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.

The epidemiology and control of Toxocara canis in puppies.

Toxocara canis is a helminth zoonosis that is estimated to infect more than 100 million dogs and 1 billion people, mostly in the tropics. Humans can be infected by accidentally ingesting embryonated T. canis eggs from the environment or occasionally after ingesting L3 larvae from paratenic hosts. This study investigated the importance of vertical transmission and the role of puppies in the epidemiology of T. canis through the examination of fecal samples from dogs less than one year of age in Grenada, West Indies, a small island tropical developing country. Samples were stored at 4 °C or in 10% formalin until microscopic examination for helminth eggs or using a rapid antigen test for the presence of protozoan species. A knowledge, attitudes and practices study was completed among dog owners, physicians and veterinary students. Of 306 dogs less than one year of age, 147 (48%) were found to have T. canis eggs. Vertical transmission was indicated by the proportion of infected dogs increasing from 50% at two weeks of age (from in utero transmission) to 70% by 12 weeks (in utero and lactogenic transmission). After 12 weeks the positivity rate dropped rapidly with no dogs over 40 weeks of age being infected. As T. canis eggs were found in puppy feces at two weeks of age, initial treatment of puppies should begin earlier, at twelve days post-partum, than currently recommended to prevent shedding of eggs. Perhaps even more importantly, treatment of pregnant dogs, preventing vertical transmission, would have a major impact on the control of T. canis infection. Knowledge of T. canis and other zoonotic helminths such as Ancylostoma caninum was found to be low among dog owners, physicians and veterinary students. None of the dog owners treated their dogs for helminths, all were unaware of the risk of zoonoses, and only 9% picked up dog feces. Efforts to prevent vertical transmission and to increase awareness and knowledge of these zoonoses could result in reducing their public health impact.

Reduced Susceptibility and Resistance to Vancomycin of Staphylococcus aureus: A Review of Global Incidence Patterns and Related Genetic Mechanisms.

Staphylococcus aureus is a Gram-positive bacterium causing a wide range of infections ranging from cutaneous infections to endocarditis and bacteremia. Beta-lactamases such as penicillin and, subsequently, methicillin have been used in the treatment of S. aureus infections. With the emergence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin, a bacterial cell wall synthesis inhibitor, has been used as the treatment of choice for MRSA infections. However, over the past few decades, there have been reports of reduced susceptibility and resistance of S. aureus to vancomycin globally, most recently from Michigan, United States, in July 2021. Based on the minimum inhibitory concentration (MIC) of the antibiotic against S. aureus, there are three strains of resistance, vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-resistant Staphylococcus aureus (VRSA), and heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA). The increasing prevalence of VISA and VRSA infections is a cause of global concern. This qualitative review of peer-reviewed research publications aims to describe the cases of VISA and VRSA reported in the literature globally and summarizes the genetic mechanisms implicated in their resistance. The most common mechanism implicated in VRSA infections is the vanA operon, while cell wall thickening is responsible for VISA infections. This review aims to perform a global comparison between the MIC corresponding to the strength of resistance to vancomycin and the presence of the vanA operon. In this review, VISA and VRSA are noted to be most susceptible to quinupristin-dalfopristin and linezolid, respectively. Maintaining active systemic surveillance for such infections, employing strict infection control measures, and continuing to mitigate indiscriminate and irrational use of antibiotics are some of the actions that can be undertaken to reduce the incidence and transmission of VISA, VRSA, and hVISA infections worldwide.

Defining the Need for Dermatologic Surgery Global Health in an Afro-Caribbean Country.

