Promoting Access to Dental Care in a Developing Caribbean Nation, Post-disaster.

In September 2017, Hurricane Irma struck several Caribbean islands, which suffered catastrophic damage. Anguilla, the most northerly of the Caribbean's Leeward Islands, a developing nation, experienced devastating damage to its social, physical, political, and economic infrastructures. Anguilla's longstanding Dental Unit, a public sector health care facility, was among the services that suffered irreparable destruction. Hurricane Irma's debilitating impact on a developing nation and its citizens' livelihoods exacerbated existing challenges in dental care, and created barriers to access. As part of the rehabilitation process, it was essential to promote access to dental care. This commentary shares examples of some practical and economical approaches that were employed: providing direct access to dental therapists, offering dedicated emergency and routine care appointments, delivering oral health campaigns, partaking in community health fairs, and social media engagement. The commentary also considers future approaches that could be beneficial.

Mercury assessment in invasive Lionfish Pterois (Oken, 1817) from marine protected areas in the Colombian Caribbean.

Lionfish (Pterois spp.) are invasive species reported since 2009 in the Corales del Rosario y San Bernardo National Natural Park in the Caribbean. Their capture and consumption are strategies to control their dispersion and limit ecological damage. The natural park is influenced by the vicinity of Cartagena's residential, industrial, and touristic activities, as well as sediments loaded with mercury from the Dique Channel. For the first time, total mercury levels in muscle from 58 lionfish were determined, with values ranging from 0.01 to 0.38 µg/g (mean = 0.11 ± 0.01 µg/g). Fish length ranged from 17.4 to 44.0 cm (mean = 28.0 ± 0.63 cm). Mercury levels did not increase proportionally to fish length for pooled data, but the relationship was significant for specimens from Rosario Island. Mercury levels comply with legislation for fish consumption, but the risk to human health may appear if it occurs daily. Therefore, precautionary approach and a permanent monitoring strategy are strongly advised.

Health aging and care of the older adult with chronic dis- ease: a qualitative needs assessment in 14 eastern and southern Caribbean islands

[ABSTRACT]. The objectives of this qualitative needs assessment were to assess perceived needs of health and social services professionals in the Caribbean Region to enhance services supporting healthy aging and care of older adults and to assess perceived facilitators and barriers to increasing capacity to serve their aging populations. The assess- ment, informed by the Consolidated Framework for Implementation Science, was conducted in 14 islands in the eastern and southern Caribbean. The results demonstrated need for education of professionals and the general population about the prevention and treatment of non-communicable diseases (NCDs), assessment and services for individuals with dementia, Alzheimer’s disease, depression, and harmful alcohol use, all of which pose signif- icant challenges for older adults. Education of health and social services professionals, families, and the public on the risk factors for NCDs and common mental and physical health problems is critical. Barriers to implementa- tion of educational programs include lack of community awareness and resources within the islands. The needs assessment findings are foundational to planning educational interventions. These will be developed by local health providers with the collaboration and support of external resources including those of the Pan American Health Organization/World Health Organization Collaborating Centre in Gerontological Nursing Education.

[RESUMEN]. Los objetivos de esta evaluación cualitativa de las necesidades fueron evaluar las necesidades que perciben los profesionales de la salud y de los servicios sociales en el Caribe a fin de mejorar los servicios de apoyo al envejecimiento saludable y el cuidado de las personas mayores, así como evaluar los factores percibidos como facilitadores y como obstáculos para mejorar su capacidad de atender a la población que está envejeciendo. La evaluación, basada en el marco consolidado para la ciencia de la implementación, se realizó en 14 islas del Caribe oriental y meridional. Los resultados mostraron la necesidad de capacitar a los profesionales y educar a la población en general acerca de la prevención y el tratamiento de las enfermedades no transmisi- bles (ENT), la evaluación y los servicios para las personas con demencia, alzhéimer, depresión y problemas de consumo nocivo de alcohol, todos los cuales plantean importantes desafíos para las personas mayores. Es imprescindible capacitar a los profesionales de la salud y de los servicios sociales, así como educar a las familias y al público en general sobre los factores de riesgo de las ENT y los problemas de salud mental y física más habituales. Entre los obstáculos a la aplicación de los programas educativos se encuentran la falta de concientización de la comunidad y la falta de recursos en las islas. Los resultados de la evaluación de las necesidades son fundamentales para planificar las intervenciones educativas, que serán formuladas por los prestadores de atención de salud locales con la colaboración y el apoyo de recursos externos, incluidos los del Centro Colaborador de la Organización Panamericana de la Salud/Organización Mundial de la Salud en Educación en Enfermería Gerontológica.

