Cervical Cancer and Human Papillomavirus Awareness among Women in Antigua and Barbuda.

Background and objectives: Cervical cancer is the fourth leading cause of cancer-related deaths in women. Human papilloma virus (HPV) is known to cause cervical cancer. The incidence and mortality of cervical cancer has drastically reduced due to effective vaccination against HPV in developed countries. The projected rise in cervical cancer cases in Latin American and Caribbean countries necessitates a study to evaluate awareness about HPV, cervical cancer, the HPV vaccine, and prevention among women in Antigua and Barbuda. Materials and methods: This was an observational, cross-sectional study. The participants were women aged between 18 and 65 years, residing in Antigua and Barbuda. The study was conducted over the period of February to April 2023. After taking informed consent electronically, sociodemographic and behavioral data was collected through questionnaires sent out as links and QR-codes and were analyzed by QualtricsXM. The association between the demographic groups and awareness about HPV, cervical cancer, the HPV vaccine, and prevention was analyzed by a Chi-square test. Results: In total, 467 women were included in the study. The percentage of participants aware of HPV was 91.6% (n = 412). A total of 70.7% (n = 318) and 56.7% (n = 255) women were aware that cervical cancer is caused by HPV and is sexually transmitted, respectively. Although 70.6% (n = 315) of participants were aware that the vaccine protects against HPV, only 12.8% (n = 57) were vaccinated. Of the participants, 49.7% (n = 192) were willing to get vaccinated. The percentage of participants aware of the Papanicolaou (Pap) smear procedure was 98.9% (n = 435) and 87.8% (n = 382) had a Pap smear within the last 10 years while 12.2% (n = 53) never had a Pap smear screening. The willingness to know more information about HPV and the HPV vaccine among the participants was 77% (n = 335). Conclusions: The overall awareness among women in Antigua and Barbuda about HPV, cervical cancer, the HPV vaccine, and prevention was high. We recommend a national health education program and vaccine drive to complement our findings.

Politics and palliative care: Antigua and Barbuda.

Dion Smyth's review of the internet for palliative nursing.

[Chikungunya fever in Mexico: confirmed case and notes on the epidemiologic response]. / Fiebre chikungunya en México: caso confirmado y apuntes para la respuesta epidemiológica.

Chikungunya fever (CHIK) is a viral disease transmitted to human beings by the same vector as dengue -the Aedes mosquito. Besides fever and severe pain in the joints, it produces other symptoms such as myalgias, headache, nausea, fatigue and exanthema. There is no specific treatment for it; the therapeutic management of patients focuses on symptom relief. Historically, outbreaks of large proportions have been reported; even since 2010 it was considered to be a potential emerging epidemic. In 2013 it was introduced into the islands of the Caribbean, and it has recently been reported in the American continent. This paper describes the first confirmed case of chikungunya in Mexico -in the municipality of Tlajomulco de Zúñiga, Jalisco, in May, 2014-, which was imported from the Caribbean island of Antigua and Barbuda by a 39 year-old woman.

'Sometimes it's fun to play with them first': girls and boys talking about sexual harassment in Caribbean schools.

This paper discusses findings from a qualitative study conducted in four government secondary schools in the Caribbean state of Antigua and Barbuda on students' experiences at school in relation to sexuality. Both girls and boys experienced a range of anxieties and confusions in relation to sexuality, whilst also seeing (hetero)sexual attraction as an exciting part of schooling. Sexual harassment of girls emerged as a widespread and serious (as well as 'normalised') occurrence in all the schools studied. However, the data also showed that girls were far from passive. Instead, girls demonstrated complex and contradictory responses to boys' behaviour due to their own investments in being desirable within discourses of hetero-femininity, as well as the pleasure they gained from their relationships. Both genders would clearly benefit from opportunities to discuss their needs, beliefs and desires regarding sexuality and relationships.

Land use scenarios, seasonality, and stream identity determine the water physicochemistry of tropical cloud forest streams.