BACKGROUND: Dermatologic surgery services are largely absent in Africa and in Afro-Caribbean counties. In the USA, studies of people of African ancestry have demonstrated health care gaps, but there are no data for Africa nor a Afro-Caribbean country. Dermatology surgery has been largely absent from global health because there are few data to demonstrate the need. We sought to determine skin cancer tumor types, and local knowledge and perception in an Afro-Caribbean country. OBJECTIVE: We sought to determine whether there exist knowledge gaps and whether a dermatology surgery medical missions program would improve the health of Afro-Caribbean people. METHODS: First, we conducted a survey of knowledge and behaviors related to skin cancer. Second, we analyzed the number and types of tumors treated during a multi-year surgical dermatology project. RESULTS: In the survey, 62% did not know what melanoma was. Eighty-one percent did not think skin cancer is preventable. Of 163 surgical specimens, 64 were malignancies with 91% related to UV exposure. CONCLUSION: There is a need for a skin cancer treatment and education program in a country of mostly African-ancestry people.

Needlestick injury prevention training among health care workers in the Caribbean

[ABSTRACT]. The rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among health care workers that is caused by sharps injuries is higher in the Caribbean and Latin America than in other regions of the world. To respond to and reduce occupational exposures to bloodborne pathogens while also strengthening capacities in the Caribbean, needlestick injury prevention training programs for health care workers were implemented, beginning in 2011. The programs included lectures, workshops, policy reviews, evaluations of safety devices, and workplace assessment. During the training, baseline data from health care workers on their personal history of needlestick injuries and bloodborne pathogen exposure was collected. That baseline data showed that 40% of the participants had sustained sharps injuries during their professional career. In this capacity-building effort, 210 health care workers from five countries have been trained, six health care centers in the Caribbean have been evaluated. and occupational safety and health committees have been established in various countries to monitor and improve safety policies and practices.

[RESUMEN]. La tasa de infecciones por los virus de la inmunodeficiencia humana (VIH), de la hepatitis B (VHB) y de la hepatitis C (VHC) en los trabajadores de atención de salud debidas a heridas por materiales punzocortantes es mayor en América Latina y el Caribe que en otras regiones del mundo. Con objeto de responder a las exposiciones laborales a los agentes patógenos de transmisión sanguínea y reducirlas, además de reforzar las capacidades en el Caribe, se instituyeron programas de capacitación para la prevención de las heridas por pinchazos accidentales en los trabajadores de salud a partir del 2011. Los programas comprendían conferencias, talleres, revisión de las políticas, análisis de los dispositivos de seguridad y evaluación de los lugares de trabajo. Durante la capacitación, se recopilaron datos iniciales suministrados por los trabajadores de atención de salud sobre sus antecedentes personales de heridas por pinchazos accidentales y exposición a agentes patógenos de transmisión sanguínea. Esos datos iniciales indicaron que 40% de los participantes habían sufrido alguna herida por materiales punzocortantes a lo largo de su carrera profesional. En esta iniciativa de formación de capacidades, se han capacitado 210 trabajadores de atención de salud de cinco países, se han evaluado seis centros de atención de salud en el Caribe y se han establecido comités de seguridad y salud ocupacional en diversos países para vigilar y mejorar las normas y prácticas de seguridad.

[RESUMO]. As taxas de infecção pelo vírus da imunodeficiência humana (HIV), vírus da hepatite B (HBV) e vírus da hepatite C (HCV) em profissionais da saúde decorrentes de accidentes com materiais perfurocortantes são mais elevadas no Caribe e na América Latina que em outras regiões do mundo. Para combater e reduzir a exposição ocupacional a patógenos de transmissão sanguínea, igualmente reforçando as competências no Caribe, programas de capacitação em prevenção de acidentes com agulhas para profissionais da saúde foram implementados a partir de 2011. Os programas consistiram de palestras, seminários, análises de políticas, avaliações de dispositivos de segurança e avaliação dos locais de trabalho. Durante a capacitação, foram coletados dados de base dos profissionais da saúde relativos ao histórico pessoal de acidentes com agulhas e exposição a patógenos de transmissão sanguínea. Estes dados indicaram que 40% dos participantes haviam sofrido acidentes com materiais perfurocortantes durante a atividade profissional. Como parte desta iniciativa de capacitação, foi dado treinamento a 210 profissionais da saúde de cinco países, foram avaliados seis centros de saúde no Caribe e instituídos comitês de saúde e segurança ocupacional em diversos países para monitorar e melhorar as políticas e práticas de segurança.

