Update on the Geographic Distribution of the Intermediate Host Snails of Schistosoma mansoni on St. Lucia: A Step Toward Confirming the Interruption of Transmission of Human Schistosomiasis.

To provide information to guide considerations of declaring interruption of transmission of human schistosomiasis due to Schistosoma mansoni on St. Lucia, we undertook an island-wide survey in June-July 2022 to determine the presence of Biomphalaria snails, the intermediate hosts of S. mansoni, and their infection status. Snail surveys were carried out at 58 habitats to determine presence of Biomphalaria snails followed by examination of the collected snails for evidence of infection with S. mansoni. Furthermore, water samples were collected at the snail habitats and screened for presence of S. mansoni DNA using an eDNA approach. We found B. glabrata present in one habitat (Cul de Sac) where it was abundant. Specimens provisionally identified as Biomphalaria kuhniana were recovered from 10 habitats. None of the Biomphalaria specimens recovered were positive for S. mansoni. None of the eDNA water samples screened were positive for S. mansoni. Experimental exposures of both field-derived and laboratory-reared St. Lucian B. glabrata and B. kuhniana to Puerto Rican and Kenyan-derived S. mansoni strains revealed B. glabrata to be susceptible to both and B. kuhniana proved refractory from histological and snail shedding results. We conclude, given the current rarity of B. glabrata on the island and lack of evidence for the presence of S. mansoni, that transmission is unlikely to be ongoing. Coupled with negative results from recent human serological surveys, and implementation of improved sanitation and provision of safe water supplies, St. Lucia should be considered a candidate for declaration of interruption of human schistosomiasis transmission.

Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities.

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.

Sources of microbial contamination in the watershed and coastal zone of Soufriere, St. Lucia.

The Sustainable Development Goal 6 calls for global progress by 2030 in treating domestic wastewater and providing access to adequate sanitation facilities. However, meeting these goals will be a challenge for most Small Island Developing States, including Caribbean island nations. In the nearshore zone of the Soufriere region on the Caribbean island of St. Lucia, there is a history of high levels of bacteria of fecal origin. Possible land-based sources of microbial contamination in the Soufriere Bay include discharges from the Soufriere River and transport of wastewater, including fecal material from the town of Soufriere. This area is an important tourist destination and supports a local fishery. To identify the sources of microbial contamination in Soufriere Bay, a range of monitoring methods were employed in this study. In grab samples of surface water collected from the Soufriere River, counts of total coliforms and Escherichia coli were elevated above water quality guidelines. However, the spikes in concentrations of these indicator organisms in the river did not necessarily coincide with the spikes in the levels of total coliforms and E. coli detected in samples collected on the same dates in Soufriere Bay, indicating that there are other sources of pollution in the Bay besides discharges from the river. Monitoring for chemical indicators of wastewater (i.e., caffeine, sucralose, fluconazole) in the Soufriere River indicated that there are inputs of sewage or human fecal material throughout the watershed. However, analysis of Bacteroidales 16S rRNA genetic markers for fecal bacteria originating from humans, bovine ruminants, or other warm-blooded animals indicated that the majority of microbial contamination in the river was not from humans. Monitoring for chemical indicators of wastewater using passive samplers deployed in Soufriere Bay indicated that there are two "hot spots" of contamination located offshore of economically depressed areas of the town of Soufriere. This study indicates that efforts to control contamination of Soufriere Bay by fecal microorganisms must include management of pollution originating from both sewage and domestic animals in the watershed.

Major Hospital Fire in Saint Lucia.

This paper provides a field report on a hospital fire at the St. Jude hospital in the Eastern Caribbean Island of Saint Lucia. The hospital was completely destroyed by the fire and three deaths were recorded. This paper analyses the emergency response to this hospital fire and discusses the lessons learned from this experience. This is a valuable lesion for developing countries in the Caribbean, especially since there have been four hospital fires reported in the Caribbean within the past decade.

Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia.

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

Circulating Anodic Antigen (CAA): A Highly Sensitive Diagnostic Biomarker to Detect Active Schistosoma Infections-Improvement and Use during SCORE.

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato-Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications.

