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Risk factors for open-angle glaucoma. The Barbados Eye Study.

OBJECTIVE: To evaluate risk factors for open-angle glaucoma among black participants in the Barbados Eye Study. DESIGN: Population-based study of demographic, medical, ocular, familial, and other factors possibly related to open-angle glaucoma. SETTING AND PARTICIPANTS: The Barbados Eye Study included 4709 Barbados residents identified by a simple random sample of Barbadian-born citizens, 40 to 84 years of age; participation was 84%. This report is based on the 4314 black participants examined at the study site; 302 (7%) met the Barbados Eye Study criteria for open-angle glaucoma. DATA COLLECTION: A standardized protocol included applanation tonometry, Humphrey perimetry, fundus photography, blood pressure, anthropometry, and an interview. An ophthalmologic examination was performed for participants who met specific criteria. MAIN OUTCOME MEASURES: Open-angle glaucoma was defined by the presence of both characteristic visual field defects and optic disc damage. Association of open-angle glaucoma with specific factors was evaluated in logistic regression analyses. RESULTS: Age, male gender, high intraocular pressure, and family history of open-angle glaucoma were major risk factors; the latter association was stronger in men than women. Lean body mass and cataract history were the only other factors related to open-angle glaucoma. Although hypertension and diabetes were common in Barbados Eye Study participants, they were unrelated to the prevalence of open-angle glaucoma. However, associations were found with low diastolic blood pressure-intraocular pressure differences and low systolic and diastolic blood pressure/intraocular pressure ratios. CONCLUSIONS: In the Barbados Eye Study black population, persons most likely to have open-angle glaucoma were older men and had a family history of open-angle glaucoma, high intraocular pressure, lean body mass, and cataract history. These results suggest the importance of possible genetic or familial factors in open-angle glaucoma. The role of vascular risk factors is consistent with our finding of low blood pressure to intraocular pressure relationships, but the results could be explained by the high intraocular pressure in open-angle glaucoma.

Adult

Leptospiral infection: a household serosurvey in urban and rural communities in Barbados and Trinidad.

A longitudinal study of leptospiral agglutinins in subjects five years of age and over was undertaken in Trinidad and Barbados between 1980 and 1982. Households were sampled randomly from one urban and two rural communities on each island, giving a total of 576 eligible individuals in Barbados and 524 in Trinidad. Participants were examined three times at approximately annual intervals. The prevalence of seropositivity at a titre of 1:50 using the microscopic agglutination test was 18.5% in Barbados and 21.9% in Trinidad. Prevalence increased steeply with age in both sexes and was higher in males than females on both islands. There was a marked difference in predominating serogroups on the two islands--Autumnalis (42% of positive cases) predominated in Barbados while Bataviae (29% of positive cases) predominated in Trinidad. Estimates of incidence rates for seroconversion were 2.9% per annum for Barbados and 3.5% per annum for Trinidad. Occupational risk varied between the islands, but in both cases highest seropositivity rates (greater than 50%) were found in outdoor labourers and lowest were found in indoor non-manual workers and urban homeworkers. In Barbados seroprevalence was higher among persons who cleared drains or who had contact with livestock. Lack of an inside toilet was associated with an increase in seropositivity on both islands. There was little evidence of household clustering of seropositive cases.

Adolescent

Features of age-related macular degeneration in a black population. The Barbados Eye Study Group.

OBJECTIVE: To report on the frequency of features of age-related macular degeneration in a black population based on fundus photograph gradings. DESIGN: Population-based study. SETTING: Barbados, West Indies. STUDY POPULATION: Residents of Barbados, selected by a random sample of Barbados-born citizens, aged 40 to 84 years. MAIN OUTCOME MEASURE: Gradings from 30 degrees stereoscopic macular photographs. RESULTS: Black participants (n = 3444) completed examinations at the study site and had gradable macular photographs in both eyes. Drusen larger than 63 microns occurred with comparable frequency in men and women. The frequency of small drusen decreased with age, while medium and large drusen were more common in older participants. Frequencies of all age-related macular degeneration-related characteristics were similar for men and women except for small drusen, which occurred more commonly in women. Confluent drusen and pigment atrophy also increased significantly with age. Exudative features occurred in 0.5% of the participants. CONCLUSIONS: This study provides population-based data on the frequency of features of age-related macular degeneration based on photographic gradings of a black population. Features of early age-related macular degeneration were common, but appeared at a lower frequency than has been reported for white populations. Exudative disease was infrequent, occurring in about one of 200 participants.

Adult

Leptospiral infection in school-children from Trinidad and Barbados.

A serological survey for leptospiral agglutinins was undertaken between 1980 and 1983 in over 500 Barbadian and 500 Trinidadian school-children aged 7-14 years. The children were selected randomly from urban and rural schools, and examined three times at approximately annual intervals. A total of 12.5% of the Barbadian children and 9.5% of the Trinidadian children were seropositive at a titre of 50 using the microscopic agglutination test. On both islands, seroprevalence was higher in males than females, the difference being significant in rural schools. There was no evidence of a difference in prevalence between urban and rural schools, or between junior and secondary age-ranges. Analysis of the association of serology with socio-economic and behavioural factors showed a significant association in Trinidad with father's occupation, but most other variables on both islands showed only weak non-significant associations. Fourteen children in Trinidad and three in Barbados seroconverted. Seroconversion in Trinidad occurred at a rate of 1.6% per annum and was significantly associated with livestock contact and with absence of a tapped water supply. In Trinidad, Autumnalis was the most commonly recorded serogroup, but this accounted for less than a quarter of seropositives. In Barbados, Panama accounted for over half the seropositives and was about four times more common than the next most common serogroup, Autumnalis. In Barbados, 39 persons aged 19 or less were hospitalized with leptospirosis between November 1979 and December 1986. Average annual incidence rates were 2.2, 4.9 and 13.3 per 100,000 in the 5-9, 10-14 and 15-19 age-groups, respectively.