Background: Land use is a major factor determining stream water physicochemistry. However, most streams move from one land use type to another as they drain their watersheds. Here, we studied three land use scenarios in a tropical cloud forest zone in Mexico. We addressed three main goals, to: (1) assess how land use scenarios generate different patterns in stream physicochemical characteristics; (2) explore how seasonality (i.e., dry, dry-to-wet transition, and wet seasons) might result in changes to those patterns over the year; and (3) explore whether physicochemical patterns in different scenarios resulted in effects on biotic components (e.g., algal biomass). Methods: We studied Tropical Mountain Cloud Forest streams in La Antigua watershed, Mexico. Streams drained different three scenarios, streams with (1) an upstream section draining forest followed by a pasture section (F-P), (2) an upstream section in pasture followed by a forest section (P-F), and (3) an upstream forest section followed by coffee plantation (F-C). Physicochemistry was determined at the upstream and downstream sections, and at the boundary between land uses. Measurements were seasonal, including temperature, dissolved oxygen, conductivity, and pH. Water was analyzed for suspended solids, alkalinity, silica, chloride, sulfate, magnesium, sodium, and potassium. Nutrients included ammonium, nitrate, and phosphorus. We measured benthic and suspended organic matter and chlorophyll. Results: Streams presented strong seasonality, with the highest discharge and suspended solids during the wet season. Scenarios and streams within each scenario had distinct physicochemical signatures. All three streams within each scenario clustered together in ordination space and remained close to each other during all seasons. There were significant scenario-season interactions on conductivity (F = 9.5, P < 0.001), discharge (F = 56.7, P < 0.001), pH (F = 4.5, P = 0.011), Cl- (F = 12.2, P < 0.001), SO42- (F = 8.8, P < 0.001) and NH4+ (F = 5.4, P = 0.005). Patterns within individual scenarios were associated with stream identity instead of land use. Both P-F and F-C scenarios had significantly different physicochemical patterns from those in F-P in all seasons (Procrustes analysis, m12 = 0.05-0.25; R = 0.86-0.97; P < 0.05). Chlorophyll was significantly different among scenarios and seasons (F = 5.36, P = 0.015, F = 3.81, P = 0.42, respectively). Concentrations were related to physicochemical variables more strongly during the transition season. Conclusion: Overall, land use scenarios resulted in distinctive water physicochemical signatures highlighting the complex effects that anthropogenic activities have on tropical cloud forest streams. Studies assessing the effect of land use on tropical streams will benefit from assessing scenarios, rather than focusing on individual land use types. We also found evidence of the importance that forest fragments play in maintaining or restoring stream water physicochemistry.

The epidemiology of travel-related Salmonella Enteritidis in Ontario, Canada, 2010-2011.

BACKGROUND: Increases in the number of salmonellosis cases due to Salmonella Enteritidis (SE) in 2010 and 2011 prompted a public health investigation in Ontario, Canada. In this report, we describe the current epidemiology of travel-related (TR) SE, compare demographics, symptoms and phage types (PTs) of TR and domestically-acquired (DA) cases, and estimate the odds of acquiring SE by region of the world visited. METHODS: All incident cases of culture confirmed SE in Ontario obtained from isolates and specimens submitted to public health laboratories were included in this study. Demographic and illness characteristics of TR and DA cases were compared. A national travel survey was used to provide estimates for the number of travellers to various destinations to approximate rates of SE in travellers. Multivariate logistic regression was used to estimate the odds of acquiring SE when travelling to various world regions. RESULTS: Overall, 51.9% of SE cases were TR during the study period. This ranged from 35.7% TR cases in the summer travel period to 65.1% TR cases in the winter travel period. Compared to DA cases, TR cases were older and were less likely to seek hospital care. For Ontario travellers, the adjusted odds of acquiring SE was the highest for the Caribbean (OR 37.29, 95% CI 17.87-77.82) when compared to Europe. Certain PTs were more commonly associated with travel (e.g., 1, 4, 5b, 7a, Atypical) than with domestic infection. Of the TR cases, 88.9% were associated with travel to the Caribbean and Mexico region, of whom 90.1% reported staying on a resort. Within this region, there were distinct associations between PTs and countries. CONCLUSIONS: There is a large burden of TR illness from SE in Ontario. Accurate classification of cases by travel history is important to better understand the source of infections. The findings emphasize the need to make travellers, especially to the Caribbean, and health professionals who provide advice to travellers, aware of this risk. The findings may be generalized to other jurisdictions with travel behaviours in their residents similar to Ontario residents.

