The 10,000-year biocultural history of fallow deer and its implications for conservation policy.

Over the last 10,000 y, humans have manipulated fallow deer populations with varying outcomes. Persian fallow deer (Dama mesopotamica) are now endangered. European fallow deer (Dama dama) are globally widespread and are simultaneously considered wild, domestic, endangered, invasive and are even the national animal of Barbuda and Antigua. Despite their close association with people, there is no consensus regarding their natural ranges or the timing and circumstances of their human-mediated translocations and extirpations. Our mitochondrial analyses of modern and archaeological specimens revealed two distinct clades of European fallow deer present in Anatolia and the Balkans. Zooarchaeological evidence suggests these regions were their sole glacial refugia. By combining biomolecular analyses with archaeological and textual evidence, we chart the declining distribution of Persian fallow deer and demonstrate that humans repeatedly translocated European fallow deer, sourced from the most geographically distant populations. Deer taken to Neolithic Chios and Rhodes derived not from nearby Anatolia, but from the Balkans. Though fallow deer were translocated throughout the Mediterranean as part of their association with the Greco-Roman goddesses Artemis and Diana, deer taken to Roman Mallorca were not locally available Dama dama, but Dama mesopotamica. Romans also initially introduced fallow deer to Northern Europe but the species became extinct and was reintroduced in the medieval period, this time from Anatolia. European colonial powers then transported deer populations across the globe. The biocultural histories of fallow deer challenge preconceptions about the divisions between wild and domestic species and provide information that should underpin modern management strategies.

Assessing Freshwater Microbiomes from Different Storage Sources in the Caribbean Using DNA Metabarcoding.

Next-generation sequencing (NGS) and the technique of DNA metabarcoding have provided more efficient and comprehensive options for testing water quality compared to traditional methods. Recent studies have shown the efficacy of DNA metabarcoding in characterizing the bacterial microbiomes of varied sources of drinking water, including rivers, reservoirs, wells, tanks, and lakes. We asked whether DNA metabarcoding could be used to characterize the microbiome of different private sources of stored freshwater on the Caribbean Island nation of Antigua and Barbuda. Two replicate water samples were obtained from three different private residential sources in Antigua: a well, an above-ground tank, and a cistern. The bacterial microbiomes of different freshwater sources were assessed using 16S rRNA metabarcoding. We measured both alpha diversity (species diversity within a sample) and beta diversity (species diversity across samples) and conducted a taxonomic analysis. We also looked for the presence of potentially pathogenic species. Major differences were found in the microbiome composition and relative abundances depending on the water source. A lower alpha diversity was observed in the cistern sample compared to the others, and distinct differences in the microbiome composition and relative abundance were noted between the samples. Notably, pathogenic species, or genera known to harbor such species, were detected in all the samples. We conclude that DNA metabarcoding can provide an effective and comprehensive assessment of drinking water quality and has the potential to identify pathogenic species overlooked using traditional methods. This method also shows promise for tracing the source of disease outbreaks due to waterborne microorganisms. This is the first study from small island countries in the Caribbean where metabarcoding has been applied for assessing freshwater water quality.

Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis.

OBJECTIVE: To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. DATA SOURCES: Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. SELECTION OF STUDIES: Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. DATA COLLECTION: Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. DATA SYNTHESIS: Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. CONCLUSION: There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

OBJETIVO: Determinar a associação entre macrossomia fetal (FM) e hemorragia pós-parto (HPP) em mulheres da América Latina e Caribe (ALC). FONTES DE DADOS: Estudos avaliando a associação entre FM e HPP (≥ 500 ml) e HPP grave (≥ 1.000 ml) até 4 de novembro de 2021, indexados no CINHAL, Scopus, Embase, Biblioteca Cochrane, MEDLINE, LILACS e SciELO. SELEçãO DE ESTUDOS: Os critérios de inclusão foram estudos de corte e caso-controle que forneceram o número de casos de HPP e FM. Os critérios de exclusão foram estudos sem informação sobre o número de casos, com uma população de mulheres que não eram da ALC; publicado em um idioma diferente do inglês, espanhol ou português e com um design diferente. COLETA DE DADOS: A extração de dados foi realizada independentemente por dois autores, as discrepâncias foram resolvidas com um terceiro autor. Os dados relativos aos casos de FM e HPP foram recuperados. SíNTESE DOS DADOS: Dos 1.044 artigos avaliados, foram incluídos 5 estudos, de 6 países diferentes: Argentina e Uruguai (multipaíses), Índias Ocidentais, Antígua e Barbuda, Guiana Francesa e Suriname. O odds ratio agrupado (OR) para FM e HPP na meta-análise (cinco estudos) foi de 2,10 (intervalo de confiança de 95% [IC]: 1,79­2,47; I2: 0%), com estimativas dentro deste IC de 95% no análise sensitiva. O OR combinado para HPP grave (3 estudos) foi de 1,61 (95% CI: 0.40­6.48; I2: 91.89%), mostrando alta heterogeneidade. CONCLUSãO: Houve associação positiva entre FM e HPP na ALC, aumentando em 2 vezes o risco da presença desse evento. A alta heterogeneidade dos estudos que mediram a HPP grave não permite tirar conclusões sobre as estimativas obtidas.

