Anthelmintic usage on the performance of the Agouti (Dasyprocta leporina) reared intensively in Trinidad and Tobago, West Indies / Uso de anti-helmíntico no desempenho da cutia (Dasyprocta leporina) criada intensivamente em Trinidad e Tobago, Índias Ocidentais

Anthelmintic drugs have been used strategically in livestock reared in the tropics. These drugs have been used in the treatment of endoparasitism which have resulted in an increase in the animals’ performance. The agouti (Dasyprocta leporina) is a neo-tropical rodent with the potential for domestication and has been farmed intensively in Trinidad. However, the objective of this research was to investigate the effect of anthelmintic use of the growth performance of the agouti. In searching the literature, it was found that this type of study on the agouti has not been done. In this experiment fourteen weaned agoutis weighing 1kg were divided into two groups randomly. The first group (T1) was not given any anthelmintic treatment but the second group (T2) was treated with Endovet Ces® subcutaneously every three months. There were no significant differences (p > 0.05) between the two groups in the carcass weight, weight gain, dressing percentage (hot and cold), heart, lungs, skin, head and feet. However, a significant difference (p < 0.05) was seen between groups in the weight of liver and pluck. To the authors knowledge this is the first time that carcass parameters has been presented in literature. The live weight of the animals at the end of the experiment ranged from 2.4 kg to 2.6 kg and animals had a dressing percentage of 57% to 55%. The results are suggestive that the use of anthelmintic drugs in agoutis reared intensively had no significant effect on weight gain and dressing percentage.

Drogas anti-helmínticas têm sido usadas estrategicamente em rebanhos criados nos trópicos. Essas drogas têm sido utilizadas no tratamento do endoparasitismo, o que resultou em um aumento no desempenho dos animais. A cutia (Dasyprocta leporina) é um roedor neotropical com potencial para domesticação e tem sido criada intensivamente em Trinidad. Porém, o objetivo desta pesquisa foi investigar o efeito do uso de anti-helmínticos no desempenho de crescimento da cutia. Através de uma busca na literatura, constatou-se que esse tipo de estudo na cutia não foi realizado. Neste experimento, quatorze cutias desmamadas pesando 1kg foram divididas em dois gruposale atoriamente. O primeiro grupo (T1) não recebeu nenhum tratamento anti-helmíntico, mas o segundo grupo (T2) foi tratado com Endovet Ces® por via subcutânea a cada três meses. Não houve diferenças significativas (p> 0,05) entre os dois grupos no peso da carcaça, ganho de peso, porcentagem de cobertura (quente e frio), coração, pulmão, pele, cabeça e pés. No entanto, uma diferença significativa (p <0,05) foi observada entre os grupos no peso do fígado e depenagem. Para os autores, esta é a primeira vez que parâmetros de carcaça são apresentados na literatura. O peso vivo dos animais ao final do experimento variou de 2,4 kg a 2,6 kg e os animais tinham uma porcentagem de curativo de 57% a 55%. Os resultados sugerem que o uso de anti-helmínticos em cutias criadas intensivamente não teve efeito significativo no ganho de peso e na porcentagem de curativo.

Teaching of Veterinary Parasitology to University students in Trinidad, West Indies: are our local wildlife species neglected? / Ensino de parasitologia veterinária para estudantes universitários em Trinidad, Índias Ocidentais: nossas espécies selvagens locais são negligenciadas?

Parasites of veterinary importance have been heavily focused on domesticated livestock that was introduced into the neo-tropics. The text used in the teaching parasitology to veterinary students in Trinidad has only investigated the parasites of domesticated species. In the reviewed veterinary parasitology text no mention was made on the parasites that affect wild neo-tropical animals. Information on wild neo-tropical animals had to be sourced from texts on the management of wild life animals in the Neotropics. The texts that were reviewed in this document spanned from the mid-1950s to 2020. The information presented in this review reveals the exhaustive work done on the parasites of domesticated species but also revealed little information on neo-tropical animals with the potential for domestication. In conclusion, this review reveals the gap of information that is missing from parasitology texts used in the teaching of veterinary students. In the future these parasitology texts can be revised to include chapters on the parasites of neo-tropical animals with the potential for domestication. At present students that graduate from the veterinary parasitology course has little information on the parasites of animals which are present in their 'backyards'.

Parasitas de importância veterinária têm se concentrado fortemente em animais domésticos que foram introduzidos na região neotrópica. O texto usado no ensino de parasitologia para estudantes de veterinária em Trinidad investigou apenas os parasitas de espécies domesticadas. No texto de parasitologia veterinária revisado, nenhuma menção foi feita sobre os parasitas que afetam os animais selvagens neotropicais. As informações sobre animais selvagens neotropicais tiveram que ser obtidas a partir de textos sobre o manejo de animais selvagens nos Neotrópicos. Os textos revisados neste documento vão de meados da década de 1950 até 2020. As informações apresentadas nesta revisão revelam o trabalho exaustivo realizado sobre os parasitas de espécies domesticadas, mas também revelaram poucas informações sobre animais neotropicais com potencial para domesticação. Em conclusão, esta revisão revela a lacuna de informação que existe nos textos de parasitologia utilizados no ensino de estudantes de veterinária. No futuro, esses textos de parasitologia podem ser revisados para incluir capítulos sobre os parasitas de animais neotropicais com potencial para domesticação. Atualmente, os alunos que se formam no curso de parasitologia veterinária têm poucas informações sobre os parasitas de animais que estão presentes em seus "quintais".

Anthelmintic usage on the performance of the Agouti (Dasyprocta leporina) reared intensively in Trinidad and Tobago, West Indies

Abstract Anthelmintic drugs have been used strategically in livestock reared in the tropics. These drugs have been used in the treatment of endoparasitism which have resulted in an increase in the animals performance. The agouti (Dasyprocta leporina) is a neo-tropical rodent with the potential for domestication and has been farmed intensively in Trinidad. However, the objective of this research was to investigate the effect of anthelmintic use of the growth performance of the agouti. In searching the literature, it was found that this type of study on the agouti has not been done. In this experiment fourteen weaned agoutis weighing 1kg were divided into two groups randomly. The first group (T1) was not given any anthelmintic treatment but the second group (T2) was treated with Endovet Ces® subcutaneously every three months. There were no significant differences (p > 0.05) between the two groups in the carcass weight, weight gain, dressing percentage (hot and cold), heart, lungs, skin, head and feet. However, a significant difference (p 0.05) was seen between groups in the weight of liver and pluck. To the authors knowledge this is the first time that carcass parameters has been presented in literature. The live weight of the animals at the end of the experiment ranged from 2.4 kg to 2.6 kg and animals had a dressing percentage of 57% to 55%. The results are suggestive that the use of anthelmintic drugs in agoutis reared intensively had no significant effect on weight gain and dressing percentage.