[RESUMO]. Os objetivos desta avaliação qualitativa das necessidades foram avaliar as necessidades percebidas do pessoal da saúde e dos serviços de assistência social na região do Caribe, visando a melhorar os serviços de apoio ao envelhecimento saudável e de atenção às pessoas idosas e determinar os facilitadores e as barreiras percebidos, com vistas a melhorar a capacidade de prestar assistência às populações idosas. Esta avaliação foi realizada com base na Consolidated Framework for Implementation Science em 14 ilhas do Caribe oriental e meridional. Os resultados obtidos demonstraram que é necessário prover conhecimento aos profissionais e à população geral sobre a prevenção e o tratamento de doenças não transmissíveis, e a avaliação de pessoas com demência, doença de Alzheimer, depressão e uso prejudicial de álcool e os respectivos serviços, visto que são enormes desafios enfrentados pelas pessoas idosas. É fundamental que o pessoal da saúde e dos serviços sociais, os familiares e o público em geral conheçam os fatores de risco para doenças não transmissíveis e os problemas comuns de saúde mental e física que afligem a população idosa. A falta de sensibilização da comunidade e a escassez de recursos são barreiras à implementação de programas educacionais. As conclusões desta avaliação servem de base para o planejamento de inter- venções educacionais a serem desenvolvidas localmente pelo pessoal da saúde, com a colaboração e o apoio de entidades internacionais, como o Centro Colaborador da Organização Pan-Americana da Saúde/ Organização Mundial da Saúde para Educação em Enfermagem Gerontológica.

Healthy aging and care of the older adult with chronic disease: a qualitative needs assessment in 14 eastern and southern Caribbean islands / Envejecimiento saludable y atención de las personas mayores con enfermedades crónicas: evaluación cualitativa de las necesidades en 14 islas del Caribe oriental y meridional / Envelhecimento saudável e atenção à pessoa idosa com doença crônica: avaliação qualitativa das necessidades em 14 ilhas do Caribe oriental e meridional

ABSTRACT The objectives of this qualitative needs assessment were to assess perceived needs of health and social services professionals in the Caribbean Region to enhance services supporting healthy aging and care of older adults and to assess perceived facilitators and barriers to increasing capacity to serve their aging populations. The assessment, informed by the Consolidated Framework for Implementation Science, was conducted in 14 islands in the eastern and southern Caribbean. The results demonstrated need for education of professionals and the general population about the prevention and treatment of non-communicable diseases (NCDs), assessment and services for individuals with dementia, Alzheimer's disease, depression, and harmful alcohol use, all of which pose significant challenges for older adults. Education of health and social services professionals, families, and the public on the risk factors for NCDs and common mental and physical health problems is critical. Barriers to implementation of educational programs include lack of community awareness and resources within the islands. The needs assessment findings are foundational to planning educational interventions. These will be developed by local health providers with the collaboration and support of external resources including those of the Pan American Health Organization/World Health Organization Collaborating Centre in Gerontological Nursing Education.

Resumen Los objetivos de esta evaluación cualitativa de las necesidades fueron evaluar las necesidades que perciben los profesionales de la salud y de los servicios sociales en el Caribe a fin de mejorar los servicios de apoyo al envejecimiento saludable y el cuidado de las personas mayores, así como evaluar los factores percibidos como facilitadores y como obstáculos para mejorar su capacidad de atender a la población que está envejeciendo. La evaluación, basada en el marco consolidado para la ciencia de la implementación, se realizó en 14 islas del Caribe oriental y meridional. Los resultados mostraron la necesidad de capacitar a los profesionales y educar a la población en general acerca de la prevención y el tratamiento de las enfermedades no transmisibles (ENT), la evaluación y los servicios para las personas con demencia, alzhéimer, depresión y problemas de consumo nocivo de alcohol, todos los cuales plantean importantes desafíos para las personas mayores. Es imprescindible capacitar a los profesionales de la salud y de los servicios sociales, así como educar a las familias y al público en general sobre los factores de riesgo de las ENT y los problemas de salud mental y física más habituales. Entre los obstáculos a la aplicación de los programas educativos se encuentran la falta de concientización de la comunidad y la falta de recursos en las islas. Los resultados de la evaluación de las necesidades son fundamentales para planificar las intervenciones educativas, que serán formuladas por los prestadores de atención de salud locales con la colaboración y el apoyo de recursos externos, incluidos los del Centro Colaborador de la Organización Panamericana de la Salud/Organización Mundial de la Salud en Educación en Enfermería Gerontológica.

