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1.
Article in English | MEDLINE | ID: mdl-33972010

ABSTRACT

Trichuris spp. are common helminths in NHP, and benzimidazoles and avermectins have both been used to treat theseintestinal parasites. The current study compared the efficacy of fenbendazole and ivermectin against natural infection ofTrichuris spp. in African green monkeys (Chlorocebus sabaeus). Anthelmintic-naive animals (n = 65) were randomly assignedto 4 groups: an untreated control group, and 3 groups treated with either fenbendazole, ivermectin, or both compounds. Fecalsamples were collected before treatment and on days 7, 14, 28, and 60 after treatment, and fecal egg counts (FEC) were determined by using fecal flotation. The mean percentages of FEC reduction at day 60 were 100%, 86%, and 100% for treatmentwith fenbendazole, ivermectin, and both compounds, respectively. Analyzing the time series of FEC by using a Bayesian generalized linear model showed no significant difference in the proportional reduction in FEC among the 3 treatment groups, although all FEC from treated groups were significantly lower than the FEC of the control group. In contrast, the probability of shedding was highest in the ivermectin group and the lowest in the animals treated with both compounds. The probability of shedding differed significantly between the fenbendazole and ivermectin groups and between the ivermectin and combined-treatment groups. In conclusion, both fenbendazole and ivermectin are effective anthelmintics in treating Trichuris spp. infection in African green monkeys. All treatment groups showed significant reductions in FEC when compared with baseline counts and control animals; however, fenbendazole may be more effective than ivermectin when used solely or in combination with other anthelmintic treatments.

2.
Pan Afr Med J ; 38: 111, 2021.
Article in English | MEDLINE | ID: mdl-33912281

ABSTRACT

Millions of patients, with suspected complex neurogenetic disorders, living in resource limited regions around the world have no access to genetic testing despite the rapidly expanding availability and decreasing costs of genetic testing in first world nations. The barriers to increasing availability of genetic testing in resource limited nations are multifactorial but can be attributed, in large part, to a lack of awareness of the power of genetic testing to lead to a rapid, cost-effective, diagnosis that potentially will have profound clinical implications on treatment and patient outcomes. We report our experience with whole exome sequencing (WES) done for the first time in 5 patients of African descent with a suspected neurogenetic disorder living in a resource limited setting on the Eastern Caribbean island of Barbados. A diagnostic pathogenic mutation was found in 3 patients in the SCN1A, STXBP1 and SCN4A, who clinically were diagnosed with Dravet syndrome, Lennox-Gastaut syndrome, paramytonia and seizures respectively. A variant of undetermined significance was found in a patient with global developmental delays, hypotonia, with abnormal eye movements. In one patient WES was non-diagnostic. This result highlights the high yield of WES in carefully selected patients with a neurologic disease and the need for increase access to genetic testing in resource limited settings globally.


Subject(s)
Genetic Testing/methods , Nervous System Diseases/diagnosis , Whole Exome Sequencing/methods , Adult , Barbados , Child , Cost-Benefit Analysis , Genetic Testing/economics , Humans , Infant , Munc18 Proteins/genetics , Mutation , NAV1.1 Voltage-Gated Sodium Channel/genetics , NAV1.4 Voltage-Gated Sodium Channel/genetics , Nervous System Diseases/genetics , Nervous System Diseases/physiopathology , Whole Exome Sequencing/economics , Young Adult
3.
Article in English | PAHO-IRIS | ID: phr-53673

ABSTRACT

[ABSTRACT]. Objectives. To assess the demographics, risk profiles and outcome indicators of one of the few government-supported programs on pre-exposure prophylaxis (PrEP) in the English-speaking Caribbean. Methods. Chart review of all persons enrolled into the national PrEP Program from its inception on March 1st 2018 to November 30th 2019, with a descriptive summary analysis of the data extracted. Results. Of the 134 persons enrolled into the program most identified as men who have sex with men (67.9%), followed by men who have sex with men and women (14.9%); there were 20 persons, mostly men (85%), in sero-discordant relationships. PrEP uptake was 96%; however, the continuation rate (continuing for three consecutive months after initiation) was 61.5%. Continuation status for many could not be ascertained due to loss-to-follow-up. PrEP-associated toxicity prevalence was 2.3%, although side-effects occurred in 52% (mostly gastrointestinal). HIV positivity during the study period was 1.5%. Conclusion. Uptake of Barbados’ national PrEP Program is excellent but fairly low continuation rates and the HIV positivity rate indicate the need for improved pre-ART initiation education and follow-up processes. Service utilisation is mainly by men who have sex with men, and provision expansion to other civil society partners and private practitioners, as well as increased public awareness could increase access by other high-risk groups.