Resumo Drogas anti-helmínticas têm sido usadas estrategicamente em rebanhos criados nos trópicos. Essas drogas têm sido utilizadas no tratamento do endoparasitismo, o que resultou em um aumento no desempenho dos animais. A cutia (Dasyprocta leporina) é um roedor neotropical com potencial para domesticação e tem sido criada intensivamente em Trinidad. Porém, o objetivo desta pesquisa foi investigar o efeito do uso de anti-helmínticos no desempenho de crescimento da cutia. Através de uma busca na literatura, constatou-se que esse tipo de estudo na cutia não foi realizado. Neste experimento, quatorze cutias desmamadas pesando 1kg foram divididas em dois grupos aleatoriamente. O primeiro grupo (T1) não recebeu nenhum tratamento anti-helmíntico, mas o segundo grupo (T2) foi tratado com Endovet Ces® por via subcutânea a cada três meses. Não houve diferenças significativas (p> 0,05) entre os dois grupos no peso da carcaça, ganho de peso, porcentagem de cobertura (quente e frio), coração, pulmão, pele, cabeça e pés. No entanto, uma diferença significativa (p 0,05) foi observada entre os grupos no peso do fígado e depenagem. Para os autores, esta é a primeira vez que parâmetros de carcaça são apresentados na literatura. O peso vivo dos animais ao final do experimento variou de 2,4 kg a 2,6 kg e os animais tinham uma porcentagem de curativo de 57% a 55%. Os resultados sugerem que o uso de anti-helmínticos em cutias criadas intensivamente não teve efeito significativo no ganho de peso e na porcentagem de curativo.

Teaching of Veterinary Parasitology to University students in Trinidad, West Indies; are our local wildlife species neglected?

Abstract Parasites of veterinary importance have been heavily focused on domesticated livestock that was introduced into the neo-tropics. The text used in the teaching parasitology to veterinary students in Trinidad has only investigated the parasites of domesticated species. In the reviewed veterinary parasitology text no mention was made on the parasites that affect wild neo-tropical animals. Information on wild neo-tropical animals had to be sourced from texts on the management of wild life animals in the Neotropics. The texts that were reviewed in this document spanned from the mid-1950s to 2020. The information presented in this review reveals the exhaustive work done on the parasites of domesticated species but also revealed little information on neo-tropical animals with the potential for domestication. In conclusion, this review reveals the gap of information that is missing from parasitology texts used in the teaching of veterinary students. In the future these parasitology texts can be revised to include chapters on the parasites of neo-tropical animals with the potential for domestication. At present students that graduate from the veterinary parasitology course has little information on the parasites of animals which are present in their backyards.

Resumo Parasitas de importância veterinária têm se concentrado fortemente em animais domésticos que foram introduzidos na região neotrópica. O texto usado no ensino de parasitologia para estudantes de veterinária em Trinidad investigou apenas os parasitas de espécies domesticadas. No texto de parasitologia veterinária revisado, nenhuma menção foi feita sobre os parasitas que afetam os animais selvagens neotropicais. As informações sobre animais selvagens neotropicais tiveram que ser obtidas a partir de textos sobre o manejo de animais selvagens nos Neotrópicos. Os textos revisados neste documento vão de meados da década de 1950 até 2020. As informações apresentadas nesta revisão revelam o trabalho exaustivo realizado sobre os parasitas de espécies domesticadas, mas também revelaram poucas informações sobre animais neotropicais com potencial para domesticação. Em conclusão, esta revisão revela a lacuna de informação que existe nos textos de parasitologia utilizados no ensino de estudantes de veterinária. No futuro, esses textos de parasitologia podem ser revisados para incluir capítulos sobre os parasitas de animais neotropicais com potencial para domesticação. Atualmente, os alunos que se formam no curso de parasitologia veterinária têm poucas informações sobre os parasitas de animais que estão presentes em seus quintais.

Anthelmintic usage on the performance of the Agouti (Dasyprocta leporina) reared intensively in Trinidad and Tobago, West Indies / Uso de anti-helmíntico no desempenho da cutia (Dasyprocta leporina) criada intensivamente em Trinidad e Tobago, Índias Ocidentais

Abstract Anthelmintic drugs have been used strategically in livestock reared in the tropics. These drugs have been used in the treatment of endoparasitism which have resulted in an increase in the animals' performance. The agouti (Dasyprocta leporina) is a neo-tropical rodent with the potential for domestication and has been farmed intensively in Trinidad. However, the objective of this research was to investigate the effect of anthelmintic use of the growth performance of the agouti. In searching the literature, it was found that this type of study on the agouti has not been done. In this experiment fourteen weaned agoutis weighing 1kg were divided into two groups randomly. The first group (T1) was not given any anthelmintic treatment but the second group (T2) was treated with Endovet Ces® subcutaneously every three months. There were no significant differences (p > 0.05) between the two groups in the carcass weight, weight gain, dressing percentage (hot and cold), heart, lungs, skin, head and feet. However, a significant difference (p < 0.05) was seen between groups in the weight of liver and pluck. To the authors knowledge this is the first time that carcass parameters has been presented in literature. The live weight of the animals at the end of the experiment ranged from 2.4 kg to 2.6 kg and animals had a dressing percentage of 57% to 55%. The results are suggestive that the use of anthelmintic drugs in agoutis reared intensively had no significant effect on weight gain and dressing percentage.

Resumo Drogas anti-helmínticas têm sido usadas estrategicamente em rebanhos criados nos trópicos. Essas drogas têm sido utilizadas no tratamento do endoparasitismo, o que resultou em um aumento no desempenho dos animais. A cutia (Dasyprocta leporina) é um roedor neotropical com potencial para domesticação e tem sido criada intensivamente em Trinidad. Porém, o objetivo desta pesquisa foi investigar o efeito do uso de anti-helmínticos no desempenho de crescimento da cutia. Através de uma busca na literatura, constatou-se que esse tipo de estudo na cutia não foi realizado. Neste experimento, quatorze cutias desmamadas pesando 1kg foram divididas em dois grupos aleatoriamente. O primeiro grupo (T1) não recebeu nenhum tratamento anti-helmíntico, mas o segundo grupo (T2) foi tratado com Endovet Ces® por via subcutânea a cada três meses. Não houve diferenças significativas (p> 0,05) entre os dois grupos no peso da carcaça, ganho de peso, porcentagem de cobertura (quente e frio), coração, pulmão, pele, cabeça e pés. No entanto, uma diferença significativa (p <0,05) foi observada entre os grupos no peso do fígado e depenagem. Para os autores, esta é a primeira vez que parâmetros de carcaça são apresentados na literatura. O peso vivo dos animais ao final do experimento variou de 2,4 kg a 2,6 kg e os animais tinham uma porcentagem de curativo de 57% a 55%. Os resultados sugerem que o uso de anti-helmínticos em cutias criadas intensivamente não teve efeito significativo no ganho de peso e na porcentagem de curativo.

