Prevalence and risk factors of airflow obstruction in a Caribbean population.

SETTING: The prevalence of airflow obstruction (AO) in the Caribbean population is unknown.OBJECTIVE: To measure the prevalence of and risk factors for AO (post-bronchodilator ratio of forced expiratory volume in 1 sec to forced vital capacity of <0.7) in the Trinidad and Tobago general population using the Burden of Obstructive Lung Disease methodology.DESIGN: National cross-sectional, stratified, cluster sampling of adults aged ≥40 years.RESULTS: AO prevalence was 9.5% among 1104 participants, most of whom were unaware of this. Compared to those aged 40-49 years, the adjusted odds ratio of AO by age group was 2.73 (60-69 years) and 3.30 (≥70 years). Risk factors for AO were unemployment (OR 4.31), being retired (OR 2.17), smoking ≥20 pack-years (OR 1.88) and exposure to dusty jobs for more than 1 year (OR 2.06). Related symptoms were history of wheezing, unscheduled visits to the doctor or admission to hospital for breathing problems and in subjects with at least one respiratory symptom (OR 1.90), at least one risk factor (OR 2.81), either symptoms or risk factors (OR 3.71) and both symptoms and risk factors (OR 5.78) (P < 0.05 in all cases).CONCLUSION: AO prevalence in the general population of Trinidad and Tobago aged ≥40 years was 9.5%, almost all of which was undiagnosed. AO was associated with smoking, age >59 years, lack of employment and working in a dusty job.

Occupational dust exposure is independently associated with Chronic Obstructive Pulmonary Disease (COPD) in Trinidad and Tobago population

Objective: COPD is a leading cause of mortality and morbidity worldwide. Although cigarette smoking is a well-known risk factor for COPD, nonsmokers may account for one fourth to half of all cases. The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study objective was to measure the COPD prevalence and its risk factors in the local population aged 40 years and older. Design and Methodology: In this cross-sectional survey participants were selected using two-stage stratified-cluster sampling to represent the national population in terms of gender, age and ethnic distributions. Quality assured spirometry and questionnaires were administered. Results: Among the 1,104 participants, 36% reported occupational dust exposure for more than one year and about 40% of them were never-smokers. Overall 9.5% (95% CI: 7.78 to 11.23%) of the studied population showed COPD, accounting for an estimated 49,170 persons (95% CI = 40,267; 58,124) in Trinidad and Tobago. The majority (60%) of the diagnosed COPD was attributable to non-smoking causes, and more than half of them reported occupational dust exposure. Multiple logistic regression analysis confirmed COPD's independent association with working in a dusty job (OR 2.05; 95% CI=1.26, 3.35). Conclusions: Risk of COPD in the Trinidad and Tobago general population is significantly associated with occupational dust exposure which is probably contributing about one-third of current COPD burden. International studies showed that only about 15% of overall COPD could be ascribed to occupational risk factors. The higher occupational related COPD risk in the local population should be further studied prospectively.

Indo-Caribbean population has lower vital capacities than Afro-Caribbean population in Trinidad and Tobago

Objective: Low forced vital capacity (FVC) is a good predictor of mortality and morbidity including cardiovascular disease, diabetes and chronic kidney disease in the general population. Objective of the current post-hoc analysis was to compare the FVCs among the major ethnic groups of Trinidad and Tobago. Design and Methodology: The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study was conducted to measure the COPD prevalence and its risk factors in the local population of 40 years and older by using questionnaires and quality assured spirometry. The participants were selected using two-stage stratified, cluster sampling to represent the national population in terms of gender, age and ethnic distributions. To avoid the influence of contentious international spirometry predictive values, FVC was used as a continuous variable after adjusting for age, gender, height and height square. Results: Among the 1,104 participants, 42% were Indo- Caribbeans, and 36% were Afro-Caribbeans. Indo- Caribbeans had a similar prevalence of abnormal waist circumference (57.0% vs. 58.7%; p=0.751), a lower prevalence of obesity (30.0% vs. 41.8%; p=0.008), but a higher prevalence of abnormal waist-hip ratio (74.1% vs. 57.5%; p<0.001) and diabetes (21% vs. 10%; p<0.001) than the Afro- Caribbeans. Multiple regression analysis indicated that FVC was independently associated with ethnicity and revealed lower volumes in Indo- Caribbean participants than Afro-Caribbeans (-180ml; 95%CI:-90ml,-269ml; p<0.001). Conclusions: The Indo-Caribbean population has a lower FVC than the Afro-Caribbean population which was independent of age, gender, and height. Healthrelated consequences of low FVC among local ethnic groups warrant further research using longitudinal studies.

