muito em comum, qualquer intervenção que vise um dos fatores poderia reduzir consideravelmente a prevalência futura da demência.


Assuntos
Humanos , Comportamentos Relacionados com a Saúde , Demência/prevenção & controle , Barbados/epidemiologia
16.
J Glob Health ; 7(2): 020407, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28959440

RESUMO

BACKGROUND: Both fasting plasma glucose (FPG) and HbA1c are recommended for the diagnosis of diabetes and prediabetes by the American Diabetes Association (ADA), and for diabetes by the World Health Organization. The ADA guidance is influential on clinical practice in many developing countries, including in the Caribbean and Latin America. We aimed to compare the prevalence and characteristics of individuals identified as having diabetes and prediabetes by FPG and HbA1c in a predominantly African ancestry Caribbean population. METHODS: A representative population-based sample of 1234 adults (≥25 years of age) resident in Barbados was recruited. Standard methods with appropriate quality control were used to collect data on height, weight, blood pressure, fasting lipids and history of diagnosed diabetes, and to measure fasting glucose and HbA1c. Those with previously diagnosed diabetes (n = 192) were excluded from the analyses. Diabetes was defined as: FPG ≥7.0 mmol/L or HbA1c ≥6.5%; prediabetes as: FPG ≥5.6 to <7mmol/L or HbA1c ≥5.7 to <6.5%. RESULTS: Complete data were available on 939 participants without previously diagnosed diabetes. The prevalence of undiagnosed diabetes was higher, but not significantly so, by HbA1c (4.9%, 95% CI 3.5, 6.8) vs FPG (3.5%, 2.4, 5.1). Overall 79 individuals had diabetes by either measure, but only 21 on both. The prevalence of prediabetes was higher by HbA1c compared to FPG: 41.7% (37.9, 45.6) vs 15.0% (12.8, 17.5). Overall 558 individuals had prediabetes by either measure, but only 107 on both. HbA1c, but not FPG, was significantly higher in women than men; and FPG, but not HbA1c, was significantly associated with raised triglycerides and low HDL cholesterol. CONCLUSION: The agreement between FPG and HbA1c defined hyperglycaemia is poor. In addition, there are some differences in the phenotype of those identified, and HbA1c gives a much higher prevalence of prediabetes. The routine use of HbA1c for screening and diagnosis in this population would have major implications for clinical and public health policies and resources. Given the lack of robust evidence, particularly for prediabetes, on whether intervention in the individuals identified would improve outcomes, this approach to screening and diagnosis cannot be currently recommended for this population.


Assuntos
Glicemia/análise , Diabetes Mellitus/epidemiologia , Jejum/sangue , Hemoglobina A Glicada/análise , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Barbados/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Fenótipo , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Prevalência , Reprodutibilidade dos Testes
17.
Curr HIV Res ; 15(3): 154-160, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28521724

RESUMO

BACKGROUND: We review research findings and the limitations of recent qualitative and quantitative studies of HIV prevalence and risk behaviors in military populations in three Caribbean countries (Dominican Republic, Belize, and Barbados). METHODS: This research shows how mental health issues, disordered substance use, and structuring aspects of the occupational field produce and reproduce patterns of risk behaviors. RESULTS: We discuss the use of formative research, the Positive Health, Dignity, and Prevention framework, and the use of implementation science (including research methods that employ alternative methodological assumptions to better elucidate both cultural nuances and unknown components of program impact in different military populations) as a means to tailor individual prevention strategies to military populations. CONCLUSION: We conclude that greater adaption and ingenuity in prevention could improve behavioral prevention of HIV among military personnel in the Caribbean region.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Infecções por HIV/prevenção & controle , Militares , Assunção de Riscos , Barbados/epidemiologia , Terapia Comportamental/métodos , Belize/epidemiologia , República Dominicana/epidemiologia , Infecções por HIV/epidemiologia , Humanos
18.
PLoS One ; 12(5): e0176779, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28542162

