The aim of this study was to investigate sources of stress and psychological disturbance in dental students across the five years of undergraduate study at a dental school in Trinidad. Eighty-three percent of students completed a modified version of the Dental Environment Stress questionnaire (DES) and the Brief Symptom Inventory (BSI). On a scale ranging from 0 (not stressful) to 5 (highly stressful), overall mean DES scores for each of the five years of study were 1.58, 1.83, 2.65, 2.39, and 2.61 respectively, suggesting that levels of stress increase over the five years with a noticeable spike at the transition between the preclinical and clinical phases. Significant differences were found between specific stressors across the five years of study. Seven specific stressors and the stressor domains of Academic work and Clinical factors were more stressful for female students (t-test p< 0.05). The Global Severity Index of the BSI indicated that 54.8 percent of males and 44.2 percent of females were in the clinical range indicating significant psychological disturbance. Psychological disturbance was significantly associated with stress levels for male students (Spearmans rank correlation r = 0.56; p< 0.001), but not generally for female students. Further development is needed of dental educational programs that enhance students' psychosocial well-being.Dr. Naidu is Lecturer in Community Dentistry,

Dementia and depression among the elderly living in the Hobart community. PsycholMed 1985;15:771-8. 17 Lindesay J, Briggs C, Murphy E. The Guy's Age Concem survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. BrJPsychiatty 1989;153:317-29 Design-Retrospective cohort study. Setting-27 schools closest to University Hospital ofthe West Indies, Kingston, Jamaica.Subjects-2337 children aged 6-16 years who were born at university hospital were recruited, and their birth records were recovered: 1610 had suitable records, 659 had records including birth length, and 610 ofthese were prepubertal.Main outcome measures-Blood pressure, glycated haemoglobin level, serum cholesterol concentration, anthropometry at birth, current anthropometry, and socioeconomic status.Results-Multiple regression analysis showed that children's systolic blood pressure was inversely related to their birth weight (P < 0.0001) and directly related to their current weight. Glycated haemoglobin level was higher in children with thicker triceps skinfolds (P<0.001) and who had been shorter at birth (P=0.003). Serum cholesterol concentration was inversely related to current height (P=0.001) and to length at birth (P=0.09) and was directly related to triceps skinfold thickness and higher socioeconomic status (P < 0.001).Conclusions-Blood pressure in childhood was inversely related to birth weight and directly to current weight. Glycaemic control and serum cholesterol were related to short length at birth, height deficit in childhood, and childhood obesity.

We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in fluency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in the digit span backwards tests, and wasted members of the malnourished groups were adversely affected in efficiency of problem solving and those in the control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children.

The effects of treating Trichuris trichiura infections were investigated in 407 Jamaican children age 6 to 12 y. The children were randomly assigned to receive treatment (albendazole) or a placebo. The outcome variables included growth, tests of reading, spelling and arithmetic, and school attendance. After 6 mo of treatment, there was no significant main effect on any of the outcomes. However, there were significant treatment-by-infection intensity interactions with spelling (P < 0.05) and body mass index (P < 0.01), and a significant treatment-by-stunting interaction with school attendance (P < 0.01). In spelling, the children with heavy infections showed improvements with treatment that approached significance (P = 0.06), whereas those with lower intensities did not. However, the children with lower infection intensities had increased body mass index with treatment (P = 0.02), although there was no difference in children with heavy infections. In school attendance, the stunted children improved with treatment (P < 0.04), whereas there was no difference in the nonstunted children. These findings suggest that in the sample of Jamaican children examined, the treatment of T. trichiura was more likely to benefit school performance in children of poor nutritional status and those with heavy infections, and to improve weight gain in children with lighter infection intensities.

Objective To determine if misoprostol (exogenous prostaglandin E, PGE,) used vaginally was of value in improving the Bishop score, leading to an early safe vaginal delivery in women in whom the cervix is unripe and delivery is indicated.Design A double-blind clinical trial.Setting Antenatal and labour wards of the University Hospital of the West Indies, Jamaica.Subjects Forty-five women in the third trimester with various obstetric indications for induction of labour and with no contra-indications to prostaglandins. InterventionsThe women were randomly assigned to receive treatment or a placebo. The treated group had 100 pg misoprostol inserted vaginally while the placebo was similarly inserted.Main outcome measures Efficacy of the misoprostol was measured by the increase in the Bishop score 12 h after giving the treatment, the time between insertion and delivery, the need for oxytocin, and the outcome of the pregnancy. ResultsThe prostaglandin was superior to the placebo in ripening the cervix and inducing labour. The change in Bishop score was 5-3 in the misoprostol group compared with 1.5 in the placebo group (P