RESUMO Os objetivos desta avaliação qualitativa das necessidades foram avaliar as necessidades percebidas do pessoal da saúde e dos serviços de assistência social na região do Caribe, visando a melhorar os serviços de apoio ao envelhecimento saudável e de atenção às pessoas idosas e determinar os facilitadores e as barreiras percebidos, com vistas a melhorar a capacidade de prestar assistência às populações idosas. Esta avaliação foi realizada com base na Consolidated Framework for Implementation Science em 14 ilhas do Caribe oriental e meridional. Os resultados obtidos demonstraram que é necessário prover conhecimento aos profissionais e à população geral sobre a prevenção e o tratamento de doenças não transmissíveis, e a avaliação de pessoas com demência, doença de Alzheimer, depressão e uso prejudicial de álcool e os respectivos serviços, visto que são enormes desafios enfrentados pelas pessoas idosas. É fundamental que o pessoal da saúde e dos serviços sociais, os familiares e o público em geral conheçam os fatores de risco para doenças não transmissíveis e os problemas comuns de saúde mental e física que afligem a população idosa. A falta de sensibilização da comunidade e a escassez de recursos são barreiras à implementação de programas educacionais. As conclusões desta avaliação servem de base para o planejamento de intervenções educacionais a serem desenvolvidas localmente pelo pessoal da saúde, com a colaboração e o apoio de entidades internacionais, como o Centro Colaborador da Organização Pan-Americana da Saúde/Organização Mundial da Saúde para Educação em Enfermagem Gerontológica.

Comparative cost of diets for low-income families in the Caribbean

[ABSTRACT]. Objective. To assess the ability of low-income families to obtain a standard basket of healthy foods before and during the COVID-19 pandemic. Methods. The costs of 191 food items were averaged from supermarkets, municipal markets, wholesalers, and community food outlets in high- and low-income areas in three Caribbean countries. The analysis compared foods not only by selecting high- and low-ranked commodities but by the proportions of those foods, by food group, that will be required to meet a low-cost, nutritionally balanced diet of 2 400 kcal. Results. The main finding was that low-income households will need between 22% and 47% of their earnings to obtain a healthy diet. Despite higher food prices in Saint Kitts and Nevis, low-income households there will need a smaller proportion of their income to obtain a similar basket of foods than in Jamaica or Saint Vincent and the Grenadines. Conclusions. While the COVID-19 pandemic has added economic stressors to low-income households the basic vulnerability of the poor to obtain a healthy diet remains. Despite country variations, the findings point to the need for an increase in the minimum wage, particularly in Jamaica. It is essential to embed policies that ensure reduced economic and social vulnerability at the household level.

[RESUMEN]. Objetivo. Evaluar la capacidad de las familias de bajos ingresos para obtener una cesta estándar de alimentos saludables antes y durante la pandemia de COVID-19. Métodos. Se promediaron los costos de 191 alimentos en supermercados, mercados municipales, mayoristas y puestos de venta de alimentos en la comunidad en zonas de altos y bajos ingresos de tres países del Caribe. En el análisis se compararon los comestibles por grupo de alimentos mediante una selección de productos de alto y bajo rango, así como por las proporciones necesarias para tener un régimen alimentario nutricionalmente equilibrado de 2 400 kcal y de bajo costo. Resultados. La conclusión principal fue que los hogares de bajos ingresos necesitan entre 22% y 47% de sus ingresos para tener un régimen alimentario saludable. A pesar de los elevados precios de los alimentos en Saint Kitts y Nevis, los hogares de bajos ingresos necesitarán una proporción menor de sus ingresos para obtener una cesta de alimentos similar en Jamaica o San Vicente y las Granadinas. Conclusiones. La vulnerabilidad básica de las personas pobres para tener un régimen alimentario saludable persiste, a lo que se suma que la pandemia de COVID-19 ha agregado factores económicos estresantes a los hogares de bajos ingresos. A pesar de las variaciones entre países, los resultados apuntan a la necesidad de incrementar el salario mínimo, particularmente en Jamaica. Es esencial incorporar políticas que garanticen una reducción de la vulnerabilidad económica y social a nivel de los hogares.