RESUMO

INTRODUCTION: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is of growing concern globally. The risk for transmission of antimicrobial resistant organisms across several continents to the Caribbean is a real one given its tourism industry. After a cluster of cases of CRKP were detected, several studies detailed in this report were initiated to better characterize the problem. METHODS: A hospital-wide point prevalence study and active surveillance were performed at Queen Elizabeth Hospital (QEH) in Barbados in 2013 to assess the prevalence of CRKP infection/colonization. Following this, a 1-year longitudinal study measured the prevalence of CRKP isolates in the hospital and across all healthcare facilities in the country. RESULTS: In 2013, eleven viable isolates of CRKP from cluster of cases were sent for molecular epidemiology studies. When sequenced, they were found to be the ST-258 clone. Identification of a cluster of cases of CRKP ST-258/512 clones indicated person-to-person transmission. In September 2013, the hospital-wide point prevalence study revealed 18% of patients (53/299) at the hospital were either colonized or infected with CRKP. The infection to colonization ratio was 1:7. Patients who were infected/colonized vs. non-colonized were older (64.7 vs. 48.7 years, p<0.0001), were hospitalized longer (42.5 days vs. 27 days, p = 0.0042), were more likely to have an invasive device (66% vs. 32%, p<0.0001), especially urinary catheters (55% vs. 24%, p<0.0001), and were more likely to have used antimicrobials within the prior 14 days (91% vs. 46%, p<0.0001). Specific antimicrobials, including fluoroquinolones and piperacillin-tazobactam, were significantly associated with infection/colonization. In 2014, the 12-month period prevalence of CRKP in Barbados was 49.6 per 100,000 population and of blood stream infections was 3.2 per 100,000 population. CONCLUSIONS: This point prevalence study identified patients at-risk of acquisition of CRKP and allowed QEH to implement interventions aimed at decreasing the prevalence of CRKP. Organization of a National and regional Infection Prevention and Control Committee in 2014 aimed to strengthen antimicrobial resistance surveillance programs across the English-speaking Caribbean were established.


Assuntos
Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Região do Caribe/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Infecções por Klebsiella/microbiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
19.
Lupus ; 26(10): 1034-1041, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28420049

RESUMO

Objective The objective of this study was to examine neuropsychiatric lupus in a Black Caribbean population. Methods We reviewed Barbados National Lupus Registry patients with ≥4 American College of Rheumatology criteria and a diagnosis of neuropsychiatric lupus using the American College of Rheumatology 19 case definitions. Results From 366 patients with four or more American College of Rheumatology criteria for systemic lupus erythematosus, 55 (15%) had evidence of neuropsychiatric lupus. There were 51 females and four males (F:M = 13:1) with a median age of 31 years. A total of 76.4% had a single neuropsychiatric lupus complication and 23.6% had two or three complications occurring sequentially or concurrently. The top three complications were psychosis - 49.1% (95% CI 35.8, 62.5); ischaemic stroke - 32.7% (21.4, 46.5); and generalized tonic-clonic seizures - 12.7% (6.0, 24.8). Twelve of the American College of Rheumatology 19 neuropsychiatric syndromes were represented: 91.2% central; 8.8% peripheral. There were 521 observation years, and for 32 patients (58%) neuropsychiatric lupus was a presenting feature. For the remaining 23 (42%) the first neuropsychiatric lupus event came after systemic lupus erythematosus diagnosis - median time of two years. Of the 22 deaths, systemic lupus erythematosus nephritis caused almost half (45.5%) at a median age of 32. The prevalence of nephritis was lower in the neuropsychiatric lupus subgroup (25.5%) compared with the Barbados National Lupus Registry data (47%) ( P = 0.01). Ischaemic stroke caused 22.7% of deaths at a median age of 46 and was the main cause of chronic neurologic deficits amongst survivors. Conclusion Neuropsychiatric lupus was an early cause of morbidity in systemic lupus erythematosus with predominantly singular central nervous system complications, the most common of which was psychosis. Most deaths occurred at a young age, principally from systemic lupus erythematosus nephritis. Ischaemic stroke was the main neurologic cause of death and disability.


Assuntos
Grupo com Ancestrais do Continente Africano , Lúpus Eritematoso Sistêmico/epidemiologia , Nefrite Lúpica/epidemiologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/epidemiologia , Adulto , Barbados/epidemiologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etnologia , Isquemia Encefálica/etiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/etnologia , Nefrite Lúpica/etnologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/complicações , Vasculite Associada ao Lúpus do Sistema Nervoso Central/etnologia , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/etnologia , Transtornos Psicóticos/etiologia , Sistema de Registros , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
20.
J Trop Pediatr ; 63(1): 43-49, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27516419

RESUMO

This study describes the epidemiology, the clinical features and the course of confirmed chikungunya among a cohort of children. It is a prospective audit of chikungunya cases among children registered for routine medical care at a primary care center. Children presenting with suspected chikungunya were confirmed using real-time reverse transcription polymerase chain reaction. There were 203 suspected cases of chikungunya; of these, 115 samples were tested and 69 (59.0%) were confirmed. The attack rate of chikungunya was 10.2% and 3.5% for the suspected and confirmed cases, respectively. Only six (8.7%) of the children with confirmed chikungunya required hospitalization. Joint pain was a clinical feature in 68 of 69 (98.6%) and skin rash was seen in 32 (46.4%) confirmed cases. The duration of illness was <2 weeks in 89.9% and less than a week in 62.3% of cases. In conclusion, most children had mild clinical manifestations and recovered fully within 2 weeks.


Assuntos
Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Epidemias , Adolescente , Barbados/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos
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