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SETTING: The prevalence of airflow obstruction (AO) in the Caribbean population is unknown.OBJECTIVE: To measure the prevalence of and risk factors for AO (post-bronchodilator ratio of forced expiratory volume in 1 sec to forced vital capacity of DESIGN: National cross-sectional, stratified, cluster sampling of adults aged ≥40 years.RESULTS: AO prevalence was 9.5% among 1104 participants, most of whom were unaware of this. Compared to those aged 40–49 years, the adjusted odds ratio of AO by age group was 2.73 (60–69 years) and 3.30 (≥70 years). Risk factors for AO were unemployment (OR 4.31), being retired (OR 2.17), smoking ≥20 pack-years (OR 1.88) and exposure to dusty jobs for more than 1 year (OR 2.06). Related symptoms were history of wheezing, unscheduled visits to the doctor or admission to hospital for breathing problems and in subjects with at least one respiratory symptom (OR 1.90), at least one risk factor (OR 2.81), either symptoms or risk factors (OR 3.71) and both symptoms and risk factors (OR 5.78) (P < 0.05 in all cases).CONCLUSION: AO prevalence in the general population of Trinidad and Tobago aged ≥40 years was 9.5%, almost all of which was undiagnosed. AO was associated with smoking, age >59 years, lack of employment and working in a dusty job.

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. Methods: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR, based on research in eight countries, including interviews with key stakeholders (n = 42). Results: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. Conclusion: Although HPSR is recognised as valuable for decision making and policy development, it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries. Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders.

Trinidad and Tobago, a small island developing state, has been ranked as number one in a report published by the University of Oxford that assessed responses to COVID-19 based on four of the six WHO criteria for rolling back COVID-19 “lockdown” measures. The key mitigation and containment strategies implemented by the country were evidence-informed and demonstrated an “all-of-government” approach. The COVID-19 health system response of this country demonstrates that although developing countries face many health system challenges, political will, evidence-informed decision-making, respect for science, and timely, coordinated, collaborative actions can strengthen the resilience and response of the health system during a health emergency.

Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.

Background Relationships between low forced vital capacity (FVC), and morbidity have previously been studied but there are no data available for the Caribbean population. This study assessed the association of low FVC with risk factors, health variables and socioeconomic status in a community-based study of the Trinidad and Tobago population. Methods A cross-sectional survey was conducted using the Burden of Obstructive Lung Disease (BOLD) study protocol. Participants aged 40 years and above were selected using a two-stage stratified cluster sampling. Generalized linear models were used to examine associations between FVC and risk factors. Results Among the 1104 participants studied a lower post-bronchodilator FVC was independently associated with a large waist circumference (− 172 ml; 95% CI, − 66 to − 278), Indo-Caribbean ethnicity (− 180 ml; 95% CI, − 90 to − 269) and being underweight (− 185 ml; 95% CI, − 40 to − 330). A higher FVC was associated with smoking cannabis (+ 155 ml; 95% CI, + 27 to + 282). Separate analyses to examine associations with health variables indicated that participants with diabetes (p = 0∙041), history of breathlessness (p = 0∙007), and wheeze in the past 12 months (p = 0∙040) also exhibited lower post-bronchodilator FVC. Conclusion These findings suggest that low FVC in this Caribbean population is associated with ethnicity, low body mass index (BMI), large waist circumference, chronic respiratory symptoms, and diabetes. Electronic supplementary material The online version of this article (10.1186/s12890-019-0823-9) contains supplementary material, which is available to authorized users.

With high mortality in breast, cervical, prostate, and colorectal cancers in Caribbean Community (CARICOM) countries, we examined cancer control initiatives including screening as well as the implementation of relevant international and regional mandates. Secondary data were used to examine cancer control initiatives, which included the presence of national policies, programs, and screening services as well as the implementation of international and regional mandates. To identify the data, an on-line search was conducted using Google/Google Scholar. Data were available for 14 of the 15 full members of CARICOM. Although only six countries had distinct cancer control policies, strategies or action plans, all 14 had key elements of cancer control programs. Screening services were available in the 14 countries for cervical, in 12 countries for breast and in 11 for colorectal cancer. However, only four countries had screening policies. In addition, screening guidelines were available for cervical cancer in nine countries, in one country for breast and in none for colorectal cancer. Selected tobacco control policies were present in the 14 countries and immunization policies for human papillomavirus (HPV) in 13. Treatment services included chemotherapy in 10 countries and radiotherapy in six. Nine countries had palliative care services for patients with advanced disease. The countries were at different stages of implementation/compliance with international and regional mandates and frameworks. There is an urgent need to develop and implement comprehensive and customized cancer control policies addressing screening programs, treatment and palliative care.

In the Caribbean region, an estimated 1.1% of the population aged 15-49 is living with HIV. We aimed to measure factors associated with condom use, the primary form of positive prevention in the Caribbean, among people living with HIV (PLHIV) in its major agency advocating on behalf of PLHIV (the Caribbean Regional Network of People Living with HIV/AIDS, or CRN +). Condom use at last sex was selected for analysis from a broad-ranging cross-sectional survey (n=394) among PLHIV who were members of or received services from CRN+ in Antigua and Barbuda, Grenada, Trinidad and Tobago. PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews. Fifty-four percent of respondents reported using a condom the last time they had sex. Condom use was positively associated with partner being HIV negative, disclosure of HIV status, alcohol use, economic security, education level and being employed. Multivariate logistic regression found independent associations between condom use and economic security (p=0.031; odds ratio (OR) for "enough" income 5.06; 95% CI 1.47-17.39), partner being HIV negative (p=0.036; OR 2.85; 95% CI 1.28-6.33) and being married (p=0.043; OR 2.86; 95% CI 1.03-7.91). Seventy-three percent of respondents reported inadequate family income, 26% reported an HIV-negative partner and 9% were married. Condom use appears to be motivated by protection of HIV-negative partners and spouses. Low socioeconomic status is associated with the overall percentage using condoms. Restriction to members of CRN+ limits generalisability of the findings. Nevertheless, the findings support the view that programmes for the socioeconomic empowerment of PLHIV are needed to slow the Caribbean HIV epidemic. Expectations for protection of different types of partners should be further explored in order to develop culturally appropriate interventions with couples.