Adolescent

Ovulation rate and litter size of Barbados, Targhee and crossbred ewes.

Ovulation rate was measured in Barbados Blackbelly (United States strain; B), Targhee (T), Barbados X Targhee (B X T) and Barbados X Dorset-Targhee (B X DT) ewes at first and second estrus following synchronization of cycles early in the breeding season. Body weight at sponge removal differed (P less than .001) between B (30.9 kg) and T ewes (54.9 kg) and was intermediate for B X T (44.9 kg) and B X DT (43.5 kg) ewes. Ovulation rate was higher (P less than .01) at first and second estrus for B (1.86, 2.04), B X T (1.93, 2.04) and B X DT (1.72, 1.80) than for T (1.29, 1.40) ewes. Regressions of ovulation rate on body weight within the breed groups did not differ significantly from each other and the average was significant (b = .049 +/- .014 CL/kg at first estrus and b = .046 +/- .011 CL/kg at second estrus, where CL = number of corpora lutea), but differences between the groups in body weight did not explain the differences in ovulation rate. Litter size for B, B X T, B X DT and T groups was 1.71, 1.84, 1.84 and 1.28, respectively. The B X T ewes were superior to the average of the B and T ewes for ovulation rate (P less than .05) and litter size (P less than .01); there was no direct estimate of embryo survival, but the results indirectly indicate superiority of the crossbreds for this component also.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Kerosene poisoning in children in Barbados.

A retrospective study is reported of 140 children aged between seven months and five years who were admitted to the Queen Elizabeth Hospital, St Michael, Barbados during a six-year period with kerosene poisoning. Seventy-eight were male (56%) and 62 female (44%). The majority (61%) were brought to the hospital less than four hours after ingestion. Vomiting, cough, fever and drowsiness were the most common symptoms observed. Twenty-four of 48 patients X-rayed showed pneumonia. There were no deaths. Physical findings were normal in those patients who were seen at follow-up clinic. Kerosene ingestion remains the commonest cause of childhood poisoning in Barbados. There is a greater need to stress its prevention in order to reduce its incidence.

Barbados

Bim, a new serovar of Leptospira interrogans isolated from a dog in Barbados.

A new serovar of Leptospira interrogans was isolated from a dog in Barbados. The proposed name of the new serovar is bim, and the designated type strain is 1051. The serogroup of the new serovar is the Autumnalis serogroup. The new serovar was subsequently isolated from six patients with leptospirosis in Barbados.

Animals

A pilot project of glaucoma in Barbados.

The prevalence of open-angle glaucoma is believed to be very high among West Indian blacks. To begin investigating the prevalence and risk factors for glaucoma and other eye diseases in Barbados, WI, a pilot study was conducted. The pilot project identified a stratified, random national sample of 300 persons over 35 years of age who were invited to participate in an ophthalmic examination and an interview. Of those contacted 89% were eligible and 95% of these agreed to participate. The overall glaucoma prevalence in the participants was 6%; it was 13% among black and mixed persons over 54 years. Age related cataract, hypertension, and diabetes were frequent findings. Although the sample size of the pilot project is small, the results suggest a high prevalence of glaucoma in Barbados, a finding that merits further study.

Adult

Blood pressure in blacks. Twin studies in Barbados.

We have recently reported that there are significant genetic influences on the population variation in blood pressure in black twins in Los Angeles. The present cross-sectional study was undertaken to replicate these findings in a black twin population that lives in a different biosocial environment. We chose the Caribbean island nation of Barbados, where 96% of the population is black, the literacy rate is 99%, and the access to health care is guaranteed. The goals were 1) to test the feasibility of twin studies in blood pressure research in a developing country and 2) to estimate the relative contribution of genes and environment to blood pressure variability in blacks in the Caribbean. The names of 200 twin sets were obtained with the assistance of community resources including a twin club, by media advertisement, and by asking people at public blood pressure screenings if they knew any twins. By using these methods, we identified 200 sets of twins. Of these, 37.5% (75/200) met our criteria for study. Although 97% of the sets of twins (73/75) said they were willing to participate, only 69% (52/75) were able to be scheduled during the 1 week of the study when the full team of investigators was in Barbados. Of those scheduled, 83% (43/52) were examined. Examination included medical history, physical examination, recumbent blood pressure measurements by two observers, anthropometric measurements, 24-hour urine collections for sodium and potassium tests, and blood tests for zygosity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

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

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

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

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

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

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

Osteology of a slave burial population from Barbados, West Indies.

A unique seventeenth-nineteenth century slave cemetery population from Newton plantation, Barbados, allows examination of craniodental characters in relation to ethnohistorical data. Age-at-death estimates suggest life expectancy at birth of 29 years and low infant mortality; historical demography, however, suggests life expectancy of 20 years and very high infant mortality. Tooth decay, bilateral tooth loss, periodontal disease, root hypercementosis, and severe enamel hypoplasia are high in frequency. The teeth yield evidence of such cultural practices as pipe-smoking and incisor mutilation. Several skeletal features reflect periodic near-starvation. Directional and fluctuating dental asymmetry, relative tooth size, and hypoplasia distribution suggest slaves experienced considerable weaning trauma; metabolic stress at this time exceeded that of prenatal and immediate postnatal periods. Odontometrics and dental and cranial nonmetric traits indicate that modern Blacks are intermediate between the ancestral slaves and modern Whites but more similar to the latter, suggesting effects of environmental covariance exceed those of genetic admixture. Nonmetric trait distributions show nonrandom patterns according to area of burial in the cemetery, a possible result of family segregation.

Adolescent