Diabetic retinopathy in a black population: the Barbados Eye Study.

OBJECTIVE: The distribution of diabetic retinopathy in black populations is largely unknown. The authors present retinopathy data from the predominately black participants of the Barbados Eye Study (BES). DESIGN AND PARTICIPANTS: Prevalence study of 4631 participants based on a random sample of the Barbados population 40 to 84 years of age (84% participation). MAIN OUTCOME MEASURES: Diabetes was defined as self-reported history of physician-diagnosed diabetes or glycosylated hemoglobin greater than 10% (>2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent gradings of 30 degrees color stereo fundus photographs of the disc and macula. RESULTS: Diabetes was present in 19.4% of black (n = 4314), 15.2% of mixed (black and white; n = 184), and 7.5% of white/other (n = 133) self-reported racial groups. In the black/mixed population, regardless of diabetes status, the prevalence of retinopathy was 5.9%. In the 636 black and mixed participants with diabetes, the prevalence of retinopathy was 28.5%: 19.8% had minimum changes, 7.7% had moderate changes, and 0.9% had severe retinopathy. Clinically significant macular edema (CSME) was found in 8.6% of those with diabetes. CONCLUSIONS: In the population of African origin, approximately 1 in 17 persons had retinopathy. Among those with diabetes, 28.5% had retinopathy and 8.6% had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the black population.     

Self-care adherence and affective disorders in Barbadian adults with type 2 diabetes

PurposeDiabetes management requires adherence to complicated self-care behaviors. Therefore, the emotional state of the individual living with diabetes, is likely to affect their ability to comply with recommendations. This study explored the relationship of self-care adherence to diabetes distress and depression in Barbadian adults with type 2 diabetes.MethodsAdults aged 20 to 80 years, with type 2 diabetes, completed self-report questionnaires comprised of a profile section consisting of demographic and clinical characteristics; and standardized questionnaires comprising, The Diabetes Distress Scale (DDS), The Patient Health Questionnaire (PQH-9), and the Summary of Diabetes Self-care Activities Scale (SDSCA). Additionally biological measures (BP and HbA1c) were collected.ResultsFor the 509 participants there were no differences in adherence for males (30.8%) and females (69.2%), high diabetes distress and depression were associated with low adherence. General diet was negatively associated with BP and HbA1c; while HbA1c was positively correlated with blood glucose testing.ConclusionSelf-care non-adherence is more than a behavioral problem; it is a multidimensional phenomenon inclusive of demographic factors, condition or disease factors, psychological and social factors.     

Seroprevalence of HSV-1 and HSV-2 in Barbados

Type-specific enzyme-linked immunosorbent assays, based upon recombinant glycoprotein G (gG), were used to detect antibodies to HSV-1 and HSV-2, in a small Caribbean island population. A blinded serosurvey was performed on samples from 184 blood donors, 122 pregnant women, and 120 HIV-positive patients. The seroprevalence of HSV-1 and HSV-2 was 81% and 34%, respectively, in blood donors, 84% and 40% in the antenatal population and 89% and 77% in the HIV-positive group. As expected the majority of adults were seropositive against HSV-1. However, the HSV-2 seroprevalence was significantly higher in HIV-infected adults than in the other groups. These findings support the need for prospective epidemiological studies in this population.     

Assessing dietary patterns in Barbados highlights the need for nutritional intervention to reduce risk of chronic disease

Background The dietary habits of the Caribbean have been changing to include more fast foods and a less nutrient dense diet. The aims of this study are to examine dietary patterns in Barbados and highlight foods for a nutritional intervention. Methods Four‐day food diaries collected from control participants in the population‐based, case–control Barbados National Cancer Study (BNCS). Results Forty‐nine adult participants (91% response) completed the diaries providing 191 days of dietary data. Total energy intake was almost identical to data collected 5‐years earlier in the Barbados Food Consumption and Anthropometric Survey 2000, but the percent energy derived from fat was from 2.1% to 5.2% higher. Sugar intake exceeded the Caribbean recommendation almost four‐fold, while intakes of calcium, iron (women only), zinc and dietary fibre were below recommendations. Fish and chicken dishes were the two largest sources of energy and fat. Sweetened drinks and juices provided over 40% of total sugar intake. Conclusions These data provide existing dietary patterns and strongly justify a nutritional intervention program to reduce dietary risk factors for chronic disease. The intervention could focus on the specific foods highlighted, both regarding frequency and amount of consumption. Effectiveness can be evaluated pre‐ and post‐intervention using our Food Frequency Questionnaire developed for BNCS.     

Physical activity levels of barbadian youth and comparison to a U.S. sample

This isthe first study toreport on physical activity levels of young people in Barbados. The Self-Administered Physical Activity Checklist was administered to 1,579 children aged 8 to 18 years. The majority of youth (69%) reported at least 60 min of physical activity on the previous school day. Boys and younger students reported greater physical activity than girls and older students (p < .001). Participation in physical education was low among primary (30%) and secondary (18%) school students, and youth reported the majority of their physical activity took place after school (58%). Physical activity levels and patterns were similar to those of U.S. youth. Gender and grade differences in physical activity could put girls and older youth at higher risk for health problems such as obesity. Policy recommendations to support youth physical activity in Barbados include mandatory daily physical education and after-school physical activity programs.     

