Drug utilization patterns in pregnant women: a case study at the Mount Hope Women's Hospital in Trinidad, West Indies / Patrones de utilización de medicamentos en las mujeres embarazadas: un caso de estudio en el Hospital de Mujeres Mount Hope en Trinidad, West Indies

OBJECTIVE: To explore drug (prescription, over-the-counter and herbal) utilization in pregnant women attending a public sector tertiary healthcare institution. METHODS: This was a cross-sectional case study in women attending antenatal clinics at the Mount Hope Women's Hospital. Women (506) who consecutively presented for routine care at the antenatal clinic were interviewed on the medication they took. Descriptive statistics and logistic regression for predictors of drug use were done using SPSS 16. RESULTS: There were 200 (39.5%) primigravidae, 306 (60.5%) multigravidae and 299 (59%) women were in the third trimester of pregnancy. Most women (69.8%) were between 20-35 years of age. Women took an average of 1.32, 1.22 and 0.94 prescribed drugs in each trimester, respectively. Multivitamins (59.8%) and iron/folic acid (54.2%) were the most frequently prescribed drugs. Regardless of trimester, only 20% of women took supplemental calcium. Very few women (2.4%) took herbal medications. Paracetamol was the most common over-the-counter (OTC) medication in all trimesters. Women with secondary level education were most likely to use OTC iron/folic acid (p = 0.02), paracetamol and histamine2 receptor antagonists [H2RAs] (p = 0.001). More primigravidae took non-steroidal anti-inflammatory drugs (p = 0.02) and more women in the first trimester used antiemetics (p = 0.001). Age group (p = 0.048), marital status (p = 0.001) and the trimester of pregnancy (p = 0.001) were predictors of drug utilization. CONCLUSION: Overall, women in tertiary healthcare institutions took medication as prescribed particularly multivitamins and iron/folic acid. More women with higher education took OTC paracetamol, iron/folic acid and vitamin supplements. Herbal supplements were rarely used. Research on drug utilization in primary care facilities is recommended.

OBJETIVO: Explorar el uso de los medicamentos (con prescripción, sin receta médica, herbarios) en mujeres embarazadas que asisten a una institución terciaria de atención a la salud pública dentro del sector público. MÉTODOS: Se trató de un estudio transversal de mujeres que asisten a las clínicas prenatales en el Hospital de Mujeres Mount Hope. Las mujeres (506) que consecutivamente se presentaron para cuidados de rutina en la clínica prenatal, fueron entrevistadas acerca de la medicación que tomaban. Se hicieron estadísticas descriptivas y se hizo una regresión logística para los predictores del uso del medicamento usando SPSS 16. RESULTADOS: Había 200 (39.5%) primerizas, 306 (60.5%) multíparas, y 299 (59%) embarazadas en su tercer trimestre. La mayoría de las mujeres (69.8%) tenían entre 20-35 años de edad. Las mujeres tomaban un promedio de 1.32, 1.22 y 0.94 medicamentos prescritos en cada trimestre, respectivamente. Las multivitaminas (59.8%) y el hierro/ácido fólico (54.2%) fueron los medicamentos más frecuentemente prescritos. Con independencia del trimestre, sólo 20% de las mujeres tomaron suplemento de calcio. Muy pocas mujeres (2.4%) tomaban medicaciones herbarias. El paracetamol fue el medicamento sin receta más común en todos los trimestres. Las mujeres con nivel de educación secundaria presentaban una mayor probabilidad de usar hierro/ácido fólico (p = 0.02), el paracetamol y los antagonistas de los receptores de la histamina-2- [H2RAs] (p = 0.001). Un mayor número de primerizas tomaron medicamentos anti-inflamatorios no esteroideos (p = 0.02) y más mujeres en el primer trimestre usaron anti-eméticos (p = 0.001). El grupo etario (p = 0.048), el estado matrimonial (p = 0.001) y el trimestre de embarazo (p = 0.001) fueron predictores de la utilización de medicamentos. CONCLUSIÓN: En general, las mujeres en las instituciones terciarias de atención a la salud tomaron la medicación como fue prescrita, en particular las multivitaminas y el hierro/ácido fólico. Más mujeres con mayor escolaridad tomaron medicamentos sin recetas: paracetamol, hierro/ácido fólico y suplementos de vitamina. Raramente se usaron suplementos herbarios. Se recomienda la investigación del uso de medicamentos en centros de atención primaria.

Evaluation of asthma control using patient based measures and peak expiratory flow rate / Evaluación del control del asma usando medidas basadas en el paciente y tasas de flujo expiratorio máximo

