Department of Para-Clinical Sciences
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In the Faculty of Medical Sciences, St Augustine, the Department of Para-Clinical Sciences bridges the Pre-Clinical and Clinical Sciences. The Department has three (3) Units comprising: Pathology/Microbiology, Pharmacology, and Public Health & Primary Care (PHPC). Pathology/Microbiology and Pharmacology are taught in Years 1 and 3 and the PHPC department provides teaching from Year 1 to Year 5 of the undergraduate medical curriculum. The department also coordinates the skills laboratory. All units are involved in postgraduate medical programmes.
The Unit of Public Health and Primary Care delivers the Diploma in Family Medicine, the Doctor of Medicine (DM) in Family Medicine, the Master of Public Health and hosts the year 2 medical student research programme. The Unit of Pathology delivers Master, MPhil/PhD degrees in Medical Microbiology, MPhil/PhD in Pathology and DM in Haematology and Blood Banking, and DM in Anatomical Pathology. The Unit of Pharmacology delivers MPhil/PhD in Pharmacology. Research is a mandatory requirement of all MPhil/PhD and DM programmes.
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Item Diabetes and nutrition: factors affecting dietary choices(2016) Arthur, SandiItem Developing a community‑based breast cancer risk prediction tool for resource‑poor settings(Journal of Education and Health Promotion, 2019) Pillai, Divya; Shah Hossain, Shaikh; Chattu, Vijay KumarBACKGROUND: With an estimation of every two women newly diagnosed with breast cancer, one dies. It is accounted that 1 in 28 women is likely to develop breast cancer during her lifetime. Developing a risk prediction tool by assessing the prevalence of known risk factors in the community will help public health intervention. METHODOLOGY: A cross‑sectional study was conducted among 18–64‑year‑old women to gather the prevalence of known breast cancer risk factors, through a community survey (sample survey). In this multistage random number‑based cluster sampling study, the results were compiled, collated, and analyzed in rates and proportions. Statistical conclusions were made using spreadsheets (Microsoft) and the values were converted into ordinal values using modified Likert scale and median was used to estimate central values. The estimated prevalence of these known risk factors was re‑assorted for analysis and these re‑assorted data were categorized into range of values across the communities. The internal validity of the survey questionnaire was measured using Cronbach’s alpha (α). RESULTS: The analysis of 558 participants was performed for the known risk factors for breast cancer including participant’s age, age at menarche, marriage, first childbirth, menopause, family history of breast cancer and benign breast disease, history of abortion, and body mass index. Based on the estimated prevalence of these risk factors, a community‑based risk prediction tool was developed with Cronbach’s α score of medium internal validity. CONCLUSIONS: The risk assessment tool has collated most of the risk factors of breast cancer that are capable of being measured at community level. The survey findings concluded that the community under survey was bearing moderate risk for breast cancer for womenItem The Emerging Role of Blockchain Technology Applications in Routine Disease Surveillance Systems to Strengthen Global Health Security(Big Data and Cognitive Computing, 2019) Chattu, Vijay Kumar; Nanda, Anjali; Chattu, Soosanna Kumary; Manzoor Kadri, Syed; Knight, W. AndyBlockchain technology has an enormous scope to revamp the healthcare system in many ways as it improves the quality of healthcare by data sharing among all the participants, selective privacy and ensuring data safety. This paper explores the basics of blockchain, its applications, quality of experience and advantages in disease surveillance over the other widely used real-time and machine learning techniques. The other real-time surveillance systems lack scalability, security, interoperability, thus making blockchain as a choice for surveillance. Blockchain o ers the capability of enhancing global health security and also can ensure the anonymity of patient data thereby aiding in healthcare research. The recent epidemics of re-emerging infections such as Ebola and Zika have raised many concerns regarding health security which resulted in strengthening the surveillance systems. We also discuss how blockchains can help in identifying the threats early and reporting them to health authorities for taking early preventive measures. Since the Global Health Security Agenda addresses global public health threats (both infectious and NCDs); strengthen the workforce and the systems; detect and respond rapidly and e ectively to the disease threats; and elevate global health security as a priority. The blockchain has enormous potential to disrupt many current practices in traditional disease surveillance and health care researchItem Global Health Diplomacy Fingerprints on Human Security(International Journal of Preventive Medicine, 2019) Chattu, Vijay Kumar; Knight, W. Andy; Reddy, K. Srikanth; Aginam, ObijioforHuman security is a concept that challenges the traditional notion of national security by placing the ‘human’ as the central referent of security instead of the ‘state.’ It is a concept that encompasses health and well-being of people and prioritizes their fundamental freedoms and basic livelihoods by shielding them from acute socioeconomic threats, vulnerabilities and stress. The epicenter of “health security” is located at the intersection of several academic fields or disciplines which do not necessarily share a common theoretical approach. Diverse players in the “health security” domain include practitioners in such fields as security studies, foreign policy, international relations, development theory, environmental politics and the practices of the United Nations system and other multilateral bodies like the World Health Organization (WHO) and the Pan American Health Organization (PAHO). Improvements in health are not only dependent on continued commitments to enhance the availability of healthcare and to strengthen disease prevention systems; they are very much enhanced by that intersection between global security and global health. What is emerging is global health diplomacy paradigm that calls for strengthening of core capacities in the public health and foreign policy arenas aimed at advancing human security through the strengthening of global health diplomacy practices. Human security in its broadest sense embraces far more than the absence of violence and conflict. It encompasses human rights, good governance, access to education and health care, and ensuring that each individual has opportunities and devices to fulfill his or her potential. Every step in this direction is a step towards reducing poverty, achieving growth and preventing conflict. Freedom from want, freedom from fear and the freedom of future generations to inherit a natural environment – these are the interrelated building blocks of human‑ and therefore national securityItem Port of Spain Summit Declaration as a successful outcome of global health diplomacy in the Caribbean region: a systematic review(Health Promotion Perspective, 2019) Chattu, Vijay Kumar; Knight, W. AndyBackground: The Caribbean region, with a population of around 17 million, has the highest burden of chronic noncommunicable diseases (NCDs) in the region of the Americas. It is estimated that diabetes and hypertension has an economic impact of around 5%-8% of the gross domestic product of the region. The purpose of this study was to explore and understand how global health diplomacy contributed to the evolution of a collective Caribbean regional summit declaration to address the epidemic of NCDs. Methods: A systematic review was conducted, and all the major databases such as MEDLINE, PubMed, EMBASE, Scopus, Web of Science, EBSCO, Global Health database and other available policy documents from various sources were screened. All articles available from 1910-2018 were extracted. From the total of 3223 titles, after filtering, the search narrowed down to 28 full texts that are included in this study. Policy documents and articles related to NCDs, global health diplomacy, and the Port of Spain Declaration (POSD) were the focused themes. Results: The Caribbean region showed significant commitment to the prevention and control of NCDs through its united voice and commitment since 2001. The successful rounds of negotiations for regional health have led to the formulation of the 15- point multisectoral POSD “Uniting to Stop the Epidemic of Chronic NCDs.” This was the first Summit in the world where the Heads of Government focused on prevention and control of NCDs with a clear road map for policy implementation, collaboration, and collective action. This regional summit declaration gained global attention and resulted in the United Nations Political Declaration on the Prevention and Control of NCDs and as WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020. Conclusion: There is enormous scope for this evolving area of Global Health Diplomacy in addressing the future challenges of health securityItem The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus(Healthcare, 2019) Chattu, Vijay Kumar; Chattu, Soosanna Kumary; Burman, Deepa; Spence, David Warren; Pandi-Perumal, Seithikurippu R.For healthy existence, humans need to spend one-third of their time sleeping. Any qualitative or quantitative disturbances in sleep would result in an increased prevalence of obesity, metabolic disorders, diabetes, cardiovascular diseases, and hypertension. The paper aims to highlight the growing global problem of insufficient sleep and its significant impact on the rising incidence of diabetes mellitus. An extensive literature search was done in all major databases for “insufficient sleep” and “Diabetes Mellitus” for this review. Shorter (<6 h) and longer (>9 h) durations of sleep have been adversely related to insulin resistance. Though the relation between insufficient sleep and diabetes mellitus is more or less understood, little is known about how oversleeping or hypersomnia (10–12 h) increases the risk of diabetes. The relationship between sleep disturbances and diabetes is dual-sided, as chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Both the qualitative and quantitative disturbances in sleep significantly increase the risk of developing diabetes, which is supported by numerous community-based and hospital-based epidemiological studies discussed in this review. Obstructive sleep apnea is one of the most common sleep disorders and is characterized by chronic intermittent hypoxia