Teaching of Veterinary Parasitology to University students in Trinidad, West Indies; are our local wildlife species neglected? / Ensino de parasitologia veterinária para estudantes universitários em Trinidad, Índias Ocidentais; nossas espécies selvagens locais são negligenciadas?

Abstract Parasites of veterinary importance have been heavily focused on domesticated livestock that was introduced into the neo-tropics. The text used in the teaching parasitology to veterinary students in Trinidad has only investigated the parasites of domesticated species. In the reviewed veterinary parasitology text no mention was made on the parasites that affect wild neo-tropical animals. Information on wild neo-tropical animals had to be sourced from texts on the management of wild life animals in the Neotropics. The texts that were reviewed in this document spanned from the mid-1950s to 2020. The information presented in this review reveals the exhaustive work done on the parasites of domesticated species but also revealed little information on neo-tropical animals with the potential for domestication. In conclusion, this review reveals the gap of information that is missing from parasitology texts used in the teaching of veterinary students. In the future these parasitology texts can be revised to include chapters on the parasites of neo-tropical animals with the potential for domestication. At present students that graduate from the veterinary parasitology course has little information on the parasites of animals which are present in their 'backyards'.

Resumo Parasitas de importância veterinária têm se concentrado fortemente em animais domésticos que foram introduzidos na região neotrópica. O texto usado no ensino de parasitologia para estudantes de veterinária em Trinidad investigou apenas os parasitas de espécies domesticadas. No texto de parasitologia veterinária revisado, nenhuma menção foi feita sobre os parasitas que afetam os animais selvagens neotropicais. As informações sobre animais selvagens neotropicais tiveram que ser obtidas a partir de textos sobre o manejo de animais selvagens nos Neotrópicos. Os textos revisados neste documento vão de meados da década de 1950 até 2020. As informações apresentadas nesta revisão revelam o trabalho exaustivo realizado sobre os parasitas de espécies domesticadas, mas também revelaram poucas informações sobre animais neotropicais com potencial para domesticação. Em conclusão, esta revisão revela a lacuna de informação que existe nos textos de parasitologia utilizados no ensino de estudantes de veterinária. No futuro, esses textos de parasitologia podem ser revisados ​​para incluir capítulos sobre os parasitas de animais neotropicais com potencial para domesticação. Atualmente, os alunos que se formam no curso de parasitologia veterinária têm poucas informações sobre os parasitas de animais que estão presentes em seus "quintais".

Improving cardiovascular health with the patient-centered, integrated primary care HEARTS model in Trinidad and Tobago / Mejorar la salud cardiovascular con HEARTS, un modelo integrado de atención primaria centrado en el paciente, en Trinidad y Tabago / Melhoria da saúde cardiovascular com o modelo HEARTS de atenção primária integrada e centrada no paciente em Trinidad e Tobago

ABSTRACT This article describes the introduction of the Pan American Health Organization's HEARTS in the Americas program in Trinidad and Tobago and the successful experiences and challenges encountered in introducing and scaling it up as a strategy for strengthening the health system's response to cardiovascular diseases. Evidence about implementation of the HEARTS program in the World Health Organization's Region of the Americas was reviewed to identify the progress made, barriers, success factors and lessons learned. In 2019, the Ministry of Health commenced implementation of the program in 5 (4.9%) of the 102 primary health care centers, and by the end of 2021, it had been scaled up to 46 (45.0%) centers. The HEARTS program ensures that patients' cardiovascular health is managed in a comprehensive way through providing counseling about a healthy lifestyle, using evidence-based treatment protocols, ensuring access to essential medicines and technologies, and using a risk-based team approach, a monitoring and evaluation system and also a team-based approach to care delivery. The barriers encountered during implementation included the fragmentation of the existing health care system, the paternalistic role assumed by health care professionals, the resistance of some health care workers to change and a lack of team-based approaches to providing care. Successful implementation of the program was enabled through ensuring high-level political commitment, establishing the national HEARTS Oversight Committee, ensuring stakeholder involvement throughout all phases and implementing standardized approaches to care. When implemented in the context of existing primary health care settings, the HEARTS program provides an exceptionally well integrated and comprehensive model of care that embodies the principles of universal health care while ensuring the health of both populations and individuals. Thus, it enables and promotes a strengthened primary health care system and services that are responsive and resilient.

RESUMEN En este artículo se describe la introducción del programa HEARTS en las Américas de la Organización Panamericana de la Salud en Trinidad y Tabago y las experiencias satisfactorias y los desafíos encontrados con su ejecución y ampliación como estrategia para fortalecer la respuesta del sistema de salud a las enfermedades cardiovasculares. Se reunieron datos sobre la ejecución del programa HEARTS en la Región de las Américas de la Organización Mundial de la Salud con el fin de determinar cuáles han sido los avances, los obstáculos, los factores de éxito y las enseñanzas extraídas. En el año 2019, el Ministerio de Salud inició la ejecución del programa en cinco (4,9%) de los 102 centros de atención primaria de salud, y para fines del 2021, se había ampliado a 46 (45,0%). El programa HEARTS garantiza el manejo integral de la salud cardiovascular de los pacientes mediante la prestación de asesoramiento sobre hábitos saludables, la aplicación de protocolos de tratamiento basados en la evidencia, la garantía de acceso a medicamentos y tecnologías esenciales, así como el uso de un enfoque de trabajo en equipo basado en el riesgo, un sistema de monitoreo y evaluación, y un enfoque basado en el equipo para abordar la prestación de la atención. Entre los obstáculos para su ejecución se encontraron la fragmentación del sistema de atención médica, el papel paternalista asumido por los profesionales de la salud, la resistencia al cambio de algunos trabajadores de salud y la falta de enfoques de trabajo en equipo para la prestación de la atención. La ejecución satisfactoria del programa fue posible gracias a un compromiso político de alto nivel, la creación de un comité nacional de supervisión de HEARTS, la participación de las partes interesadas en todas las fases del programa y la aplicación de enfoques estandarizados para la atención. En su ejecución en el contexto de los entornos de atención primaria de salud existentes, el programa HEARTS proporciona un modelo de atención excepcionalmente bien integrado y exhaustivo que encarna los principios de acceso universal a la atención de salud al tiempo que garantiza la salud individual y poblacional. De este modo, este modelo fomenta un sistema de atención primaria de salud fortalecido y unos servicios receptivos y resilientes.

