A public health approach to reducing violence within the CARICOM region.

Widespread crime has become a worldwide problem so much so that violence is now ranked fourth globally in its contribution to disability-adjusted life years in the 10 to 24 age group. Homicides, a surrogate marker of violent crime, have shown an upward trend in almost all of the CARICOM countries, and homicide rates over the past 3 years have consistently increased, though the pattern of violence varies by country. This background has informed the need for greater emphasis on the need for a different approach to dealing with crime in the CARICOM region. The CARICOM governments recently hosted a symposium on crime and violence as a public health issue. The public health approach to crime has been used with measurable success in different parts of the world and, more recently in Trinidad, one of the CARICOM countries. The paper outlines the outcomes of the symposium and discusses its implications for the region.

Safeguarding the Caribbean's future: making the case to research the direct and indirect impacts of climate change on youth mental health and wellbeing.

This article makes a call for attention to paid on the development of a research agenda for studying the impact of climatic events on youth mental health in the Caribbean. It details the climate injustices that the region faces and the potential mental health problem which can arise from climatic events. It makes a call for interdisciplinary research and a multi stakeholder approach to dealing with this potential issue.

Experiences with SARS-CoV-2 (Covid-19) in Trinidad and Tobago, a small island developing state: realities and opportunities.

The COVID-19 pandemic has exerted significant global challenges that are expressed in a variety of socio-politico-economic scenarios, depending upon individual countries' preparedness and resilience. The impact COVID-19 in Small Island Developing States (SIDS), most of which are categorized as Lower and Middle-Income Countries, has been pronounced. Furthermore, many of these SIDS possess specific vulnerabilities to global threats. This paper contextualizes the experience of Trinidad and Tobago from some perspectives of geoeconomics, healthcare, and international relations. In many ways, the experience is similar to that of other SIDS with the inherent nuances of a post-colonial world. Trinidad and Tobago was ranked number one by the Oxford University COVID-19 Government Response Tracker (OxCGRT) "Lockdown rollback checklist: Do countries meet WHO recommendations for rolling back lockdown?". Despite the significant political support to combat the disease, by the end of 2022, the country had recorded over four thousand deaths and just over 50% of the population is vaccinated. This paper seeks to discuss the successes and challenges faced by this twin island state.

Resilient Coping is More Important Than Previous Virtual Learning Experience: Predicting Pharmacy Student Stress During the COVID-19 Pandemic.

Purpose: The COVID-19 pandemic precipitated a swift transition to online learning in medical and health sciences. This study investigated the associations of previous experience with online learning, current confidence with online learning, and resilient coping skills with perceived stress reported by pharmacy students during the emergency transition to online learning. Methods: Undergraduate pharmacy students (N=113, response rate = 41%) completed an online, self-report, cross-sectional survey during April-June 2020. Measures included Likert items measuring prior experience and current comfort levels with online learning, the Brief Resilient Coping Scale (BRCS), and the Perceived Stress Scale 10-Item Version (PSS-10). Experience, comfort with online learning, reported scores, and internal consistency for the BRCS and PSS-10 were summarized. A linear regression model examined the associations of prior experience with online education, gender, and resilient coping with perceived stress. Results: Of the 113 respondents (78% female, mean age 22.3 years), > 50% had only occasional prior experience with online learning, coursework, and examinations, but 63% expressed confidence with online learning. Mean PSS-10 and BRCS scores were 23.8 and 13.3, respectively, and both scales demonstrated good internal consistency (α > 0.80). BRCS score was the single predictor of the PSS-10 score (r2 = 0.18, p < 0.001). Female gender was not a significant predictor (p = 0.11). A multiple regression model explained moderate variation in perceived stress (adjusted R2 = 0.19). Conclusion: PSS-10 and BRCS scores indicated moderate levels of stress and coping skills among students during online teaching. Most students had some prior exposure to online learning, coursework, and examinations. Higher resiliency scores, but not prior online learning experience, predicted lower perceived stress.

Leveraging research, community and collaboration towards robust COVID-19 mental health response in the Caribbean.

The CARICOM region has experienced significant challenges during the COVID-19 pandemic, one being issues surrounding mental health. This article seeks to highlight that mental health was a major issue prior to the pandemic and the situation could be potentially worst. Therefore we suggest supporting communities remains a pivotal tool in the armamentarium in dealing with diseases that have psychosocial aspects. Collaboration with regional bodies, transnational organizations and philanthropic entities and the process of health diplomacy will open the means through which valuable resources can become available. CARICOM as a Regional health body should be empowered to recognize population mental health challenges as a real and present danger to the well-being of the persons under its care and have an actionable plan that is realistic and sustainable.

Assessment of Risk Factors, Prehospital Measures and Clinical Needs of Patients Admitted With Snake Envenomation at a Rural Hospital in Trinidad and Tobago.

