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A comparison of Caribbean and non-Caribbean clients in a residential addiction treatment facility in Antigua, West Indies.

The first 50 Caribbean clients admitted to a private, multicultural, not for profit addiction treatment center in Antigua, West Indies, were compared with the first 100 non-Caribbean clients admitted. There was no significant difference in age, 38 years (18-61 years) versus 40 years (22-63 years), or gender, 74% versus 67% male. Caribbean clients were more likely to be Black, 68% versus 2%, P < .001. Caribbean clients were less likely to have a prior psychiatric diagnosis, 18% versus 43%, P < .01, or to have been in prior treatment program, 22% versus 64%, P < .001. Caribbean and non-Caribbean clients were equally likely to be polydrug users, 48% versus 50%, and to use alcohol as a primary drug, 52% versus 51%. Caribbean clients were more likely to use cocaine, 30% versus 11%, P < .01, and marijuana, 12% versus 0%, P < .001, but less likely to use heroin, 6% versus 30%, P < .001 or pills, 0% versus 8%, P < .05. Caribbean clients were less likely to have elevated MCV, 24% versus 57%, P < .001 or serum transaminases, 23% versus 46%, P < .01. Differences between groups in this multicultural setting warrant further investigation.

Adolescent↗

Incidence of childhood-onset IDDM in black African-heritage populations in the Caribbean. The Caribbean African Heritage IDDM Study (CAHIS) Group.

OBJECTIVE: To compare incidence rates of childhood-onset IDDM among black African-heritage populations age 0-19 years in the Caribbean region. RESEARCH DESIGN AND METHODS: Population-based registries for IDDM were established on the eastern Caribbean islands of Antigua, Barbados, Dominica, St. Croix, St. Kitts, St. Thomas, and Tortola using standardized criteria from the World Health Organization (WHO) Multinational Project for Childhood Diabetes (DiaMond). Average annual incidence rates (IR) with 95% CI for 0-19 years olds were computed using the DiaMond Registry program for the 5-year period from 1989 to 1993. Poisson regression analysis was used to determine differences in incidence rates. RESULTS: The highest incidence rate for 0-19 year olds was for the black African-heritage population of St. Croix (IR 10.09 per 100,000; 95% CI 4.35-19.89), one of the U.S. Caribbean islands. A significant (P < 0.05) 3.9 variation in IDDM incidence across the registries was found when the IR for St. Croix was compared to the IR for Barbados (IR 2.57 per 100,000; 95% CI 0.90-4.64). CONCLUSIONS: The variation in childhood-onset IDDM incidence rates among the black populations of the eastern Caribbean islands is consistent with the geographic variation in IDDM incidence seen among African Americans in the U.S. Variation in incidence rates of childhood diabetes in black populations may reflect differences in level of white genetic admixture or exposure to environmental diabetogenic agents.

Adolescent↗

Eradication of the tropical bont tick in the Caribbean: is the Caribbean amblyomma program in a crisis?

The progress and problems in the Caribbean Amblyomma Program (CAP) are reviewed since its inception in 1995. During 1998, there were funding and administrative management problems. USDA resolved the acute funding crisis, and after three years of negotiation, the CAP has now secured an additional euro 1.5 million from the European Community. Changes in administration in 1998 included the withdrawal of IICA from the program, and the transition during the decentralization of administrative and financial management from FAO headquarters to the Regional Office for Latin America and the Caribbean, based in Chile. A general overview of technical progress and one case study, St. Kitts, is presented. One major concern that emerged during 2000 is that the elimination of the small remaining tropical bont tick (TBT) "hot spots" in both St. Kitts and St. Lucia remained elusive. Why is this so? Egrets? Alternative residual hosts? Or is it fatigue in both technical and administrative management functions? Of even greater concern is the finding of two, apparently new, foci in St. Croix (USVI) in the north and St. Vincent in the south. A critical overview of the program has identified one major remaining constraint-an appropriate management support function at both regional and, in some countries, at the national level. A proposal for a revised management strategy, coupled with the identification of a future strategy to succeed the CAP, namely a Caribbean Animal Resources Management (CARM) Program.

Animals↗

Dengue viruses in the Caribbean. Twenty years of dengue virus isolates from the Caribbean Epidemiology Centre.

