Background Preconception care (PCC) is the term used for activities and interventions designed to... more Background Preconception care (PCC) is the term used for activities and interventions designed to address and prevent problems related to pregnancy, the neonatal period and childhood. This study assessed maternal health status prior to conception in Trinidad by means of a screening tool, physical measurements, and laboratory samples. Methods A cross-sectional study was conducted among women aged 18–45 years at a primary care centre in Arima, Trinidad. A de novo PCC screening tool was used to assess 13 domains of high-risk pregnancy in participants. These domains included dietary details, gynaecological and obstetric histories, and genetic and vaccination histories, among others. Blood pressure, weight, height, and waist circumference were recorded, and a capillary blood sample was used to determine random blood glucose and HbA1c levels. All data were coded and entered into SPSS ver. 21. Results A total of 400 nongravid participants were recruited, of whom 366 were included in the fi...
The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood p... more The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood pressure from awake to sleep periods), as captured by ambulatory blood pressure monitoring, is a valuable element of risk prediction for cardiovascular disease, independent of daytime or clinic blood pressure measurements. However, capturing measurements, including determination of wake/sleep periods, is challenging. Accordingly, we sought to evaluate the impact of different definitions and algorithms for defining sleep onset on the classification of nocturnal nondipping. Using approaches based upon participant self-reports, applied definition of a common sleep period (12 am -6 am), manual actigraphy, and automated actigraphy we identified changes to the classification of nocturnal nondipping, and conducted a secondary analysis on the potential impact of an ambulatory blood pressure monitor on sleep. Among 61 participants in the Eastern Caribbean Health Outcomes Research Network hypertens...
This paper is a descriptive one and provides the background and programme description of the Post... more This paper is a descriptive one and provides the background and programme description of the Postgraduate Diploma in Primary Care and Family Medicine at The University of the West Indies, St Augustine, Trinidad and Tobago. This time-efficient model, built on the principles of adult learning, draws on the participants' past and present work experiences and uses their present work experiences as a source for reflection and change in a student-friendly, academic, educational setting. Core courses within the programme include medical education, biomedical ethics, evidence-based medicine and communication skills. There is also a strong clinical component to the programme.
Background: The aim of this study was to measure the patient’s perception of patient centeredness... more Background: The aim of this study was to measure the patient’s perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement.Method: A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum of 12. Results: There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 ...
International Journal of Environmental Research and Public Health
Improving public health initiative requires an accurate anthropometric index that is better suite... more Improving public health initiative requires an accurate anthropometric index that is better suited to a specific community. In this study, the anthropometric grouping index is proposed as a more efficient and discriminatory alternative to the popular BMI for the Eastern Caribbean population. A completely distribution-free cluster analysis was performed to obtain the 11 categories, leading to AGI-11. Further, we studied these groups using novel non-parametric clustering summaries. Finally, two generalized linear mixed models were fitted to assess the association between elevated blood sugar, AGI-11 and BMI. Our results showed that AGI-11 tends to be more sensitive in predicting levels of elevated blood sugar compared to BMI. For instance, individuals identified as obese III according to BMI are (POR: 2.57; 95% CI: (1.68, 3.74)) more likely to have elevated blood sugar levels, while, according to AGI, individuals with similar characteristics are (POR: 3.73; 95% CI: (2.02, 6.86)) more ...
BACKGROUND: Despite overwhelming evidence that preconception care (PCC) has the promise to improv... more BACKGROUND: Despite overwhelming evidence that preconception care (PCC) has the promise to improve the health and welfare of women, infants, and children; it is not routinely undertaken nor recommended to the population of Trinidad and Tobago. This study assessed maternal health status prior to conception by means of a screening tool, physical measurements and laboratory samples in Trinidad.METHODS: A cross-sectional study was conducted among women, aged 18-45, at a primary care centre in Arima, Trinidad, between December 4th 2016 and January 14th 2017. A de novo PCC screening tool assessed 13 domains of high-risk pregnancy in participants. Blood pressure, weight, height and waist circumference were recorded, and a capillary blood sample determined random blood glucose and HbA1c. All data were coded and entered into SPSS ver. 21. RESULTS: A total of 400 women were recruited. 366 were included in the final analysis. Most (96.7%) had one or more risk factors for adverse pregnancy outc...