Clinical, Serological, and Molecular Observations from a Case Series Study during the Asian Lineage Zika Virus Outbreak in Grenada during 2016.

This paper describes the spatial and temporal distribution of cases, demographic characteristics of patients, and clinical manifestations of Zika virus (ZIKV) during the 2016 outbreak in Grenada. The first reported case was recorded in St. Andrew Parish in April, and the last reported case was seen in November, with peak transmission occurring in the last week of June, based on test results. Data were collected from a total of 514 patients, of whom 207 (40%) tested positive for ZIKV. No evidence was found that testing positive for ZIKV infection was related to age, gender, or pregnancy status. Clinical presentation with rash (OR = 2.4, 95% CI = 1.5 to 3.7) or with lymphadenopathy (OR = 1.7, 95% CI = 1.0 to 2.9) were the only reported symptoms consistent with testing positive for ZIKV infection. During the Zika outbreak, the infection rate was 20 clinical cases per 10,000 in the population compared to 41 cases per 10,000 during the chikungunya outbreak in Grenada in 2014 and 17 cases per 10,000 during the dengue outbreak in 2001-2002. Even though the country has employed vector control programs, with no apparent decrease in infection rates, it appears that new abatement approaches are needed to minimize morbidity in future arbovirus outbreaks.

Needlestick injury prevention training among health care workers in the Caribbean.

The rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among health care workers that is caused by sharps injuries is higher in the Caribbean and Latin America than in other regions of the world. To respond to and reduce occupational exposures to bloodborne pathogens while also strengthening capacities in the Caribbean, needlestick injury prevention training programs for health care workers were implemented, beginning in 2011. The programs included lectures, workshops, policy reviews, evaluations of safety devices, and workplace assessment. During the training, baseline data from health care workers on their personal history of needlestick injuries and bloodborne pathogen exposure was collected. That baseline data showed that 40% of the participants had sustained sharps injuries during their professional career. In this capacity-building effort, 210 health care workers from five countries have been trained, six health care centers in the Caribbean have been evaluated. and occupational safety and health committees have been established in various countries to monitor and improve safety policies and practices.

La tasa de infecciones por los virus de la inmunodeficiencia humana (VIH), de la hepatitis B (VHB) y de la hepatitis C (VHC) en los trabajadores de atención de salud debidas a heridas por materiales punzocortantes es mayor en América Latina y el Caribe que en otras regiones del mundo. Con objeto de responder a las exposiciones laborales a los agentes patógenos de transmisión sanguínea y reducirlas, además de reforzar las capacidades en el Caribe, se instituyeron programas de capacitación para la prevención de las heridas por pinchazos accidentales en los trabajadores de salud a partir del 2011. Los programas comprendían conferencias, talleres, revisión de las políticas, análisis de los dispositivos de seguridad y evaluación de los lugares de trabajo. Durante la capacitación, se recopilaron datos iniciales suministrados por los trabajadores de atención de salud sobre sus antecedentes personales de heridas por pinchazos accidentales y exposición a agentes patógenos de transmisión sanguínea. Esos datos iniciales indicaron que 40% de los participantes habían sufrido alguna herida por materiales punzocortantes a lo largo de su carrera profesional. En esta iniciativa de formación de capacidades, se han capacitado 210 trabajadores de atención de salud de cinco países, se han evaluado seis centros de atención de salud en el Caribe y se han establecido comités de seguridad y salud ocupacional en diversos países para vigilar y mejorar las normas y prácticas de seguridad.