OBJECTIVE: This study assessed the risk factors for sustaining a snake bite, the prehospital measures employed, and the clinical needs of patients admitted with confirmed envenomation. METHODOLOGY: Data was collected at a single center, a rural secondary care hospital in Trinidad and Tobago. A cross-sectional method was used that enrolled all consenting patients requiring admission following clinical confirmation of snake envenomation during the period 2017-2019. Data collection involved a review of the patient record from the emergency room and hospital admission to establish the clinical need during the time of admission which was defined as the administration of medication, need for surgery, and critical care intervention. Data collection also involved a patient interview to establish demographics, prehospital measures employed, and assessment of the risk factors associated with sustaining the snake bite. RESULTS: 29 patients were admitted for snakebite envenomation during 2017-2019 and all patients consented to enrolment. Of these patients, 22 were male and most commonly were within the age range of 18-40 years old. 34.5% of patients were farmers and 68.9% of patients identified being bitten by the Mapepire Balsain snake. 65.5% of patients reported being unaware of the risk of snake bites and 82.8% were not wearing boots, with the lower limb being the most common bite site among 55.2%. 41.4% of bites were sustained during work-related activity while 34.5% of bites were sustained during recreational activity. Prehospital measures were employed by 18 of the 29 patients with the most common types being irrigation (10.3%), cutting (6.9%), tourniquets (44.8%), pressure immobilization (6.9%), topical applications (3.4%), and ingestion of a substance (6.9%). 34.5% received hospital care within 1 hour of the bite while 55.2% arrived at the hospital between 1 and 4 hours of being bitten. The clinical challenges of these patients included local reactions (82.8%), coagulopathy (72.4%), compartment syndrome (17.2%), cellulitis (3.4%), and dislocated shoulder (3.4%). The clinical needs of these patients included vitamin K (13.8%), antibiotics (93.1%), tetanus shots (17.2%), analgesia (6.8%), and anti-venom (82.7%). 10.3% of patients required debridement and 3.4% required a fasciotomy. The average stay in the hospital was 3.8 days. There were no documents of deaths or need for critical care. CONCLUSION: Persons are most likely to be envenomated by the M. Balsain in Trinidad. These patients are commonly males ranging anywhere from 18 to 40 years presenting local reactions and coagulopathy needing admittance to the hospital. While the majority of patients requiring admission performed some type of prehospital measure, very few did so with pressure immobilization. Furthermore, the majority of patients had a prolonged time before presenting to the hospital; this is a potential area for improvement in the health system through education and sensitization. There was a significant utilization of resources on these patients when taking into consideration their clinical needs, medication, and hospital stay; primary prevention should be a focus through the education of groups who are at higher risk for a venomous snake encounter.

Pharmacist Rethink through a Planetary Health Lens.

Planetary Health is a rapidly developing field that is gaining momentum and significance as the world grapples with the devastating effects of infectious diseases, climate change, biodiversity loss, complex food insecurities, and international competition for resources. These challenges are often attributable to the financial activity made by nation states and increasing disposable individual wealth. The outcomes have created a perfect storm of events that, if not managed properly, threatens the health of current and future generations. Given the front-line role pharmacists play within health system in the community and institutional levels, the profession is uniquely positioned to make a meaningful impact to planetary health. This article aims to explore contributions pharmacists can make to secure planetary health.

Identifying dispensing errors in pharmacies in a medical science school in Trinidad and Tobago.

BACKGROUND: A dispensing error can be defined as an inconsistency between the drug prescribed and drug dispensed to a patient. These errors can lead to ineffective and sometimes unwanted pharmaceutical outcomes. Dispensing errors can be harmful or even fatal to patients. CASE PRESENTATION: The objective to this study was (a) to determine the types and frequency of dispensing errors at the Eric Williams Medical Sciences Complex (EWMSC), (b) to explore the reasons for the occurrence of dispensing errors, and (c) to make suitable recommendations for their prevention. An observational study for a period of 2 weeks was carried out at various in- and outpatient departments of the EWMSC. The observations were carried out during 7:00 am to 3:00 pm. Dispensing errors identified during this period were recorded and analyzed. RESULTS: Sixty-eight errors were identified in the adult outpatient pharmacy of the EWMSC; 19 errors in the pediatric outpatient pharmacy, whereas 22 errors were found in inpatient pharmacy. The most common plausible causes for the dispensing errors include high workload, failure to verify patient information, incorrect data in the pharmacy's record system, inadequate notes made by pharmacists during prior patient visit, and in a few cases, uncomfortable working conditions. CONCLUSION: Dispensing errors were encountered in 2.1% of all the prescriptions filled at the EWMSC pharmacies. The factors which influenced these dispensing errors include but are not limited to a heavy workload, distractions, failure to verify patient information, and uncomfortable working conditions.

Natural Bioactive Thiazole-Based Peptides from Marine Resources: Structural and Pharmacological Aspects.