and increased sympathetic activity, thus leading to a higher prevalence of diabetes. Sleep therapy may serve as a low-cost method for fighting against the rising epidemic of diabetesItem Global epidemiology, risk factors, and histological types of ovarian cancers in Trinidad(Journal of Family Medicine and Primary, 2019) Umakanthan, Srikanth; Chattu, Vijay Kumar; Kalloo, ShereneOvarian cancer is the seventh most common cancer in women in the world and Trinidad and Tobago is ranked 18th in the world with respect to the rate of occurrence. About 68% cases are diagnosed at a late stage, resulting in low survival rates. Since there is very scanty literature available on the epidemiology of ovarian cancer in the Caribbean region, this study was undertaken to assess the most common risk factors, presenting symptoms and common histological varieties in Trinidad. Methods: A hospital‑based, cross‑sectional study was designed, and all the 23 diagnosed ovarian cancer cases registered during 2015–2017 were considered. Information on sociodemographics, presenting symptoms, and histological type of cancers were collected after getting the ethical approval. Of the total 23 cases, 17 cases were included in this study after ensuring completeness of data as detailed analysis of patient data was done using Microsoft Excel. Results: The common risk factors identified were previous pregnancies, previous surgeries, and irregularities in the menstrual cycle. The commonest histological variety was granulosa tumors and the most common associated symptoms were irregular menses and abdominal pain in premenstrual women, and abdominal distention in postmenopausal women. Conclusions: It would greatly enhance the detection rate if screening and testing for the CA‑125 gene were a mandatory practice, for any patient found with more than three risk factors. The public health authorities should identify the modifiable risk factors and implement cancer reduction and health promotion activities to reduce the mortality related to ovarian cancersItem The need for health diplomacy in health security operations(Health Promotion Perspective, 2019) Chattu, Vijay Kumar; Kevany, SebastianThe concept of health security involves the intersection of several fields and disciplines and is an inherently political and sensitive area. It is also a relatively a new field of study and practice which lacks a precise definition - though numerous disciplines and areas like foreign policy, national interests, trade interests, health security, disaster relief, and human rights contribute to the concept. The purpose of this paper is to highlight the need for, health diplomacy in improving health security. For example, it is not unusual for developing country societies to build their health security measures by restricting travel and movement of those emanating from affected areas. When extreme health security measures threaten cordial and cooperative relations between nations, the issue of protection of one country’s population may lead to the risk of international conflict. As the World Health Organization (WHO) stated in 2007 that ‘functioning health systems are the bedrock of health security,’ it is crucial that partners with sound financial and technical capacities benefit developing countries through their assistance and sharing information. This paper explores how health diplomacy holds great promise to address the needs of global health security through binding or nonbinding instruments, enforced by global governance mechanismsItem Strengthening the COVID-19 pandemic response, global leadership, and international cooperation through global health diplomacy(Health Promotion Perspective, 2020) Javed, Sumbal; Chattu, Vijay KumarThe coronavirus disease 2019 (COVID-19) pandemic continues to claim lives around the world and, to some extent, reflects the failure of international cooperation. Global health diplomacy (GHD) can be a bridge for international cooperation for tackling public health crises, strengthening health systems through emphasizing universal health coverage for sustainable and equitable development, and rebuilding multilateral organizations. It can be a catalyst for future global health initiatives. Health should not be used as a political tool at the cost of people’s lives, nor should it become a proxy for geopolitics but can be used to diffuse tensions and create a positive environment for political dialogue. Health diplomacy’s focus should be to mitigate inequality by making available diagnostics, therapeutics, and vaccines as a global public good. The implications for the lack of international cooperation will lead to increased global disparities and inequities as the countries that cannot procure vaccines will find their population more vulnerable to the pandemic’s repercussion. Though the international cooperation on trade has suffered the impact of geopolitical shifts and competition, through engaging in GHD, the governments can align the trade and health policies. Amid this global health crisis, the World Health Organization (WHO) has faced an increase in International Health Regulations violations, limiting its influence and response during this COVID-19 pandemic. Nations need to develop a sense of cooperation that serves as the basis for a mutual strategic trust for international development. The priorities of all the countries should be to find the