This study ascertained demographic information and prevalence rates of medical problems among 571 new and consecutive dental patients attending the emergency clinic of the School of Dentistry, The University of the West Indies. Patients were interviewed by specially trained and calibrated dental students and interns. Various medical problems of patients were recorded in individual open-ended case sheets, maintaining their privacy and confidentiality. This information was then transcribed into a specially designed and pretested form. The data were entered into a Microsoft Excel spreadsheet and analyzed using the SPSS statistical package to obtain the prevalence rates of medical conditions, which were then cross-tabulated with gender, age, ethnicity, and other variables. Significance of differences, if any, was evaluated by chi-square test. In all, 303 medical conditions were encountered in 239 individuals, giving a prevalence rate of 42 percent. Hypertension (12.6 percent), diabetes (6.1 percent), asthma (5.8 percent), arthritis (4.7 percent), and various allergies (8.3 percent) constituted an important segment of the problems. Gender, ethnic, and age differences were also evident for some diseases. In this study-which was the first of this kind in the West Indies-vital information on medical problems among dental patients was obtained by interviews conducted by dental students and interns, forming an important part of their dental education.

The aim of this study was to document the perceptions of elders in six Caribbean countries about ‘active ageing’ and on the basis of their reports to make recommendations to improve their situation. Data were collected principally through 31 focus group discussions conducted in both urban and rural areas. Comparative analysis was carried out of the qualitative information, focusing on three components of ‘active ageing’: health and social services access and use, social support, and economic circumstances. Most of the participants were women, aged 60–79 years, of lower socio-economic status and from urban areas. Large disparities in the responses of Caribbean societies to population ageing were indicated, as well as unequal opportunities to obtain health care and social services, public transport, income and food by both socio-economic status and location. Home-care services are either insufficient or non-existent. Some elders receive social and financial support from relatives while others fear isolation and face deprivation. Social participation varies by place, physical condition, financial situation, association membership, and transport opportunities. Social protection benefits do not provide adequate income and some older people face food insecurity. It was concluded that a comprehensive and multi-sectoral approach using the ‘active ageing’ framework should be implemented to ensure a healthy ageing process.

The Annual Caribbean Health Research Conference has been recognized as the primary forum for the sharing of research outputs in the Caribbean for the last 60 years. The value and longevity of the Conference are largely due to the unique mix of its delegates, which have always included, inter alia, the region's Chief Medical Officers. Consequently, the latter's participation has resulted in the uptake of research to guide the development of health policies and programmes in their respective countries. Indeed, the Conference has had a significant impact on the health of the Caribbean people by enabling innovative practice and evidence-informed health policies (1). Over the last six decades, there have been more than 4200 presentations at the Conference. Remarkably, the number continues to increase each year. There were 32 papers in its inaugural year (1956) compared with over 170 in 2015 when the Conference celebrated its 60th Diamond Jubilee. In addition to its growth, there have been a number of innovations that were introduced to ensure that the Conference remained relevant, addressing the needs of its stakeholders. Notably, since 1983 the abstracts of the papers presented have been published in a yearly Supplement of the West Indian Medical Journal (WIMJ). This initiative ensured that the research findings were available to health professionals and policy-makers who were not present at the Conference. Even so, the researchers who made the presentations were encouraged to publish the full texts in peer reviewed journals, including the WIMJ. However, the findings of a study conducted in 2000 revealed a low conversion rate (2) and programmes were introduced to increase the number of publications such as the hosting of scientific writing workshops. There was also the requirement that researchers submit full manuscripts to be considered for presentation at the Conference. The reasoning behind the latter was that since a full text was already prepared, it can then be reformatted, if necessary, and sent to a journal for publication. Nevertheless, there has been limited success in terms of an increase in publications. In order to improve the publication rate, we have now implemented an even more innovative initiative. Having received the support from WIMJ, the Caribbean Public Health Agency's (CARPHA) Research Advisory Committee identified a few of the more outstanding studies with policy and programme implications, which were presented at the 2013 Conference, for publication in a Special Issue of WIMJ. These manuscripts were subjected to a rigid peer-review process before they were accepted for publication. This Special WIMJ Issue is unique as it comprises the full text of research that was presented at the Annual Caribbean Health Research Conference. It not only addresses the need to increase the number of Conference presentations that are subsequently published but also the accessibility of Caribbean research findings through regional and international databases. This is noteworthy as CARPHA has a commitment to ensure that research evidence is available and accessible to guide policy making in the region. Indeed, at the recent launch of the EvIDeNCe portal by CARPHA at the 2015 Research Conference, the value of having accessible full text papers of Caribbean research was highlighted. The Caribbean Public Health Agency's EvIDeNCe is the Evidence Informed Decision Making Network of the Caribbean (3). This strategic initiative was established to provide support to Caribbean countries as they make evidence-informed health policy decisions by making robust and relevant research findings more accessible. This includes promoting knowledge exchange and regular dialogue between policy-makers, researchers and other stakeholders as well as building the competencies needed by policy-makers to incorporate research evidence in their policy and planning processes. The publication of this Special Issue is also very timely as it follows the launch of the excellent report commemorating the 60th Diamond Jubilee of the annual Conference (4). The report includes some very informative statistics. For example, when the research presented at the annual Conference for the last decade was analysed by the programme areas of the Caribbean Cooperation in Health (CCH III), the areas in which most of the research was conducted were family health (25.4%), non-communicable diseases [NCDs] (20.9%), communicable diseases including HIV (12.3%) and health services research (12.2%). Notably, the manuscripts published in this issue are an excellent reflection of this. Family health, which as defined by CCH III includes child health and development, reproductive and sexual health, adolescent health, inter alia, was represented in most of the papers. In addition, two addressed NCDs (5, 6) and two communicable diseases including HIV (7, 8). It must also be noted that the Health Research Agenda for the Caribbean (9), which defines the priority areas for health research in the region is closely aligned to CCH III. Critically, the research presented at the Conference and published in this Special Issue is making a timely contribution to the dissemination of research findings as the Agenda is implemented. Of special significance is the paper on environmental health (10). This is an under-researched area that is likely to increase in prominence in the Caribbean given the importance and attention being paid to climate change globally as well as its impact on health. A remarkable feature of the annual Conference is the wide participation of Caribbean countries producing quality research (4). This is reflected in the Special Issue, which includes reports of research conducted in six of CARPHA's Member States. Good science is not determined by the size of a country where a researcher is based. This is exemplified by the presence of an excellent paper from the Turks and Caicos Islands (11), a British Overseas Territory with a population of just over 30 000. At CARPHA, we see the publication of this Special Issue as another innovative strategy to support our efforts to promote the uptake of research that will guide policies, programmes and clinical practice. Indeed, we expect that this will be the first of many, perhaps biennial, special issues of WIMJ that publish and make available full manuscripts from the research presented at the annual Caribbean Health Research Conference. The latter is now themed so future special issues are likely to focus on research consistent with the Conference theme. In closing, I congratulate the scientists who had their research published in this Special Issue. It is also important to recognize all the health professionals who conduct priority research and choose to share their findings at the annual Caribbean Health Research Conference, which the longest serving health research conference in Latin America and the Caribbean as well as the largest scientific meeting in the Caribbean. We look forward to your continued dedication toward the conduct of quality research. You can rest assured that the fruits of your efforts are making valuable contributions by providing the evidence to guide the work of the region's policy-makers, programme managers and healthcare providers. Lastly, I must thank the West Indian Medical Journal for collaborating with CARPHA to make this initiative a reality.