[RESUMO]. Objetivo. Avaliar a capacidade das famílias de baixa renda de adquirir uma cesta básica de alimentos saudáveis antes e durante a pandemia de COVID-19. Métodos. Calculou-se a média do custo de 191 produtos alimentícios em supermercados, mercados municipais, atacadistas e estabelecimentos comunitários em áreas de alta e baixa renda em três países do Caribe. A análise comparou os alimentos não apenas pela escolha de produtos classificados em posição alta e baixa, mas também pelas proporções desses alimentos, por grupo alimentar, necessárias para ter uma alimentação de baixo custo e nutricionalmente equilibrada, com 2 400 kcal. Resultados. A principal constatação foi que as famílias de baixa renda precisarão gastar entre 22% e 47% de sua renda para ter uma alimentação saudável. Apesar do maior preço dos alimentos em Saint Kitts e Nevis, as famílias de baixa renda nesse país precisarão usar uma menor proporção da renda para comprar uma cesta de alimentos semelhante à adquirida na Jamaica ou em São Vicente e Granadinas. Conclusões. Embora a pandemia de COVID-19 tenha agregado fatores de estresse econômico às famílias de baixa renda, persiste a vulnerabilidade subjacente das pessoas pobres em relação à obtenção de uma alimentação saudável. Apesar das variações entre os países, as constatações indicam a necessidade de um aumento do salário mínimo, sobretudo na Jamaica. É essencial a incorporação de políticas que reduzam a vulnerabilidade econômica e social no âmbito familiar.

Occurrence, spatial distribution, and risk assessment of microplastics in surface water and sediments of Saint Martin Island in the Bay of Bengal.

Microplastics (MPs) are emerging contaminants in aquatic and terrestrial ecosystems and have caused substantial concern worldwide. This study surveyed the presence of MPs in surface water and sediments across the coastal area of Saint Martin Island in the Bay of Bengal. MPs were collected following the standard protocol and identified as various types like expanded polystyrene, foam, filaments, fragments, lines, fibres, and paint flakes. Total MPs pollution in beach sediment was 317 particles/kg across 14 sampling sites, varied from 11 to 10589 particles/m2 of dry sediment and 0.95 particles/m3, having ~2 to 19 particles/30 min trawl in coastal surface water samples. Most of the frequent MPs in beach sediments ranged from 1.0 to 2.0 mm, whereas the fragments were predominant in sediment and surface water samples. MPs distribution revealed that different shapes were dominant at different sites within the Island. The calculated pollution risk index due to the presence of MPs indicated that the sediment and surface water samples were under the low-risk category. However, polymeric risk assessment and contamination factors suggest that the coastline is significantly polluted, as high pollution load indices (PLI >1) were observed for sediments and coastal surface water samples. This work provides the detailed MPs data in the coastal environment of Saint Martin Island for the first time; hence it may be helpful to develop proper strategies to deal with environmental problems.

Micropollutant content of Sargassum drifted ashore: arsenic and chlordecone threat assessment and management recommendations for the Caribbean.

Massive Sargassum beachings occurred since 2011 on Caribbean shores. Sargassum inundation events currently involve two species, namely S. fluitans and S. natans circulating and blooming along the North Atlantic subtropical gyre and in the entire Caribbean region up to the Gulf of Mexico. Like other brown seaweeds, Sargassum have been shown to bioaccumulate a large number of heavy metals, alongside with some organic compounds including the contamination by historical chlordecone pollution in French West Indies (FWI), an insecticide used against the banana's weevil Cosmopolites sordidus. The present study reports, during two successive years, the concentration levels of heavy metals including arsenic in Martinique and Guadeloupe (FWI). We found that Sargassum can also accumulate a high concentration of chlordecone. Sargassum contamination by chlordecone is observed in areas close to contaminated river mouth but can be partly due to chlordecone desorption when secondary drifted on chlordecone-free shore. Our results further demonstrate that algae bleaching raises a number of questions about inorganic and organic pollutant (i) bioaccumulation, at sea for arsenic and close to river plumes for chlordecone, (ii) transport, and (iii) dissemination, depending the shoreline and the speciation for arsenic and/or metabolization for both.

