A cross-national study on adolescent substance use: Intentions, peer substance use, and parent-adolescent communication.

This longitudinal two-wave cross-national study investigated whether intentions, friends' substance use, and parent-adolescent substance-use specific communication predict adolescent alcohol and cannabis use 1 year later, while estimating reversed links. The temporal order between these two substances was also examined. We used multi-group cross-lagged panel modeling on data from 2 ethnically and socioeconomically diverse samples: Sint Maarten (N = 350; Mage  = 14.19) and the Netherlands (N = 602; Mage  = 13.50). Results showed that in the Netherlands, cannabis use predicts more subsequent problems (alcohol use, intention to use cannabis, and affiliation with cannabis-using friends). But for Sint Maarten, alcohol use predicts more subsequent problems (cannabis use, intention to use alcohol, and affiliation with alcohol-using friends). These opposing results demonstrate that caution is warranted when generalizing results across countries.

Netherlands

Country located in EUROPE. It is bordered by the NORTH SEA, BELGIUM, and GERMANY. Constituent areas are Aruba, Curacao, and Sint Maarten, formerly included in the NETHERLANDS ANTILLES.

País ubicado en EUROPA. Está bordeado por el MAR DEL NORTE, BÉLGICA Y ALEMANIA. Áreas constituyentes son Aruba, Curasao y Sint Maarten, anteriormente incluidas en las ANTILLAS HOLANDESAS.

País localizado na EUROPA. Faz fronteira com o MAR DO NORTE, BÉLGICA e ALEMANHA. As áreas ultramarinas que os constituem são Aruba, Curaçao, São Martinho, antigamente incluído nas ANTILHAS HOLANDESAS.

Sint Maarten

Dutch part of the island of Saint Martin in the Caribbean Sea; Sint Maarten lies east of the US Virgin Islands.

Parte holandesa de la isla de San Martín en el Mar Caribe. Se encuentra al este de las Islas Vírgenes de los Estados Unidos.

Parte holandesa da ilha de São Martinho no Mar do Caribe. Encontra-se a leste das Ilhas Virgens dos Estados Unidos.

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.

Annual Report 2021. Aruba, Curaçao, Sint Maarten, and Bonaire, Sint Eustatius and Saba: Responding to COVID-19 and Preparing for the Future

In 2022 the Pan American Health Organization (PAHO) is celebrating its 120th anniversary. Operating as the independent specialized health agency of the inter-American system, PAHO provides technical cooperation to its Member States to address communicable and noncommunicable diseases and their causes, strengthen health systems, and respond to emergencies and disasters throughout the Americas. In addition, in its capacity as the World Health Organization’s Regional Office for the Americas, PAHO participates in the United Nations Country Team, collaborating with other United Nations agencies, funds, and programs to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. At the subregional level, PAHO works with integration mechanisms to position health and its determinants on the political agenda. The 2021 Country Annual Reports reflect PAHO’s technical cooperation in countries and territories in implementing the Country Cooperation Strategies, responding to their needs and priorities, and operating within the framework of PAHO’s regional and global mandates and the SDGs. Under the overarching theme of Responding to COVID-19 and Preparing for the Future, they highlight PAHO’s actions on the COVID-19 pandemic and its continuing efforts in priority areas such as health emergencies, health systems and services, communicable diseases, noncommunicable diseases and mental health, health throughout the life course, and health equity. They also provide a financial summary for the biennium 2020-2021.

Vulnerability and Resilience in the Caribbean Island States; the Role of Connectivity.