Asymptomatic 'normal' subjects may have a respiratory health burden as assessed by the St Georges Respiratory Questionnaire (SGRQ)

Objectives: The Burden of Obstructive Lung Disease study in Trinidad and Tobago identified subjects with obstruction and no symptoms in approximately 5% of the general population over 40 years old. We reviewed data from a previously published study involving asymptomatic subjects to determine respiratory health burden and relation to lung function. Results: Subject characteristics were: 16 (64%) males, Mean (SD) age 64.8 (6.78) years, forced expiratory volume (FEV1) 2.25 (0.77)L, forced vital capacity (FVC) 2.91 (1.02) L, FEV1/FVC 78.1 (8.31)%. Parameters assessed were FEV1 (1.21 to 3.69 L); FVC (1.32 to 4.88 L); FEV1/FVC (65.2 - 94.7%); SGRQ Total Score (0 to 20.8). Three subjects (12%) had a FEV1/FVC ratio of less than 70%. The correlations (rho, p) of total SGRQ scores were FEV1 (-0.62, 0.001), FEV1% (-0.52, 0.008); FVC (-0.69, < 0.001). Conclusion: Asymptomatic normal elderly subjects had significant respiratory health burden as measured by the SGRQ and this was worse in those with a lower FEV1%. This may apply to elderly persons in the general population.

Sex and social class inequities in physical and mental health: an analysis using data from the Burden of Obstructive Lung Disease Trinidad and Tobago (BOLD-TT) study

Objectives: To examine sex and social class differences in physical and mental health in the Trinidad and Tobago population aged ≥40 years. Design and Methodology: Data from the BOLD-TT study, which included a stratified cluster sample of 1104 persons, were analysed. The Veteran Rand (VR)-12 instrument assessed physical (general health, physical functioning and role playing and bodily pain) and mental health (vitality, role-emotional, mental health and social functioning); using a physical health component (PCS) and mental health component (MCS) scores. Highest level of education attained, and employment status were used as measures of social class. General Linear Models were used to examine differences in PCS and MCS by sex, education and employment, controlling for age. Results: Mean age of the participants was 54.1 (SD10.8) years; 59.9% were females; 47% had no/primary education; 56% were employed. Mean PCS and MCS (SEM) scores were 47.8 (0.3) and 54.7 (0.3). Females had lower mean PCS and MCS than males (p<.001 in each case). There were significant mean differences in PCS (p<.001) and MCS (p=.04) by employment status. Persons who were not working had lower mean PCS (p<.001) and MCS (p=.002) than those employed. There were differences in PCS by education (p=.019); persons with no/primary education had lower PCS than those with post-secondary and university education. Multiple regression identified employment (p<.001) and education (p=.097) as independent predictors of PCS while sex (p=.002) and employment (p=.021) predicted MCS. Conclusion: The VR-12 provided initial results indicating health inequities i.e. poorer health status among females, the unemployed and uneducated.

