Reforming primary medical care in our Caribbean communities, part 1: continuity of care and the healing interpersonal relationship. A position paper of the Caribbean College of Family Physicians

This brief paper highlights the demographic transition to CNCD, the poor success of our present model of care for CNCD and advocates for a re-focusing of our community medical services to provide through regional policy a focus on improved interpersonal continuity of care.

Obesity in food handlers

The object of this study was to determine whether obesity is an occupational hazard in food handlers. 309 persons who presented to two Barbadian group General Practices for food handling certification were studied. The results demonstrate that a majority of food handlers were obese (55.3 percent), more so than in population studies despite the relatively young age of the sample. The men 67/104 (64 percent) were just as obese as the women 104/175 (59.4 percent) and obesity was seen in the relatively young age groups, 30-39 (60.9 percent), 40-49 (75 percent) and 50-59 (69.7 percent). Among food handlers obesity was seen more frequently than in those with sedentary lifestyles 76/116 (65.5 percent) and in those who worked more than 10 years in the food handling industry 91/140 (65 percent). No association was found between obesity and use of alcohol or tobacco, but among the food handlers studied were many who demonstrated inaccurate perception of their body image, with 74 of the 190 who thought their weight to be O.K. actually measuring as obese (39 percent). Obesity is most likely an occupational hazard in food handlers. They work in an industry that is growing rapidly in Barbados as tourism services expand and as the local population adopts the western lifestyle of eating out more often. Food handlers are required by law to be certified annually as fit to work. It is important that doctors recognize the threat of obesity and use the opportunity of this annual examination to screen and intervene for this hazard.

Obesity in food handlers

The object of this study was to determine whether obesity is an occupational hazard in food handlers. 309 persons who presented to two Barbadian group General Practices for food handling certification were studied. The results demonstrate that a majority of food handlers were obese (55.3 percent), more so than in population studies despite the relatively young age of the sample. The men 67/104 (64 percent) were just as obese as the women 104/175 (59.4 percent) and obesity was seen in the relatively young age groups, 30-39 (60.9 percent), 40-49 (75 percent) and 50-59 (69.7 percent). Among food handlers obesity was seen more frequently than in those with sedentary lifestyles 76/116 (65.5 percent) and in those who worked more than 10 years in the food handling industry 91/140 (65 percent). No association was found between obesity and use of alcohol or tobacco, but among the food handlers studied were many who demonstrated inaccurate perception of their body image, with 74 of the 190 who thought their weight to be O.K. actually measuring as obese (39 percent). Obesity is most likely an occupational hazard in food handlers. They work in an industry that is growing rapidly in Barbados as tourism services expand and as the local population adopts the western lifestyle of eating out more often. Food handlers are required by law to be certified annually as fit to work. It is important that doctors recognize the threat of obesity and use the opportunity of this annual examination to screen and intervene for this hazard. (AU)

Diabetes care in middle-income countries: a Caribbean case study.

Many middle-income countries now have a high prevalence of diabetes and need to address the problem of providing care for people with diabetes within limited resources. This study evaluated standards of preventive care in primary settings in three Caribbean countries. We studied case records at 17 clinics in 15 government health centres and 17 private general practitioners' offices in Barbados, Trinidad and Tobago and Tortola (British Virgin Islands). A census of all attenders over a 4 to 7 week period identified 1661 attenders with diabetes mellitus, approximately two-thirds were women with a median age over 60 years. Overall 676/1342 (50%) had 'poor' blood glucose control (> or = 8 mmol l-1 fasting or > or = 10 mmol l-1 random). The proportion with BP > or = 160/95 mmHg or receiving treatment for hypertension was 943/1661 (57%), of whom 781/943 (83%) were prescribed drug treatment. Among those treated for hypertension only 181/781 (23%) had blood pressures < 140/90 mmHg. Surveillance for complications affecting the feet (11%) or eyes (2%) was not performed systematically in any setting. Only 533 (32%) had recorded dietary advice and 79 (5%) had recorded exercise advice in the last 12 months. To begin to address some of these problems at a regional level, we incorporated results from this survey into a series of workshops held in collaboration with health ministries in 10 Caribbean countries, with participants from 13 countries. At these workshops health care workers participated in the process of developing guidelines for diabetes management in primary care. The guidelines have subsequently been widely disseminated through health ministries and non-governmental organizations in the region. Further research is needed to evaluate the effectiveness of this approach, the constraints on diabetes care, and the most cost-effective means of addressing them.