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1.
Ticks Tick Borne Dis ; 12(4): 101727, 2021 Apr 09.
Article in English | MEDLINE | ID: mdl-33865177

ABSTRACT

Anaplasma platys is a tick-transmitted rickettsial pathogen, which is known to be the etiologic agent for cyclic thrombocytopenia in its primary canine host. Infections with this pathogen are also reported in cats, cattle and people. Similarly, Ehrlichia canis is another tick-borne rickettsial pathogen responsible for canine monocytic ehrlichiosis and is also reported to cause infections in people. We describe infections in dogs with these two pathogens on the Caribbean island of Grenada, West Indies by detection using molecular methods. We utilized a 16S rRNA gene-based PCR assay to detect both Ehrlichia and Anaplasma species by screening 155 canine blood samples from asymptomatic dogs. We found 18.7 % of the dogs to be positive for A. platys and 16.8 % for E. canis. Samples that tested positive for A. platys were further assessed by sequence analysis targeting 16S rRNA, 23S rRNA, citrate synthase (gltA) and heat shock protein (groEL) genes. Phylogenetic analysis revealed high correlation of A. platys 16S rRNA and gltA gene sequences with the geographic origins, while 23S rRNA and groEL gene sequences clustered independent of the geographic origins. This study represents an important step in defining the widespread distribution of active rickettsial infections in Caribbean dogs with no apparent clinical signs, thus posing a high risk for canine health and to a lesser extent to humans, as most dogs in the Caribbean are free-roaming.

2.
Article in English | MEDLINE | ID: mdl-33884439

ABSTRACT

PURPOSE: Psychiatric hospitals or mental asylums grew across the world in the colonial era. Despite concerns over quality of care and human rights violations, these hospitals continue to provide the majority of mental health care in most low- and middle-income countries (LMICs). We sought to review the evidence of reform of mental hospitals and associated patient outcomes. METHODS: We adopted an integrative review methodology by including experimental and non-experimental research. The review protocol was registered on PROSPERO (CRD42019130399). A range of databases and systematic hand searches were conducted by two independent reviewers. Research conducted between 1980 and May 2019, that focused on any aspect of reform in mental hospitals for adults (age 18 and upwards) with severe mental illness and published in English, were considered. RESULTS: 16 studies were included in the review. 12 studies met inclusion criteria, and four additional reports emerged from the hand search. Studies covered-India, China, South Africa, Grenada, Georgia, Sri Lanka, Argentina and Brazil. Key findings emphasise the role of judicial intervention as a critical trigger of reform. Structural reform composed of optimisation of resources and renovations of colonial structures to cater to diverse patient needs. Process reforms include changes in medical management, admission processes and a move from closed to open wards. Staff engagement and capacity building have also been used as a modality of reform in mental hospital settings. CONCLUSION: There is some documentation of reform in psychiatric hospitals. However, poor methodological quality and variation in approach and outcomes measured, make it challenging to extrapolate specific findings on process or outcomes of reform. Despite being integral service providers, psychiatric hospitals still do not adopt patient centric, recovery-oriented processes. Hence, there is an urgent need to generate robust evidence on psychiatric reform and its effect on patient outcomes.

3.
Zootaxa ; 4951(3): zootaxa.4951.3.2, 2021 Apr 07.
Article in English | MEDLINE | ID: mdl-33903389

ABSTRACT

The Lesser Antillean island chain in the eastern Caribbean formerly supported a diverse rodent fauna including multiple endemic genera of oryzomyine rice rats. The Caribbean rice rats are now all extinct, with most island populations known only from Holocene palaeontological and zooarchaeological material and with many remaining taxonomically undescribed. Rice rat material is reported from several pre-Columbian Ceramic Age (late Holocene) archaeological sites on the Grenada Bank, including sites on Grenada and Carriacou, but the taxonomic identity and diversity of the Grenada Bank rice rats has remained uncertain. We provide a morphology-based description of rice rats from Grenada and Carriacou, and analyze their phylogenetic and biogeographical affinities to other Caribbean and mainland Neotropical oryzomyines. We recognize two taxa from the Grenada Bank: we describe the new species Megalomys camerhogne from Pearls (Grenada), representing the largest-bodied member of the extinct endemic Caribbean genus Megalomys, and we refer smaller-bodied oryzomyine material from Pearls and Sabazan (Carriacou) to the widespread extant Neotropical species Zygodontomys brevicauda. Body size variation within Megalomys correlates with island bank area and might thus reflect historical rather than modern biogeography. Zygodontomys specimens from the Grenada Bank fall within the upper end of size variation in extant populations and may constitute an example of 'island gigantism', but it is possible that occurrence of this widespread species on the Grenada Bank might reflect prehistoric human-mediated translocation. We predict further endemic Caribbean rice rat taxa remain to be discovered, including a possible species of Megalomys on the neighbouring island of St. Vincent.