Summary. Objective. To describe the oral health and treatment need of schoolchildren in Trinidad and Tobago. Design and method. Cross-sectional survey using stratified cluster sampling. Participants were children in primary (aged 6–8 years) and secondary school (aged 12 and 15 years). Main outcome measures were DMFT/dmft, treatment need, and fluorosis. Results. Examinations were completed on 1064 children. The dmft of the 6–8-year-olds was 2·54 (95% CI = 2·32, 2·76). For 12-year-olds, the DMFT was 0·61 (95% CI = 0·51, 0·71), whereas for 15-year-olds, the DMFT was 1·06 (95% CI = 0·87, 1·25). Most of the caries experience in 6–8-year-olds was from decayed teeth. Sixty-seven per cent of the sample (95% CI = 64%, 69%) had some type of treatment need. Most frequently occurring need was for fillings at 42% (95% CI = 40%, 44%) with 28% (95% CI = 26%, 31%) of the total sample needing two or more surface fillings, followed by fissure sealants at 33% (95% CI = 30%, 36%) and caries-arresting care at 12% (95% CI = 10%, 14%). Extraction of one or more teeth was needed in 13% (95% CI = 11%, 15%) of children. Rates of fluorosis were negligible. Conclusion. The caries experience of 12- and 15-year-old children were low but was high for schoolchildren aged 6–8 years, in terms of prevalence and severity. Effective oral health promotion strategies need to be implemented to improve the oral health of primary schoolchildren in Trinidad and Tobago.

To determine the difference in hearing between a group of steelband musicians (pannists) and a control group.We conducted a controlled cross-sectional pilot study consisting of 29 steelpan players and 30 control subjects from a steelpan orchestra (steelband) in the Otolaryngology Department of the Eric Williams Medical Sciences Complex.Significantly more steelpan players had a hearing loss than the control subjects at 3000 Hz, 4000 Hz, and 6000 Hz ( P0.01). chi 2 testing for trend demonstrated that the longer a steelpan player played his instrument the greater the hearing loss.These results indicate that pannists suffer permanent auditory damage from high-intensity sound levels and that preventative measures are required to prevent this hearing loss, particularly in younger players.

The bacteriological loads of “bara”, “channa”, condiments/spices and ready-to-consume “doubles” sold by street vendors in St. George and Caroni counties of Trinidad were determined. Questionnaires were administered to 100 vendors from both counties to determine which of their practices had effect on the bacteriological quality of the products. In addition, a total of 300 randomly selected members of the public in both counties were interviewed using questionnaires, to assess their attitudes, knowledge and perceptions concerning “doubles” consumption. Of a total of 196 samples each of “bara”, “channa”, condiments/spices and ready-to-eat “doubles” tested, the log 10 mean (±SD) total aerobic plate count (TAPC) per g was 4.87±5.51, 5.79±6.61, 6.26±6.77 and 6.88±7.91, respectively. The difference was statistically significant ( P χ 2 ). Applying a recommended maximum standard of log 10 TAPC per g of 5.00, 10 (5.1%), 19 (9.7%), 57 (29.1%) and 78 (39.8%) of 196 samples of “bara”, “channa”, condiments/spices and ready-to-consume “doubles”, respectively, were deemed unfit for human consumption. Vendor practices, which significantly affected the prevalence of unfit “doubles” were re-use of leftover product ( P =0.01), wearing of hand gloves ( P =0.02), availability of water at sale outlet ( P =0.0008) and source of water ( P =0.0008). Consumption of “doubles” was more common amongst East Indians (69.2%) than other races (30.8%) ( P P P >0.05) affect consumption of “doubles”. The high prevalence of ready-to-consume “doubles” assessed unfit for human consumption coupled with a significantly higher proportion of consumers than non-consumers being aware that the product could cause food-poisoning, definitely poses a health risk to consumers of “doubles” in the population. Enforcement of sanitary practices during the preparation and sale of “doubles” should reduce the health risk.