Adaptation of the INTERGROWTH-21st neurodevelopment assessment (INTER-NDA) to the context of the English-speaking Caribbean.

BACKGROUND: Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings. METHODS: We report the cross-cultural adaptation of an international, standardized ECD instrument, the INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA), measuring cognitive, language, motor and behavioural outcomes in 2-year-olds, from a UK-based English-speaking population to the English-speaking Caribbean. Children aged 22-30 months were recruited from a pre-existing randomized controlled neurodevelopment intervention study in Grenada, West Indies. RESULTS: Eight of 37 INTER-NDA items (22%) were culturally and linguistically adapted for implementation in the Caribbean context. Protocol adherence across seven newly-trained non-specialist child development assessors was 89.9%; six of the seven assessors scored ≥80%. Agreement between the expert assessor and the non-specialist child development assessors was substantial (κ = 0.89 to 1.00 (95% CI [0.58, 1.00]). The inter-rater and test-retest reliability for non-specialist child development assessors was between κ = 0.99 -1.00 (95% CI [0.98, 0.99]) and κ = 0.76 - 1.00 (95% CI [0.33, 1.00]) across all INTER-NDA domains. CONCLUSIONS: The current study provides evidence to support the use of the adapted INTER-NDA by trained, non-specialist assessors to measure ECD prevalence in the English-speaking Caribbean. It also provides a methodological template for the adaptation of child developmental measures to cultural and linguistic contexts that conform to the cultural standards of the countries in which they are utilized to aid in the measurement of neurodevelopmental impairments (NDIs) in a variety of global clinical settings.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. The Bahamas and Turks and Caicos Islands

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the countries for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

Expanding Opportunities for American Descendants of Slavery to Build a More Inclusive and Diverse Global Health Workforce.

Historically, the terms African American and Black have been used interchangeably to describe any person with African ancestry living in the United States. However, Black Americans are not a monolith, and legitimate differences exist between those with generational roots in the United States and either African or Caribbean immigrants. American descendants of slavery (ADOS) are underrepresented in many fields, but I have noticed during my decades long career in global health that they are acutely absent in this field. Here, I offer seven recommendations to improve recruitment, retention, and advancement of ADOS in the global health field. Immediate implementation of these recommendations will not only bring diverse perspectives and immense capacity to the field but also allow ADOS an opportunity to engage in compelling and meaningful work and to collaborate with those from their ancestral homelands.

Plutonium in coral archives: A good primary marker for an Anthropocene type section.

While we officially live in the Holocene epoch, global warming and many other impacts of global change have led to the proposal and wide adoption of the Anthropocene to define the present geological epoch. The Anthropocene Working Group (AWG) established that it should be treated as a formal stratigraphic unit, demonstrated by a reference level commonly known as "golden spike", still under discussion. Here we show that the onset of bomb-derived plutonium recorded in two banded massive corals from the Caribbean Sea is consistent (1955-1956 CE), so sites far from nuclear testing grounds are potentially suitable to host a type section of the Anthropocene. Coastal coral demonstration sites are feasible, could foster economic development, and may serve as focal points for scientific dissemination and environmental education.

Culturally Sensitive Health Education in the Caribbean Diaspora: A Scoping Review.

CONTEXT: The Caribbean diaspora in the United States is a diverse community that is afflicted with high morbidity and mortality due to preventable chronic diseases. OBJECTIVE: Our goal is to determine which culturally sensitive health and nutrition educational modalities have the highest efficacy for improving general health in the Caribbean diaspora. METHODS: A scoping literature review was performed on the MEDLINE, CINAHL, and Web of Science databases using terms related to health and nutrition in the Caribbean population. Original, peer-reviewed research published from 2010 to 2020, which took place in the U.S. and Caribbean countries, were included in our review. RESULTS: We identified a total of nine articles that met our inclusion criteria. Rate differences for individual education program features were calculated to assess the likelihood of a positive impact on diet, physical activity, and diabetes. CONCLUSION: Our review helps to identify key educational modalities targeting diabetes, diet, and physical activity levels that can be used to meet the health and nutritional needs of the Caribbean diaspora population.

