Are women the main victims of violence within relationships? prevalence, type and frequency of intimate partner violence and aggression by sex in Barbados, Jamaica and Trinidad and Tobago

OBJECTIVE: In the Caribbean, studies of intimate partner violence and aggression (IPVA) have rarely incorporated the experiences of men. In this study we compare the sexes in examining types, frequency and prevalence of IPVA. DESIGN AND METHODS: Data were from a population-based study of 15–30 year olds in Barbados, Jamaica and Trinidad and Tobago. The Revised Conflict Tactics Scales (CTS2) were used to measure incidence levels of IPVA in the 12-months preceding the survey. IPVA was defined as the combination of three subscales: physical violence, sexual coercion and psychological aggression. Physical injury was measured. RESULTS: Of 3,401 participants, more than half had experienced IPVA (53.0%), comprising physical violence (22.1%), sexual coercion (14.5%) and psychological aggression (43.5%). There were no significant differences by sex in IPVA or any contributing subscale. More women experienced injury (odds ratio 1.52; 95% confidence interval 1.07 - 2.15) and women experienced significantly greater frequency of physical violence. Physical violence and psychological aggression were lowest in Trinidad, and sexual coercion was highest in Jamaica with no other statistically significant country-level differences. CONCLUSION: Most of our results do not support the idea that women are the main victims of IPVA. Studies should examine a variety of potential risk factors beyond the sex of victims and perpetrators, as suggested by country differences, with further attention to IPVA frequency. Services should respond to the range of risks. Longitudinal studies and age group comparisons should identify whether these results signify shifts in gender relations within couples.

Trends in stroke and acute myocardial infarction in Barbados, 2009–2013

OBJECTIVE: To describe trends in incidence, mortality and 28-day case fatality rate (CFR) for stroke and acute myocardial infarction (MI) in Barbados during the first 5 years of the Barbados National Registry for Chronic Non-communicable Disease (BNR). DESIGN AND METHODS: BNR data on strokes and acute MIs diagnosed nationwide were collected prospectively from data sources including public and private healthcare providers. Analyses included annual incidence and mortality rates per 100,000 (IR and MR), and 28 day post-event CFR, with 95% CI and trend estimation (fitting models to data using Poisson regression). RESULTS: Approximately 593 strokes and 349 acute MIs were registered annually with the BNR between 2009 and 2013, with a small 5-year decline in acute MI IR and a small 5-year increase in stroke IR by 2013. The MR for acute MI showed a small 5-year decline, but stroke MR increased significantly over the 5 years, from 78.9 (95%CI 68.8–90.0) in 2009 to 131.7 (118.8–145.8) in 2013 (p<0.03). Similar trends to MR were seen in CFR for both stroke and acute MI. CONCLUSION: We are cautiously optimistic about the (albeit non-significant) decline in IR, MR and CFR for acute MI, which could imply improvements in healthcare service provision. However, despite little change in stroke annual incidence, significant MR increase highlights the need for improved stroke care in Barbados. Thrombolysis for acute ischaemic stroke has only been available since the new stroke unit was implemented in late 2013; continued monitoring will allow assessment of this important initiative.

HIV Gateway: expanding access to Caribbean HIV research via a website

BACKGROUND/OBJECTIVES: Evidence-based HIV programming and policy in the Caribbean is hampered by limited access to existing research and other information about HIV in the region. A website was developed to facilitate such access. DESIGN AND METHODS: The HIV Gateway is a repository of publications and reports on HIV in the Caribbean searchable via a public website (www.hivgateway.com). Eligibility criteria were developed and used for searches to identify content on databases such as PubMed and Scopus. HIV researchers were approached to recommend and submit items, including unpublished research. Infographic tools were developed. RESULTS: By November 2014, the HIV Gateway contained over 5,500 journal publications, reports, conference abstracts, posters and slide presentations on HIV in the Caribbean, including over 250 documents not previously published or available online. All references include abstracts and web addresses (URLs) or PDFs providing access to original publications. Infographic tools enable users to analyse content by keyword, author and country. CONCLUSION: HIV Gateway provides opportunities for researchers and practitioners to build evidence-based approaches and to collaborate based on knowledge of who is working on issues and topics. Since it is publicly accessible, it facilitates the informed involvement of Caribbean people, including vulnerable populations, in the HIV response. Healthcare professionals can contribute articles or reports to continually expand and update the database and make this the website of choice for anyone wanting to find out about HIV in the Caribbean.

