National policy and plan of action on healthy ageing 2017- 2027

The twin island state of Antigua and Barbuda lies in the eastern arc of the Leeward Islands of the Lesser Antilles, separating the Atlantic Ocean from the Caribbean Sea. Antigua is 650 km southeast of Puerto Rico and Barbuda lies 48 km due north of Antigua. Low-lying and volcanic in origin, they are part of the Leeward Islands group in the northeast Caribbean. Antigua has an area of 108 sq miles and Barbuda 62 sq miles. The terrain is mostly low-lying limestone and coral islands, with some higher volcanic areas. The sandy soil on much of the islands has only scrub vegetation. Some parts of Antigua are more fertile­most notably the central plain­due to the volcanic ash in the soil. These areas support some tropical vegetation and agricultural uses The climate is characterized as tropical maritime with little seasonal temperature variation. Rainfall averages 990 mm (39 in) per year, with the amount varying widely from season to season. The islands generally experience low humidity and recurrent droughts.

National strategic plan for health 2016-2020

Government has accepted the fact that HEALTH is much more than the prevention or reduction of disease, but is a resource for national productivity and development. As such investments in ensuring, a healthy population is an asset for national development. It is for this reason that Government re-affirms its strong commitment to providing better health care to all Grenadians. The National Strategic Plan for Health 2016-2025 provides the framework that will guide the efforts of the Ministry of Health and Social Security (MOHSSSSSS) and its partners over the next ten years. It reflects the Ministry's fundamental belief that health is a basic human right and as a result no one should be denied access to health care. Consequently, one of the overarching goals of this strategic plan is ensure that health services are made available, accessible and affordable to all people without discrimination. Like many other developing countries, Grenada continues to be challenged by meeting the demands for health care services to its citizens. Chronic non-communicable diseases are the leading cause of morbidity and mortality. Life style and food choices are the main contributing factors of the disease profile and pose a significant challenge to the delivery of secondary care due to the escalating cost associated with the management of these diseases. This requires the Ministry of Health to place greater emphasis on prevention and health promotion. Notwithstanding the fact, every citizen must however accept responsibility for his/her individual health outcomes. Recently, Grenada has also been experiencing the outbreaks of new and re-emerging communicable diseases, which have been linked to climate change factors. It behooves us therefore to take necessary steps to protect and maintain our environment for our future generations. The Plan further reflects the belief that health fundamentally affects individual productivity and is therefore a critical input for long-term development of the country. To this end, we have set out our major priorities and therefore in concert with the private sector, we will heighten our focus and continue to promote health and wellness among our citizens.

Vertical and horizontal facial proportions of Indian American men / 대한해부학회지

The importance of understanding all gender facial differences is critical in providing a successful cosmetic outcome. Men are a growing segment of the cosmetic industry. Understanding of the male face and its appropriate treatment with minimally invasive cosmetic procedures are essential. The aim was to investigate various facial ratios in Indian American men and to compare them with the Indian and Caucasian norms. Additionally, we wanted to evaluate whether these values satisfy golden and silver ratios. Direct facial anthropometric measurements were made using a digital caliper in 100 Indian American men students (18-30 years) at the American University of Antigua (AUA), Antigua. A set of facial ratios were calculated and compared with coefficients of variation (CV). Most of the facial ratios had small CV thus making them highly reliable due to reduced intra-sample variability. The upper face to face height and mandibulo upper face height indices were close to golden ratios whereas mandibulo lower face height, upper face height biocular width, and nasal indices were close to silver ratios. There was significant difference in most of the values when compared with previous studies. The present facial ratios data can be used as a reference value for Indian American men.

Small babies on a small island: survival of very low birthweight infants in Antigua and Barbuda 1986 to 2006 / Bebés pequeños en islas pequeñas: supervivencia de infantes con muy bajo peso al nacer en Antigua y Barbuda, de 1986 a 2006

INTRODUCTION: Recent attention has been focussed on pregnancy outcomes in developing countries, with the publication of the World Health Organization Report 2005, Make Every Mother and Child Count and the Neonatal Survival Series from the Lancet in 2005. Scant outcome data from the smaller islands of the Caribbean exist for very low birthweight (VLBW) babies (birthweight < 1500 g). PATIENTS AND METHODS: a retrospective review of mortality data on vlbw babies in antigua and barbuda was performed. antigua and barbuda had a population of 71 500 with per capita income of (us) $6054 dollars in 1998. in november 1985, a neonatal special care nursery (scn) was established. the survival to discharge from scn for vlbw babies was reviewed from january 1986 to december 2006. RESULTS: there were 26 455 babies born from 1986 to 2006; 344 (1.3%) were vlbw babies. survival to scn discharge was 45% from 1986 to 1992, 46% from 1993 to 1999, and increased to 60% from 2000 to 2006 (p < 0.05 compared with the first two time-periods). babies from 1000 to 1499 g accounted for 64% of vlbw babies and survival to scn discharge was 60% from 1986 to 1992, 58% from 1993 to 1999, and increased to 83% from 2000 to 2006 (p < 0.01 compared with the first time period; p < 0.001 compared with the second). babies < 1000g accounted for 36% of VLBW babies and survival to SCN discharge was 10% from 1986 to 1992, increased to 25% from 1993 to 1999 and to 28% from 2000 to 2006 (trend of p < 0.10 compared with first time period). conservative newborn care only was available. antenatal steroids were given from 2000 to 2006. CONCLUSION: the outlook for vlbw babies using conservative newborn care techniques has significantly improved over 21-years in antigua and barbuda.

