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OBJECTIVE: To determine perimenopausal and post menopausal women’s epidemiological risk factors (including the calculated ten year fracture probability of obtaining an osteoporotic fracture), knowledge and attitudes toward osteoporosis in the Bahamas, in a specialist Family Medicine practice setting. DESIGN AND METHODS: Using a cross-sectional survey design, researchers determined epidemiological risk factors, knowledge and attitudes concerning osteoporosis among Bahamian perimenopausal and postmenopausal women and calculated their Fracture Risk Assessment Tool (FRAX) scores for a major osteoporotic and hip fracture. Informed consent was obtained from all participants. The study took place in the Family Medicine clinic of the Public Hospital Authority and selected Public Health Clinics. Data was collected using questionnaires and analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The 347 enrolled female participants mean age was 57.91 (ñ 8.98) years and 76.9% knew what osteoporosis was but had less accurate knowledge about the risk factors. 47.6% was not sure menopause was a contributing factor. 93.1% did not know the recommended daily calcium amount and 34% consumed calcium rich meals daily. 88.3% knew and practiced walking as a preventative method. Attitudes were mainly positive as 82% thought it should be discussed with their physician. FRAX scores were relatively low with only 20% requiring a bone density scan. CONCLUSION: Overall, low FRAX scores indicated low fracture risk among Bahamian women. However, limited knowledge about related risk factors was also evident. Increasing awareness through public education campaigns, addressing modifiable risk factor and involving younger women as well can avoid major complications from osteoporosis in the future.

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OBJECTIVE: To determine the level of adherence, using a validated tool, among diabetics at the Princess Margaret Hospital. DESIGN AND METHODS: A cross-sectional observational study design was used. There were 150 participants, who were admitted to the Princess Margaret Hospital, with diabetes mellitus from May to July 2014. Patients were of either gender, 18 years or older, taking at least one hypoglycaemic medication. Random sampling was used to endeavor that the sample represented the population. The identified patients gave informed consent and then were given self-administered questionnaires on knowledge, compliance and depression. They were assessed through Modified Morisky Scale, and Self -Care habits form. RESULTS: The mean total number of drugs taken daily was 4.77 (+ 2.7). The mean duration on current medications was 8.08(+ 8.12) years. The mean number of changes to medications was 0.87(+ 1.82). The mean number of days in a week participants spaced carbohydrates was 4.09 + 2.365 days. Participants did 30 minutes of physical activity at a mean of 2.21 + 2.6 days a week. The mean previous Morisky score was 1.80 (+ 1.35). The mean of current modified Morisky score was 1.88 (+ 1.32). The mean current motivation score was 1.44 (+ 1.05). The mean of current knowledge score was 2 (+0 .94). The mean score on the Patient Health Questionnaire (PHQ9) depression screening questionnaire was 3.91 (+ 4.21). CONCLUSIONS: The modified Morisky Score showed a medium level of adherence amongst diabetics in the Bahamas.

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OBJECTIVE: To determine the prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas. DESIGN AND METHODS: This study used a cross-sectional design with consecutive sampling. Data about sociodemographic characteristics, depression, and quality of life were collected using a sociodemographic questionnaire, the Beck Depression Inventory BDI-II, and the Short Form36 (SF 36) respectively. Data were analyzed using the Statistical Package for Social Sciences (SPSS). RESULT: 305 individuals (CMI: 106; Dialysis: 199) participated, 22 refused; 50.2% were males, 49.8% were female; mean age was 53.44 (ñ14.44); 45.9% were married; and 32.8% were unemployed for more than 2 years. The prevalence of depression was 43.7% for dialysis patients and 36.8% for CMI patients. Age of patients was associated with marital status, occupational status, ethnicity, and educational level. Hemodialysis patients were shown to have a lower quality of life than CMI patients. Linear regression analysis found that eight quality of life items were statistically significant predictor factors of the Beck score for the CMI and dialysis groups, and accounted for 45.5% of the variance. CONCLUSION: Although, these results did not necessarily demonstrate causality, patients receiving hemodialysis were as likely to be depressed as patients with chronic medical illness. Having to be on hemodialysis detracts significantly from patients’ quality of life.

