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2.
Soc Work Public Health ; 36(5): 558-576, 2021 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-34182897

RESUMO

The Novel Coronavirus Disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. Trinidad and Tobago reported its first infection on March 12th 2020. This study assessed knowledge, attitudes and practices toward COVID-19 among Trinidadians during the post-lockdown period. A validated questionnaire was used to conduct a cross-sectional survey from May 25th to June 6th 2020.Most respondents (512, 96.6%) knew that COVID-19 is highly infectious. Many (523, 98.7%) identified vulnerable groups as persons 65 years and older and those with preexisting co-morbidities (480, 90.6%). Respondents identified COVID-19 symptoms as fever (498, 94.0%), dry cough (495, 93.4%), myalgia (403, 76.0%) and sore throat (441, 83.2%). Most 504 (95.1%) acknowledged that COVID-19 threatened the country's economy. Dominant practices included regular hand washing (97.2%) and social distancing (512, 96.6%).Health authorities should continue public education efforts to increase knowledge and the adoption of recommended practices.


Assuntos
COVID-19 , Conhecimentos, Atitudes e Prática em Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Humanos , Quarentena , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia
3.
Vasc Health Risk Manag ; 17: 187-194, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33976549

RESUMO

Background: Ideal cardiovascular health behaviour (CVHB) measures four ideal health behaviours (non-smoking, body mass index <85th Percentile, healthy diet, and physical activity). This study aimed to determine the prevalence, distribution, and correlates of ideal CVHB among adolescents in the Caribbean. Methods: Nationally representative cross-sectional data of 2016 or 2017 with complete CVHB measurements were analysed from 7556 school adolescents from four Caribbean countries. Results: The prevalence of 0-1 ideal metrics CVHB was 20.4%, 2 ideal metrics 48.7%, and 3-4 ideal metrics 30.8%. Only 5.0% had all 4 ideal CVHB metrics, 41.0% intermediate CVH (≥1 metric in the intermediate category and none in the poor category), and 54.0% had poor CVH (≥1 metric in poor category). In adjusted logistic regression analysis, compared to students from Dominican Republic, students from Jamaica (Adjusted Odds Ratio-AOR: 1.36, 95% confidence interval-CI: 1.01-1.85), students from Trinidad and Tobago (AOR: 1.46, 95% CI: 1.17-1.82) and male sex (AOR: 1.35, 95% CI: 1.11-1.64) were positively associated with meeting 3-4 ideal CVHB metrics. In addition, in unadjusted analysis, rarely or sometimes experiencing hunger was negatively and high peer and parent support were positively associated with meeting 3-4 ideal CVHB metrics. Conclusion: The proportion of meeting 3-4 ideal CVHB metrics was low among adolescents in four Caribbean countries. Both high-risk and school-wide intervention programmes should be implemented in aiding to improve CVHB in Caribbean countries. Several factors associated with ideal CVHB were identified, which can be targeted in school health interventions.


Assuntos
Comportamento do Adolescente , Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Estilo de Vida Saudável , Comportamento de Redução do Risco , Adolescente , Fatores Etários , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Dieta Saudável , República Dominicana/epidemiologia , Exercício Físico , Feminino , Inquéritos Epidemiológicos , Fatores de Risco de Doenças Cardíacas , Humanos , Jamaica/epidemiologia , Masculino , não Fumantes , Medição de Risco , Suriname/epidemiologia , Trinidad e Tobago/epidemiologia
4.
AIDS Res Ther ; 18(1): 20, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892747

RESUMO

BACKGROUND: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. METHODS: Two Social Workers were trained as patient tracers and hired for 15 months (April 2017-June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016-May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. RESULTS: Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care-89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07-1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26-2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90-3.24). Persons initiated on ART for 4-6 years (OR, 3.09; 95% CI 1.13-8.48,), 7-9 years (OR, 3.97; 95% CI 1.39-11.31), > 10 years (OR, 5.99; 95% CI 1.74-20.64 were more likely to be retained in care. CONCLUSIONS: Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Trinidad e Tobago/epidemiologia , Carga Viral
5.
Int J STD AIDS ; 32(9): 830-836, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33890834

