Anthropometry and blood pressure changes in a caribbean adolescent population of african ancestry: an evaluation of longitudinal data using a multilevel mixed regression approach / Antropometría y cambios de presión sanguínea en una población adolescente caribeña de ascendencia africana: evaluación de datos longitudinales en un enfoque de regresión multinivel mixto

OBJECTIVE: The aim of this study was to determine the effect of growth pattern on blood pressure changes in an adolescent population of African ancestry based on longitudinal data and to compare this with estimates derived from cross-sectional data. METHODS: Participants had measurements of weight, height, blood pressure and percentage body fat taken annually using standardized procedures. Annual blood pressure and anthropometry velocities as well as one- and three-year interval gender specific tracking coefficients were computed. We investigated whether changes in blood pressure could be explained by measures of growth using a multilevel mixed regression approach. RESULTS: The results showed that systolic blood pressure (SBP) increased by 1.27 and 3.09 mmHg per year among females and males, respectively. Similarly, diastolic blood pressure (DBP) increased by 1.16 and 1.92 mmHg per year among females and males, respectively. Multilevel analyses suggested that weight, body mass index, percentage body fat and height were the strongest anthropometric determinants of blood pressure change in this population. The results also suggest that there are gender differences in the relative importance of these anthropometric measures with height playing a minor role in predicting blood pressure changes among adolescent females. With the exception of DBP at 18 years among females, there were no significant differences between mean blood pressure generated from cross-sectional and longitudinal data by age in both males and females. CONCLUSION: Anthropometric measures are important covariates of age-related blood pressure changes and cross-sectional data may provide a more cost-effective and useful proxy for generating age-related blood pressure estimates in this population.

OBJETIVO: El objetivo de este estudio fue determinar el efecto del patrón de crecimiento sobre los cambios de presión sanguínea en una población juvenil de ascendencia africana sobre la base de datos longitudinales, y comparar esto con los estimados derivados de los datos transversales. MÉTODOS: A los participantes se les hicieron mediciones de peso, altura, presión sanguínea, y porcentaje de grasa corporal, las cuales fueron realizadas anualmente mediante procedimientos estandarizados. Se computarizaron la presión sanguínea anual y las velocidades de la antropometría así como los coeficientes de rastreo específicos de género en intervalos de uno y tres años. Se investigó si los cambios de presión sanguínea podrían explicarse por las medidas de crecimiento, usando un enfoque de regresión multinivel mixto. RESULTADOS: Los resultados mostraron que la presión sanguínea sistólica (PSS) aumentaba en 1.27 y 3.09 mmHg por año entre las hembras y los varones respectivamente. De modo similar, la presión sanguínea diastólica (PSD) aumentaba en 1.16 y 1.92 mmHg por año entre las hembras y varones respectivamente. Los análisis multiniveles sugirieron que el peso, el índice de masa corporal, el porcentaje de grasa corporal y la altura, fueron los determinantes antropométricos más fuertes del cambio de presión sanguínea en esta población. Los resultados también sugieren que hay diferencias de género en la importancia relativa de estas mediciones antropométricas, siendo el caso que la altura juega un papel menor a la hora de predecir los cambios de presión sanguínea entre las adolescentes. Con excepción de la PSD a los 18 años entre las hembras, no hubo ninguna diferencia significativa entre la presión sanguínea promedio obtenida a partir de los datos transversales y longitudinales por edad, tanto en los varones como en las hembras. CONCLUSIÓN: Las medidas antropométricas son covariantes importantes de los cambios de presión sanguínea relacionadas con la edad. Los datos transversales pueden ofrecer un recurso útil y costo-efectivo para producir estimados de la presión sanguínea relacionada con la edad en esta población.

The nutritional status of clinic attendees living with HIV/AIDS in St Vincent and the Grenadines / Estatus nutricional de personas con VIH/SIDA atendidas en clínicas en San Vicente y las Granadinas