4.
Zootaxa ; 4958(1): zootaxa.4958.1.43, 2021 Apr 14.
Article in English | MEDLINE | ID: mdl-33903490

ABSTRACT

Only three species assigned to two genera of the flat bug subfamily Carventinae Usinger, 1950 are recorded to date from Costa Rica and one genus and species from Grenada. Following apterous carventine taxa are described and illustrated in the present paper: Joceliaptera graziae gen. et sp. nov.; Peggicoris cahuitanus sp. nov.; Peggicoris grenadensis sp. nov. Joceliaptera gen. nov. is compared with most similar Neotropical genera. A key to species of Peggicoris is presented.

5.
J Parasitol ; 107(2): 267-274, 2021 Mar 01.
Article in English | MEDLINE | ID: mdl-33784742

ABSTRACT

The hawksbill turtle Eretmochelys imbricata is a critically endangered species with a worldwide distribution. Limited information is available about the naturally occurring intestinal parasites of this species and what impact these parasites may have on the health of the hawksbill turtle. Diaschistorchis pandus was identified postmortem in 5 hawksbill turtles from Grenada, West Indies, using morphologic characterization. Sanger sequencing was performed for conserved ribosomal regions (5.8S, ITS2, 28S) and the mitochondrial cytochrome c oxidase subunit 1 gene (COI). Phylogenetic analysis of the 28S rRNA gene sequence data shows D. pandus clustering with other trematodes in the family Pronocephalidae, corroborating morphological classification. No genetic sequences have been previously reported for this trematode species, which has limited the collection of objective epidemiological data about this parasite of marine turtles.

6.
Pathogens ; 10(2)2021 Feb 10.
Article in English | MEDLINE | ID: mdl-33578784

ABSTRACT

Infections with tick-borne pathogens belonging to Anaplasma/Ehrlichia in various vertebrate hosts are a persistent problem resulting in nonspecific clinical signs during early infection. Diagnosis of single and multi-infections with these pathogens, causing diseases in companion/agricultural animals and people, remains a challenge. Traditional methods of diagnosis, such as microscopy and serology, have low sensitivity and specificity. Polymerase chain reaction (PCR) assays are widely used to detect early-phase infections, since these have high sensitivity and specificity. We report the development and validation of an assay involving PCR followed by magnetic capture method using species-specific oligonucleotides to detect six Anaplasma/Ehrlichia species pathogens in canine, bovine, caprine, and ovine blood samples. Overall, the assay application to 455 samples detected 30.1% (137/455) positives for one or more out of six screened pathogens. Single-pathogen infections were observed in 94.9% (130/137) of the positive samples, while co-infections were detected in 5.1% (7/137). Anaplasma marginale infection in cattle had the highest detection rate (34.4%), followed by canines positive for Anaplasma platys (16.4%) and Ehrlichia canis (13.9%). The assay aided in documenting the first molecular evidence for A. marginale in cattle and small ruminants and Ehrlichia chaffeensis and Ehrlichia ewingii in dogs in the Caribbean island of Grenada.

7.
J Contin Educ Health Prof ; 41(1): 16-23, 2021 01 01.
Article in English | MEDLINE | ID: mdl-33433130

ABSTRACT

INTRODUCTION: The conceptual framework of One Health (OH) provides a strategy for promoting collaboration across the nexus of animal, human, and environmental health, which is essential for tackling emerging disease threats, such as COVID-19. However, there is no accreditation requirement for OH to prepare students across the professions for collaborative practice. This study aimed to explore the perspectives of faculty across the medical, veterinary, and public health programs about the need, opportunities, and challenges of developing OH in the curricula. METHODS: In this qualitative study, faculty across the three disciplines were invited to participate in audio-recorded, focus group interviews. Recordings were transcribed verbatim and analyzed using inductive and deductive thematic analysis. RESULTS: All participants recognized the need for OH as a critical concept for preparing students for collaborative practice. Opportunities were identified for shared learning and research across the disciplines, particularly through the use of interprofessional education. The lack of an accreditation mandate for OH in the medical curriculum was perceived to be the greatest challenge, leading to an anticipation of significant resistance among medical educators and students. DISCUSSION: Successful development of OH in all three curricula is vital to prepare students for current and future threats to global health. The role of accreditation bodies in ensuring medical, veterinary, and public health curricula prepare students for these threats is crucial. Implications for practice include strategies for persuading medical educators and medical students to embrace OH in the curriculum and promote a culture of shared learning.