[RESUMEN]. Objetivos. Evaluar la información demográfica, los perfiles de riesgo y los indicadores de resultados de uno de los pocos programas de profilaxis previa a la exposición (PrEP, por su sigla en inglés) respaldado por un gobierno en el Caribe de habla inglesa. Métodos. Análisis de gráficos de todas las personas que se registraron en el Programa Nacional de PrEP desde su inicio el 1 de marzo de 2018 hasta el 30 de noviembre 2019, con un análisis de los datos extraídos en forma de resumen descriptivo. Resultados. De las 134 personas que se registraron en el programa, la mayoría se identificaba como hombres que tienen relaciones sexuales con hombres (67,9%), seguido de hombres que tienen relaciones sexuales con otros hombres y con mujeres (14,9%). Había 20 personas, principalmente hombres (85%), en relaciones serodiscordantes. La tasa de captación del programa de PrEP fue de 96%; sin embargo, la tasa de continuación (continuar en el programa durante tres meses consecutivos después del inicio) fue de 61,5%. En muchos casos no se pudo verificar la continuación debido a la falta de seguimiento. La prevalencia de la toxicidad asociada con la PrEP fue de 2,3%, aunque se observaron efectos colaterales en un 52% (principalmente en el aparato digestivo) de las personas. La positividad para el VIH durante el período del estudio fue de 1,5%. Conclusiones. El Programa Nacional de PrEP de Barbados tiene una tasa de captación excelente; sin embargo, la tasa de continuación relativamente baja y la tasa de positividad para el VIH indican la necesidad de mejorar la educación inicial previa al tratamiento antirretroviral y los procesos de seguimiento. Estos servicios fueron utilizados principalmente por hombres que tienen relaciones sexuales con hombres; si se ampliase el suministro de estos a otros colaboradores de la sociedad civil y médicos particulares, y si se concientizase más al público, se mejoraría el acceso para otros grupos de alto riesgo.


[RESUMO[. Objetivos. Avaliar as características demográficas, perfis de risco e indicadores de resultados de um dos poucos programas de profilaxia pré-exposição (PrEP) com apoio governamental existentes em países de língua inglesa do Caribe. Métodos. Revisão dos prontuários de todos os participantes inscritos no Programa Nacional de PrEP desde o seu início em 1. de março de 2018 a 30 de novembro de 2019, com uma análise sumária descritiva dos dados extraídos. Resultados. Dos 134 participantes inscritos no programa, a maioria se identificou como homens que fazem sexo com homens (67,9%), seguido de homens que fazem sexo com homens e mulheres (14,9%). Vinte participantes, sobretudo homens (85%), estavam em relacionamentos sorodiscordantes. O índice de captação de participantes ao PrEP foi de 96%, porém a taxa de continuidade no programa (continuar participando por três meses consecutivos após ter iniciado o programa) foi de 61,5%. Não foi possível confirmar a continuidade no programa em muitos casos por perda de seguimento. A prevalência de toxicidade associada à PrEP foi 2,3%, apesar de terem ocorrido efeitos colaterais em 52% dos participantes (na sua maioria efeitos gastrointestinais). A taxa de positividade ao HIV durante o período de estudo foi de 1,5%. Conclusões. A captação do Programa Nacional de PrEP de Barbados foi excelente, mas a continuidade da participação relativamente baixa e a taxa de positividade ao HIV observada indicam que é necessário instruir melhor as pessoas antes de iniciar a terapia antirretroviral e aprimorar o processo de acompanhamento. Este programa é utilizado principalmente por homens que fazem sexo com homens. Ampliar a prestação do serviço a outros parceiros da sociedade civil e a profissionais particulares, assim como melhorar a conscientização do público, poderia aumentar o acesso por outros grupos de alto risco.