It is well-known that small states, because of their size, tend to be less endowed with natural resources than big ones. This makes small states vulnerable and raises the question if specific policies can be implemented to offset the drawbacks of their small size and to increase resilience. We address this question in this paper, thereby focusing on the role of connectivity - between states, organisations, parties, or otherwise - in understanding a country's vulnerability and resilience. Here 'policies' are interpreted as 'institutions' in the sense of Douglass C. North (1990), i.e. as 'humanly devised constraints that structure political, economic and social interaction'. We focus on the Caribbean area, which is characterised by a wide variety of small states, each with its own set of rules and regulations. Within this area, we concentrate on the relationship between three Dutch Caribbean islands, i.e., Aruba, Curaçao, and Sint Maarten, on the one hand, and the Netherlands, the former colonizer, on the other hand. As a first step we have measured the economic vulnerability and resilience of 17 Caribbean island states, both dependent and independent, employing the theoretical framework proposed by Lino Briguglio. The outcomes show that the three Dutch island states are performing comparatively well, although there are individual differences. We provide a first effort to explain this outcome in terms of the continuing interest of the three island states to keep their ties to the former colonizer viable. Here the presence of 'systemic interest' as shown by the stakeholders appears to be a most important variable. Supplementary Information: The online version contains supplementary material available at 10.1007/s11067-021-09533-w.

Validation of the Panbio COVID-19 Antigen Rapid Test (Abbott) to screen for SARS-CoV-2 infection in Sint Maarten: a diagnostic accuracy study

ObjectivesControl of the pandemic has required countries to look for other forms of tests besides the gold standard real-time polymerase chain reaction (RT-PCR). Rapid antigen tests (RAT), though less sensitive than RT-PCR, offer the possibility of rapid, inexpensive and early detection of the most infectious COVID-19 cases. Only very few studies have assessed the performance of the Abbott Panbio COVID-19 RAT among asymptomatic people or in Latin America. This study set out to validate this test among people attending the public test street in Sint Maarten, Dutch Caribbean. MethodsPeople of all ages were recruited from the public COVID-19 test street regardless of COVID-19 symptoms. They received a nasopharyngeal swab for the Abbott Panbio COVID-19 RAT and the RT-PCR Qtower. Diagnostic accuracy of the RAT was compared to the RT-PCR among the overall study population and for subgroups with/without symptoms, with/without close contact and different Ct values. ResultsUsing a RT-PCR Ct cut-off value of <33, 119 out of 1,411 people (8.4%) tested positive for SARS-CoV-2. Most were asymptomatic (59%). The overall sensitivity and specificity of the RAT was 84% (95% CI 76.2-90.1) and 99.9% (95% CI 99.6-100) respectively. The sensitivity reduced to 67.6% (95% CI: 49.5%, 82.6%) among people without symptoms, regardless of whether they were in close contact with a known COVID-19 case. Sensitivity reduced considerably with a Ct cut-off value of <35. ConclusionsThe Abbott Panbio RAT is a valid and cheaper alternative to RT-PCR when used on symptomatic individuals among the general population. However, among asymptomatic people it should not be used as a stand-alone test and negative results should be confirmed with RT-PCR.

Epidemiological Update: Coronavirus disease (COVID-19) (21 August 2021)

As of 20 August 2021, 210,112,064 confirmed cumulative cases of COVID-19 have been reported globally, including 4,403,765 deaths, for which the Region of the Americas contributed 39% of cases and 47% of deaths. Although the South America subregion continued to account for the highest proportions of monthly cases (54.6%) and deaths (79.8%) in the month of July for the Region of the Americas, a decreasing trend has been observed for the first time since February 2021. Meanwhile, the North America subregion has experienced an increase of 233% in cases compared to the previous month. As of 20 August 2021, Antigua and Barbuda, Argentina, Aruba, Brazil, Canada, the Cayman Islands, Chile, Costa Rica, Curacao, French Guiana, Guadeloupe, Guatemala, Martinique, Mexico, Panama, Puerto Rico, Sint Maarten, Suriname, the United States of America, and Uruguay have detected all four variants of concern (VOC). Among indigenous populations in 18 countries of the Americas, 604,264 cases were reported, including 15,027 deaths. A total of 24 countries and territories have reported 7,030 cumulative confirmed cases of multisystem inflammatory syndrome in children and adolescents (MIS-C) temporally related to COVID-19, including 138 deaths. Regarding health workers, 39 countries and territories have reported 1,792,212 cases, including 10,302 deaths.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. Aruba, Curaçao, Sint Maarten, Bonaire, Sint Eustatius, and Saba

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the territories for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