CO2 emissions in Latin America: a time series perspective based on fractional integration.

This article deals with the analysis of [Formula: see text] emissions in Latin America by using a long memory process based on fractional integration. Using data of [Formula: see text] emission and [Formula: see text] emissions per capita, for 32 Latin American and Caribbean countries, the results show significant differences according to the variable examined, the model used, and the country under examination. In particular, for the [Formula: see text] emissions, mean reversion is found in Belize and also under some circumstances in Antigua and Barbuda, Colombia, Dominica, Dominican Republic, Ecuador, Grenada, Honduras, Nicaragua, Panama, Peru, and Uruguay. Thus, shocks in these series have a transitory effect. With respect to the time trends, only for some Caribbean countries, namely, Antigua and Barbuda, Aruba, Bahamas, Cuba, and Jamaica, the trend is insignificant; on the other hand, large countries like Brazil, Mexico, and Argentina display the highest time trend coefficients; for the [Formula: see text] emissions per capita, there are eleven countries where mean reversion is detected, and there are ten that share a lack of significance for the trend. The most significant trends now take place in Trinidad and Tobago, British Virgin Islands, Barbados, and Guyana. Policy implications of the results obtained are reported at the end of the paper.

Perfil de carga de enfermedad por diabetes 2023: Antigua y Barbuda

El propósito fundamental de esta serie de perfiles nacionales de la carga de enfermedad por diabetes y de enfermedad renal crónica debida a diabetes es apoyar a los países de la Región de las Américas en el seguimiento de las estrategias puestas en marcha para enfrentar la diabetes. Esta primera versión de los perfiles, que abarca el período comprendido entre el 2000 y el 2019, muestra la tendencia de la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida ajustados por discapacidad de ambas enfermedad. Se han elaborado con los últimos datos disponibles de las estimaciones mundiales de salud de la Organización Mundial de la Salud y tiene como objetivo convertirse en una herramienta útil para llevar a cabo el monitoreo de las estrategias conexas.

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

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

Implementing the voluntary guidelines for the marking of fishing gear in eastern Caribbean small-scale fisheries: An assessment of gear marking provisions.

Managing abandoned, lost and otherwise discarded fishing gear (ALDFG) is a critical challenge that can be aided by the establishment of strong provisions for the marking of gear. This study presents an analysis of implementation of the VGMFG in Eastern Caribbean states. It provides a socio-legal review of this issues and an analysis of compliance and implementation gaps. Empirical data was gathered through interviews with 56 fishers in 2 jurisdictions as well as 6 national and regional fisheries management experts. Antigua and Barbuda's Fisheries Regulations provided the strongest support to implementation of the VGMFG, while neither Dominica nor Grenada had weak regulatory support for gear marking. Both fishers and fisheries managers in the region confirmed compliance and implementation gaps in the establishment of gear marking schemes, while regional fisheries experts highlighted the limited human, financial and infrastructural capacity of departments to effectively implement such schemes along with other ALDFG management measures.

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

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

[Mortality and disability-adjusted life years in motorcyclists in Latin America and the Caribbean during the first decade of action for road safetyMortalidad y años de vida ajustados por discapacidad de los motociclistas en América Latina y el Caribe en la primera década de seguridad vial]. / Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária.