Subject(s)
HIV , Pre-Exposure Prophylaxis , Barbados , Caribbean Region , HIV , Pre-Exposure Prophylaxis , Caribbean Region , Pre-Exposure Prophylaxis , Caribbean Region
4.
Health Qual Life Outcomes ; 19(1): 97, 2021 Mar 19.
Article in English | MEDLINE | ID: mdl-33741000

ABSTRACT

BACKGROUND: The EQ-5D instrument is increasingly used in clinical and resource allocation decision making in developed and developing countries. EQ-5D valuation and population norms studies have been undertaken for Trinidad and Tobago, however no population norms or value sets have been generated for the other Caribbean countries. The aims of this study were to provide population norms for Barbados and Jamaica, and to develop a set of population norms that could be used by the other English-speaking Caribbean countries. METHODS: The EQ-5D-5L self-reported health questionnaire was included in surveys of representative samples of adults in Barbados and adults in Jamaica in 2013. EQ-5D health states, mean EQ VAS scores and mean EQ-5D-5L index values (using the Trinidad and Tobago value set) were calculated for demographic groups in both countries based on 2347 respondents from Barbados and 1423 from Jamaica. A set of 'Caribbean' norms were developed by combining the Barbados and Jamaica data with norms recently published for Trinidad and Tobago. RESULTS: Data were obtained for 2347 and 1423 respondents in Barbados and Jamaica respectively. The mean index and EQ VAS values were 0.943 and 81.9 for Barbados, and 0.948 and 87.8 for Jamaica. The health states most commonly observed in the two countries were similar. Generally the demographic patterns of self-reported health were consistent with those found in other studies. Some differences between the countries were observed in the patterns of rates of reporting problems on the EQ-5D dimensions among age-gender groups specifically for anxiety/depression and pain/discomfort CONCLUSION: This study has produced a set of EQ-5D population norms that can be used as base-line values in clinical and clinico-economic analyses for Barbados and Jamaica and for the English-Speaking Caribbean region.

5.
JAMA Netw Open ; 4(3): e210307, 2021 Mar 01.
Article in English | MEDLINE | ID: mdl-33646313

ABSTRACT

Importance: Rates of breast and ovarian cancer are high in the Caribbean; however, to date, few published data quantify the prevalence of inherited cancer in the Caribbean population. Objective: To determine whether deleterious variants in genes that characterize the hereditary breast and ovarian cancer syndrome are associated with the development of breast and ovarian cancer in the English- and Creole-speaking Caribbean populations. Design, Setting, and Participants: This multisite genetic association study used data from germline genetic test results between June 2010 and June 2018 in the Bahamas, Cayman Islands, Barbados, Dominica, Jamaica, Haiti, and Trinidad and Tobago. Next-generation sequencing on a panel of 30 genes and multiplex ligation-dependent probe amplification (BRCA1 and BRCA2) were performed. Medical records were reviewed at time of study enrollment. Women and men diagnosed with breast and ovarian cancer with at least 1 grandparent born in the participating study sites were included; 1018 individuals were eligible and consented to participate in this study. Data were analyzed from November 4, 2019, to May 6, 2020. Exposures: Breast and/or ovarian cancer diagnosis. Main Outcomes and Measures: Rate of inherited breast and ovarian cancer syndrome and spectrum and types of variants. Results: Of 1018 participants, 999 (98.1%) had breast cancer (mean [SD] age, 46.6 [10.8] years) and 21 (2.1%) had ovarian cancer (mean [SD] age, 47.6 [13.5] years). Three individuals declined to have their results reported. A total of 144 of 1015 (14.2%) had a pathogenic or likely pathogenic (P/LP) variant in a hereditary breast and ovarian cancer syndrome gene. A total of 64% of variant carriers had P/LP variant in BRCA1, 23% in BRCA2, 9% in PALB2 and 4% in RAD51C, CHEK2, ATM, STK11 and NBN. The mean (SD) age of variant carriers was 40.7 (9.2) compared with 47.5 (10.7) years in noncarriers. Individuals in the Bahamas had the highest proportion of hereditary breast and ovarian cancer (23%), followed by Barbados (17.9%), Trinidad (12%), Dominica (8.8%), Haiti (6.7%), Cayman Islands (6.3%), and Jamaica (4.9%). In Caribbean-born women and men with breast cancer, having a first- or second-degree family member with breast cancer was associated with having any BRCA1 or BRCA2 germline variant (odds ratio, 1.58; 95% CI, 1.24-2.01; P < .001). A BRCA1 vs BRCA2 variant was more strongly associated with triple negative breast cancer (odds ratio, 6.33; 95% CI, 2.05-19.54; P = .001). Conclusions and Relevance: In this study, among Caribbean-born individuals with breast and ovarian cancer, 1 in 7 had hereditary breast and ovarian cancer. The proportion of hereditary breast and ovarian cancer varied by island and ranged from 23% in the Bahamas to 4.9% in Jamaica. Each island had a distinctive set of variants.