Objectives To determine if there is seasonal variation in acute asthmatic visits to accident and emergency (AE P

Objective: To examine the perceptions of body size among adolescents in Trinidad and to determine whether there were ethnic differences. Design: Cross-sectional survey. Setting: Secondary schools in Trinidad. Subjects: A stratified random sample of 1139 adolescents, aged 14–17 y. Measurements: Silhouettes of different body sizes were used to determine perceptions of body size, while weights and heights were measured to determine actual body size. Results: A total of 1090 students (96% response rate) participated, comprising 578 (53%) females. The main ethnic groups were South Asian (49%), African (25%) and persons of mixed ethnicity (23%). The calculated body mass index (BMI) indicated that 14% were thin, 73% normal and 13% overweight; however there was a preponderance of thinness among South Asian males (28%). Whereas 68% of students correctly identified their body size, South Asian males were also more likely to overestimate their body size than the other adolescents, ie they were thinner than they thought. Overall, 64% of the sample was satisfied with their current size, but thin South Asians were more likely to be satisfied with their size than other thin adolescents (P=0.04), while overweight Africans were more likely to be satisfied than other overweight persons (P=0.03). The majority of the sample associated the normal body size with good health, but the majority also associated the overweight and obese silhouettes with wealth. In addition, 40% of them associated the male overweight and obese silhouettes with happiness. Conclusion: Although the prevalence of overweight/obesity was not high, the perception of the Trinidadian adolescent that obesity was associated with wealth, and to a lesser extent happiness, and the satisfaction of the overweight African females with their size, were all causes for concern.

Setting At the Faculty of Medical Sciences, The University of the West Indies, St Augustine first-year students take two courses in health communication. In the Centre for Medical Sciences Education students completed a course experience questionnaire. This instrument is potentially useful in evaluating innovative programmes and securing support for their development. Context The Faculty of Medical Sciences, The University of the West Indies, St Augustine was the first of three campuses to introduce compulsory health communication courses in 1995. Using a modified form of the 25-item course experience questionnaire (CEQ25) (Broomfield & Bligh, 1998) normally employed in overall degree or course evaluation, this study developed a 30-item questionnaire (CEQ30) to test its applicability to the evaluation of medical communication skills teaching Measures In 1997 - 1998 medical, dentistry, veterinary medicine and pharmacy students completed the original short form of the CEQ25 including five items specific to medical communication skills teaching. Students used a five-point Likert scale ranging from one, indicating that they strongly disagreed with the statement, to a score of five, reporting that they strongly agreed with the statement. Principal Components Analysis with Varimax rotation analysed the scale structure of the evaluation tool. Results The principal components factor analysis of responses (n = 165) broadly confirmed five of Broomfield and Bligh's six factors, but identified a sixth factor in their original instrument (appropriate assessment) that split into two, and a seventh factor, use of available materials and resources. Conclusion The modified CEQ30 is a reliable instrument with which to evaluate a course in medical communication skills, and encourage reflection on teaching and course design. Its use is applicable to medical courses during overall curriculum change and innovation in a medical school.

Study objectives Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies. Setting Chest Clinic, Ministry of Health, Trinidad. Participants Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000. Measurements and results A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%). Conclusions Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.

This study tested the hypotheses that a) the dream content of crack cocaine abusers in Trinidad and Tobago changes during abstinence, and b) the change in dream content can be used to predict treatment outcome. The sample comprised 46 consecutive patients who completed a 3-month residential treatment program and were followed up after 6 months. Dreams and associated emotions were recorded during the first month of inpatient treatment and at 6 months follow-up. Forty-one (89.1%) patients reported drug dreams during the first month, mainly of using the drug. Twenty-eight (60.9%) had drug dreams at 6 months follow-up, mainly of using or refusing the drug. There was an abstinence rate of 56.5% at 6 months. A better treatment outcome was associated with having drug dreams at 6 months follow-up (p < .05) and dreams of refusing the drug (p < .05). Findings support the need to further explore the progression of dreams during treatment as a predictive tool.

The clinical, laboratory and epidemiological characteristics of 38 adult Jamaican patients with polymyositis were evaluated. Twenty-four patients (63%) were human T-lymphotropic virus 1 (HTLV-1) seropositive and 14 patients (37%) were HTLV-1 seronegative. Polymyositis runs a more protracted course in seropositive patients who had more frequent hospital admissions and a significantly longer duration of symptoms prior to presentation. Joint swelling, chest pain and dyspnoea were more frequent complaints among the seronegative patients. There was no significant difference between the two serological groups in muscle enzyme levels, antinuclear antibody positivity or frequency of Jo-1 antibodies. HTLV-1 infection may define a subgroup of polymyositis patients with a more insidious presentation and poorer response to corticosteroid therapy.