RESUMO

A chart review study was conducted to determine the prevalence of syphilis and explore the associated risk factors among men who have sex with men (MSM) who attended a large HIV clinic in Trinidad during the period January-December 2019. Patients were routinely screened for syphilis annually, and demographic, clinical, and laboratory data were extracted from the medical records. Descriptive and bivariate analyses were performed, and factors significantly associated with a syphilis diagnosis were assessed using multivariate logistic regression. During the period, 218 MSM were seen, age range 19-67 years, and median age 34.0 years. The prevalence of syphilis was 41.3% (90/218), and 71.1% (64//90) of these infections were asymptomatic. Multivariate analysis using logistic regression showed that MSM living with HIV in the 30-34 years old-age group (OR, 4.32; 95% CI, 1.04-18.02), and those with a previous history of treated syphilis (OR, 10.18; 95% CI, 4.60-22.53) were more likely to be diagnosed with syphilis. The prevalence of syphilis is high among MSM attending the HIV clinic in Trinidad, and most of these infections were asymptomatic; hence, targeted and sustained interventions to reduce syphilis transmission are urgently required. Repeat episodes of syphilis may play a role in the transmission dynamics of syphilis in MSM.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Sífilis , Adulto , Idoso , China , Estudos Transversais , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comportamento Sexual , Sífilis/diagnóstico , Sífilis/epidemiologia , Trinidad e Tobago/epidemiologia , Adulto Jovem
6.
Cancer Causes Control ; 32(7): 763-772, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33835281

RESUMO

PURPOSE: The aim of this study is to determine the demographic, pathological, and treatment-related factors that predict recurrence and survival in a Trinidadian cohort of breast cancer patients. METHODS: The inclusion criteria for this study were female, over 18 years, and with a primary breast cancer diagnosis confirmed by a biopsy report occurring between 2010 and 2015 at Sangre Grande Hospital, Trinidad. Univariate associations with 5-year recurrence-free survival and 5-year overall survival were calculated using the Kaplan-Meier method for categorical variables and Cox Proportional Hazards for continuous variables. A multivariate model for prediction of recurrence and survival was determined using Cox regression. RESULTS: For the period 2010-2015, 202 records were abstracted. Five-year overall survival and recurrence-free survival rates were found to be 74.3% and 56.4%, respectively. Median times from first suspicious finding to date of biopsy report, date of surgery, and date of chemotherapy were 63 days, 125 days, and 189 days, respectively. In the univariate analysis, age (p = 0.038), stage (p < 0.001), recurrence (p = 0.035), surgery (p = 0.016), ER (p < 0.001) status, PR status (p < 0.001), and subtype (p < 0.001) were significantly associated with survival. Additionally, stage (p = 0.004), N score (p = 0.002), ER (p = 0.028) status, PR (p = 0.018) status, and subtype (p = 0.025) were significantly associated with recurrence. In the Cox multivariate model, Stage 4 was a significant predictor of survival (HR 6.77, 95% CI [0.09-2.49], p = 0.047) and N3 score was a significant predictor of recurrence (HR 4.47, 95% CI [1.29-15.54], p = 0.018). CONCLUSION: This study reports a 5-year breast cancer survival rate of 74.3%, and a recurrence-free survival rate of 56.4% in Trinidad for the period 2010-2015.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/mortalidade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/mortalidade , Neoplasias da Mama/terapia , Demografia , Intervalo Livre de Doença , Feminino , Hospitais Públicos , Humanos , Estimativa de Kaplan-Meier , Registros Médicos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Trinidad e Tobago/epidemiologia
7.
BMJ Open ; 11(4): e044397, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849850

RESUMO

OBJECTIVES: To determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic. DESIGN: Cross-sectional online survey. SETTING: HCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago. PARTICIPANTS: 395 HCWs aged ≥18 years. MAIN OUTCOME MEASURES: Depression, anxiety and stress scores. RESULTS: Among the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI -5.233 to -1.692) and stress, p<0.001 (95% CI -5.364 to -1.591). CONCLUSIONS: This study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.