Objectives Somatoform disorders are common in international primary care settings, but have been ... more Objectives Somatoform disorders are common in international primary care settings, but have been little studied in the developing world. The objective of this study was to determine the prevalence of severe undifferentiated somatoform disorder, and its relationship to depression and anxiety, among patients attending walk-in clinics in Trinidad. Methods The study participants, who were all aged 18 years or older and attending walk-in clinics at 16 randomly selected health centres, were surveyed between May and August 2007 using the PRIME-MD questionnaire. Results There were 594 participants (the response rate was 92%), of whom 72.7% were female. Their ages ranged from 18 to 93 years, and 54.5% were over 50 years of age. In total, 37.2% were married and 25.9% were single. Indo-Trinidadians represented 43.1% and Afro-Trinidadians represented 36% of the study sample; 56.5% of the participants reported that their income was less than US$ 400 per month, and 65.7% were unemployed. At walk-...
Additional file 1: Appendices. Appendix A. Comparison of included and excluded cases from the ECS... more Additional file 1: Appendices. Appendix A. Comparison of included and excluded cases from the ECS. Appendix B. Odds of elevated cardiovascular risk by elevated BMI, waist-to-hip ratio and waist-to-height ratio stratified by race. Appendix C. Odds of elevated cardiovascular risk by elevated BMI, waist-to-hip ratio and waist-to-height ratio [all participants classified as "AFRICAN AMERICAN" except those who self-identify as white – classified as "OTHER" for ASCVD Calculation].
Background: The aim of this paper was to review and summarize research on prevalence of health ri... more Background: The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean. Methods: Searching of online databases and the World Wide Web as well as hand searching of the West Indian Medical Journal were conducted. Papers on research done on adolescents aged 10 – 19 years old and published during the period 1980 – 2005 were included. Results: Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000–2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of substance use: cigarettes-24 % and marijuana-17%; high risk sexual behaviour: initiation of sexual activity ≤ 10 years old-19 % and those having more than six partners-19%; teenage pregnancy: teens account for 15–20 % of all pregnancies and o...
Background: To determine the prevalence of abuse by their partners and its association with menta... more Background: To determine the prevalence of abuse by their partners and its association with mental disorders among female patients at walk-in clinics in Trinidad. Methods: Female participants from 16 randomly selected walk-in clinics, previously stratified to represent all administrative regions and urban and rural settings, who were 18 years or older, were surveyed during May to August 2007 using the WAST-Short and PRIME-MD questionnaires.
AIMS To determine the level of glycemic control and cardiovascular (CVD) risk among adults with d... more AIMS To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.
Background Accurately defining obesity using anthropometric measures that best capture obesity-re... more Background Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. Methods Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. Results Mean age (SD) of...
Background Preconception care (PCC) is the term used for activities and interventions designed to... more Background Preconception care (PCC) is the term used for activities and interventions designed to address and prevent problems related to pregnancy, the neonatal period and childhood. This study assessed maternal health status prior to conception in Trinidad by means of a screening tool, physical measurements, and laboratory samples. Methods A cross-sectional study was conducted among women aged 18–45 years at a primary care centre in Arima, Trinidad. A de novo PCC screening tool was used to assess 13 domains of high-risk pregnancy in participants. These domains included dietary details, gynaecological and obstetric histories, and genetic and vaccination histories, among others. Blood pressure, weight, height, and waist circumference were recorded, and a capillary blood sample was used to determine random blood glucose and HbA1c levels. All data were coded and entered into SPSS ver. 21. Results A total of 400 nongravid participants were recruited, of whom 366 were included in the fi...
The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood p... more The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood pressure from awake to sleep periods), as captured by ambulatory blood pressure monitoring, is a valuable element of risk prediction for cardiovascular disease, independent of daytime or clinic blood pressure measurements. However, capturing measurements, including determination of wake/sleep periods, is challenging. Accordingly, we sought to evaluate the impact of different definitions and algorithms for defining sleep onset on the classification of nocturnal nondipping. Using approaches based upon participant self-reports, applied definition of a common sleep period (12 am -6 am), manual actigraphy, and automated actigraphy we identified changes to the classification of nocturnal nondipping, and conducted a secondary analysis on the potential impact of an ambulatory blood pressure monitor on sleep. Among 61 participants in the Eastern Caribbean Health Outcomes Research Network hypertens...
This paper is a descriptive one and provides the background and programme description of the Post... more This paper is a descriptive one and provides the background and programme description of the Postgraduate Diploma in Primary Care and Family Medicine at The University of the West Indies, St Augustine, Trinidad and Tobago. This time-efficient model, built on the principles of adult learning, draws on the participants' past and present work experiences and uses their present work experiences as a source for reflection and change in a student-friendly, academic, educational setting. Core courses within the programme include medical education, biomedical ethics, evidence-based medicine and communication skills. There is also a strong clinical component to the programme.
Background: The aim of this study was to measure the patient’s perception of patient centeredness... more Background: The aim of this study was to measure the patient’s perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement.Method: A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum of 12. Results: There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 ...