RESUMO Este artigo descreve a introdução do programa HEARTS nas Américas da Organização Pan-Americana da Saúde em Trinidad e Tobago e as experiências bem-sucedidas e os desafios encontrados durante a introdução e expansão do programa como estratégia para fortalecer a resposta do sistema de saúde às doenças cardiovasculares. Analisaram-se evidências sobre a implementação do programa HEARTS na Região das Américas da Organização Mundial da Saúde para identificar os avanços obtidos, os obstáculos, os fatores de sucesso e as lições aprendidas. Em 2019, o Ministério da Saúde iniciou a implementação do programa em 5 (4,9%) dos 102 centros de atenção primária à saúde; no final de 2021, o programa havia sido ampliado para 46 (45,0%) centros. O programa HEARTS assegura que a saúde cardiovascular dos pacientes seja manejada de uma forma abrangente por meio de aconselhamento sobre estilo de vida saudável, uso de protocolos de tratamento baseados em evidências, garantia de acesso a medicamentos e tecnologias essenciais e utilização de uma estratégia de equipe baseada no risco, de um sistema de monitoramento e avaliação e de uma abordagem de atendimento baseado em equipe. Os obstáculos encontrados durante a implementação incluíam a fragmentação do sistema de saúde existente, o papel paternalista assumido pelos profissionais de saúde, a resistência de alguns profissionais de saúde a mudanças e a falta de abordagens baseadas em equipe na prestação do atendimento. Para permitir que a implementação do programa fosse bem-sucedida, obteve-se compromisso político de alto nível, criou-se o Comitê de Supervisão do HEARTS nacional, assegurou-se o envolvimento de interessados diretos em todas as fases e implementaram-se abordagens padronizadas de atendimento. Quando implementado no contexto dos ambientes existentes de atenção primária à saúde, o programa HEARTS oferece um modelo de atenção excepcionalmente bem integrado e abrangente que incorpora os princípios de atenção universal à saúde, ao mesmo tempo em que garante a saúde das populações e dos indivíduos. Dessa forma, viabiliza e promove um sistema de atenção primária à saúde fortalecido e serviços responsivos e resilientes.

Burden of Palliative Care in a Public General Hospital Setting

ABSTRACT Objective: The number of palliative care patients in Trinidad and Tobago is unknown. The purpose of this study is to estimate the prevalence of palliative care patients on a public general medical ward. Methods: A retrospective cross-sectional study was undertaken to collect information on patients' diagnoses, symptoms and Palliative Performance Scale (PPS) scores. Patients who would benefit from palliative care services and satisfied inclusion criteria were referred to as palliative-care-appropriate patients. Results: The one-month prevalence of palliative-care-appropriate patients was found to be 23.47% on an acute medical ward of a public hospital. Most of these patients had diagnoses that were either neurologic or cardiac in nature. Pain (46.8%) and dyspnoea (51.1%) were the most common symptoms documented for palliative-care-appropriate patients. Seven (14.95%) palliative-care-appropriate patients died while in hospital. Conclusion: There is a significant palliative care burden in this pilot study as evidenced by the high prevalence of palliative-care-appropriate patients on a general medicine ward. A larger prospective study should be undertaken to elucidate the number of patients who could benefit from hospice and palliative care services. Palliative performance scale scores may be considered for more widespread use in the Caribbean.

What Are the Roles of Carbapenems in an Institution-specific Epidemiological Antibiogram in East Trinidad?

ABSTRACT Objective: To provide an overview of the development of an institution-specific epidemiological antibiogram. Emphasis was on last-line antibiotics, such as carbapenems. Methods: In 2013, the antibiograms of various organisms were retrieved from the computerized database of the Microscan (Siemens Healthcare) at the Microbiology Laboratory of the Sangre Grande Hospital in East Trinidad, West Indies. These were divided into blood and urine specimen antibiograms. All the wards and hospital clinics were included. A 20% cut-off was used to determine that a particular antibiotic or antibiotic class could be used for empiric therapy. All the organisms were not chosen. Only the most common and clinically relevant organisms were chosen. Results: Blood: Escherichia coli, Klebsiella pneumonia, Proteus mirabilis: Imipenem, mero- penem, ertapenem showed greater than 80% sensitivity, respectively. Pseudomonas aeruginosa: ceftazidime, ciprofloxacin, gentamicin, levofloxacin and tazobactam/piperacillin showed 100%, 80%, 80%, 100% and 100% sensitivity, respectively. Urines: E. coli, Klebsiella pneumonia, Proteus mirabilis: Imipenem, meropenem, ertapenem, were greater than 80% sensitive. Enterobacter cloacae: Imipenem, meropenem were 92%, 100% sensitive. Pseudomonas aeruginosa: tazobactam-piperacillin and amikacin were both 85% susceptible. Acinetobacter baumanii/haemolyticus: All the antibiotics were above the 20% resistance threshold. Conclusion: Patient-specific antibiograms and unit-specific trends (eg, ICU, surgical wards and outpatient clinic) can be used as a guide in patients with less severe infections. Carbapenems can still be used empirically, in East Trinidad, for sepsis.

Understanding of Human Papilloma Virus Vaccine Receipt among Adolescents in Trinidad and Tobago / Comprensión del Recibo de la Vacuna Contra el VPH entre los Adolescentes en Trinidad y Tobago

ABSTRACT Objective: To understand the barriers or factors that may hinder receipt of the human papilloma virus (HPV) among adolescent girls, 14-18 years old, and evaluate the awareness level about HPV and the HPV vaccine acceptance. Methods: A questionnaire consisting of two parts, demographic and family history of cervical cancer, and a cluster of questions about HPV, was distributed to 651 female adolescents in 17 secondary schools in Trinidad and Tobago to determine knowledge, attitude, and awareness levels pertaining to HPV and acceptance of the HPV vaccine. Chi-square tests and logistic regressions were used. Results: Of the 651 students completing questionnaires, the majority (61%) were in the 15-16 age group; and 76% were either of African descent or multi-racial. There were significant associations between a family member having a diagnosis of cervical cancer and knowledge that cervical cancer is caused by the HPV virus, that the virus is spread sexually, and the likelihood of getting cervical cancer in the future (p = < 0.05). However, the majority (63%) did not know that cervical cancer is caused by the HPV virus or that the virus was spread sexually. Conclusion: Lack of knowledge of the HPV vaccine was seen among adolescents from each school. There is need for education on cervical cancer and its causes, and the HPV virus.