Eficacia de las vacunas frente a las variantes del SARS-CoV-2: (marzo de 2021) / Efficacy of vaccines against variants of the SARS-CoV-2: (March 2021)

INTRODUCCIÓN: Desde la identificación inicial del SARS-CoV-2 hasta la fecha, múltiples variantes han sido notificadas alrededor del mundo. Tres de éstas variantes resultan de importancia, 1) la variante B.1.1.7, también conocida como VOC-202012/01, 501Y.V1 o "variante Kent" identificada inicialmente en Reino Unido y notificada a la OMS el 14 de diciembre de 2020; 2) la variante B.1.351 o 501Y.V2 fue inicialmente reportada en Sudáfrica el 18 de diciembre de 2020; y 3) la variante B.1.1.28.1, también denominada P.1, previamente identificada en Brasil en diciembre de 2020 y notificada por Japón en 4 viajeros procedentes de Brasil (1­3). La OMS ha clasificado a 3 de estas variantes como variantes de preocupación (VOC por su acrónimo en inglés) del SARS-CoV-2, en base a criterios como: 1) aumento de la transmisibilidad o el daño causado por el cambio en la epidemiología de la COVID-19, 2) aumento de la virulencia o cambio en la presentación clínica de la enfermedad o 3) disminución de la eficacia de las medidas de distanciamiento social y de salud pública o de los diagnósticos, vacunas y terapéuticas disponibles. En adición a las VOC, otras 3 variantes han sido clasificadas como variantes de interés en salud pública (VOI por su acrónimo en inglés) de SARS-CoV-2. Una de ellas correspondería a la variante B.1.1.28.2 también denominada P.2, notificada inicialmente por Brasil y luego en Argentina, Chile, Estados Unidos de América, México, Sint Maarten, Uruguay y Venezuela (4,5). Hasta el 23 de marzo de 2021, 28 países/territorios de la Región de las Américas, habían notificado casos debidos a la variante B.1.1.7; mientras que, 15 países/territorios lo hacían para la variante P.1 y 9 para la variante B.1.351. El Perú había notificado casos con identificación de las dos primeras variantes (5). Ante la creciente propagación a nivel mundial de estas variantes, resulta de preocupación el potencial de estas para escapar de la inmunidad inducida por la vacunación. En este informe, se busca identificar la evidencia disponible respecto a la eficacia de 7 vacunas frente a las 3 VOC. MÉTODOS: Se efectuó una búsqueda sistemática hasta el 24 de marzo de 2021 en las bases científicas MEDLINE/Ovid, EMBASE/Ovid, LILACS/Biblioteca virtual en salud (BVS) y medRxiv (un servidor de distribución de manuscritos aún no publicados, sin certificación de revisión por pares) incluyendo términos en lenguaje natural y lenguaje estructurado (Tesauros) según cada base de datos para "COVID-19", "SARS-CoV-2" y los nombres de cada vacuna. De forma complementaria, se efectuó una segunda búsqueda en las bases ya señaladas y en BioRxiv (un servidor de distribución de manuscritos aún no publicados, sin certificación de revisión por pares), con términos referidos a "COVID-19", "SARS-CoV-2" y la variante brasileña P.1. Se revisaron también las referencias de los estudios incluidos. RESULTADOS: Características de los estudios incluidos: Se identificaron 13 estudios, 3 cumplieron con los criterios de selección al tratarse de ensayos clínicos que informaron resultados de eficacia para alguna de estas variantes. Dos ensayos se trataron de la vacuna AZD1222 (AstraZeneca) y uno de la vacuna Ad26.COV2.S (Janssen). Los 10 estudios restantes correspondieron a estudios con resultados de la actividad neutralizante de los anticuerpos generados en participantes vacunados (1 a 2 vacunas evaluadas) frente a las variantes consideradas. 8 reportes corresponden a manuscritos no publicados ni certificados por una revisión por pares, por lo que éstos podrían modificar sus resultados y/o conclusiones en sucesivas versiones hasta su publicación y no es posible garantizar que respondan satisfactoriamente la revisión por pares y sean finalmente publicados. CONCLUSIONES: El objetivo de este informe es identificar la evidencia disponible respecto a la eficacia de 7 vacunas contra COVID-19 frente a 3 variantes del SARS-CoV-2: variante B.1.351 (identificada inicialmente en Sudáfrica), variante B.1.1.7 (identificada en Reino Unido) y variante P.1 (Identificada en Brasil). Se identificaron 13 estudios, 8 reportes corresponden a manuscritos no publicados ni certificados por una revisión por