Cancer in Barbados: first year of data from the National Cancer Registry in Barbados

OBJECTIVE: To describe the most common cancers diagnosed in Barbados in 2008. DESIGN AND METHODS: All malignant neoplasms diagnosed in 2008 were ascertained by trained data abstractors via ‘hot pursuit’, mainly at the single tertiary public hospital, the Queen Elizabeth Hospital (QEH), but also from private hospital and clinics. Demographic (e.g. sex, age, vital status) and other data, including site of primary tumour, histology and treatment, were collected and abstracted directly onto laptops, using the International Agency for Research on Cancer (IARC)’s CanReg software, version 5. RESULTS: A total of 1106 persons (597 men; 509 women) were diagnosed with malignant cancers in Barbados and registered with the National Registry in 2008. Skin was the second leading site among men and women (27% of cases). With the exclusion of skin cancer, prostate and breast cancers were the principal cancers in men (204; 49%) and women (131; 34%) respectively, followed by colorectal cancers (123; 15% of cases). The third most common site for women was the uterus (40; 10%), followed by the cervix (18; 5%) and stomach (13; 3%). For men, other top sites included the lung (21; 5%), stomach (18; 4%) and pancreas (12; 3%). The age-standardised incidence rates per 100,000 population (ASRs; world standard) for prostate and breast cancer in 2008 were 113.9 and 63.5, respectively. CONCLUSION: Prostate and breast cancers were the most common cancers diagnosed in Barbados in 2008

Albumin/creatinine ratio as an indicator of diabetic foot in a Barbados population

OBJECTIVE: High levels of circulating glucose affect the vasculature in diabetes leading to complications such as retinopathy, nephropathy and diabetic foot. In diabetic nephropathy, the elevated glucose levels also serve to alter the physiology of the glomerulus resulting in elevated albumin excretion. In this case-control study, we examined the Albumin/Creatinine ratio in persons with self-reported type II diabetes, with and without non-healing foot wounds (failure to heal <30 days). DESIGN AND METHODS: Fasting EDTA blood (2ml) samples and urine samples (15ml) were obtained from 90 persons self reported as living with diabetes. Cases were described as persons with non healing foot wounds and controls as persons with no current foot wounds or history of non healing foot wounds. HbA1c levels and Albumin/Creatinine ratios were assessed using a Bayer DCA2000+ Analyser. Fasting glucose levels were determined using a Roche Reflotron+ Analyser. Results were compiled and analysis performed using STATA SE 12.1 (Stata Corporation). RESULTS: Mean HbA1c in cases was 9.1% (ñ2.1 SD) and in controls was 8.3% (ñ1.9 SD) (p=0.05). Mean fasting glucose in cases was 142.19mg/dL (ñ50.76 SD) and in controls 134.57mg/dL (ñ60.10 SD) (p=0.52). Mean Albumin/Creatinine ratio in cases was 210.23 mg/g (ñ275.44 SD) and in controls 42.62 mg/g (ñ103.49 SD) (p<0.001). CONCLUSIONS: In this diabetic case control study, Albumin/Creatinine ratio was markedly higher in persons with diabetes and non-healing foot wounds. This may be a marker of interest as an early indicator of the diabetic foot.

Ethnic and gender disparities in premature adult mortality in Belize 2008-2010

OBJECTIVE: To determine if differences exist in premature adult mortality between the four main ethnic groups in Belize, by men and women aged 15-59 years. DESIGN AND METHODS: The analysis used 2008 to 2010 mortality data (Ministry of Health, Belize) and census data (2010) stratified by age, sex, and ethnicity (Statistical Institute of Belize). Underlying cause of death was classified using ICD10, then into 3-groups: communicable diseases, non-communicable diseases and injuries. We calculated the probability of death at 5-year intervals, 15-59 years (45q15) for all deaths and for the 3-broad (and competing) mortality causes. RESULTS: The probability of death among the population 15-59 years was 18.1%, and was higher in men than in women (women 13.5%, men 22.7%). Important ethnic variation existed, with Creole and Garifuna ethnic groups having three times the 45q15 probability of death compared to Mayan and Mestizo groups (Creole 31.2%, Garifuna 31.1%, Mayan 10.2%, Mestizo 12.0%). This ethnic disparity pattern existed in both sexes but was greater in men. The female probability of death in the Creole and Garifuna groups was roughly twice that of the Mayan and Mestizo groups. For males it was between three and four times higher. Violent death contributes to this difference, particularly in Creole men, where roughly 1 in 7 can expect to die a violent death before their 60th birthday. CONCLUSIONS: This study starts to identify health inequities. Targeted work to identify potential interventions aimed at reducing the excess adult mortality in the Garifuna and Creole groups is needed.