Correct pressurised metered dose inhalers (pMDI) usage is reportedly sub-optimal in patients and data for Caribbean populations is not available. We studied proficiency of inhaler use in Trinidadian patients, and determined sub-groups to be targeted for educational interventions. Inhaler use by 331 consecutive stable patients with airway disease (over 7 years) was observed and marked on a standard checklist. From direct observation only 41% of patients correctly inhaled, though 92% were confident of accurate technique. Few elderly patients (6%) received appropriate instructions on inhaler technique and only 35% (n = 23/66) understood the rationale for two different inhaler therapies (P < 0.001). More children (33%) and elderly patients (21%) reported escaping drug with use. Multiple regression analysis indicated the independent predictors of correct pMDI were age (P < 0.01) and correct understanding of different inhalers. Intensive patient education in Trinidadian children and elderly patients with airway disorders can enable active participation in disease management and maximal benefit from medication.

This paper reviews two studies that evaluated the school feeding program in Jamaica. The first examined 115 children aged 12-13 y who were enrolled in three classes in a poor, rural school. One class was served the standard school meal at 0900 whereas the other two classes served as controls. The outcome variables included school achievement, attendance, and weight gain. After one semester, the class receiving the meal showed improved arithmetic scores and school attendance compared with the control classes; however, they showed no weight gain. The academic improvement remained significant after school attendance was controlled for. It was therefore hypothesized that the gains in arithmetic resulted from the alleviation of hunger in the classroom. The other study, conducted in a metabolic ward, examined the effects of missing breakfast on cognitive function in 90 children aged 9-10 y and of differing nutritional status. Using a crossover design, the investigators tested each child on two mornings 1 wk apart, once after serving them breakfast and second without. Breakfast, consisting of the school program meal, was served at 0800. When severely malnourished, stunted, or wasted children received no breakfast, their performance in various cognitive tests deteriorated. These results indicate that alleviation of hunger was one of the mechanisms by which school feeding improved academic achievement in the previous study. Undernourished children are more likely to benefit from school feeding programs than are adequately nourished children.

Using national statistics for the period 1973-1992, associations were examined between suicide rates and measures of social distress in Trinidad and Tobago. The latter included unemployment, serious crimes, emigration rates and admissions to the country's psychiatric hospital. There was a 319% increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in 1992. Although there were fluctuations in the rate for females, it remained below 8/100,000. Over the 15-year period examined, there was a 51 % increase in serious crime while male and female unemployment increased by 89% and 33% respectively. There was a 63% fall in the rate of permanent emigration while male and female admissions to the psychiatric hospital fell by 28% and 19% respectively. There were significant positive associa tions between male suicide and serious crimes as well as with male and female unemployment (p < 0.01). Male suicide rates were also negatively associated with the male admissions to the psychiatric hospital (p < 0.01). Female suicide rates were positively associated with serious crime and male unemployment (p < 0.01). Although it is not possible to determine whether the observed associations were causal, the results suggest that social distress may be an important contributor to the suicide rate in Trinidad and Tobago, particularly among men. The organisation of preventive strategies for suicidal behaviour must therefore include measures to counter the experience of social distress in this setting.

SummarySummaryBetween March 1992 and November 1994, 48 patients with intrauterine death had labour induced, 36 with the prostaglandin analogue misoprostol and 12 with the prostaglandin dinoprostone. Both were used as a single dose in 24 hours intravaginally. The patients were all of low parity and all but one were in the third trimester. Of those getting misoprostol, 92 per cent, and of those getting dinoprostone, 67 per cent, went into spontaneous labour. Eighty-one per cent of those getting misoprostol and 67 per cent of those getting dinoprostone delivered within 24 hours without the need for further prostaglandin or oxytocin, a difference that was not significant. No differences were found in other outcome variables such as diagnosis or induction to delivery time or need for oxytocin, between the two groups. Only one maternal medical complication occurred, chorioamnionitis in a patient who had misoprostol, and in whom labour was delayed 6 days.

SummaryA prospective randomised double blind trial was performed in 106 patients to compare the use of intravenous midazolam (mean dose 6·5 mg. range 4–9 mg) versus 10 mg diazepam. during gynaecologic laparoscopy under local anaesthesia. The parameters examined were: the ease of laparoscopy, patient tolerance, the amnesic effect and intra-operative blood pressure changes. Depth of sedation and recovery time were also measured, using the Trieger test. The preoperative demographic variables and the operators ability to perform the procedures were similar in the two groups. The patients were more deeply sedated with the midazolam but the recovery time was similar. The patients tolerated the procedure better with midazolam with fewer of them describing the procedure as unpleasant (22 per cent versus 53 per cent) (P

SUMMARYThe effects of mild to moderate infections of Trichuris trichiura on cognitive functions were investigated in Jamaican children aged 7 to 10 years. In all, 189 infected children and 100 uninfected classmates were studied. The infected children were randomly assigned to receive treatment (albendazole) or a placebo. All children were given cognitive tests on enrolment and 14 weeks later. These included verbal fluency (generation of ideas), digit span (working memory), number choice (speed of processing of visual stimuli), visual search (sustained attention) and a French Vocabulary test (paired-associate learning). At baseline, the infected children had lower scores than the uninfected ones in fluency (P = 0·01), search (P = 0·02) and French (P = 0·01). Treatment effects were examined among infected children and there was no significant treatment effect for any of the tests. However, there was a significant treatment by weight-for-age interaction in fluency (P < 0·05). The children with low weight-for-age (Z-score < – 1) improved with treatment while there was no improvement with treatment among the other children. We concluded that treatment of children with mild to moderate T. trichiura infections using albendazole produces little benefit in cognition if they are adequately nourished; however, undernourished children are more likely to benefit.

