Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study.

BACKGROUND: Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS: Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS: Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION: We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.

Consumption of sugar-sweetened beverages and T2D diabetes in the Eastern Caribbean.

OBJECTIVE: Sugar-sweetened beverages (SSB) are implicated in the increasing risk of diabetes in the Caribbean. Few studies have examined associations between SSB consumption and diabetes in the Caribbean. DESIGN: SSB was measured as teaspoon/d using questions from the National Cancer Institute Dietary Screener Questionnaire about intake of soda, juice and coffee/tea during the past month. Diabetes was measured using self-report, HbA1C and use of medication. Logistic regression was used to examine associations. SETTING: Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), collected in Barbados, Puerto Rico, Trinidad and Tobago and US Virgin Islands, were used for analysis. PARTICIPANTS: Participants (n 1701) enrolled in the ECS. RESULTS: Thirty-six percentage of participants were unaware of their diabetes, 33% aware and 31% normoglycaemic. Total mean intake of added sugar from SSB was higher among persons 40-49 (9·4 tsp/d), men (9·2 tsp/d) and persons with low education (7·0 tsp/d). Participants who were unaware (7·4 tsp/d) or did not have diabetes (7·6 tsp/d) had higher mean SSB intake compared to those with known diabetes (5·6 tsp/d). In multivariate analysis, total added sugar from beverages was not significantly associated with diabetes status. Results by beverage type showed consumption of added sugar from soda was associated with greater odds of known (OR = 1·37, 95 % CI (1·03, 1·82)) and unknown diabetes (OR = 1·54, 95 % CI (1·12, 2·13)). CONCLUSIONS: Findings indicate the need for continued implementation and evaluation of policies and interventions to reduce SSB consumption in the Caribbean.

High resolution mass spectrometric suspect screening, wide-scope target analysis of emerging contaminants and determination of legacy pollutants in adult black-tailed godwit Limosa limosa limosa in the Netherlands - A pilot study.

The Dutch breeding population of the black-tailed godwit Limosa limosa limosa has declined substantially over recent decades; the role of contaminants is unknown. We analysed liver samples from 11 adult birds found dead on their breeding grounds in SW Friesland 2016-2020, six from extensive, herb-rich grasslands, five from intensive grasslands. We carried out LC and GC wide-scope target analysis of more than 2400 substances, LC suspect screening for more than 60,000 substances, target analysis for Cd, Hg, Ni and Pb, organo-phosphate flame retardants (OPFRs), dechlorane plus compounds and selected polybrominated diphenyl ether flame retardants (PBDEs), and bioassay for polybrominated dibenzo-p-dioxins and dibenzofurans (PBDDs/PDBFs) and dioxin-like polychlorinated biphenyls (dl-PCBs). Residues of 29 emerging contaminants (ECs) were determined through wide-scope target analysis. Another 20 were tentatively identified through suspect screening. These contaminants include industrial chemicals (personal care products, surfactants, PAHs and others), plant protection products (PPPs) and pharmaceuticals and their transformation products. Total contaminant load detected by wide-scope target analysis ranged from c. 155 to c. 1400 ng g-1 and was generally lower in birds from extensive grasslands. Heatmaps suggest that birds from intensive grasslands have a greater mix and higher residue concentrations of PPPs, while birds from extensive grasslands have a greater mix and higher residue concentrations of per- and polyfluoroalkyl substances (PFAS). All four metals and two OPFRs were detected. All tested PBDEs were below the respective LODs. Bioassay revealed presence of PBDDs, PBDFs and dl-PCBs. Further research is required to elucidate potential health risks to godwits and contaminant sources.

Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes research Network (ECHORN) Cohort study.

INTRODUCTION: Studies conducted in the US and other high-income countries show that the local food environment influences dietary intakes that are protective for cardiovascular health.However, few studies have examined this relationship in the Caribbean. This study aimed to determine whether perceptions of the local food environment were associated with fruit and vegetable (FV) intake in the Eastern Caribbean, where daily FV intake remains below recommended levels. METHODS: Cross-sectional analysis of Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) baseline data (2013-2016) from Barbados, Puerto Rico, Trinidad and Tobago, and US Virgin Islands was conducted in 2020. The National Cancer Institute Dietary Screener Questionnaire was adapted to measure daily servings of FV. Existing scales were used to assess participant perceptions of the food environment (availability, affordability, and quality). Chi-square tests and Poisson regression were used for analyses. RESULTS: Participants reported eating one mean daily serving of FV. Mean daily intake was higher among those who perceived FV as usually/always affordable, available, and high quality. Multivariate results showed statistically significant associations between FV and affordability. Persons who perceived FV as affordable had 0.10 more daily servings of FV compared to those who reported FV as not always affordable (p = 0.02). Food insecurity modified the association between affordability and FV intake. CONCLUSIONS: This study highlights the importance of affordability in consumption of FV in the Eastern Caribbean, and how this relationship may be modified by food insecurity.

