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Aim: To determine the outcomes and satisfaction of patients who presented to a primary care musculoskeletal clinic and sports medicine clinic with a clinical or magnetic resonance imaging confi rmation of knee meniscal tear and who subsequently received an injection of intra articular hyaluronic acid.

Aim: To determine the effect of a very brief structured exercise prescription given by general practitioners (GPs) to sedentary patients attending chronic disease clinics in a primary care setting lead them to begin exercising. Materials and Methods: One hundred and six patients of the intervention (INV) group were counselled for 1–2 minutes individually about a benefit of regular exercise after which a written exercise prescription was provided by the GP. The 110 patients in the control (CON) group received usual care given to patients attending health centres. The patients in both groups were called at both one month (T1), and three months (T3) post intervention, respectively where they were interviewed about their current exercise habits. Results: At T1, 84/106 (79.2%) of INV vs. 34 (30.9%) of CON were exercising and at T3, 79/106 (74.5%) of INV vs 19/110 (17.4%) of CON were exercising at least one time weekly (P < 0.0005). Greater than 90% of patients who began exercising “agreed/strongly agreed” that the doctors’ advice was “important to start exercising.” Conclusion: The brief intervention seemed to be more effective than regular care in getting patients to begin exercising at 1 month and 3 months post intervention than regular care. The intervention was well received by most of the patients receiving the intervention.

Background Over 60% of households (HHs) in Trinidad and Tobago (T&T) consume alcohol. These HHs were more likely to report illnesses, relationship problems, and behavioral problems with children. This study set out to determine what proportion of HHs were willing to support changes in specific policies, laws and regulations in a national alcohol campaign. Methods A cross-sectional convenience sample of HHs were surveyed from a random sample of enumeration districts (ED) in T&T. An interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after an extensive literature review and consultation. Many of the WHO ‘best buys’ recommendations were included. Results One thousand six hundred ninety-five HHs (from 53 ED) responded from a total of 1837 HHs approached (response rate 92%). In a national campaign the following proportions of HHs would support: setting the legal age for drinking at 21 years (82.4%); restricting or banning alcohol advertising on TV and other media (73.1% and 54.4% respectively); banning all alcohol advertising at sports and cultural events (64.8%); banning radio stations playing songs with reference to alcohol use (71.3%); holding sellers of alcohol responsible for the amount of alcohol sold (79.5%); advocating that proof of age to be shown by persons buying alcohol (87.4%); placing more prominent warning labels on products displaying alcohol content (87.2%); placing more prominent warning labels on products showing harmful effects (88.5%); increasing taxes on alcohol sales (87.7%). Less than 50% of HH supported restrictions in density of outlets and reduction in opening times for alcohol outlets. Conclusions Many HHs in T&T are willing to support changes in policies around alcohol, including many of the policies shown by the WHO to be effective in reducing the harmful consumption of alcohol.

Aim: To determine the outcomes and satisfaction of patients who presented to a primary care musculoskeletal clinic and sports medicine clinic with a clinical or magnetic resonance imaging confirmation of knee meniscal tear and who subsequently received an injection of intra articular hyaluronic acid.

Background To determine the patterns of alcohol use among households in Trinidad and Tobago (T&T) and to estimate the association between alcohol use and negative psychological, social, or physical events experienced by the household. Methods A convenience sample of 1837 households across T&T. We identified bivariate correlates of alcohol use, and heavy episodic drinking using chi-square and t-test analyses and used multivariable logistic regression to estimate adjusted associations between household alcohol use and experiences within the past 12 months adjusted for sociodemographic covariates. Results One thousand five hundred two households had complete data for all variables (82% response rate). Nearly two thirds (64%) of households included alcohol users; 57% of household that consumed alcohol also reported heavy episodic drinking. Households that reported alcohol consumption were significantly more likely to report illnesses within the households, relationship problems, and behavioral and antisocial problems with children. Among households where a member was employed, those who consumed alcohol were nearly twice as likely (OR = 1.98; 95% confidence interval (CI) 1.03, 3.82) to have a household member call in sick to work and 2.9 times as likely (OR = 2.9; CI 1.19, 7.04) to have a household member suffer work related problems compared with households who reported not consuming alcohol. Conclusions Approximately two thirds of households in T&T reported using alcohol. These households were more likely to report psychological, physical, and social problems. These findings would support efforts to enforce current policies, laws, and regulations as well as new strategies to reduce the impact of harmful alcohol consumption on households in T&T. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4266-z) contains supplementary material, which is available to authorized users.