Subject(s)
/epidemiology , Education, Medical , Education, Veterinary , Faculty/psychology , Interprofessional Education , Public Health/education , Adult , Curriculum , Female , Focus Groups , Grenada/epidemiology , Humans , Male , Needs Assessment , Qualitative Research
8.
Perit Dial Int ; : 896860820982221, 2021 Jan 05.
Article in English | MEDLINE | ID: mdl-33402053

ABSTRACT

Omental wrapping is a common cause of peritoneal catheter malfunction. This diagnosis should be confirmed by radiography before proceeding with surgical omentectomy. We report two cases of peritoneal dialysis (PD) catheter outflow obstruction from our developing PD program in Grenada, in which contrast studies accurately diagnosed omental wrap, allowing for prompt surgical correction. In both cases, the contrast study indicated the presence of omental wrapping, confirmed at time of surgical correction. Radiographic features of omental wrap are distinctive, which allows for reliable differentiation from other causes of obstruction. Radiographic contrast study reliably diagnoses the cause of peritoneal catheter obstruction, permitting prompt diagnosis and treatment. This is vital for regions with limited access to haemodialysis.

9.
Vet Parasitol ; 290: 109337, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33476902

ABSTRACT

Toxoplasma gondii infections are common in humans and animals worldwide. The present review summarizes worldwide information on the prevalence of clinical and subclinical infections, epidemiology, diagnosis, and genetic diversity of T. gondii in wild canids and other carnivores for the past decade. Seroprevalence estimates of T. gondii worldwide were tabulated for each host. Seroprevalence in wild foxes was very high compared with farmed Arctic foxes. Economic and public health aspects of some of the carnivore species raised for fur and meat (raccoon dogs, mink) are discussed. Diagnostic efficacies of different serological methods and PCR methods are discussed. Clinical toxoplasmosis was observed mainly in carnivores concurrently infected with immunosuppressive Canine Distemper Virus infection. Abortion and blindness were noted in mink. Genetic diversity of isolates using DNA derived from 162 (89 viable T. gondii isolates and 73 DNA extracted from tissues) of wild carnivores from several countries is discussed. However, 69 of the 162 T. gondii isolates were strains from USA and these were genetically diverse with predominance of ToxoDB genotypes #4 and #5 (haplogroup 12). Only limited information is available concerning genotyping of T. gondii isolates from other countries; none of the 93 T. gondii isolates from other countries (Brazil, China, France, Grenada) were haplogroup 12.

10.
Mol Genet Genomic Med ; 9(1): e1567, 2021 01.
Article in English | MEDLINE | ID: mdl-33332776

ABSTRACT

BACKGROUND: Grenada is a small, resource-limited Caribbean country with a high incidence of sickle cell disease (SCD). Since little is known about the challenges facing individuals living with SCD in the West Indies, we sought to assess barriers to healthcare and the impact of SCD on quality of life in Grenada. METHODS: Both adults aged 18+ (n = 19) and caregivers of children aged 2-17 (n = 26) completed validated survey measures regarding barriers to care and quality of life, along with a genetics knowledge questionnaire. Caregivers also completed a caregiver burden scale. Survey scores were calculated, and responses were analyzed for an association between demographic variables. RESULTS: The Barriers to Care Questionnaire, in which lower scores indicate more barriers, revealed that both adults (mean = 69.9) and children (mean = 75.5) with SCD experienced reduced access to care. The Adult Sickle Cell Quality of Life Measurement Information System indicated increased depression and loneliness in adults, with the lowest scores in the Emotional subscale. However, the Pediatric Quality of Life Inventory answered by caregivers of children with SCD showed the lowest scores in the Physical Functioning subscale. Further analysis using the Caregiver Burden Scale-Zarit Burden Interview revealed that 53.8% of caregivers of children with SCD indicated "little to no burden," which may reflect a difference in cultural expectations of a caregiver between high-income countries and Grenada. Finally, ~80% of respondents knew that SCD was a genetic condition; however, 61%-84% could not correctly indicate recurrence risks, demonstrating a need for additional education. CONCLUSION: These data provide new insights regarding the experience of living with SCD in Grenada and support the need for further investigations into specific barriers to healthcare delivery, which could also improve education and well-being for those affected by SCD in Grenada and in the broader Caribbean community.