INTRODUCCIÓN: Recientemente se ha centrado la atención en los resultados del embarazo en los países en vías de desarrollo, a partir de la publicación del Informe 2005 de la Organización Mundial de la Salud, Que cada madre y cada niño cuente y la Serie de Supervivencia Neonatal de la Lancet en 2005. Son escasos los datos de resultados existentes en las islas más pequeñas del Caribe, acerca de los bebés con muy bajo peso al nacer (MBPN) (peso al nacer < 1500 g). PACIENTES Y MÉTODOS: se llevó a cabo una revisión retrospectiva de datos sobre la mortalidad de bebés mbpn en antigua y barbuda. antigua y barbuda tenían una población de 71 500 con un ingreso per cápita de $6054 usd en 1998. en noviembre de 1985, se creó una sala de cuidados especiales del Recién Nacido (SCN). La supervivencia en término de los bebés MBPN dados de alta de la SCN fue examinada de enero de 1986 a diciembre de 2006. RESULTADOS: De 1986 a 2006, hubo 26 455 bebés nacidos; de ellos 344 (1.3%) fueron bebés MBPN. La supervivencia en término de las altas de la SCN fue de 45% de 1986 a 1992, 46% de 1993 a 1999, y aumentó a 60% de 2000 a 2006 (p <0.05 en comparación con los primeros dos períodos de tiempo). Los bebés de 1000 a 1499g representaron el 64% de los bebés MBPN y la cifra de los supervivientes dados de alta del SCN fue de 60% de 1986 a 1992, 58% de 1993 a 1999, y aumentó a 83% de 2000 a 2006 (p < 0.01 en comparación con el primer periodo de tiempo; p <0.001 en comparación con el segundo). Los bebés <1000 g representaron el 36% de los bebés MBPN, y la supervivencia en términos de los dados de alta de la SCN fue 10% de 1986 a 1992, aumentó a 25% de 1993 a 1999, y a 28% de 2000 a 2006 (la tendencia de p <0.10 en comparación con el primer periodo de tiempo). Sólo hubo disponible atención neonatal conservadora Se administraron esteroides antenatales desde el año 2000 al 2006. CONCLUSIÓN: El pronóstico para MBPN usando técnicas de cuidado neonatal conservadoras ha mejorado significativamente a lo largo de 21 años en Antigua y Barbuda.

Client characteristics associated with failure to complete residential treatment at a multicultural drug and alcohol treatment facility in Antigua, West Indies / Características del cliente asociadas con el fracaso para terminar el tratamiento residencial en un centro multicultural para el tratamiento de la adicción a las drogas y al alcohol en Antigua, West Indies

The purpose of this study is to compare the demographic and clinical characteristics of clients leaving treatment prior to completion of the 29day residential stay at a multicultural addiction treatment centre. The charts of 446 clients (62% from the United States of America, 29% from the Caribbean region, 9% European) were reviewed. The mean age was 39.7 years, 33% female, with 91% using alcohol, 49% using cocaine, 25% using opioids (single drug 27%, polydrug use 73%), with mean 13.1 years of harmful use, 33% using prescribed mental health medications and 46% having had prior residential treatment. Of 446 clients, 76 (17%) did not complete treatment stay. A comparison of clients leaving early and those completing stay revealed no difference in age (38.6 vs 39.9 years) or years of harmful use (11.7 vs 13.4 years). There were trends toward those leaving to be more often female (42 vs 31%, p < 0.10) and noncaribbean (20% american or european vs 12% Caribbean, p < 0.10). Clients who left early were more likely to use opioids (41 vs 22%, p < 0.001) and less likely to use alcohol/sedative (83 vs 1%, p < 0.02). cocaine/stimulant use did not differ (49 vs 49%). Those leaving treatment early had greater use of mental health medications (50 vs 29%, p < 0.001). prior treatment was not significantly different (53 vs 44%). An analysis of the 128 clients from the Caribbean region showed 15 clients (12%) failed to complete treatment. Those leaving treatment early were more likely to be female (53 vs 26%, p < 0.05), had a trend toward being younger (35.6 vs 39.9 years, p = 0.19) and had fewer years of harmful use (8.1 vs 13.1, p < 0.02). ethnicity (73 vs 74% African) and alcohol/sedative (87 vs 94%), cocaine/stimulant (53 vs 65%), and opioid use (0 vs 4%) did not differ. Those leaving were more likely to use mental health medication (47 vs 12%, p < 0.001) and there was a trend toward prior treatment (40 vs 23%, p < 0.10).

El propósito de este estudio es comparar las características demográficas y clínicas de clientes que abandona el tratamiento antes de que cumplan los 29 días de estancia residencial en un centro multicultural de tratamiento a la adicción. Se revisaron las estadísticas de 446 clientes (62% de los Estados Unidos de América, 29% de la región del Caribe, 9% de 'Europa). La edad promedio fue de 39.7 años; 33% eran mujeres; el 91% usaban alcohol; 49% usaban cocaína; 25% usaban opioides (27% droga simple, 73% polidroga), con un promedio de 13.1 años de uso perjudicial; 33% usaban medicamentos bajo prescripción para la salud mental, y 46% habían tenido tratamiento residencial con anterioridad. De 446 clientes, 76 (17%) no terminaron la estancia del tratamiento. Una comparación de clientes que dejan el tratamiento antes de tiempo con aquellos que completan su estancia, no reveló diferencia en cuanto a edad (38.6 contra 39.9años) o años de uso dañino (11.7 contra 13.4años). La tendencia a abandonar el tratamiento fue más frecuente entre las mujeres (42 contra 31%, p <0.10) y los no caribeños (20% americanos o europeos contra 12% caribeños, p < 0.10). Los clientes que abandonaban antes de tiempo eran más proclives al uso de opioides (41 contra 22%, p <0.001), y menos propensos al uso de alcohol/sedativos (83 contra 1%, p < 0.02). el uso de cocaína/estimulantes no difirió (49 contra 49%). los que abandonaron el tratamiento de manera temprana hacían un mayor uso de medicamentos para la salud mental (50 contra 29%, p < 0.001). el tratamiento anterior no fue significativamente diferente (53 contra 44%). un análisis de los 128 clientes de la región del caribe mostró que 15 clientes (12%) no terminaron el tratamiento. quienes abandonaban el tratamiento de manera temprana eran con mayor probabilidad mujeres (53 contra 26%, p < 0.05), tenía tendencia a ser más jóvenes (35.6 contra 39.9años, p < = 0.19) y tenían menos años de uso perjudicial (8.1 contra 13.1, p < 0.02). la etnicidad (73 contra 74% africanos) y el uso de alcohol/sedativos (87 contra 94%), cocaína/estimulantes (53 contra 65%), y opioides (0 contra 4%) no difirieron. los que abandonaban el tratamiento presentaban una mayor probabilidad de usar medicamentos para la salud mental (47 contra 12%, p < 0.001) y una tendencia a haber estado sometido a tratamiento con anterioridad (40 contra 23%, p < 0.10).