pares. Únicamente 3 estudios informaron resultados de eficacia de dos vacunas frente a estas variantes y los estudios restantes reportaron la actividad neutralizante de los anticuerpos generados en participantes vacunados frente a las variantes consideradas. Respecto de la vacuna AZD1222 desarrollada por AstraZeneca, se identificaron 3 estudios. La eficacia para prevenir COVID-19 frente a la variante B.1.1.7 fue del 74.6% (IC 95%: 41.6% a 88.9%) a diferencia de lo observado para la variante B.1.351, donde no demostró prevenir la enfermedad, eficacia del 10.4% (IC 95%: -76.8% a 54.8%). La actividad de neutralización de los anticuerpos inducidos por esta vacuna frente a la variante P.1, se vio reducida 2.9 veces en comparación a lo observado frente a un linaje similar al SARS-CoV-2 original. Sobre la vacuna Ad26.COV2-S desarrollada por Janssen, se encontró un ensayo clínico con datos de Sudáfrica, en donde el 95% de los casos correspondieron a la variante B.1.351 reportando una eficacia de 64.0% (IC 95%: 41.2 a 78.7) para prevenir COVID-19 moderado-severo/crítico y una eficacia de 81.7% (IC 955: 46.2 a 95,4) para prevenir COVID-19 severo/crítico. Asimismo, este mimo estudio, en base a los datos de Brasil, donde el 69% de los casos con secuenciamiento identificaron a la variante P.2, reportó una eficacia de 68.1% (IC 95%: 48.8 a 80.7) para prevenir COVID-19 moderado-severo/crítico y una eficacia de 87.6% (IC 95%: 7.8 a 99.7) para COVID-19 severo/crítico. No se identificaron estudios que evalúen la eficacia ni la capacidad de neutralización de esta vacuna frente a la variante británica. Respecto a la vacuna BBIBP-CorV2 desarrollada por Sinopharm, no se identificaron estudios que reporten la eficacia o efectividad frente a las variantes. Un estudio in vitro frente a la variante B.1.351 reportó que la actividad neutralizante se redujo 1.6 veces en comparación al virus circulante. No se identificaron estudios que reporten la eficacia o efectividad de la vacuna BNT162b2 desarrollada por Pfizer/BioNTech. 4 estudios con resultados respecto a la actividad neutralizante frente a las 3 variantes fueron recuperados. Dos estudios que reportan la actividad neutralizante contra la variante B.1.1.7, indicaron que existiría una reducción entre 2.1 a 3.2 veces frente a lo observado con el virus salvaje en muestras de participantes que recibieron 1 dosis única y 2 dosis de la vacuna; respectivamente. Frente a la variante B.1.351, la reducción observada en la capacidad neutralizante es mayor, comparada con el virus original. Un estudio reportó una disminución de 10.3 veces su capacidad mientras que otro reporte que evaluó además 3 mutaciones de la variante, encontró una disminución en 34.5 veces para B.1.351 v1; 41.2 veces para B.1.351 v2 y 42.4 veces para B.1.351 v3. Frente a la variante P.1, se identificaron 2 estudios que encontraron que la reducción osciló entre 2.6 a 6.7 veces en comparación al virus original. Con relación a la vacuna mRNA-1273 desarrollada por Moderna, no se identificaron estudios que reporten la eficacia o efectividad frente a las 3 variantes consideras. La evidencia disponible corresponde a resultados de la capacidad neutralizante frente a las variantes. De 5 estudios realizados frente a la variante B.1.1.7, 4 (1 publicado y 3 en pre-impresión) encontraron que la capacidad de neutralización se mantuvo frente a virus vivo o pseudovirus, mientras que solo un estudio publicado observó una disminución de la actividad neutralizante entre 1 a 3 veces en un ensayo de neutralización basado en pseudovirus. En relación a la variante B.1.351, los resultados son heterogéneos. Un estudio publicado observó una disminución en la capacidad de neutralización entre 19 a 28 veces comparado con virus vivo. En un segundo estudio, la disminución de capacidad neutralizante frente a un ensayo basado en pseudovirus se encontró entre 2 a 6 veces. Un tercer estudio en pre-impresión, frente a virus vivo, encontró que la capacidad neutralizante se mantuvo. Un estudio publicado sobre la variante P.1, encontró que se redujo la capacidad neutralizante 4.5 veces en comparación a lo observado frente al virus salvaje. No se identificaron estudios que reporten la eficacia, efectividad o capacidad de neutralización frente a las 3 variantes consideras para las vacunas desarrolladas por Gamaleya y Curevac.