As taxas de infecção pelo vírus da imunodeficiência humana (HIV), vírus da hepatite B (HBV) e vírus da hepatite C (HCV) em profissionais da saúde decorrentes de acidentes com materiais perfurocortantes são mais elevadas no Caribe e na América Latina que em outras regiões do mundo. Para combater e reduzir a exposição ocupacional a patógenos de transmissão sanguínea, igualmente reforçando as competências no Caribe, programas de capacitação em prevenção de acidentes com agulhas para profissionais da saúde foram implementados a partir de 2011. Os programas consistiram de palestras, seminários, análises de políticas, avaliações de dispositivos de segurança e avaliação dos locais de trabalho. Durante a capacitação, foram coletados dados de base dos profissionais da saúde relativos ao histórico pessoal de acidentes com agulhas e exposição a patógenos de transmissão sanguínea. Estes dados indicaram que 40% dos participantes haviam sofrido acidentes com materiais perfurocortantes durante a atividade profissional. Como parte desta iniciativa de capacitação, foi dado treinamento a 210 profissionais da saúde de cinco países, foram avaliados seis centros de saúde no Caribe e instituídos comitês de saúde e segurança ocupacional em diversos países para monitorar e melhorar as políticas e práticas de segurança.

Needlestick injury prevention training among health care workers in the Caribbean / Capacitación para la prevención de las heridas por pinchazos accidentales con agujas en trabajadores de salud en el Caribe / Capacitação em prevenção de acidentes com agulhas de profissionais da saúde no Caribe

ABSTRACT The rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among health care workers that is caused by sharps injuries is higher in the Caribbean and Latin America than in other regions of the world. To respond to and reduce occupational exposures to bloodborne pathogens while also strengthening capacities in the Caribbean, needlestick injury prevention training programs for health care workers were implemented, beginning in 2011. The programs included lectures, workshops, policy reviews, evaluations of safety devices, and workplace assessment. During the training, baseline data from health care workers on their personal history of needlestick injuries and bloodborne pathogen exposure was collected. That baseline data showed that 40% of the participants had sustained sharps injuries during their professional career. In this capacity-building effort, 210 health care workers from five countries have been trained, six health care centers in the Caribbean have been evaluated. and occupational safety and health committees have been established in various countries to monitor and improve safety policies and practices.

RESUMEN La tasa de infecciones por los virus de la inmunodeficiencia humana (VIH), de la hepatitis B (VHB) y de la hepatitis C (VHC) en los trabajadores de atención de salud debidas a heridas por materiales punzocortantes es mayor en América Latina y el Caribe que en otras regiones del mundo. Con objeto de responder a las exposiciones laborales a los agentes patógenos de transmisión sanguínea y reducirlas, además de reforzar las capacidades en el Caribe, se instituyeron programas de capacitación para la prevención de las heridas por pinchazos accidentales en los trabajadores de salud a partir del 2011. Los programas comprendían conferencias, talleres, revisión de las políticas, análisis de los dispositivos de seguridad y evaluación de los lugares de trabajo. Durante la capacitación, se recopilaron datos iniciales suministrados por los trabajadores de atención de salud sobre sus antecedentes personales de heridas por pinchazos accidentales y exposición a agentes patógenos de transmisión sanguínea. Esos datos iniciales indicaron que 40% de los participantes habían sufrido alguna herida por materiales punzocortantes a lo largo de su carrera profesional. En esta iniciativa de formación de capacidades, se han capacitado 210 trabajadores de atención de salud de cinco países, se han evaluado seis centros de atención de salud en el Caribe y se han establecido comités de seguridad y salud ocupacional en diversos países para vigilar y mejorar las normas y prácticas de seguridad.