11.
BMJ Open ; 10(12): e042869, 2020 12 12.
Article in English | MEDLINE | ID: mdl-33310811

ABSTRACT

OBJECTIVES: To summarise the occurrence of congenital Zika syndrome (CZS) in Latin America and the Caribbean from 2015 to 2017 using two outcome measures derived from infectious disease surveillance reports and to assess the completeness of these reports. DESIGN: Surveillance study. SETTING: Pan American Health Organization (PAHO)/WHO epidemiology reports on confirmed and suspected Zika virus infection and cases of CZS. PARTICIPANTS: Populations of 47 countries in the South and Central Americas, Mexico and the Caribbean. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of CZS cases per 1000 births (using 2016-2017 births as a denominator) and the number of CZS cases per 1000 births in women with Zika virus infection during pregnancy. RESULTS: By 4 January 2018, 548623 suspected and 239063 confirmed Zika virus infections had been reported to PAHO/WHO from 47 countries. In 25 countries, over 80% of infections were reported as suspected. There were 3617 confirmed CZS cases in 25 countries; 2952 (82%) had occurred in Brazil. The number of CZS cases per 1000 births varied considerably with Brazil and several Caribbean island communities (Puerto Rico, St Martin, Martinique, Guadeloupe and Grenada) having the highest CZS prevalence above 0.5 per 1000 births. Analysing the number of CZS cases per 1000 births in women infected with Zika virus during their pregnancy highlighted the inaccuracies of the data, with Venezuela likely to have had severe under-reporting of CZS. CONCLUSIONS: Expressing data on CZS in relation to total births, rather than as absolute numbers, better illustrates the burden of disease, providing that under-reporting of CZS is not too severe. Data on infections in pregnant women enable potential under-reporting of CZS to be identified. Both measures are recommended for future PAHO/WHO publications. Evidence of severe under-reporting of Zika virus infections and CZS makes interpretation of the data and comparisons between countries challenging.


Subject(s)
Communicable Diseases , Epidemics , Microcephaly , Pregnancy Complications, Infectious , Zika Virus Infection , Zika Virus , Brazil , Female , Grenada/epidemiology , Humans , Infant, Newborn , Latin America/epidemiology , Martinique/epidemiology , Mexico/epidemiology , Microcephaly/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Puerto Rico/epidemiology , Venezuela/epidemiology , Zika Virus Infection/epidemiology
12.
PLoS Negl Trop Dis ; 14(11): e0008874, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33253174

ABSTRACT

Children with Congenital Zika Syndrome and microcephaly are at high risk for epilepsy; however, the risk is unclear in normocephalic children with prenatal Zika virus (ZIKV) exposure [Exposed Children (EC)]. In this prospective cohort study, we performed epilepsy screening in normocephalic EC alongside a parallel group of normocephalic unexposed children [Unexposed Children (UC)]. We compared the incidence rate of epilepsy among EC and UC at one year of life to global incidence rates. Pregnant women were recruited from public health centers during the ZIKV outbreak in Grenada, West Indies and assessed for prior ZIKV infection using a plasmonic-gold platform that measures IgG antibodies in serum. Normocephalic children born to mothers with positive ZIKV results during pregnancy were classified as EC and those born to mothers with negative ZIKV results during and after pregnancy were classified as UC. Epilepsy screening procedures included a pediatric epilepsy screening questionnaire and video electroencephalography (vEEG). vEEG was collected using a multi-channel microEEG® system for a minimum of 20 minutes along with video recording of participant behavior time-locked to the EEG. vEEGs were interpreted independently by two pediatric epileptologists, who were blinded to ZIKV status, via telemedicine platform. Positive screening cases were referred to a local pediatrician for an epilepsy diagnostic evaluation. Epilepsy screens were positive in 2/71 EC (IR: 0.028; 95% CI: 0.003-0.098) and 0/71 UC. In both epilepsy-positive cases, questionnaire responses and interictal vEEGs were consistent with focal, rather than generalized, seizures. Both children met criteria for a clinical diagnosis of epilepsy and good seizure control was achieved with carbamazepine. Our results indicate that epilepsy rates are modestly elevated in EC. Given our small sample size, results should be considered preliminary. They support the use of epilepsy screening procedures in larger epidemiological studies of children with congenital ZIKV exposure, even in the absence of microcephaly, and provide guidance for conducting epilepsy surveillance in resource limited settings.

