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Biomedical subjects

D T Simeon

Publications and source records attributed to D T Simeon.

At least 19 recordsLinked to original sources
PubMed2005

Surgery in the elderly: is age a risk factor?

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources.

Age Factors↗
PubMed2005

Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad.

This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60% and a specificity of 94%. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76%. The patients were primarily Indo-Trinidadian (70%), over 50 years (76.4%) and female (72.3%). The prevalence of depression was 28.3%. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics.

Adolescent↗
PubMed2004

Social and health determinants of well being and life satisfaction in Jamaica.

BACKGROUND: Psychological well being and the degree of satisfaction with life are likely to affect a range of social behaviours and determine uptake of health and social services. It is important to identify the factors that inform these constructs. AIMS: We sought to identify the variables which best predicted psychological well being in the Caribbean country, Jamaica and also those associated with feelings of satisfaction with life. METHODS: Interviews were conducted on young adults aged 15-50 years as part of a sexual decision-making survey in Jamaica. Information was collected on a range of social, health and demographic variables and a measure of psychological well being--Centre for Epidemiological Studies of Depression (CES-D). Satisfaction with life was measured using a Likert scale in response to the question 'Are you satisfied with your life as a whole?' Multiple regression analyses were used to determine the predictors of psychological well being and satisfaction with life. RESULTS: There were 2580 respondents (1601 women and 979 men). The mean age was 29.7 years (standard deviation 9.2 years). Women had lower levels of psychological well being and satisfaction with life. Independent predictors of lower psychological well being were having an acute illness, having a chronic illness in women and high religious behaviour in men. Satisfaction with life was predicted by younger age, marital status and employment. CONCLUSIONS: Our findings suggest that health variables are more important for psychological well being while social circumstances are more significant for satisfaction with life. There are important gender differences in the mediation of psychological well being as well as age differences in the variables associated with satisfaction with life.

Adolescent↗
PubMed2003

Body image of adolescents in a multi-ethnic Caribbean population.

OBJECTIVE: To examine the perceptions of body size among adolescents in Trinidad and to determine whether there were ethnic differences. DESIGN: Cross-sectional survey. SETTING: Secondary schools in Trinidad. SUBJECTS: A stratified random sample of 1139 adolescents, aged 14-17 y. MEASUREMENTS: Silhouettes of different body sizes were used to determine perceptions of body size, while weights and heights were measured to determine actual body size. RESULTS: A total of 1090 students (96% response rate) participated, comprising 578 (53%) females. The main ethnic groups were South Asian (49%), African (25%) and persons of mixed ethnicity (23%). The calculated body mass index (BMI) indicated that 14% were thin, 73% normal and 13% overweight; however there was a preponderance of thinness among South Asian males (28%). Whereas 68% of students correctly identified their body size, South Asian males were also more likely to overestimate their body size than the other adolescents, ie they were thinner than they thought. Overall, 64% of the sample was satisfied with their current size, but thin South Asians were more likely to be satisfied with their size than other thin adolescents (P=0.04), while overweight Africans were more likely to be satisfied than other overweight persons (P=0.03). The majority of the sample associated the normal body size with good health, but the majority also associated the overweight and obese silhouettes with wealth. In addition, 40% of them associated the male overweight and obese silhouettes with happiness. CONCLUSION: Although the prevalence of overweight/obesity was not high, the perception of the Trinidadian adolescent that obesity was associated with wealth, and to a lesser extent happiness, and the satisfaction of the overweight African females with their size, were all causes for concern.

Adolescent↗
PubMed2003

Climatic variables are associated with seasonal acute asthma admissions to accident and emergency room facilities in Trinidad, West Indies.