6.
Allergol. immunopatol ; 49(1): 17-24, ene.-feb. 2021. tab
Article in English | IBECS | ID: ibc-199221

ABSTRACT

OBJECTIVES: The main objective was to determine the prevalence of recurrent wheezing (RW) among infants and toddlers as well as the prevalence of asthma predictive risk factors among those with RW. MATERIALS AND METHODS: A prospective study of a cohort of babies recruited after their birth during July 2015-June 2017. Mothers were contacted using the WhatsApp messaging system for digital follow-up on their baby's condition at 3-monthly intervals until they were 18 months old. Information on wheezing and its correlates were collected by digital follow-up and corroborated at an in-person interview and examination of their baby at 18 months of age. Recurrent wheezing was defined as more than three episodes of wheezing or its correlates during the follow-up period. RESULTS: There were 338 males (41.5%) and 476 (58.5%) females. Overall, 31.1% (95% CI = 27.9%, 34.4%) had RW by 18 months and the same number had RW during their first year of life. Of the infants with RW, 121 (47.8%; 95% CI = 41.6, 54.2) had at least one or both of the major criteria and/or at least two minor criteria of the stringent Asthma Predictive Index (API). Of those with RW, 32.0% received antihistamine and 20% had received antibiotics on their last visit to a physician for wheezing or symptoms of cough, cold, and/or breathing difficulty. CONCLUSIONS: Nearly a third of infants and toddlers had RW and nearly half of the infants with RW had risk factors fulfilling the criteria of the stringent API


No disponible


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Respiratory Sounds/diagnosis , Cohort Studies , Recurrence , Asthma/epidemiology , Prospective Studies , Barbados/epidemiology , Risk Factors , Surveys and Questionnaires , Longitudinal Studies
7.
Allergol Immunopathol (Madr) ; 49(1): 17-24, 2021.
Article in English | MEDLINE | ID: mdl-33528925

ABSTRACT

OBJECTIVES: The main objective was to determine the prevalence of recurrent wheezing (RW) among infants and toddlers as well as the prevalence of asthma predictive risk factors among those with RW. MATERIALS AND METHODS: A prospective study of a cohort of babies recruited after their birth during July 2015-June 2017. Mothers were contacted using the WhatsApp messaging system for digital follow-up on their baby's condition at 3-monthly intervals until they were 18 months old. Information on wheezing and its correlates were collected by digital follow-up and corroborated at an in-person interview and examination of their baby at 18 months of age. Recurrent wheezing was defined as more than three episodes of wheezing or its correlates during the follow-up period. RESULTS: There were 338 males (41.5%) and 476 (58.5%) females. Overall, 31.1% (95% CI = 27.9%, 34.4%) had RW by 18 months and the same number had RW during their first year of life. Of the infants with RW, 121 (47.8%; 95% CI = 41.6, 54.2) had at least one or both of the major criteria and/or at least two minor criteria of the stringent Asthma Predictive Index (API). Of those with RW, 32.0% received antihistamine and 20% had received antibiotics on their last visit to a physician for wheezing or symptoms of cough, cold, and/or breathing difficulty. CONCLUSIONS: Nearly a third of infants and toddlers had RW and nearly half of the infants with RW had risk factors fulfilling the criteria of the stringent API.