Morphological variants of Aedes aegypti collected from the Leeward Island of Antigua.

Nineteen Aedes aegypti larvae were collected in rural Antigua, West Indies, from an 18-liter plastic bucket. The location was in a rural area at the northern end of Antigua bordering the coast of Dickenson Bay and approximately 50 m south of Halcyon Cove Beach (17 degrees 09'42.54"N, 61 degrees 50'44.50"W; elevation 16 m). Atypical morphology was noted in larvae and 3 reared adult females. Fourth instars showed a reduction in length of the lateral hair on the saddle (seta 1-X) with measurements ranging from 0.36 to 0.57 the length of the saddle. Two atypical female specimens displayed an abundance of dull white to gold scales that blanketed the abdomen. A 3rd specimen bore fine, golden scales on the mesonotum and bronze scales on the vertices of the head. These adult specimens demonstrated morphological characteristics that closely parallel described mutations, although the genetic basis for these characters was not confirmed. The remaining adults in the collection were morphologically typical. Adults and larvae were compared to field populations from Florida, Bahamas, and Antigua, as well as to the Rockefeller strain maintained at Rutgers University.

A new species of planthopper in the genus Patara (Hemiptera: Derbidae) on coconut palm (Cocos nucifera) from the island of Barbuda.

The island of Barbuda was recently surveyed for the presence of Haplaxius crudus to establish the risk of Lethal Yellowing to palms on the island. After extensive collecting, H. crudus was not found on the island. A new species of Patara Westwood was found on coconut palms on the southwest portion of Barbuda. Herein, we describe the new species as Patara cooki sp. n. and provide DNA sequence data for cytochrome c oxidase subunit I (COI) and 18S genes for it and Patara guttata Westwood. Patara cooki differed from Patara guttata sp. n. by 1.8% for 18S and 7.8% for COI, similar to intrageneric differences reported for other taxa. A phylogenetic analysis of available Otiocerinae near Patara using found Patara cooki sp. n. nested among other Patara species. We also offer commentary regarding the interpretation of forewing venation in Patara.

Population increase and changes in behavior and morphology in the Critically Endangered Redonda ground lizard (Pholidoscelis atratus) following the successful removal of alien rats and goats.

Redonda is a small volcanic Caribbean island that is home to at least 4 endemic lizard species, including the Critically Endangered ground lizard (Pholidoscelis atratus). Black rats (Rattus rattus) and domestic goats (Capra hircus) were introduced to the island at some time after its discovery by Europeans in the late 1500s. They had a devastating effect on the island, resulting in the loss of nearly all trees and most of the ground vegetation. Point count surveys of P. atratus in 2012 indicated low densities, and the invasive rats were observed hunting and preying on the lizards. Both populations of rats and goats were successfully removed in 2017 as part of an ecological restoration program, and native vegetation and invertebrate populations have increased rapidly since. Population surveys in 2017, 2018, and 2019 show the lizard population has increased by more than sixfold. In 2017, as rats and goats were being removed, we evaluated the morphology and escape behavior of this species and repeated these measurements 1 year later. We observed that P. atratus had become bolder, with a reduced flight distance. We also detected changes in limb morphology related to locomotion and suggest possible explanations that will need to be further investigated in the future. These results show how the removal of invasive species can rapidly affect lizard population recovery and behavior, potentially restoring island ecosystems to their pre-human interference dynamics.