Assuntos
Ansiedade/epidemiologia , COVID-19/psicologia , Depressão/epidemiologia , Pessoal de Saúde/psicologia , Estresse Ocupacional/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia
8.
Pathog Glob Health ; 115(3): 188-195, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33645470

RESUMO

Mayaro virus, which can often go undetected due to its clinical manifestations and intimate alignment with dengue and chikungunya viruses, is one of the most neglected arboviruses. The virus has been found in several outbreaks, where a moderate-to-severe and potentially incapacitating joint disease has been observed. MAYV usually circulates in a sylvan cycle of forest mosquitoes and vertebrates, causing sporadic sylvatic infections to humans, and some outbreaks in sub-urban areas. This study focuses on the demonstration of the possible co-circulation of Mayaro virus with chikungunya virus and Zika virus during the outbreaks that occurred in Trinidad and Tobago in 2014 and 2016, respectively. Acute samples from patients who previously tested negative for chikungunya, dengue, and Zika, and specifically exhibiting joint pain were selected and investigated for the presence of Mayaro virus genome using real-time RT-PCR techniques. Nine persons were shown to be positive for Mayaro virus during the chikungunya outbreak of 2014, while no one during the Zika outbreak in 2016. Five results correspond to persons living in highly urbanized areas across Trinidad. These findings provide evidence that multiple arboviral circulations are possible and could easily go undetected especially during outbreak situations. Our study is the first to demonstrate the possible co-circulation of Mayaro and chikungunya viruses and the occurrence of human cases for both diseases during an outbreak in the Caribbean. A possible change in the pattern of distribution of human cases to more urbanized areas is also discussed.


Assuntos
Febre de Chikungunya , Vírus Chikungunya , Dengue , Infecção por Zika virus , Zika virus , Animais , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/genética , Dengue/diagnóstico , Dengue/epidemiologia , Surtos de Doenças , Humanos , Trinidad e Tobago/epidemiologia , Zika virus/genética , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia
9.
Nutr Health ; 27(1): 105-121, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33089756

RESUMO

BACKGROUND: Over 50% of adults in Latin America and the Caribbean have a body mass index (BMI) ≥ 25 suggesting excess energy intakes relative to energy expenditure. Accurate estimation of resting metabolic rate (RMR), the largest component of total energy requirements, is crucial to strategies aimed at reducing the prevalence and incidence of overweight and obesity. AIM: We evaluated the accuracies of established and locally developed RMR prediction equations (RMRP) among adults. METHODS: Four hundred adult volunteers ages 20 to 65 years had RMR measured (RMRM) with a MedGem® indirect calorimeter according to recommended procedures. RMRP were compared to RMRM with values ± 10% of RMRM deemed accurate. Anthropometry was measured using standard procedure. Linear regression with bootstrap analyses was used to develop local RMRP equations based on anthropometric and demographic variables. The University of the West Indies Ethics Committee approved the study. RESULTS: Males had higher mean absolute RMR (p < 0.001) but similar mean age-adjusted measured RMR per kg of body (20.9 vs. 21.5 kcals/day; p = 0.1) to females. The top performing established anthropometry-based RMRP among participants by sex, physical activity (PA) level and BMI status subgroups were Mifflin-St Jeor, Owen, Korth, Harris-Benedict, and Livingston, while Johnstone, Cunningham, Müller (body composition (BC)), Katch and McArdle, Mifflin-St Jeor (BC) were the most accurate BC-based RMRP. Locally developed RMRP had accuracies comparable to their top-ranked established RMRP counterparts. CONCLUSIONS: Accuracies of established RMRP depended on habitual PA level, BMI status, BC and sex. Furthermore, locally developed RMRP provide useful alternatives to established RMRP.


Assuntos
Metabolismo Basal , Saúde/estatística & dados numéricos , Adulto , Idoso , Composição Corporal , Índice de Massa Corporal , Calorimetria Indireta , Feminino , Voluntários Saudáveis , Humanos , Masculino , Matemática , Pessoa de Meia-Idade , Caracteres Sexuais , Trinidad e Tobago/epidemiologia , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-33120963

RESUMO

OBJECTIVE: The study aimed to estimate the prevalence and correlates of oral hygiene (OH) and hand hygiene (HH) behavior among school adolescents in three Caribbean countries. METHOD: In all, 7476 school adolescents (median age 14 years) from the Dominican Republic, Suriname, and Trinidad and Tobago responded to the cross-sectional Global School-Based Student Health Survey (GSHS) in 2016-2017. RESULTS: The prevalence of poor OH (tooth brushing < 2 times/day) was 16.9%, poor HH (not always before meals) was 68.2%, poor HH (not always after toilet) was 28.4%, and poor HH (not always with soap) was 52.7%. In the adjusted logistic regression analysis, current cannabis use, inadequate fruit and vegetable intake, poor mental health, and low parental support increased the odds for poor OH. Rarely or sometimes experiencing hunger, trouble from alcohol use, inadequate fruit and vegetable intake, poor mental health, and low parental support were associated with poor HH (before meals and/or after the toilet, and/or with soap). CONCLUSION: The survey showed poor OH and HH behavior practices. Several sociodemographic factors, health risk behaviors, poor mental health, and low parental support were associated with poor OH and/or HH behavior that can assist with tailoring OH and HH health promotion.


