Descriptive Epidemiology of Asthma in Trinidad, West Indies

This cross-sectional study documents the demographic features of asthmatics seeking acute asthma care at four institutions on the island of Trinidad from January 1 to December 31, 1997. More than 15,000 (15,035) different patients made 27,353 visits during the study period. Pediatric and adolescent male patients outnumbered females, but this was reversed in patients aged 20-69 years. Frequency of visits per patient ranged from 1 to 242. Significant variation in monthly admissions was observed; admission rates were highest in the last quarter of the year but were lowest in July and August. The overall crude prevalence rate was estimated at 1.71 per 100 (range 1.16-2.34).     

The neurodevelopmental abilities of very-low-birthweight children in Trinidad, West Indies

Neurodevelopmental abilities of 33 very-low-birthweight (VLBW) Trinidadian children and randomly selected matched pairs of classmates who were of normal birth weight were tested in 1998 at ages 68-88 months, using the McCarthy Scales of Children's Abilities. The 1 min Apgar score was significantly lower in the VLBW children, 6.5 (SD 1.0) versus 7.7 (SD 1.27), P相似文献   

Dengue cases and Aedes aegypti indices in Trinidad, West Indies

This study was conducted to determine whether any relationships exist between Aedes aegypti indices, dengue seroprevalence and dengue transmission in County Victoria, Trinidad, West Indies. The cardinal points surveillance method was used to evaluate 50 suspected dengue fever (DF) cases. Thirty-three (33) confirmed DF cases were fully investigated within 48 h of clinical diagnosis. Using retrospective data collected during the previous year (2003-2004) and study data, key premises and key containers were determined. Ninety-two percent of the houses were considered key premises, and 66% (22/33) of the houses with dengue positive cases harboured Ae. aegypti immature stages. These results showed that significantly (P < 0.001) more adults (1050 vs 493) and immatures were collected during dengue case investigations than during routine inspection and treatment cycles. In addition, when the DF diagnosis was made the pupae per person rates increased from 0.65 to 1.35 with significantly (P < 0.001) larger numbers of Ae. aegypti females emerging daily, increasing from 221 to 472.5. That is, the mosquito density required for DF transmission may be high for Trinidad given the high seroprevalence rates (94% among pregnant women). These results suggest that dengue transmission occurs, not at a fixed entomologic figure/quantity but rather at a variable level based on numerous factors including seroprevalence, mosquito density and climate. These findings have implications for effective programs: by combining cardinal points and the key premises approaches; vector control programs can now target the most productive containers in key premises thus reducing dengue transmission levels.     

Impact of vector control on a dengue fever outbreak in Trinidad, West Indies, in 1998

In 1998, Trinidad experienced its first major outbreak of dengue haemorrhagic fever. Data from the Trinidad Public Health Laboratory, the National Surveillance Unit and Insect Vector Control Division, Ministry of Health, Trinidad and Tobago were analysed to determine the impact of vector control measures on the dengue outbreak. Geographical Information Systems (GIS)/Global Positioning Systems (GPS) were used to map cases and to distinguish epidemiological clusters. The Aedes aegypti population densities were higher than the 5% transmission threshold in all counties. The spatial distribution of dengue fever cases was significantly correlated with the heavily populated east-west corridor in the north and several distinctly separate clusters in the western part of the island. The temporal distribution patterns showed significantly more dengue fever cases occurring during the rainy season than during the dry season. This study documents the importance of vector control in the prevention of dengue transmission since no vaccine is currently available, and emphasizes the urgent need to understand better the environmental factors which contribute to the proliferation of this disease vector Ae. aegypti.     

Leptospirosis in dogs and cats on the Island of Trinidad: West Indies

Confirming previous observations on dog populations in other parts of the world, notably Japan, the Philippine Islands, and some countries in South America, we found that a high percentage of dogs in Trinidad are infected with organisms from many serogroups of Leptospira. Serogroups Canicola and Icterohaemorrhagiae were most commonly found. Ten isolates obtained from 50 kidneys from stray dogs (20% infectivity rate) were typed as portland-vere (six) and canicola (two) of the Canicola serogroup, copenhageni of the Icterohaemorrhagiae serogroup (one), and georgia in the Hebdomadis serogroup (one). To the best of our knowledge, this is the first record of a serotype in the Hebdomadis serogroup being isolated from a dog. A cat isolation was identified as canicola. Serological results showed that 55% or more of stray dogs had been exposed as opposed to only 12.5% of the cats examined. Serogroups Canicola, Icterohaemorrhagiae and Hebdomadis are found most frequently in dogs, cats, mongooses, and man in Trinidad.     