RESUMEN Objetivo: Entender las barreras o factores que pueden obstaculizar la recepción del virus del papiloma humano (VPH) entre las adolescentes, de 14-18 años, y evaluar el nivel de concientización sobre el VPH y la aceptación de la vacuna contra el VPH. Métodos: Un cuestionario de dos partes -antecedentes demográficos e historia familiar de cáncer cervicouterino--, y un grupo de preguntas sobre el VPH, fueron distribuidos entre 651 adolescentes femeninas en 17 escuelas secundarias de Trinidad y Tobago para determinar los niveles de conocimiento, actitud y concientización relacionados con el VPH y la aceptación de la vacuna contra el VPH. Se utilizaron pruebas de Chi-cuadrada y regresiones logísticas. Resultados: De las 651 estudiantes que respondieron los cuestionarios, la mayoría (61%) estaban en el grupo de edad de 15-16 años; y el 76% eran de ascendencia africana o multirracial. Hubo asociaciones significativas entre un miembro de la familia con diagnóstico de cáncer cervical y el conocimiento de que el cáncer cervical es causado por el virus del VPH, que el virus se propaga sexualmente, y que existe la probabilidad de contraer cáncer cervical en el futuro (p = < 0.05). Sin embargo, la mayoría (63%) no sabía que ese tipo de cáncer es causado por el virus VPH, ni que el virus se propaga sexualmente. Conclusión: Se observó falta de conocimiento de la vacuna contra el VPH entre las adolescentes de cada escuela. Hay necesidad de educación sobre el cáncer cervical y sus causas, y el virus del VPH.

A morte e a ressurreição do Messias: A Sombra, o Mal e o Anticristo. Um estudo da função ética, pela Psicologia Simbólica Junguiana / The death and resurrection of the Messiah: The Shadow, the Evil and the Antichrist. A study of the ethical function, by Jungian Symbolic Psychology / La muerte y la resurrección del Mesías: La Sombra, el Mal y el Anticristo. Un estudio de la función ética, por la Psicología Simbólica Junguiana

O artigo conceitua o Arquétipo da Sombra como o Arquétipo do Mal na Psicologia Simbólica Junguiana e busca integrá-lo como expressão do Arquétipo Central, ao lado do Arquétipo do Bem. A interpretação de Jung da limitação da imagem de Jeovah na relação com Job é aqui continuada com o reconhecimento do sadismo do Deus patriarcal, que necessita do filicídio sacrificial para transformar-se no Deus da compaixão e do entendimento, pois só assim se tornará a Trindade e expressará o Arquétipo da Alteridade. Em conclusão, o autor segue Jung na interpretação do Apoccomo a Sombra do Novo Testamento e chama a atenção para o texto ser escrito em nome de Jesus, o que sugere a integração do símbolo do Anticristo no mito, como a Sombra de Jesus. ■

The article conceives the archetype of shadow as the archetype of evil in Jungian Symbolic Psychology and tries to interpret it as an expression of the central archetype (Self) side by side with the archetype of good. Jung's interpretation of Jehovah's limitation in the relationship with Job is followed by the recognition of the patriarchal sadism within the Godhead which needs the sacrifice of the Son to be transformed in the God of compassion and understanding because only so will it become the Trinity capable of expressing the archetype of alterity. In conclusion, the author follows Jung in the interpretation of the Apocalypse as the shadow of the New Testament and calls attention for Jesus' shadow expressed in His name as symbol of the integration of the Anti-Christ in the myth. ■

El artículo conceptualiza el Arquetipo de la Sombra como el Arquetipo del Mal en la Psicología Simbólica Junguiana y busca integrarlo como expresión del Arquetipo Central, al lado del Arquetipo del Bien. La interpretación de Jung de la limitación de la imagen de Jeovah en la relación con Job es aquí continuada con el reconocimiento del sadismo del Dios patriarcal, que necesita del filicidio sacrificial para transformarse en el Dios de la compasión y del entendimiento, pues sólo así se convertirá en la Trinidad y expresará el Arquetipo de la Alteridad. En conclusión, el autor sigue a Jung en la interpretación del Apocalipsis como la Sombra del Nuevo Testamento y llama la atención sobre el texto ser escrito en el nombre de Jesús, lo que sugiere la integración del símbolo del Anticristo en el mito, como la Sombra de Jesús. ■

Screening for Non-communicable Diseases at a Walk-in Clinic in Trinidad and Tobago: A Time-motion Cross-sectional Study and Net Present Value Analysis / Pruebas de detección de enfermedades no transmisibles en una clínica ambulatoria de Trinidad y Tobago: estudio transversal de tiempos y movimientos y análisis del valor actual neto

ABSTRACT Objective: To determine the feasibility of recommending a screening process for non-communicable diseases (NCDs) and their risk factors, as a national and regional model. Methods: A cross-sectional, six-station process was carried out. It consisted of invitation and consent, history (personal and family history of NCDs), biometrics (waist circumference and body mass index), blood levels (lipids and glycosylated haemoglobin) and urinalysis (microalbuminuria), basic examinations (blood pressure, peripheral neuropathy, presence of acanthosis nigricans and visual acuity), and an exit interview. Net present value (NPV) calculations were carried out for very high-risk patients (those with a > 30% risk of a cardiovascular event (limb amputation) in the next 10 years) for two discount rates: 0.75% (United States of America) and 3.4% (Trinidad and Tobago). Results: A convenience sample of 514 walk-in patients (56.2% recruitment rate) was screened (about 23 patients per day). The median time for a patient attending all stations was 21 minutes (range: 11-59 minutes). Of the six stations, the laboratory took the longest: median 10 minutes (range: 2-50 minutes). The entire project cost US$20 439 (US$39.76 per patient). Between one and seven very high-risk patients (three sub-groups of patients had this risk profile) were identified. The cost of identifying a very high-risk patient ranged from US$2907 to US$20 349. The NPV of identifying these high-risk patients ranged from -US$6748.71 to US$14 725 and was favourable for three of four monetary scenarios. Conclusion: A six-station process to provide rapid screening of walk-in patients for NCDs was found to be feasible and provided monetary value in three of four scenarios in a Trinidad and Tobago setting.