Objective: To identify the temporal trend in mortality and years of life lost to death or disability (DALY) due to motorcycle accidents in males from Latin America and the Caribbean from 2010 to 2019, using estimates produced by the Global Burden of Disease (GBD) study. Method: In this ecological study, the time series was analyzed using a piecewise linear regression model (joinpoint) to estimate and test the annual percent change and the average annual percent change with a 95% confidence interval. Results: The super-region defined by GBD 2019 as Latin America and the Caribbean ranked first globally in mortality and DALY for male motorcyclists aged 15-49 in 2019. Rates increased significantly from 2010 to 2013, with a significant reduction in both after this period. During the analyzed decade, the Tropical Latin America sub-region (Brazil and Paraguay) had the highest mortality and DALY rates in the population of interest; nevertheless, this was the only sub-region achieving a significant reduction in these rates. The Caribbean sub-region (Bermuda, Dominica, Suriname, Guyana, Belize, Bahamas, Puerto Rico, Saint Lucia, Dominican Republic, Haiti, Saint Kitts and Nevis, U.S. Virgin Islands, Grenada, Trinidad and Tobago, Barbados, Saint Vincent and the Grenadines, Antigua and Barbuda, Cuba e Jamaica) showed a significant increase in both rates over the same period, while Andean Latin America (Ecuador, Bolivia and Peru) and Central Latin America (Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Honduras, and Venezuela) remained stable. Conclusions: The data underscore the importance of developing surveillance actions aimed at preventing motorcycle accidents, since the observed declining rates are still insufficient to address the morbidity and mortality associated with road accidents as a public health problem.

Objetivo: Determinar la tendencia temporal de la mortalidad y los años de vida perdidos por muerte o ajustados por discapacidad (AVAD) de hombres por accidentes de motocicleta en América Latina y el Caribe en el período 2010-2019, a partir de las estimaciones del estudio de la carga mundial de enfermedades (CME). Métodos: En este estudio ecológico se analizaron las series temporales mediante el modelo de regresión lineal segmentada (joinpoint), con cálculo y comprobación del cambio porcentual anual y del cambio porcentual anual promedio, con un intervalo de confianza del 95%. Resultados: La región de América Latina y el Caribe definida por el estudio de la CME ocupó el primer lugar a nivel mundial en mortalidad y AVAD de motociclistas varones de 15 a 49 años en el 2019. Las tasas tuvieron un notable aumento del 2010 al 2013, y ambas registraron una reducción importante después de ese período. En la década analizada, la subregión de América Latina Tropical (Brasil y Paraguay) presentó las mayores tasas de mortalidad y de AVAD en la población de estudio, pero fue la única con una reducción importante de las mismas. La subregión del Caribe (Antigua y Barbuda, Bahamas, Barbados, Belice, Bermudas, Cuba, Dominica, Granada, Guyana, Haití, Islas Vírgenes de Estados Unidos, Jamaica, Puerto Rico, República Dominicana, Saint Kits y Nevis, San Vicente y las Granadinas, Santa Lucía, Suriname, y Trinidad y Tabago) mostró un aumento importante de ambas tasas, mientras que América Latina Andina (Bolivia, Ecuador y Perú) y América Latina Central (Colombia, Costa Rica, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá y Venezuela) se mantuvieron estables. Conclusiones: Los datos refuerzan la importancia de las actividades de vigilancia destinadas a prevenir los accidentes de motocicleta, puesto que la reducción observada de las tasas aún es insuficiente para abordar la morbimortalidad por accidentes de tráfico como problema de salud pública.

Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária

[RESUMO]. Objetivo. Identificar a tendência temporal da mortalidade e dos anos de vida perdidos por morte ou incapaci- dade (DALY) de homens por acidente motociclístico na América Latina e Caribe no período de 2010 a 2019, utilizando estimativas do estudo Global Burden of Disease (GBD). Métodos. Este estudo ecológico analisou a série temporal pelo modelo de regressão linear segmentada (joinpoint), estimando-se e testando-se a variação percentual anual e a variação percentual anual média, com intervalo de confiança de 95%. Resultados. A grande região da América Latina e Caribe definida pelo GBD ocupou o primeiro lugar global em mortalidade e DALY de motociclistas homens de 15 a 49 anos em 2019. As taxas aumentaram significa- tivamente de 2010 a 2013, havendo redução significativa de ambas após esse período. Durante a década analisada, a sub-região da América Latina Tropical (Brasil e Paraguai) apresentou as maiores taxas de mortali- dade e DALY na população em estudo, porém foi a única com redução significativa das mesmas; a sub-região do Caribe (Bermudas, Dominica, Suriname, Guiana, Belize, Bahamas, Porto Rico, Santa Lúcia, República Dominicana, Haiti, São Cristóvão e Névis, Ilhas Virgens/EUA, Granada, Trinidad e Tobago, Barbados, São Vicente e Granadinas, Antígua e Barbuda, Cuba e Jamaica) apresentou aumento significativo de ambas as taxas, enquanto América Latina Andina (Equador, Bolívia e Peru) e América Latina Central (Colômbia, Costa Rica, El Salvador, Guatemala, México, Nicarágua, Panamá, Honduras e Venezuela) permaneceram estáveis. Conclusões. Os dados reforçam a importância das ações de vigilância destinadas à prevenção de acidentes motociclísticos, uma vez que os resultados de queda nas taxas ainda são insuficientes frente à morbimortali- dade no trânsito como problema de saúde pública.