Effect of a government funded medication programme on paediatric asthma hospital admissions in Antigua and Barbuda / Efecto de un programa de medicación subvencionado por el gobierno, sobre los ingresos por asma al hospital pediátrico en Antigua y Barbuda

OBJECTIVE: To assess the effect of a government funded asthma medication programme on paediatric (age # 12 years) asthma hospital admissions in Antigua and Barbuda. METHODS: A retrospective review of all hospital admissions for asthma in children was performed for the six years before and six years after a Medical Benefits Scheme (MBS) programme was established in 1997 to provide asthma medications at no out-of-pocket cost. Holberton Hospital records (1992 to 2003) which include all paediatric asthma admissions in Antigua and Barbuda, were reviewed. RESULTS: Paediatric admissions for asthma fell from mean ± standard deviation of 77.0 ± 24.8 per year before the MBS programme was started to 48.0 ± 17.1 per year (p < 0.05) after the MBS programme was started. The number of multiple admissions fell from 18.7 ± 2.7 to 9.5 ± 4.8 (p < 0.005) and the number of children admitted multiple times per year fell from 7.8 ± 1.9 to 4.7 ± 2.5 (p < 0.05). The number of children aged four to nine years admitted with asthma fell from 7.8 per 1000 annually during 1992 to 1997 to 4.4 per 1000 per year during 1998 to 2003. CONCLUSIONS: The government funded MBS programme for asthma medication has resulted in a 38% decrease in hospital admissions for paediatric asthma over a six-year period. The benefits of a similar programme in other developing countries should be considered.

OBJETIVO: Evaluar el efecto de un programa de medicación subvencionado por el Gobierno, sobre los ingresos por asma al hospital pediátrico (edad # 12 años) en Antigua y Barbuda. MÉTODOS: Se llevó a cabo un examen retrospectivo de todos los casos de niños ingresados al hospital por asma, durante los seis años previos y los seis años posteriores a la puesta en marcha del programa de beneficios médicos, conocido como Medical Benefits Scheme (MBS). Dicho programa fue establecido en 1997 con el propósito de ofrecer medicamentos para asmáticos, sin costo alguno. Se examinaron las historias clínicas del Hospital Holberston, de 1992 al 2003, las cuales incluían todos los ingresos pediátricos por asma en Antigua. RESULTADOS: Los ingresos pediátricos por asma descendieron de un promedio ± desviación estándar de 77.0 ± 24.8 por año antes de que comenzara el programa MBS, 48.0 ± 17.1 por año (p < 0.05) después del comienzo del programa MBS. El número de ingresos múltiples descendió de 18.7 ± 2.7 a 9.5 ± 4.8 (p < 0.005) y el número de niños ingresados múltiples veces por año disminuyó de 7.8 ± 1.9 a 4.7 ± 2.5 (p < 0.05). El número de niños de cuatro a nueve años de edad, ingresados por asma, descendió de 7.8 por 1000 anualmente de 1992 a 1997 hasta 4.4 por 1000 por año, de 1998 a 2003. CONCLUSIONES: El programa MBS para la medicación por asma, subvencionado por el gobierno, ha tenido por resultado una disminución del 38% de los ingresos hospitalarios infantiles a causa de asma por un período de seis años. Debe tomarse en consideración los beneficios de posibles programas similares en otros países en vías de desarrollo.

Diseases and medical disabilities of enslaved Barbadians, from the seventeenth century to around 1838: part II / Enfermedades y discapacidades médicas de los Barbadenses esclavizados, desde el siglo diecisiete hasta alrededor de 1838: parte II

The disease environment, health problems and causes of mortality of enslaved Barbadians are described. Data are derived mainly from documentary sources; also included are bioarchaeological data from analyses of skeletons recovered from Newton Plantation cemetery. Major topics include infectious diseases trans-mitted from person to person, as well as those contracted through water, soil, and other environmental contaminations, and diseases transmitted by insects, parasites and other animals; nutritional diseases, including protein energy mal-nutrition, vitamin deficiencies, anaemia, and geophagy or "dirt eating"; dental pathologies, lead poisoning, alcoholism, traumas, and other disorders, including psychogenic death or illness caused by beliefs in witchcraft or sorcery.

Se describe el ambiente de enfermedades, problemas de salud y causas de mortalidad de los barbadenses esclavizados. Los datos proceden de fuentes documentales, e incluyen también datos bioarqueológicos a partir del análisis de esqueletos recuperados del cementerio de la Plantación Newton. Los asuntos principales incluyen las enfermedades infecciosas transmitidas de persona a persona, así como aquellas contraídas por el agua, el suelo, y otros medios de contaminación ambiental. Asimismo se incluyen enfermedades transmitidas por insectos, parásitos, y animales; enfermedades nutricionales, incluida la malnutrición energético-proteica, las deficiencias de vitaminas, la anemia y la geofagia o el "comer tierra", las patologías dentales, el envenenamiento por plomo, el alcoholismo, los traumas, y otros trastornos, incluyendo la muerte psicogénica o las enfermedades causadas por creencias en la brujería y la hechicería.