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia.

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women's rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings.

Survey of Schistosomiasis in Saint Lucia: Evidence for Interruption of Transmission.

Saint Lucia at one time had levels of schistosomiasis prevalence and morbidity as high as many countries in Africa. However, as a result of control efforts and economic development, including more widespread access to sanitation and safe water, schistosomiasis on the island has practically disappeared. To evaluate the current status of schistosomiasis in Saint Lucia, we conducted a nationally representative school-based survey of 8-11-year-old children for prevalence of Schistosoma mansoni infections using circulating antigen and specific antibody detection methods. We also conducted a questionnaire about available water sources, sanitation, and contact with fresh water. The total population of 8-11-year-old children on Saint Lucia was 8,985; of these, 1,487 (16.5%) provided urine for antigen testing, 1,455 (16.2%) provided fingerstick blood for antibody testing, and 1,536 (17.1%) answered the questionnaire. Although a few children were initially low positives by antigen or antibody detection methods, none could be confirmed positive by follow-up testing. Most children reported access to clean water and sanitary facilities in or near their homes and 48% of the children reported contact with fresh water. Together, these data suggest that schistosomiasis transmission has been interrupted on Saint Lucia. Additional surveys of adults, snails, and a repeat survey among school-age children will be necessary to verify these findings. However, in the same way that research on Saint Lucia generated the data leading to use of mass drug administration for schistosomiasis control, the island may also provide the information needed for guidelines to verify interruption of schistosomiasis transmission.

A new genus and five new species of Anostostomatidae from the Lesser Antilles (Orthoptera: Ensifera).

Most high volcanic islands of Lesser Antilles harbor one single genus of Anostostomatidae: Rhumosa n. gen: Rhumosa bolognei n. gen. n. sp. in Guadeloupe, Rhumosa macoucheriei n. gen. n. sp. in Dominica, Rhumosa depazei n. gen. n. sp. in Martinique, Rhumosa admiralrodneyei n. gen. n. sp. in Saint Lucia, Rhumosa captainblighei n. gen. n. sp., in Saint Vincent. These species are restricted to well preserved rainforests; species from northern islands apparently occurring at higher elevation than species of southern islands. The distribution and generic position of Rhumosa n. gen. species is discussed, as well as the generic position of Lutosa cubaensis (Haan, 1843).

Research in epidemic and emergency situations: A model for collaboration and expediting ethics review in two Caribbean countries.

Various forms of research are essential in emergency, disaster and disease outbreak situations, but challenges exist including the long length of time it takes to get research proposals approved. Consequently, it would be very advantageous to have an acceptable model for efficient coordination and communication between and among research ethics committees/IRBs and ministries of health, and templates for expediting (done with speed and efficiency) ethical review of research proposals in emergency and epidemic situations to be used across the Caribbean and in other low and middle income countries. This project involved a literature search and the interviewing of ministry of health officials, public health practitioners, and research ethics committee/IRB members in Jamaica and St. Lucia, to obtain suggestions for the best model for efficient coordination and communication between research ethics committees (RECs), and developed a template for expediting review of research protocols in epidemic and emergency conditions.

MMR2 vaccination coverage and timeliness among children born in 2004 - 2009: a national survey in Saint Lucia, 2015 / Cobertura de vacunación y respeto de los plazos de la segunda dosis de la vacuna triple viral en los niños nacidos en el período 2004-2009: encuesta nacional realizada en Santa Lucía en el 2015 / Cobertura e momento oportuno de vacinação da segunda dose da vacina tríplice viral em crianças nascidas em 2004-2009: pesquisa nacional em Santa Lúcia, 2015