Prevalence of COPD in Trinidad and Tobago - A National Study

Purpose: Chronic Obstructive Pulmonary Disease (COPD) is preventable and treatable, yet it is the third leading cause of death and fifth leading cause of disability globally. Local studies in restricted settings have reported about 20% COPD prevalence, but the national prevalence and risk factors are unknown. We aimed to measure the prevalence of COPD and its risk factors in Trinidad and Tobago as part of the multicentre Burden of Obstructive Lung Disease (BOLD) Study. Research Design and Methodology Used: A cross-sectional study was conducted during 2014-2015 using the BOLD standardised protocol. A stratified cluster sample of non-institutionalised males and females aged ≥ 40 years (N = 1104) and a sample of 18-39 year olds (N = 807) were selected. Questionnaires on respiratory symptoms, health status, and exposure to COPD risk factors were administered and spirometry conducted before and after bronchodilator. Spirometry quality control measures utilised were (1) direct spirometer feedback and (2) BOLD international centre review. Spirometry readings below international standards required technician retraining. Post- bronchodilator forced expiratory volume in the first second of expiration (FEV1) was expressed as a percentile of the forced vital capacity (FVC). COPD was defined by FEV1/FVC < 70% and a smoker as having smoked >200 cigarettes in a lifetime. Logistic regression was used to examine associations a (expressed as Odds Ratios (OR) and multivariate logistic regression to determine independent risk factors. Findings: There was a 95% response rate The mean age (SD) of these participants was 54 (11) years and Body Mass Index (BMI) 29 (7) kg/m2; with N (%) males, 443 (40) males; Afro-Trinidadians 400 (37), Indos 454(42), Mixed 234 (21), ever-smokers 302 (27), current smokers 157 (14), Adverse events 13(<1%)]. The prevalence of COPD was 9.5%, Of those with COPD, only 4% reported a previous doctor diagnosed COPD. COPD was more likely among those aged 60-69 years or over 70 (OR=4.15 and 5.88 respectively, p<0.001), among males (OR=1.64, p=0.023), ever smokers (OR=1.72, p=.016), retirees and the unemployed (OR=4.41 and 3.59 respectively, p<.001), with BMI<21 (OR=2.64, p=.001), asthma (OR=5.20, p<.001) or wheezing (OR=3.48, p<.001). Multivariate analysis showed significant risk factors for COPD were: older age groups, low BMI, working over a year in dusty jobs, cigarette or cannabis smoking. There was no non-responder bias in age, gender, ethnicity, smoking or BMI but unacceptable spirometry was more likely in the elderly and smokers. Among the 807 participants aged 18-39 years old, 23% smoked with the prevalence of smoking in males being 32% vs. 11.7% in females (p < 0.001). Conclusions: COPD is prevalent yet under-diagnosed in the general population. Health care education and use of spirometry for prevention of COPD should target males, the elderly, smokers, those working in dusty jobs and those with a history of asthma or wheeze. We suggest spirometry measurements be available at all district health facilities.

Adherence to antiretroviral therapy by people accessing services from non-governmental HIV support organisations in three Caribbean countries.

OBJECTIVE: To identify factors associated with antiretroviral therapy (ART) adherence in order to guide the development of strategies to improve the situation. DESIGN AND METHODS: A cross-sectional survey was conducted with people living with HIV (PLHIV) who receive services from non-governmental organisations affiliated to the Caribbean Regional Network of People Living with HIV/AIDS (CRN+) in Antigua and Barbuda, Grenada and Trinidad and Tobago. PLHIV from CRN+, traced potential participants, administered informed consent procedures and carried out structured interviews. The main outcome measure was 95% to 100% adherence over the previous seven days. Multiple logistic regression was conducted to identify associations with demographic characteristics, psychological status, health and support service use, sexual behaviour and substance abuse. RESULTS: Of 394 respondents, 69.5% were currently taking ART. Of these, 70.1% took 95% to 100% of their prescribed pills. One in 20 took more pills than prescribed, all of whom were prescribed fewer or equal to the median pill number. Factors independently associated with adherence were use of a counselling service (OR 3.20; 95% CI 1.55, 6.61), revelation of HIV status without consent (OR 2.31; 95% CI 1.13, 4.74), alcohol consumption (OR 0.47; 95% CI 0.23, 0.96) and side effects (OR 0.32; 95% CI 0.15, 0.68). Drug resistance to ART was reported by 6% of users. CONCLUSION: Improvements in ART adherence may be achieved by counselling, focussed attention to alcohol users and developing drugs with reduced side effects. Such measures are critical to maintain PLHIV quality of life gains and prevent the proliferation of drug resistant HIV strains.

Factors associated with condom use: economic security and positive prevention among people living with HIV/AIDS in the Caribbean.

In the Caribbean region, an estimated 1.1% of the population aged 15-49 is living with HIV. We aimed to measure factors associated with condom use, the primary form of positive prevention in the Caribbean, among people living with HIV (PLHIV) in its major agency advocating on behalf of PLHIV (the Caribbean Regional Network of People Living with HIV/AIDS, or CRN +). Condom use at last sex was selected for analysis from a broad-ranging cross-sectional survey (n=394) among PLHIV who were members of or received services from CRN+ in Antigua and Barbuda, Grenada, Trinidad and Tobago. PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews. Fifty-four percent of respondents reported using a condom the last time they had sex. Condom use was positively associated with partner being HIV negative, disclosure of HIV status, alcohol use, economic security, education level and being employed. Multivariate logistic regression found independent associations between condom use and economic security (p=0.031; odds ratio (OR) for "enough" income 5.06; 95% CI 1.47-17.39), partner being HIV negative (p=0.036; OR 2.85; 95% CI 1.28-6.33) and being married (p=0.043; OR 2.86; 95% CI 1.03-7.91). Seventy-three percent of respondents reported inadequate family income, 26% reported an HIV-negative partner and 9% were married. Condom use appears to be motivated by protection of HIV-negative partners and spouses. Low socioeconomic status is associated with the overall percentage using condoms. Restriction to members of CRN+ limits generalisability of the findings. Nevertheless, the findings support the view that programmes for the socioeconomic empowerment of PLHIV are needed to slow the Caribbean HIV epidemic. Expectations for protection of different types of partners should be further explored in order to develop culturally appropriate interventions with couples.