RESUMO As taxas de infecção pelo vírus da imunodeficiência humana (HIV), vírus da hepatite B (HBV) e vírus da hepatite C (HCV) em profissionais da saúde decorrentes de acidentes com materiais perfurocortantes são mais elevadas no Caribe e na América Latina que em outras regiões do mundo. Para combater e reduzir a exposição ocupacional a patógenos de transmissão sanguínea, igualmente reforçando as competências no Caribe, programas de capacitação em prevenção de acidentes com agulhas para profissionais da saúde foram implementados a partir de 2011. Os programas consistiram de palestras, seminários, análises de políticas, avaliações de dispositivos de segurança e avaliação dos locais de trabalho. Durante a capacitação, foram coletados dados de base dos profissionais da saúde relativos ao histórico pessoal de acidentes com agulhas e exposição a patógenos de transmissão sanguínea. Estes dados indicaram que 40% dos participantes haviam sofrido acidentes com materiais perfurocortantes durante a atividade profissional. Como parte desta iniciativa de capacitação, foi dado treinamento a 210 profissionais da saúde de cinco países, foram avaliados seis centros de saúde no Caribe e instituídos comitês de saúde e segurança ocupacional em diversos países para monitorar e melhorar as políticas e práticas de segurança.

Public health response and lessons learned from the 2014 chikungunya epidemic in Grenada.

In June 2014, the first cases of chikungunya virus (CHIKV) were diagnosed on the island of Carriacou, part of the tri-island state of Grenada. In the three months that followed, CHIKV spread rapidly, with conservative estimates of the population infected of at least 60%. Multiple challenges were encountered in the battle to manage the spread and impact of this high-attack rate virus, including 1) limited indigenous laboratory diagnostic capabilities; 2) an under-resourced health care system; 3) a skeptical general public, hesitant to accept facts about the origin and mode of transmission of the new virus; and 4) resistance to the vector control strategies used. Lessons learned from the outbreak included the need for 1) a robust and reliable epidemiological surveillance system; 2) effective strategies for communicating with the general population; 3) exploration of other methods of mosquito vector control; and 4) a careful review of all health care policies and protocols to ensure that effective, organized responses are triggered when an infectious outbreak occurs.

Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean.

Background Potential Drug-Drug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-income countries. Objective To compare the incidence of drug-drug interactions and polypharmacy in older and younger patients attending the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micromedex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of ≥5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275 (42.3%) were ≥65 years and 381 (58.7%) were female. There were 814 DDIs, of which 6 (.7%) were contraindications and 148 (18.2%) were severe. Polypharmacy was identified in 244 (37.6%) patients. Older patients were more likely to have potential DDI (67.5 vs 48.9%) and polypharmacy (56 vs 24.1%). Herbal products, OTC and combination drugs were present in 8, 36.7 and 22.2% of patients, respectively. On multivariate analysis, polypharmacy and the presence of hypertension and ischaemic heart disease were associated with an increased risk of potential DDI. Conclusion Polypharmacy and potential drug-drug interactions are common in ED patients in the Caribbean. Older patients are particularly at risk, especially as they are more likely to be on multiple medications. The association between herbal medication and polypharmacy needs further investigation. This study indicates the need for a more robust system of drug reconciliation in the Caribbean.

Assessment of current occupational safety and health regulations and legislation in the Caribbean.

Neglecting occupational safety and health (OSH) can have adverse and even deadly consequences. While OSH is important in any nation, the issue is particularly concerning in developing countries, including ones in the Caribbean. The purpose of this study, which was carried out in 2012 and 2013, was to examine the reasons for an apparent fundamental lack of awareness of OSH in the Caribbean. We conducted a descriptive study, in which a questionnaire was administered, via telephone, to key policy-making representatives from six English-speaking Caribbean nations, in order to assess the current OSH environment in their countries. We also did a situational analysis of current OSH regulations and legislation within the six countries. We found that that some of the countries' OSH laws are out of date or are limited to a certain type of industry. We also found that there is very little documentation on research on exposure to and risks from hazards and on psychological and reproductive health as related to OSH. It is recommended that these Caribbean countries both increase national OSH awareness and strengthen enforcement of OSH regulations. Additionally, further assistance and a more coordinated effort from intergovernmental bodies could help build and fortify OSH systems in the Caribbean.