To determine if misoprostol (exogenous prostaglandin E1 PGE1) used vaginally was of value in improving the Bishop score, leading to an early safe vaginal delivery in women in whom the cervix is unripe and delivery is indicated.A double-blind clinical trial.Antenatal and labour wards of the University Hospital of the West Indies, Jamaica.Forty-five women in the third trimester with various obstetric indications for induction of labour and with no contra-indications to prostaglandins.The women were randomly assigned to receive treatment or a placebo. The treated group had 100 micrograms misoprostol inserted vaginally while the placebo was similarly inserted.Efficacy of the misoprostol was measured by the increase in the Bishop score 12 h after giving the treatment, the time between insertion and delivery, the need for oxytocin, and the outcome of the pregnancy.The prostaglandin was superior to the placebo in ripening the cervix and inducing labour. The change in Bishop score was 5.3 in the misoprostol group compared with 1.5 in the placebo group (P0.001). The mean time from insertion to delivery was 15.6 h in the former while it was 43.2 h in the placebo group (Por = 0.001). The need for oxytocin was also significantly less in the women receiving the prostaglandin compared with those who received the placebo (29% vs 62%, P0.02). There was no difference in the two groups in the delivery outcome in terms of complications, Apgar scores and mode of delivery.Intravaginal misoprostol is an effective and cheap method of inducing labour in the third trimester.A double-blind clinical trial was conducted to determine if misoprostol (exogenous prostaglandin E1 PGE1) used vaginally was of value in improving the Bishop score, leading to an early safe vaginal delivery in women in whom the cervix is unripe and delivery is indicated. 45 women were selected from the antenatal ward and clinic of the University Hospital of the West Indies. All were women in the 3rd trimester of pregnancy who had an indication for induction, an unripe cervix, and no contraindication to prostaglandins. The women were randomly assigned to receive treatment or a placebo. The treated group had 100 mcg misoprostol inserted vaginally, while the placebo was similarly inserted. Efficacy of the misoprostol was measured by the increase in the Bishop score 12 hours after giving the treatment, the time between insertion and delivery, the need for oxytocin, and the outcome of the pregnancy. The prostaglandin was superior to the placebo in ripening the cervix and inducing labor. The change in Bishop score was 5.3 in the misoprostol group compared with 1.5 in the placebo group (P0.001). 8% of patients had no change in their Bishop score in the misoprostol group compared to 62% in the placebo group (P0.001). The mean time from insertion to delivery was 15.6 hours in the former while it was 43.2 hours in the placebo group (P=0.001). 29% of women receiving misoprostol needed oxytocin compared with 62% of those who received the placebo (P0.02). There was no difference in the 2 groups in the delivery outcome in terms of complications, Apgar scores, and mode of delivery. There were no significant changes in maternal vital signs in both groups. Fetal distress, as evidenced by the presence of meconium stained amniotic fluid or fetal tachycardia, was similar in both groups. Polystole (more than 5 contractions in 10 minutes occurred in 1 woman in the misoprostol group. Extra-amniotic misoprostol is a cheap, effective, and safe prostaglandin for cervical ripening.

Children aged 9-24 mo were recruited by a survey of poor areas of Kingston, Jamaica. Stunted children were randomly assigned to supplementation or not. Weekly morbidity histories were taken for 2 y. Separate multiple regressions on each symptom for weight or length gain in 2-mo intervals showed significant reductions in weight gain with coughing, apathy, anorexia, diarrhea, and fever, ranging from -2.1 to -16.8 g/d ill. Apathy and diarrhea reduced gains in length (-0.26 and -0.20 mm/d ill). Significant reductions in linear growth with lower respiratory-tract infections (-0.16 mm/d ill) occurred only in nonsupplemented children. Growth over 4-mo intervals was reduced if diarrhea occurred in the first 2 mo of the interval but there were no long-term effects of apathy, fever, or anorexia. Some of the effects of morbidity on growth were therefore transient and morbidity is unlikely to be a major cause of growth retardation in this population.

An observational cross-sectional study conducted in Kingston in 2004 showed that seat belts were used by 81.2% of private motor vehicle drivers and 74.0% offront seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996 before the introduction of legislation in 1999 (p0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p0. 001) and as front seat passengers (79.9% vs 66.3%; p0.001). Of the 2289 motor vehicles examined, all except one were equipped with seat belts. Rear passenger utilization of seat belts was not examined. Drivers of new vehicles were more likely than other drivers to use seat belts (p0.001). Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign if the maximum benefits of seat belt use are to be realized

This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60% and a specificity of 94%. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76%. The patients were primarily Indo-Trinidadian (70%), over 50 years (76.4%) and female (72.3%). The prevalence of depression was 28.3%. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics.

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources.

Objective: To identify risk factors for urinary tract stones in Trinidad and Tobago. Methods: A consecutive series of patients presenting to institutions in Trinidad for the management of proven urinary tract calculi was interviewed by questionnaires designed to obtain data on age gender ethnicity occupation stone location a family history of stone disease a past history of certain medical diseases and a semiquantitative estimate of the magnesium intake in food over-the-counter-drugs and drinking water. An equivalent number of patients attending the same institutions for follow-up and verified from hospital records as having a previous radiological diagnosis of urinary tract stones as well as a group of asymptomatic members of the community working in the same area underwent the same interview. Chi-square anova and Kruskal–Wallis tests were used to examine differences between the groups. Multiple logistic regression analysis was used to determine persistence of the significance of these differences after controlling for confounding variables. Results: Data sufficient for analysis were obtained for 122 previous and 102 prospective patients and 102 controls. The mean age of the patients was 32 years. The ratio of males to females was 0.9–1.8:1 for the affected groups but significantly more males than females had calculi in the lower urinary tract (19% vs. 6%; P = 0.004). More patients (30%) than controls (7%) gave a positive family history of urinary tract stone disease (P < 0.001). Affected persons had a lower dietary magnesium intake (P = 0.003) which accounted for a significantly lower total magnesium intake (P = 0.02). Logistic regression analysis of the variables studied indicated that independent predictors of the disease were a positive family history (P = 0.001) total magnesium intake (P = 0.001) and age (P < 0.001). Conclusion: A low magnesium intake and a positive family history are highly predictive of urinary tract calculi in this population. (authors)