OBJECTIVES: To determine if there is seasonal variation in acute asthmatic visits to accident and emergency (A&E) facilities in Trinidad and to identify the climatic variables associated with such visits. DESIGN AND METHODS: A retrospective census of patients with asthma, defined as those who required emergency bronchodilator nebulization, was taken at two A&E facilities in Trinidad from 1 January 1997 to 31 December 1999. The study included patients aged 64 years and under. Patient demographic data were obtained from the A&E records. Climate variables were taken from the island's sole Meteorological Office. Multiple regression was used to identify climate variables that were independent predictors of A&E asthma visits. RESULTS: There were a total of 45 842 asthma admissions to the two facilities during the study period. Visits exhibited a cyclic pattern over the 3 years that varied according to the island's dry (January-May) and wet (June-December) seasons. There were more visits during the wet season than the dry (40 [SD=2] vs. 32 [SD=2] visits/day; P<0.001). The results of multiple regression indicated that season (P<0.001), barometric pressure (P<0.001), temperature difference (P<0.001), minimum temperature2 (P<0.001) and wind speed2 (P=0.032) were predictors of paediatric visits. Independent predictors of adult visits were season (P<0.001), relative humidity (P<0.001), minimum temperature (P=0.01), temperature difference2 (P<0.001) and minimum temperature2 (P=0.004). Season and climatic variables explained 18% of the variance of the total A&E asthma admissions. CONCLUSION: There is seasonal variation in acute asthma visits to A&E facilities in Trinidad, which remains significant after controlling for climate variables. However, while climate has a role, there are other factors that may also be responsible for increased visits during the wet season. More research is needed to identify these factors.

Acute Disease↗
PubMed2003

Motivation for and concerns about entering a medical programme.

The motivation for and concerns about studying medicine and future career plans of students at the Faculty of Medical Sciences, The University of the West Indies (UWI), were studied using a cross-sectional survey that included Year 1 medical students at both the Mona (Jamaica) and St Augustine (Trinidad and Tobago) medical schools of the UWI. The data were collected using a self-administered questionnaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences. A total of 193 students took part in the study, 103 from Mona and 90 from St Augustine (88% response rate). Seventy per cent of the students were between 18 to 22 years of age with 59% being females. The highest rated motives for studying medicine were the 'opportunity for working with people' and an 'interest in human biology'. Female students scored significantly higher for the motive of an 'opportunity for working with people', while males rated the 'social prestige/status' significantly higher. The greatest concerns of the students were 'fear of failure' and 'contracting diseases'. The female students had a greater concern for dealing with the long hours involved in medical training than their male counterparts. Surgical specialties (43%), family medicine (38%) and paediatrics (34%) were the top choices of the students for future specialty and more women than men chose obstetrics. Although the motives that students have reported are varied, there was a reasonable spread of desirable motives. This study provides a baseline for observing possible changes as students advance through medical training. A programme of study that strives to maintain these well-placed motives while providing opportunities for dealing with the concerns of the students will assist in creating caring, empathetic physicians for the Caribbean.

Adolescent↗
PubMed2002

Value of routine long bone radiographs in management of babies with a positive VDRL at the Mount Hope Women's Hospital.

This retrospective study examined the records of 44 mothers and 44 babies with a positive blood VDRL test and/or who showed symptoms of congenital syphilis at the Mount Hope Women's Hospital (MHWH), Trinidad, between June 1, 1996 and September 30, 1998. Long bone radiographs of 40/44 (91%) babies were assessed independently by two radiologists for signs of congenital syphilis and the data were analysed using frequency tables. Of the 44 mothers in the study, 34 (77%) were VDRL positive and the rest were either negative or unknown. Maternal age ranged from 14 to 39 years and most (92%) had antenatal care. Fourteen of the 34 (41%) VDRL positive mothers received treatment antenatally. All mothers were asymptomatic and none had any clinical features of syphilis. In 35/44 babies, the VDRL test was positive and in nine, the test was either negative or unknown. Twenty-six of the babies had signs suggestive of congenital syphilis and in 12, (46%) long bone radiographs revealed changes compatible with the diagnosis of congenital syphilis. Radiographic abnormalities were present only in infants with VDRL titres > 1:8.

Adolescent↗
PubMed2001

Progression of dreams of crack cocaine abusers as a predictor of treatment outcome: a preliminary report.