8.
BMC Public Health ; 21(1): 399, 2021 Feb 25.
Article in English | MEDLINE | ID: mdl-33632164

ABSTRACT

BACKGROUND: Accurately defining obesity using anthropometric measures that best capture obesity-related risk is important for identifying high risk groups for intervention. The purpose of this study is to compare the association of different anthropometric measures of obesity with 10-year cardiovascular disease (CVD) risk in adults in the Eastern Caribbean. METHODS: Data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were analyzed. The ECS is comprised of adults aged 40 and older residing in the US Virgin Islands, Puerto Rico, Barbados, and Trinidad. 10-year CVD risk was calculated using the American Heart Association (ACC/AHA) ASCVD Risk Algorithm and categorized in the following high-risk groups: > 7.5, > 10, and > 20%. Logistic regression was used to examine associations between four anthropometric measures of obesity (BMI, waist circumference, waist-to-hip ratio, waist-to height ratio) and 10-year CVD risk. RESULTS: Mean age (SD) of participants (n = 1617) was 56.6 years (±10.2), 64% were women, 74% were overweight/obese, and 24% had an ASCVD risk score above 10%. Elevated body mass index (BMI, > 30 kg/m2) and waist circumference were not associated with CVD risk. Elevated waist-to-hip ratio (WHR, > 0.9 men, > 0.85 women) and elevated waist-to-height ratio (> 0.5) were associated with all three categories of CVD risk. Area under the receiver curve was highest for WHR for each category of CVD risk. Elevated WHR demonstrated odds of 2.39, 2.58, and 3.32 (p < 0.0001) for CVD risk of > 7.5, > 10 and > 20% respectively. CONCLUSION: Findings suggest that WHR is a better indicator than BMI of obesity-related CVD risk and should be used to target adults in the Caribbean, and of Caribbean-descent, for interventions.

9.
JAMA ; 325(7): 658-668, 2021 02 16.
Article in English | MEDLINE | ID: mdl-33591345

ABSTRACT

Importance: Pregnancy may be a key window to optimize cardiovascular health (CVH) for the mother and influence lifelong CVH for her child. Objective: To examine associations between maternal gestational CVH and offspring CVH. Design, Setting, and Participants: This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study (examinations: July 2000-April 2006) and HAPO Follow-Up Study (examinations: February 2013-December 2016). The analyses included 2302 mother-child dyads, comprising 48% of HAPO Follow-Up Study participants, in an ancillary CVH study. Participants were from 9 field centers across the United States, Barbados, United Kingdom, China, Thailand, and Canada. Exposures: Maternal gestational CVH at a target of 28 weeks' gestation, based on 5 metrics: body mass index, blood pressure, total cholesterol level, glucose level, and smoking. Each metric was categorized as ideal, intermediate, or poor using pregnancy guidelines. Total CVH was categorized as follows: all ideal metrics, 1 or more intermediate (but 0 poor) metrics, 1 poor metric, or 2 or more poor metrics. Main Outcomes and Measures: Offspring CVH at ages 10 to 14 years, based on 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Total CVH was categorized as for mothers. Results: Among 2302 dyads, the mean (SD) ages were 29.6 (2.7) years for pregnant mothers and 11.3 (1.1) years for children. During pregnancy, the mean (SD) maternal CVH score was 8.6 (1.4) out of 10. Among pregnant mothers, the prevalence of all ideal metrics was 32.8% (95% CI, 30.6%-35.1%), 31.7% (95% CI, 29.4%-34.0%) for 1 or more intermediate metrics, 29.5% (95% CI, 27.2%-31.7%) for 1 poor metric, and 6.0% (95% CI, 3.8%-8.3%) for 2 or more poor metrics. Among children of mothers with all ideal metrics, the prevalence of all ideal metrics was 42.2% (95% CI, 38.4%-46.2%), 36.7% (95% CI, 32.9%-40.7%) for 1 or more intermediate metrics, 18.4% (95% CI, 14.6%-22.4%) for 1 poor metric, and 2.6% (95% CI, 0%-6.6%) for 2 or more poor metrics. Among children of mothers with 2 or more poor metrics, the prevalence of all ideal metrics was 30.7% (95% CI, 22.0%-40.4%), 28.3% (95% CI, 19.7%-38.1%) for 1 or more intermediate metrics, 30.7% (95% CI, 22.0%-40.4%) for 1 poor metric, and 10.2% (95% CI, 1.6%-20.0%) for 2 or more poor metrics. The adjusted relative risks associated with 1 or more intermediate, 1 poor, and 2 or more poor (vs all ideal) metrics, respectively, in mothers during pregnancy were 1.17 (95% CI, 0.96-1.42), 1.66 (95% CI, 1.39-1.99), and 2.02 (95% CI, 1.55-2.64) for offspring to have 1 poor (vs all ideal) metrics, and the relative risks were 2.15 (95% CI, 1.23-3.75), 3.32 (95% CI,1.96-5.62), and 7.82 (95% CI, 4.12-14.85) for offspring to have 2 or more poor (vs all ideal) metrics. Additional adjustment for categorical birth factors (eg, preeclampsia) did not fully explain these significant associations (eg, relative risk for association between 2 or more poor metrics among mothers during pregnancy and 2 or more poor metrics among offspring after adjustment for an extended set of birth factors, 6.23 [95% CI, 3.03-12.82]). Conclusions and Relevance: In this multinational cohort, better maternal CVH at 28 weeks' gestation was significantly associated with better offspring CVH at ages 10 to 14 years.