Toward effective school-based substance abuse prevention "Breaking the Cycle" programme in Antigua and Barbuda / "Rompiendo el Ciclo": hacia un programa de prevención efectiva del abuso de sustancias en las escuelas de Antigua y Barbuda

The "Breaking the Cycle" programme, based on the Project Charlie programme, was developed for Antigua and Barbuda third grade students and was implemented in 2001. Aspects of the programme are compared with aspects recently proven effective in randomized studies in developed countries. The "Breaking the Cycle" programme includes life-skills training, teaches decision making skills, includes peer resistance training, uses trained teachers, interactive teaching methods, effective content and delivery, targets students prior to onset of drug use, teaches drug harm, teaches community values and is culturally sensitive, all aspects of successful programmes overseas. The cost of about $7 US per student would suggests cost-benefit effectiveness compared with overseas programmes. The "Breaking the Cycle" school-based drug and alcohol use prevention programme includes most aspects of evidence-based successful programmes overseas, appears cost effective and could serve as a model for programmes in the Caribbean region.

El programa "Rompiendo el ciclo", basado en el programa del Proyecto Charlie, se desarrolló para los estudiantes de tercer grado de Antigua y Barbuda, y fue implementado en 2001. Los diferentes aspectos del programa son comparables con aspectos cuya efectividad ha quedado recientemente demostrada en los estudios aleatorios en países desarrollados. El programa "Rompiendo el ciclo" incluye entrenamiento en aptitudes para la vida, enseña habilidades para la toma de decisiones, incluye entrenamiento en resistencia al grupo de iguales, usa maestros adiestrados, métodos interactivos de enseñanza, contenido e impartición efectivos, se dirige a estudiantes antes del comienzo del uso de drogas, enseña sobre el daño de las drogas, enseña valores de la comunidad, y es culturalmente sensible, y contiene todos los aspectos de los programas exitosos en el extranjero. El costo de alrededor de $7 USD por estudiante sugiere la efectividad costo-beneficio en comparación con programas en el extranjero. El programa "Rompiendo el ciclo" para la prevención del uso del alcohol y las drogas entre escolares, se presenta costo-efectivo y podría servir de modelo para otros programas en la región del Caribe.

Trends in the prevalence of adolescent births in Antigua and Barbuda over 35 years / Tendencias en la prevalencia de nacimientos de partos en adolescentes en Antigua y Barbuda por espacio de 35 años

A retrospective study was undertaken to determine trends in teenage births in Antigua and Barbuda from 1969 to 2003. Maternity Ward records were reviewed at Holberton Hospital, site of over 90% of deliveries in Antigua and Barbuda. Maternal age for all births were included. The estimated population in Antigua and Barbuda increased from 60 159 in 1969 to 69 866 in 1998, with no suspected change in age-group or gender distribution. Births to mothers 12-13, 14-15, 16-17 and 18-19 years old were analyzed separately. Yearly birth totals for the 10-year period from 1969 to 1973 and 1999 to 2003 were compared using student t test analysis. The total number of births averaged 1075 per year with no change in trend. For females aged 12 and 13 years, there was no change in births from 1969 to 1978 compared with 1994 to 2003. For females aged 14 years, there was a 54% drop; for females aged 15 years, a 59% drop; for females aged 16 years, a 53% drop; for females aged 17 years, a 51% drop; for females 18 years, a 37% drop and for females aged 19 years, a 30% drop, while births to mothers $ 20 years increased 25%. The decrease for all teen births was 42% from 1969-1978 to 1994-2003. Teen births accounted for 29% of all births at Holberton in 1969 to 1973 but only 16% of births in 1999 to 2003. In conclusion, Antigua and Barbuda has seen a marked drop of 42% in teenage deliveries, including a 53% drop in school-aged teens from 1969 to 2003. Explanations include factors such as economic, social, educational and medical developments.

Se llevó a cabo un estudio retrospectivo a fin de determinar las tendencias de partos en adolescentes en Antigua y Barbuda de 1969 a 2003. Se revisaron las historias clínicas de la Sala de Maternidad del Hospital Holberton, lugar en que tuvieran lugar más del 90% de esos partos en Antigua y Barbuda. Se incluyó la edad de las madres para todos los nacimientos. La población estimada en Antigua y Barbuda, aumentó de 60 159 en 1969 a 69 866 en 1998, sin sospecha de cambio en el grupo etáreo o la distribución de género. Los nacimientos en madres de 12-13, 14-15, 16-17 y 18-19 años de edad, fueron analizados por separado. Los totales de nacimientos anuales durante el período de 10 años 1969 a 1973 y 1999 a 2003 fueron comparados usando el análisis de prueba t de estudiante. El número total de nacimientos fue de un promedio de 1075 por año, sin cambios en la tendencia. Para las hembras de 12 y 13 años de edad, no hubo cambios en los partos de 1969 a 1978 en comparación con los ocurridos de 1994 a 2003. Para las hembras de 14 años de edad, hubo una caída de un 54%; para las hembras de 15 años de edad, una caída de 59%; para las hembras de 16 años de edad una caída del 53%; para las hembras de 16 años de edad una caída de 53%; para las hembras de 17 años de edad una caída de 51%; para las hembras de 18 años de edad una caída de 37%; y para las hembras de 19 años de edad una caída de 30%, en tanto que los nacimientos para madres $ 20 años aumentaron un 25%. El descenso para todos los partos en adolescentes fue de 42% de 1969-1978 a 1994-2003. Los partos en adolescentes representaron el 29% de todos los nacimientos en Holberton desde 1969 a 1973 pero sólo un 16% de los nacimientos de 1999 a 2003. En conclusión, Antigua y Barbuda han visto un marcado descenso de 42% en los alumbramientos en adolescentes, incluyendo una caída de 53% en los adolescentes de edad escolar desde 1969 a 2003. Las explicaciones incluyen factores relacionados con el desarrollo económico, social, educacional y médico.

