RESUMO
INTRODUCTION: Recent attention has been focussed on pregnancy outcomes in developing countries, with the publication of the World Health Organization Report 2005, Make Every Mother and Child Count and the Neonatal Survival Series from the Lancet in 2005. Scant outcome data from the smaller islands of the Caribbean exist for very low birthweight (VLBW) babies (birthweight < 1500 g). PATIENTS AND METHODS: A retrospective review of mortality data on VLBW babies in Antigua and Barbuda was performed. Antigua and Barbuda had a population of 71 500 with per capita income of (US) $6054 dollars in 1998. In November 1985, a neonatal Special Care Nursery (SCN) was established. The survival to discharge from SCN for VLBW babies was reviewed from January 1986 to December 2006. RESULTS: There were 26 455 babies born from 1986 to 2006; 344 (1.3%) were VLBW babies. Survival to SCN discharge was 45% from 1986 to 1992, 46% from 1993 to 1999, and increased to 60% from 2000 to 2006 (p < 0.05 compared with the first two time-periods). Babies from 1000 to 1499 g accounted for 64% of VLBW babies and survival to SCN discharge was 60% from 1986 to 1992, 58% from 1993 to 1999, and increased to 83% from 2000 to 2006 (p < 0.01 compared with the first time period; p < 0.001 compared with the second). Babies < 1000g accounted for 36% of VLBW babies and survival to SCN discharge was 10% from 1986 to 1992, increased to 25% from 1993 to 1999 and to 28% from 2000 to 2006 (trend of p < 0.10 compared with first time period). Conservative newborn care only was available. Antenatal steroids were given from 2000 to 2006. CONCLUSION: The outlook for VLBW babies using conservative newborn care techniques has significantly improved over 21-years in Antigua and Barbuda.
Assuntos
Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Antígua e Barbuda/epidemiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Análise de SobrevidaRESUMO
The purpose of this study is to compare the demographic and clinical characteristics of clients leaving treatment prior to completion of the 29-day residential stay at a multicultural addiction treatment centre. The charts of 446 clients (62% from the United States of America, 29% from the Caribbean region, 9% European) were reviewed. The mean age was 39.7 years, 33% female, with 91% using alcohol, 49% using cocaine, 25% using opioids (single drug 27%, poly-drug use 73%), with mean 13.1 years of harmful use, 33% using prescribed mental health medications and 46% having had prior residential treatment. Of 446 clients, 76 (17%) did not complete treatment stay. A comparison of clients leaving early and those completing stay revealed no difference in age (38.6 vs 39.9 years) or years of harmful use (11.7 vs 13.4 years). There were trends toward those leaving to be more often female (42 vs 31%, p < 0.10) and non-Caribbean (20% American or European vs 12% Caribbean, p < 0.10). Clients who left early were more likely to use opioids (41 vs 22%, p < 0.001) and less likely to use alcohol/sedative (83 vs 1%, p < 0.02). Cocaine/stimulant use did not differ (49 vs 49%). Those leaving treatment early had greater use of mental health medications (50 vs 29%, p < 0.001). Prior treatment was not significantly different (53 vs 44%). An analysis of the 128 clients from the Caribbean region showed 15 clients (12%) failed to complete treatment. Those leaving treatment early were more likely to be female (53 vs 26%, p < 0.05), had a trend toward being younger (35.6 vs 39.9 years, p = 0.19) and had fewer years of harmful use (8.1 vs 13.1, p < 0.02). Ethnicity (73 vs 74% African) and alcohol/sedative (87 vs 94%), cocaine/stimulant (53 vs 65%), and opioid use (0 vs 4%) did not differ. Those leaving were more likely to use mental health medication (47 vs 12%, p < 0.001) and there was a trend toward prior treatment (40 vs 23%, p < 0.10).
Assuntos
Tratamento Domiciliar , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Recusa do Paciente ao Tratamento , Adulto , Antígua e Barbuda , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/etnologiaRESUMO
OBJECTIVE: To assess the effect of a government funded asthma medication programme on paediatric (age < or = 12 years) asthma hospital admissions in Antigua and Barbuda. METHODS: A retrospective review of all hospital admissions for asthma in children was performed for the six years before and six years after a Medical Benefits Scheme (MBS) programme was established in 1997 to provide asthma medications at no out-of-pocket cost. Holberton Hospital records (1992 to 2003) which include all paediatric asthma admissions in Antigua and Barbuda, were reviewed RESULTS: Paediatric admissions for asthma fell from mean +/- standard deviation of 77.0 +/- 24.8 per year before the MBS programme was started to 48.0 +/- 17.1 per year (p < 0.05) after the MBS programme was started. The number of multiple admissions fell from 18.7 +/- 2.7 to 9.5 +/- 4.8 (p < 0.005) and the number of children admitted multiple times per year fell from 7.8 +/- 1.9 to 4.7 +/- 2.5 (p < 0.05). The number of children aged four to nine years admitted with asthma fell from 7.8 per 1000 annually during 1992 to 1997 to 4.4 per 1000 per year during 1998 to 2003. CONCLUSIONS: The government funded MBS programme for asthma medication has resulted in a 38% decrease in hospital admissions for paediatric asthma over a six-year period. The benefits of a similar programme in other developing countries should be considered.
Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Antiasmáticos/economia , Antígua e Barbuda , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
In the epidemiological transition from infectious diseases in the Caribbean, chronic non-communicable diseases, including cardiovascular disease, have emerged as important public health interest. Although hypertensive heart disease predominates in Afro-Caribbean populations, ischaemic heart disease and acute myocardial infarction have also been present, but the prevalence has been somewhat under-appreciated.
Assuntos
Infarto do Miocárdio/etnologia , Infarto do Miocárdio/epidemiologia , Povo Asiático , População Negra , Feminino , Previsões , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índias Ocidentais/epidemiologiaAssuntos
População Negra , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etnologia , Eletrocardiografia , Adulto , Idoso , Antígua e Barbuda/epidemiologia , Bloqueio de Ramo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , UltrassonografiaRESUMO
A retrospective study was undertaken to determine trends in teenage births in Antigua and Barbuda from 1969 to 2003. Maternity Ward records were reviewed at Holberton Hospital, site of over 90% of deliveries in Antigua and Barbuda. Maternal age for all births were included. The estimated population in Antigua and Barbuda increased from 60,159 in 1969 to 69,866 in 1998, with no suspected change in age-group or gender distribution. Births to mothers 12-13, 14-15, 16-17 and 18-19 years old were analyzed separately. Yearly birth totals for the 10-year period from 1969 to 1973 and 1999 to 2003 were compared using student t test analysis. The total number of births averaged 1075 per year with no change in trend. For females aged 12 and 13 years, there was no change in births from 1969 to 1978 compared with 1994 to 2003. For females aged 14 years, there was a 54% drop; for females aged 15 years, a 59% drop; for females aged 16 years, a 53% drop; for females aged 17 years, a 51% drop; for females 18 years, a 37% drop and for females aged 19 years, a 30% drop, while births to mothers > or = 20 years increased 25%. The decrease for all teen births was 42% from 1969-1978 to 1994-2003. Teen births accounted for 29% of all births at Holberton in 1969 to 1973 but only 16% of births in 1999 to 2003. In conclusion, Antigua and Barbuda has seen a marked drop of 42% in teenage deliveries, including a 53% drop in school-aged teens from 1969 to 2003. Explanations include factors such as economic, social, educational and medical developments.
Assuntos
Coeficiente de Natalidade/tendências , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Antígua e Barbuda/epidemiologia , Criança , Feminino , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
Increased left ventricular mass (LVM) on echocardiogram is an independent risk factor for cardiac complications from hypertension. It is associated with a four-fold increase in untoward cardiac events when present. Data were reviewed for 100 treated hypertensive Afro-Caribbean patients, aged 29 to 65 years, recruited from village health clinics. Age, gender, height, weight, systolic and diastolic blood pressure, echocardiogram (ECHO) and drug history were recorded for each patient. The best single predictor of increased LVM was blood pressure with systolic (163 vs 152 mmHg, p < 0.01) and diastolic blood pressure (105 vs 98, p < 0.01) being significantly higher in patients with increased LVM. Systolic blood pressure over 150 mmHg was associated with increased LVM in 64% vs 44% below 150 mmHg (p < 0.10). Diastolic blood pressure over 95 mmHg was associated with increased LVM in 63% vs 36% below 95 mmHg (p < 0.02). BMI showed a trend (31.1 vs 29.7 kg/m2, p < 0.20) toward higher values in patients with increased LVM. BMI above 28 kg/m2 was associated with increased LVM in 61% vs 44% below that value (p < 0.15). Females more than males had increased LVM (61% vs 44%, p = 0.30) possibly due to higher BMI (31 vs 29.4 kg/m2) and higher systolic blood pressure (160 vs 155 mmHg). Age (48.3 vs 46.5 years, p = 0.30) and years of hypertension (8.6 vs 7.3 years, p = 0.33) were not significantly different between the two groups. Drug treatment was reported in 90% (69% monotherapy, 27% > one drug, 4% > 2 drugs) and no drug was associated with significant difference in LVM compared to others. Only 15% of treated hypertensive patients had systolic blood pressure below 140 mmHg and 8% had diastolic blood pressure below 90 mmHg. The major determinant of increased LVM in this group of Afro-Caribbean hypertensive patients appears to be poorly controlled hypertension with obesity being a possible contributing factor
Assuntos
População Negra , Ventrículos do Coração/patologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/diagnóstico , Adulto , Fatores Etários , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Índice de Massa Corporal , Região do Caribe/epidemiologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , UltrassonografiaRESUMO
Echocardiographic findings were reviewed for 106 patients (mean age 41.3 +/- 23.0 years, range 3 to 90 years, 61% female) referred for evaluation of unexplained syncope. Abnormal echocardiographic findings were seen in 36/106 (34%) patients, of which 12/106 (11%) may have an abnormality that contributed to symptoms. Abnormal echocardiographic findings (64 vs 6%, p < 0.01) and those possibly causing syncope (22 vs 0%, p < 0.05) were significantly more likely in the oldest tercile of patients compared with the youngest. No patient less than 35 years old had a possibly diagnostic abnormality.