Subject(s)
Adolescent Health , Cardiovascular System , Child Health , Maternal Health , Pregnancy , Adolescent , Adult , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Child , Cohort Studies , Female , Health Behavior , Humans , Male , Prevalence
10.
Clin Child Psychol Psychiatry ; : 1359104520972447, 2020 Nov 13.
Article in English | MEDLINE | ID: mdl-33183096

ABSTRACT

The extent to which students' level of depressive and anxiety symptoms and student engagement were predicted by parental emotional support, monitoring and harsh parenting was investigated using a series of multiple regression analyses. Grade six students from public primary schools (n = 293; 49% females, 51% males; mean age = 10 years) in Barbados completed the Revised Children's Anxiety and Depression Scale, a Parenting Questionnaire and an adapted Student Engagement scale. Students' level of depressive symptoms were predicted by parental emotional support and harsh parenting, but not by parental monitoring. With the exception of harsh parenting, neither parental emotional support nor parental monitoring were significant predictors of the anxiety levels of students. Student engagement was predicted by all three types of parenting practices. Limitations, recommendations for future research and practical implications of the study are discussed.

11.
Zookeys ; 991: 85-109, 2020.
Article in English | MEDLINE | ID: mdl-33223900

ABSTRACT

The cerithioid Supplanaxis nucleus (Bruguière, 1789) is widespread in the Caribbean, where it lives in often dense aggregates on hard surfaces in the middle-high intertidal. Molecular evidence shows that it comprises two species that are in fact morphologically diagnosable. We fix the nomenclature of Supplanaxis nucleus by designating a sequenced neotype from Bruguière's historical locality of Barbados, and identify the second, cryptic species as S. nancyae (Petuch, 2013). The two live syntopically across the Caribbean and form a closely related species group with the Panamic S. planicostatus (G.B. Sowerby I, 1825). Planaxis nucleola Mörch, 1876, described from St Croix, in the Virgin Islands, never again recorded in the literature but listed as a synonym of S. nucleus in taxonomic authority lists, is recognized as a valid species of Hinea Gray, 1847. Proplanaxis Thiele, 1929 and Supplanaxis Thiele, 1929, are synonyms and the latter is given precedence over the former.

12.
Lancet ; 396(10261): 1511-1524, 2020 Nov 07.
Article in English | MEDLINE | ID: mdl-33160572

ABSTRACT

BACKGROUND: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS: We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING: Wellcome Trust, AstraZeneca Young Health Programme, EU.