International Journal of Environmental Research and Public Health
Improving public health initiative requires an accurate anthropometric index that is better suite... more Improving public health initiative requires an accurate anthropometric index that is better suited to a specific community. In this study, the anthropometric grouping index is proposed as a more efficient and discriminatory alternative to the popular BMI for the Eastern Caribbean population. A completely distribution-free cluster analysis was performed to obtain the 11 categories, leading to AGI-11. Further, we studied these groups using novel non-parametric clustering summaries. Finally, two generalized linear mixed models were fitted to assess the association between elevated blood sugar, AGI-11 and BMI. Our results showed that AGI-11 tends to be more sensitive in predicting levels of elevated blood sugar compared to BMI. For instance, individuals identified as obese III according to BMI are (POR: 2.57; 95% CI: (1.68, 3.74)) more likely to have elevated blood sugar levels, while, according to AGI, individuals with similar characteristics are (POR: 3.73; 95% CI: (2.02, 6.86)) more ...
BACKGROUND: Despite overwhelming evidence that preconception care (PCC) has the promise to improv... more BACKGROUND: Despite overwhelming evidence that preconception care (PCC) has the promise to improve the health and welfare of women, infants, and children; it is not routinely undertaken nor recommended to the population of Trinidad and Tobago. This study assessed maternal health status prior to conception by means of a screening tool, physical measurements and laboratory samples in Trinidad.METHODS: A cross-sectional study was conducted among women, aged 18-45, at a primary care centre in Arima, Trinidad, between December 4th 2016 and January 14th 2017. A de novo PCC screening tool assessed 13 domains of high-risk pregnancy in participants. Blood pressure, weight, height and waist circumference were recorded, and a capillary blood sample determined random blood glucose and HbA1c. All data were coded and entered into SPSS ver. 21. RESULTS: A total of 400 women were recruited. 366 were included in the final analysis. Most (96.7%) had one or more risk factors for adverse pregnancy outc...
Objectives Somatoform disorders are common in international primary care settings, but have been ... more Objectives Somatoform disorders are common in international primary care settings, but have been little studied in the developing world. The objective of this study was to determine the prevalence of severe undifferentiated somatoform disorder, and its relationship to depression and anxiety, among patients attending walk-in clinics in Trinidad. Methods The study participants, who were all aged 18 years or older and attending walk-in clinics at 16 randomly selected health centres, were surveyed between May and August 2007 using the PRIME-MD questionnaire. Results There were 594 participants (the response rate was 92%), of whom 72.7% were female. Their ages ranged from 18 to 93 years, and 54.5% were over 50 years of age. In total, 37.2% were married and 25.9% were single. Indo-Trinidadians represented 43.1% and Afro-Trinidadians represented 36% of the study sample; 56.5% of the participants reported that their income was less than US$ 400 per month, and 65.7% were unemployed. At walk-...
Additional file 1: Appendices. Appendix A. Comparison of included and excluded cases from the ECS... more Additional file 1: Appendices. Appendix A. Comparison of included and excluded cases from the ECS. Appendix B. Odds of elevated cardiovascular risk by elevated BMI, waist-to-hip ratio and waist-to-height ratio stratified by race. Appendix C. Odds of elevated cardiovascular risk by elevated BMI, waist-to-hip ratio and waist-to-height ratio [all participants classified as "AFRICAN AMERICAN" except those who self-identify as white – classified as "OTHER" for ASCVD Calculation].
Background: The aim of this paper was to review and summarize research on prevalence of health ri... more Background: The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean. Methods: Searching of online databases and the World Wide Web as well as hand searching of the West Indian Medical Journal were conducted. Papers on research done on adolescents aged 10 – 19 years old and published during the period 1980 – 2005 were included. Results: Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000–2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of substance use: cigarettes-24 % and marijuana-17%; high risk sexual behaviour: initiation of sexual activity ≤ 10 years old-19 % and those having more than six partners-19%; teenage pregnancy: teens account for 15–20 % of all pregnancies and o...
Background: To determine the prevalence of abuse by their partners and its association with menta... more Background: To determine the prevalence of abuse by their partners and its association with mental disorders among female patients at walk-in clinics in Trinidad. Methods: Female participants from 16 randomly selected walk-in clinics, previously stratified to represent all administrative regions and urban and rural settings, who were 18 years or older, were surveyed during May to August 2007 using the WAST-Short and PRIME-MD questionnaires.
AIMS To determine the level of glycemic control and cardiovascular (CVD) risk among adults with d... more AIMS To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.
Background Accurately defining obesity using anthropometric measures that best capture obesity-re... more Background Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. Methods Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. Results Mean age (SD) of...
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Papers by Rohan Maharaj