[ABSTRACT]. Objective. To identify the temporal trend in mortality and years of life lost to death or disability (DALY) due to motorcycle accidents in males from Latin America and the Caribbean from 2010 to 2019, using estimates produced by the Global Burden of Disease (GBD) study. Method. In this ecological study, the time series was analyzed using a piecewise linear regression model (joinpoint) to estimate and test the annual percent change and the average annual percent change with a 95% confidence interval. Results. The super-region defined by GBD 2019 as Latin America and the Caribbean ranked first globally in mortality and DALY for male motorcyclists aged 15-49 in 2019. Rates increased significantly from 2010 to 2013, with a significant reduction in both after this period. During the analyzed decade, the Tropical Latin America sub-region (Brazil and Paraguay) had the highest mortality and DALY rates in the population of interest; never- theless, this was the only sub-region achieving a significant reduction in these rates. The Caribbean sub-region (Bermuda, Dominica, Suriname, Guyana, Belize, Bahamas, Puerto Rico, Saint Lucia, Dominican Republic, Haiti, Saint Kitts and Nevis, U.S. Virgin Islands, Grenada, Trinidad and Tobago, Barbados, Saint Vincent and the Grenadines, Antigua and Barbuda, Cuba e Jamaica) showed a significant increase in both rates over the same period, while Andean Latin America (Ecuador, Bolivia and Peru) and Central Latin America (Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Honduras, and Venezuela) remained stable. Conclusions. The data underscore the importance of developing surveillance actions aimed at preventing motorcycle accidents, since the observed declining rates are still insufficient to address the morbidity and mortality associated with road accidents as a public health problem.

[RESUMEN]. Objetivo. Determinar la tendencia temporal de la mortalidad y los años de vida perdidos por muerte o ajusta- dos por discapacidad (AVAD) de hombres por accidentes de motocicleta en América Latina y el Caribe en el período 2010-2019, a partir de las estimaciones del estudio de la carga mundial de enfermedades (CME). Métodos. En este estudio ecológico se analizaron las series temporales mediante el modelo de regresión lineal segmentada (joinpoint), con cálculo y comprobación del cambio porcentual anual y del cambio porcentual anual promedio, con un intervalo de confianza del 95%. Resultados. La región de América Latina y el Caribe definida por el estudio de la CME ocupó el primer lugar a nivel mundial en mortalidad y AVAD de motociclistas varones de 15 a 49 años en el 2019. Las tasas tuvieron un notable aumento del 2010 al 2013, y ambas registraron una reducción importante después de ese período. En la década analizada, la subregión de América Latina Tropical (Brasil y Paraguay) presentó las mayores tasas de mortalidad y de AVAD en la población de estudio, pero fue la única con una reducción impor- tante de las mismas. La subregión del Caribe (Antigua y Barbuda, Bahamas, Barbados, Belice, Bermudas, Cuba, Dominica, Granada, Guyana, Haití, Islas Vírgenes de Estados Unidos, Jamaica, Puerto Rico, República Dominicana, Saint Kits y Nevis, San Vicente y las Granadinas, Santa Lucía, Suriname, y Trinidad y Tabago) mostró un aumento importante de ambas tasas, mientras que América Latina Andina (Bolivia, Ecuador y Perú) y América Latina Central (Colombia, Costa Rica, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá y Venezuela) se mantuvieron estables. Conclusiones. Los datos refuerzan la importancia de las actividades de vigilancia destinadas a prevenir los accidentes de motocicleta, puesto que la reducción observada de las tasas aún es insuficiente para abordar la morbimortalidad por accidentes de tráfico como problema de salud pública.

Sickle Cell Disease Newborn Screening-An Audit of a Twin Island State Pilot Program.

The prevalence of Sickle Cell Disease (SCD) within the Caribbean region remains second only to that of West Africa. The Newborn Screening (NBS) Program in Antigua and Barbuda remains heavily dependent on grants, therefore ultimately facing sustainability challenges. Early intervention and implementation of preventative measures post-NBS result in significant improvements in morbidity, quality of life, and survival. This audit reviewed the pilot SCD NBS Program in Antigua and Barbuda from September 2020 to December 2021. A conclusive result was received by 99% of babies eligible for screening, 84.3% of which were HbFA, whilst 9.6% and 4.6% were HbFAS and HbFAC, respectively. This was comparable to other Caribbean countries. Sickle Cell Disease was noted in 0.5% of babies screened, which translates to 1 in 222 live births. Eighty-two percent of mothers were aware of their sickle cell status, compared to 3% of fathers. The importance of instituting a quality improvement team post the initiation of a screening program and the need for a robust public education program have been demonstrated by this audit.