Public health response and lessons learned from the 2014 chikungunya epidemic in Grenada / Respuesta de salud pública y enseñanzas extraídas de la epidemia de chikungunya del 2014 en Granada

In June 2014, the first cases of chikungunya virus (CHIKV) were diagnosed on the island of Carriacou, part of the tri-island state of Grenada. In the three months that followed, CHIKV spread rapidly, with conservative estimates of the population infected of at least 60%. Multiple challenges were encountered in the battle to manage the spread and impact of this high–attack rate virus, including 1) limited indigenous laboratory diagnostic capabilities; 2) an under-resourced health care system; 3) a skeptical general public, hesitant to accept facts about the origin and mode of transmission of the new virus; and 4) resistance to the vector control strategies used. Lessons learned from the outbreak included the need for 1) a robust and reliable epidemiological surveillance system; 2) effective strategies for communicating with the general population; 3) exploration of other methods of mosquito vector control; and 4) a careful review of all health care policies and protocols to ensure that effective, organized responses are triggered when an infectious outbreak occurs.

En junio del 2014, se diagnosticaron los primeros casos de infección por el virus del chikungunya (CHIKV) en la isla de Carriacou, perteneciente al Estado triinsular de Granada. En los tres meses siguientes, el CHIKV se diseminó con rapidez, llegando a afectar, según cálculos moderados, al menos al 60% de la población. Se encontraron varias dificultades en la batalla por controlar la propagación y las consecuencias de este virus que tiene una alta tasa de ataque, a saber: 1) limitaciones de la capacidad de diagnóstico de los laboratorios locales; 2) escasez de recursos del sistema de atención de salud; 3) escepticismo general del público, reacio a aceptar los datos sobre el origen y la vía de transmisión del nuevo virus; y 4) resistencia a las estrategias empleadas para controlar los vectores. Entre las enseñanzas extraídas del brote cabe señalar la necesidad de lo siguiente: 1) un sistema sólido y confiable de vigilancia epidemiológica; 2) estrategias eficaces para comunicarse con la población general; 3) exploración de otros métodos de control de mosquitos vectores; y 4) un examen meticuloso de todas las políticas y protocolos de atención de salud para garantizar que se activen respuestas eficaces y organizadas cuando se produce un brote infeccioso.

Occupational exposure and respiratory health problems among nutmeg production workers in Grenada, the Caribbean.

BACKGROUND: The nutmeg industry is a major contributor to the Grenadian economy. However, workers in the industry face many environmental and occupational health risks. OBJECTIVES: The goal of this study was to investigate respiratory health problems and possible related occupational exposures among nutmeg production workers. METHODS: A questionnaire, spirometry and allergen skin-prick test was given to 92 nutmeg workers. Samples for measurement of airborne dust, mold, and phosphine were also collected from work environments. RESULTS: Approximately half of the workers with lower respiratory symptoms such as dry cough (49.4%) and shortness of breath (42.9%) reported that their symptoms were work related. Spirometry results showed that 18.8% of workers had obstruction. Area geometric mean (GM) inhalable dust concentrations, GM personal concentrations, and total mold spores during work activities were found to be high. CONCLUSIONS: High prevalence of respiratory symptoms among workers in this facility was consistent with measured levels of dust and mold, and was widespread over all work areas.

Assessment of current occupational safety and health regulations and legislation in the Caribbean / Evaluación de los reglamentos y la legislación actuales sobre seguridad y salud de los trabajadores en el Caribe

Neglecting occupational safety and health (OSH) can have adverse and even deadly consequences. While OSH is important in any nation, the issue is particularly concerning in developing countries, including ones in the Caribbean. The purpose of this study, which was carried out in 2012 and 2013, was to examine the reasons for an apparent fundamental lack of awareness of OSH in the Caribbean. We conducted a descriptive study, in which a questionnaire was administered, via telephone, to key policy-making representatives from six English-speaking Caribbean nations, in order to assess the current OSH environment in their countries. We also did a situational analysis of current OSH regulations and legislation within the six countries. We found that that some of the countries’ OSH laws are out of date or are limited to a certain type of industry. We also found that there is very little documentation on research on exposure to and risks from hazards and on psychological and reproductive health as related to OSH. It is recommended that these Caribbean countries both increase national OSH awareness and strengthen enforcement of OSH regulations. Additionally, further assistance and a more coordinated effort from intergovernmental bodies could help build and fortify OSH systems in the Caribbean.