Anaesthetic morbidity at the University Hospital of the West Indies / Morbilidad anestésica en el Hospital Universitario de West Indies: un estudio transversal prospectivo

OBJECTIVE: There is little information on adverse anaesthetic outcomes from the Caribbean. The aim of this study was to investigate the occurrence of anaesthetic morbidity and mortality at the University Hospital of the West Indies (UHWI) and to identify possible risk factors. METHODS: All anaesthetic procedures at the UHWI were monitored for adverse events and patient outcomes for the 12-month period from March 2004 to February 2005. Possible risk factors for these adverse events were assessed using logistic regression. RESULTS: Of 3185 anaesthetic proceduress, the incidence of intra-operative events was 201 per 1000 (95% CI 187, 215); 151 per 1000 being cardiovascular and 26 per 1000 respiratory. Others included excess blood loss and equipment failure, hyperglycaemia, nausea and vomiting. Patients with intraoperative complications were three times more likely to have complications during recovery (OR = 3.35; 95% CI 2.59, 4.33, p < 0.001). The incidence of complications among paediatric patients was 139 per 1000 (95% CI 104, 174) intra-operatively and 58 per 1000 (95% CI 34, 81) during recovery. Risk factors for developing complications (p < 0.05) included age > 50 years, ASA status > II, prolonged anaesthesia, high surgical risk, general or combined anaesthetic techniques, senior anaesthetist, intubated patients and co-morbidities. There were 14 operative mortalities, none of which was anaesthesia-related. CONCLUSION: Anaesthetic complication rates at the UHWI are comparable to those in developed countries, except for higher paediatric complication rates and ICU admissions and lower rates of postoperative nausea and vomiting.

OBJETIVO: Existe poca información sobre resultados anestésicos adversos en el Caribe. El propósito del presente estudio fue investigar la manifestación de la morbilidad y la mortalidad anestésicas en el Hospital Universitario de West Indies (UHWI) e identificar los posibles factores de riesgo. MÉTODOS: Todos los procedimientos anestésicos en el UHWI fueron monitoreados en busca de eventos adversos y resultados con los pacientes, durante un período de 12 meses a partir de marzo del 2004. Los posibles factores de riesgo para estos eventos adversos fueron evaluados mediante regresión logística. RESULTADOS: De 3185 procedimientos anestésicos, la incidencia de eventos intraoperatorios fue de 201 por 1000 (95% CI 187, 215); siendo 151 por 1000 cardiovasculares y 26 por 1000 respiratorios. Otros incluyeron exceso en pérdida de sangre y fallo de equipos, hiperglicemia, náusea, y vómitos. Los pacientes con complicaciones intraoperatorias presentaron una probabilidad de complicaciones tres veces mayor en la fase de recuperación (OR = 3.35; 95% CI 2.59, 4.33, p < 0.001). La incidencia de complicaciones entre pacientes pediátricos fue 139 por 1000 (95% CI 104, 174) intraoperatoriamente y 58 por 1000 (95% CI 34, 81) durante la recuperación. Entre los factores de riesgo que desarrollaban complicaciones (p < 0.05) se hallaban: la edad > 50 años, estatus de ASA > II, anestesia prolongada, alto riesgo quirúrgico, técnicas anestésicas combinadas o generales, anestesiólogos de la tercera edad, pacientes entubados, y comorbilidades. Se produjeron 14 mortalidades operatorias, ninguna de las cuales guardó relación con la anestesia. CONCLUSIÓN: Las tasas de complicación anestésica en UHWI son comparables a las que se producen en países desarrollados, excepto por las tasas de complicación pediátrica más altas, mayor número de ingresos a las UCIs, y tasas más bajas de náuseas y vómitos postoperatorios.

