Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados.

INTRODUCTION: Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados. RESEARCH DESIGN AND METHODS: A cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs. RESULTS: The prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m2 and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m2 (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%-46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3). CONCLUSIONS: While BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.The project was supported by the Ministry of Health of the Government of Barbados. ANW is supported by the Fogarty International Center of the National Institutes of Health under Award Number K43TW010698. This paper describes the views of the authors and does not necessarily represent the official views of the National Institutes of Health (USA)

Trends in Longevity in the Americas: Disparities in Life Expectancy in Women and Men, 1965-2010

<div><p>Objective</p><p>We describe trends in life expectancy at birth (LE) and between-country LE disparities since 1965, in Latin America and the Caribbean.</p><p>Methods & Findings</p><p>LE trends since 1965 are described for three geographical sub-regions: the Caribbean, Central America, and South America. LE disparities are explored using a suite of absolute and relative disparity metrics, with measurement consensus providing confidence to observed differences. LE has increased throughout Latin America and the Caribbean. Compared to the Caribbean, LE has increased by an additional 6.6 years in Central America and 4.1 years in South America. Since 1965, average reductions in between-country LE disparities were 14% (absolute disparity) and 23% (relative disparity) in the Caribbean, 55% and 51% in Central America, 55% and 52% in South America.</p><p>Conclusions</p><p>LE in Latin America and the Caribbean is exceeding ‘minimum standard’ international targets, and is improving relative to the world region with the highest human longevity. The Caribbean, which had the highest LE and the lowest between-country LE disparities in Latin America and the Caribbean in 1965-70, had the lowest LE and the highest LE disparities by 2005-10. Caribbean Governments have championed a collaborative solution to the growing burden of non-communicable disease, with 15 territories signing on to the Declaration of Port of Spain, signalling regional commitment to a coordinated public-health response. The persistent LE inequity between Caribbean countries suggests that public health interventions should be tailored to individual countries to be most effective. Between- and within-country disparity monitoring for a range of health metrics should be a priority, first to guide country-level policy initiatives, then to contribute to the assessment of policy success.</p></div

Digital Vaginal Assessment: An inter-tester reliability study

A variety of methods may be employed to assess pelvic floor muscle activity, the most widely used being digital vaginal assessment. However, this is a subjective form of assessment and consequently there are issues concerning reliability when two or more clinicians are involved in assessment before and after treatment of patients with urinary incontinence. This article presents the results of a study assessing inter-tester reliability between four clinicians on three different sites. Thirty patients (ten for each clinician from three sites) were assessed by four clinicians. One clinician from each of the three sites was compared to a fourth. Each patient was assessed twice (once by clinician 1, 2 or 3 and once by clinician 4). All four clinicians adhered to the same written protocol and were prevented from conferring until the end of the investigation. For clinicians 1 and 3 there were few discrepancies between their scores and those of clinician 4. However, initially there were considerable differences in assessment techniques between clinicians 2 and 4. After appropriate training the disparity between these two clinicians was considerably reduced. Inter-tester reliability should not be assumed between clinicians and should be established when two or more clinicians are involved in pre-and post-treatment assessment. If disparity does occur between assessors the difference in assessment technique may be overcome with appropriate training

Trends in between-country disparities using two ‘simple’ disparity metrics (LER, LED), and four ‘complex’ disparity metrics (MD, ID, STI, BGV) for four sub-regions of the Americas, 1965–2010 (women and men combined).

<p>Trends in between-country disparities using two ‘simple’ disparity metrics (LER, LED), and four ‘complex’ disparity metrics (MD, ID, STI, BGV) for four sub-regions of the Americas, 1965–2010 (women and men combined).</p

Life expectancy at birth (LE), the absolute difference in LE compared to the global average (the LE gap), and the absolute difference in LE compared to the region with the highest LE (the LE shortfall) for women and men in the Americas between 1965 and 2010.

<p>Life expectancy at birth (LE), the absolute difference in LE compared to the global average (the LE gap), and the absolute difference in LE compared to the region with the highest LE (the LE shortfall) for women and men in the Americas between 1965 and 2010.</p

Gender disparities in life expectancy at birth (LE) in 1965–70 and in 2005–10 among 4 sub-regions of the Americas.

<p>Gender disparities in life expectancy at birth (LE) in 1965–70 and in 2005–10 among 4 sub-regions of the Americas.</p

Establishing national noncommunicable disease surveillance in a developing country: a model for small island nations

ABSTRACT Objective To describe the surveillance model used to develop the first national, population-based, multiple noncommunicable disease (NCD) registry in the Caribbean (one of the first of its kind worldwide); registry implementation; lessons learned; and incidence and mortality rates from the first years of operation. Methods Driven by limited national resources, this initiative of the Barbados Ministry of Health (MoH), in collaboration with The University of the West Indies, was designed to collect prospective data on incident stroke and acute myocardial infarction (MI) (heart attack) cases from all health care facilities in this small island developing state (SIDS) in the Eastern Caribbean. Emphasis is on tertiary and emergency health care data sources. Incident cancer cases are obtained retrospectively, primarily from laboratories. Deaths are collected from the national death register. Results Phased introduction of the Barbados National Registry for Chronic NCDs (“the BNR”) began with the stroke component (“BNR–Stroke,” 2008), followed by the acute MI component (“BNR–Heart,” 2009) and the cancer component (“BNR–Cancer,” 2010). Expected case numbers projected from prior studies estimated an average of 378 first-ever stroke, 900 stroke, and 372 acute MI patients annually, and registry data showed an annual average of about 238, 593, and 349 patients respectively. There were 1 204 tumors registered in 2008, versus the expected 1 395. Registry data were used to identify public health training themes. Success required building support from local health care professionals and creating island-wide registry awareness. With spending of approximately US$148 per event for 2 200 events per year, the program costs the MoH about US$ 1 per capita annually. Conclusions Given the limited absolute health resources available to SIDS, combined surveillance should be considered for building a national NCD evidence base. With prevalence expected to increase further worldwide, Barbados’ experiences are offered as a “road map” for other limited-resource countries considering national NCD surveillance