Assuntos
Higiene das Mãos , Saúde Mental , Higiene Bucal , Adolescente , Estudos Transversais , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Proteção , Assunção de Riscos , Suriname/epidemiologia , Trinidad e Tobago/epidemiologia
11.
BMC Psychiatry ; 20(1): 498, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032571

RESUMO

BACKGROUND: This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients' demographics, comorbidities, and cardiovascular medications with depressive symptoms. METHODS: In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher's exact test, Chi-square test, and multivariate logistic regression. RESULTS: The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414-2.797), OR 1.847 (CI 1.251-2.728), OR 1.872 (CI 1.207-2.902) and OR 1.703 (CI 1.009-2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). CONCLUSIONS: Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03863262 . This trial was retrospectively registered on 20th February 2019.


Assuntos
Depressão , Questionário de Saúde do Paciente , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Masculino , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia
12.
J Card Surg ; 35(12): 3387-3390, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32845035

RESUMO

BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) pandemic has seen the cancellation of elective cardiac surgeries worldwide. Here we report the experience of a cardiac surgery unit in a developing country in response to the COVID-19 crisis. METHODS: From 6th April to 12th June 2020, 58 patients underwent urgent or emergency cardiac surgery. Data was reviewed from a prospectively entered unit-maintained cardiac surgery database. To ensure safe delivery of care to patients, a series of strict measures were implemented which included: a parallel healthcare system maintaining a COVID-19 cold site, social isolation of patients for one to 2 weeks before surgery, polymerase chain reaction testing for COVID-19, 72 hours before surgery, discrete staff assigned only to cardiac surgical cases socially isolated for 2 weeks as necessary. RESULTS: The mean age at surgery was 59.7 ± 11 years and 41 (70.7%) were male. Fifty-two patients were hypertensive (90%), and 32 were diabetic (55.2%). There were three emergency type A aortic dissections. Forty-seven patients underwent coronary artery bypass graft surgery with all but three performed off-pump. Fourteen cases required blood product transfusion. One patient had postoperative pneumonia associated with chronic obstructive pulmonary disease. The median length of stay was 5.7 ± 1.8 days. All patients were discharged home after rehabilitation. There were no cases of COVID-19 infection among healthcare workers during the study period. CONCLUSION: These strategies allowed us to maintain a service for urgent and emergency procedures and may prove useful for larger countries when there is decrease in COVID-19 cases and planning for the restart of elective cardiac surgery.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/cirurgia , Pandemias , SARS-CoV-2 , Comorbidade , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trinidad e Tobago/epidemiologia
13.
J Card Surg ; 35(11): 3017-3024, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32827179

RESUMO

BACKGROUND AND AIM: Access to specialized cardiac surgery is a problem in emerging countries. Here, we reflect on the approach we used to establish a cardiac surgery unit in Trinidad and Tobago. METHODS: The program started in 1993 with monthly visits by a team from Bristol Heart Institute. A group of local doctors, nurses, and perfusionists were identified for training, and a senior nurse moved to the island to start a teaching program. The visiting support was gradually reduced, and the local team gained independence in managing the service in 2006. RESULTS: The initial low volume surgery increased to around 380 cases a year with the implementation of comprehensive service in 2006. Most patients required coronary artery bypass graft (CABG). In-hospital mortality declined from 5% in the nascent years to below 2% thereafter. In the last 5 years (2015-2019), 1764 patients underwent surgery (mean age 59.6 ± 10.8 years, 66% male). The majority were East-Indian-Caribbean (79.1%) or Afro-Caribbean (16.7%), half had diabetes, and two-thirds hypertension (EuroScore II 1.8 ± 1.9). The majority (1363 patients) underwent CABG (99.5% off-pump; conversion to on-pump 1.5%). The mean number of grafts was 2.5 ± 0.7 with 98.5% and 23.1% receiving one and two or more arterial grafts, respectively. In-hospital mortality was 1.1%, re-exploration for bleeding 2%, stroke 0.1%, mediastinitis 0.2%. The length of the postoperative hospital stay was 5.8 ± 2 days. CONCLUSION: Frequent outside visits complemented by training in an overseas center, and transfer of knowledge proved to be an effective strategy to develop a cardiac surgery unit in an emerging country with results comparable to accepted international standards.