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OBJECTIVES: To assess parents’ knowledge of HIV and sexually transmitted infection (STI) reduction through male circumcision, determine their desire to have their newborn son circumcised, and quantify impacts of circumcision procedural awareness. DESIGN AND METHODS: A cross-sectional survey of parents attending public healthcare facilities in Nassau, Bahamas, including a subsection completed after reading a circumcision information pamphlet. RESULTS: 314 mothers and 39 fathers were included. 87.8% were Bahamian and 7.4% Haitian. 97.1% followed Christianity. 7.4% had at least one other circumcised son and 25.7% of parents reported a circumcised father. 15.7% were aware that male circumcision reduces a man’s chance of getting HIV and 29.8% knew the procedure reduces STI. 88.5% and 88.4% of Haitians were unaware of male circumcision reducing HIV and STI acquisition, while awareness was greater amongst all those with higher levels of formal education. 55.6% of parents initially opted for neonatal male circumcision - especially circumcised fathers, Bahamian and Jamaican nationals, those who completed at least high school, and those believing male circumcision reduces HIV and STI rates. Improved health, appearance, and hygiene motivated participants more than cultural and religious affiliation. Both parents felt that the decision on neonatal male circumcision should be made in unison. Acceptance rose to 68.0% after reading the information pamphlet on male circumcision. CONCLUSION: Newborn male circumcision is decided on by both parents in most cases with little influence of culture and religion. Information on neonatal male circumcision risks and benefits, including reduction of HIV and STI, lead to an increase in its acceptance.

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OBJECTIVES: To identify factors associated with the Burnout Syndrome in light of the prevalence of that syndrome in physicians working in the Public Hospital Authority (PHA), Nassau, Bahamas. DESIGN AND METHODS: A cross-sectional study was done utilizing a self-administered survey comprising of demographics, general health, work environment, and Maslach Burnout Inventory items to assess burnout among salaried Physicians working in 9 departments of PHA. The Statistical Package for Social Sciences was used for data analysis. RESULTS: 153 physicians participated. Their mean age was 35.84 (ñ 7.09) years; median 34.00 (IQR: 31.00, 40.00) years . 64.7% (99) were females. No association was found between these, other socio-demographic variables measured and burnout status. Physicians in the department of Internal Medicine represented 22.2% (34), Family Medicine 20.3% (31), Emergency Medicine 19.6% (30), Pediatrics 13.7 (21), and physicians in other departments 22.3% (34) of the sample, 55.7% of physicians employed under the PHA collectively exhibited a moderate level of burnout, 9.9% of these physicians having severe burnout Separately, poor balance of family, 15 work environment potential stressors and 4 potential stress relievers were found to be each weakly or very weakly related to burnout status. Postgraduate programme year, irregular sleep pattern and lack of appreciation were moderately strong positively related. Logistic regression analysis showed the key predictors of burnout status to be lack of appreciation (OR=1.69, p=.002) and number of years worked post-internship (OR=.94, p=.039). CONCLUSION: Physicians sensing of appreciation and sleep hygiene were clear predictors of burnout.

