West Indian diabetic population of a large inner city diabetic clinic

West Indians form a sizable minority of diabetics attending many inner city diabetic clinics. There are 554 diabetics of West Indian origin on our computer files--7% of the total recorded clinic population. Of these 554 patients (56% female, 44% male), 70% have been diagnosed within the past five years; and only 9% have had diabetes for over 10 years; in only five (1%) was diabetes diagnosed before the age of 20. Sixteen per cent were taking insulin, but only 4% of the total West Indian population were truly insulin dependent. Of 65 patients admitted in hyperglycaemic coma or precoma over the past three years, 10 were of West Indian origin; eight of these 10 had hyperosmolar coma compared with only six of the remaining 55. We conclude that diabetics of West Indian origin attending our clinic show differences in the distribution of age and duration of diabetes from the caucasian population. Most are non-insulin dependent, and the frequency of hyperosmolar coma is higher than that of ketoacidosis. Diabetics of West Indian origin may have a different pattern of disease from the rest of the clinic population.     

Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community

CONTEXT: Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infections have been acquired primarily in nosocomial settings. Four recent deaths due to MRSA infection in previously healthy children in the Midwest suggest that serious MRSA infections can be acquired in the community in rural as well as urban locations. OBJECTIVES: To document the occurrence of community-acquired MRSA infections and evaluate risk factors for community-acquired MRSA infection compared with methicillin-susceptible S aureus (MSSA) infection. DESIGN: Retrospective cohort study with medical record review. SETTING: Indian Health Service facility in a rural midwestern American Indian community. PATIENTS: Patients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997. MAIN OUTCOME MEASURES: Proportion of MRSA infections classified as community acquired based on standardized criteria; risk factors for community-acquired MRSA infection compared with those for community-acquired MSSA infection; and relatedness of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of 112 S aureus isolates, 62 (55%) were MRSA and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified as community acquired. Risk factors for community-acquired MRSA infections were not significantly different from those for community-acquired MSSA. Pulsed-field gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired MRSA isolates were clonally related and distinct from nosocomial MRSA isolates found in the region. CONCLUSIONS: Community-acquired MRSA may have replaced community-acquired MSSA as the dominant strain in this community. Antimicrobial susceptibility patterns and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in this and possibly other rural US communities.     

Growth and development of West Indian children. Part I: Growth

The growth of Caribbean infants is comparable to the NCHS standards until approximately 3 months of age despite somewhat lower birthweights. After this, growth rates decline. This pattern is similar to that seen in other developing countries (Condon-Paolini et al, 1977; Whitehead, 1979; Rowland et al, 1988). By 18 months of age, average weights and heights of Jamaican children approached the 10th centile of the NCHS standards and remained below the 40th centile throughout childhood. Ashcroft's studies of growth in childhood showed that the pattern of growth was similar in a number of countries in the Region but, in more recent nutritional surveys, differences between countries can be detected. For example, the prevalence of undernutrition is lower in Barbados but conversely obesity, especially in older girls, is becoming a significant problem. Most of the growth data on which this review is based was collected in the 1960s and early 1970s. Only a few studies provided longitudinal data. These were primarily those concerned with growth in the first year of life and the Lawrence Tavern study in which children were measured up to 4 years of age. There is clearly a need for more recent data, particularly longitudinal, since the available data suggest that secular changes are occurring. Surveys of nutritional status provide some information on the adequacy of growth but cannot be a substitute for measurements of normal growth patterns.