OBJECTIVE: The purpose of this study was to assess nutritional status and dietary practices in persons living with HIV/AIDS (PLWHA). METHODS: A case-control design was used. Cases consisted of 36 PLWHA. Controls consisted of 37 persons within the same age range from the general population. Participants filled out a questionnaire consisting of sociodemographic, dietary and health history items. In addition, they had weight, height, upper mid-arm circumference and triceps skinfold measured using standard procedure. Biochemical and clinical data for cases were extracted from their clinic file. RESULTS: HIV-positive persons had significantly lower mean weight, BMI, upper mid-arm circumferences, arm muscle area and arm fat area than persons in the control group. They were also less likely to use multivitamins, dietary supplements, fruit and vegetables than persons in the control group. Correlation coefficients between corrected arm muscle area (CAMA) and BMI and weight ranged from 0.67 to 0.74 in cases and 0.41 to 0.68 for the control group, respectively. Screening for depleted CD4 counts using gender specific CAMA cut-offs indicative of depleted arm muscle reserves resulted in 48% sensitivity and 100% specificity in identifying PLWHA with CD4 counts < 200 cells/µL. CONCLUSION: The findings suggest that PLWHA are at increased risk for poor intakes of fruits and vegetables and depleted lean body mass. In addition, CAMA along with other clinic measures might be useful in the identification of PLWHA who might be responding adequately to treatment.

OBJETIVOS: El propósito de este estudio fue evaluar es estatus nutricional y las prácticas dietéticas de personas que viven con VIH/SIDA (PVVS). MÉTODOS: Se usó un diseño de control de casos. Los casos consistían en 36 PVVS. Los controles consistían en 37 personas en el mismo rango de edad de la población general. Los participantes llenaron un cuestionario contentivo de aspectos socio-demográficos, dietéticos, y cuestiones relacionadas con la historia de la salud. Además, se les determinó el peso, y se les tomó las medidas de la altura, la circunferencia del brazo medio superior, y el pliegue cutáneo del tríceps, usando procedimientos estándar: Los datos bioquímicos y clínicos para los casos, fueron extraídos de sus historias clínicas. RESULTADOS: Las personas VIH positivas tuvieron un promedio de peso, IMC, circunferencias del brazo medio superior, área muscular del brazo, y área adiposa del brazo, significativamente más bajo que las personas en el grupo control. También mostraron una menor tendencia a usar multivitaminas, suplementos dietéticos, frutas y vegetales, que las personas en el grupo control. Los coeficientes de correlación entre el área muscular del brazo corregida (AMBC), y el IMC y el peso tuvieron un rango de 0.67 a 0.74 en los casos y de 0.41 a 0.68 en el grupo control, respectivamente. El pesquisaje para el conteo de células CD4 agotadas usando límites de AMBC específicos del género, indicativos del agotamiento de las reservas musculares del brazo, arrojó un 48% de sensibilidad y un 100% de especificad en la identificación de PVVS con conteos de CD4 < 200 células/µL. CONCLUSIÓN: Los hallazgos sugieren que las PVVS enfrentan un riesgo mayor debido a un consumo pobre de frutas y vegetales, y a una masa corporal magra menguada. Además, la AMBC junto con las otras medidas clínicas, podría ser útil a la hora de identificar PVVS que pudieran esta respondiendo adecuadamente al tratamiento.

Patient satisfaction and quality of life among persons attending chronic disease clinics in South Trinidad, West Indies / Satisfacción del paciente y calidad de vida entrel as personas que atienden las clínicas de enfermedades crónicas en Trinidad Sur, West Indies

OBJECTIVE: Patient satisfaction and quality of life are increasingly being recognized as central elements in the monitoring and evaluation of healthcare. In this survey, the level of patient satisfaction and quality of life were investigated in regular attendees at public health chronic disease facilities in South Trinidad. METHOD: A random sample of 200 clients attending the three public chronic disease clinics during the period August 12, 2002 to December 31, 2002, completed self-administered questionnaires consisting of socio-demographic, quality of life (SF 12) and health service items. RESULTS: Participants had an average of four annual visits and 75% of them were 50 years and older. Approximately two-thirds of participants gave health and support staff a rating of good to excellent. Overall clinic experience was rated as poor to fair by 41.5%. Forty-five and a half per cent gave a rating of the explanations given by doctors and nurses about their illnesses. Fifty-three and a half per cent and 58% gave a poor to fair rating for the length of the waiting time and explanation offered when there was a significant delay in the starting times of clinics respectively. In regression analyses controlling for age, gender and number of illnesses, ratings of clinic experience and all categories of clinic staff were significantly associated with SF-12 mental and physical component summary scores. CONCLUSION: The findings suggest that in this population of regular clinic attendees, levels of client satisfaction and numbers of illnesses are associated with subjective quality of life.

