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PubMed2004

Dialysis in Barbados: the cost of hemodialysis provision at the Queen Elizabeth Hospital.

OBJECTIVE: The purpose of this study was to assess the health service cost of hemodialysis delivered at the Queen Elizabeth Hospital in St. Michael, Barbados. METHODS: A cost analysis was performed from the viewpoint of the tertiary hospital studied here, using treatment protocols based on current practice for establishing vascular access sites (surgical set-up) and dialysis maintenance. Cost and patient data were collected for the period from 1 April 1998 to 31 March 1999. Sixty-four patients were studied and a total of 7 488 hemodialysis sessions were performed in the study period. The costs analyzed were personnel, drug expenditure, supplies (dialysis and nondialysis), inpatient costs, laboratory and other ancillary services, and indirect or overhead costs such as engineering, housekeeping, laundry and administration. RESULTS: The cost per hemodialysis treatment was calculated as US$ 156.64 in the first year and US$ 145.55 in subsequent years. The total cost per patient per year was US$ 18 327.22 in the first year of dialysis including surgical set-up, and US$ 17 029.54 thereafter. Direct costs (determined by patients' utilization of resources and labor costs for physicians and nurses) contributed to 80.7% of the total cost. The main expenditures were dialysis-related supplies, labor and overheads. CONCLUSION: These findings are important in the light of limited economic resources available to health services in Caribbean countries coupled with the spiraling prevalence of kidney failure in these countries. Further analyses are recommended to review the provision of renal replacement therapy services in Barbados and to develop plans to expand and optimize services.

Barbados↗
PubMedDate not supplied

Historical and current predictors of self-reported health status among elderly persons in Barbados.

OBJECTIVE: To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. METHODS: The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and of three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. RESULTS: Historical determinants of health status accounted for 5.2% of the variation in reported health status, and this was reduced to 2.0% when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1% of the variation in reported health status, lifestyle risk factors for 7.1%, and current disease indicators for 33.5%. CONCLUSIONS: Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the current elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly.

Aged↗
PubMed1994

Incidence of type I diabetes in people under 30 years of age in Barbados, West Indies, 1982-1991.

OBJECTIVE: To determine the incidence of type I diabetes among individuals < 30 years of age on the island of Barbados in the Caribbean. The population is predominantly African in origin but exhibits a relatively westernized lifestyle. RESEARCH DESIGN AND METHODS: Cases occurring during the years 1982-1991 were drawn from records at Queen Elizabeth Hospital and from physicians treating insulin-dependent diabetes mellitus (IDDM) patients. Patients using insulin and < 30 years of age at onset were included. Ascertainment was estimated at 94%. RESULTS: The average annual incidence of type I diabetes among Barbadians was 4.1/100,000 when age-adjusted to the world's population. There were 59 incident cases during this 10-year interval. The risk for males was 4.4 and for females 4.0/100,000. Among those 0-14 years of age, the risk was 5.0/100,000. Mean age at onset (+/- SD) was 14.7 +/- 6.9 for males and 12.5 +/- 5.7 for females. Males showed marked seasonal variation in risk and a more than threefold increase in annual incidence during 1984-1985. In contrast, females exhibited a stable pattern of IDDM risk during the 10-year interval. CONCLUSIONS: The incidence rate in Barbados falls near the lower limits of rates reported for Caribbean populations. There was a marked seasonal effect among males, even though the climate varies little throughout the year. This observation, and the incidence peak during 1984-1985, provide support for the role of environmental factors in the etiology of IDDM.

Adolescent↗
PubMed2000

Detection of dengue infection in patients investigated for leptospirosis in Barbados.

The annual incidence of leptospirosis in Barbados is approximately 13 severe cases/100,000. The peak incidence occurs in October to December of each year, coinciding with the months of heaviest rainfall. During the second half of 1995, an epidemic of dengue type 1 infection produced almost 1,000 laboratory-confirmed cases. During the same period, leptospirosis mortality was twice the average, suggesting that some cases of leptospirosis were being misdiagnosed and treated inappropriately. Sera from patients investigated for dengue or leptospirosis were analyzed retrospectively to determine the extent of misdiagnosis. During 1995 and 1996, 31 of 139 and 29 of 93 patients, respectively, were confirmed as having leptospirosis. Sera from the remaining leptospirosis-negative patients were tested for IgM antibodies to dengue virus. During 1995 and 1996, 48 of 108 patients and 21 of 64 patients, respectively, were found to have dengue. In 1997, sera from all patients investigated for leptospirosis were also tested prospectively for IgM antibodies to dengue: 38 of 92 leptospirosis-negative patients (41%) were dengue IgM-positive, while 2 of 25 leptospirosis cases also had serologic evidence suggesting acute dengue infection. A second large outbreak of dengue caused by serotype 2 occurred in 1997. During the 1995 and 1997 dengue epidemics in Barbados, dengue cases outnumbered leptospirosis cases investigated in the leptospirosis diagnostic protocol. During 1997, patients investigated but negative for dengue were also tested for anti-leptospiral IgM: 7.3% (19 of 262) were IgM-positive. Substantial misdiagnosis of both dengue and leptospirosis can occur and greater public awareness and clinical suspicion of the similar presentations of these two diseases are necessary.

Agglutination Tests↗
PubMed1987

Leptospires in vervet monkeys (Cercopithecus aethiops Sabaeus) on Barbados.

Agglutinins to Leptospira were found at titers of greater than or equal to 1:100 in 150 of 501 (29.9%) vervet monkeys (Cercopithecus aethiops sabaeus) bled within 1 mo of capture in Barbados. Including a further 34 of 145 bled within 1 yr of capture, the seropositivity prevalence was 28.5%. A further 35 monkeys (5.4%) had traces of agglutinins or gave titers of 1:50. The proportion of seropositive adults (41.5%) was more than twice that of seropositive immature monkeys (17.6%). Among adults, 49.2% of males and 35.7% of females were seropositive, while among juveniles proportions of seropositive males and females were similar (17.8% and 17.4%, respectively). Seropositivity prevalences tended to increase in proportion to rainfall. In each of 165 of the 184 positive sera, a single serogroup predominated in the serological reactions. These serogroups were Ballum (61%), Icterohaemorrhagiae (16%), Autumnalis (15%), Pyrogenes, Panama, Pomona, Tarassovi and Canicola (8% altogether). In the other 19 positive sera no single serogroup predominated. Serial bleeding showed that vervet monkeys can retain naturally-acquired antibodies to Leptospira for at least 2.5 yr. The evidence suggests that vervet monkeys in Barbados are transmitting leptospiral infections among themselves independently of other groups of animals, and are not a major source of human leptospirosis.

Agglutinins↗
PubMed1988

Leptospires in the marine toad (Bufo marinus) on Barbados.

Leptospires were isolated from the kidneys of four of 211 toads (Bufo marinus) caught on Barbados. Two of the isolates were identified as Leptospira interrogans serovar bim in the Autumnalis serogroup (the most common cause of leptospiral illness on Barbados), and two as possibly new serovars in the Australis serogroup. Sera from 198 of the toads were examined by the leptospire microscopic agglutination test. Forty-two (21%) were positive at titers of greater than or equal to 1:100, and 54 (27%) at greater than or equal to 1:50. The predominating serogroups were Australis (50%), Autumnalis (23%) and Panama (13%). The agglutination tests on the culture-positive toads showed that serologic studies alone may be of limited value in these animals. Bufo marinus can harbor pathogenic leptospires, and it may be a significant source of the Autumnalis serogroup infections in the Caribbean.

Agglutination Tests↗
PubMed1975

Emigration and fertility decline: the case of Barbados.

This paper examines the role of emigration in the recent fertility declines which have occurred on the island of Barbados. Barbados with a history of over two centuries of out-migration has experienced in the period 1951-1970 very significant migration loss. In the period 1960-1970 and up to the present fertility has been declining. An important question is what part has this net migration loss of 32,600 had on the reduction of the crude birth rate from 33.6 in 1960 or from 31.5 in 1956 to 20.5 in 1970? Using officially published net migration loss figures and supplementing them with data on Barbadians living overseas, we calculated the crude birth rates which would have occurred had there been no migration loss. We also calculated the numbers of births to be expected if certain age-specific fertility rates were maintained and compared these with the births to residents plus the calculated births to Barbadians overseas. We conclude that in both cases emigration is a very significant contributor to the fertility declines which have occurred and are still underway.

Adolescent↗
PubMed2002

Leptospiral carriage by mice and mongooses on the island of Barbados.

Leptospirosis is a zoonotic disease, maintained by chronic infection of the kidneys of reservoir animals, usually small mammals. Infection in humans is acquired from direct or indirect exposure to the urine of infected animals. Leptospirosis has a high incidence in tropical regions, and has been studied extensively in several Caribbean countries. We studied the carriage of Leptospira serovars by two small mammals which are potential maintenance hosts of the disease in Barbados. A total of 136 mongooses (Herpestes auropunctatus) and 97 mice (Mus musculus) were caught in live traps. Leptospiral antibodies were detected by microscopic agglutination test (MAT) using antigens representing 12 serogroups, and kidney tissues were inoculated into polysorbate medium for isolation of leptospires. The seroprevalence (at a titre of > or = 100) in mice was 28.2% (24/85, 95% CI 19.0, 39.1) and in mongooses 40.7% (48/118, 95% CI 31.7, 50.1). In mice, antibodies were detected predominantly against serogroups Ballum and Autumnalis, while in mongooses the predominant serogroup was Autumnalis. Leptospires were isolated from 28 mice (28.9%, 95% CI 20.1, 39.0) and from 4 mongooses (2.9%, 95% CI 0.8, 7.4). Mouse isolates were identified as serovars arborea (17) and bim (7). As in other parts of the world, common house mice (Mus musculus) represent a significant reservoir of leptospirosis. Although carriage of the Ballum serovar, arborea, was not unexpected, this represents the first time that an animal reservoir of serovar bim has been identified. This is significant because bim causes about 63% of human leptospirosis in Barbados, and control efforts and education for prevention can now be targeted at a specific reservoir.

Animals↗
PubMed2004

Genetic influences on the increase in blood pressure with age in normotensive subjects in Barbados.

The authors tested the single and combined effects of nuclear and mitochondrial DNA genotypes on the phenotypes of systolic blood pressure (SBP) and weight, and their changes over 5 years in normotensive subjects living in Barbados. The nuclear genotypes were gender (Y chromosome), haptoglobin (HP), and group specific component (Gc). A mitochondrial genotype was chosen as a marker for maternal lineage. Baseline clinic SBP and weight (N=78), 24-hour SBP (N=28) were measured. Five years later, clinic SBP and weight were measured again in 28 participants. Male participants generally had higher pressures than female participants. The HP genotype was associated with 5 of the 8 SBP phenotypes. The haptoglobin-1 (HP1) allele was associated with higher clinic (P=.024) and evening SBP at baseline (P=.020). The effect of HP1 appears to be dominant. Haptoglobin-2 (HP2) was associated with the increase in weight over 5 years (P=.002). Group specific component (Gc) genotype was associated with 6 of the 8 SBP phenotypes. The Gc polymorphism 2 was associated with higher 24-hour SBP, sleep SBP (midnight-6 AM), afternoon SBP (noon-6 PM) and evening SBP (6 PM to midnight). Furthermore, we found a significant association between the haptoglobin/mt-DNA and Gc/mt-DNA polymorphisms with SBP between 6 PM and midnight (P=.009 and P=.011, respectively). The 5-year changes in SBP were significantly associated with the haptoglobin/mt-DNA and Gc/mt-DNA polymorphisms (P=.005 and P=.011, respectively). Multivariate analysis for genetic effects on change in weight and change in BP suggested the rise in BP, but was not suggestive of change in weight. Furthermore, multivariate analysis was associated with Gc, but not Haptoglobin genotype. In normotensive subjects of African descent living in Barbados, the increase in blood pressure with age is significantly influenced by both nuclear and mitochondrial genotypes that are more common in African derived populations.

Adult↗
PubMed2006

Human Campylobacter-associated enteritis on the Caribbean island of Barbados.

A longitudinal study of the incidence of Campylobacter enteritis in Barbados was undertaken from January 2000 to August 2003. Diarrheal stools received by the central public health laboratory were cultured for Campylobacter. The number of reported Campylobacter cases exceeded those of Shigella but were less than those of Salmonella, and increased steadily with each year. Isolates from stools were mainly C. jejuni (63.6%) and C. coli (31.8%). The highest isolation rate was found in children 1-4 years of age (40.8%), followed by infants less than 1 year of age (16.9%) and those 5-9 years of age (11.3%). The number of reported cases was higher in March, from June to August, and in November and December. There was no correlation between incidence and either rainfall, temperature, or humidity. Further epidemiologic investigation of this disease is needed to evaluate risk factors for Campylobacter infection and determine routes of transmission in Barbados.

Adolescent↗
PubMed1990

The elderly in Barbados: problems and policies.

Empirical data on conditions affecting elderly people in the Caribbean are very limited. To help deal with this lack of information in the specific case of Barbados, in 1982 a survey was conducted of 525 randomly selected people 65 years of age or older. This article summarizes data derived from that survey in order to provide an overview of the social and economic circumstances affecting Barbados' elderly population. While it is true that these circumstances do not necessarily mirror those found elsewhere, they clearly have elements in common; and it seems likely that the survey approach applied in this instance could prove useful elsewhere in obtaining worthwhile information.

Aged↗
PubMed1990

Leptospires in the whistling frog (Eleutherodactylus johnstonei) on Barbados.

Two groups of whistling frogs (Eleutherodactylus johnstonei) comprising 99 and 117 animals were examined for leptospiral infection. Group I animals were caught in 14 areas of Barbados, and Group II animals in seven areas of suburban Bridgetown. Leptospires were isolated from the kidneys or body fluid of six frogs in Group I and the kidneys of 3 frogs in Group II. Two of the Group I isolates died out; the others were identified as bajan (a new serovar in the Australis serogroup) (6) and bim (Autumnalis) (1). The macerated body tissues and fluid of Group I frogs were put into phosphate buffered saline and examined by the microscopic agglutination test using 22 antigens. The results were all negative. For the Group II frogs the methodology was altered; blood was collected onto filter paper discs and allowed to dry out before being agitated in PBS and examined by the MAT. 15/117 (12.8%) animals were positive at greater than or equal to 1:100 and 19 (16.2%) at greater than or equal to 1:50. The geometric mean titre was 179. Seventeen of the sera reacted predominantly to antigens in the Australis serogroup, and two to Pyrogenes on its own. The serological results reflected the identity of the isolates. Serovars of Australis are not known to cause illness on Barbados, but bim is the commonest cause of severe leptospirosis on the island.

Animals↗
PubMed1993

Resistance to third-generation cephalosporins in Barbados.

Resistance to third-generation, or extended-spectrum, cephalosporins caused by induction of class I beta-lactamases has been reported rarely from developing countries. Seven isolates of cephalosporin-resistant Gram-negative rods were recovered recently from urine, burns and ulcers in the Queen Elizabeth Hospital, Barbados. The isolates were identified as Acinetobacter calcoaceticus (2), Citrobacter freundii (1), Enterobacter cloacae (1), Morganella morganii (1), Providencia stuartii (1) and Proteus sp. (1). Induction of beta-lactamase by cefoxitin was demonstrated, and minimal inhibitory concentrations (MIC) were determined by agar dilution. beta-lactamases were demonstrated by isoelectric focusing; the presence of chromosomal beta-lactamases was confirmed in at least three of the resistant isolates. The only antibiotics which were uniformly active against these resistant strains were imipenem and ciprofloxacin. These data confirm the existence of resistance to the third-generation cephalosporins in Barbados, and emphasise the necessity for continuous surveillance of resistance patterns in the Caribbean region.

Barbados↗
PubMed1993

Use by visitors of the services of the Queen Elizabeth Hospital, Barbados, W.I.

This paper analyses data for 1990 culled from the medical records of the Queen Elizabeth Hospital, Barbados and examines the use of inpatient and emergency services by visitors to Barbados. The 473 visitors admitted represented 2.1% of all admissions. The records of 425 contained information on country of origin: 145 were from non-Caribbean and 280 from Caribbean countries. The distribution by country of non-Caribbean visitors was the same as that of regular tourist arrivals--the majority came from the USA. Canada and the UK. Caribbean visitors represented 14.4% of the tourists, but accounted for 65.9% of visitor admissions. Non-Caribbean visitors were 85.6% of tourists, but 34.1% of admissions. Young patients predominated among Caribbean, and older patients among non-Caribbean. Accidents, cardiovascular disease, alcohol-related illnesses and near drowning were commoner in the non-Caribbean visitors, while cancer and obstetrical/gynaecological problems were commoner in Caribbean visitors. Seven per cent of visitor admissions went to the Intensive Care Unit as against 0.15% of other patients. The average hospital stay of visitors was 11.7 days compared with 7.0 days for Barbadians. There were 898 visitors treated in the Accident and Emergency Department and the commonest problems were lacerations, abrasions and infections. The UK provided most of these patients. These data show that there is appreciable visitor use of the public health services. Non-Caribbean visitors use them because they fall ill on holiday, but many Caribbean visitors may come specifically for health care. The cost to the Barbadian health service is not insignificant: at the 1990 estimated bed-day cost of Bds$250, it represents a cost of Bds$1.1 million per annum to the Government for inpatient services alone, or 2% of total hospital costs.

Adolescent↗
PubMed1977

Fertility decline in Barbados: some spatial considerations.

Despite its small size, Barbados exhibits some striking regional differences in fertility levels, which persisted during a period of major fertility decline in the 1960s. Regression analyses are performed for 28 subregions, using sex ratio, male occupational structure, female education, and female employment for 1960 and 1970 as the independent variables. The spatial influence of the Barbados family planning program is also considered. The author argues that a concentration of family planning programs in areas of greatest accessibility and modernization contributes to spatial variations in fertility.

Adolescent↗
PubMed2004

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.

Anti-Infective Agents↗
PubMed1998

Vitamin C in Barbados cherry Malpighia glabra L. pulp submitted to processing and to different forms of storage.

Ripe fruits of Barbados cherry Malpighia glabra L. proceeding from the fruit-growing section of Iguatemi Experimental Farm of Universidade Estadual de Maringa (PR), were triturated in a liquefier and hulled in a stainless steel sieve with 25 mesh. The bagasse (seeds and hull) was discarded and the vitamin C content was immediately determined, which was 1.79 g by 100 g of pulp. After that, the integral pulp was packed in glass flasks and submitted to the exhaustion and pasteurization processes and then hermetically closed. After the heat treatment the vitamin C content was 1.54 g by 100 g of pulp. The sealed flasks of Barbados cherry pulp, with and without the aluminum foil protection, were stored for 40 days. The first portion was kept at room temperature, the second in a refrigerator (1 degree C), and the third in a freezer (-18 degrees C). The vitamin C content analysis were realized on the 5th, 10th, 15th, 20th, 30th and 40th day. For the flasks stored without the aluminum foil protection, there was a loss of 22.08%, 7.79% and 1.30% and with aluminum foil the loss was of 10.40%, 3.90% and 1.30% for the storage at room, refrigeration and freezing temperatures, respectively. The results show that freezing method is the best form of vitamin C preservation.

Ascorbic Acid↗
PubMed2003

Corneal thickness and intraocular pressure in the Barbados eye studies.

OBJECTIVES: To describe the distribution of central corneal thickness (CCT) and evaluate its relationship to intraocular pressure (IOP) in the predominantly black population of the Barbados Eye Studies (BES). METHODS: Participants received a standardized examination, including pachymetry, applanation tonometry, and a comprehensive ophthalmologic evaluation. Analyses were based on data from all eyes, and generalized estimating equation methods were applied to account for the correlation between eyes. RESULTS: Among the 1142 consecutive participants with pachymetry measurements, the mean age was 64.3 years, and 58% were women. Black participants tended to have thinner corneas (mean thickness, 529.8 microm) than mixed (black and white) (537.8 microm) and white participants (545.2 microm), respectively. Among black participants, increasing values of CCT were significantly related to younger age (P<.001), diabetes history (P =.03), and refractive error (P =.03); a marginally significant relationship (with thinner corneas) was found with a clinical diagnosis of glaucoma (P =.07). Intraocular pressure was not associated with CCT in this population. CONCLUSIONS: Although other studies have reported a positive correlation between CCT and IOP, such a relationship was not substantiated in the black BES population. Black participants tended to have thinner corneas than white participants, whereas younger individuals, as well as those with a history of diabetes and more positive refractive errors, had thicker corneas.

Age Distribution↗