This study tested the hypotheses that a) the dream content of crack cocaine abusers in Trinidad and Tobago changes during abstinence, and b) the change in dream content can be used to predict treatment outcome. The sample comprised 46 consecutive patients who completed a 3-month residential treatment program and were followed up after 6 months. Dreams and associated emotions were recorded during the first month of inpatient treatment and at 6 months follow-up. Forty-one (89.1%) patients reported drug dreams during the first month, mainly of using the drug. Twenty-eight (60.9%) had drug dreams at 6 months follow-up, mainly of using or refusing the drug. There was an abstinence rate of 56.5% at 6 months. A better treatment outcome was associated with having drug dreams at 6 months follow-up (p < .05) and dreams of refusing the drug (p < .05). Findings support the need to further explore the progression of dreams during treatment as a predictive tool.

Adult↗
PubMed2001

Breastfeeding knowledge and beliefs among adults in eastern Tobago.

Using a cross-sectional survey, the knowledge and beliefs about breastfeeding were evaluated among adults in Eastern Tobago (N = 509). Of the respondents, 95%, 69%, and 48% indicated that a baby should be exclusively breastfed at birth, 3 months, and 6 months, respectively. The baby's mother was thought to have the greatest influence on breastfeeding decisions. Of the respondents, 63% and 80% were unaware of expressed breast milk and cup-feeding a neonate, whereas 82% believed that a solely breastfed baby should receive water. Additionally, 23% and 44% felt that breastfeeding should be terminated before 6 months and between 6 and 12 months, respectively. Inadequate maternal nutrition and employment were reported as the principal factors affecting breastfeeding. There is a lack of knowledge about the anatomy and physiology of lactation and about the benefits of exclusive breastfeeding. These findings are useful for guiding the development and implementation of interventions to promote breast-feeding in Tobago.

Adult↗
PubMed1999

Perceptions about mental illness among pre-clinical medical students in Trinidad & Tobago.

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad & Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88% felt that medical treatment in hospital was the best means of treating the illness and 86% suggested that discharge should be conditional on regular visits to a doctor. 89% however opposed the patient's marrying into their families and 85% to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illness (p < 0.03). Surprisingly, 25% believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.

Adult↗
PubMed1999

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago.

We investigated the rate of HIV infection in patients at the St Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9%) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75%. Among the high-risk group tested, being positive for HIV was associated with age (p = 0.01) and ethnicity (p = 0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p < 0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p < 0.001). These findings indicate that psychiatric patients are at greater than average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.

Adolescent↗
PubMed1999

Experiences and socialization of Jamaican men with multiple sex partners.

One of the goals of the Acquired Immunodeficiency Syndrome (AIDS) control programme in Jamaica is to encourage persons to have a single sex partner. Before this can be achieved in men, it is important to identify the demographic characteristics as well as the sexual attitudes and socialization of men who have multiple sex partners. A national survey was conducted on sexual decision-making in Jamaica in which a random sample of 3,001 persons was selected for study and of 2,580 (86%) interviewed 979 were men. The following analyses included the 769 men who were sexually active. Thirty-four per cent (34%), 95% CI, 30.6-37.4%) of these men said that they were currently having sex with more than one woman. Although condom use was higher in men with multiple sex partners, 33% of them said that they never used condoms. Independent predictors of having multiple sex partners were: not being in a stable union; being raised by fathers only; and having a secondary school education. There was no significant association with church attendance or with occupation. Compared with other males, men who had multiple sex partners started having sex at an earlier age and were more likely to engage in high-risk sex behaviours such as having sex with prostitutes and abusing drugs prior to coitus. They were also more likely to believe in the use of sex as a means to control their partners and were less likely to think that being married or involved in a long-term relationship was important. These data must be taken into consideration by the AIDS control programme in Jamaica when formulating policies to promote monogamy. There may also be a need to implement parenting support or education programmes for single men who raise their sons.

Adolescent↗
PubMed1998

School feeding in Jamaica: a review of its evaluation.