OBJECTIVE: Asthma control has not been formally evaluated in the Caribbean. This study evaluated disease control on The Asthma Control Test (ACT), The Royal College of Physicians "Three questions" for Assessing Asthma Control (RCP), peak expiratory flow rate (PEFR) and patients'self-assessment of control. SUBJECTS AND METHODS: Asthma control was examined in a cross-section of 205 asthmatics above 16 years of age using the ACT, RCP and on the PEFR % predicted. Scores below 20 and equal to or above 1 on the ACT and RCP respectively, and PEFR below 80% predicted indicated uncontrolled asthma. Patients stated whether they perceived their asthma was controlled or uncontrolled. RESULTS: Overall there were more females (63.9%, p < 0.001) than males (36.1%). Males aged between 17-30 years predominated (60.8%, p < 0.001) with gender reversal beyond 30 years of age (33.2%, p < 0.002) years. Self-assessed control was higher (69.3%, p < 0.001) than control evaluated by the ACT and RCP tests, which were comparable (p > 0.05). Fewer patients (13.2%) achieved control on PEFR > 80% predicted than on the ACT (22.4%) and RCP (18%). The Kappa statistic indicated good reproducibility of the RCP and ACT and concordance between the PEFR and RCP (0.63) and the PEFR and ACT (0.56). Higher education was associated with control on the ACT (p < 0.0005) and RCP (p < 0.002) but not on PEFR or self-assessment (p > 0.05). CONCLUSION: Approximately 80% of study asthmatics were uncontrolled, and patients tended to overestimate their disease control. The ACT and RCP instruments were comparable with the PEFR. Efforts to study their validity and formal evaluation of asthma control in Trinidad are recommended.

OBJETIVO: El control del asma no ha sido evaluado formalmente en el Caribe. El estudio evaluó el control de la enfermedad utilizando el Test de Control del Asma (TCA), las "tres preguntas" del Colegio Real de Médicos para evaluar el control del asma (CRM), y la tasa de flujo expiratorio máximo (FEM) así como la autoevaluación del control por parte de los pacientes. SUJETOS Y MÉTODOS: El control del asma fue examinado en una sección transversal de 205 asmáticos de más de 16 años de edad, mediante el TCA, el CRM, y la predicción del FEM%. Las puntuaciones por debajo de 20 e iguales o por encima de 1 en el TCA y el CRM respectivamente, por debajo del 80% de predicción de la FEM, indicaban asma no controlada. Los pacientes informaban si percibían su asma como controlada o no controlada. RESULTADOS: En general hubo más (p < 0.001) mujeres (63.9%) que hombres (36.1%). Los hombres predominaron (p < 0.001) entre los 17 - 30 años (60.8%) con reversión del género (p < 0.002) pasados los 30 (33.2%) años. El control autoevaluado (69.3%) fue mayor (p < 0.001) que el control evaluado por las pruebas TCA y CRM, que fueron comparables (p > 0.05). Menos pacientes (13.2%) lograron un control con FEM > 80% de predicción que con TCA (22.4%) y CRM (18%). La estadística Kappa indicó una buena reproductibilidad de CRM y TCA, así como concordancia entre FEM y CRM (0.63) y FEM y TCA (0.56). Un nivel de educación más alto estuvo asociado con el control en TCA (p < 0.0005) y CRM (p < 0.002) pero no en FEM o autoevaluación (p > 0.05). CONCLUSIÓN: Aproximadamente el 80% de los asmáticos fueron no controlados, y los pacientes sobrestiman su control de la enfermedad. Los instrumentos TCA y CRM fueron comparables con la FEM. Se recomienda hacer esfuerzos por estudiar la validez de estos, así como la evaluación formal del control del asma en Trinidad.

Heavy metals in sediments, mussels and oysters from Trinidad and Venezuela

Abstract: The Gulf of Paria is bordered by both Trinidad and Venezuela,from which various metallic pollutants and other contaminants can originate.The Gulf is still a significant source of fish,crabs and shellfish for human consumption to both countries,where concerns over the quality of this marine environment have been long expressed but never properly addressed.In addition,the circulatory current patterns in the Gulf ensure that contaminants originating from either country are likely to affect both countries eventually.Heavy metals were determined in oysters (Crassostrea rhizophorae and C.virginica ),green mussels (Perna viridis )and sediments from the Gulf of Paria.Samples were obtained at four sites in Trinidad and three sites in Venezuela in the Gulf of Paria,in addition to comparative samples collected from three sites on the north coast of Venezuela.Edible tissues of twelve shellfish from each location were blended and aliquots digested with concentrated nitric acid, for extraction of cadmium,chromium,copper,lead,nickel and zinc.The solutions were analysed by flame atomic absorption spectroscopy.Mercury was extracted with a mixture of nitric,hydrochloric and sulphuric acids and determined by cold vapour atomic absorption.Sediments were oven-dried at 60°C, before being similarly extracted.Results showed that mercury in sediments at all sites in Trinidad and Venezuela exceeded NOAA and Canadian sediment quality guidelines,while cadmium, copper, nickel, lead and zinc also exceeded these guidelines at several sites.Heavy metal levels in oysters and green mussels varied widely with location. However,oysters from the Gulf of Paria contained significantly higher mean levels of cadmium,copper,nickel and zinc than those from the north coast of Venezuela, but this difference was not apparent in mussels.Cadmium, mercury and zinc in sediments were significantly correlated with those of mussels,but not of oysters,in which copper and zinc at several sites in the Gulf of Paria exceeded local maximum permissible levels (Cu =20 µg g-1 wet wt; Zn =50 µg g-1 wet wt)for human consumption. These findings indicate that while mussels may be better biological indicators of heavy metal pollution in sediments than oysters,the latter may provide copper and zinc contamination.Further research is needed to determine the most appropriate biological indicators of heavy metal and other pollutants in the local marine environment and to develop protocols for their use