Medical problems among dental patients at the school of dentistry, the university of the West Indies.

This study ascertained demographic information and prevalence rates of medical problems among 571 new and consecutive dental patients attending the emergency clinic of the School of Dentistry, The University of the West Indies. Patients were interviewed by specially trained and calibrated dental students and interns. Various medical problems of patients were recorded in individual open-ended case sheets, maintaining their privacy and confidentiality. This information was then transcribed into a specially designed and pretested form. The data were entered into a Microsoft Excel spreadsheet and analyzed using the SPSS statistical package to obtain the prevalence rates of medical conditions, which were then cross-tabulated with gender, age, ethnicity, and other variables. Significance of differences, if any, was evaluated by chi-square test. In all, 303 medical conditions were encountered in 239 individuals, giving a prevalence rate of 42 percent. Hypertension (12.6 percent), diabetes (6.1 percent), asthma (5.8 percent), arthritis (4.7 percent), and various allergies (8.3 percent) constituted an important segment of the problems. Gender, ethnic, and age differences were also evident for some diseases. In this study-which was the first of this kind in the West Indies-vital information on medical problems among dental patients was obtained by interviews conducted by dental students and interns, forming an important part of their dental education.

The elderly in Trinidad: health, social and economic status and issues of loneliness.

OBJECTIVES: To determine the general health and social status of elderly persons surveyed in Trinidad and to explore issues of loneliness. METHOD: An island-wide survey of persons aged 65 years and older was conducted in early 2002 in Trinidad Eight hundred and forty-five (845) elderly persons were chosen using systematic random sampling. The main survey instrument for data collection was a questionnaire that included structured as well as open-ended questions. The subjects were chosen in a house-to-house survey conducted in all eight counties in Trinidad. Elderly people who were unable to comprehend the questions were excluded from the survey. RESULTS: Those selected ranged in age from 65-102 years and represented all the ethnic groups in Trinidad. These elderly persons lived in a wide range of housing situations. The majority lived in the homes of family members (57%) and 16% lived on their own. A large proportion (80%) had at least one chronic medical problem, although 44% reported their health as "fairly good" or "good". More than a half of the males (53%) and 67% of the females were taking at least one prescribed medicine. The main sources of income were old age pension (85%) and National Insurance (15%). Thirty-three per cent reported feelings of loneliness. This figure includes 28% of those who did not live alone. CONCLUSION: The data revealed that across all ethnic groups more than one-third of the sample reported themselves to be in fair to good health. Many of these elders were lonely because their relatives were quite occupied with their own affairs.

The oral health and treatment needs of schoolchildren in Trinidad and Tobago: findings of a national survey.

OBJECTIVE: To describe the oral health and treatment need of schoolchildren in Trinidad and Tobago. DESIGN AND METHOD: Cross-sectional survey using stratified cluster sampling. Participants were children in primary (aged 6-8 years) and secondary school (aged 12 and 15 years). Main outcome measures were DMFT/dmft, treatment need, and fluorosis. RESULTS: Examinations were completed on 1064 children. The dmft of the 6-8-year-olds was 2.54 (95 per cent CI = 2.32, 2.76). For 12-year-olds, the DMFT was 0.61 (95 per cent CI = 0.51, 0.71), whereas for 15-year-olds, the DMFT was 1.06 (95 per cent CI = 0.87, 1.25). Most of the caries experience in 6-8-year-olds was from decayed teeth. Sixty-seven per cent of the sample (95 per cent CI = 64 per cent, 69 per cent) had some type of treatment need. Most frequently occurring need was for fillings at 42 per cent (95 per cent CI = 40 per cent, 44 per cent) with 28 per cent (95 per cent CI = 26 per cent, 31 per cent) of the total sample needing two or more surface fillings, followed by fissure sealants at 33 per cent (95 per cent CI = 30 per cent, 36 per cent) and caries-arresting care at 12 per cent (95 per cent CI = 10 per cent, 14 per cent). Extraction of one or more teeth was needed in 13 per cent (95 per cent CI = 11 per cent, 15 per cent) of children. Rates of fluorosis were negligible. CONCLUSION: The caries experience of 12- and 15-year-old children were low but was high for schoolchildren aged 6-8 years, in terms of prevalence and severity. Effective oral health promotion strategies need to be implemented to improve the oral health of primary schoolchildren in Trinidad and Tobago.