ABSTRACT Objectives To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

RESUMEN Objetivos Determinar con mayor precisión la cobertura y el respeto de los plazos de vacunación de la segunda dosis de la vacuna contra el sarampión, la rubéola y la parotiditis (triple viral), al tiempo que se detectan los factores asociados con la baja aceptación de esa vacuna en Santa Lucía. Métodos En octubre y noviembre del 2015 se llevó a cabo una encuesta centrada en niños nacidos entre el 2004 y el 2009. En 86 centros preescolares y primarios se seleccionó al azar a dos niños de cada grado, lo que arrojó un tamaño real de la muestra de 836 niños. Se analizaron los registros de salud para evaluar la cobertura y el respeto de los plazos de vacunación. Se entrevistó a los padres o tutores y los directores de las 86 escuelas sobre conocimientos, actitudes y prácticas en materia de vacunación. Resultados De los 767 niños incluidos, el 75% fueron vacunados con la segunda dosis de la triple viral (n = 572); el 46,7% fueron vacunados a tiempo, es decir, a los 5 años de edad. La proporción más baja se dio en las cohortes nacidas en el 2004, 2005 y 2008. Se observó que las madres cuidadoras influían positivamente en el respeto de los plazos de vacunación de la segunda dosis de la triple viral. Aunque el 97% de los directores encuestados consideraba que la vacunación era importante, el 48,8% desconocía la legislación nacional que exige la vacunación completa antes de ingresar a la escuela. Los resultados de la encuesta estaban en consonancia con las tasas bajas de cobertura administrativa de la segunda dosis de la triple viral informadas por Santa Lucía, muy por debajo del 95% recomendado. Conclusiones Según los resultados de esta encuesta, el programa nacional de vacunación de Santa Lucía redujo la edad de la segunda dosis de la triple viral a los 18 meses en el 2016, aumentó las actividades de promoción en las escuelas para fomentar el cumplimiento de la ley que obliga a recibir la vacunación antes de ingresar a la escuela y está trabajando para vacunar a las cohortes de niños que no recibieron la segunda dosis de la triple viral en su debido momento.

RESUMO Objetivos Determinar com precisão a cobertura vacinal e o momento oportuno para ministrar a segunda dose da vacina tríplice viral (sarampo, caxumba e rubéola - SCR) e identificar os fatores associados à baixa utilização da vacina em crianças. Métodos Uma pesquisa direcionada a crianças nascidas de 2004 a 2009 foi realizada em Santa Lúcia em outubro e novembro de 2015. Em 86 unidades de ensino infantil e fundamental, duas crianças de cada série foram selecionadas aleatoriamente, constituindo uma amostra efetiva de 836 crianças. Dados sobre a cobertura e o momento oportuno de vacinação foram obtidos das fichas de saúde. Foram conduzidas entrevistas com os pais e/ou responsáveis e os diretores das 86 escolas sobre conhecimento, atitudes e práticas relacionadas à vacinação. Resultados Das 767 crianças incluídas na amostra, 75% foram vacinadas com a segunda dose de SCR (n = 572) e 46,7% receberam a vacina no momento oportuno (ou seja, até os 5 anos de idade). Observou-se menor proporção de vacinados nas coortes nascidas em 2004, 2005 e 2008. "Mães como cuidadoras" teve uma associação positiva com ministrar a segunda dose de SCR no momento oportuno. Apesar de 97% dos diretores entrevistados considerarem a vacinação importante, 48,8% desconheciam a legislação nacional que exige vacinação completa para a matrícula escolar. Os resultados reforçaram a baixa cobertura vacinal da segunda dose de SCR registrada em Santa Lúcia, bem inferior ao índice recomendado de 95%. Conclusões A partir dos resultados desta pesquisa, em 2016, o programa nacional de vacinação de Santa Lúcia reduziu para 18 meses a idade de administração da segunda dose de SCR, intensificou a recomendação para que as escolas cumpram com a legislação para matrícula escolar e está empenhado em vacinar as coortes de crianças que não receberam a segunda dose de SCR no momento oportuno.

Knowledge of and attitudes toward heel prick screening for sickle cell disease in Saint Lucia.