13.
J Food Prot ; 2020 Oct 09.
Article in English | MEDLINE | ID: mdl-33038258

ABSTRACT

Scombroid poisoning is a seafood-associated disease in which consumed fish contain high levels of histamine, resulting in allergic-like symptoms that range from mild to occasionally severe. To date, there is no published information on scombroid poisoning on the Caribbean island of Grenada, West Indies, particularly with respect to Selar crumenophthalmus. This is a common and heavily-consumed fish that has been implicated in scombroid poisoning in Hawaii. Preliminary data on S. crumenophthalmus in Grenada have demonstrated the presence of Photobacterium damselae, a bacterium associated with scombroid poisoning. The present study further tested S. crumenophthalmus purchased in Grenada for factors indicating the potential for scombroid poisoning, including increased histamine levels in fish muscle and DNA evidence of bacteria associated with scombroid poisoning. Results demonstrated histamine levels between 7,160 and 66,688 ppm after temperature abuse at 37°C for 19 hours (h), far exceeding the acceptable limit for both the USA (50 ppm) and European Union (100-200 ppm). Even after 4 h incubation at ambient temperature (28.9°C) during a time-point study, histamine levels exceeded USA acceptable limits (>50 ppm); and five samples used for temperature-abuse studies had elevated histamine levels (ranging from 141 to 2510 ppm) at 0 h. PCR and sequence analysis of bacteria in temperature-abused fish identified P. damselae and Morganella morganii, both of which have been documented as histamine-producing bacteria implicated in scombroid poisoning. These results suggest the potential for scombroid poisoning in Grenada and the need for promoting awareness about this disease.

14.
PLoS Negl Trop Dis ; 14(10): e0008546, 2020 10.
Article in English | MEDLINE | ID: mdl-33017393

ABSTRACT

BACKGROUND: The 2005-06 chikungunya virus (CHIKV) outbreak in La Réunion suggested that mothers could transmit CHIKV to their neonates while viremic during the intrapartum period, and more than half of the infected neonates showed impaired neurodevelopment at two years of age. However, data sparsity precluded an overview of the developmental impact of vertical infection within the whole prenatal period. OBJECTIVE & METHODS: The current study assessed two-year old children born to mothers who were infected during the 2014 CHIKV outbreak in Grenada to determine the neurodevelopmental impact of perinatal CHIKV infection throughout gestation. Mother and child infection status were confirmed by serologic testing (IgG and IgM) for CHIKV. Cognitive, fine motor, gross motor, language and behavioral outcomes were assessed at two years of age on the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA). RESULTS: No differences in neurodevelopmental outcomes were observed between two-year-old children born to mothers infected with CHIKV during gestation (n = 149) and those born to mothers not infected with CHIKV (n = 161). No differences were found in INTER-NDA scores between children infected with CHIKV (n = 47) and children not infected with CHIKV (n = 592). Likewise, there were no differences between children infected with CHIKV post-partum (n = 19) versus children not infected with CHIKV (n = 592). CONCLUSION: Our findings suggest that children exposed and/or infected with CHIKV outside of the intrapartum period experience no significant neurodevelopmental delay at two years of age, as measured by the INTER-NDA, compared to their unexposed and/or uninfected peers. These results complement those of previous studies which showed a neurodevelopmental risk only for children infected during the intrapartum period, while the mother was highly viremic. These results might be reassuring for women of childbearing age and public health officials in CHIKV-endemic regions.