The oral health and treatment needs of school children in Trinidad and Tobago: findings of a national survey

OBJECTIVE: To describe the oral health and treatment need of schoolchildren in Trinidad and Tobago. Design and method: Cross-sectional survey using stratified cluster sampling. Participants were children in primary (aged 6-8 years) and secondary school (aged 12 and 15 years). Main outcome measures were DMFT/dmft, treatment need, and fluorosis. RESULTS: Examinations were completed on 1064 children. The dmft of the 6-8-year-olds was 2·54 (95 per cent CI = 2·32, 2·76). For 12-year-olds, the DMFT was 0·61 (95 per cent CI = 0·51, 0·71), whereas for 15-year-olds, the DMFT was 1·06 (95per cent CI = 0·87, 1·25). Most of the caries experience in 6-8-year-olds was from decayed teeth. Sixty-seven per cent of the sample (95 per cent CI = 64 per cent, 69 per cent) had some type of treatment need. Most frequently occurring need was for fillings at 42 per cent (95 per cent CI = 40 per cent, 44 per cent) with 28 per cent (95 per cent CI = 26 per cent, 31 per cent) of the total sample needing two or more surface fillings, followed by fissure sealants at 33 per cent (95 per cent CI = 30 per cent, 36 per cent) and caries-arresting care at 12 per cent (95 per cent CI = 10 per cent, 14 per cent). Extraction of one or more teeth was needed in 13 per cent (95 per cent CI = 11 per cent, 15 per cent) of children. Rates of fluorosis were negligible. CONCLUSION: The caries experience of 12- and 15-year-old children were low but was high for schoolchildren aged 6-8 years, in terms of prevalence and severity. Effective oral health promotion strategies need to be implemented to improve the oral health of primary schoolchildren in Trinidad and Tobago.

The oral health and treatment needs of schoolchildren in Trinidad and Tobago: findings of a national survey.

OBJECTIVE: To describe the oral health and treatment need of schoolchildren in Trinidad and Tobago. DESIGN AND METHOD: Cross-sectional survey using stratified cluster sampling. Participants were children in primary (aged 6-8 years) and secondary school (aged 12 and 15 years). Main outcome measures were DMFT/dmft, treatment need, and fluorosis. RESULTS: Examinations were completed on 1064 children. The dmft of the 6-8-year-olds was 2.54 (95% CI = 2.32, 2.76). For 12-year-olds, the DMFT was 0.61 (95% CI = 0.51, 0.71), whereas for 15-year-olds, the DMFT was 1.06 (95% CI = 0.87, 1.25). Most of the caries experience in 6-8-year-olds was from decayed teeth. Sixty-seven per cent of the sample (95% CI = 64%, 69%) had some type of treatment need. Most frequently occurring need was for fillings at 42% (95% CI = 40%, 44%) with 28% (95% CI = 26%, 31%) of the total sample needing two or more surface fillings, followed by fissure sealants at 33% (95% CI = 30%, 36%) and caries-arresting care at 12% (95% CI = 10%, 14%). Extraction of one or more teeth was needed in 13% (95% CI = 11%, 15%) of children. Rates of fluorosis were negligible. CONCLUSION: The caries experience of 12- and 15-year-old children were low but was high for schoolchildren aged 6-8 years, in terms of prevalence and severity. Effective oral health promotion strategies need to be implemented to improve the oral health of primary schoolchildren in Trinidad and Tobago.

The prevalence of seat belt use in Kingston, Jamaica: a follow-up observational study five years after the introduction of legislation / Prevalencia del uso del cinturón de seguridad en Kingston, Jamaica: un estudio observacional de seguimiento, cinco años después de introducida la legislación

An observational cross-sectional study conducted in Kingston in 2004 showed that seat belts were used by 81.2% of private motor vehicle drivers and 74.0% offront seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996 before the introduction of legislation in 1999 (p < 0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p < 0. 001) and as front seat passengers (79.9% vs 66.3%; p < 0.001). Of the 2289 motor vehicles examined, all except one were equipped with seat belts. Rear passenger utilization of seat belts was not examined. Drivers of new vehicles were more likely than other drivers to use seat belts (p < 0.001). Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign if the maximum benefits of seat belt use are to be realized