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OBJECTIVE: To determine accuracy of knowledge and sexual behaviour patterns of junior high school students in New Providence towards HIV/AIDS and identify gender variations. METHODS: A cross-sectional study with cluster sampling of classrooms was undertaken at two schools utilizing a questionnaire. SPSS was used for statistical analysis. RESULTS: Three hundred and fifty-four students participated in the study; the mean age was 12.25 years, 55.1% males and 44.9% females. Most (88%) students identified sexual intercourse as a mode of HIV transmission, 62.5% were accurate regarding anal sex and 32.9% were accurate about sexual intercourse in the water, as modes of HIV transmission. Abstinence was identified as a method of HIV prevention by 54.1% of students although 85.2% of students knew that condoms were a method of prevention. On beliefs regarding transmission, 21.2% believed mosquito bites and 13.1% believed toilet seats were routes for disease spread. Only 16.9% of participants reported a history of sexual intercourse; of those, 57.6% indicated that they were age < 10 years when they first had intercourse. Concerning use of birth control, 64.5% of sexually experienced respondents reported never using any method. CONCLUSION: Junior high school students have fairly accurate knowledge of HIV/AIDS but misconceptions regarding transmission are still prevalent; patterns in gender variation are few.

OBJETIVO: Determinar la exactitud del conocimiento y los patrones de comportamiento sexual hacia el VIH/SIDA, así como identificar las variaciones de género, entre los estudiantes de escuela secundaria básica en Nueva Providencia. MÉTODOS: Se realizó un estudio transversal con muestreo por conglomerados de aulas en dos escuelas utilizando un cuestionario. Se utilizó el programa SPSS para el análisis estadístico. RESULTADOS: Trescientos cincuenta y cuatro estudiantes participaron en el estudio, de los cuales 55.1% fueron varones y 44.9% hembras. La edad promedio fue 12.25 años. La mayoría (88%) de los estudiantes identificaron las relaciones sexuales como un modo de transmisión del VIH, 62,5% fueron precisos con respecto a la transmisión por sexo anal, y 32,9% fueron precisos acerca de las relaciones sexuales en el agua, como modos de transmisión del VIH. La abstinencia fue identificada como método de prevención del VIH por 54,1% de los estudiantes, aunque 85,2% de ellos sabían que los condones son un método de prevención. Sobre las creencias con respecto a la transmisión, 21.2% creía que las picaduras de mosquitos constituían vías de propagación, en tanto que 13.1% consideraba los asientos de inodoro como rutas para la enfermedad. Sólo 16.9% de los participantes reportaron una historia de las relaciones sexuales. De ellos, 57.6% indicó que tenían < 10 años de edad cuando tuvieron su primera relación sexual. Sobre el uso del control de la natalidad, 64.5% de los encuestados con experiencia sexual, reportaron no haber usado nunca ningún método. CONCLUSIÓN: Los estudiantes de escuela secundaria tienen un conocimiento bastante preciso del VIH/SIDA, pero los conceptos erróneos acerca de la transmisión son aún frecuentes. Los patrones de variación de género son pocos.

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OBJECTIVE: To assess the knowledge, compliance and practice among healthcare workers of occupational infection control at two hospitals in Jamaica. METHODS: Employing a cross-sectional study design, medical personnel (physicians and nurses) at two hospitals in Jamaica, were studied, utilizing a structured questionnaire consisting of 14 items to collect the data. RESULTS: Participants considered the following fluids, not blood stained, high risk for HIV transmission: breast milk (79%), saliva (14%), urine (27%), pleural fluid (53%), CSF (55%), synovial fluid (37%), faeces (27%), peritoneal fluid (53%) and vomitus (21%). The respondents estimated the risk of transmission of infection after a needlestick injury from a patient with: HIV, mean 22.5%, HBV, 34% and HCV, 26%. Needles for drawing blood were identified as having the highest risk for transmission of infections in 63%. The following precautions were adhered to all the time: wearing gloves (38%), not resheathing needles (22%), not passing needles directly to others (70%), properly disposing of sharps (86%) and regarding patients' blood and other high risk fluid as potentially infected (62%). Post exposure, 43% indicated bleeding/squeezing the NSI site as the initial first-aid procedure, washing with soap and water (29%) and irrigating the area with water (20%) CONCLUSIONS: Healthcare workers are aware of the risk of transmission of infection, however compliance with universal precautions was inadequate. An improvement in knowledge and practice with clear guidelines are needed and a comprehensive programme to educate HCWs regarding compliance with universal precautions is urgently required.

OBJETIVO: Evaluar los conocimientos, el cumplimiento de medidas, y la práctica entre los trabajadores de la salud encargados del control ocupacional de infecciones en dos hospitales en Jamaica. MÉTODOS: Empleando un diseño de estudio transversal, se estudió el personal médico (médicos y enfermeras) de dos hospitales en Jamaica. En el estudio se utilizó una encuesta estructurada de 14 puntos, para recoger los datos. RESULTADOS: Los participantes consideraron que los fluidos siguientes, no sanguinolentos, presentan un alto riesgo de transmisión de VIH: leche materna (79%), saliva (14%), orina (27%), fluido pleural (53%), LCR (55%), fluido sinovial (37%), heces (27%), fluido peritoneal (53%) y vómito (21%). Los encuestados estimaron el riesgo de transmisión de infección después de una lesión por punción con aguja de un paciente con: VIH, media 22.5%, VHB, 34% y VHC, 26%. Las agujas para extraer sangre fueron identificadas como el factor de mayor riesgo en la transmisión de infecciones, con 63%. Las precauciones siguientes se observaron todo el tiempo: uso de guantes (38%), no recapar agujas usadas (22%), no pasar agujas directamente a otros (70%), eliminar adecuadamente los desechos cortopunzantes (86%), y considerar la sangre de los pacientes y otros fluidos de alto riesgo de los pacientes, como potencialmente infectados (62%). En cuanto a la post-exposición, el 43% indicó hacer sangrar/ejercer presión sobre el sitio de la LPA como el procedimiento inicial para los primeros auxilios, lavando con jabón y agua (29%) e irrigando el área con agua (20%) CONCLUSIONES: Los trabajadores de la salud tienen conciencia del riesgo de la transmisión de infecciones. No obstante, el cumplimiento de las medidas universales era inadecuado. Es necesario mejorar los conocimientos y las prácticas con normas claras, y se requiere con urgencia un programa integral para educar a los trabajadores de la salud en relación con el cumplimiento de las medidas universales.

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OBJECTIVE: To assess the prevalence of needlestick injuries (NSIs) and other high risk exposures among healthcare workers at two hospitals in Jamaica. METHODS: Employing a cross-sectional study design, medical personnel (physicians, nurses) at two hospitals in Jamaica, were studied, utilizing a structured questionnaire consisting of 14 items to collect data on needle stick injuries and other injuries. RESULTS: There were 67 needlestick injuries in 47 persons. Of those sustaining an injury, 52% of physicians and 40% of nurses had NSIs. re-capping needles accounted for 21% of injuries, various minor procedures, 21%, injury during surgery, 19.4% and taking blood, 12%. In those sustaining NSIs, 47% were reported and 26% of reported cases received counselling. Appropriate blood tests were performed on 34% and post-exposure prophylaxis (PEP) for HIV was administered to 30%. Hollow bore needles caused 47.8% of injuries, 25.4% occurred with suture needles and 19.4% with intravenous branulas. Other occupational exposure was reported by 31%, including blood on hands and other body parts 39%, blood to face and eyes, 18%, splashed with liquor, 18%, splashed with bloody fluid, 11% and contact with vomitus and urine in eye, 4%. CONCLUSION: Needlestick injuries and other high risk exposures were high; incident reporting and post exposure management were inadequate. A comprehensive programme to address factors that contribute to the occurrence of NSIs and other occupational exposures is urgently needed.