15.
Zootaxa ; 4830(3): zootaxa.4830.3.4, 2020 Aug 14.
Article in English | MEDLINE | ID: mdl-33056145

ABSTRACT

After reviewing the systematics and distribution of the living and fossil small West Indian taxa of Tytonidae (Tyto), we reached the following conclusions: (1) Strix tuidara J. E. Gray, 1827, type locality of Brazil, is the earliest available and correct name to be used in a binomen for New World mainland barn owls; (2) the North American mainland subspecies Tyto tuidara pratincola (Bonaparte, 1838), new combination, is resident in the Bahamas ("Tyto perlatus lucayanus" Riley, 1913, is a synonym), where it probably did not colonize until after the European introduction of Rattus Fischer, in Hispaniola (Dominican Republic and Haiti) where it became established in the 20th century, and subsequently in Puerto Rico; (3) Tyto furcata (Temminck, 1827) of Cuba, Jamaica and the Cayman Islands is a different species restricted to its insular distribution, with "T. alba niveicauda" Parkes Phillips, 1978, of the Isle of Pines (now Isla de la Juventud) as a synonym; (4) the distinct species Tyto glaucops (Kaup, 1852), now endemic to Hispaniola, once occurred in Puerto Rico, as the fossil species "T. cavatica" Wetmore, 1920, is here shown to be a synonym; (5) the smallest taxon Tyto insularis (Pelzeln, 1872) of the southern Lesser Antilles is treated as a separate species, in which the nominate subspecies T. i. insularis (St. Vincent, Grenada, and the Grenadines) differs slightly but consistently in coloration from T. i. nigrescens (Lawrence, 1878) of Dominica; (6) another barn owl, Tyto maniola, new species, of this group of small tytonids from the West Indies inhabited Cuba during part of the Quaternary, and is here named and described.


Subject(s)
Strigiformes , Animals , Fossils , Rats , West Indies
16.
Zootaxa ; 4838(4): zootaxa.4838.4.7, 2020 Aug 28.
Article in English | MEDLINE | ID: mdl-33056806

ABSTRACT

The known cicada fauna of the Republic of Trinidad and Tobago is identified. Calyria hyperochelabrys n. sp., Carineta trinidadensis n. sp., and Herrera grammosticta n. sp. are described as new. The first records of Fidicinoides descampsi Boulard Martinelli, 1996, Proarna hilaris (Germar, 1834), Guyalna bogotana (Distant, 1892a), Majeorona aper (Walker, 1850), Taphura boulardi Sanborn, 2011a, Carineta matura Distant, 1892b, and Herrera nigropercula Sanborn, 2020b are provided. The first reports for the genera Guyalna Boulard Martinelli, 1996, Majeorona Distant, 1905d, Calyria Stål, 1862, Carineta Amyot Audinet-Serville, 1843 and Herrera Distant, 1905c and the tribes Parnisini Distant, 1905e and Carinetini Distant, 1905c are represented by the records for the new species and new records. The first records of Proarna hilaris (Germar, 1830) for Anegada, Antigua, Grenada, Canoun Island, Mayreau Island and Union Island in the Grenadines, Little St. James, Little Thatch Island, Montserrat, Mosquito Island, and St. Kitts, Proarna palisoti (Metcalf, 1963a) for Navarro Island, Majeorona aper (Walker, 1850) for Grenada, and Ariasa albimaculosa Sanborn, 2016c for Bonaire are provided to increase the known distributions of these species and the Caribbean fauna. The currently known cicada fauna for Trinidad is increased here to 15 species representing ten genera, four tribes and two subfamilies. Only Quesada gigas (Olivier, 1790) is known currently from Tobago.


Subject(s)
Culicidae , Hemiptera , Animals , Trinidad and Tobago
17.
BJOG ; 2020 Oct 11.
Article in English | MEDLINE | ID: mdl-33040457

ABSTRACT

OBJECTIVE: To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). DESIGN: Retrospective observational study. SETTING: Grenada. POPULATION: Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible. METHODS: This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA. MAIN OUTCOME MEASURES: Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity. RESULTS: Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (µ = 898 days, σ = 277 days) compared with infections outside of pregnancy (µ = 1064 days, σ = 244 days) (P < 0.0001). Rates of pregnancy complications (RR = 0.76, P = 0.599), intrapartum complications (RR = 1.50, P = 0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%). CONCLUSION: CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV. TWEETABLE ABSTRACT: Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.