Does group B streptococcal infection contribute significantly to neonatal sepsis in Antigua and Barbuda?

Group B streptococcus is the most common cause of neonatal sepsis in the United States of America (USA). This study was undertaken to determine the contribution of group B streptococcus to neonatal septicaemia in Antigua and Barbuda. From 1994 to 2002, there were about 12 000 births, with 2500Special Care Nursery admissions, 1100 (44%) with potential neonatal septicaemia. Blood cultures were done in 433/1100 (39%) and cerebrospinal fluid cultures in 52/1100 (5%). Positive cultures were seen in 41/433 (9.5%) with group B streptococcus in 1/41 (2.4%), streptococcus “species” in 3/41 (7.4%) and positive cerebrospinal fluid cultures were seen in 2/52 (one group B streptococcus) giving 5 per 12 000 or 0.4 cases per 1000 babies. Vaginal cultures from 1994 to 2002 revealed group B streptococcus in 14/163 (8.6%) of positive bacterial cultures. A sample of pregnant women from a private office had positive culture for group B streptococcus in 2/120 (1.7%). The prevalence rate of carriage (15 to 40%) and infection (1.7 to 4 per 1000 babies) was much higher in the USA in the same period. Universal screening of mothers for group B streptococcus may not be as necessary or cost-effective inAntigua and Barbuda.

Los estreptococos del grupo B son la causa más común de sepsis neonatal en los Estados Unidos (EE.UU.). Este estudio se llevó a cabo con el propósito de determinar en que medida los estreptococos del grupo B contribuyen a la septicemia neonatal en Antigua y Barbuda. Desde el año 1994 hasta el2002, hubo alrededor de 12000 nacimientos, con 2500 ingresos a la Guardería de Cuidados Especiales, 1100 (44%) con septicemia neonatal potencial. Se realizaron cultivos de sangre en 433/1100 (39%) y cultivos del líquido cefalorraquídeo cerebroespinal) en 52/1100 (5%). Seobservaron cultivos positivos en 41/433 (9.5%) con estreptococos B en 1/41 (2.4%), “especies“ de estreptococos en 3/41 (7.4%), y se observaron cultivos cefalorraquídeos positivos en 2/52 (1 de estreptococosdel grupo B), para 5 por 12 000 ó 0.4 casos por 1000 recién nacidos. Los cultivos vaginales desde el año 1994 al 2002 revelaron estreptococos del grupo B en 14/163 (8.6%) de los cultivosbacterianos positivos. Una muestra de mujeres embarazadas – provenientes de una oficina privada – tuvo un cultivo positivo para estreptococos del grupo B en 2/120 (1.7%). La tasa de prevalencia de portación (15 a 40%) e infección (1.7 a 4 por 1000 recién nacidos) fue mucho más alta en los EE.UU. en el mismo período. El pesquisaje universal de madres en relación con el estreptococo de grupo Bpuede no ser tan necesario o costo-efectivo en Antigua y Barbuda.

Comparison of general anaesthesia and spinal anaesthesia for caesarean section in Antigua and Barbuda

Regional anaesthesia has become the anaesthetic of choice for Caesarean section (CS) in developed countries, with use extended to smaller, less developed countries in the past decade. This study is a comparison of maternal and neonatal outcomes comparing general anaesthesia (GA) and the early experience with spinal anaesthesia (SA) for CS in Antigua and Barbuda. Data obtained included maternal age, gravidity, parity, indication for operation, emergent versus routine operation and type of anaesthesia used. Outcome data comprised estimated blood loss, transfusion requirement, length of stay, postoperative wound infection for mothers. Data obtained for babies included birthweight, one and five minute Apgar scores, neonatal special care unit admission or perinatal death. The sample population included 103 CS patients who underwent GA and 45 who underwent SA. There was no difference in age (mean 29.3 vs 29.4 years), gravidity (mean 3.25 vs 3.27), parity (mean 1.74 vs 1.56) or emergency vs routine CS (44.4% vs 49.5%). Mothers who underwent GA had significantly greater estimated blood loss (mean 787 vs 632 mL, p < 0. 02) and rate of transfusion (13.6% vs 2.2%, p < 0. 05). There was a trend toward longer hospital stay (mean 6.86 vs 6.42 days, p = 0. 16) but a lower rate of postoperative wound infection (8.7% vs 20%, p < 0. 10) for mothers who underwent GA. There were no maternal deaths. Babies demonstrated no difference in birthweight (mean 3238 vs 3258 g) but those born to mothers who underwent GA had significantly lower one minute (mean 6.84 vs 8.17, p < 0.0001) and five minute (mean 8.13 vs 8.91, p < 0.001) Apgar scores, with a trend toward more frequent neonatal special care unit admission (26.2% vs 17.7%, p < 0.20) and perinatal death (3.9 vs 0%, p < 0.30). GA and SA appear equally safe, but SA was associated with significantly better outcome for both mothers and babies.