Un estudio transversal observacional llevado a cabo en Kingston en el año 2004 mostró que los cinturones de seguridad eran usados por el 81.2% de los conductores de vehículos motorizados privados, y el 74.0% de los pasajeros del asiento delantero. Esto representa una mejoría significativa en comparación con el 21.1% y el 13.6% respectivamente en 1996 antes de que se introdujera la legislación en 1999 (p < 0.001). Las tendencia de las mujeres a usar cinturones de seguridad fue significativamente mayor que la de los hombres, tanto al conducir (92.5% vs 77.3%; p < 0.001) como al viajar como pasajeras en el asiento delantero (79.9% vs 66.3%; p < 0.001). De los 2289 vehículos motorizados examinados, todos – excepto uno – estaban equipados con cinturones de seguridad. No se examinó la utilización de los cinturones de seguridad por parte de los pasajeros en los asientos traseros. Los conductores de vehículos nuevos mostraron una tendencia mayor que los otros conductores a usar cinturones de seguridad (p < 0.001). Los conductores varones, los conductores de vehículos más viejos, y todos los pasajeros puede que requieran ser objeto específico de una campaña destinada a educarlos o a hacer cumplir la ley si se desea maximizar los beneficios del uso del cinturón de seguridad.

The prevalence of seat belt use in Kingston, Jamaica: a follow-up observational study five years after the introduction of legislation.

An observational cross-sectional study conducted in Kingston in 2004 showed that seat belts were used by 81.2% of private motor vehicle drivers and 74.0% offront seat passengers. This was significantly improved compared to 21.1% and 13.6% respectively in 1996 before the introduction of legislation in 1999 (p < 0.001). Females were significantly more likely than males to wear seat belts, both when driving (92.5% vs 77.3%; p < 0. 001) and as front seat passengers (79.9% vs 66.3%; p < 0.001). Of the 2289 motor vehicles examined, all except one were equipped with seat belts. Rear passenger utilization of seat belts was not examined. Drivers of new vehicles were more likely than other drivers to use seat belts (p < 0.001). Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign if the maximum benefits of seat belt use are to be realized

Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad / La depresión y sus factores asociados entre los pacientes que asisten a las clínicas de enfermedades crónicas en el suroeste de Trinidad

This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60and a specificity of 94. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76. The patients were primarily Indo-Trinidadian (70), over 50 years (76.4) and female (72.3). The prevalence of depression was 28.3. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics.

Este estudio determinó la prevalencia de la depresión y los factores asociados con ella, entre los pacientes que asisten a las clínicas en el suroeste de Trinidad. El mismo consistió en una encuesta transversal que utiliza una muestra de pacientes consecutivos en cuatro clínicas grandes. A fin de determinar la presencia de la depresión, validamos una escala de depresión de Zung modificada y aplicada por un entrevistador. La escala de Zung modificada, a un índice límite de 60, tiene una sensibilidad de 60% y una especificidad de 94%. Se recibieron setecientos treinta y cuatro cuestionarios respondidos, lo que equivale a una tasa de respuesta de 76%. Los pacientes fueron fundamentalmente indotrinitenses (70%), mayores de 50 años (76.4%) y mujeres (72.3%). La prevalencia de la depresión fue 28.3%. Hubo diferencias estadísticas significativas en el nivel de depresión por edad, sexo, nivel educacional alcanzado, y ocupación (p < 0.05). Hubo también diferencias estadísticamente significativas en el nivel de depresión por el número de quejas que se presentaban, el número de enfermedades crónicas, la presencia de artritis, la presencia de diabetes mellitus junto con otras enfermedades crónicas, y la presencia de cardiopatías isquémicas (p < 0.05). No se hallaron diferencias significativas en relación con la etnicidad (p = 0.97) o la presencia de diabetes mellitus por sí sola (p = 0.34). Los resultados de la regresión logística indican que los predictores independientes de la depresión (p < 0.05) fueron: el nivel educacional alcanzado, poseyendo aquellos con niveles de educación más altos, menos depresión; el número de quejas, presentándose en aquellos con más quejas, una mayor probabilidad de sentirse deprimidos; la presencia de artritis y género femenino. Es imprescindible desarrollar una política encaminada a abordar los problemas de salud mental de los pacientes que asisten a estas clínicas de enfermedades crónicas.

Surgery in the elderly: is age a risk factor?

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources.