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PubMed1985

Comparative seroepidemiology of HTLV-I and HTLV-III in the French West Indies and some African countries.

The prevalence of antibodies detected by ELISA against human T-lymphotropic viruses, type I (HTLV-I) and type III (HTLV-III-LAV), is described in a comparative serosurvey in the French West Indies and African countries. The data confirm that the Caribbean basin is endemic for HTLV-I. In this region, HTLV-I antibody prevalence varied from 3.4% to 5.2% among blood donors and increased with age to reach a value of 33% among elderly people from the Dominica Island. In French Guyana, a South American country bordering the Caribbean sea, differences in antibody distribution across three ethnic groups (black Bonis, Indian Wayanas, and Hmongs from Asia) provide clues for investigation of the mode of HTLV-I transmission. Africa appears to be an endemic continent for HTLV-I and HTLV-III. For both viruses, the antibody prevalence exhibited an increasing gradient from northern to equatorial through Sudanic areas. These preliminary data by showing that Africa represents an endemic reservoir of HTLVs and, possibly, of other human retroviruses should stimulate further investigations on the natural history and the geographical origin of these viruses.

Adolescent↗
PubMed2007

Factors affecting future choice of specialty among first-year medical students of the University of the West Indies, Trinidad.

BACKGROUND: This study was conducted to determine factors that influence career choice among 1st-year medical students. DESIGN AND METHODS: A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. RESULTS: The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). CONCLUSION: The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice.

Adolescent↗
PubMed2003

Infective endocarditis at the University Hospital of the West Indies. A revisit.

Many countries have reported a change in the profile of infective endocarditis (IE) over the past three decades. The objective of this study was to evaluate the characteristics of IE from the autopsy service of the University Hospital of the West Indies (UHWI) during the last 15 years and to compare the results with that of an earlier study. There were 26 cases of IE during the period under review with a M:F ratio of 1.2:1. The ages ranged from 15 days to 74 years with a mean of 36.4 +/- 24.57 years. The largest number of cases (n = 7) occurred in the 10 to 19-year-age group. Cardiac predisposing factors were identified in 14 patients; nine with rheumatic heart disease, four with prosthetic valves and one with a bicuspid aortic valve. All vegetations were located on valves, the aortic being the most frequently involved followed by the mitral. Streptococcus species were the most common causative organisms followed by Staphylococcus aureus. Compared with the profile seen 15 years ago, there have been only minor changes in the characteristics of IE cases observed in the autopsy service at the UHWI.

Adolescent↗
PubMed1991

HTLV-I infection in French West Indies: a case-control study.

A case-control study was performed in Martinique, French West Indies, comparing 66 anti-p24 antibody carriers to 91 seronegative subjects for HTLV-I, matched for age and place of residence. The aim of our study was to identify factors associated with HTLV-I infection and to observe whether clinical examination and biological measurements would reveal any abnormalities among the seropositive subjects. We observed a predominance of females among seropositive subjects (74% compared to 59%, p less than 0.05), and a greater risk due to earlier blood transfusions (p less than 0.001). This survey revealed important differences between cases and controls regarding socioeconomic factors: cases had fewer luxuries or advantages (i.e. bathroom, toilets, refrigerator, telephone, p less than 0.01), were more corpulent (p less than 0.05), and more often widowed, divorced or separated (p less than 0.01) than the controls. Although the differences were not significant, the seropositive donors seemed to be less educated, and were from a lower socioprofessional class than the seronegative donors. With regard to clinical symptoms (infections, adenopathies, splenomegaly, hepatomegaly) and biological parameters (blood count; T-cell subsets, electrophoresis of protids, immunoglobulins, calcemia, antischistosomal antibody), seropositive subjects appeared to be healthy; no parameters, except for alpha 1 globulin (p less than 0.05) and monocytes (p less than 0.05), were found to be correlated with seropositivity; but these two parameters remained within their normal ranges. This study confirms blood transfusion as a risk factor. It underscored the importance of socioeconomic factors for seropositivity.

Adult↗
PubMed1994

Distribution patterns of Tunga penetrans within a community in Trinidad, West Indies.

This paper describes patterns of infection with Tunga penetrans within the town of Icacos, Trinidad, West Indies, assessed by the number of persons infected and the extent of the chigoe flea burden by physical examination. The overall prevalence of infection was 31.4% (102 infected persons) of the 325 persons examined (41% of males and 23% of females). Both measures showed a significant difference among the different age groups with peak chigoe burden found in the 5-9, 10-14 and > 55 age-groups, with 9, 5.6 and 12 fleas per infected person, respectively. The aggregated distribution of chigoe flea burden showed a few persons with many fleas and many persons with none (68%). In contrast, in chigoe flea burden there were no significant sex differences but age-associated differences (G = 17.9; d.f. 7; P < 0.01). It is recommended that all cases of tungiasis should be treated and the source of infection effectively managed or eradicated.

Adolescent↗
PubMed1991

Systolic blood pressure levels in black populations in sub-Sahara Africa, the West Indies, and the United States: a meta-analysis.

Average systolic blood pressure levels from epidemiological studies conducted on black populations in sub-Sahara Africa were pooled and compared with pooled systolic blood pressure levels from black populations in the northern portion of the Western hemisphere (the West Indies and the United States). Studies published in English that listed systolic blood pressure means and standard deviations and sample sizes in 40-49-year-old men and women were included. Overall, systolic blood pressure levels were higher (p less than 0.05) in blacks from the northern Western hemisphere than in blacks from sub-Sahara Africa for both men (12 mm Hg higher) and women (13 mm Hg higher). The analysis was also conducted on regions within sub-Sahara Africa and in rural and urban subgroups. Systolic blood pressure was lower (p less than 0.05) in East Africa than in the other three regions within Africa for both sexes. Overall, urban blacks within Africa had higher systolic blood pressures (p less than 0.05) than rural blacks for both sexes. In the northern Western hemisphere, rural blacks had higher systolic blood pressures (p less than 0.05) than urban blacks for both sexes. Studies should be designed with standardized methods to unravel these intraracial differences in blood pressure levels.

Adult↗
PubMed1987

Studies on an isolated West Indies population (V): Genetic differentiation, evidence for founder effect and drift.

Red cell antigens [A,B,H,C,c,C(w),D,E,e,M,N,S,s,P1,K,FY(a),JK(a)] and 20 serum proteins or erythrocyte enzymes were tested in a white isolate of the French West Indies (the island of St-Barthélémy). The genetic differentiation mainly due to genetic drift and founder effect between France and this isolate and between the Leeward (parish of Gustavia) and Windward (parish of Lorient) areas within the island is discussed. Genetic admixture with black populations of African origin is very low.

ABO Blood-Group System↗
PubMed2004

Andrew Halliday, Kt FRCPE (1781-1839): service in the Napoleonic Wars and West Indies, and first physician to the Seamen's Hospital Society.

Sir Andrew Halliday (1781-1839) was domestic physician to HRH the Duke of Clarence (1765-1837) (who was later to become King William IV). He also served in the Napoleonic Wars-in Portugal, Spain and Waterloo-as well as in the West Indies, and became the first physician to the Seamen's Hospital Society. Unlike many of his contemporaries, Halliday was also a prolific author, many of his publications being on lunatic asylums in Great Britain and Ireland.

History, 18th Century↗
PubMed1992

Quantification of HTLV-1 proviral copy number in peripheral blood of symptomless carriers from the French West Indies.

The development of human T-cell leukemia type 1 (HTLV-1) diseases are related to an increase in the proviral copy number (VCN) in peripheral blood mononuclear cells (PBMCs). Twenty symptomless anti-HTLV-1-positive blood donors, as well as four symptomatic individuals, all from the French West Indies, were studied. The VCN in PBMCs was determined by quantitative PCR. The VCN values for asymptomatic HTLV-1 carriers (range of less than 100 to approximately 9,500/micrograms of DNA) was nearly always less than the values for symptomatic carriers (range of approximately 5,500 to approximately 29,000/micrograms of DNA). Consequently, the proportion of HTLV-1-infected PBMCs in symptomless and in symptomatic individuals ranged from less than 1/1,500 to approximately 1/16 and approximately 1/27 to approximately 1/5, respectively. No correlation could be found between VCN and age or sex, suggesting the importance of factors other than age and sex as influences on the VCN number.

Adult↗
PubMed1987

Seasonal incidence and diel patterns of oviposition in the field of the mosquito, Aedes aegypti (L.) (Diptera:Culicidae) in Trinidad, West Indies: a preliminary study.

Diel patterns of oviposition of domestic Aedes aegypti in the field in Trinidad, West Indies were monitored weekly for one year using standard ovitraps. During the wet season (May to November) a large, well defined peak of oviposition (comprising more than 80% of eggs laid) occurred one to two hours before sunset, and a much smaller peak (about 5% of eggs laid) occurred one to two hours after sunrise. During the dry season (December to May) a broad, poorly defined peak (about 36% of eggs laid) fell two to four hours before sunset. During both seasons some oviposition occurred throughout the daytime between about one hour after sunrise and one hour before sunset. During wet and dry seasons the number of ovitraps receiving eggs was similar (6% to 7%), but in the wet season oviposition occurred in fewer ovitraps and more eggs were laid on each occasion.

Aedes↗
PubMed1990

Reported versus recorded health service utilization in Grenada, West Indies.

Calls for household surveys to provide information on service utilization in less developed countries raise questions regarding the accuracy and reliability of reporting. This paper compares reported to recorded health service utilization for diarrhoea and any other morbidity over a 2-week and 3-month period for information obtained from a household survey in Grenada, West Indies. A sensitivity analysis is used to derive minimum and maximum estimates of the accuracy of reported utilization. Over-reporting utilization was found to be between 33 and 62% for diarrhoea and 49 and 81% for any other morbidity. Under-reporting of all utilization was estimated to be between 47 and 65%. These results cast doubt on the utility of household surveys as a reliable source of information regarding service utilization.

Child↗
PubMed1990

The ecology of health services utilization in Grenada, West Indies.

Few empirical investigations into the nature of health services utilization fully acknowledge that the home environment may act as a socio-geographic focus of both disease transmission and of learned health behavior. This paper examines the role of the home environment, as well as of personal characteristics and accessibility, in the utilization of health services in Grenada, West Indies. Bivariate and logit analyses of household survey data are employed to identify markers of high user individuals and households. Aspects of each domain of the home environment (physical and behavioral environment, demographics, and residential mobility) emerge as contributors to the utilization phenomenon in the study communities. Both etiological and socio-economic linkages are postulated to underlie the observed relationships. The implications of this work for health planning in developing countries is discussed.

Age Factors↗
PubMed1993

Geographic spread of measles on the island of Dominica, West Indies.

Because of the short incubation period of most acute infectious diseases, short-term and daily mobility are more important than permanent and seasonal migration for the spread of these diseases. Yet most studies of population mobility focus on permanent or semipermanent change of residence. Here, we describe the results from a field study conducted on the island of Dominica, West Indies, during the summers of 1989 and 1990 and the winter of 1991. The study was designed to collect data on short-term mobility rather than migration. These mobility data are linked with data on the patterns of measles transmission during a 1984 epidemic. Three-hundred five individuals from all parts of the island were interviewed about their daily travel patterns, their travel off the island, and the travel of members of their immediate family. In addition to these respondents, interviews were conducted with representatives of most of the major occupations that involve travel in the course of a workday. Data were also collected on the number and type of motor vehicles traveling along various routes on the island and on travel of native residents to the capital city, Roseau, to buy or sell at the major weekly market. Analysis of the interviews shows that travel within the island is clearly nonrandom. For example, almost everyone interviewed traveled to Roseau at least once a month, but 40% of the respondents had never been to any of the major villages in the Grand Bay Health District, which is only about a half-hour from Roseau. Patterns of disease transmission have been directly affected by these mobility patterns. The measles epidemic in 1984 apparently did not reach the Grand Bay Health District, even though all other areas of the island experienced significant rates of infection. Analysis of reasons for the relative isolation of the Grand Bay Health District indicates the importance of transportation patterns, as well as social, cultural, and geographic factors, to the disease transmission patterns throughout the island.

Adolescent↗
PubMed1996

Bacteriocin Typing of Burkholderia (Pseudomonas) solanacearum Race 1 of the French West Indies and Correlation with Genomic Variation of the Pathogen.

Burkholderia solanacearum race 1 isolates indigenous to the French West Indies were characterized by bacteriocin typing and two genomic fingerprinting methods: pulsed-field gel electrophoresis of genomic DNA digested by rare-cutting restriction endonucleases (RC-PFGE) and PCR with primers corresponding to repetitive extragenic palindromic (REP), enterobacterial repetitive intergenic consensus (ERIC), and BOX elements (collectively known as rep-PCR). The survey comprised 24 reference strains and 65 isolates obtained from a field trial in Guadeloupe in 1993. Comparison of the data identified RC-PFGE as the most discriminatory method, delineating 17 pulsed-field gel profile types. rep-PCR and bacteriocin typing identified nine rep-PCR profile types and nine bacteriocin groups. Independent determination of similarity coefficients and clustering of RC-PFGE and rep-PCR data identified six groups common to both sets of data that correlated to biovar and bacteriocin groups. Further study of bacteriocin production in planta gave results consistent with in vitro bacteriocin typing. It was observed that spontaneous bacteriocin-resistant mutants exhibited a cross-resistance to other bacteriocins as identified by the typing scheme and that such mutants possessed a selective advantage for growth over isogenic nonmutants in the presence of a bacteriocin. The results are significant in the search for biological control of disease by nonpathogenic mutants of the wild-type organism.

Journal Article↗
PubMed1994

Outcome of solid renal tumours in children at the University Hospital of the West Indies.

Of the twenty-nine children with solid renal tumours treated at the University Hospital of the West Indies (UHWI) between January, 1972 and December, 1991, there were twenty-eight cases of nephroblastoma and one of mesoblastic nephroma. Peak incidence was between the ages of two and four years. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy +/- radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in 24 and 13 cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was a 100% cure rate in Stages I and II, Stage III had only a 55.5% survival rate and none of the Stage IV survived. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of the two cases. The benign mesoblastic nephroma, in a one-month-old infant, was cured by nephrectomy alone. While the present therapy of radical nephrectomy along with combination chemotherapy is satisfactory for early stages, more aggressive adjuvant therapy is needed for improving the results in Stages III and IV.

Child↗
PubMed1992

Family planning in St Vincent, West Indies: a population history perspective.

St Vincent's population history, first as a slave society, then, after Emancipation, as a migration-oriented society, has strongly influenced cultural attitudes towards sexuality and fertility. In contemporary St Vincent, sexual activity and procreative ability are highly valued and linked to social status for both men and women. This paper assesses historical and contemporary factors influencing population dynamics in St Vincent, West Indies, and Vincentians' reactions to programs developed to curb population growth. The efforts of private and government programs to introduce family planning and change pronatalist attitudes are evaluated for their cultural appropriateness. Shifting migration patterns and modernization are also affecting gender roles, the social and economic value of children, and the acceptability of contraception to contribute to recent fertility declines.

Adolescent↗
PubMed2004

Discrepancies between clinical and postmortem diagnoses in Jamaica: a study from the University Hospital of the West Indies.

AIMS: It has previously been shown that the low necropsy request rate at the University Hospital of the West Indies (UHWI) in Jamaica (35.3%) results primarily from clinicians' confidence in clinical diagnoses and laboratory investigations. This study aimed to determine the rates of discrepancy between clinical and necropsy diagnoses at the UHWI, because many previous studies from other institutions have shown persistent high rates of discrepancy, despite advances in medical investigative technology over the past several years. METHODS: Data were extracted retrospectively from consecutive necropsies performed at the UHWI over a two year period. The data were analysed to determine the categories and rates of discrepancy, and to determine the relation between discrepancy rates and age, sex, type and number of diagnoses for each patient, hospital service, and length of hospitalisation. RESULTS: Necropsies were performed on 446 patients; 348 were suitable for further analysis. The overall discrepancy rate was 48.4% and the diagnoses with the highest individual discrepancy rates were pneumonia (73.5%), pulmonary thromboembolism (68.3%), and myocardial infarction (66.7%). Males and older patients were more likely to have discrepant diagnoses. There was a high frequency of discrepancies in patients who died within 24 hours of admission, but there was no consistent relation between length of hospitalisation and discrepancy rate. CONCLUSIONS: The high discrepancy rates documented at the UHWI are similar to those reported globally. This study supports previous attestations that the necropsy remains a vital tool for determining diagnostic accuracy, despite modern modalities of clinical investigation and diagnosis.

Adolescent↗