The first isolate of a dengue virus in the Americas was obtained in Trinidad and Tobago in 1953, and several dengue virus isolates were obtained in subsequent years. However, the systematic isolation and typing of dengue viruses in support of virus surveillance and outbreak investigations did not start until the creation of the Caribbean Epidemiology Centre (CAREC) in 1975. Since then, over two thousand viral isolates have been obtained and typed from many countries in the English and Dutch-speaking Caribbean. In this communication, virological data from 17 countries between 1977 and 1996 are presented and analyzed together for the first time with available epidemiological data. Types 1, 2 and 4 were isolated over the period, and geographic and temporal patterns in the distribution of the most prevalent strains are presented. The historical surveillance data is critically assessed. A temporal correlation with reported dengue incidence and rainfall data in Trinidad and Tobago is reported. Recent changes in epidemiological patterns are described, including reference to two large later outbreaks. Risk assessment of complicated forms of dengue virus infections in the Caribbean has been attempted, with some success. The importance of ongoing systematic surveillance is discussed.

Age Distribution↗

[Serpulids (Polychaeta: Serpulidae) from the Northwestern Caribbean with keys to the Grand Caribbean region: Salmacina, Ficopomatus, Pomatoceros, Pomatostegus, Protula, Pseudovermilia, Spirobranchus and Vermiliopsis].

From the revision of more than 1,250 serpulids, 15 species from the Grand Caribbean Region were identified and characterized. Thirteen species were collected along the shores of the Yucatan Peninsula and eight were found in other localities in the Gulf of Mexico, seven others are from Cuba and comments on type specimens of two species are also included. Three morphometric analyses were made to evaluate some characters. The first on Pomatostegus stellatus (Abildgaard), and related species and subspecies: P. brachysoma Schmarda, P. macrosoma Schmarda, P. s. fruticosa Mörch, P. s. pentapoma Mörch and P. s. tetrapoma Mörch, indicated that they are conspecific. Another one on Spirobranchus de Blainville species: S. dendropoma Mörch, S. giganteus (Pallas), S. polycerus (Schmarda) and S. polycerus augeneri ten Hove; indicated that S. giganteus differs from the other three taxa. The third analysis was made on Vermiliopsis annulata (Schmarda) sensu lato; it allowed the recognition of three different forms. Several incomplete specimens might belong to an undescribed genus. A key for identification of all the species recorded in the Grand Caribbean Region is also included.

Animals↗

[Exogoninae (Polychaeta: Syllidae) from the Mexican Caribbean region with a key for the Gran Caribbean species].

This paper identifies the Exogoninae (Syllidae) from the Mexican Caribbean coasts and includes a key to identify all the species recorded from the Grand Caribbean Sea. The classification of the family and the composition of Exogoninae are briefly examined; the correct names of the subfamilies are Syllinae Grube, 1850, Eusyllinae Malaquin, 1893, Autolytinae Malaquin, 1893 and Exogoninae Langerhans, 1879. Exogoninae includes Anguillosyllis Day, 1963, Brania de Quatrefages, 1866, Braniella Hartman, 1963, Exogone Ørsted, 1845, Exogonella Hartman, 1961, Exogonoides Day, 1963, Parapionosyllis Fauvel, 1923, Psammosyllis Westheide, 1990, Spermosyllis Claparède, 1864, and Sphaerosyllis Claparède, 1863. Pseudexogone Augener, 1922, formerly included in the group, is not a syllid; it belongs to Pilargidae. We collected 814 specimens belonging to 3 genera, 3 subgenera and 13 species as Brania (4), Exogone (4) and Sphaerosyllis (5); five new species are described: Brania russelli n. sp, Brania uebelackerae n. sp, Brania westheidei n. sp., Exogone (Exogone) bondi n. sp. and Exogone (Parexogone) sanmartini n. sp. For each species, selected references, diagnostic features, observations on morphological variability, distribution and illustrations are provided; new species also have an english diagnosis. Most abundant species were B. uebelackerae n. sp. (295), S. taylori Perkins (169), E. (E.) dispar Webster (76), and E. (E.) bondi n sp. (72).

Animals↗

Guidelines for young child feeding in the Caribbean--Part. II. Caribbean Food and Nutrition Institute.

This is the second of a three-part series by the Caribbean Food and Nutrition Institute (CFNI) on revised guidelines for young child feeding in the Caribbean. In Part 1, the guidelines dealt with the period before birth. These covered maternal nutrition and guidelines for promoting, protecting and supporting breastfeeding. This part covers the broad area of breastfeeding, nutrition of the newborn with low birthweight or other special requirements, and replacement feeding for infants who are not breastfed. It also discusses the introduction of complementary foods with emphasis on the continuation of breastfeeding for two years and beyond.

Bottle Feeding↗

The African Caribbean Eye Survey: risk factors for glaucoma in a sample of African Caribbean people living in London.