OBJECTIVES: In the Caribbean country of Saint Lucia, umbilical-cord-blood screening for sickle cell disease (SCD) was the testing method that health care workers (HCWs) on the maternity wards of the hospitals preferred until the new heel prick (HP) testing method was introduced in the country in 2014. This SCD study sought to assess HCWs' knowledge of and attitude toward HP screening and also determine new mothers' favorability toward HP screening. METHODS: A total of 70 HCWs and 132 new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. RESULTS: Among the HCWs interviewed, 85.7% of them had knowledge of the HP test. However, only 25.7% had attended training sessions on the procedure. Among the HCWs, 64.3% of them felt the HP test should be mandatory, 27.1% said it should not be mandatory, and 8.6% did not know if it should be mandatory. In their focus groups, the HCWs said they believed the mothers would accept the HP method. For their part, 22.0% of the mothers said they had heard about the HP test, and 63.6% reported knowing the reason why the baby would be tested. Further, 83.3% indicated that the test would be beneficial for the baby. In addition, 88.6% of the mothers said that more information on the HP test was needed. In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby. CONCLUSIONS: The HCWs' knowledge of the HP screening method was high. The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method.

Knowledge of and attitudes toward heel prick screening for sickle cell disease in Saint Lucia / Conocimiento y actitudes hacia la prueba del talón para la detección de la anemia de células falciformes en Santa Lucía / Conhecimento e atitudes em relação ao “teste do pezinho” para triagem de doença falciforme em Santa Lúcia

ABSTRACT Objectives In the Caribbean country of Saint Lucia, umbilical-cord-blood screening for sickle cell disease (SCD) was the testing method that health care workers (HCWs) on the maternity wards of the hospitals preferred until the new heel prick (HP) testing method was introduced in the country in 2014. This SCD study sought to assess HCWs’ knowledge of and attitude toward HP screening and also determine new mothers’ favorability toward HP screening. Methods A total of 70 HCWs and 132 new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. Results Among the HCWs interviewed, 85.7% of them had knowledge of the HP test. However, only 25.7% had attended training sessions on the procedure. Among the HCWs, 64.3% of them felt the HP test should be mandatory, 27.1% said it should not be mandatory, and 8.6% did not know if it should be mandatory. In their focus groups, the HCWs said they believed the mothers would accept the HP method. For their part, 22.0% of the mothers said they had heard about the HP test, and 63.6% reported knowing the reason why the baby would be tested. Further, 83.3% indicated that the test would be beneficial for the baby. In addition, 88.6% of the mothers said that more information on the HP test was needed. In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby. Conclusions The HCWs’ knowledge of the HP screening method was high. The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method.

RESUMEN Objetivo En el país caribeño de Santa Lucía, el hemocribado del cordón umbilical para la detección de la anemia de células falciformes o drepanocitosis era el método de tamizaje preferido por el personal de salud en las salas de maternidad de los hospitales hasta que se introdujo la nueva prueba del talón en el 2014. Este estudio sobre la anemia de células falciformes tuvo por objetivo evaluar el conocimiento y las actitudes del personal de salud hacia la prueba del talón, así como determinar si las madres tenían una actitud favorable hacia este método de tamizaje. Método Un total de 70 trabajadores de salud y 132 madres participaron en los cuestionarios realizados en tres hospitales. Además, se celebraron cuatro grupos de debate: dos con el personal de salud y dos con las madres. Resultados Del personal de salud entrevistado, 85,7% tenía conocimientos acerca de la prueba del talón. Sin embargo, únicamente 25,7% había asistido a sesiones de capacitación sobre el procedimiento. Además, 64,3% del personal de salud opinaba que la prueba debía ser obligatoria, 27,1% afirmaba que no debía ser obligatoria y 8,6% manifestó que no lo sabía. En los grupos de debate, el personal de salud manifestó su creencia de que las madres aceptarían este método de tamizaje. Por su parte, 22,0% de las madres afirmaron conocer la prueba del talón y 63,6% manifestó conocer los motivos por los que se sometería al bebé a dicha prueba. Asimismo, 83,3% de las madres señaló que la prueba sería beneficiosa para el bebé. Además, 88,6% de las madres indicó que era necesaria más información sobre la prueba del talón. En sus grupos de debate, las madres expresaron que, por lo general, no les preocupaba el dolor que pudiese suponer para el bebé la prueba del pinchazo en el talón. Conclusiones El personal de salud tiene un nivel alto de conocimiento acerca de la prueba del talón. Las madres confían en el personal de salud, y aceptarían este procedimiento independientemente de sus conocimientos sobre la prueba y cualquier malestar asociado a este método de tamizaje.