The age-specific incidence of admission to the intensive care unit for acute myocardial infarction in Antigua and Barbuda

This study was done to assess the age-specific incidence of admission for acute myocardial infarction in Antigua and Barbuda from 1990 to 2001. A retrospective review of Intensive Care Unit admissions for possible acute myocardial infarction was performed. Data obtained included age, gender, country of residence, electrocardiogram, creatine kinase results and intensive care unit outcome. There were, 250 admissions, 194 (78%) having data available for review. Acute myocardial infarction was found in 107/194 (55.2%) patients, age 59.9 +/- 13.7 years, 28% female, 70% from Antigua and Barbuda, 90/107 (85%) were between 35 and 75 years old. The incidence would be 7.5 per year or 9.7 per year if the confirmation rate documented was similar for all admissions. With a yearly population of 9555 men age 35 to 75 years in Antigua and Barbuda, with men accounting for 72% of acute myocardial infarctions, the incidence rate was 0.57 (confirmed) to 0.73 (all admissions) per year per 1000 men. For women, the yearly population was 10822 age 35 to 75 years, and the incidence rate was 0.19 to 0.24 per year per 1000 women. The mortality rate was 12/107 (11.2%), with women being older (67 vs 57 years, p = 0.001) and dying more often (17% vs 9%) compared with men. The mortality rate in the Intensive Care Unit was 0.07 per year for men, 0.04 per year for women per 1000 aged 35 to 75 years. In the United States of America (USA), the admission rate is 4.1 for men and 1.8 for women per year per 1000 aged 35 to 75 years; the mortality rate is 1.0 for men and 0.5 for women per year per 1000 aged 35 to 75 years. Rates of admission to the Intensive Care Unit for acute myocardial infarction in Antigua and Barbuda are 20%, and mortality rates are 10% of those reported in the USA.

Antibiotic use and overuse for appendicectomy in Antigua and Barbuda

The use of antibiotics for appendicectomy in Antigua and Barbuda, from January 1998 to December 1999, was examined with respect to current Surgical Infection Society guidelines from developed countries. There were 143 cases of appendicectomy performed at Holberton Hospital. The mean patient age and standard deviation (SD) was 28.1 +/- 15.8 years, 57female. Pathology showed inflammed appendix only in 56, peri-appendiceal abscess/perforation in 17, [quot ]fibrosed[quot ] appendix in 10and normal appendix in 17. Postoperative infection (wound infection, fever > three days) was seen in 7/24 (29) of cases with peri-appendiceal abscess/perforation and 2/119 (1.7) of the other cases. A subset of 88 cases had antibiotic use reviewed: 3/88 (3.4) were given no antibiotics, 7/88 (8) were given one antibiotic, 5/88 (5.7) were given two antibiotics, 72/88 (81.8) were given three antibiotics and 1/88 (1.1) was given four antibiotics. Parenteral antibiotics were given a mean and SD of 5.39 +/- 1.94 days followed by oral antibiotics in 18/88 (20.5) cases. Those with appendiceal abscess/perforation were treated parenterally for mean and SD of 6.56 +/- 2.35 days, not significantly different from others. Most frequent antibiotics used were gentamicin, metronidazole and ampicillin/penicillin/cloxacillin/cephradine (81.8). The Surgical Infection Society recommends starting prophylactic antibiotics before surgery, using appropriate spectrum agents for less than 24 hours if not contaminated and less than five days if infected. It may be possible to safely reduce antibiotic use for appendicectomy in Antigua and Barbuda.

Se examinó el uso de los antibióticos en apendicectomías en Antigua y Barbuda, en el período comprendido de enero de 1998 a diciembre de 1999, sobre la base de las guías actuales de la Sociedad de Infecciones Quirúrgicas de los países desarrollados. Un total de 143 casos de apendicectomía fueron atendidos en el Hospital Holberton. La edad media de los pacientes y la desviación estándar (DE) fue 28.1 + 15.8 años, 57% mujeres. La patología mostró apéndice inflamado sólo en el 56% de los casos, absceso periapendicular/perforación en 17%, apéndice "fibroso"en el 10% y apéndice normal en el 17%. Se vio infección postoperatoria (infección de heridas, fiebre>tres días) en 7/24 (29%) de los casos con absceso periapendicular/perforación y 2/119 (1.7%) de los otros casos. A un subconjunto de 88 casos se le revisó el uso de antibióticos: a 3/88 (3.4%) no se les dio antibióticos, 7/88 (8%) recibieron un antibiótico, 5/88 (5.7%) recibieron dos antibiótico, 72/88 (81.8%) recibieron tres antibióticos, y 1/88 (1.1%) recibió cuatro antibióticos. Se suministraron antibióticos parenterales para una media y DE equivalente a 5.39 ± 1.94 días, seguidos de antibióticos orales en 18/88 (20.5%) casos. Los pacientes con absceso apendicular/perforación fueron tratados parenteralmente para una media y DE equivalente a 6.56 + 2.35 días, sin diferencia significativa con respecto a los otros. Los antibióticos más frecuentes fueron la gentamicina, el metronidazol, y la ampicilina/ penicilina/ cloxacilina/ cefradina (81.8%). La Sociedad de Infecciones Quirúrgicas recomienda que se comience con antibióticos profilácticos antes de la cirugía, usando agentes de espectro apropiado durantes menos de 24 horas si no hay contaminación y menos de 5 días si hay infección. El uso de antibióticos en la apendicectomía puede reducirse sin peligro en Antigua.