Words matter: political and gender analysis of speeches made by heads of government during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has put a spotlight on political leadership around the world. Differences in how leaders address the pandemic through public messages have practical implications for building trust and an effective response within a country. METHODS: We analysed the speeches made by 20 heads of government around the world (Bangladesh, Belgium, Bolivia, Brazil, Dominican Republic, Finland, France, Germany, India, Indonesia, New Zealand, Niger, Norway, Russia, South Africa, Scotland, Sint Maarten, United Kingdom, United States and Taiwan) to highlight the differences between men and women leaders in discussing COVID-19. We used an inductive analytical approach, coding speeches for specific themes based on language and content. FINDINGS: Five primary themes emerged across a total of 122 speeches on COVID-19, made by heads of government: economics and financial relief, social welfare and vulnerable populations, nationalism, responsibility and paternalism, and emotional appeals. While all leaders described the economic impact of the pandemic, women spoke more frequently about the impact on the individual scale. Women leaders were also more often found describing a wider range of social welfare services, including: mental health, substance abuse and domestic violence. Both men and women from lower-resource settings described detailed financial relief and social welfare support that would impact the majority of their populations. While 17 of the 20 leaders used war metaphors to describe COVID-19 and the response, men largely used these with greater volume and frequency. CONCLUSION: While this analysis does not attempt to answer whether men or women are more effective leaders in responding to the COVID-19 pandemic, it does provide insight into the rhetorical tools and types of language used by different leaders during a national and international crisis. This analysis provides additional evidence on the differences in political leaders' messages and priorities to inspire citizens' adhesion to the social contract in the adoption of response and recovery measures. However, it does not consider the influence of contexts, such as the public audience, on leaders' strategic communication approaches.

How do you build back better so no one is left behind? Lessons from Sint Maarten, Dutch Caribbean, following Hurricane Irma.

The Sendai Framework for Disaster Risk Reduction 2015-2030 and the United Nations' Sustainable Development Goals call for action to build back better in ways that leave no one behind. At the same time, ensuring a local voice is increasingly central to humanitarian engagement. These aims contrast with limited analysis of how local actors might be supported in these respects during response and recovery, and how far recommendations are specific or generalisable across richer and poorer national contexts. The paper begins by comparing lessons learnt by survivors and community organisations in Sint Maarten, Dutch Caribbean, following a high-income state-led response to Hurricane Irma in 2017 with the priorities of lower income, humanitarian-led endeavours. The differences reveal the importance of economic resources as the basis for individual self-reliance and a fragmented civil society with limited leadership ambitions in Sint Maarten. Strong cross-cultural alignment nevertheless allows for a globally-relevant and yet contextually-sensitive framework for survivor-led action and reconstruction.