West Indies

Islands lying between southeastern North America and northern South America, enclosing the Caribbean Sea. They comprise the Greater Antilles (CUBA; DOMINICAN REPUBLIC; HAITI; JAMAICA; and PUERTO RICO), the Lesser Antilles (ANTIGUA AND BARBUDA and the other Leeward Islands, BARBADOS; MARTINIQUE and the other Windward Islands, NETHERLANDS ANTILLES; VIRGIN ISLANDS OF THE UNITED STATES, BRITISH VIRGINI ISLANDS, and the islands north of Venezuela which include TRINIDAD AND TOBAGO), and the BAHAMAS. (From Webster's New Geographical Dictionary, 1988, p1330)

Islas que se extienden entre el sudeste de América del Norte y el norte de América del Sur, que encierra el mar Caribe. Comprenden las Antillas Mayores (CUBA; REPÚBLICA DOMINICANA; HAITÍ; JAMAICA y PUERTO RICO), las Antillas Menores (ANTIGUA y BARBUDA y las demás islas de Sotavento, BARBADOS, MARTINICA y el resto de las Islas de Barlovento, ANTILLAS HOLANDESAS; ISLAS VÍRGENES DE LOS ESTADOS UNIDOS, ISLAS VÍRGENES BRITÁNICAS, y las islas del norte de Venezuela que incluyen TRINIDAD Y TOBAGO), y las BAHAMAS. (Traducción libre del original: Webster's New Geographical Dictionary, 1988, p1330)

Ilhas que se situam entre o sudeste da América do Norte e norte da América do Sul, incluindo o Mar do Caribe. Compreendem as Grandes Antilhas (CUBA, REPÚBLICA DOMINICANA, HAITI, JAMAICA e PORTO RICO), as Pequenas Antilhas (ANTÍGUA E BARBUDA e as outras Ilhas de Sotavento, BARBADOS, MARTINICA e as outras Ilhas de Barlavento, ANTILHAS HOLANDESAS, ILHAS VIRGENS AMERICANAS, e as ilhas ao norte da Venezuela que incluem TRINIDAD E TOBAGO) e as BAHAMAS. (Tradução livre do original: Webster's New Geographical Dictionary, 1988, p1330)

Caribbean People

People native to or inhabitants of islands in the Caribbean Sea or CARIBBEAN including ANTIGUA AND BARBUDA; ARUBA; BAHAMAS; BARBADOS; BRITISH VIRGIN ISLANDS; CARIBBEAN NETHERLANDS; CUBA; CURACAO; DOMINICA; DOMINICAN REPUBLIC; GRENADA; GUADELOUPE; HAITI; JAMAICA; MARTINIQUE; PUERTO RICO; SAINT KITTS AND NEVIS; SAINT LUCIA; SAINT VINCENT AND THE GRENADINES; SINT MAARTEN; TRINIDAD AND TOBAGO; and UNITED STATES VIRGIN ISLANDS.

Personas nativas o habitantes de islas en el Mar Caribe o CARIBE incluyendo ANTIGUA Y BARBUDA, ARUBA, BAHAMAS, BARBADOS, ISLAS VIRGENES BRITÁNICAS, PAÍSES BAJOS DEL CARIBE, CUBA, CURAZAO, DOMINICA, REPÚBLICA DOMINICANA, GRANADA, GUADALUPE, HAITÍ, JAMAICA, MARTINICA, PUERTO RICO, SAN CRISTÓBAL Y NIEVES, SANTA LUCÍA, SAN VICENTE Y LAS GRANADINAS, SAN MAARTÉN, TRINIDAD Y TOBAGO e ISLAS VIRGENES DE LOS ESTADOS UNIDOS.

Pessoas nativas ou habitantes de ilhas no Mar do Caribe ou CARIBE, incluindo ANTIGUA E BARBUDA, ARUBA, BAHAMAS, BARBADOS, ILHAS VIRGENS BRITÂNICAS, PAÍSES BAIXOS CARIBENHOS, CUBA, CURAÇAO, DOMINICA, REPÚBLICA DOMINICANA, GRANADA, GUADALUPE, HAITI, JAMAICA, MARTINICA, PORTO RICO, SÃO CRISTÓVÃO E NÉVIS, SANTA LÚCIA, SÃO VICENTE E GRANADINAS, SÃO MARTINHO (PAÍSES BAIXOS), TRINIDAD E TOBAGO, e ILHAS VIRGENS AMERICANAS.