An unpleasant souvenir: Endoscopic finding of Trichuris trichiura (Nematoda: Trichuridae).

Whipworms are responsible for up to 500 million cases of trichuriasis worldwide, with higher endemicity in tropical and sub-tropical countries. In non-endemic countries, trichuriasis can be accidentally diagnosed upon colonoscopy, often in the presence of negative microscopy. Here, we describe an incidental diagnosis of trichuriasis in an HIV patient residing in a non-endemic area (i.e., Turin, Italy), six months after his return from Antigua. The species-level diagnosis was made thanks to PCR-based molecular identification of Trichuris sp. following optical microscopy detection. Overall, this case highlights the importance of improving parasitic diseases diagnosis through cutting-edge clinical and laboratory diagnostic tools alongside advanced training of specialists in the area of parasitology.

Small babies on a small island: survival of very low birthweight infants in Antigua and Barbuda 1986 to 2006.

INTRODUCTION: Recent attention has been focussed on pregnancy outcomes in developing countries, with the publication of the World Health Organization Report 2005, Make Every Mother and Child Count and the Neonatal Survival Series from the Lancet in 2005. Scant outcome data from the smaller islands of the Caribbean exist for very low birthweight (VLBW) babies (birthweight < 1500 g). PATIENTS AND METHODS: A retrospective review of mortality data on VLBW babies in Antigua and Barbuda was performed. Antigua and Barbuda had a population of 71 500 with per capita income of (US) $6054 dollars in 1998. In November 1985, a neonatal Special Care Nursery (SCN) was established. The survival to discharge from SCN for VLBW babies was reviewed from January 1986 to December 2006. RESULTS: There were 26 455 babies born from 1986 to 2006; 344 (1.3%) were VLBW babies. Survival to SCN discharge was 45% from 1986 to 1992, 46% from 1993 to 1999, and increased to 60% from 2000 to 2006 (p < 0.05 compared with the first two time-periods). Babies from 1000 to 1499 g accounted for 64% of VLBW babies and survival to SCN discharge was 60% from 1986 to 1992, 58% from 1993 to 1999, and increased to 83% from 2000 to 2006 (p < 0.01 compared with the first time period; p < 0.001 compared with the second). Babies < 1000g accounted for 36% of VLBW babies and survival to SCN discharge was 10% from 1986 to 1992, increased to 25% from 1993 to 1999 and to 28% from 2000 to 2006 (trend of p < 0.10 compared with first time period). Conservative newborn care only was available. Antenatal steroids were given from 2000 to 2006. CONCLUSION: The outlook for VLBW babies using conservative newborn care techniques has significantly improved over 21-years in Antigua and Barbuda.

Client characteristics associated with failure to complete residential treatment at a multicultural drug and alcohol treatment facility in Antigua, West Indies.

The purpose of this study is to compare the demographic and clinical characteristics of clients leaving treatment prior to completion of the 29-day residential stay at a multicultural addiction treatment centre. The charts of 446 clients (62% from the United States of America, 29% from the Caribbean region, 9% European) were reviewed. The mean age was 39.7 years, 33% female, with 91% using alcohol, 49% using cocaine, 25% using opioids (single drug 27%, poly-drug use 73%), with mean 13.1 years of harmful use, 33% using prescribed mental health medications and 46% having had prior residential treatment. Of 446 clients, 76 (17%) did not complete treatment stay. A comparison of clients leaving early and those completing stay revealed no difference in age (38.6 vs 39.9 years) or years of harmful use (11.7 vs 13.4 years). There were trends toward those leaving to be more often female (42 vs 31%, p < 0.10) and non-Caribbean (20% American or European vs 12% Caribbean, p < 0.10). Clients who left early were more likely to use opioids (41 vs 22%, p < 0.001) and less likely to use alcohol/sedative (83 vs 1%, p < 0.02). Cocaine/stimulant use did not differ (49 vs 49%). Those leaving treatment early had greater use of mental health medications (50 vs 29%, p < 0.001). Prior treatment was not significantly different (53 vs 44%). An analysis of the 128 clients from the Caribbean region showed 15 clients (12%) failed to complete treatment. Those leaving treatment early were more likely to be female (53 vs 26%, p < 0.05), had a trend toward being younger (35.6 vs 39.9 years, p = 0.19) and had fewer years of harmful use (8.1 vs 13.1, p < 0.02). Ethnicity (73 vs 74% African) and alcohol/sedative (87 vs 94%), cocaine/stimulant (53 vs 65%), and opioid use (0 vs 4%) did not differ. Those leaving were more likely to use mental health medication (47 vs 12%, p < 0.001) and there was a trend toward prior treatment (40 vs 23%, p < 0.10).