OBJETIVO: La satisfacción del paciente y la calidad de vida ganan cada vez mayor reconocimiento como elementos centrales en el monitoreo y evaluación de la atención a la salud. En este estudio se investigó el nivel de satisfacción del paciente y la calidad de vida en personas que asisten regularmente a los centros de salud pública de Trinidad Sur, especializados en enfermedades crónicas. MÉTODO: Una muestra aleatoria de 200 clientes que asistían a las tres clínicas públicas de enfermedades crónicas en el período comprendido de agosto 12, 2002 a diciembre 31, 2002; llenado de cuestionarios auto-administrados consistente en ítems relacionados con datos socio-demográficos, la calidad de vida (formato corto SF 12), y los servicios de salud. RESULTADOS: Los participantes tuvieron un promedio de cuatro visitas anuales y el 75% de ellos tenían 50 años de edad o más. Aproximadamente dos tercios de los participantes le dieron al personal de la salud y al de apoyo calificaciones de bien a excelente. La experiencia clínica en general obtuvo de parte del 41.5% calificaciones de pobre a aceptable. Cuarenta y cinco y medio por ciento dieron calificaciones a las explicaciones que sobre sus enfermedades dieron los doctores y las enfermeras. El cincuenta y tres y medio por ciento y el 58% dieron calificaciones de pobre a aceptable por el tiempo de espera y la explicación ofrecida cuando se producía una demora significativa en los horarios de comienzo de las clínicas, respectivamente. En los análisis de regresión que controlaban la edad, el género, y el número de enfermedades, las calificaciones de la experiencia clínica y todas las categorías del personal clínico estuvieron asociadas significativamente con las puntuaciones sumarias SF-12 de los componentes físico y mental. CONCLUSIÓN: Los hallazgos sugieren que en esta población de personas que asisten regularmente a las clínicas, los niveles de satisfacción del cliente y el número...

Ethnicity, body image perception and weight-related behaviour among adolescent Females attending secondary school in Trinidad / Etnicidad, percepción de la imagen del cuerpo y comportamiento respecto al peso entre las adolescentes que asisten a la escuela secundaría en trinidad

OBJECTIVE: The correlates of body image perception among an ethnically diverse group of adolescent females attending secondary school in Trinidad were investigated. METHODS: A cross-sectional survey was carried out among adolescent females from selected secondary schools in Trinidad. Participants completed a self-administered questionnaire consisting of sociodemographic items and standardized psychometric instruments. RESULTS: Two hundred and fifty-one students participated in the survey with an ethnic composition as follows: Indo-Trinidadian (35.9), Afro-Trinidadian (28.7), Indo-Afro mixed Trinidadian (21.9) and other (13.5). The results suggest that 2.4of the participants reported having a medical diagnosis for an eating disorder Indo-Trinidadians had significantly greater body dissatisfaction than Indo-Afro-mixed Trinidadians but not more than Afro-Trinidadians (p = 0.04). Also, a significantly higher proportion of Indo-Trinidadians engaged in binge eating behaviour compared to the other ethnic groups (p < 0.001). Afro-Trinidadians were more likely to use vomiting as a mean of weight control compared to Indo- and Indo-Afro-mixed Trinidadian (p < 0. 05). Fifty-one per cent of participants had a negative body image perception. Altered body image perception was associated with a significant higher mean Body Shape Questionnaire BSQ 16 score (p < 0.001) and increased likelihood of reporting being diagnosed with an eating disorder (OR = 2.03, 95CI: 1.78, 2.31; p = 0.01) compared to non-altered body image state. Eating Attitude Test (EAT-26) score was positively correlated with Drive-for-Thinness (p < 0.001) and BSQ16 (p < 0.001) scores and inversely correlated with the Rosenberg self-esteem score (p = 0.012). CONCLUSION: In this group of adolescents, there are ethnic differences in the level of concern over body image and associated eating, and weight-related behaviour.

Blood pressure and its correlates in Tobagonian adolescents / La presión sanguínea y sus correlatos en los adolescentes de Tobago

OBJECTIVE: To determine age-specific patterns and correlates of blood pressure (BP) in Tobagonian adolescents. METHODS: Blood pressure, weight and heights were measured using standardized procedures. Age-height and gender-specific BP levels were established and compared with those established for adolescents in the United States of America, the United Kingdom and Jamaica. RESULTS: Of the available population, 3749 or 84.9% participated in the study. Among Tobagonian adolescents, the mean one-year age increment in systolic blood pressure (SBP) was 3.6 (95% CI: 3.2, 3.9) mmHg in males and 1.5 (95% CI: 1.2, 1.8) mmHg in females. Likewise, the mean one-year increment in diastolic blood pressure (DBP) was 2.1 (95% CI: 1.7, 2.4) mmHg in males and 1.2 (95% CI: 0.9, 1.4) mmHg in females. There was an inversion of mean BP with age. Females 12-13 years having significantly higher mean SBP while those 15-18 years had lower SBP than their male counterparts. Similarly, females 12-14 years had significantly higher mean DBP while those 16-18 years had lower DBP than their male counterparts. Approximately, 6.1% (95% CI: 5.4, 7.0) and 8.2% (95% CI: 7.4, 9.1) of participants had elevated SBP and DBP based on the US reference standards. Adolescents from the UK had average SBP and DBP that were 10 mmHg higher and lower respectively than their Tobagonian counterparts while Jamaican adolescents had diastolic BP consistently lower than Tobagonian adolescents of similar age. Elevated BP was associated with overweight and family history of hypertension. CONCLUSION: Growth and maturational factors are important determinants of blood pressure levels in this population. Furthermore, the wide variation in these key variables among possible BP referent populations necessitates the development of local blood pressure reference standards for Tobagonian adolescent populations.