Impact of road networks on the distribution of dengue fever cases in Trinidad, West Indies

This study examined the impact of road networks on the distribution of dengue fever cases in Trinidad, West Indies. All confirmed cases of dengue hemorrhagic fever (DHF) observed during 1998 were georeferenced and spatially located on a road map of Trinidad using Geographic Information Systems software. A new digital geographic layer representing these cases was created and the distances from these cases to the nearest classified road category (5 classifications based on a functional utility system) were examined. The distance from each spatially located DHF case to the nearest road in each of the 5 road subsets was determined and then subjected to an ANOVA and t-test to determine levels of association between minor road networks (especially 3rd and 4th class roads) and DHF cases and found DHF cases were located away from forests, especially 5th class roads). The frequency of DHF cases to different road classes was: 0% (1st class roads), 7% (2nd class roads), 32% (3rd class roads), 57% (4th class roads) and 4% (5th class road). The data clearly demonstrated that both class 3 and class 4 roads account for 89% of nearby dengue cases. These results represent the first evidence of dengue cases being found restricted between forested areas and major highways and would be useful when planning and implementing control strategies for dengue and Aedes aegypti mosquitoes.     

Plasmodium malariae in East Timor

A community-based rainy-season malaria prevalence survey was conducted in Bobonaro district, in recently independent East Timor, in 2001. Although the survey was primarily aimed at defining the prevalence of Plasmodium falciparum and P. vivax, six individuals with P. malariae infection were identified (prevalence 0.57%). We believe these are the first reported cases of P. malariae from the island of Timor.     

Chloroquine-resistant Plasmodium malariae in south Sumatra,Indonesia

Oral chloroquine is the treatment of choice for uncomplicated Plasmodium malariae infections worldwide. We did a prospective 28-day in-vivo assessment of the efficacy of chloroquine for treatment of P malariae on Legundi Island in Lampung Bay, Sumatra, Indonesia. Of 28 patients, one had recurrent parasitaemia on day 28, and two had persistent parasitaemia to day 8. Whole-blood chloroquine and desethylchloroquine concentrations were at ordinarily effective levels (> or = 100 microg/L) on day 8 in both cases of persistent parasitaemia. These findings suggest that clinical resistance to chloroquine by P malariae occurs in the Indonesian archipelago of southeast Asia.     

Chronic obstructive pulmonary disease is missed in asthmatics in specialty care in Trinidad, West Indies.

SETTING: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in asthmatics attending specialty care in Trinidad, West Indies. OBJECTIVE: To determine the prevalence of COPD in diagnosed asthmatics receiving specialty respiratory care. DESIGN: In a cross-sectional study, 258 asthmatics were screened for lung function measures to examine forced expiratory volume after 1 second (FEV1), forced vital capacity (FVC) and post-bronchodilator FEV1/FVC (COPD was defined as FEV1/FVC < 70%). RESULTS: Of 165 patients evaluated (response rate 64.0%), 53 (32.1%, 95%CI 25.0-39.2) had a study diagnosis of COPD and a mean FEV1/FVC of 60.12 +/- 1.2. Proportionally, more males had COPD (50.9%) than asthma (24.1%, P < 0.001). Patients with COPD were 10 years older than asthmatics (P < 0.001). Persons with asthma who smoked were more likely to have COPD (56.0%) (OR 3.26, 95%CI 1.36-7.80, P = 0.006). In both sexes, FEV1/FVC was lower among older people (P < 0.001), with a greater effect (OR 2.75, 95%CI 1.00-7.56, P < 0.01) seen among men in this cross-sectional study. CONCLUSIONS: One third of diagnosed asthmatics in specialty care also have COPD. Lung function was lower among older persons. Early spirometric evaluation of elderly asthmatics who smoke can determine the presence of COPD and facilitate appropriate management.     

Serum cholinesterase levels of vector control workers in Trinidad, West Indies (1979-1987).

During 1979-1987 studies were carried out in vitro on the serum cholinesterase levels of 46 vector control workers exposed to insecticides on a daily basis but without clinical manifestations of insecticide poisoning. The results were compared with those of a control group of workers who had not been exposed to insecticides at home or at work. Cholinesterase levels of both groups were determined by a standard colorimetric method. Suppressed serum cholinesterase levels were detected in all 46 workers exposed to insecticides, 25 of whom were aged 30-39 years. Four persons from the control group showed suppressed levels of enzyme; one of these had a genetically low level, and the other three were on medication when the low levels were recorded.     