RESUMEN Objetivo: Determinar la viabilidad de recomendar un proceso de cribado de las enfermedades no transmisibles (ENT) y sus factores de riesgo, como modelo nacional y regional. Métodos: Se realizó un proceso transversal de seis estaciones. El mismo consistió en invitación y consentimiento; historia (antecedentes personales y familiares de ENT); biometría (circunferencia de la cintura e índice de masa corporal); niveles sanguíneos (lípidos y hemoglobina glicosilada); y análisis de orina (microalbuminuria); exámenes básicos (presión arterial, neuropatía periférica, presencia de acantosis nigricans y agudeza visual); y una entrevista de salida. Se realizaron cálculos del valor actual neto (VAN) para pacientes de muy alto riesgo - pacientes con riesgo de un 30% de evento cardiovascular (amputación de extremidades) en los próximos 10 años - para dos tasas de descuento: 0.75% (Estados Unidos de América) y 3.4% (Trinidad y Tobago). Resultados: Una muestra de conveniencia de 514 pacientes ambulatorios (tasa de reclutamiento de 56.2%) fue sometida a pruebas de detección (unos 23 pacientes por día). El tiempo promedio para que un paciente asistiera a todas las estaciones fue de 21 minutos (rango: 11-59 minutos). De las seis estaciones, el laboratorio tomó el tiempo más largo: un promedio de 10 minutos (rango: 2-50 minutos). El proyecto entero costó $20 439 USD (39.76 USD por paciente). Entre uno y siete pacientes de muy alto riesgo (tres subgrupos de pacientes tenían este perfil de riesgo) fueron identificados. El costo de identificar a un paciente de muy alto riesgo osciló entre $2907 USD y $20 349 USD. El VAN de identificación de estos pacientes de alto riesgo fluctuó de $6748.71 a $14 725 USD, y fue favorable para tres de cuatro escenarios monetarios. Conclusión: Se halló que un proceso de seis estaciones para pruebas de detección rápidas de ENT a pacientes ambulatorios, es factible y proporciona valor monetario en tres de cuatro escenarios en un contexto de Trinidad y Tobago.

Prolonged Zika virus viremia in a patient with Guillain-Barré syndrome in Trinidad and Tobago / Viremia prolongada por el virus del Zika en un paciente con síndrome de Guillain-Barré en Trinidad y Tabago / Viremia prolongada do vírus zika em paciente com síndrome de Guillain-Barré em Trinidad e Tobago

ABSTRACT An emerging mosquito-borne flavivirus, Zika virus (ZIKV) is a significant public health concern because of the syndromes associated with the infection. In addition, ZIKV is considered a major problem due to large-scale spread of the disease and the possible clinical complications for the central nervous system, especially Guillain-Barré syndrome (GBS) and microcephaly. Since the introduction of ZIKV in the Caribbean, molecular detection of the viral RNA has been utilized as a more specific and sensitive approach to demonstrating acute infection. However, it is generally accepted that the virus has a short viremic period, generally less than 5 days. Serologic testing has the inconvenience of strong cross-reactivity among flaviviruses, such as dengue and yellow fever. As part of the laboratory surveillance activities for Zika and other arboviruses at the Caribbean Public Health Agency, in 2016 a sample from a male who was clinically diagnosed with GBS tested positive for Zika virus by real-time polymerase chain reaction (rRT-PCR). The serum sample had been taken on day 21 after the onset of symptoms. The case had initially been characterized as a typical ZIKV infection (mild fever with a generalized maculopapular rash). Later, weakness of limbs and other peripheral neurological symptoms appeared. Enzyme-linked immunoassay (ELISA) showed that the sample was negative for IgM antibodies against Zika, Chikungunya, and dengue viruses. The plaque reduction neutralization test was positive for ZIKV. This indicated parallel development of viremia and immune response against ZIKV. Recent reports have demonstrated a longer duration of the viremia in ZIKV infections. However, our report is the first one that links the infection with extended viremia and the development in parallel of a GBS case.(AU)

RESUMEN El virus del Zika (ZIKV), un flavivirus emergente transmitido por mosquitos, es una inquietud importante en el ámbito de la salud pública por los síndromes asociados con la infección. Además, el ZIKV se considera un problema acuciante debido a la propagación a gran escala de la enfermedad y a las posibles complicaciones clínicas en el sistema nervioso central, en concreto, el síndrome de Guillain-Barré y la microcefalia. Desde que el ZIKV se introdujera en el Caribe, la detección molecular del ARN viral ha sido el método más específico y sensible utilizado para comprobar una infección aguda. Sin embargo, se cree que el virus tiene un período virémico corto, de menos de 5 días en general. La prueba serológica presenta el inconveniente de la fuerte reactividad cruzada entre los flavivirus, como el dengue y la fiebre amarilla. Como parte de las actividades de vigilancia de laboratorio para el Zika y otros arbovirus del Agencia Caribena de Salud Publica, en el 2016 la muestra de un hombre diagnosticado con la enfermedad de Guillain Barré dio positiva para el virus del Zika por medio de una reacción en cadena de la polimerasa en tiempo real (rRT-RCP). La muestra de suero se había tomado en el día 21 después de la aparición de los síntomas. En un principio, el caso se calificó como una infección por ZIKV típica (fiebre leve con una erupción maculopapular generalizada). Posteriormente, apareció la debilidad de los miembros y otros síntomas neurológicos periféricos. La prueba de inmunoadsorción enzimática (ELISA) fue negativa para los anticuerpos de tipo IgM contra los virus del Zika, el chikunguña y el dengue. La prueba de neutralización por reducción del número de placas dio positivo para el ZIKV, lo que probó que paralelamente se había desarrollado una respuesta virémica e inmune contra el ZIKV. En informes recientes se ha demostrado que en las infecciones de ZIKV el periodo virémico es más largo. Sin embargo, nuestro informe es de los primeros que relaciona un periodo virémico prolongado con el desarrollo paralelo del síndrome de Guillain-Barré.(AU)