A comparison of patients relapsing to addictive drug use with non-relapsing patients following residential addiction treatment in Antigua / Una Comparación de Pacientes que Recayeron en el uso Adictivo de Drogas, con Pacientes que no Experimentaron Recaída Tras Seguir un Tratamiento Residencial de la Adicción en Antigua

The outcome of a 29-day residential addiction treatment programme for persons from Antigua and Barbuda with addiction to drugs or alcohol was assessed. All 100 patients entering the drug and alcohol treatment programme at Crossroads Centre Antigua between November 1998 and October 2002 were included. All patients were assessed with regards to drug or alcohol use or abstinence in November 2002 using telephone and mail follow-up as well as informal follow-up with families and other community contacts. Crossroads Centre Antigua is a 35 bed, 29-day residential treatment centre for drug and alcohol addiction serving patients from developed countries (85%) and from the Caribbean region (15%). Patients records were also reviewed to obtain age, gender, ethnicity, drug of choice, years of problematic use, completion of the 29 day programme, family member participation at Crossroads Centre Antigua (a four-day programme) and acceptance of halfway house placement. Of the 100 Antiguan patients admitted, 46 (46%) were abstinent (non-relapsers) at average 20.7+/-14.7 months after treatment. Abstinence did not have to be continuous. Forty-nine were known to be using drug or alcohol (49%) and five (5%) were lost to follow-up and considered to be using drugs (relapsers). Age (37.5 vs 41.1 years), gender (28% vs 22% female), ethnicity (87% vs 87% Afro-Caribbean), years of harmful use (12.7 vs 12.5 years) did not differ significantly between relapsers and non-relapsers. Crack cocaine use (67% vs 65%) and alcohol use (26% vs 31%) as primary addiction did not differ significantly between relapsers and non-relapsers. Relapsers were significantly less likely to complete the 29- day programme (81% vs 100%, p < 0.01), have family members participate at Crossroads (32% vs 54%, p < 0.05) or accept halfway house placement (4% vs 54%, p < 0.001). In conclusion, abstinence was achieved in 46% of those entering treatment, in 51% completing treatment, in 60% whose families participated and in 92% of those accepting halfway house placement

Se evaluó el resultado de un programa de 29 días de tratamiento residencial de la adicción para personas de Antigua y Barbuda adictas a drogas o alcohol. Fueron incluidos todos los pacientes de un total de 100 que entraron a formar parte del programa de tratamiento contra las drogas y el alcohol en el Crossroads Centre Antigua entre noviembre de 1998 y octubre de 2002. Todos los pacientes fueron evaluados en relación con el uso o la abstinencia de drogas o alcohol en noviembre 2002, mediante un seguimiento por vía telefónica o correo, así como a través de un seguimiento informal con familiares u otros contactos en la comunidad. El Crossroads Centre Antigua es un centro de 35 camas para el tratamiento residencial por 29 días de la adicción a las drogas o el alcohol. El centro presta servicios a pacientes de los países desarrollados (85%) y de la región del Caribe (15%). También se revisaron los récords médicos de los pacientes para obtener datos sobre edad, sexo, etnicidad, droga de elección, años de uso problemático, cumplimiento del programa de 29 días, participación de miembros de la familia en el Crossroads Centre Antigua (un programa de cuatro días) y aceptación de su inclusión en una "casa de medio camino." De los 100 pacientes antigüenses admitidos, 46 (46%) eran abstinentes (no recayentes) en un momento determinado, ubicado como promedio 20.7 ± 14.7 meses después del tratamiento. La abstinencia no tenía que ser continua. Se sabía que 49 (49%) estaban usando drogas o alcohol, y cinco (5%) fueron dados por perdidos del seguimiento y de regreso al uso de las drogas (recayentes). La edad (37.5 vs 41.1 años), sexo (28% varones vs 22% hembra), etnicidad (87% vs 87% Afrocaribeños), y los años de consumo perjudicial (12.7 vs 12.5 años) no presentaron diferencias significativas entre los recayentes y los no recayentes. El uso de la cocaína-crack (67% vs 65%) y el uso del alcohol (26% vs.31%) como adicción primaria, no mostró diferencias significativas entre los recayentes y los no recayentes. Los recayentes mostraron una probabilidad significativamente menor en cuanto a completar el programa de 29 días (81% vs 100%, p < 0.01), hacer que miembros de su familia participaran en Crossroads (32% vs 54%, p < 0.05) o aceptar su inclusión en la casa de medio camino (4% vs 54%, p < 0.001). En conclusión, se logró abstinencia en el 46% de los que adoptaron el tratamiento, el 51% de los que completaron el tratamiento, el 60% de aquellos cuyas familias participaron, y el 92% de quienes aceptaron ser ubicados en la casa de medio camino.

How well does fetal ultrasound predict the date of birth in Antigua and Barbuda / Precisión del Ultrasonido Fetal en la Predicción de la fecha de Nacimiento en Antigua y Barbuda?

This study was done to determine the accuracy of fetal ultrasound (U.S.) predicting the estimated date of delivery (EDD) in a primarily Afro-Caribbean population in Antigua and Barbuda. A total of 206 women had retrospective review offetal ultrasound tests done between July 1994 and January 1996. The EDD based on last menstrual period (LMP) was calculated for 104 women with dates and compared with EDD calculated from ultrasound test. These were then compared with actual date of birth from maternity records. For women with unreliable menstrual data (102 women), ultrasound EDD was compared with actual date of birth. Ultrasound EDD demonstrated a trend toward being more accurate than menstrual history EDD, being 10.0 +/- 9.4 (mean +/- standard deviation) days off versus 13.3 +/- 15 days, p = 0.057, (n=104), CI: -0.1, 6.73 days. Ultrasound EDD was within ten days of delivery 60 of the time versus 57 for menstrual history EDD. The average error in estimating EDD was + 1.7 days for ultrasound and + 3.7 days for menstrual history. In women without menstrual history data (n=102), the ultrasound EDD was just as accurate in both the second trimester, 11.8 +/- 9.5 versus 11.4 +/- 10.7 days off (not statistically significant) and the third trimester, 10.0 +/- 8.0 versus 8.1 +/- 7.0 days off (not statistically significant). Fetal ultrasound is marginally better at predicting the date of birth compared with menstrual history but the difference does notjustify routine use for that purpose. When menstrual history is unknown, ultrasound EDD is just as accurate as when menstrual history is known, making it a very useful test