Associations between climate variables and asthma visits to accident and emergency facilities in Trinidad,West Indies

The purpose of the present study was to describe patterns in weekly asthma visits to Accident and Emergency (A&E) facilities in Trinidad during 1997 and to examine associations with climatic conditions. A census of patients with asthma, defined as those who required bronchodilator nebulization, was taken at five A&E facilities in the Caribbean island of Trinidad from 1 January to 31 December 1997. Data on patients’ ages, gender and dates of visits were obtained from the A&E records. Climate variables, including rainfall, temperature, relative humidity and wind speed, were obtained from the island’s meteorological office. There was a total of 27 848 asthma visits to the five facilities during 1997, of which the pediatric population (< 16 years) accounted for 43.7%. There were steady increases in adult and elderly visits from January to December. In the pediatric population, there was a decrease in visits from weeks 5–36 in the year, followed by a sharp increase during the next 3 weeks. This sharp increase coincided with the start of the academic school year in September after a 2 month break. The results of multiple regression analysis indicated that pediatric visits to the A&E were positively associated with temperature and wind speed, while visits by adults were positively associated with temperature and relative humidity. There were no independent predictors of asthma visits in the elderly. The results show that there is an association between the climate and asthma visits in Trinidad. However, there is a need for further research to explain the increase in pediatric visits at the start of the school year as well as to elucidate the mechanisms for the observed associations between asthma visits and climate variables.     

Do current standards of primary care of diabetes meet with guideline recommendations in Trinidad,West Indies?

AimsPrimary care management of diabetes was examined using the Caribbean Health Research Council (CHRC) guidelines.MethodsWe retrospectively examined a cross-section of 646 type 2 people with diabetics over 12 months with 1st visit between 1997 and 2005.ResultsThere were more women (65.8%) than men (34.2%) with age range between 29 and 89 years. Blood pressure and weight were evaluated in >95% of patients at each centre. Waist circumference and BMI were not measured at any time and HbA₁c was infrequently measured (1.6–7%) over the 12 months. Information on family history (87.5%), smoking and alcohol (78.1%), exercise (21.4%), socioeconomic status (19.4%) and education (0.3%), and fasting blood sugar (97.2%), lipid profile (51.8%) and serum creatinine (37.9%) were assessed at the 1st visit. At follow-up patients were advised on treatment compliance (47.2%), diet (34.2%), exercise (18.5%) and rarely on home monitoring of blood glucose (0.3%). Peripheral sensations, pedal pulses (6%), visual acuity (3.3%), fundoscopy (12.1%) and ECG (3.9%) were scarcely examined at the annual visit.ConclusionsCurrent management of diabetes in primary care in Trinidad falls short of Caribbean guideline recommendations. The CHRC and Ministry of Health should jointly educate caregivers of diabetes to implement the guidelines, with annual audits to identify shortfalls in management.     

三日疟与恶性疟混合感染一例报告

患者．男性，36岁，四川省射洪县人。2004年11月中旬到云南，在瑞丽中缅两国边境接壤的秀岛镇做运输木材工作。弄岛三面被缅甸环绕，距瑞丽市28km。患者从边境多次往返于缅甸境内运木材．每次停留约1周。于2005年3月底返乡后有过感冒样前驱症状：表现为周身不适、头晕、乏力、腰酸背痛、食欲不振伴有轻微呕吐，并于4月5日起反复发热，4月9日后表现为不规则发热并日渐加重．体温最高达40．4℃，伴有寒战、呕吐、头痛、咳嗽。     

Environmental conditions in water storage drums and influences on Aedes aegypti in Trinidad, West Indies

Water storage drums are often a primary breeding site for Aedes aegypti in developing countries. Habitat characteristics can impact both adult and larval fitness and survival, which may potentially influence arbovirus transmission. Our objective was to compare fundamental environmental differences in water drums based on the presence or absence of larvae in Trinidad. Drums were categorized according to the larval status, and if the drum was constructed of steel or plastic. Water samples were analyzed for ammonium, nitrate, and soluble reactive phosphorus (SRP). Continuous surface water temperatures were also recorded. Nutrient concentrations were considerably lower than those reported for other container breeding mosquitoes. No nutrient measured differed in concentration between drums positive compared to those that were negative for the presence of A. aegypti larvae. Levels of SRP and ammonium in steel drums were significantly lower than in plastic water drums. Both maximum and minimum surface temperatures were significantly lower in drums positive for the presence of larvae than in drums without larvae. Water temperatures in March and May were warmer than during October sampling periods. Larval presence is likely dependent upon the interaction among multiple biotic and abiotic factors. Despite appearance, not all water storage drums are equally suitable for A. aegypti development. Exposing water storage drums to direct sunlight or increased heat may be used in conjunction with sealing containers to reduce production of A. aegypti when draining and chemical treatment are impractical.