RESUMO Objetivos No país caribenho de Santa Lúcia, o exame de sangue de cordão umbilical para detecção da doença falciforme (DF) era o método de triagem preferido pelos profissionais da saúde atuantes em maternidades, até a introdução do “teste do pezinho” (TP) no país em 2014. Este estudo sobre DF buscou avaliar o conhecimento e atitudes de profissionais da saúde em relação à triagem pelo TP e também determinar a favorabilidade das novas mães em direção à triagem de TP. Métodos Setenta profissionais da saúde e 132 novas mães responderam a questionários de pesquisa em três hospitais. Além disso, foram realizadas quatro discussões com grupos focais: dois de profissionais da saúde e dois de mães. Resultados Entre os profissionais da saúde entrevistados, 85,7% tinham conhecimento acerca do TP. Porém, somente 25,7% haviam comparecido às sessões de capacitação sobre o procedimento. Entre os profissionais da saúde, 64,3% opinaram que o TP deveria ser obrigatório, 27,1% disseram que não deveria ser obrigatório e 8,6% não sabiam se deveria ser obrigatório. Em seus grupos focais, os profissionais da saúde disseram acreditar que as mães aceitariam o método do TP. Por sua vez, 22,0% das mães disseram ter ouvido falar sobre o TP, e 63,6% relataram saber o motivo pelo qual o exame seria realizado; ademais, 83,3% indicaram que o exame seria benéfico para o bebê. Além disso, 88,6% das mães disseram que precisavam de maiores informações sobre o TP. Em seus grupos focais, as mães disseram que, em geral, não estavam preocupadas com dor que o teste do pezinho poderia causar ao bebê. Conclusões Os profissionais da saúde apresentaram alto nível de conhecimento acerca do método de triagem pelo TP. As mães confiam nos profissionais da saúde, e aceitariam o procedimento de TP independentemente de seu conhecimento acerca do teste e de qualquer desconforto associado a este método de triagem.

Training needs assessment of health care professionals in a developing country: the example of Saint Lucia.

BACKGROUND: Continuing education (CE) is crucial for quality improvement in health care. The needs assessment of CE helps ensure effectiveness. However, such an assessment necessitates certain techniques that are unfamiliar to health care communities in developing countries. This study identifies the needs of providing CE to health care personnel in Saint Lucia. METHODS: This study was designed as a questionnaire survey to investigate the demographics, training needs, and preferred approaches to improve performance of the target population. The study population included the health care professionals of major public health care facilities in Saint Lucia. We used the World Health Organization-adopted Hennessy Hicks Training Needs Analysis Questionnaire, a self-reported close-ended structured questionnaire with a core set of 30 items. These items refer to tasks that are central to the role of health care professionals and are categorized into six superordinate categories: research/audit, communication/teamwork, clinical skills, administrative, managerial/supervisory, and continuing professional education. RESULTS: In total, 208 questionnaires were distributed; the response rate was 66.8%, and most respondents were nurses. The need for continuing professional education was rated the highest priority, followed by research/audit activities. The evidence suggests that most respondents required training in communication skills, management, clinical skills, and research methods. CONCLUSIONS: Providing training according to the needs is vital, particularly in developing countries. The present research methodology and findings offer perspectives on how to conduct needs assessment and offer reference points for developing countries whose background and health care environment are similar to those of Saint Lucia.

Population Viability and Vital Rate Sensitivity of an Endangered Avian Cooperative Breeder, the White-Breasted Thrasher (Ramphocinclus brachyurus).