Antigua and Barbuda

Islands in the Lesser Antilles, within the Leeward Islands. ANTIGUA, BARBUDA, and Redonda, an uninhabited island, constitute the independent state of ANTIGUA AND BARBUDA. The capital is St. Johns.

Islas de las Antillas Menores, dentro de las Islas Leeward. Antigua, Barbuda y Redonda, una isla inhabitada, constituyen el estado independiente de Antigua y Barbuda. Su capital es St. Johns.

Ilhas nas Pequenas Antilhas, dentro das Ilhas Leeward. Antígua, Barbuda e Redonda, uma ilha despovoada, constituem o estado independente de Antígua e Barbuda. A capital é St. Johns.

Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis / Macrossomia fetal e hemorragia pós-parto na região da América Latina e Caribe: Revisão sistemática e metanálise

Abstract Objective To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. Data Sources Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. Selection of Studies Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. Data Collection Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. Data Synthesis Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. Conclusion There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

Resumo Objetivo Determinar a associação entre macrossomia fetal (FM) e hemorragia pós-parto (HPP) em mulheres da América Latina e Caribe (ALC). Fontes de dados Estudos avaliando a associação entre FM e HPP (≥ 500 ml) e HPP grave (≥ 1.000 ml) até 4 de novembro de 2021, indexados no CINHAL, Scopus, Embase, Biblioteca Cochrane, MEDLINE, LILACS e SciELO. Seleção de estudos Os critérios de inclusão foram estudos de corte e caso-controle que forneceram o número de casos de HPP e FM. Os critérios de exclusão foram estudos sem informação sobre o número de casos, com uma população de mulheres que não eram da ALC; publicado em um idioma diferente do inglês, espanhol ou português e com um design diferente. Coleta de dados A extração de dados foi realizada independentemente por dois autores, as discrepâncias foram resolvidas com um terceiro autor. Os dados relativos aos casos de FM e HPP foram recuperados. Síntese dos dados Dos 1.044 artigos avaliados, foram incluídos 5 estudos, de 6 países diferentes: Argentina e Uruguai (multipaíses), Índias Ocidentais, Antígua e Barbuda, Guiana Francesa e Suriname. O odds ratio agrupado (OR) para FM e HPP na meta-análise (cinco estudos) foi de 2,10 (intervalo de confiança de 95% [IC]: 1,79-2,47; I2: 0%), com estimativas dentro deste IC de 95% no análise sensitiva. O OR combinado para HPP grave (3 estudos) foi de 1,61 (95% CI: 0.40-6.48; I2: 91.89%), mostrando alta heterogeneidade. Conclusão Houve associação positiva entre FM e HPP na ALC, aumentando em 2 vezes o risco da presença desse evento. A alta heterogeneidade dos estudos que mediram a HPP grave não permite tirar conclusões sobre as estimativas obtidas.

Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária / Mortality and disability-adjusted life years in motorcyclists in Latin America and the Caribbean during the first decade of action for road safety / Mortalidad y años de vida ajustados por discapacidad de los motociclistas en América Latina y el Caribe en la primera década de seguridad vial

RESUMO Objetivo. Identificar a tendência temporal da mortalidade e dos anos de vida perdidos por morte ou incapacidade (DALY) de homens por acidente motociclístico na América Latina e Caribe no período de 2010 a 2019, utilizando estimativas do estudo Global Burden of Disease (GBD). Métodos. Este estudo ecológico analisou a série temporal pelo modelo de regressão linear segmentada (joinpoint), estimando-se e testando-se a variação percentual anual e a variação percentual anual média, com intervalo de confiança de 95%. Resultados. A grande região da América Latina e Caribe definida pelo GBD ocupou o primeiro lugar global em mortalidade e DALY de motociclistas homens de 15 a 49 anos em 2019. As taxas aumentaram significativamente de 2010 a 2013, havendo redução significativa de ambas após esse período. Durante a década analisada, a sub-região da América Latina Tropical (Brasil e Paraguai) apresentou as maiores taxas de mortalidade e DALY na população em estudo, porém foi a única com redução significativa das mesmas; a sub-região do Caribe (Bermudas, Dominica, Suriname, Guiana, Belize, Bahamas, Porto Rico, Santa Lúcia, República Dominicana, Haiti, São Cristóvão e Névis, Ilhas Virgens/EUA, Granada, Trinidad e Tobago, Barbados, São Vicente e Granadinas, Antígua e Barbuda, Cuba e Jamaica) apresentou aumento significativo de ambas as taxas, enquanto América Latina Andina (Equador, Bolívia e Peru) e América Latina Central (Colômbia, Costa Rica, El Salvador, Guatemala, México, Nicarágua, Panamá, Honduras e Venezuela) permaneceram estáveis. Conclusões. Os dados reforçam a importância das ações de vigilância destinadas à prevenção de acidentes motociclísticos, uma vez que os resultados de queda nas taxas ainda são insuficientes frente à morbimortalidade no trânsito como problema de saúde pública.