Assuntos
População Negra , Síncope/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Região do Caribe/epidemiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síncope/epidemiologia , Síncope/patologia , Ultrassonografia , Adulto JovemRESUMO
The "Breaking the Cycle" programme, based on the Project Charlie programme, was developed for Antigua and Barbuda third grade students and was implemented in 2001. Aspects of the programme are compared with aspects recently proven effective in randomized studies in developed countries. The "Breaking the Cycle" programme includes life-skills training, teaches decision making skills, includes peer resistance training, uses trained teachers, interactive teaching methods, effective content and delivery, targets students prior to onset of drug use, teaches drug harm, teaches community values and is culturally sensitive, all aspects of successful programmes overseas. The cost of about $7 US per student would suggests cost-benefit effectiveness compared with overseas programmes. The "Breaking the Cycle" school-based drug and alcohol use prevention programme includes most aspects of evidence-based successful programmes overseas, appears cost effective and could serve as a model for programmes in the Caribbean region.
Assuntos
Desenvolvimento de Programas , Serviços de Saúde Escolar , Instituições Acadêmicas , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Antígua e Barbuda , Barbados , Criança , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde/métodosRESUMO
Group B streptococcus is the most common cause of neonatal sepsis in the United States of America (USA). This study was undertaken to determine the contribution of group B streptococcus to neonatal septicaemia in Antigua and Barbuda. From 1994 to 2002, there were about 12 000 births, with 2500Special Care Nursery admissions, 1100 (44%) with potential neonatal septicaemia. Blood cultures were done in 433/1100 (39%) and cerebrospinal fluid cultures in 52/1100 (5%). Positive cultures were seen in 41/433 (9.5%) with group B streptococcus in 1/41 (2.4%), streptococcus species in 3/41 (7.4%) and positive cerebrospinal fluid cultures were seen in 2/52 (one group B streptococcus) giving 5 per 12 000 or 0.4 cases per 1000 babies. Vaginal cultures from 1994 to 2002 revealed group B streptococcus in 14/163 (8.6%) of positive bacterial cultures. A sample of pregnant women from a private office had positive culture for group B streptococcus in 2/120 (1.7%). The prevalence rate of carriage (15 to 40%) and infection (1.7 to 4 per 1000 babies) was much higher in the USA in the same period. Universal screening of mothers for group B streptococcus may not be as necessary or cost-effective inAntigua and Barbuda.
Los estreptococos del grupo B son la causa más común de sepsis neonatal en los Estados Unidos (EE.UU.). Este estudio se llevó a cabo con el propósito de determinar en que medida los estreptococos del grupo B contribuyen a la septicemia neonatal en Antigua y Barbuda. Desde el año 1994 hasta el2002, hubo alrededor de 12000 nacimientos, con 2500 ingresos a la Guardería de Cuidados Especiales, 1100 (44%) con septicemia neonatal potencial. Se realizaron cultivos de sangre en 433/1100 (39%) y cultivos del líquido cefalorraquídeo cerebroespinal) en 52/1100 (5%). Seobservaron cultivos positivos en 41/433 (9.5%) con estreptococos B en 1/41 (2.4%), especies de estreptococos en 3/41 (7.4%), y se observaron cultivos cefalorraquídeos positivos en 2/52 (1 de estreptococosdel grupo B), para 5 por 12 000 ó 0.4 casos por 1000 recién nacidos. Los cultivos vaginales desde el año 1994 al 2002 revelaron estreptococos del grupo B en 14/163 (8.6%) de los cultivosbacterianos positivos. Una muestra de mujeres embarazadas provenientes de una oficina privada tuvo un cultivo positivo para estreptococos del grupo B en 2/120 (1.7%). La tasa de prevalencia de portación (15 a 40%) e infección (1.7 a 4 por 1000 recién nacidos) fue mucho más alta en los EE.UU. en el mismo período. El pesquisaje universal de madres en relación con el estreptococo de grupo Bpuede no ser tan necesario o costo-efectivo en Antigua y Barbuda.