RESUMO O vírus zika é um flavivírus emergente transmitido por mosquitos e tem sido motivo de grande preocupação em saúde pública por causa das síndromes associadas à infecção. É também considerado um importante problema devido à propagação em grande escala e possíveis complicações clínicas no sistema nervoso central decorrentes da infecção, sobretudo síndrome de Guillain-Barré e microcefalia. Desde a introdução do vírus zika no Caribe, a detecção molecular do RNA viral tem sido usada como método mais específico e sensível para demonstrar infecção aguda. Porém, admite-se em geral que o vírus tem um curto período virêmico, inferior a 5 dias. O teste sorológico tem o inconveniente de produzir intensa reação cruzada com outros flavivírus, como os vírus da dengue e febre amarela. Como parte da vigilância laboratorial do vírus zika e outros arbovírus pela Agência de Saúde Pública do Caribe, em 2016, foi examinada uma amostra de um paciente do sexo masculino com diagnóstico clínico de síndrome de Guillain-Barré e o resultado foi positivo para o vírus zika com a técnica de reação em cadeia da polimerase em tempo real. A amostra sérica havia sido coletada no dia 21 após o início dos sintomas. O caso foi inicialmente descrito como infecção típica pelo vírus zika (febre baixa com erupção cutânea maculopapular generalizada) e, posteriormente, o paciente apresentou fraqueza dos membros e outros sintomas neurológicos periféricos. A amostra foi testada com a técnica de imunoensaio enzimático (ELISA) e foi negativa para anticorpos da classe IgM contra o zika vírus, vírus chikungunya e vírus da dengue. O teste de neutralização por redução de placas foi positivo para o vírus zika, indicando aumento em paralelo da viremia e resposta imunológica ao vírus. Informes recentes têm demonstrado viremia de duração mais prolongada em infecções por vírus zika. Porém, este é o primeiro relato que associa a infecção com viremia prolongada ao surgimento em paralelo da síndrome de Guillain-Barré.(AU)

Yeast-generated CO2:A convenient source of carbon dioxide for mosquito trapping using the BG-Sentinel?traps

Objectives: To evaluates carbon dioxide (CO2) production from yeast/sugar mixtures and its efficiency as an attractant in BG-Sentinel traps. Methods: The rate of CO2production was optimized for different yeast/sugar mixtures. The optimized mixture was then used as bait in BG-Sentinel traps.The efficiency of this bait was then compared to octenol baited traps. Results: The yeast/sugar(5 g:280 g)in 300 mL water generated the highest volume of CO2. The CO2baited traps caught significantly more mosquitoes than octenol baited traps. Conclusions: Yeast-produced CO2can effectively replace octenol baits in BG traps. This will significantly reduce costs and allow sustainable mass-application of the CO2 baited traps in large scale surveillance programs.

Yeast-generated CO

Objectives To evaluates carbon dioxide (CO

Barriers and facilitators to establishing a national public health observatory / Barreras y facilitadores para el establecimiento de un observatorio de salud pública nacional

OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

OBJETIVO:Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. MÉTODOS: Se realizó un estudio descriptivo basado en 15 entrevistas a informantes clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. RESULTADOS: La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. CONCLUSIONES: Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.

Building capacity for human genetics and genomics research in Trinidad and Tobago / Aumento de la capacidad de investigación en genética y genómica humanas en Trinidad y Tabago

Advances in human genetics and genomic sciences and the corresponding explosion of biomedical technologies have deepened current understanding of human health and revolutionized medicine. In developed nations, this has led to marked improvements in disease risk stratification and diagnosis. These advances have also led to targeted intervention strategies aimed at promoting disease prevention, prolonging disease onset, and mitigating symptoms, as in the well-known case of breast cancer and the BRCA1 gene. In contrast, in the developing nation of Trinidad and Tobago, this scientific revolution has not translated into the development and application of effective genomics-based interventions for improving public health. While the reasons for this are multifactorial, the underlying basis may be rooted in the lack of pertinence of internationally driven genomics research to the local public health needs in the country, as well as a lack of relevance of internationally conducted genetics research to the genetic and environmental contexts of the population. Indeed, if Trinidad and Tobago is able to harness substantial public health benefit from genetics/genomics research, then there is a dire need, in the near future, to build local capacity for the conduct and translation of such research. Specifically, it is essential to establish a national human genetics/genomics research agenda in order to build sustainable human capacity through education and knowledge transfer and to generate public policies that will provide the basis for the creation of a mutually beneficial framework (including partnerships with more developed nations) that is informed by public health needs and contextual realities of the nation.

Los avances en materia de ciencias genéticas y genómicas humanas y la correspondiente expansión de las tecnologías biomédicas han ampliado la comprensión actual de la salud humana y han revolucionado la medicina. En las naciones desarrolladas, ello ha conducido a intensas mejoras en la estratificación del riesgo y el diagnóstico de las enfermedades. Estos avances también han conducido a estrategias de intervención dirigidas a promover la prevención de las enfermedades, retardar su aparición, y atenuar sus síntomas, como en el caso del cáncer de mama y el gen BRCA1. Por el contrario, en Trinidad y Tabago, nación en desarrollo, esta revolución científica no se ha traducido en la elaboración y aplicación de intervenciones eficaces basadas en la genómica para mejorar la salud pública. Aunque las razones de ello son multifactoriales, el motivo subyacente puede radicar en la falta de adecuación de la investigación genómica a escala internacional a las necesidades locales de salud pública del país, así como a la escasa relevancia de la investigación en genética realizada internacionalmente para los contextos genéticos y ambientales de la población. En efecto, para que Trinidad y Tabago pueda aprovechar los sustanciales beneficios en materia de salud pública de la investigación en genética y genómica, es extremadamente necesario, en un futuro próximo, desarrollar la capacidad local para la realización y traducción de ese tipo de investigación. En concreto, es esencial establecer un programa nacional de investigación en genética y genómica humanas con objeto de desarrollar una capacidad humana sostenible mediante la educación y la transferencia de conocimientos, y generar políticas públicas que proporcionen la base para la creación de un marco mutuamente beneficioso (incluidas las alianzas con naciones más desarrolladas) fundamentado en las necesidades de salud pública y en las realidades contextuales del país.

Epidemiology of Diabetes Mellitus and Molecular Characterization of Bacterial Isolates Recovered from Cases with Asymptomatic Bacteriauria in Trinidad and Tobago.