Este estudio fue hecho para determinar la exactitud del ultrasonido fetal (EEUU) en la predicción de la fecha estimada de parto (FEP) en una población principalmente afro-caribeña en Antigua y Barbuda. A un total de 206 mujeres, se les hizo una revisión retrospectiva de las pruebas de ultrasonido fetal, entre julio del 1994 y enero de 1996. La FEP basada en la historia menstrual (UPM) se le calculó a 104 mujeres con fechas, comparándosele luego con la FEP calculada mediante la prueba de ultrasonido. Estas fueron entonces comparadas con la fecha real de nacimiento tomada de los archivos de maternidad. Para las mujeres con datos menstruales inestables (102 mujeres), la FEP basada en ultrasonido fue comparada con la fecha real de nacimiento. La FEP basada en el ultrasonido, mostró una tendencia a ser más exacta que la FEP basada en la historia menstrual, con 10.0 + 9.4 (media + desviación estándar) días de diferencia, frente a 13.3 + 15 días, p = 0.057, (n = 104), CI: -0.1, 6.73 días. La FEP mediante ultrasonido estuvo dentro de los 10 días de parto 60% del tiempo frente al 57% en el caso de la FEP basada en historia menstrual. El error medio de estimación de la FEP fue de + 1.7 días para el ultrasonido y + 3.7 días para la historia menstrual. En mujeres sin datos de historia menstrual (n = 102), la FEP mediante ultrasonido fue igualmente exacta tanto en el segundo trimestre, 11.8 + 9.5 frente a 11.4 + 10.7 días de diferencia, (no significativo estadísticamente) y el tercer trimestre, 10.0 + 8.0 frente a 8.1 + 7.0 días de diferencia, (no significativo estadísticamente). El ultrasonido fetal es marginalmente mejor en predecir la fecha de nacimiento en comparación con el procedimiento basado en la historia mensual, pero la diferencia no justifica el uso rutinario para ese propósito. Cuando se desconoce la historia menstrual, la FEP mediante ultrasonido es tan exacta como cuando se sabe la historia mensual, lo cual la hace una prueba muy útil.

A case control study of the prevalence of perinatal complications associated with fetal macrosomia in Antigua and Barbuda

The prevalence of obstetric, perinatal and neonatal complications associated with fetal macrosomia at Holberton Hospital in Antigua and Barbuda was assessed by a retrospective, case-control study. All babies of birthweight (BW) greater than 4.5 kg born between July 1991 and January 1997 and all babies with BW greater than 4.0 kg born between July 1991 and January 1995, were included. Control babies, were selected from those born on the same day as the index case. Babies of BW > 4.0 kg and babies of BW > 4.5 kg were 5.7 and 1 of births respectively Records were complete for 157 large babies (40 with BW > 4.5 kg) and 157 control babies < 4.0 kg. Mothers of large babies were significantly older, more parous, more likely to have diabetes mellitus, hypertension, and deliver after 40 weeks gestation. At delivery, mothers of large babies were more likely to bleed. Large babies had lower one minute and five minute Apgar score, were more likely to be meconium stained, have respiratory distress, have birth trauma or dystocia and to be admitted to Special Care Nursery. There was no difference in Caesarean section rate, hospital days, neonatal jaundice or mortality. Babies with BW > 4.5 kg had mortality of 7.5 versus 1.8 for those < 4.5 kg. Fetal macrosomia remains a difficult obstetrical problem associated with significant maternal, perinatal and neonatal consequences. Morbidity and mortality are still significant in developed and developing countries alike

The spectrum of accidental childhood poisoning in the Caribbean

Objective. To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America. Design and Methods. We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. Results. In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45 percent) were in 1-year-old children, 69 (27 percent) were in 2-year-old children, and 26 (10 percent) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20 000 children below 13 years of age, for a rate of 1.3 per 1 000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. Conclusions. There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step

M-mode echocardiographic findings in a contemporary Afro-Caribbean population referred for evaluation of congestive cardiac failure

Congestive cardiac failure is emerging as a significant public health problem around the world, including the Caribbean. Recent reports from developed countries suggest that 30 to 40 of patients with congestive cardiac failure have normal systolic function. This percentage may be even higher in non-Caucasian, non-male populations. This study was undertaken to determine the M-mode echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for congestive cardiac failure. There were 165 patients, 51 male, mean and standard deviation (SD) age of 63 +/- 15 years, referred between May 1998 and June 2000. Echocardiographic findings included left atrial size (LA), left ventricular (LV) end systolic (ESD) and end diastolic dimension (EDD), LV posterior wall thickness (PWT) and ventricular septal thickness (VST). LV ejection fraction (EF) was derived. LA > 4 cm, PWT or VST > 13 mm and LVEF < 50 were considered abnormal. Increased LV wall thickness (LV hypertrophy) only was the most frequent finding, 68/165 (41), consistent with possible diastolic dysfunction. If a less restrictive definition for abnormal LV wall thickness, 12 mm, is used, this finding increases to 79/165 (48). Decreased LVEF (LV systolic dysfunction) was seen in 57/165, (35) and was seen in significantly more men (42 versus 29, p < 0.01). Valvular disease was seen in 13/165, 8. Normal findings on echocardiography were found in 27/165 (16), more commonly in women (19 versus 8, p < 0.05) and younger patients (54 years versus 65 years, p < 0.05) and in only 10 if 12 mm is used for LV wall limit. LV hypertrophy was seen in 42 of patients (61 if 12 mm is used for LV wall limit) with systolic dysfunction. Thus, congestive cardiac failure with LV hypertrophy is the most frequent finding in this Afro-Caribbean population, with LV systolic dysfunction in only 35 of patients. These findings are consistent with possible diastolic LV dysfunction due to hypertension as the primary cause of cardiac failure in the population.