Descuidar la seguridad y la salud de los trabajadores puede tener consecuencias adversas e, incluso, letales. Si bien la seguridad y la salud de los trabajadores son importantes en todos los países, revisten particular importancia en los países en desarrollo, especialmente en aquellos ubicados en el Caribe. El propósito de este estudio, que se llevó a cabo en los años 2012 y 2013, fue examinar las razones de la evidente falta fundamental de conciencia sobre esta cuestión en el Caribe. Realizamos un estudio descriptivo, en el cual administramos un cuestionario telefónico a representantes clave de la formulación de políticas de seis países de habla inglesa del Caribe con el fin de evaluar la situación actual de la seguridad y la salud de los trabajadores en su país. También hicimos un análisis de la situación de los reglamentos y la legislación vigentes en los seis países. Observamos que las leyes de algunos países son obsoletas o están limitadas a un determinado tipo de industria. También observamos que es muy escasa la documentación sobre las investigaciones realizadas tanto acerca de la exposición a los riesgos como de la salud psicológica y reproductiva vinculadas a la seguridad y la salud de los trabajadores. Se recomienda que estos países del Caribe aumenten la concientización nacional sobre esta cuestión y fortalezcan el cumplimiento de los reglamentos pertinentes. Por otra parte, una mayor asistencia y un esfuerzo más coordinado de los cuerpos intergubernamentales podrían ayudar a establecer y fortificar los sistemas de seguridad y salud de los trabajadores en los países del Caribe.

Assessment of current occupational safety and health regulations and legislation in the Caribbean / Evaluación de los reglamentos y la legislación actuales sobre seguridad y salud de los trabajadores en el Caribe

ABSTRACT Neglecting occupational safety and health (OSH) can have adverse and even deadly consequences. While OSH is important in any nation, the issue is particularly concerning in developing countries, including ones in the Caribbean. The purpose of this study, which was carried out in 2012 and 2013, was to examine the reasons for an apparent fundamental lack of awareness of OSH in the Caribbean. We conducted a descriptive study, in which a questionnaire was administered, via telephone, to key policy-making representatives from six English-speaking Caribbean nations, in order to assess the current OSH environment in their countries. We also did a situational analysis of current OSH regulations and legislation within the six countries. We found that that some of the countries' OSH laws are out of date or are limited to a certain type of industry. We also found that there is very little documentation on research on exposure to and risks from hazards and on psychological and reproductive health as related to OSH. It is recommended that these Caribbean countries both increase national OSH awareness and strengthen enforcement of OSH regulations. Additionally, further assistance and a more coordinated effort from intergovernmental bodies could help build and fortify OSH systems in the Caribbean.(AU)

RESUMEN Descuidar la seguridad y la salud de los trabajadores puede tener consecuencias adversas e, incluso, letales. Si bien la seguridad y la salud de los trabajadores son importantes en todos los países, revisten particular importancia en los países en desarrollo, especialmente en aquellos ubicados en el Caribe. El propósito de este estudio, que se llevó a cabo en los años 2012 y 2013, fue examinar las razones de la evidente falta fundamental de conciencia sobre esta cuestión en el Caribe. Realizamos un estudio descriptivo, en el cual administramos un cuestionario telefónico a representantes clave de la formulación de políticas de seis países de habla inglesa del Caribe con el fin de evaluar la situación actual de la seguridad y la salud de los trabajadores en su país. También hicimos un análisis de la situación de los reglamentos y la legislación vigentes en los seis países. Observamos que las leyes de algunos países son obsoletas o están limitadas a un determinado tipo de industria. También observamos que es muy escasa la documentación sobre las investigaciones realizadas tanto acerca de la exposición a los riesgos como de la salud psicológica y reproductiva vinculadas a la seguridad y la salud de los trabajadores. Se recomienda que estos países del Caribe aumenten la concientización nacional sobre esta cuestión y fortalezcan el cumplimiento de los reglamentos pertinentes. Por otra parte, una mayor asistencia y un esfuerzo más coordinado de los cuerpos intergubernamentales podrían ayudar a establecer y fortificar los sistemas de seguridad y salud de los trabajadores en los países del Caribe.(AU)