Words Matter: Political and gender analysis of speeches made by heads of government during the COVID-19 pandemic

Background: The COVID-19 pandemic has put a spotlight on political leadership and decision-making around the world. Differences in how leaders address the pandemic through public messages have practical implications for building trust and an effective response within a country. Methods: We analyzed the public statements and speeches made by 20 heads of government around the world (Bangladesh, Belgium, Bolivia, Brazil, Dominican Republic, Finland, France, Germany, India, Indonesia, New Zealand, Niger, Norway, Russia, South Africa, Scotland, Sint Maarten, United Kingdom, United States, Taiwan) to highlight the differences between men and women leaders in discussing COVID-19 and pandemic response. We used a deductive analytical approach, coding speeches for specific themes based on language used and content discussed. Findings: Five primary themes emerged across a total of 122 speeches on COVID-19 made by heads of government: economics and financial relief, social welfare and vulnerable populations, nationalism, responsibility and paternalism, and emotional appeals. While all leaders described the economic impact of the pandemic, women leaders spoke more frequently about the impact on local or individual scale. Women leaders were also more often found describing a wider range of social welfare services, including addressing to: mental health, substance abuse, and domestic violence. Both men and women from lower-resource settings described detailed financial relief and social welfare support that would impact the majority of their citizen population. While 17 of the 20 leaders used war metaphors to describe the COVID-19 virus and response, men largely used these with greater volume and frequency. Conclusion: While this analysis does not attempt to answer whether men or women are more effective leaders in responding to the COVID-19 pandemic, it does provide insight into the rhetorical tools and types of language used by different leaders during a national and international crisis. This language is important because it influences how leaders inspire citizens to adhere to the social contract, and the priorities they highlight and the words they use are meant to resonate with the rest of the nation.

Flood risk management in Sint Maarten - A coupled agent-based and flood modelling method.

Disaster risk reduction is a major concern of small island developing states. Measures to reduce risk should not only be based on the magnitude of physical hazard, but also on the exposure and vulnerability of communities. In this article, we examine flood risk management policies in the Caribbean island of Sint Maarten using coupled agent-based and flood models. The agent-based model is used to model actors' behaviour in relation to urban building development and policies that are designed to reduce flood hazard and communities' vulnerability and exposure. The policies considered in the model are a Beach Policy, a Building and Housing Ordinance, a Flood Zoning policy and hazard mitigation structural measures. The flood model is used to simulate coastal and pluvial floods on the island. Agent behaviour such as building new houses and implementing hazard reduction measures affect the flood model as these actions affect the rainfall-runoff process. The flood maps generated from the updated flood model simulations are then used to assess the impact and update agents' attributes and behaviour. The simulations results show that low-lying areas are populated, which increases the exposure, and the number of vulnerable houses is also high. Hence, out of the four policies, implementing hazard reduction measures is the most important. Reducing the flood hazard by widening existing drainage channels, constructing new ones and building dykes as coastal flood defence would reduce the hazard, hence reducing the number of flooded houses. As it affects all households on the island, the Building and Housing Ordinance is an important policy to reduce vulnerability. In general, the coupled model outputs can be used to inform policy decision making and provide insights to policymakers on the island.

Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study.

BACKGROUND: To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in family medicine who provide patient care in the U.S. METHODS: A cross-sectional study design, using descriptive statistics on combined data from the Educational Commission for Foreign Medical Graduates and the American Medical Association, including medical school attended, country of medical school, and citizenship when entering medical school. RESULTS: In total, 118,817 physicians in family medicine were identified, with IMGs representing 23.8% (n = 28,227) of the U.S. patient care workforce. Of all 9579 residents in family medicine, 36.0% (n = 3452) are IMGS. In total, 35.9% of IMGs attended medical school in the Caribbean (n = 10,136); 19.9% in South-Central Asia (n = 5607) and 9.1% in South-Eastern Asia (n = 2565). The most common countries of medical school training were Dominica, Mexico, and Sint Maarten. Of all IMGs in family medicine who attended medical school in the Caribbean, 74.5% were U.S. citizens. In total, 40.5% of all IMGs in family medicine held U.S. citizenship at entry to medical school. IMGs comprise almost 40% of the family medicine workforce in Florida, New Jersey and New York. CONCLUSIONS: IMGs play an important role in the U.S. family medicine workforce. Many IMGs are U.S. citizens who studied abroad and then returned to the U.S. for graduate training. Given the shortage of family physicians, and the large number of IMGs in graduate training programs, IMGs will continue to play a role in the U.S. physician workforce for some time to come. Many factors, including the supply of residency training positions, could eventually restrict the number of IMGs entering the U.S., including those contributing to family practice.