A content analysis of health research reported by the daily newspapers of Trinidad and Tobago / Análisis del contenido de las investigaciones de salud reportadas por los diarios de Trinidad y Tobago

The ability to translate health research into useful information for the layperson requires both excellent scientific expertise and communication skills that are often foreign to journalist and editors. In this study, we assessed the content of health research articles published in the local daily newspapers for the year 2003. Issues considered included physical presentation, coverage, primary content of the article relative to the country health profile, accuracy of the article compared to its original publication, health model (ie preventative versus medical/curative) and tone (emotive nature of the report, stakeholder addressed). The authors identified 321 eligible articles as follows, The Trinidad Express (108), The Trinidad Guardian (100) and The Trinidad and Tobago Newsday (113). More than 90of the reports appeared in the newspapers within two weeks of their original journal publication; 10.5of the articles had over 50newspaper readership coverage. Headlines were prominently displayed for 70of articles while 86of the written text were located on the top right and left quadrant of pages where the eye naturally falls during reading. Photographs accompanied 36of the articles. Approximately 72.5of articles accurately reflected the content of the original publication and 67of them were classified as preventative. There were similar proportions of good (45) and bad (47) articles. The top five predominant themes were nutrition (24.3), cancer (18.2) women's health (17.6), heart disease (14.2) and mental health (10.3). The findings suggest a tremendous effort by journalist and editors to provide relevant health information in a timely and attractive manner; however, this should not be at the expense of accuracy.

En este estudio, los autores examinaron la calidad científica de las investigaciones de salud reportadas en los tres diarios de Trinidad y Tobago. Todos los artículos de investigación médica publicados en el período de enero 1 a diciembre 31, 2003, fueron extractados mediante una planilla estandarizada de recolección de datos. La calidad científica de los artículos fue analizada tomando en consideración varios aspectos del diseño del estudio, así como otros problemas asociados con el arte de reportar con exactitud. De los 321 artículos elegibles, 108 fueron tomados del periódico The Trinidad Express, 100 del diario The Trinidad Guardian, y 113 del rotativo The Trinidad and Tobago Newsday. Los porcentajes de artículos que reportaban componentes metodológicos correspondientes a una buena calidad, fueron como sigue: objetivos(s) (99.7%), diseño del estudio (79.8%), procedimiento del estudio (70.1%), procedimiento de selección (70.1%), descripción de participantes (87.5%), grupo de control/apareamiento (74.9%), variables del resultado (99.4%) y problemas de validez y confiabilidad (2.5%). Además, el porcentaje de artículos que contienen aspectos sobre escritura de buenos reportes, fue como sigue: autoría (71.3%), afiliación de autores (59.5%), lugar del estudio (25.4%), fuentes del material de la investigación (83.1%), duración del estudio (27.7%), entorno del estudio (72.0%), número de participantes (74.1%), período en que se llevo a cabo el estudio (12.0%) y cuantificación de los resultados (66.7%). La probabilidad de publicación de los reportes fue significativamente mayor para los estudios observacionales en comparación con los estudios experimentales (71.5% versus 28.5%). En general, los artículos reportados en el Trinidad Express y el Trinidad and Tobago Newsday presentaron una mayor calidad científica que los publicados en el Trinidad Guardian. Estos hallazgos sugieren la necesidad de...