Assuntos
Ponte de Artéria Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Cirurgia Torácica , Idoso , Comorbidade , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/etnologia , Diabetes Mellitus/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Trinidad e Tobago/epidemiologia
14.
J Parasitol ; 106(4): 506-512, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32745169

RESUMO

Discus (Symphysodon spp.) are costly and prized specimens in the international ornamental fish trade. The majority of discus submitted to the Aquatic Animal Health Unit at the University of the West Indies School of Veterinary Medicine for necropsy between September 2010 and September 2015 had lesions consistent with Cryptobia iubilans infection, thus prompting this study. To determine the prevalence of the flagellated gastrointestinal protozoan C. iubilans in discus fish, 32 discus were sourced from 10 suppliers, including breeders, importers, and hobbyists across Trinidad. Fish were euthanized, and the internal organs, particularly the stomach and intestine, were observed under a light microscope for characteristic granulomatous lesions and/or live C. iubilans parasites. All wet-mount slides on which granulomas were observed were also Ziehl-Neelsen acid-fast stained to presumptively exclude the presence of Mycobacterium spp., the main differential when diagnosing C. iubilans-associated granulomatous gastritis or to determine the presence of dual infections. Further histological analyses were performed on stomach and intestinal sections, and transmission electron microscopy was used to confirm the parasite in stomach sections. The prevalence of C. iubilans infection was found to be 81.3%, and the prevalence of presumptive dual infections with Mycobacterium spp. was found to be 21.9%. To the best of our knowledge, this is the first documented study of C. iubilans infections in the wider Caribbean region.


Assuntos
Ciclídeos/parasitologia , Infecções por Euglenozoa/veterinária , Doenças dos Peixes/parasitologia , Kinetoplastida/fisiologia , Animais , Autopsia/veterinária , Região do Caribe/epidemiologia , Infecções por Euglenozoa/epidemiologia , Infecções por Euglenozoa/parasitologia , Doenças dos Peixes/epidemiologia , Kinetoplastida/ultraestrutura , Microscopia Eletrônica de Transmissão/veterinária , Prevalência , Estômago/parasitologia , Estômago/patologia , Estômago/ultraestrutura , Trinidad e Tobago/epidemiologia
15.
Infect Dis Health ; 25(4): 294-301, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32800598

RESUMO

BACKGROUND: Newly educated RNs are vulnerable to needle stick injuries (NSIs). Most needle stick injuries occur during practice and associated with nurses' practice and available resources. METHODS: This was a quantitative, descriptive study. Registered nurses (N = 120) with less than three years' experience. Data collected using a 26-item questionnaire among newly registered nurses. Data were analyzed descriptively and inferentially using (SPSS) version 20. RESULTS: Most of the nurses between the ages 20-30 years (49.7%), were female (73.4%), had 2 to <3 years' experience (44.2%) and experienced a needle stick injury (43.3%). Respondents knew about the policies on standard precautions but their practice was not compliant with safe practices. Adherence was associated with knowledge of policies on standard precautions (r. = 534, p < .01), having updated policies (r = .404, p < .01) and the appropriate use of resources (r. = 805, p < .01). CONCLUSION: There are a number of factors that contribute to NSIs among newly registered nurses which are personal as well as structural. Avoidable practices such as non-adherence to standard precautions while using hypodermic needles contributed to NSIs. Mandatory training and evaluation of nurses' knowledge and attitude regarding safety practices should be examined.


Assuntos
Controle de Infecções , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital , Adulto , Feminino , Humanos , Masculino , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Fatores de Risco , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia , Adulto Jovem
16.
BMJ Open ; 10(6): e039004, 2020 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-32565481

RESUMO

INTRODUCTION: There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health. METHODS: INTREPID II is a programme of research incorporating incidence, case-control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological. ETHICS AND DISSEMINATION: Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.