Glycemic control and management of cardiovascular risk factors among adults with diabetes in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study.

AIMS: To determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean. METHODS: Baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control. RESULTS: Twenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control. CONCLUSION: There is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.

Diabetes prevention in the Caribbean using Lifestyle Intervention and Metformin Escalation (LIME): Protocol for a hybrid Type-1 effectiveness-implementation trial using a quasi-experimental study design.

BACKGROUND: Globally, several diabetes prevention interventions have been shown to be cost-effective, yet they have had limited adaptation, implementation, and evaluation in the Caribbean and among Caribbean-descent individuals, where the burden of type 2 diabetes is high. We report on the protocol for the Lifestyle Intervention with Metformin Escalation (LIME) study - an evidence-based diabetes prevention intervention to reduce the incidence of diabetes among Caribbean-descent individuals with prediabetes. METHODS: LIME is a hybrid type-I effectiveness-implementation quasi-experimental study taking place in 4 clinical sites in Barbados, Trinidad, the U.S. Virgin Islands, and Puerto Rico. LIME targets individuals who self-identify as Caribbean or Caribbean-descent and have high-risk prediabetes with a hemoglobin A1c (HbA1c) between 6 and 6.4%. Eligible participants in the intervention arm are enrolled in a six-week lifestyle modification workshop. Six months later, individuals who have not lost at least 5% of their bodyweight or continue to have an HbA1c of 6% or higher are prescribed metformin medication. In total, participants are followed for one year. The primary effectiveness outcome is proportion of individuals who lower their HbA1c below 6%. DISCUSSION: LIME is a unique diabetes prevention intervention for Caribbean and Caribbean-descent individuals. LIME utilizes a tailored lifestyle change curriculum, incorporates appropriate metformin prescribing when lifestyle change alone is insufficient, targets the highest-risk individuals with prediabetes, and is based in a clinical setting to ensure sustainability.

Disparity in biomedical publication trends in the CARICOM countries: Is there a need for a more vibrant research culture in the region?

BACKGROUND: Biomedical research and publications provide evidence-based information about the extent and burden of health-related problems of a country and help to formulate strategic and operational plans to tackle the problems. PURPOSE: To determine the biomedical publication rates of CARICOM full member countries. METHODS: Biomedical publications of full member CARICOM countries were retrieved using PubMed (1990-2015) and SCImago Journal & Country Rank (1996-2015) databases. CARICOM countries having >50 publications in the PubMed (1990-2015) database were subject to further analysis, whereby publications of each country were adjusted by total population (million population), gross domestic product (billion-dollar), and Internet usage rate (hundred thousand population). RESULTS: Total publications by all countries were 7281 and 8378 in PubMed and SCImago Journal & Country Rank, respectively. Jamaica produced highest number of publications (PubMed: 3928 (53.9%); SCImago Journal & Country Rank: 2850 (34.0%)). In both databases, Grenada had the highest research publications when adjusted with per million population (4721 and 10,633), per billion gross domestic product (803 and 1651), and per hundred thousand Internet users (1487 and 3387). Trend analysis revealed Jamaica produced the highest number of additional PubMed listed publications each year, averaging 4.8/year, followed by Trinidad and Tobago (4.4). According to SCImago Journal & Country Rank, Jamaica also had the highest number of citations (42,311) and h-index (76), followed by Trinidad and Tobago (29,152 and 71). Barbados had the highest number of citations per document (24.9), followed by Haiti (18.4). The publication rates determined by PubMed and SCImago Journal & Country Rank databases were significantly correlated (p < 0.001). Most publications (68% SCImago Journal & Country Rank and 85% PubMed) can be attributed to authors affiliated with Barbados, Jamaica, and Trinidad. CONCLUSION: Publication and citation rates varied markedly between CARICOM countries and were in general low. Most publications could be attributed to researchers affiliated with The University of the West Indies. More universities valuing biomedical research are needed in the region, and more resources needed to improve publication rates.

Management Of Chronic Noncommunicable Diseases After Natural Disasters In The Caribbean: A Scoping Review.

Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30 percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.

Role of an oscillatory electric field on the Lehmann rotation of cholesteric droplets.