areas of common interest, common operational overlap on development issues, and resource allocation for this global fight against COVID-19Item An Exploratory Study of Quality of Life and Its Relationship with Academic Performance among Students in Medical and other Health Professions(Medical Sciences, 2020) Chattu, Vijay Kumar; Sahu, Pradeep Kumar; Seedial, Neela; Seecharan, Gerlisa; Seepersad, Amanda; Seunarine, Melina; Sieunarine, Shivanna; Seymour, Kahamaron; Simboo, Samantha; Singh, ArissaQuality of life (QOL) is a broader concept which represents experiences, states, appraisals, behaviors, capacities and emotional reactions to circumstances. The study aimed to evaluate the di erences in various domains of QOL among the students of five schools (medicine, dentistry, veterinary medicine, pharmacy and nursing) and an optometry unit in the Faculty of Medical Sciences, Trinidad and Tobago. Further, the study evaluated the factors (sociodemographic variables and academic performance) predictive of physical, psychological, social and environment domains of quality of life. The research tool consisted of a validated questionnaire which had two sections; (1) sociodemographics inclusive of students’ cumulative grade point average and (2) the shorter version of WHO quality of life (WHOQOL-BREF). The data were transformed into a linear scale and exported into the IBM SPSS version 24 where t-tests, one-way ANOVA and stepwise regression were performed. Of the total 535 participants, most 383 (71.6%) were females. While comparing the di erences in the domains of QOL that existed based on the schools (professions) they were enrolled, significant di erences were recorded for physical (p < 0.05), psychological (p < 0.05) social (p < 0.05) and environmental domains (p < 0.05). Though the domains of physical health, psychological health and environment showed a significant association with the academic performance of students, the social domain had no such relationship. The overall quality of life has a positive connection with the academic performance of students in medical and health professions. Therefore, universities and all stakeholders involved in health professions need to play a critical role to ensure the students in health professions maintain a high QOL. At the same time, there is a great need for extra attention for students who showed poor academic performance in the previous semester to bring them on track.Item Strengthening African health systems through global health diplomacy(Health Promotion Perspective, 2020) Chattu, Vijay Kumar; Pooransingh, ShaliniItem Equity in health care: is it achievable?(Elsevier Public Health Emergency Collection, 2020) Pooransingh, Shalini; Chattu, Vijay KumarItem Tuberculosis Skin Test Screening in the National Tuberculosis Program of Trinidad and Tobago(Healthcare, 2020) Chattu, Vijay Kumar; Sakhamuri, Sateesh; Motilal, Shastri; Pounder, Liam J.; Persad, Vasishma Kanita; Pierre, Neelmani; Persad, Shivannie; Pooran, Nikesha; Pottinger, Akua MosiGlobally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of theWorld Health Organization’s (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO’s standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018–2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher’s exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette–Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and genderItem Canada’s role in strengthening global health security during the COVID-19 pandemic(Biomed Central (Springer Nature), 2020) Chattu, Vijay Kumar; Adisesh, Anil; Yaya, SanniThe world is confronted by the current pandemic of Corona Virus Disease (COVID-19), which is a wake-up call for all nations irrespective of their development status or geographical location. Since the start of the century we have seen five big infectious outbreaks which proved that epidemics are no more regarded as historic and geographically confined threats. The Canadian government underlined that these infectious disease outbreaks are threats to global health security and disrupt societal wellbeing and development. In this context, the Public Health Agency of Canada is proactive and has shown its preparedness for outbreaks of emerging and epidemic-prone diseases, and in dealing with these pathogens. Even before the declaration of pandemic, Canada has proved its global health leadership by ensuring collective action and multisectoral coordination which still remains a serious challenge especially for low and middle- income countries with existing poor health systems. In this article we discuss how Canada is addressing the global challenges posed by the COVID-19 pandemic through its leadership and practice of global health diplomacy.Item Subjective Well-Being and Its Relation to Academic Performance among Students in Medicine, Dentistry, and Other Health Professions(Education Sciences, 2020) Chattu, Vijay Kumar; Sahu, Pradeep Kumar; Seedial, Neela; Seecharan, Gerlisa; Seepersad, Amanda; Seunarine, Melina; Sieunarine, Shivanna; Seymour, Kahamaron; Simboo, Samantha; Singh, ArissaSubjective well-being is defined as a person’s cognitive and a ective evaluations of his or her life. This study aims to investigate the di erences in the domains of subjective well-being based on gender, type of school, and academic performance. Additionally, the study aimed to determine the factors (socio-demographic