Assuntos
Serviços de Saúde Mental , Transtornos Psicóticos , Projetos de Pesquisa , Estudos de Casos e Controles , Seguimentos , Comportamento de Busca de Ajuda , Humanos , Incidência , Índia/epidemiologia , Nigéria/epidemiologia , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Trinidad e Tobago/epidemiologia
17.
Transbound Emerg Dis ; 67 Suppl 2: 193-200, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32239640

RESUMO

Gastrointestinal nematode (GIN) infestations are a major constraint to sheep production in the West Indies (WI). Intensive and semi-intensive management systems are most commonly employed. These islands display tropical weather patterns with wet and dry seasons. Semi-intensive farming combined with increased rainfall during the wet season has been reported to be most favourable for development and survival of GIN. This study was conducted to determine whether there was a relationship between GIN burdens in sheep with seasonality and management practices of farmers in Trinidad and Tobago (T&T). Farms were visited on a monthly basis from January to December 2017. A maximum of ten sheep, three to nine months of age, were selected from each farm. A total of 3,053 faecal samples were collected and analysed using the Modified McMaster technique. Environmental data on daily precipitation and temperature were collected from the Trinidad and Tobago Meteorological Office during the period of sampling. A mixed effects negative binomial regression model was constructed to analyse the relationship between gastrointestinal nematode faecal egg counts (GINFEC) with season, management system and use of dewormers as fixed effects and farm as a random effect. Average diurnal temperatures of T&T fluctuated between 23.2°C to 32.6°C and 23.9°C to 32.3°C in the dry and wet seasons, respectively. Average daily precipitation ranged between 1.6-1.8 mm and 6.1-8.5 mm during the dry and wet seasons, respectively. A decreased risk of 0.34 (95% CI 0.25-0.47, p < .0001) for GINFEC was observed in dewormed animals versus not dewormed. Semi-intensive management systems experienced an increased risk of GINFEC by 1.39 (95% CI 1.05-1.84, p = .021) compared with intensive and the risk of GINFEC was reduced by 0.40 (95% CI 0.33-0.49, p < .0001) in the wet season versus the dry. A higher prevalence of GIN was observed during the drier months of the year. Climatic conditions observed in T&T remained favourable for GIN survival, development and distribution year-round. Proper management is therefore required for reducing the occurrence of GIN in sheep of T&T throughout the year. This is the first reported study in the WI on the influence of seasonality and management on GIN infestations in sheep during the dry and wet seasons. Further investigation is needed to elucidate why GIN burdens appear to be higher in the dry season than the wet season. This study can be used as a baseline for public education in T&T as well as other developing countries.


Assuntos
Nematoides/isolamento & purificação , Infecções por Nematoides/veterinária , Doenças dos Ovinos/epidemiologia , Animais , Fazendas , Fezes/parasitologia , Feminino , Trato Gastrointestinal/parasitologia , Ilhas/epidemiologia , Masculino , Infecções por Nematoides/epidemiologia , Infecções por Nematoides/parasitologia , Estações do Ano , Ovinos , Doenças dos Ovinos/parasitologia , Temperatura , Trinidad e Tobago/epidemiologia , Tempo (Meteorologia)
18.
J Infect Dis ; 221(Suppl 4): S375-S382, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32034942

RESUMO

Bat-borne zoonotic pathogens belonging to the family Paramxyoviridae, including Nipah and Hendra viruses, and the family Filoviridae, including Ebola and Marburg viruses, can cause severe disease and high mortality rates on spillover into human populations. Surveillance efforts for henipaviruses and filoviruses have been largely restricted to the Old World; however, recent studies suggest a potentially broader distribution for henipaviruses and filoviruses than previously recognized. In the current study, we screened for henipaviruses and filoviruses in New World bats collected across 4 locations in Trinidad near the coast of Venezuela. Bat tissue samples were screened using previously established reverse-transcription polymerase chain reaction assays. Serum were screened using a multiplex immunoassay to detect antibodies reactive with the envelope glycoprotein of viruses in the genus Henipavirus and the family Filoviridae. Serum samples were also screened by means of enzyme-linked immunosorbent assay for antibodies reactive with Nipah G and F glycoproteins. Of 84 serum samples, 28 were reactive with ≥1 henipavirus glycoprotein by ≥1 serological method, and 6 serum samples were reactive against ≥1 filovirus glycoproteins. These data provide evidence of potential circulation of viruses related to the henipaviruses and filoviruses in New World bats.