Managing cancer care during the COVID-19 pandemic-experience at a cancer department in a tertiary hospital in Antigua and Barbuda.

The emergence of corona virus disease 2019 (COVID-19) has caused a global public health emergency and the pandemic has forced the healthcare givers to organise their work differently to provide the same level of care to their patients. Meticulous planning and implementation of robust infection control, proper triage of patients, patient education and awareness and establishment of good command structure has become the norm. In this article we illustrate how the COVID-19 pandemic has affected the oncology department in a tertiary centre in the Caribbean country of Antigua & Barbuda. We describe the changes in treatment decisions for outpatient and inpatient services along with a look at the ethical considerations and the well-being of the oncology team.

Schistosoma mansoni Vector Snails in Antigua and Montserrat, with Snail-Related Considerations Pertinent to a Declaration of Elimination of Human Schistosomiasis.

Investigations leading to a WHO-validated declaration of elimination of schistosomiasis transmission are contemplated for several countries, including Caribbean island nations. With assistance from the Pan American Health Organization, we undertook freshwater snail surveys in two such nations, Antigua and Barbuda, and Montserrat in September and October 2017. Historically, the transmission of Schistosoma mansoni supported by the Neotropical vector snail Biomphalaria glabrata occurred in both countries. Transmission on the islands is thought to have been interrupted by the treatment of infected people, improved sanitation, introduction of competitor snails, and on Montserrat with the eruption of the Soufrière volcano which decimated known B. glabrata habitats. Guided by the available literature and local expertise, we found Biomphalaria snails in seven of 15 and one of 14 localities on Antigua and Montserrat, respectively, most of which were identified anatomically and molecularly as Biomphalaria kuhniana. Two localities on Antigua harbored B. glabrata, but no schistosome infections in snails were found. For snail-related aspects of validation of elimination, there are needs to undertake basic local training in medical malacology, be guided by historical literature and recent human schistosomiasis surveys, improve and validate sampling protocols for aquatic habitats, enlist local expertise to efficiently find potential transmission sites, use both anatomical and molecular identifications of schistosomes or putative vector snail species found, if possible determine the susceptibility of recovered Biomphalaria spp. to S. mansoni, publish survey results, and provide museum vouchers of collected snails and parasites as part of the historical record.

Diseases and medical disabilities of enslaved Barbadians, from the seventeenth century to around 1838 part II.

The disease environment, health problems and causes of mortality of enslaved Barbadians are described. Data are derived mainly from documentary sources; also included are bio-archaeological data from analyses of skeletons recovered from Newton Plantation cemetery. Major topics include infectious diseases transmitted from person to person, as well as those contracted through water soil, and other environmental contaminations, and diseases transmitted by insects, parasites and other animals; nutritional diseases, including protein energy malnutrition, vitamin deficiencies, anaemia, and geophagy or "dirt eating"; dental pathologies, lead poisoning, alcoholism, traumas, and other disorders, including psychogenic death or illness caused by beliefs in witchcraft or sorcery.

Effect of a government funded medication programme on paediatric asthma hospital admissions in Antigua and Barbuda.