Clinical and Serological Insights from the Asian Lineage Chikungunya Outbreak in Grenada, 2014: An Observational Study.

Chikungunya virus (CHIKV) spread rapidly throughout the Caribbean region in 2014, and the first serologically confirmed case was seen in Grenada in July. This study investigated the outbreak of CHIKV in Grenada to identify the distinguishing clinical manifestations and the symptoms that corresponded the closest with serological test results. Sera were tested by IgM enzyme-linked immunosorbent assay and polymerase chain reaction to distinguish between cases positive or negative for CHIKV. Of 493 cases, 426 (86%) tested positive for CHIKV. The diagnostic decision rule, "Define as CHIKV positive a patient presenting with joint pain and any combination of fever, body pain, or rash," produced the closest agreement (85%) with the serological test results (Cohen's kappa, k = 0.289, P value < 0.001). When laboratory facilities are not available for diagnostic confirmation, syndromic surveillance using these four symptoms could be useful to define cases during a CHIKV outbreak when CHIKV is the predominant circulating arbovirus.

Pesticide Exposure in the Caribbean: A Case From Nutmeg Processing.

Many developed countries around the world have implemented regulations to phase out or greatly restrict the use of pesticides. Pesticides are still utilized with minimal restrictions, however, in fumigating agricultural commodities in developing countries such as Grenada. This special report presents the case of a nutmeg factory worker in Grenada who worked with various pesticides including methyl bromide, magnesium phosphide (magtoxin), and aluminum phosphide (phostoxin) without the proper awareness and utilization of health and safety measures. The nutmeg factory worker later developed metastatic bladder cancer, which may have been triggered by a combination of individual risk factors along with long-term occupational exposure to these pesticides. In this special report, the occupational health importance of prevention in a work environment with significant exposure to pesticides is highlighted as well as some of the fundamental deficiencies in awareness among workers in developing nations concerning the deleterious effects of frequent exposure to pesticides.

Zoonoses and one health: a review of the literature.

Background. One health is a concept that was officially adopted by international organizations and scholarly bodies in 1984. It is the notion of combining human, animal, and environmental components to address global health challenges that have an ecological interconnectedness. Methods. A cross-sectional study of the available literature cited was conducted from January 1984 when the one health concept was adopted till December 2012 to examine the role of the one health approach towards zoonoses. Inclusion criteria included publications, professional presentations, funding allocations, official documentation books, and book chapters, and exclusion criteria included those citations written outside the period of review. Results. A total of 737 resources met the inclusion criteria and were considered in this review. Resources showed a continuous upward trend for the years from 2006 to 2012. The predominant resources were journal publications with environmental health as the significant scope focus for one health. There was also an emphasis on the distribution of the work from developed countries. All categories of years, resources, scopes, and country locale differed from the means (P = 0.000). Year of initiative, scope, and country locale showed a dependent relationship (P = 0.022, P = 0.003, and P = 0.021, resp.). Conclusion. Our findings demonstrate the rapid growth in embracing the concept of one health, particularly in developed countries over the past six years. The advantages and benefits of this approach in tackling zoonoses are manifold, yet they are still not seemingly being embraced in developing countries where zoonoses have the greatest impact.