Status of Schistosomiasis Elimination in the Caribbean Region.

Schistosomiasis elimination status in the Caribbean is reviewed with information on historical disease background, attempts to control it and current situation for each locality in the region where transmission has been eliminated (Sint Maarten, Saint Kitts, Vieques), eliminated but not yet verified (Puerto Rico, Dominican Republic, Antigua, Montserrat, Guadeloupe, Martinique) and still ongoing (Saint Lucia, Suriname). Integrated control initiatives based on selective and mass treatment and snail control using environmental, chemical and biological methods along with public service improvements (housing, safe water, sanitation) and changes in demography (urbanization) and economy (change from sugarcane and banana production to tourism) have resulted in reduction in the burden of schistosomiasis over the past century. Introduction of Biomphalaria-competitor snails into the region as a cost-effective, low maintenance control method appears to have had the most sustainable impact on transmission reduction. A regional inventory of B. glabrata, other Biomphalaria species and Biomphalaria-competitor snails as well as investigation of possible animal reservoir hosts in persisting endemic areas would be helpful for control. Elimination of schistosomiasis appears achievable in the Caribbean. However, a regional surveillance and monitoring program is needed to verify elimination in the various localities and identify and monitor areas still endemic or at risk.

Chikungunya virus outbreak in Sint Maarten: Long-term arthralgia after a 15-month period.

BACKGROUND & OBJECTIVES: The first chikungunya (CHIK) epidemic in the Americas was reported in December 2013. Chikungunya virus (CHIKV) causes an acute febrile illness and is transmitted to humans by Aedes mosquitoes. Although earlier studies have described long-term clinical manifestations of CHIK patients infected with the East/Central/South African (ECSA) genotype, little is known about persistent manifestations in the Caribbean region, for which the Asian genotype is responsible. The objective of this study was to describe the presence of persisting clinical manifestations, specifically arthralgia, in CHIKV-infected patients on the Caribbean Island, Sint Maarten, 15 months after onset of the disease. METHODS: This retrospective cohort study included confirmed CHIK patients that were recorded by the participating general practitioners (GPs) during the chikungunya outbreak in 2014 in Sint Maarten. Between March and July 2015, 15 months after the onset of disease, patients were interviewed via telephone about the presence, duration and impact of clinical CHIKV manifestations. RESULTS: In total, 56 patients were interviewed (median age 47 yr), of which 30 (54%) were females. Out of the total interviewed patients, 52 (93%) reported arthralgia for the first three months after the disease onset, of which 23 (44%) patients reported to have persistent arthralgia, 15 months after the disease onset. Pain intensity of persistent arthralgia was perceived as mild in the majority of patients (n = 14; 60%), moderate in 7 (30%) patients and severe in 2 (9%) patients. During the acute phase of disease, most patients had to miss school or work (n = 39; 72%) due to clinical CHIKV manifestations and reported a negative impact on daily activities (n = 36; 57%). INTERPRETATION & CONCLUSION: Results suggested that persisting arthralgia is a frequent complication in CHIK patients included in the study. Future research on strain-specific clinical long-term manifestations and on their impact on daily life of patients, in the form of a comparative study between patients and controls, is recommended.

Microplastic pollution on Caribbean beaches in the Lesser Antilles.

Here we investigate microplastics contamination on beaches of four islands of the Lesser Antilles (Anguilla, St. Barthélemy, St. Eustatius and St. Martin/Maarten). These islands are close to the North Atlantic subtropical gyre, which contains high levels of microplastics. On average 261 ±â€¯6 microplastics/kg of dry sand were found, with a maximum of 620 ±â€¯96 microplastics on Grandes Cayes, Saint Martin. The vast majority of these microplastics (>95%) were fibers. Levels of microplastics differed among islands, with significantly lower levels found in St. Eustatius compared to the other Islands. No difference in microplastic levels was found between windward and leeward beaches. Our research provides a detailed study on microplastics on beaches in the Lesser Antilles. These results are important in developing a deeper understanding of the extent of the microplastic challenge within the Caribbean region, a hotspot of biodiversity.