ABSTRACT Objective. To identify the temporal trend in mortality and years of life lost to death or disability (DALY) due to motorcycle accidents in males from Latin America and the Caribbean from 2010 to 2019, using estimates produced by the Global Burden of Disease (GBD) study. Method. In this ecological study, the time series was analyzed using a piecewise linear regression model (joinpoint) to estimate and test the annual percent change and the average annual percent change with a 95% confidence interval. Results. The super-region defined by GBD 2019 as Latin America and the Caribbean ranked first globally in mortality and DALY for male motorcyclists aged 15-49 in 2019. Rates increased significantly from 2010 to 2013, with a significant reduction in both after this period. During the analyzed decade, the Tropical Latin America sub-region (Brazil and Paraguay) had the highest mortality and DALY rates in the population of interest; nevertheless, this was the only sub-region achieving a significant reduction in these rates. The Caribbean sub-region (Bermuda, Dominica, Suriname, Guyana, Belize, Bahamas, Puerto Rico, Saint Lucia, Dominican Republic, Haiti, Saint Kitts and Nevis, U.S. Virgin Islands, Grenada, Trinidad and Tobago, Barbados, Saint Vincent and the Grenadines, Antigua and Barbuda, Cuba e Jamaica) showed a significant increase in both rates over the same period, while Andean Latin America (Ecuador, Bolivia and Peru) and Central Latin America (Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Honduras, and Venezuela) remained stable. Conclusions. The data underscore the importance of developing surveillance actions aimed at preventing motorcycle accidents, since the observed declining rates are still insufficient to address the morbidity and mortality associated with road accidents as a public health problem.

RESUMEN Objetivo. Determinar la tendencia temporal de la mortalidad y los años de vida perdidos por muerte o ajustados por discapacidad (AVAD) de hombres por accidentes de motocicleta en América Latina y el Caribe en el período 2010-2019, a partir de las estimaciones del estudio de la carga mundial de enfermedades (CME). Métodos. En este estudio ecológico se analizaron las series temporales mediante el modelo de regresión lineal segmentada (joinpoint), con cálculo y comprobación del cambio porcentual anual y del cambio porcentual anual promedio, con un intervalo de confianza del 95%. Resultados. La región de América Latina y el Caribe definida por el estudio de la CME ocupó el primer lugar a nivel mundial en mortalidad y AVAD de motociclistas varones de 15 a 49 años en el 2019. Las tasas tuvieron un notable aumento del 2010 al 2013, y ambas registraron una reducción importante después de ese período. En la década analizada, la subregión de América Latina Tropical (Brasil y Paraguay) presentó las mayores tasas de mortalidad y de AVAD en la población de estudio, pero fue la única con una reducción importante de las mismas. La subregión del Caribe (Antigua y Barbuda, Bahamas, Barbados, Belice, Bermudas, Cuba, Dominica, Granada, Guyana, Haití, Islas Vírgenes de Estados Unidos, Jamaica, Puerto Rico, República Dominicana, Saint Kits y Nevis, San Vicente y las Granadinas, Santa Lucía, Suriname, y Trinidad y Tabago) mostró un aumento importante de ambas tasas, mientras que América Latina Andina (Bolivia, Ecuador y Perú) y América Latina Central (Colombia, Costa Rica, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá y Venezuela) se mantuvieron estables. Conclusiones. Los datos refuerzan la importancia de las actividades de vigilancia destinadas a prevenir los accidentes de motocicleta, puesto que la reducción observada de las tasas aún es insuficiente para abordar la morbimortalidad por accidentes de tráfico como problema de salud pública.

The Effects of Virtual Caregiver Coaching in Antigua & Barbuda on the Implementation of EMT Language Support Strategies in Naturalistic Environments.