OBJETIVO: Evaluar la prevalencia de lesiones por punción con aguja (LPA) y otras exposiciones de alto riesgo entre trabajadores de la salud en dos hospitales de Jamaica. MÉTODOS: Empleando un diseño de estudio transversal, se estudió el personal médico (médicos y enfermeras) de dos hospitales en Jamaica. En el estudio se utilizó una encuesta estructurada de 14 puntos, para recoger datos sobre lesiones por punción con aguja y otros tipos de lesiones. RESULTADOS: Hubo 67 lesiones por punción con agujas en 47 personas. De las personas con heridas, 52% fueron médicos y 40% enfermeras que sufrieron lesiones por punción con agujas. El intento por recapar agujas dio cuenta del 21% de las lesiones; varios procedimientos menores, representaron el 21%; las lesiones durante cirugías, 19.4%; y la recogida de sangre, 12%. Entre los que tuvieron LPAs, 47% fueron reportados y el 26% de los casos reportados recibieron aconsejamiento. Se realizaron análisis de sangre apropiados en 34% y la profilaxis post-exposición (PPE) para el VIH se administró al 30%. Las agujas hipodérmicas causaron el 47.8% de las lesiones; el 25.4% ocurrieron con agujas de sutura, y 19.4% con bránulas IV. Otra exposición ocupacional fue reportada por 31%, incluyendo sangre en las manos y otras partes del cuerpo, 39%; sangre en la cara y los ojos, 18%; salpicados con fluido corporal, 18%; salpicados con fluido sanguinolento, 11%; y contacto con vómito y orina en los ojos, 4%. CONCLUSIÓN: Las lesiones por punción con agujas y otras exposiciones de alto riesgo fueron altas. Los reportes de incidentes y el tratamiento de la post exposición fueron inadecuados. Se necesita urgentemente un programa integral para abordar los factores que contribuyen a que se produzcan LPAs y otras exposiciones ocupacionales.

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OBJECTIVE: To determine antibiotic usage patterns in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI). METHOD: A cross-sectional, analytical study of consecutive patients admitted to the ICU was conducted between July and December 2007. Exclusion criteria were HIV-positive patients, patients < 12 years and those discharged or who died within 48 hours of admission. Data were collected from medical records, stored and analysed using the SPSS Version 12. RESULTS: Of the 150 eligible patients, 109 had complete data (73%). Mean age was 50.8 ± 20.7 years, with mean APACHE II score of 15.6 ± 6.7. Forty-five patients (41.3%) received prophylactic antibiotics, most commonly ceftriaxone (31.7%) and metronidazole (19.0%). Appropriate discontinuation within 24 hours occurred in only 11.1%. Two-thirds of patients (67.9%) were treated with empiric antibiotics, most commonly piperacillin/tazobactam (32.1%), ceftazidime (27.5%) or metronidazole (27.5%). Reasons for empiric choice were primarily coverage of organisms based on presumed source of sepsis (45.6%), and broad spectrum, high-powered coverage (23.5%). Courses ranged from 1 - 42 days and were adequate based on subsequent cultures in 71% of cases. Culture reports took between 2 - 8 days with a mean of 3.7 days to become available. De-escalation was practised in only 2 of 26 (7.7%) cases and intravenous to oral switch therapy in only 3.3%. Thirty-two (29.4%) patients died, with sepsis being a cause in 12 (37.5%). CONCLUSIONS: Improved attention to discontinuation of prophylactic antibiotics, appropriate duration of antibiotic courses and de-escalation are essential if the antibiotic practices in the ICU at the UHWI are to compare favourably with international recommendations.

