The centrality of community dynamics in the socio-economic recovery of devastated communities / El carácter central de la dinámica de la comunidad en la recuperación socio-económica de las comunidades devastadas

OBJECTIVE: To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery. METHODS: The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups. RESULTS: Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery. CONCLUSION: Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However, issues related to the community's economic recovery are still unresolved.

OBJETIVO: Evaluar y explorar la salud y los resultados socio-económicos de Jubilee, una comunidad de la isla caribeña de Granada, afectada por el huracán Iván en el 2004, e identificar los obstáculos que aún quedan para la recuperación. MÉTODOS: La evaluación consistió en un abordaje de métodos mezclados que empleaban la observación, encuestas domésticas, entrevistas detalladas, y grupos focales (grupos de discusión). RESULTADOS: El ochenta y cinco por ciento de los residentes viven en viviendas que son para una sola familia, pero están ocupadas por familias múltiples. El veinte por ciento de los encuestados dependían de un río o una corriente para obtener agua, y un 83% utilizaba letrinas de pozo exteriores. La construcción daba cuenta del 28% de los empleos, en tanto que el 16% reportó no tener ocupación. Tanto el transporte público como el privado se hallaban limitados, y el 48% de los residentes vivían con menos de un dólar americano (1 USD) por día. Acceso a la atención a la salud fue reportado por 89% y la prevalencia de la diabetes y la hipertensión fue identificada por el 13% y el 30% de los residentes, respectivamente. La fragmentación social dentro de la comunidad representa un obstáculo que impide que la comunidad desarrolle metas comunes, que conduzcan a una plena recuperación económica. CONCLUSIÓN: Jubilee no se ha recuperado totalmente de los efectos del huracán Iván, pero ha habido progreso en los esfuerzos por la reconstrucción. Estos esfuerzos han estado dirigidos a las necesidades básicas y más inmediatas de la comunidad, fundamentalmente a la reparación de las casas y las infraestructuras de servicios. Sin embargo, los problemas relacionados con la recuperación económica de la comunidad siguen aún sin solución.

The centrality of community dynamics in the socio-economic recovery of devastated communities.

OBJECTIVE: To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery. METHODS: The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups. RESULTS: Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery. CONCLUSION: Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However issues related to the community's economic recovery are still unresolved.

[Multicystic encephalomalacia in a surviving twin after death of the other twin in utero]. / Encéphalomalacie multikystique chez un jumeau survivant après décès d'un jumeau in utero.

A case of multicystic encephalomalacia in a twin is reported. The other twin died in utero at 32 weeks gestational age. Because there was no evidence of fetal distress the pregnancy was allowed to continue until 36 weeks gestational age. Injuries to the surviving twin due to disseminated intravascular coagulation (DIVC) and vascular thrombosis or to anoxia and ischemia may occur when there are anastomoses between the circulatory systems of the two twins, i.e., in monochorionic pregnancies. The classically recommended strategy is to wait for adequate maturity of the surviving fetus (36 weeks). It is suggested that this attitude may be overly expectant and may deserve reappraisal.

[The evaluation of the risk of spontaneous abortion at various stages of pregnancy. Study of overall risk and of normal ultrasound pregnancy]. / Evaluation à diverses périodes gestationnelles des risques d'avortements spontanés. Etude du risque global et des grossesses à échographie normale.

The authors have studied a series of 2,292 pregnancies that were unselected and have calculated from this the risks of spontaneous abortion before the 28th week of the pregnancy that patients have when they come for ultrasonography for the first time in the pregnancy. They have been able to work out the risks of spontaneous abortion even when the ultrasound was normal for the time of pregnancy. The risks diminish as the pregnancy progresses and rise with the mother's age.