Nutritional composition of the commonly consumed composite dishes for the Barbados National Cancer Study

Primary objective To provide, for the first time, the calculated nutritional composition of 32 composite dishes commonly consumed in Barbados to enable dietary intake to be calculated from a Quantitative Food Frequency Questionnaire developed specifically for this population to determine associations between diet and risk of prostate and breast cancer.

Methods and procedures Weighed recipes were collected in up to six different households for each of the 32 composite dishes. The average nutritional composition for these composite dishes was calculated using the US Department of Agriculture National Nutrient Database.

Main outcomes and results One hundred and fifty-two weighed recipes were collected for 32 composite dishes: five were fish based, two were ground beef dishes, two were chicken based, two were offal based, two were lamb dishes, one was pork based, three were rice based, three were commonly consumed home-made drinks, and the remaining were miscellaneous items.

Conclusions A total of 152 weighed recipes were collected and we provide, for the first time, nutritional composition data for 32 commonly consumed food and drink items in Barbados. Such data are essential for assessing nutrient intake and determining associations between diet and prostate and breast cancer in the Barbados National Cancer Study.     

Diabetes distress in Barbadian adults with type 2 diabetes

PurposePsychological disorders such as diabetes distress may negatively influence how patients effectively manage their illness. Therefore, discernment of such influential psychosocial components could be pertinent in promoting competent diabetes management. The vital psychosocial aspect of diabetes distress in diabetes management within the Caribbean context remains unexplored. The purpose of this study therefore was to investigate the prevalence and distribution of diabetes distress (DD), and explore its relationship to socio-demographic and clinical characteristics in Barbadian adults with type 2 diabetes(T2DM).MethodsA cross-sectional survey was conducted with adults (n = 509) ages 20–80 years with T2DM. The survey comprised, a profile section, and a standardized questionnaire—the Diabetes Distress Scale (DDS). In addition, biological (A1C and blood pressure measurements were also collected.ResultsThe sample comprised 30.8% males and 69.2% females. Moderate to high DD identified in 17% of the patients (9.4% moderate distress, 7.2% high distress). Moderate distress was more frequent in unmarried persons; younger persons had high DD. There was no difference in rates of moderate to high DD in women (16.7%) compared to men (16.2%) and, as age and years lived with diabetes increased, diabetes distress decreased.ConclusionsThe results emphasized the need for considerations that must be given to Barbadian diabetes patients'' mental well-being. In recognition of the role DD plays in the patients'' experiences, screening should be incorporated into clinical care.     

The Changing Distribution of Colorectal Cancer in Barbados: 1985–2004

Purpose Recent reports have suggested a shift to the right in older female patients of colon cancer. This is believed to be representative of more accessible national endoscopic screening programs. Methods We report the demographic shift in colorectal cancer based on an analysis of resection specimens during four five-year time periods from 1985 to 2004 at the University Hospital, Barbados. Differences in population-based colorectal cancer incidence, age, gender, site, stage, and presentation (emergency vs. elective) are analyzed. Results A total of 1,014 specimens obtained from 993 patients were analyzed, showing a progressive population-based increase in colorectal cancer in Barbados during this 20-year time period. There was an increase in right-sided tumors (P < 0.0001) without a concomitant decline in left-sided tumors. There was a significant increase in Dukes A cancers (P < 0.0001) without gender predilection. During the time period, there was a significant reduction in right-sided tumors presenting as emergencies (P < 0.005) without an effect of stage or gender. Conclusions There has been a steady increase in both right-sided and left-sided colonic cancers without gender predilection. The increase in early-stage tumors and reduction in emergency presentations during the latter part of the study suggests value in instituting a formal national colonoscopic screening program to assess its prospective effect on these parameters.     

Biological activity of barbados cherry (acerola fruits, fruit of Malpighia emarginata DC) extracts and fractions

Fractionation of barbados cherry (acerola fruit, a fruit of Malpighia emarginata DC.) extracts were performed by organic solvent extractions and column chromatographies, using two extraction methods. Higher cytotoxic activity was concentrated in fractions A4 and A6 (acetone extract), and H3 and HE3 (hexane extract). These four fractions showed higher cytotoxic activity against tumor cell lines such as human oral squamous cell carcinoma (HSC-2) and human submandibular gland carcinoma (HSG), when compared with that against normal cells such as human periodontal ligament fibroblasts (HPLF) and human gingival fibroblasts (HGF). HE2 (hexane extract), AE2 (ethyl acetate extract), AE3, AE4, AE5, A8, A9 and A10 showed some relatively higher anti-bacterial activity on the Gram-positive Staphylococcus epidermidis ATCC 1228 but were ineffective on the representative Gram-negative species E. coli and Ps. aeruginosa. The fractions were inactive against Helicobacter pylori, two representative Candida species, and human immunodeficiency virus (HIV). H3, H4 and HE3, which displayed higher tumor-specific cytotoxicity also showed higher multidrug resistance (MDR) reversal activity, than (+/-)-verapamil as positive control. ESR spectroscopy shows that the radical-mediated oxidation is not involved in the induction of tumor-specific cytotoxic activity. The tumor specific cytotoxic activity and MDR reversal activity of barbados cherry may suggest its possible application for cancer therapy.