variables, including the academic performance of the students) that are predictive of subjective well-being. Subjective well-being was assessed using a questionnaire which included the Satisfaction with Life Scale (SWLS), which measured the respondent’s life satisfaction, the Scale of Positive and Negative Experience (SPANE), which consisted of six positive and negative emotions, and, lastly, the Flourishing Scale (FS), which measured the respondents’ self-perceived success. Data were collected, transformed into a linear scale, and exported into SPSS version 24, where t-tests, one-way analysis of variance, Pearson correlation, and stepwise regression were performed. Of the total of 535 participants, the majority were females (383 = 71.6%) and studying in a school of medicine (31.8%). With respect to the SWLS and FS, a significant di erence was reported among students based on the type of school and their academic performance (p < 0.05). While comparing the di erences in the SPANE, a significant di erence was recorded based on academic performance. Among the domains of subjective well-being, only the SPANE showed a significant association with academic performance. Greater subjective well-being correlates with higher academic performance, indicating that subjective well-being is an important aspect of a student’s academic life; provisions can be made by paying more attention to those who showed poor academic performance during and at the end of each semesterItem Investigation of the Risk Factors and Associated Co-Morbid Conditions among Patients with Colorectal Cancer in Trinidad(Gastrointestinal Disorders, 2020) Chattu, Vijay Kumar; Gopie, Priya; Singh, Rajiv K.; Singh, Kimberly; Singh, Sachin; Singh, Sarah; Smith, Javanna; Sookram, Vitra; Saunders, DeAngello; Thomas, KrissiColorectal cancer (CRC) is the third most common cancer, and the fourth most common cause of cancer mortality worldwide. In Trinidad and Tobago, it is the third most common type of cancer in both sexes. Since there is scanty research on the risk factors associated with CRC, this study was conducted to determine the correlation between risk factors, including associated comorbid conditions, and CRC in Trinidad. A cross-sectional study was conducted amongst diagnosed CRC patients (>18 years) using a pre-tested questionnaire consisting of sections on demographic data, lifestyle before diagnosis, quality of life, and depression status. Additional information such as recurrence of cancer, Body Mass Index (BMI), Hypertension (HT), blood glucose levels and family history of cancer were collected from the medical records. Of the total participants, the majority were males (58%), and the mean age of diagnosis in both sexes was 65 years. The retrospective chart review showed that 68% were found to have a comorbid condition (Diabetes or HT). Upon review of the medical records, 93.2% of the subjects did not have a familial history. However, the questionnaire data showed that 73% of subjects had a family history. Around 50% of CRC patients were alcohol consumers and 30% were cigarette smokers prior to their cancer diagnosis. Interestingly, a majority of patients (91%) had never been screened for CRC prior to their diagnosis. Subjects with CRC displayed minimal depression, indicating that being diagnosed with CRC did not have a grave impact on their state of mind or quality of life. Our findings showed that prevalence of CRC was higher in males and amongst individuals of African descent. However, larger prospective studies may be warranted to fully demonstrate this effectItem Prioritizing ‘equity’ in COVID-19 vaccine distribution through Global Health Diplomacy(Health Promotion Perspective, 2021)With over 4 million deaths worldwide, the current coronavirus disease 2019 (COVID-19) pandemic is regarded as one of the worst pandemics in history. With its wider devastating consequences, even so-called affluent countries could not provide full coverage for COVID-19 vaccines and medications to all of their citizens. Against this backdrop, the main aim of this article is to examine how Global Health Diplomacy (GHD) can play a role in prioritizing vaccine equity in the global health agenda in the fight against COVID-19. The majority of developed countries’ healthcare systems have been exposed and have reached a tipping point. After the completion of eighteen months of the pandemic, only five countries were able to produce vaccines for the treatment of COVID-19. This pandemic has divided the world into two blocs: those with vaccines, such as the United States, the United Kingdom, Russia, China, and India; and those without, such as the rest of the world. The greatest challenges are vaccine inequalities, inequities and distribution, which undermine the global economic recovery. Many poor countries are still waiting for the initial doses to be delivered to their citizens, while some rich nations are planning for booster doses. GHD plays a critical role in establishing successful global collaborations, funding mechanisms and ensuring international cooperation through the combined efforts of all stakeholders. Besides, global solidarity is necessary to lessen the wider gaps between the vaccination status of rich and poor nations. Therefore, through GHD, the vaccine gaps and inequities can be addressed to strengthen global health security and accelerate global economic recovery