This paper reviews two studies that evaluated the school feeding program in Jamaica. The first examined 115 children aged 12-13 y who were enrolled in three classes in a poor, rural school. One class was served the standard school meal at 0900 whereas the other two classes served as controls. The outcome variables included school achievement, attendance, and weight gain. After one semester, the class receiving the meal showed improved arithmetic scores and school attendance compared with the control classes; however, they showed no weight gain. The academic improvement remained significant after school attendance was controlled for. It was therefore hypothesized that the gains in arithmetic resulted from the alleviation of hunger in the classroom. The other study, conducted in a metabolic ward, examined the effects of missing breakfast on cognitive function in 90 children aged 9-10 y and of differing nutritional status. Using a crossover design, the investigators tested each child on two mornings 1 wk apart, once after serving them breakfast and second without. Breakfast, consisting of the school program meal, was served at 0800. When severely malnourished, stunted, or wasted children received no breakfast, their performance in various cognitive tests deteriorated. These results indicate that alleviation of hunger was one of the mechanisms by which school feeding improved academic achievement in the previous study. Undernourished children are more likely to benefit from school feeding programs than are adequately nourished children.

Adolescent↗
PubMed1997

Suicide in Trinidad and Tobago: associations with measures of social distress.

Using national statistics for the period 1978-1992, associations were examined between suicide rates and measures of social distress in Trinidad and Tobago. The latter included unemployment, serious crimes, emigration rates and admissions to the country's psychiatric hospital. There was a 319% increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in 1992. Although there were fluctuations in the rate for females, it remained below 8/100,000. Over the 15-year period examined, there was a 51% increase in serious crime while male and female unemployment increased by 89% and 33% respectively. There was a 63% fall in the rate of permanent emigration while male and female admissions to the psychiatric hospital fell by 28% and 19% respectively. There were significant positive associations between male suicide and serious crimes as well as with male and female unemployment (p < 0.01). Male suicide rates were also negatively associated with the male admissions to the psychiatric hospital (p < 0.01). Female suicide rates were positively associated with serious crime and male unemployment (p < 0.01). Although it is not possible to determine whether the observed associations were causal, the results suggest that social distress may be an important contributor to the suicide rate in Trinidad and Tobago, particularly among men. The organisation of preventive strategies for suicidal behaviour must therefore include measures to counter the experience of social distress in this setting.

Adolescent↗
PubMed1996

Use of food expenditure data to estimate household nutrient accessibility.

The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20% and 9% of the households were less than half of requirements for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica.

Cost-Benefit Analysis↗
PubMed1996

The prevalence of seat belt use in Jamaica. An observational study.

An observational cross-sectional survey showed that 21.1% of private motor vehicle drivers and 13.5% of front seat passengers voluntarily wore seat belts in Kingston, Jamaica, where there is no law requiring this. Rear passenger utilisation was not examined. Compared to males, females were significantly more likely to wear seat belts when driving but not as front seat passengers. Of all motor vehicles examined, 10.1% were not equipped with seat belts. The oldest group of vehicles were mostly not fitted with seat belts. Drivers of older vehicles were significantly less likely to use seat belts even when the vehicles were equipped with belts. Implementation of legislation can reduce mortality, morbidity and costs from road traffic accidents which are relatively frequent in Jamaica. Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign should legislation, which is highly desirable, be implemented.

Adult↗
PubMed1996

Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases.

Because of the high prevalence of marijuana smoking in Jamaica, it is important to know if this practice is associated with increased risk for STD infections. A national sample of 2 580 randomly selected Jamaicans, aged 15 to 49 years were administered a questionnaire to measure a number of health and behavioural variables. The results indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46% vs 26%, p < 0.001) but not among women (19% vs 8%, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviours and other risk taking behaviors than non-smokers. The results of multiple logistic regression analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odds Ratio = 2.0, p = 0.04). Although it was not possible to determine if the association was causal, the increased risk for STDs among men who smoke marijuana before sex should be incorporated into the Jamaican STD/AIDS control programme by making special efforts to encourage condom use among marijuana smokers.

Adolescent↗