Peptides are distinctive biomacromolecules that demonstrate potential cytotoxicity and diversified bioactivities against a variety of microorganisms including bacteria, mycobacteria, and fungi via their unique mechanisms of action. Among broad-ranging pharmacologically active peptides, natural marine-originated thiazole-based oligopeptides possess peculiar structural features along with a wide spectrum of exceptional and potent bioproperties. Because of their complex nature and size divergence, thiazole-based peptides (TBPs) bestow a pivotal chemical platform in drug discovery processes to generate competent scaffolds for regulating allosteric binding sites and peptide-peptide interactions. The present study dissertates on the natural reservoirs and exclusive structural components of marine-originated TBPs, with a special focus on their most pertinent pharmacological profiles, which may impart vital resources for the development of novel peptide-based therapeutic agents.

Bachelor of pharmacy graduates' perceptions of the pharmacy administration curriculum in Trinidad and Tobago.

INTRODUCTION: As the profession of pharmacy has evolved, pharmacy education has developed to include competencies and skills related to pharmacy administration services. Competencies taught in pharmacy administration courses are expected to provide graduates with skills to effectively undertake administrative functions. Our study aimed to assess perceptions about knowledge and skills gained by the pharmacists during the Pharmacy Administration course at the School of Pharmacy, the University of the West Indies (UWI), Trinidad and Tobago. METHODS: A cross-sectional survey was carried out among pharmacists working in hospitals and community pharmacies in Trinidad using non-probability convenience sampling. A structured questionnaire was distributed to 262 pharmacists who completed the Pharmacy Administration course. Two-hundred eighteen (83%) usable responses were included for analysis. RESULTS: Many (45.4%) respondents agreed that the course provided them with the knowledge of running a business, 78% said they were able to apply the skills in their practice, and 80% mentioned that the course should be mandatory. Pharmacists found that the course on business management enhanced their knowledge in the fields of managing human resources, conflict management, marketing, project management, corporate turnaround, inventory, and financial management. CONCLUSIONS: The Pharmacy Administration course in the bachelor of science degree in pharmacy programme at the School of Pharmacy, UWI remains relevant in the areas of marketing, human resource management, and inventory management. The programme can be extended to a full time masters course to interested pharmacy graduates.

Toward the Synthesis and Improved Biopotential of an N-methylated Analog of a Proline-Rich Cyclic Tetrapeptide from Marine Bacteria.

An N-methylated analog of a marine bacteria-derived natural proline-rich tetracyclopeptide was synthesized by coupling the deprotected dipeptide fragments Boc-l-prolyl-l-N-methylleucine-OH and l-prolyl-l-N-methylphenylalanine-OMe. A coupling reaction was accomplished utilizing N,N'-Dicyclohexylcarbodidimde (DCC) and 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC·HCl) as coupling agents and Triethylamine (TEA) or N-methylmorpholine (NMM) as the base in the presence of the racemization suppressing agent. This was followed by the cyclization of the linear tetrapeptide fragment under alkaline conditions. The structure of the synthesized cyclooligopeptide was confirmed using quantitative elemental analysis, FTIR (Fourier-transform infrared spectroscopy), ¹H NMR (Nuclear magnetic resonance spectroscopy), 13C NMR, and mass spectrometry. From the bioactivity results, it was clear that the newly synthesized proline-rich tetracyclopeptide exhibited better anthelmintic potential against Megascoplex konkanensis, Pontoscotex corethruses, and Eudrilus eugeniae at a concentration of 2 mg/mL as well as improved antifungal activity against pathogenic dermatophytes Trichophyton mentagrophytes and Microsporum audouinii at a concentration of 6 µg/mL, as compared to non-methylated tetracyclopeptide. Moreover, N-methylated tetracyclopeptide displayed significant activity against pathogenic Candida albicans.

Total Synthesis and Pharmacological Investigation of Cordyheptapeptide A.

The present investigation reports the synthesis of a phenylalanine-rich N-methylated cyclopeptide, cordyheptapeptide A (8), previously isolated from the insect pathogenic fungus Cordyceps sp. BCC 1788, accomplished through the coupling of N-methylated tetrapeptide and tripeptide fragments followed by cyclization of the linear heptapeptide unit. Structure elucidation of the newly synthesized cyclopolypeptide was performed by means of FT-IR, ¹H-NMR, 13C-NMR, and fast atom bombardment mass spectrometry (FABMS), and screened for its antibacterial, antidermatophytic, and cytotoxic potential. According to the antimicrobial activity results, the newly synthesized N-Methylated cyclopeptide exhibited potent antibacterial activity against Gram-negative bacteria Pseudomonas aeruginosa and Klebsiella pneumoniae and antifungal activity against dermatophytes Trichophyton mentagrophytes and Microsporum audouinii at a concentration of 6 µg/mL, in comparison to the reference drugs, gatifloxacin and griseofulvin. In addition, cyclopolypeptide 8 displayed suitable levels of cytotoxicity against Dalton's lymphoma ascites (DLA) and Ehrlich's ascites carcinoma (EAC) cell lines.