Assuntos
Quirópteros/virologia , Infecções por Filoviridae/veterinária , Filoviridae , Infecções por Henipavirus/veterinária , Henipavirus , Animais , Quirópteros/sangue , Quirópteros/classificação , Infecções por Filoviridae/epidemiologia , Infecções por Filoviridae/virologia , Infecções por Henipavirus/epidemiologia , Infecções por Henipavirus/virologia , Testes Sorológicos , Trinidad e Tobago/epidemiologia
19.
Viruses ; 12(2)2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32033370

RESUMO

: Rabies virus (RABV) is the only lyssavirus known to be present within the Caribbean. The island of Trinidad, is richly diverse in chiropteran fauna and endemic for bat-transmitted rabies with low RABV isolation rates observed in this population. We aimed to determine the seroprevalence of rabies virus neutralizing antibodies (RVNA) in light of spatio-temporal and bat demographic factors to infer the extent of natural exposure to RABV in the Trinidadian bat population. RVNA titers were determined by the RABV micro-neutralization test on 383 bat samples representing 21 species, comprising 30.9% of local bat diversity, from 31 locations across the island over 5 years. RVNA was positively detected in 33 samples (8.6%) representing 6 bat species (mainly frugivorous) with titers ranging from 0.1 to 19 IU/mL (mean 1.66 IU/mL). The analyses based on a multivariable binomial generalised linear mixed-effects model showed that bat age and year of capture were significant predictors of seropositivity. Thus, juvenile bats were more likely to be seropositive when compared to adults (estimate 1.13; p = 0.04) which may suggest early exposure to the RABV with possible implications for viral amplification in this population. Temporal variation in rabies seropositivity, 2012-2014 versus 2015-2017 (estimate 1.07; p = 0.03) may have been related to the prevailing rabies epizootic situation. Regarding other factors investigated, RVNA was found in bats from both rural and non-rural areas, as well as in both hematophagous and non-hematophagous bat species. The most common seropositive species, Artibeus jamaicensis planirostris is ubiquitous throughout the island which may potentially facilitate human exposure. The findings of this study should be factored into public health assessments on the potential for rabies transmission by non-hematophagous bats in Trinidad.


Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Quirópteros/imunologia , Raiva/imunologia , Raiva/veterinária , Animais , Quirópteros/virologia , Feminino , Masculino , Raiva/epidemiologia , Vírus da Raiva/imunologia , Estudos Soroepidemiológicos , Trinidad e Tobago/epidemiologia
20.
BMC Palliat Care ; 19(1): 13, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31980019

RESUMO

BACKGROUND: Palliative care is in its infancy in most of the developing world. We set out to explore the lived experiences of families and caregivers of recently deceased cancer patients in Trinidad and Tobago and to determine the unmet needs of the patients and what recommendations could be derived to improve the current services. METHODS: A phenomenological approach with purposeful sampling was used. Participants were referred by key health professionals. Face-to-face interviews were conducted. Interviews were transcribed verbatim, with analysis and data collection occurring concurrently. Thematic content analysis was used to determine common domains, themes and sub-themes. RESULTS: Interviews were completed with 15 caregivers. All were spouses or children of the deceased. Ages of the deceased ranged from 43 to 93, the average being 65.5 years. The deceased experienced a variety of cancers including lung, colorectal and oesophageal. Unmet needs were identified under 4 domains of institutions, community, the family unit and the wider society. Institutional unmet needs were delayed diagnosis and treatment and poor inter-institution coordination. Medical and nursing care failed in the areas of health care providers' attitudes, pain management and communication. The family unit lacked physical and psychosocial support for the caregiver and financial aid for the family unit. Societal needs were for public education to address myths and cultural beliefs around cancer. CONCLUSION: There is need for systemic interventions to improve the care of those dying from cancer in Trinidad and Tobago. Stakeholders need to commit to palliative care as a public health priority, implementing education, planning services and mobilizing community resources.


Assuntos
Cuidadores/psicologia , Determinação de Necessidades de Cuidados de Saúde/normas , Neoplasias/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/tendências , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/complicações , Neoplasias/epidemiologia , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Pesquisa Qualitativa , Apoio Social , Trinidad e Tobago/epidemiologia
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