OBJECTIVE: To assess the effect of a government funded asthma medication programme on paediatric (age < or = 12 years) asthma hospital admissions in Antigua and Barbuda. METHODS: A retrospective review of all hospital admissions for asthma in children was performed for the six years before and six years after a Medical Benefits Scheme (MBS) programme was established in 1997 to provide asthma medications at no out-of-pocket cost. Holberton Hospital records (1992 to 2003) which include all paediatric asthma admissions in Antigua and Barbuda, were reviewed RESULTS: Paediatric admissions for asthma fell from mean +/- standard deviation of 77.0 +/- 24.8 per year before the MBS programme was started to 48.0 +/- 17.1 per year (p < 0.05) after the MBS programme was started. The number of multiple admissions fell from 18.7 +/- 2.7 to 9.5 +/- 4.8 (p < 0.005) and the number of children admitted multiple times per year fell from 7.8 +/- 1.9 to 4.7 +/- 2.5 (p < 0.05). The number of children aged four to nine years admitted with asthma fell from 7.8 per 1000 annually during 1992 to 1997 to 4.4 per 1000 per year during 1998 to 2003. CONCLUSIONS: The government funded MBS programme for asthma medication has resulted in a 38% decrease in hospital admissions for paediatric asthma over a six-year period. The benefits of a similar programme in other developing countries should be considered.

A new species of Elaphidion Audinet-Serville, 1834, from Antigua and comparison with E. excelsum Gahan, 1895, from Guadeloupe (Coleoptera: Cerambycidae: Elaphidiini).

A new species of Elaphidion, E. antiguensis sp. nov. is described from Antigua (West Indies). The host plants and larval biology of E. antiguensis are described and compared to those of E. excelsum, Gahan.

Trends in the prevalence of adolescent births in Antigua and Barbuda over 35 years.

A retrospective study was undertaken to determine trends in teenage births in Antigua and Barbuda from 1969 to 2003. Maternity Ward records were reviewed at Holberton Hospital, site of over 90% of deliveries in Antigua and Barbuda. Maternal age for all births were included. The estimated population in Antigua and Barbuda increased from 60,159 in 1969 to 69,866 in 1998, with no suspected change in age-group or gender distribution. Births to mothers 12-13, 14-15, 16-17 and 18-19 years old were analyzed separately. Yearly birth totals for the 10-year period from 1969 to 1973 and 1999 to 2003 were compared using student t test analysis. The total number of births averaged 1075 per year with no change in trend. For females aged 12 and 13 years, there was no change in births from 1969 to 1978 compared with 1994 to 2003. For females aged 14 years, there was a 54% drop; for females aged 15 years, a 59% drop; for females aged 16 years, a 53% drop; for females aged 17 years, a 51% drop; for females 18 years, a 37% drop and for females aged 19 years, a 30% drop, while births to mothers > or = 20 years increased 25%. The decrease for all teen births was 42% from 1969-1978 to 1994-2003. Teen births accounted for 29% of all births at Holberton in 1969 to 1973 but only 16% of births in 1999 to 2003. In conclusion, Antigua and Barbuda has seen a marked drop of 42% in teenage deliveries, including a 53% drop in school-aged teens from 1969 to 2003. Explanations include factors such as economic, social, educational and medical developments.

Toward effective school-based substance abuse prevention "breaking the cycle" programme in Antigua and Barbuda.

The "Breaking the Cycle" programme, based on the Project Charlie programme, was developed for Antigua and Barbuda third grade students and was implemented in 2001. Aspects of the programme are compared with aspects recently proven effective in randomized studies in developed countries. The "Breaking the Cycle" programme includes life-skills training, teaches decision making skills, includes peer resistance training, uses trained teachers, interactive teaching methods, effective content and delivery, targets students prior to onset of drug use, teaches drug harm, teaches community values and is culturally sensitive, all aspects of successful programmes overseas. The cost of about $7 US per student would suggests cost-benefit effectiveness compared with overseas programmes. The "Breaking the Cycle" school-based drug and alcohol use prevention programme includes most aspects of evidence-based successful programmes overseas, appears cost effective and could serve as a model for programmes in the Caribbean region.