A cross-sectional study was conducted to determine the microbial quality of domestic and imported brands of bottled water available in Trinidad, purchased from six geographical regions in Trinidad, and representing the whole island. A sample size of 344 bottles of water was determined by using a precision rate of 2% and a Type 1 error of 5%. The membrane filter technique was used with cultures grown on m-Endo agar and m-FC agar for total coliforms and thermotolerant coliforms, respectively. Aerobic plate count (APC) was determined on nutrient agar; Pseudomonas aeruginosa was detected on MacConkey agar, Escherichia coli was isolated on eosin methylene blue (EMB) and Salmonella spp. was assayed by using standard methods. Of the 344 water samples tested, 262 (76.2%) and 82 (23.8%) were domestic and imported brands, respectively. Eighteen (5.2%) of the 344 samples contained coliforms with a mean count of 0.88F6.38 coliforms per 100 ml, while 5 (1.5%) samples contained E. coli. The prevalence of total coliforms in domestic brands of bottled water was 6.9% (18 of 262) as compared with 0.0% (0 of 82) detected in imported brands. The difference was statistically significant (p=0.004). Similarly, the prevalence of aerobic bacteria in domestic brands of bottled water (33.6%) was significantly higher (p=0.001) than was found in imported brands (14.8%). Twenty-six (7.6%) of the total samples of water contained Pseudomonas species, but all were negative for thermotolerant coliforms and Salmonella spp. It was concluded that based on the recommended zero tolerance for coliforms in potable water, 5% of bottled water sold in Trinidad could be considered unfit for human consumption. D 2002 Elsevier Science B.V. All rights reserved.

Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies.Chest Clinic, Ministry of Health, Trinidad.Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000.A consecutive sample of patients who were7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%).Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.

Using a cross-sectional survey, the knowledge and beliefs about breastfeeding were evaluated among adults in Eastern Tobago (N = 509). Of the respondents, 95%, 69%, and 48% indicated that a baby should be exclusively breastfed at birth, 3 months, and 6 months, respectively. The baby's mother was thought to have the greatest influence on breastfeeding decisions. Of the respondents, 63% and 80% were unaware of expressed breast milk and cup-feeding a neonate, whereas 82% believed that a solely breastfed baby should receive water. Additionally, 23% and 44% felt that breastfeeding should be terminated before 6 months and between 6 and 12 months, respectively. Inadequate maternal nutrition and employment were reported as the principal factors affecting breastfeeding. There is a lack of knowledge about the anatomy and physiology of lactation and about the benefits of exclusive breastfeeding. These findings are useful for guiding the development and implementation of interventions to promote breastfeeding in Tobago.

The effects of treating Trichuris trichiura infections were investigated in 407 Jamaican children age 6 to 12 y. The children were randomly assigned to receive treatment (albendazole) or a placebo. The outcome variables included growth, tests of reading, spelling and arithmetic, and school attendance. After 6 mo of treatment, there was no significant main effect on any of the outcomes. However, there were significant treatment-by-infection intensity interactions with spelling (P < 0.05) and body mass index (P < 0.01), and a significant treatment-by-stunting interaction with school attendance (P < 0.01). In spelling, the children with heavy infections showed improvements with treatment that approached significance (P = 0.06), whereas those with lower intensities did not. However, the children with lower infection intensities had increased body mass index with treatment (P = 0.02), although there was no difference in children with heavy infections. In school attendance, the stunted children improved with treatment (P < 0.04), whereas there was no difference in the nonstunted children. These findings suggest that in the sample of Jamaican children examined, the treatment of T. trichiura was more likely to benefit school performance in children of poor nutritional status and those with heavy infections, and to improve weight gain in children with lighter infection intensities.

SUMMARYThe relationship between varying intensities ofTrichuris trichiurainfection and iron status was examined in Jamaican schoolchildren, aged 7 to 11 years. A total of 409 children was identified withT. trichiura(epg > 1200). A control group comprised 207 uninfected children who were matched by school and class to every pair of infected subjects. Blood samples were obtained from 421 children: 264 infected and 157 controls. Compared to the rest of the children, those with heavy infections (epg > 10 000) had significantly lower (P< 0·05) Hb (11·5 ± 1·3vs. 12·1 ± 1·1 g/dl), MCV (78·6 ± 6·3vs. 81·2 ± 5·5 fl), MCH (26·2 ± 2·9vs. 27·5 ± 2·5 pg) and MCHC (33·2 ± 1·5vs. 33·9 ± 1·4 g/dl). Similarly, the prevalence of anaemia (Hb < 11·0 g/dl) amongst heavily infected children (33%) was significantly higher (P< 0·05) than the rest of the sample (11%). These differences remained significant after controlling for confounding variables including socio-economic status, age, gender, area of residence and the presence ofAscarisinfections. Differences in red cell count, ferritin, and free erythrocyte protoporphyrin were not statistically significant and showed no association with the infectious load. These results suggest that in the Jamaican children studied, iron deficiency anaemia is associated withTrichurisinfections over 10 000 epg, but not with less intense infections.