This study sought to determine the prevalence of self-reported pain and/or injury (SRPI) experienced by Caribbean footballers and the associated behaviours associated with SRPI. The prevalence of SRPI among footballers was 46.2%, with 71.5% and 36%, respectively, of players admitting having played one game previously with an injury, and having used a painkiller before playing at least one game previously. Female players were more likely to hide an injury from the coaching staff in order to play a game (OR = 2.9, 95% CI (1.7, 4.8)) and attempt to use a banned substance in order to get fit to play (OR = 4.2, 95% CI (1.2, 14.3)) than males, but males were more likely to use a painkiller before playing games than females (OR = 2.2, 95% CI (1.9, 3.9)). Education of players on analgesics and basic injury management together with the implementation of injury prevention programs are needed for these players.

ObjectiveThe objective of the present study was to determine the knowledge and practices among Trinidad and Tobago school-attending adolescents towards energy drinks (ED), alcohol combined with energy drinks (AwED), weight-altering supplements (WAS) and vitamin/mineral supplements (VMS) and their experience of adverse effects associated with such use.DesignA cross-sectional, proportionate, stratified sampling strategy was adopted using a self-administered, de novo questionnaire.SettingSecondary schools throughout Trinidad and Tobago.SubjectsStudents aged 15–19 years.ResultsFive hundred and sixty-one students participated, an 84 % response rate; 43·0 % were male, 40·5 % East Indian and 34·1 % mixed race. VMS, ED, WAS and anabolic steroids were used by 52·4 %, 44·0 %, 8·9 % and 1·4 % of students, respectively, with 51·6 % of ED users using AwED. Predictors of use of AwED were males and students who played sport for their school (OR = 1·9; 95 % CI 1·2, 3·2 and OR = 2·6; 95 % CI 1·4, 4·7, respectively). Predictors of ED use were males and attendees of government secondary schools (OR = 1·7; 95 % CI 1·1, 2·4 and OR = 1·7; 95 % CI 1·2, 2·4, respectively). Side-effects, mainly palpitations, headaches and sleep disturbances, were reported in 20·7 % of dietary supplement users.ConclusionsMany adolescent students in Trinidad and Tobago use dietary supplements, including ED and AwED, and about one-fifth of users experience side-effects. Identification of students at risk for ED, AwED and WAS use and education of students about the dangers of using dietary supplements need to be instituted to prevent potential adverse events.

Intra-lesional glucocorticosteroid (GCS) injections are used widely for painful musculoskeletal conditions in general practice.A 26 year old female, was given an intra-lesional injection of 24 mg methyl prednisolone acetate (MPA) with 15 mg lidocaine for treatment of DeQuervain's tenosynovitis. She was six weeks postpartum and predominantly breast feeding. Lactation was suppressed at approximately 30 h post injection and this persisted for a period of approximately 36 h before spontaneous resumption of milk production. Lactation returned to normal 90 h after the injection.Studies done in lactating animals have shown that injected GCS have led to a reduction of milk production, but there is limited data on these injections in lactating humans. The dose of GCS administered and the site of the GCS injection appear to contribute to this phenomenon. Very large doses of GCS have caused suppression of lactation in humans as opposed to low doses of GCS. Injections of GCS into areas of the body subjected to high activity level like the knee or wrist could lead to greater systemic absorption of GCS than GSC administered to body sites with lower physical activity like the shoulder.Local injection of MPA reversibly suppressed lactation in a young woman for a period of 24-48 h. Doctors using injectable GCS in lactating women should apprise patients of this possibility. Mothers can take precautions like expressing and storing enough breast milk to cover this period prior to receiving these injections.