Social behaviors can significantly affect population viability, and some behaviors might reduce extinction risk. We used population viability analysis to evaluate effects of past and proposed habitat loss on the White-breasted Thrasher (Ramphocinclus brachyurus), a cooperatively breeding songbird with a global population size of <2000 individuals. We used an individual-based approach to build the first demographic population projection model for this endangered species, parameterizing the model with data from eight years of field study before and after habitat loss within the stronghold of the species' distribution. The recent habitat loss resulted in an approximately 18% predicted decline in population size; this estimate was mirrored by a separate assessment using occupancy data. When mortality rates remained close to the pre-habitat loss estimate, quasi-extinction probability was low under extant habitat area, but increased with habitat loss expected after current plans for resort construction are completed. Post-habitat loss mortality rate estimates were too high for projected populations to persist. Vital rate sensitivity analyses indicated that population growth rate and population persistence were most sensitive to juvenile mortality. However, observed values for adult mortality were closest to the threshold value above which populations would crash. Adult mortality, already relatively low, may have the least capacity to change compared to other vital rates, whereas juvenile mortality may have the most capacity for improvement. Results suggest that improving mortality estimates and determining the cause(s) of juvenile mortality should be research priorities. Despite predictions that aspects of cooperative systems may result in variation in reproduction or juvenile mortality being the most sensitive vital rates, adult mortality was the most sensitive in half of the demographic models of other avian cooperative breeders. Interestingly, vital rate sensitivity differed by model type. However, studies that explicitly modeled the species' cooperative breeding system found reproduction to be the most sensitive rate.

Reducing Health Disparities and Improving Health Equity in Saint Lucia.

St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.

Epilepsy care in the southern Caribbean.

Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes. In each southern Caribbean country, we conducted study visits and interviewed health-care providers, government health ministers, pharmacy directors, hospital medical directors, pharmacists, clinic staff, radiologists, and radiology and EEG technicians. Health-care providers completed extensive epilepsy care surveys. The five countries all have integrated government health systems with clinics and hospitals that provide free or heavily subsidized care and AEDs for patients with epilepsy. Only Trinidad and Tobago and Barbados, however, have neurology specialists. The three smaller countries lack government imaging and EEG facilities. Trinidad had up to one-year waits for public MRI/EEG. Government formularies in Grenada, Saint Vincent and the Grenadines, and Saint Lucia are limited to first-generation AEDs. One or more second-line agents are formulary in Trinidad and Barbados. Nonformulary drugs may be obtained for individual patients in Barbados. Grenada, Saint Lucia, and Saint Vincent and the Grenadines participate in an Organization of Eastern Caribbean States formulary purchasing system, which added levetiracetam following the survey. Newer generic AED formulations with the lowest risks for pregnancy malformation were not in use. In conclusion, patients with epilepsy in the southern Caribbean have excellent access to government clinics and hospitals, but AED choices are limited. Local medical providers reported that the major limitations in care were lack of specialty care, lack of imaging and EEG services, financial barriers to care, long wait times for care, and limited access to additional AEDs.

Bioclimatic comfort and the thermal perceptions and preferences of beach tourists.

The largest market segment of global tourism is coastal tourism, which is strongly dependent on the destination's thermal climate. To date, outdoor bioclimatic comfort assessments have focused exclusively on local residents in open urban areas, making it unclear whether outdoor comfort is perceived differently in non-urban environments or by non-residents (i.e. tourists) with different weather expectations and activity patterns. This study provides needed insight into the perception of outdoor microclimatic conditions in a coastal environment while simultaneously identifying important psychological factors that differentiate tourists from everyday users of urban spaces. Concurrent micrometeorological measurements were taken on several Caribbean beaches in the islands of Barbados, Saint Lucia and Tobago, while a questionnaire survey was used to examine the thermal comfort of subjects (n = 472). Universal Thermal Climate Index (UTCI) conditions of 32 to 39 °C were recorded, which were perceived as being "slightly warm" or "warm" by respondents. Most beach users (48 to 77 %) would not change the thermal conditions, with some (4 to 15 %) preferring even warmer conditions. Even at UTCI of 39 °C, 62 % of respondents voted for no change to current thermal conditions, with an additional 10 % stating that they would like to feel even warmer. These results indicate that beach users' thermal preferences are up to 18 °C warmer than the preferred thermal conditions identified in existing outdoor bioclimatic studies from urban park settings. This indicates that beach users hold fundamentally different comfort perceptions and preferences compared to people using urban spaces. Statistically significant differences (p ≤ .05) were also recorded for demographic groups (gender, age) and place of origin (climatic region).