This paper deals with the Lehmann rotation of banded cholesteric droplets subjected to a temperature gradient when they coexist with their own isotropic liquid. I show that their angular rotation velocity increases --in absolute value-- when they are subjected to an additional AC electric field in the conducting regime. This velocity increase is correlated with a prolate distortion of the droplets and the probable presence of electrohydrodynamical toroidal circulation flows inside and outside the droplets. I propose that the coupling between these flows and the director field is responsible for the increase of the angular velocity of the texture. The origin of these flows is discussed qualitatively in the framework of the leaky dielectric model by taking into account the generation of charges both in the bulk via a Carr-Helfrich mechanism (Tarasov, Krekhow and Kramer model) and at the surface of the droplet (Taylor-Melcher model).

Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Caribbean region. OBJECTIVE: This study explored the concept of a health network, relationships focused on health-related matters, and examined associations with CVD risk factors in the Eastern Caribbean. DESIGN: The Eastern Caribbean Health Outcomes Research Network Cohort Study is an ongoing longitudinal cohort being conducted in the US Virgin Islands, Puerto Rico, Trinidad and Tobago, and Barbados. PARTICIPANTS: Participants (n = 1989) were English or Spanish-speaking adults 40 years and older, who were residents of the island for at least 10 years, and who intended to live on-island for the next 5 years. MAIN MEASURES: Logistic regression was used to examine associations between health network characteristics and CVD risk factors: physical activity, hypertension, and smoking. A baseline survey asked questions about health networks using name generator questions that assessed who participants spoke to about health matters, whose opinions on healthcare mattered, and who they would trust to make healthcare decisions on their behalf. KEY RESULTS: Health networks were mainly comprised of family members and friends. Healthcare professionals comprised 7% of networks, mean network size was four, and 74% of health network contacts were perceived to be in "good" to "excellent" health. Persons with larger health networks had greater odds of being physically active compared with those with smaller networks (OR = 1.07, CI = 1.01-1.14). CONCLUSIONS: Health networks may be useful to intervention efforts for CVD risk factor reduction. More studies are needed to examine health networks in Caribbean contexts and explore associations with other CVD risk factors.

Lehmann rotation of cholesteric droplets driven by Marangoni convection.

We show experimentally and theoretically that the Lehmann effect recently observed by Yoshioka and Araoka (Nat. Commun., 2018, 9, 432) in emulsified cholesteric liquid crystal droplets under temperature gradients is due to Marangoni flows rather than to the thermomechanical or chemomechanical couplings often invoked to explain the phenomenon. Using colloidal tracers we visualize convection rolls surrounding stationary cholesteric droplets in vertical temperature gradients, while a shift in the position of internal point defects reveals the corresponding inner convection in nematic droplets thermomigrating in a horizontal temperature gradient. We attribute these phenomena to the temperature dependence of the surface tension at the interface between these partially-miscible liquids, and justify their absence in the usual case of purely lyophobic emulsions. We perform a theoretical analysis to help validate this hypothesis, demonstrating the strong dependence of the precession velocity on the configuration of the cholesteric director field.

Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Dislocations dynamics during the nonlinear creep of a homeotropic sample of smectic-A liquid crystal.

New creep experiments under sinusoidal compression/dilation deformation of a homeotropic sample of smectic-A liquid crystal (8CB) show that its response is nonlinear at very small amplitude of deformation. This behavior is explained by taking into account the crossing between the edge dislocations that climb parallel to the layers and the screw dislocations joining the two surfaces limiting the sample. The activation energy of the crossing process and the density of the screw dislocations as a function of the sample thickness are estimated experimentally.

Drag of a Cottrell atmosphere by an edge dislocation in a smectic-A liquid crystal.

In a recent letter (P. Oswald et al., EPL 103, 46004 (2013)), we have shown that a smectic-A phase hardens in compression normal to the layers when the liquid crystal is doped with gold nanoparticles. This is due to the formation of Cottrell clouds nearby the core of the edge dislocations and the appearance of an additional drag force that reduces their mobility. We theoretically calculate the shape of the Cottrell cloud and the associated drag force as a function of the climb velocity of the dislocations. The main result is that the drag force depends on velocity and vanishes when the temperature tends to the smectic-A-to-nematic transition temperature. The role of the diffusion anisotropy is also evaluated.

[Clinical characteristics among forensic inpatients: A special case, the establishment of social defense "Les Marronniers" in Tournai (Belgium)]. / Caractéristiques cliniques d'une population internée : un cas particulier, l'établissement de défense sociale « Les Marronniers ¼ à Tournai (Belgique).