Review: Type 2 diabetes in Latin America and the Caribbean: Regional and country comparison on prevalence, trends, costs and expanded prevention.

PURPOSE: To present an overview of type 2 diabetes status in Latin America and the Caribbean region. METHODS: The data were collected from the International Diabetes Federation Atlas and other available published sources where we identified the prevalence in Latin America and the Caribbean, the trends by regions, and sex. Also, we summarized the type 2 diabetes direct and indirect costs, and the current preventative programs and policies available for each region. RESULTS: Latin America and the Caribbean has one of the fastest-growing prevalence of type 2 diabetes, in particular the Caribbean region. Costs are relatively high in Central American countries and the Caribbean Islands. Currently, type 2 diabetes prevention, diagnosis, and management are insufficient in Latin America and the Caribbean and they do not offer a multidisciplinary integrative approach. CONCLUSION: Effective and preventive multidisciplinary policies should be implemented in Latin America and the Caribbean to decrease the high burden of type 2 diabetes.

Sibling mortality burden in low-income countries: A descriptive analysis of sibling death in Africa, Asia, and Latin America and the Caribbean.

In high-income countries, emerging research suggests sibling bereavement can have significant health and life course consequences for young people. Yet, we know far less about its burden in lower-income countries. Due to higher fertility and mortality in lower-income countries, the level, timing, intensity, and circumstances surrounding sibling mortality are likely to follow patterns distinct from those in higher-income settings. Thus, in this study, we offer a descriptive overview of sibling death in 43 countries across sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean. Specifically, we analyze Demographic and Health Survey data from nationally representative samples of 352,930 15- to 34-year-old women, born between 1985 and 2003, to document experiences of sibling death before age 25. On average, roughly one-third of individuals report a deceased sibling in these countries; estimates reach 40-50% of respondents in multiple African countries, particularly those that have experienced conflict and war. Although some sibling deaths occurred before the focal respondent was born, most bereaved individuals recalled a death during their lifetime-often in late childhood/early adolescence. High proportions of bereaved respondents report multiple sibling deaths, highlighting the clustering of deaths within families. Even so, bereaved individuals tend to come from large families and thus frequently have a comparable number of surviving siblings as people who never experienced a sibling die. Together, the results offer a window into global inequality in childhood experiences, and they attest to the need for research that explores the implications of sibling mortality for young people in world regions where the experience is concentrated.

The importance of Black feminism and the theory of intersectionality in analysing the position of afro descendants.

This article explains the connections between the postulates of black feminism and the theory of intersectionality. It reflects how, from social thought produced in daily life, hegemonic systems such as racism and patriarchy are reproduced and configure asymmetrical social relations. Therefore, it recognises black feminism as a critical theory and anti-hegemonic social movement in favour of women and men of African descent who have developed their life experiences in a context of social injustice sustained by intersectional oppression. Emphasis is placed on the theory of intersectionality as a development of black feminism, which has transcended its origins to become a relevant model of analysis for understanding and addressing contemporary social inequalities, as well as a theoretical tool and proposal for work in different fields of knowledge, among which Psychology is noteworthy as a science that privileges the analysis of subjectivity in the individual and social order, areas in which less progress has been made in addressing the harmful effects of cross inequalities arising from racism and patriarchy in today's societies.

Natural Disasters in the Americas, Dialysis Patients, and Implications for Emergency Planning: A Systematic Review.