13.
BMJ Open ; 10(9): e035981, 2020 09 10.
Article in English | MEDLINE | ID: mdl-32912976

ABSTRACT

OBJECTIVE: Sugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax would differentiate between high-sugar SSBs and low-sugar SSBs. We evaluated these three considerations using pre-existing nutritional survey data in a developing economy setting. METHODS: We used data from a nationally representative cross-sectional survey in Barbados (2012-2013, prior to SSB tax implementation). Data were available on 334 adults (25-64 years) who completed two non-consecutive 24-hour dietary recalls. We estimated the prevalence of SSB consumption and its contribution to total energy intake, overall and stratified by taxable status. We assessed the percentage of SSB-derived free sugars subject to the tax and identified the consumption-weighted sugar concentration of SSBs, stratified by taxable status. FINDINGS: Accounting for sampling probability, 88.8% of adults (95% CI 85.1 to 92.5) reported SSB consumption, with a geometric mean of 2.4 servings/day (±2 SD, 0.6, 9.2) among SSB consumers. Sixty percent (95% CI 54.6 to 65.4) of SSB-derived free sugars would be subject to the tax. The tax did not clearly differentiate between high-sugar beverages and low-sugar beverages. CONCLUSION: Given high SSB consumption, targeting SSBs was a sensible strategy in this setting. A substantial percentage of free sugars from SSBs were not covered by the tax, reducing possible health benefits. The considerations proposed here may help policymakers to design more effective SSB taxes.

14.
Expert Opin Pharmacother ; 21(18): 2225-2230, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32835542

ABSTRACT

INTRODUCTION: Treatment of glaucoma and systemic hypertension requires careful balancing of ophthalmic and systemic medications. This report offers background on various common therapies and considerations to minimize undesirable systemic and ophthalmic outcomes. AREAS COVERED: Key considerations relating to medical treatments for systemic hypertension and glaucoma chosen from a review of the literature are included. The historic safety of ophthalmic beta blockers and sub-types as well as combination agents are described. The potential role of ocular perfusion pressure in the pathogenesis of glaucoma is reviewed with a discussion of landmark studies, including the Barbados Eye Study and the Early Manifest Glaucoma Trial, with implications for medication choices for hypertension and glaucoma. Systemic antihypertensives are considered with regards to their potential association with glaucoma and its progression, especially in patients with low blood pressure and normal tension glaucoma. Opinions are offered with regard to therapeutic choices and considerations. EXPERT OPINION: The medical treatment of systemic hypertension and glaucoma carries the potential for drug interactions and significant adverse effects requiring customization for each patient's particular issues. The evolution of new therapies and treatment paradigms, including laser as a first-line treatment, has expanded safe options and minimized potential dangers for high-risk patients.

15.
J Med Internet Res ; 22(7): e14591, 2020 07 20.
Article in English | MEDLINE | ID: mdl-32706693

ABSTRACT

BACKGROUND: Data standards for race and ethnicity have significant implications for health equity research. OBJECTIVE: We aim to describe a challenge encountered when working with a multiple-race and ethnicity assessment in the Eastern Caribbean Health Outcomes Research Network (ECHORN), a research collaborative of Barbados, Puerto Rico, Trinidad and Tobago, and the US Virgin Islands. METHODS: We examined the data standards guiding harmonization of race and ethnicity data for multiracial and multiethnic populations, using the Office of Management and Budget (OMB) Statistical Policy Directive No. 15. RESULTS: Of 1211 participants in the ECHORN cohort study, 901 (74.40%) selected 1 racial category. Of those that selected 1 category, 13.0% (117/901) selected Caribbean; 6.4% (58/901), Puerto Rican or Boricua; and 13.5% (122/901), the mixed or multiracial category. A total of 17.84% (216/1211) of participants selected 2 or more categories, with 15.19% (184/1211) selecting 2 categories and 2.64% (32/1211) selecting 3 or more categories. With aggregation of ECHORN data into OMB categories, 27.91% (338/1211) of the participants can be placed in the "more than one race" category. CONCLUSIONS: This analysis exposes the fundamental informatics challenges that current race and ethnicity data standards present to meaningful collection, organization, and dissemination of granular data about subgroup populations in diverse and marginalized communities. Current standards should reflect the science of measuring race and ethnicity and the need for multidisciplinary teams to improve evolving standards throughout the data life cycle.

16.
Psychiatry Res ; 290: 113016, 2020 08.
Article in English | MEDLINE | ID: mdl-32682171

ABSTRACT

Childhood adversities are linked with mental health problems throughout the life course, including personality pathology. Less is known about consequences in the next generation, particularly in non-Western populations. In the Barbados Nutrition Study, we assessed associations of two parental (G1) childhood adversities- (1) maltreatment history using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and (2) clinically ascertained infant malnutrition limited to the first year of life-on PD symptoms in their G2 offspring, using NEO FFM PD prototypes. In linear regression models clustered by family and adjusted for other G1 childhood adversities and family socioeconomic status, we found that G1 parental history of childhood maltreatment was significantly associated with increased G2 offspring Borderline, Histrionic, Narcissistic, and Dependent PD scores. When G1 childhood malnutrition was the exposure of interest, we found a significant association with Schizoid PD scores. When the sample was restricted to offspring of G1 mothers, even more extensive associations with G2 personality pathology were observed. This study supports a link between parental exposure to childhood adversities and increased personality maladaptivity in the next generation, with some specific patterns worthy of further exploration.