BACKGROUND: In Belgium, the law of "social defense" stipulates that an accused "which is either in a state of dementia or in a serious state of mental disturbance or mental deficiency, incapable of controlling his actions" can be interned. The establishment of social defense (ESD) in Tournai (Belgium) hosts 350 inmates. OBJECTIVES: In collaboration with the Centre for research in social defense, we organized a systematic assessment of patients interned in ESD. This is the first study evaluating prospectively this population. METHODS: Of the total, 229 patients signed informed consent. Different scales of assessment (MINI, WAIS-III, SCID II) were used. Descriptive analyzes were applied (SPSS version 12). RESULTS: We show that 48.8 % of our participants had committed a sexual offense (rape or attempted rape, indecent assault, public outrage or mixed). The average intelligence quotient is 71.4. According to the MINI, 33.2 % of participants showed no psychiatric disorder. Among psychiatric disorders, psychotic disorders are the most represented (37.4 %). According to the SCID, personality disorders were absent in 26.8 % of our participants. Most of the axis II disorders are represented personality disorders related to cluster B (57.3 %) mainly with antisocial personality disorder (37.9 %). CONCLUSION: These data demonstrate the significant heterogeneity of our sample and the need for the establishment of specific care routes to each subpopulation.

Microscopic vs. macroscopic origin of the Lehmann effect in cholesteric liquid crystals.

In a recent letter (EPL 97, 36006 (2012)), we have shown that the Leslie thermomechanical coupling cannot alone explain the Lehmann effect (namely the rotation of cholesteric droplets when they are subjected to a temperature gradient). This result was obtained by measuring in a compensated cholesteric mixture the "Lehmann coefficient" as a function of temperature both below and at the transition to the isotropic liquid. In this article, we detail these experiments and present new ones performed with other compensated mixtures and a diluted cholesteric mixture. The new results confirm the macroscopic origin of the Lehmann effect, in contrast to the Leslie thermomechanical effect that is clearly of microscopic origin.

Elasto- and electro-capillary instabilities of a nematic-isotropic interface: Experimental results.

Recently, we have shown the existence of an electro-capillary instability of a nematic-isotropic interface stabilized by a temperature gradient (P. Oswald, EPL 90, 16005 (2010)). This instability results from a competition between the destabilizing action of the electric Maxwell stress and the stabilizing action of the thermal and capillary forces. The control parameters are the temperature gradient G , the applied voltage V and the thickness h of the nematic layer. In this paper, we present new experimental results on this instability in both the linear and nonlinear regimes. In particular, very rich phase diagrams are mapped out in the (h, V) plane for three different values of G . The divergence of the growth time close to the onset of instability is also studied in detail. In addition, we show the existence at low voltages of another instability of the de Gennes type, where the elastic Ericksen stress is responsible for the destabilization. In this case, a hill-and-valley structure or a square array of umbilics develop at the interface depending on the values of h , V and G .

Lehmann rotation of cholesteric droplets subjected to a temperature gradient: role of the concentration of chiral molecules.

We present a systematic study of the Lehmann rotation of cholesteric droplets subjected to a temperature gradient when the concentration of chiral molecules is changed. The liquid crystal chosen is an eutectic mixture of 8CB and 8OCB doped with a small amount of the chiral molecule R811. The angular velocity of the droplets strongly depend on their size and on the concentration of chiral molecules. The Lehmann coefficient is estimated by using three different methods. Our results are consistent with a Lehmann coefficient proportional to the concentration of chiral molecules. We additionally show the existence of a critical size of the droplets below which they change texture and stop rotating.

Lehmann effect in a compensated cholesteric liquid crystal: experimental evidence with fixed and gliding boundary conditions.

In a recent letter (Europhys. Lett. 80, 26001 (2007)), we have shown that a compensated cholesteric liquid crystal (in which the macroscopic helix completely unwinds) may be subjected to a thermomechanical torque (the so-called Lehmann effect), in agreement with previous findings of Eber and Jánossy (Mol. Cryst. Liq. Cryst. Lett. 72, 233 (1982)). These results prove that one must take into account the chirality of the molecules and the absence of inversion symmetry at the macroscopic scale when deriving the constitutive equations of the phase at the compensation temperature. In this paper, we present the details of our experimental work and a new experiment performed in a sample treated for planar gliding anchoring. The latter experiment, coupled with a numerical simulation, supports the existence of a thermomechanical coupling in a compensated cholesteric.