This single-case multiple baseline design investigation set out to determine the effectiveness of using a telepractice service delivery model to coach caregivers in Antigua & Barbuda in the use of Enhanced Milieu Teaching (EMT) language support strategies with a child with language impairment. A slightly modified version of the Teach-Model-Coach-Review (TMCR) method was used during virtual instruction to train a caregiver on the language support strategies of environmental arrangement, matched turns, expansions, and time delay with milieu prompting. The caregiver attended sessions three times a week for up to 45 minutes for four weeks. The results of this study indicated a positive relationship between the intervention and caregiver use of strategies. The caregiver demonstrated increased responsiveness to the child's communication attempts and exhibited the use of language support strategies across activities. This study suggests that telepractice can be an effective service delivery model for providing coaching to caregivers.

Introduction of the Hepatitis B Vaccine-Birth Dose: Methods of Improving Rates in a Milieu of Vaccine Hesitancy.

The hepatitis B virus is a public health threat, chronically infecting over 240 million persons worldwide. The hepatitis B vaccine is 90% effective in preventing perinatal transmission if the first dose is given within the first 24 h of life, followed by a minimum of two subsequent doses. Antigua and Barbuda instituted a hospital-based birth dose vaccination policy in October 2021. Data were extracted from hospital logbooks from November 2021 to October 2022, and a database was created. Frequency distributions of the hepatitis B birth dose, barriers to administration, and maternal and healthcare system factors were analyzed. The positive maternal HBsAg prevalence rate was 0.6%. The timely and total birth dose coverage was 72% and 81%, respectively. In total, 10.5% of parents refused the vaccine, of which 76% either felt uncomfortable or preferred to wait. Moreover, 100% of hepatitis B-exposed babies were vaccinated, with 83% of them receiving the Hepatitis B Immunoglobulin. Barriers to vaccine administration included vaccination hesitancy, gaps in knowledge of medical staff, and the inconsistent vaccination supply. Instituting a quality improvement team, health information system, robust educational efforts, and addressing barriers will make achieving the WHO programmatic targets of eliminating mother-to-child transmission of hepatitis B by 2030 possible.

A Bibliometric Analysis of COVID-19 Scientific Literature From the English-Speaking Caribbean.

The COVID-19 pandemic has led to a global crisis and has affected the Caribbean islands, leading to significant health and socioeconomic consequences in this region. Efforts to mitigate the burden of this disease have led to an accelerated amount of research in the English-speaking Caribbean (ESC). This bibliometric analysis aimed to evaluate the COVID-19-related scientific literature from the ESC nations. A total of 175 articles were included and analyzed from an initial PubMed search (n = 638) for COVID-19-related scientific literature from the ESC nations published between January 1, 2020, and June 30, 2022. Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) and the VOSviewer (version 1.6.18) were used to characterize countries, authorship, journals, affiliations, and keywords of the COVID-19-related articles. Trinidad and Tobago (38%), Jamaica (22%), Barbados (20%), and Grenada (15%) contributed to the greatest number of publications. The University of the West Indies (UWI) campuses in Trinidad and Tobago, Jamaica and Barbados, and St. George's University in Grenada were the most prolific institutions. Srikanth Umakanthan from the UWI was the most prolific author. Cureus, SN Comprehensive Clinical Medicine, and Frontiers in Public Health were the first three most productive journals; 59% of the 175 articles had either the first or last author affiliated with an institution in the ESC, and 19% of the articles were country-focused: Trinidad and Tobago (16/175), Jamaica (9/175), Barbados (5/175), and Antigua and Barbuda (2/175). Among the top themes of research, 27% were outbreak response and rearrangements, epidemiological studies (23%), clinical management (23%), and medical education (13%). Over the last two years, an interest stimulated by the pandemic has expanded the research in ESC countries. However, gaps in the knowledge exist, especially in the epidemiology of COVID-19 complications in the sub-populations of chronic non-communicable diseases, post-COVID syndrome, and the long-COVID syndrome in the region. Hence, there is enormous scope for more research across the region.

'Building back better' in the context of multi-hazards in the Caribbean.

The multi-hazard vulnerability of Small Island Developing States in the Caribbean has underpinned the repeated saga of destructive natural and anthropogenic events that have disrupted land, livelihoods, the economy, and society over the past several decades. Preparedness and response have been the focus of national governments and regional entities and the repeated battering calls into question the concept of recovery and 'building back better'. This paper examines the concept of recovery and 'building back better' in the context of the Caribbean, paying particular attention to the experience of the selected countries of Antigua and Barbuda, the Bahamas, Dominica, Guyana, Jamaica, and Saint Vincent and the Grenadines. These nations have recently been impacted by different disasters, ranging from storms to earthquakes to volcanic eruptions. This paper also explores the similarities among the recommendations concerning recovery needs, presenting key insights into suggested approaches for an inclusive people-centred recovery process that 'builds back better'.