17.
J Exp Biol ; 223(Pt 13)2020 Jul 07.
Article in English | MEDLINE | ID: mdl-32636241

ABSTRACT

Sandra Binning is an Assistant Professor at the Université de Montréal, Canada, and Dominique Roche is a Marie Curie Fellow at Carleton University, Canada. Together, they investigate how animals respond to environmental stressors. Binning and Roche completed their undergraduate degrees in Biology and master's degrees at McGill University, Canada, before undertaking their PhDs at the Australian National University, Australia. The pair then moved to the University of Neuchâtel, Switzerland, for a 4 year postdoc period. Binning and Roche tell us about working in field locations ranging from Barbados and Panama to Uganda and the Great Barrier Reef, and discuss scuba diving and safety when working in dangerous conditions.

18.
Article in English | MEDLINE | ID: mdl-32675331

ABSTRACT

We analyze and comment on a legal case (Edward Gatherer v. Drexel Gomez, 1989) from Barbados. We theorize that in this kind of case a forensic psychiatrist consultant could helpfully advise the principals regarding pitfalls to avoid in resolving their conflict. Use of the consultant has certain advantages over taking such disputes to courts of law. In this case the rector of an Anglican Church in Barbados sued the bishop of his diocese. At question was whether the mandatory retirement age of 65 years applied to the rector. The case was eventually appealed to the United Kingdom's Judicial Committee of the Privy Council, and their decision was rendered in June 1992 in favor of the plaintiff. We describe a reference framework of techniques and methods that we think would be useful in this hypothetical forensic consultation. One important aspect of the analysis and case commentary is that going to court circumvents the obligation of those having disputes in this unique space to safeguard each other's dignity. The court system ignores reconciliation of the disputants to each other and to the Church body. We explore the complexity that attaches to transcultural forensic consultation.

19.
J Glob Health ; 10(1): 010427, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32566165

ABSTRACT

2Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. Background: The Sustainable Development Goals call for inclusive, equitable and quality learning opportunities for all. This is especially important for children, to ensure they all develop to their full potential. We studied the prevalence and inequalities of suspected delay in child development in 63 low- and middle-income countries. Methods: We used the early child development module from national health surveys, which covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track. We calculated the age-adjusted prevalence of suspected delay at the country level and stratifying by wealth, urban/rural residence, sex of the child and maternal education. We also calculated measures of absolute and relative inequality. Results: We studied 330 613 children from 63 countries. Prevalence of suspected delay for the ECDI ranged from 3% in Barbados to 67% in Chad. For all countries together, 25% of the children were suspected of developmental delay. At regional level, prevalence of delay ranged from 10% in Europe and Central Asia to 42% in West and Central Africa. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large inequalities, and most markedly for the literacy-numeracy domain. Conclusions: To date, our study presents the most comprehensive analysis of child development using an instrument especially developed for national health surveys. With a quarter of the children globally suspected of developmental delay, we face an immense challenge. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving these children behind.

20.
Article in English | MEDLINE | ID: mdl-32513678

ABSTRACT

New ways of encouraging discussion and education around the topic of do not attempt cardiopulmonary resuscitation (DNACPR) decisions in healthcare can prove challenging. Cardiopulmonary resuscitation is still portrayed as an intervention that is successful even in people with multiple long-term conditions. In 2020, during the first months of the COVID-19 pandemic, a letter from a palliative care doctor to his patient was read out as part of an online campaign entitled #ReadALetter, organised by the organisation Letters Live. The letter addresses misconceptions regarding DNACPR decisions and encourages thoughtful dialogue. In particular, it promotes an individualised approach for clinicians, and investigates one patient's journey: from initially rejecting the concept, to later on fully embracing it as part of his holistic care. A journey that took him to Barbados, amongst other places.

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