Voices of the women: feedback from women of child-bearing age who are living with HIV can help improve efficacy of psychosocial interventions / Voces de mujeres: la retroalimentación de mujeres en edad de parir viviendo con VIH puede aayudar a mejorar la eficacia de las intervenciones psicosociales

BACKGROUND: We hypothesized that voluntary counselling and testing during pregnancy are necessary but not sufficient to provide the holistic psychosocial support needed by Jamaican women living with HIV and/or AIDS. Based on this hypothesis, we investigated a range of coping methods and support systems used by HIV-infected women and a group of their HIV-negative counterparts before, during and immediately after their pregnancies. METHODS: Women attending obstetric clinics in urban Jamaica completed a quantitative survey aimed at discovering coping behaviours, social and spiritual support systems. Presurvey focus group studies and key informant interviews contributed to the design of the questionnaire while post-survey focus groups were used to probe the validity of the data gleaned from the questionnaire survey. Survey data were analyzed using non-parametric tests for trend with independent univariate tests. RESULTS: Fifty-five HIV-infected women and 51 HIV-negative women completed the survey. Compared with HIV-negative women, more HIV-infected women reported both feeling depressed (p = 0.07) and having difficulty concentrating (p = 0.05) during the month immediately prior to the study. Other statistically significant differences included: HIV-infected women were more likely to pray, to sleep and to change eating habits in response to worry and stress (p = 0.001 in each instance). Although several women declared religious faith, significantly fewer HIV-infected women were willing to talk to a religious leader about their problems compared to their HIV-negative counterparts (p < 0.001). CONCLUSIONS: Participation of HIV-infected women in post-survey focus groups augmented the survey findings. Many of the women reported negative emotions and some indicated serious challenges in accessing social support. The results point to the need for systematic documentation of psychosocial profiles as part of the approach to caring for these women. In addition, in the Jamaican sociocultural context, we recommend improved training of religious leaders and healthcare providers in psychosocial issues.

ANTECEDENTES: Planteamos la hipótesis de que someterse al asesoramiento y prueba voluntarios durante el embarazo es necesario, pero no suficiente para el apoyo psicosocial holístico que necesitan las mujeres jamaicanas que viven con VIH y/o SIDA. Sobre la base de esta hipótesis, investigamos una serie de métodos de afrontamiento y sistemas de apoyo usados por las mujeres infectadas por el VIH y un grupo de sus contrapartes VIH negativas antes, durante e inmediatamente después de sus embarazos. MÉTODOS: Mujeres que asistían a clínicas obstétricas en áreas urbanas de Jamaica, completaron una encuesta cuantitativa, encaminada a descubrir conductas de afrontamiento, y sistemas de apoyo social y espiritual. Estudios de grupos focales mediante encuestas y entrevistas a informantes claves, contribuyeron al diseño del cuestionario, mientras que grupos focales de post-encuesta fueron usados para investigar la validez de los datos recogidos de la encuesta-cuestionario. Los datos de la encuesta fueron analizados usando tests no paramétricos para tendencia con tests univariados independientes. RESULTADOS: Cincuenta y cinco de las mujeres infectadas con VIH y 51 de las mujeres VIH negativas, completaron la encuesta. En comparación con las mujeres VIH negativas, más mujeres infectadas con VIH reportaron sentirse deprimidas (p = 0.07) y tener dificultades con la concentración (p = 0.05) durante el mes inmediatamente anterior al estudio. Otras diferencias estadísticamente significativas fueron las siguientes: las mujeres infectadas con el VIH mostraron una mayor tendencia a orar, dormir y cambiar sus hábitos alimentarios en respuesta a la preocupación y el estrés (p = 0.001 en cada caso). Aunque varias mujeres declararon tener fe religiosa, significativamente pocas mujeres infectadas con VIH estuvieron dispuestas a hablar a un líder religioso acerca de sus problemas, en comparación con sus contrapartes VIH negativas (p < 0.001). CONCLUSIONES: La participación de mujeres infectadas con VIH en grupos focales de post-encuesta aumento marcadamente los hallazgos de la encuesta. Muchas de las mujeres reportaron emociones negativas y algunas indicaron serios desafíos en cuanto a tener acceso a algún apoyo social. Los resultados apuntan a la necesidad de poseer una documentación sistemática de los perfiles psicosociales como parte del abordaje del cuidado a estas mujeres. Además, en el contexto sociocultural de jamaica, recomendamos mejorar el entrenamiento de los líderes religiosos y los proveedores de salud en cuanto a las problemáticas psicosociales.