Aims: To highlight the observed features including socio-demographic, economic and biochemical characteristics seen among uncontrolled diabetic adults that should be areas of concern or focus by healthcare providers during the management of diabetes in the country. Also to perform molecular characterization of bacterial organisms prevalent among a cross section of diabetic patients with asymptomatic bacteriauria. Study Design: This was a cross sectional prospective and descriptive study. Place and Duration of Study: Study was carried out among patients attending two noncommunicable chronic diseases health centers in Trinidad & Tobago over a 6 months period in 2012. Methodology: Following informed consent, diabetic volunteers were recruited to participate in the study. Participants fulfilled study criteria that included absence of urinary symptoms, not catheterized, no history of UTI or any form of uropathy. Blood samples were screened for Hb1Ac, serum electrolytes and urea values; urine for microscopy, culture and sensitivity. Enterobacteriaceae isolates from urine culture were subjected to screening for CTX-M, TEM, and SHV by amplification of gene fragments by conventional PCR and for KPC, and NDM and OXA48 targets by real-time PCR using Sybergreen melting curve analysis. Results: Four hundred and fourteen diabetics were surveyed. Significant (15.7%; 65/414) bacteriauria was noted in sixty five subjects. Majority, 81.5% (53/65) with positive urine cultures had high HBA1c values. Escherichia coli 48.57% (34/70) and Klebsiella pneumonia 25.7% (18/70) were the most recovered organisms, with 87.1% (61/70) from urine samples and 75.4% (49/65) from female subjects. Urine samples from males 24.6% (16/65) yielded mostly Staphylococcus epidermidis 14.3% (10/7) and Staphylococcus aureus 5.7% (4/70) respectively. All Enterobacteriaceae isolates were negative for KPC, NDM and OXA-48. Although the blaTEM and bla SHV were detected in both the E. coli and K. pneumoniae isolates as expected. Conclusion: Escherichia coli was the prevalent Enterobacteriaceae among the patients with asymptomatic bacteriauria. Poor diabetic control is significantly and strongly associated with bacteriauria that was more prevalent among female diabetics. Although none of the antimicrobial resistant targets were encountered among the Enterobacteriaceae, there is still the need to keep an eye on these targets and diabetic subjects in the country.

Burden and Impact of Acute Gastroenteritis and Foodborne Pathogens in Trinidad and Tobago.

Objectives of this study were to determine the burden and impact of acute gastroenteritis (AGE) and foodborne pathogens in Trinidad and Tobago. A retrospective, cross-sectional population survey, based on selfreported cases of AGE, was conducted in November-December 2008 and May-June 2009 (high- and low- AGE season respectively) by face-to-face interviews. From 2,145 households selected to be interviewed, the response rate was 99.9%. Of those interviewed, 5.1% (n=110; 95% CI 4.3-6.2) reported having AGE (3 or more loose watery stools in 24 hours) in the 28 days prior to the interview (0.67 episodes/person-year). Monthly prevalence of AGE was the highest among children aged <5 years (1.3 episodes/year). Eighteen (16%) persons with AGE sought medical care (4 treated with oral rehydration salts and 6 with antibiotics), and 66% reported restricted activity [range 1-16 day(s)]. The mean duration of diarrhoea was 2.3 days (range 2-10 days). One case submitted a stool sample, and another was hospitalized. Overall, 56 (10%) AGE specimens tested positive for foodborne pathogens. It was estimated that 135,820 AGE cases occurred in 2009 (84% underreporting), and for every 1 AGE case reported, an additional 6.17 cases occurred in the community. The estimated economic cost of AGE ranged from US$ 27,331 to 19,736,344. Acute gastroenteritis, thus, poses a huge health and economic burden on Trinidad and Tobago.

Prevalence of depression in type 2 diabetic patients in Trinidad and Tobago / Prevalencia de la depresión en pacientes con diabetes tipo 2 en Trinidad y Tobago

BACKGROUND: Depression is a common problem among those suffering from diabetes mellitus. The dual diagnoses of a chronic medical disease and mental disorder, symptomatic presentation and stringent treatment regimen are sources ofpsychological distress for patients and present a major challenge for healthcare workers. METHOD: In a cross-sectional study, one hundred and twenty-eight Type 2 diabetic patients were investigated for depression using the Zung Depression Scale. All cases were diagnosed by a physician and patients were selected from outpatient clinics of the four major hospitals in Trinidad. The Pearson product-moment correlation coefficient, stepwise multiple regression and t-test were utilized to examine the relationship between participant's age, gender, glucose control, coexisting medical complications and depression. RESULTS: The patients were primarily Indo-Trinidadians (49%), over 50 years (79.7%) and women (60%). The prevalence of depression was 17.9% of Type 2 diabetic patients reporting mild to moderate levels of depression. Female Type 2 diabetics had higher scores of depression (M = 42.13, SD = 9.83, p = 0.011) than male Type 2 diabetics (M = 38.71, SD = 8.9). Patients with coexisting medical complications had higher levels of depression (M = 44.01, SD = 9.52) than those with diabetes alone (M= 37.74, SD = 8.79, p = 0.000). CONCLUSION: The prevalence of depression in Type 2 diabetic patients highlights the necessity for psychological screening at diabetic health clinics in Trinidad and Tobago, particularly for women and those with co-morbid medical complications. This will aid in better control, quality of life and longevity.

ANTECEDENTES: La depresión es un problema común entre las personas que sufren de diabetes mellitus. El diagnóstico dual de una enfermedad médica crónica y un trastorno mental, la presentación sintomática y un régimen de tratamiento estricto, son fuentes de angustia psicológica para los pacientes y representan un reto importante para los trabajadores de la salud. MÉTODO: En un estudio transversal, ciento veintiocho pacientes con diabetes tipo 2 fueron investigados en relación con estados depresivos, usando la Escala de Depresión de Zung. Todos los casos fueron diagnosticados por un médico, y los pacientes fueron seleccionados de clínicas ambulatorias de los cuatro hospitales principales en Trinidad. El coeficiente de correlación producto-momento de Pearson, la regresión gradual múltiple, y la prueba t, fueron utilizados para examinar la relación entre la edad del participante, el género, el control de la glucosa, las complicaciones médicas coexistentes, y la depresión. RESULTADOS: Los pacientes eran principalmente indotrinitenses (49%), más de 50 años (79.7%) y mujeres (60%). La prevalencia de la depresión fue 17.9% de los pacientes diabéticos tipo 2 que reportaban niveles de depresión de leves a moderados. Las mujeres diabéticas tipo 2 tuvieron puntuaciones de depresión mayores (M= 42.13, SD = 9.83, p = 0.011) en comparación con los hombres diabéticos tipo 2 (M= 38.71, SD = 8.9). Los pacientes con complicaciones médicas coexistentes tenían niveles más altos de depresión (M= 44.01, SD = 9,52) que aquellos sólo con diabetes (M = 37.74, SD = 8.79, p = 0.000). CONCLUSIÓN: La prevalencia de la depresión en pacientes diabéticos tipo 2 señala la necesidad de realizar tamizajes psicológicos en las clínicas para diabéticos en Trinidad y Tobago, en particular para las mujeres y aquellos con complicaciones médicas comórbidas. Esto ayudará a un mejor control, calidad de vida y longevidad de los pacientes con diabetes tipo 2.