The quality of health research reporting by the daily newspapers in Trinidad and Tobago / La calidad de los reportajes sobre las investigaciones de salud publicadas en los diarios de Trinidad y Tobago

In this study, the authors examined the scientific quality of health research reported in the three daily newspapers in Trinidad and Tobago. All medical research articles published for the period January 1 to December 31, 2003, were extracted using a standardized data collection form. The scientific quality of the articles was analyzed by taking into consideration various aspects of study design, as well as other issues associated with accurate reporting. Of the 321 eligible articles, 108 were collected from The Trinidad Express, 100 from The Trinidad Guardian and 113 from The Trinidad and Tobago Newsday. The percentages of articles reporting methodological components consistent with good scientific quality were as follows: objective(s) (99.7), study design (79.8), study procedure (70.1), selection procedure (70.1), description of participants (87.5), control/matching group (74.9), outcome variables (99.4) and issues of validity and reliability (2.5). In addition, the percentage of articles containing aspects of good report writing were as follows: authorship (71.3), authors' affiliation (59.5), location of the study (25.4), source of the research material (83.1), duration of the study (27.7), study setting (72.0), number of participants (74.1), period in which the study was conducted (12.0) and quantification of the results (66.7). Observational studies were significantly more likely to be reported than experimental studies (71.5versus 28.5). Overall, articles reported in the Trinidad Express and the Trinidad and Tobago Newsday were of a better scientific quality than those in the Trinidad Guardian. These findings suggest a need to improve the overall scientific quality of reported health research in these newspapers by ensuring that reports answer the fundamental questions of what, why, who, where, when and how. This might be achieved by adopting a structured reporting format similar to that used by many peer-reviewed journals.

En este estudio, los autores examinaron la calidad científica de las investigaciones de salud reportadas en los tres diarios de Trinidad y Tobago. Todos los artículos de investigación médica publicados en el período de enero 1 a diciembre 31, 2003, fueron extractados mediante una planilla estandarizada de recolección de datos. La calidad científica de los artículos fue analizada tomando en consideración varios aspectos del diseño del estudio, así como otros problemas asociados con el arte de reportar con exactitud. De los 321 artículos elegibles, 108 fueron tomados del periódico The Trinidad Express, 100 del diario The Trinidad Guardian, y 113 del rotativo The Trinidad and Tobago Newsday. Los porcentajes de artículos que reportaban componentes metodológicos correspondientes a una buena calidad, fueron como sigue: objetivos(s) (99.7%), diseño del estudio (79.8%), procedimiento del estudio (70.1%), procedimiento de selección (70.1%), descripción de participantes (87.5%), grupo de control/apareamiento (74.9%), variables del resultado (99.4%) y problemas de validez y confiabilidad (2.5%). Además, el porcentaje de artículos que contienen aspectos sobre escritura de buenos reportes, fue como sigue: autoría (71.3%), afiliación de autores (59.5%), lugar del estudio (25.4%), fuentes del material de la investigación (83.1%), duración del estudio (27.7%), entorno del estudio (72.0%), número de participantes (74.1%), período en que se llevo a cabo el estudio (12.0%) y cuantificación de los resultados (66.7%). La probabilidad de publicación de los reportes fue significativamente mayor para los estudios observacionales en comparación con los estudios experimentales (71.5% versus 28.5%). En general, los artículos reportados en el Trinidad Express y el Trinidad and Tobago Newsday presentaron una mayor calidad científica que los publicados en el Trinidad Guardian. Estos hallazgos sugieren la necesidad de mejorar la calidad científica general de los reportes de...

Socio-demographic and health system factors in relation to exclusive breast-feeding in Tobago

To determine the prevalence and significant correlates of exclusive breast-feeding among nursing mothers, we conducted a survey among nursing mothers attending the Wellness Baby Clinic in Tobago from July 1 to December 1, 1998. A random sample of 151 mothers had face-to-face interviews with a standardized pretested questionnaire. Our results suggest that 48.3 and 20.8 of infants were exclusively breast-fed at two and four months respectively. Univariate logistic regression analyses showed that exclusive breast-feeding at two months was significantly positively associated with years of schooling completed by the mother, frequency of prenatal visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding, and occupation of the child's father. Exclusive breast-feeding at four months was significantly positively associated with mother's age, years of schooling completed by the mother, frequency of prenatal visits, mother's knowledge of the recommended duration of breast-feeding, years of schooling completed by the child's father and occupation of the child's father. In multivariate logistic analyses, adjusting simultaneously for all relevant explanatory variables, exclusive breast-feeding at two months was significantly positively associated with frequency of prenatal clinic visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding and occupation of the child's father. In addition, exclusive breast-feeding at four months was significantly positively associated with frequency of prenatal clinic visits, length of hospital stay, mother's knowledge of recommended duration of breast-feeding, years of schooling completed by the child's father, family structure and inversely associated with mother's age. In this sample, parental socio-demographic characteristics and health system factors were associated with subsequent infant feeding practices.