18.
Dent J (Basel) ; 8(3)2020 Sep 09.
Article in English | MEDLINE | ID: mdl-32916915

ABSTRACT

If high-conflict family environments are cariogenic across cultures, and can be studied in cultures where both these environments and cariogenic dental practices are particularly prevalent, this would afford the opportunity to examine how these two pathways of risk might interact, laying the stage for culturally competent, integrated prevention efforts. The first investigation involved qualitative data about perceptions of oral health and family stressors in Grenadian families with school-aged children. The second study used a questionnaire and observational data to assess relations among oral health behaviors, relationship satisfaction, parenting, and child behavior; it also included a pilot study of Motivational Interviewing. Most of the themes discussed in focus groups suggested overlap between U.S. and Grenadian parents; possible culture-specific issues were high prevalence of single-parent homes, normativity of physical discipline, less preventive dental care, and more fatalistic view of oral health outcomes. Significant associations were found between parent and child oral health behaviors, between child externalizing and internalizing behaviors, and between family variables (e.g., relationship satisfaction, child behavior) and oral health behaviors (e.g., parent flossing, child brush time). The results strongly support the need for research on the relations between family functioning and oral health to be embedded within culture.

19.
Vet Parasitol ; 284: 109194, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32866837

ABSTRACT

Canine heartworm disease (CHD) results from infection with Dirofilaria immitis and while it is of global concern, it is most prevalent in tropical climates where conditions support the parasite and vector life cycles. Melarsomine dihydrochloride is the sole treatment for CHD recommended by the American Heartworm Society. However, in cases where cost or access to melarsomine precludes treatment of an infected dog, therapeutic alternatives are warranted. This randomized, controlled field study evaluated the adulticidal efficacy of a combination therapeutic protocol using 10 % imidacloprid + 2.5 % moxidectin spot-on and a single 28-day course of doxycycline and compared with that of a 2-dose melarsomine dihydrochloride protocol. Of 37 naturally-infected domestic dogs with class 1, 2 or early class 3 CHD enrolled in the study, 30 were evaluated for a minimum of 12 months. Seven dogs were withdrawn due to canine ehrlichiosis, non-compliance, or wrongful inclusion. Dogs were randomly assigned to a control (CP, n = 15) or investigational (IVP, n = 15) treatment group. CP dogs received two injections of melarsomine dihydrochloride (2.5 mg/kg) 24 -hs apart and maintained on monthly ivermectin/pyrantel. IVP dogs were treated with oral doxycycline (10 mg/kg twice daily for 28 days) and topical 10 % imidacloprid + 2.5 % moxidectin once monthly for 9 months. Dogs were evaluated up to 18 months - monthly for the first 9 months, then every 3 months. Parasiticidal efficacy was based on antigen status using the IDEXX PetChek® 34 Heartworm-PF Antigen test. By month 18, antigen was not detected in any study dog except one from the IVP group. One other IVP dog was persistently antigenemic and treated with melarsomine at month 12 according to the initial study protocol. Mean antigen concentration (based on optical density) decreased more rapidly in the CP group and by month 15 was 0.11 for the IVP and 0.07 for CP groups, with equivalent median concentrations (0.04) in both groups. Conversion following heat-treatment of antigen-negative samples occurred frequently and at similar rates in both treatment groups. Based on the bias of diagnostic tests towards detection of female worms, we conclude that monthly application of 10 % imidacloprid + 2.5 % moxidectin for 9 months combined with a course of doxycycline twice daily for 28 days resulted in effective therapy against female adults in CHD. This therapeutic option may be particularly useful in cases where financial constraint or access to melarsomine precludes treatment of an infected individual. This study was supported by Bayer Animal Health.

20.
Article in English | MEDLINE | ID: mdl-32742667

ABSTRACT

Background: Mental disorders are the leading cause of years lived with disability worldwide. While over three-quarters of people with mental disorders live in low- and middle-income countries (LMICs) and effective low-cost interventions are available, resource commitments are extremely limited. This paper seeks to understand the role of philanthropy in this area and to inform discussions about how to increase investments. Methods: Novel analyses of a dataset on development assistance for health were conducted to study philanthropic development assistance for mental health (DAMH) in 156 countries between 2000 and 2015. Results: Philanthropic contributions more than doubled over 16 years, accounting for one-third (US$364.1 million) of total DAMH 2000-2015. However, across health conditions, mental disorders received the lowest amount of philanthropic development assistance for health (0.5%). Thirty-seven of 156 LMICs received no philanthropic DAMH between 2000 and 2015 and just three LMICs (Antigua and Barbuda, Grenada, Saint Vincent and the Grenadines) received more than US$1 philanthropic DAMH per capita over the entire period. Eighty-one percent of philanthropic DAMH was disbursed to unspecified locations. Conclusions: Philanthropic donors are potentially playing a critical role in DAMH, and the paper identifies challenges and opportunities for increasing their impact in sustainable financing for mental health.

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