OBJETIVO: Determinar los patrones de uso de antibióticos en la Unidad de Cuidados Intensivos (UCI) en el Hospital Universitario de West Indies. MÉTODO: Se llevó a cabo un estudio analítico transversal de un número de pacientes consecutivos ingresados a la UCI entre julio y diciembre de 2007. Los criterios de exclusión fueron los siguientes: pacientes positivos al VIH, pacientes < 12 años, y pacientes dados de alta o fallecidos dentro de las 48 horas de su ingreso. Los datos fueron tomados de las historias clínicas, y luego almacenados y analizados usando la versión doce de SPSS. RESULTADOS: De los 150 pacientes elegibles, 109 completaron los datos (73%). La edad promedio fue 50.8 ± 20.7 años, con una puntuación APACHE II media de 15.6 ± 6.7. Cuarenta y cinco pacientes (41.3%) recibieron antibióticos profilácticos, por lo general ceftriaxona (31.7%) y metronidazol (19.0%). Una descontinuación adecuada dentro de las 24 horas se produjo en sólo 11.1%. Dos tercios de los pacientes (67.9%) recibieron tratamiento antibiótico empírico, por lo general con piperacillinatazobactam (32.1%), ceftazidima (27.5%) o metronidazol (27.5%). Las razones para la opción empírica fueron principalmente la cobertura de organismos sobre la base de fuentes de sepsis presuntiva (45.6%), y el espectro ancho, cobertura de alta potencia (23.5%). Los cursos fluctuaron de 1 - 42 días y fueron adecuados a juzgar por los cultivos subsiguientes en 71% de los casos. Los reportes de cultivos tomaron entre 2 - 8 días con un promedio de 3.7 días para hallarse disponibles. El desescalamiento fue practicado en sólo 2 de 26 (7.7%) de los casos y cambio de terapia intravenosa a oral en sólo 3.3%. Treinta y dos (29.4%) pacientes murieron, siendo la sepsis la causa en 12 (37.5%). CONCLUSIONES: Una mayor atención en cuanto a descontinuar el uso de antibióticos profilácticos, una duración apropiada de cursos antibióticos, y el desescalamiento, son esenciales si se quiere que las prácticas antibióticas en las UCI en el HUWI puedan compararse favorablemente con las recomendaciones que se hacen a nivel internacional.

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BACKGROUNDS: Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally. METHOD: This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinical features. These cases were compared with non-neutropaenic cancer patients admitted with fever. RESULTS: A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients. CONCLUSION: Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

ANTECEDENTES: La neutropenia febril es una complicación común de la quimioterapia en pacientes con cáncer. Los regimenes de antibióticos empíricos se basan en las características epidemiológicas de aislados bacterianos, tanto global como localmente. MÉTODO: Este estudio examinó retrospectivamente todos los casos de neutropenia febril con confirmación de cáncer, ingresados y tratados con quimioterapia en el Hospital Universitario de West Indies, Jamaica, en el período de cuatro años entre el 1ero, de enero de 2003 y el 31 de diciembre de 2006. Se identificaron casos con historias de cultivos de sangre e historias clínicas que fueron examinadas para determinar los agentes etiológicos causantes de la bacteriemia, sus susceptibilidades antimicrobianas y características clínicas. Estos casos fueron comparados con pacientes de cáncer no neutropénicos ingresados con fiebre. RESULTADOS: Se examinaron un total de 197 episodios febriles en pacientes de cáncer. El treinta y siete por ciento tuvo neutropenia febril, mientras que el 62% eran no neutropénicos. La leucemia mieloide aguda fue la malignidad hematológica más común, y el tumor sólido más común fue el cáncer de mamas. Veintiséis por ciento de .los pacientes tuvieron cultivos de sangre positivos. En los pacientes neutropénicos febriles, Escherichia coli fue el organismo aislado más común, seguido de los estafilococos coagulasa-negativos, mientras que en los pacientes no neutropénicos, los estafilococos coagulasa-negativos fueron los más comúnes. Las infecciones por Acinetobacter fueron prominentes en pacientes no neutropénicos pero ausentes en los pacientes neutropénicos. Más de un organismo fue cultivado en 9 pacientes neutropénicos y 18 en no neutropénicos. La mortalidad fue de 10.8% en los pacientes neutropénicos y 24.4% en los no neutropénicos. CONCLUSIÓN: Los organismos gram-negativos son los aislados que predominan en los episodios neutropénicos febriles en Jamaica. Los pacientes no neutropénicos vieron su mortalidad aumentada con el incremento en infecciones Acinetobacter y aislados múltiples.

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