The purpose of the study was to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years of age living in the London Borough of Haringey. A cross-sectional voluntary sample of persons were subjected to detailed ophthalmic assessment including automated tangent screen suprathreshold visual field testing, applanation tonometry and stereoscopic disc evaluation in 50 community-based survey clinics over an 8 month period. Cases and suspects were referred to Moorfields Eye Hospital for more detailed assessment and confirmation of the diagnosis. Of 873 eligible persons examined (out of a total of 1022), 32 definite cases of glaucoma were identified, a prevalence of 3.9%; 42% of these had been previously diagnosed. Approximately 10% of the sample required further assessment and follow-up when ocular hypertensives and glaucoma suspects were included. An age-standardised comparison with the findings of the Roscommon survey revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7. Significant risk factors for glaucoma included age, African birthplace and darker skin colour. Neither diabetes nor hypertension reached significance. Despite the lack of a population base, this study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population. Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case-finding resources should be provided to meet local needs.

Africa↗

Guidelines for young child feeding in the Caribbean--Part III. Caribbean Food and Nutrition Institute.

This section is the final of three parts on the revised guidelines for young child feeding by the Caribbean Food and Nutrition Institute (CFNI). In the previous section, we covered the areas of nutrition of the newborn, feeding of low birthweight infants and those with special requirements, and replacement and complementary feedings. This section deals with the guidelines for the early childhood period and some broad policy issues. It covers the revised guidelines on vitamin and mineral supplementation, and the management of feeding-related problems in early childhood. The section also discusses nutrition policy issues and nutrition education in relation to the promotion of adequate nutrition in early childhood.

Caribbean Region↗

Guidelines for young child feeding in the Caribbean--Part I. Caribbean Food and Nutrition Institute.

The guidelines for young child feeding have been developed and prepared as a supportive-tool primarily for health personnel involved in the care of infants and children in Caribbean countries. The recommendations address some practical aspects of nutrition before, during and after pregnancy. These are: The benefits of breastfeeding and strategies for its promotion, protection and support; review of infant feeding options for mothers with HIV and other infections; nutrition of the newborn; feeding of low birth weight infants and those with special requirements; replacement feeding for infants who are not breastfed; complementary feeding with emphasis on the continuation of breastfeeding for two years and beyond; guidelines on vitamin and mineral supplementation; management of feeding-related problems in early childhood; policy issues and nutrition education in relation to the promotion of adequate nutrition in early childhood.

Breast Feeding↗

Health and health care in the English-speaking Caribbean: a British public health physician's view of the Caribbean.

People of Caribbean origin form one of the United Kingdom's most important ethnic minority groups but health conditions in the West Indies are not well understood in the UK. This review outlines past and present health conditions in the West Indies and describes the system of health care and some of the problems it faces at present. The last 30 years have seen a transition from a pattern of high childhood mortality to high mortality from chronic non-communicable diseases in adult life. Over the last ten years the severity of economic conditions undermined this progress, with the threatened re-emergence of malnutrition and infectious diseases as important health problems. Although most people in the region have access to health care, the quality and outcomes of care may be compromised by financial constraints and an unresponsive management system. Adopting modern approaches to planning and managing the health system might be one path to improvement, one to which public health professionals could make a significant contribution.

Adult↗

Relationship of glucose intolerance to coronary risk in Afro-Caribbeans compared with Europeans.

Afro-Caribbeans have low mortality rates from coronary heart disease, despite a high prevalence of diabetes mellitus. We examined 1166 Afro-Caribbean and European men and women aged 40-64 years in a community survey in London, UK. Prevalence of glucose intolerance (combining impaired glucose tolerance, new and known diabetes) was 31% in Afro-Caribbeans and 14% in Europeans (p < 0.001). In men, the prevalence of probable coronary heart disease was 6% in Afro-Caribbeans and 13% in Europeans (p < 0.01). Triglyceride was lower in Afro-Caribbeans than Europeans; in men, HDL cholesterol was higher. Afro-Caribbean men were less centrally obese, while Afro-Caribbean women were more centrally obese than their European counterparts. Fasting and 2-h insulin levels were higher in Afro-Caribbeans than Europeans. Glucose intolerance was associated with high triglyceride, low HDL cholesterol and central obesity in European but not in Afro-Caribbean men. In Europeans, fasting triglyceride was 1.49 mmol/l in normoglycaemic and 1.89 mmol/l in glucose intolerant men (p < 0.05), in Afro-Caribbean men triglyceride was 1.08 and 1.22 mmol/l, respectively. Waist hip ratio was 0.94 in normoglycaemic, and 0.98 in glucose intolerant European men (p < 0.001). In Afro-Caribbean men, waist hip ratio was 0.93 in both groups. At each level of insulin, glucose or central obesity, triglyceride was lower in Afro-Caribbean men and women than in Europeans. We speculate that despite high insulin levels, Afro-Caribbeans have a favourable lipoprotein pattern which persists in the presence of glucose intolerance, and may be related to body fat distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