INTRODUCTION: Natural hazards are elements of the physical environment caused by forces extraneous to human intervention and may be harmful to human beings. Natural hazards, such as weather events, can lead to natural disasters, which are serious societal disruptions that can disrupt dialysis provision, a life-threatening event for dialysis-dependent people. The adverse outcomes associated with missed dialysis sessions are likely exacerbated in island settings, where health care resources and emergency procedures are limited. The effect of natural disasters on dialysis patients living in geographically vulnerable areas such as the Cayman Islands is largely understudied. To inform predisaster interventions, we systematically reviewed studies examining the effects of disasters on dialysis patients and discussed the implications for emergency preparedness in the Cayman Islands. METHODS: Two reviewers independently screened 434 titles and abstracts from PubMed, Scopus, CINAHL, and Cochrane Library. We included studies if they were original research articles published in English from 2009 to 2019 and conducted in the Americas. RESULTS: Our search yielded 15 relevant articles, which we included in the final analysis. Results showed that disasters have both direct and indirect effects on dialysis patients. Lack of electricity, clean water, and transportation, and closure of dialysis centers can disrupt dialysis care, lead to missed dialysis sessions, and increase the number of hospitalizations and use of the emergency department. Additionally, disasters can exacerbate depression and lead to posttraumatic stress disorder among dialysis patients. CONCLUSION: To our knowledge, this systematic review is the first study that presents a synthesis of the scientific literature on the effects of disasters on dialysis populations. The indirect and direct effects of disasters on dialysis patients highlight the need for predisaster interventions at the patient and health care system levels. Particularly, educating patients about an emergency renal diet and offering early dialysis can help to mitigate the negative effects of disasters.

Factors Influencing the Early Development of World-Class Caribbean Track and Field Athletes: A Qualitative Investigation.

This qualitative investigation sought to explore through a socio-cultural lens the perceived early training and competition environment, and support network of world-class Caribbean track and field athletes and the influence on their sport engagement and progression during early childhood and adolescence. Sixteen world-class track and field athletes (8 males and 8 females; M age = 29, SD = 5 years) from 6 English-speaking Caribbean islands took part in semi-structured interviews. A thematic analysis was performed on the transcribed data. Three superordinate themes were identified as key factors that influenced the early sporting development of world-class Caribbean athletes: (1) conducive sporting environment, (2) functional social support network, and (3) key organizational input. Findings revealed that perceived high levels of deliberate play activity in childhood (6 - 12 years) and an intense track and field competition culture in adolescence (13 - 20 years) were conducive to the continued engagement and progression of world-class Caribbean track and field athletes at the junior level. Furthermore, world-class athletes perceived themselves to be positively influenced by the support received from their immediate social support network and key organizations during this period. This study showed that a conducive sporting environment coupled with optimal social and organizational support may have encouraged world-class Caribbean athletes to remain engaged in track and field and to successfully progress within the sport at the junior level. Findings shed light on the sporting culture at the junior level within the Caribbean region and provide insight into key environmental factors that can influence and foster the development of future World Champions and Olympians.

Socioeconomic inequalities in metabolic syndrome in the French West Indies.

BACKGROUND: Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region. We investigated the association between socioeconomic position and metabolic syndrome (MetS) prevalence and explored the contribution of diet quality to explain this association, among adults in the French West Indies. METHODS: This cross-sectional analysis included 1144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. MetS prevalence was assessed using the Joint Interim Statement. Dietary intakes were estimated from 24 h-dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and MetS prevalence, and the potential contribution of diet quality in this association were assessed using multivariable logistic regression models, adjusted for sociodemographic characteristics. RESULTS: MetS prevalence adjusted for age and sex was 21 and 30% among Guadeloupean and Martinican, respectively. Compared to high-educated participants, low-educated subjects were more likely to be at risk of MetS (OR = 2.4; 95%CI = [1.3-4.4], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.0; 95%CI = [1.0-4.0]). The DQI-I explained 10.5% of the overall variation in MetS due to education. CONCLUSIONS: Socioeconomic inequalities in MetS prevalence, reflected by education and social assistance benefits, were found. However, diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial. Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Further prospective studies are needed to improve our understanding of the mechanisms of social inequalities in MetS in a high poverty rates context.

Cancer management in the Pacific region: a report on innovation and good practice.

Pacific island countries and territories (PICTs) face the challenge of a growing cancer burden. In response to these challenges, examples of innovative practice in cancer planning, prevention, and treatment in the region are emerging, including regionalisation and coalition building in the US-affiliated Pacific nations, a point-of-care test and treat programme for cervical cancer control in Papua New Guinea, improving the management of children with cancer in the Pacific, and surgical workforce development in the region. For each innovation, key factors leading to its success have been identified that could allow the implementation of these new developments in other PICTs or regions outside of the Pacific islands. These factors include the strengthening of partnerships within and between countries, regional collaboration within the Pacific islands (eg, the US-affiliated Pacific nations) and with other regional groupings of small island nations (eg, the Caribbean islands), a local commitment to the idea of change, and the development of PICT-specific programmes.