The importance of football, or soccer as it is called in North America, was described by the late Pope John Paul II as follows: ‘amongst all unimportant subjects, football is by far the most import...

Aim: This study attempted to evaluate the real and perceived body weight, exercise habits and weight-altering dietary supplement use by adolescents attending schools in Trinidad and Tobago. Methods: A de novo questionnaire was administered prospectively to 15–19-year-old to determine their exercise habits, their perceived body weights, and their use of any weight gain or weight loss supplements. A subset of students had their actual height and weights recorded and BMI calculated. Results: Five hundred and eighty-three students did the questionnaire (88% response rate), and 363 students had BMI calculated. Some 14.9% (54/363) of the students were overweight, and 15.4% (56/363) were obese, and more than 75% of the obese students had attempted weight loss in the past. These measures included exercise in the majority of the students and use of dietary supplements in the minority. Only 6% of the obese students exercised five or more times per week. About 28% of the students misclassified their body weights, and perception of body weight influenced weight loss behaviors more than actual body weights. Conclusion: Almost one third of the students were overweight or obese. Overweight students were motivated to lose weight, and these students need to have some structured health promotion program, which educates them on correct exercise habits, safe measures to lose weight, and which informs them of their actual body weight.

The sural nerve runs a superficial course in the posterior leg. Reported sural nerve injuries in athletes are very uncommon. This case report highlights the occurrence of numbness to the heel and lateral ankle of a footballer following direct trauma to the posterior calf. This led to a hematoma developing around the sural nerve and the combination of the hematoma and the direct nerve trauma resulted in the sural nerve dysfunction. Full sensation returned in this player's heel and lateral ankle after 2 weeks of rehabilitation. Athletes presenting with numbness to the heel and lateral ankle should be questioned about leg trauma, and sural nerve injury should be added to the list of differential diagnoses.

To determine the effect on glycaemic control over three years, by selecting patients living with diabetes or diabetes and hypertension from a crowded chronic disease clinic (CDC) in a public health centre and treating them in a special diabetic clinic (DiaC) using resources available at the health centre.An uncontrolled observational cohort study. One hundred and one patients from the CDC volunteered to join the DiaC and were followed for three years in the DiaC. Patients in the DiaC were provided with greater consultation times, more frequent clinic appointments and more frequent lifestyle advice than patients in the CDC. HbA1c levels were done at the start of the project (0 months) and at three, 24 and 36 months after the start. The DiaC was run by a primary care physician (PCP) and registered nurse (RN).Eighty-six patients completed follow-up. The mean HbA1c+/-standard deviation scores at 0, 3, 24 and 36 months were: 9.44+/-1.27%, 9.50+/-2.22%, 8.33+/-1.97% and 7.96+/-1.84% respectively (P0.0005 for difference between 0 and 36 months).A special diabetic clinic run by a PCP and an RN in a primary care setting where regular monitoring of glycaemic control is done, where patients concerns and fears about diabetes are addressed, where patients are educated about diabetes, diet and exercise and advised on compliance with medication leads to improved glycaemic control after three years. This low-cost clinic could be readily established in other developing countries.

This report describes the effect of excessive cooling with ice, and compression with a plastic wrap on the common peroneal nerve (CPN) for 90 minutes in a professional footballer, which led to a common peroneal nerve palsy and a resulting footdrop. It highlights the need to be cautious with regards to the duration and frequency of icing as well as the choice of anchoring material when applying ice to injured areas that have superficial nerves passing nearby. Full recovery of the CPN function occurred in this athlete after five weeks. The major causes of footdrop and common causes of common peroneal neuropathy are discussed.