Severe infections by the geohelminth Trichuris trichiura detrimentally affect young children's growth and development. There is concern that mild to moderate infections may affect older children's school performance and nutritional status. We therefore examined the relationship between varying intensities of infection and school achievement, attendance and nutritional status in 616 schoolchildren. A total of 409 children with Trichuris infection of intensities greater than 1200 eggs per gram of stool (epg) were first identified, then for every 2 infected children in a class, an uninfected child was selected. After controlling for socioeconomic status, gender, age, school and the presence of Ascaris infections, the uninfected children had higher reading and arithmetic scores than children with infections of more than 4000 epg and were taller than those with intensities greater than 2000 epg. However, there were no significant differences in spelling, school attendance and body mass index. Although a treatment trial is needed to determine causation, these results indicate that moderate levels of infection are associated with poor school achievement and growth.

Objective To assess the efficacy of intramyometrial vasopressin for minimising bleeding and its sequelae at myomectomy. Design A randomised placebo controlled trial. Setting University Hospital of the West Indies, Kingston, Jamaica. Subjects Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group. Intervention Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline). Main outcome measures The efficacy of vasopressin was measured by comparing pre- and post-operative haemoglobin levels and haematocrit, changes in intra-operative pulse and blood pressure, measured blood loss, need for blood transfusion and post-operative febrile morbidity in the treatment and control groups. Results The use of vasopressin resulted in median blood loss of 225 ml (range 150–400 ml) compared with 675 ml (range 500–800 ml) in the placebo group (P < 0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7g/dl vs 5.3 g/dl, P < 0.001) and haematocrit (median 5%vs 13%, P < 0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P= 0.03). There were no significant differences between the groups in intra-operative pulse and blood pressure or post-operative white blood cell counts or temperature. Conclusion The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy.

This is the first report of the effects of a hurricane on children's health and nutritional status in which data were available preceding and following the event. When Hurricane Gilbert struck Jamaica in 1988, a longitudinal study was in progress in which children's weights and heights were recorded every 2 months and their morbidity histories taken every week. The investigation included 127 stunted (low height-for-age) and 32 non-stunted children aged 23-44 months, living in poor areas of Kingston. The data from the 4 months before and after the hurricane were compared. There was an increase in the occurrence of respiratory symptoms including rapid or difficult breathing (P0.04), coughs (P0.001) and nasal discharges (P0.001) during the first 2-month period after the hurricane. However there was no significant effect on the occurrence of diarrhoea and injuries. Deficits were also found in height gain (P0.001) during the same period. These adverse effects were found in spite of the large amount of food aid received and the aggressive health education programme implemented after the hurricane.

In Jamaica, early childhood undernutrition remains a problem; however, the health of all children cannot be monitored due to limited resources. Therefore, there is a need for the early identification of children at risk of undernutrition. A simple screening instrument for use by paraprofessionals in the primary health care system was developed. We conducted a case-control study using 649 children, aged 6 to 48 months. The cases were undernourished (weight-for-age less than 80% of the reference) and identified from a survey. The children's guardians were given a questionnaire comprising 31 variables thought to be associated with undernutrition and which were present from 6 weeks of age. Nine variables were significantly associated with undernutrition. Multiple logistic regression analysis indicated that low birth weight, short birth spacing, being born at home, poor ante-natal and post-natal clinic attendance, overcrowding and a lack of house-hold possessions were independent predictors of undernutrition. Using these variables, a simple scoring system was developed to identify high risk children. It had a sensitivity and specificity of 56% and 76% respectively and a positive predictive values of 31%. This simple screening instrument should be easy to use in the primary health care system. However, its low sensitivity indicates that it is difficult to identify children who are at risk of undernutrition from 6 weeks of age. Subsequent high morbidity and poor child care which were not measured may account for some of the missed cases.

OBJECTIVE--To determine relation between schoolchildren's blood pressure, glycated haemoglobin level, and cholesterol concentration and their anthropometry, socioeconomic status, and birth measurements. DESIGN--Retrospective cohort study. SETTING--27 schools closest to University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS--2337 children aged 6-16 years who were born at university hospital were recruited, and their birth records were recovered: 1610 had suitable records, 659 had records including birth length, and 610 of these were prepubertal. MAIN OUTCOME MEASURES--Blood pressure, glycated haemoglobin level, serum cholesterol concentration, anthropometry at birth, current anthropometry, and socioeconomic status. RESULTS--Multiple regression analysis showed that children's systolic blood pressure was inversely related to their birth weight (P < 0.0001) and directly related to their current weight. Glycated haemoglobin level was higher in children with thicker triceps skinfolds (P < 0.001) and who had been shorter at birth (P = 0.003). Serum cholesterol concentration was inversely related to current height (P = 0.001) and to length at birth (P = 0.09) and was directly related to triceps skinfold thickness and higher socioeconomic status (P < 0.001). CONCLUSIONS--Blood pressure in childhood was inversely related to birth weight and directly to current weight. Glycaemic control and serum cholesterol were related to short length at birth, height deficit in childhood, and childhood obesity.

The purpose of the present study was to describe patterns in weekly asthma visits to Accident and Emergency (A&E) facilities in Trinidad during 1997 and to examine associations with climatic conditions. A census of patients with asthma, defined as those who required bronchodilator nebulization, was taken at five A&E facilities in the Caribbean island of Trinidad from 1 January to 31 December 1997. Data on patients’ ages, gender and dates of visits were obtained from the A&E records. Climate variables, including rainfall, temperature, relative humidity and wind speed, were obtained from the island’s meteorological office. There was a total of 27 848 asthma visits to the five facilities during 1997, of which the pediatric population (

We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in fluency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in the digit span backwards tests, and wasted members of the malnourished groups were adversely affected in efficiency of problem solving and those in the control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children.