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1.
Ticks Tick Borne Dis ; 12(4): 101730, 2021 Apr 21.
Article in English | MEDLINE | ID: mdl-33957484

ABSTRACT

Hunters are at a higher risk for exposure to zoonotic pathogens due to their close interactions with wildlife and arthropod vectors. In this study, high throughput sequencing was used to explore the viromes of two tick species, Amblyomma dissimile and Haemaphysalis juxtakochi, removed from hunted wildlife in Trinidad and Tobago. We identified sequences from 3 new viral species, from the viral families Orthomyxoviridae, Chuviridae and Tetraviridae in A. dissimile.

2.
Vasc Health Risk Manag ; 17: 187-194, 2021.
Article in English | MEDLINE | ID: mdl-33976549

ABSTRACT

Background: Ideal cardiovascular health behaviour (CVHB) measures four ideal health behaviours (non-smoking, body mass index <85th Percentile, healthy diet, and physical activity). This study aimed to determine the prevalence, distribution, and correlates of ideal CVHB among adolescents in the Caribbean. Methods: Nationally representative cross-sectional data of 2016 or 2017 with complete CVHB measurements were analysed from 7556 school adolescents from four Caribbean countries. Results: The prevalence of 0-1 ideal metrics CVHB was 20.4%, 2 ideal metrics 48.7%, and 3-4 ideal metrics 30.8%. Only 5.0% had all 4 ideal CVHB metrics, 41.0% intermediate CVH (≥1 metric in the intermediate category and none in the poor category), and 54.0% had poor CVH (≥1 metric in poor category). In adjusted logistic regression analysis, compared to students from Dominican Republic, students from Jamaica (Adjusted Odds Ratio-AOR: 1.36, 95% confidence interval-CI: 1.01-1.85), students from Trinidad and Tobago (AOR: 1.46, 95% CI: 1.17-1.82) and male sex (AOR: 1.35, 95% CI: 1.11-1.64) were positively associated with meeting 3-4 ideal CVHB metrics. In addition, in unadjusted analysis, rarely or sometimes experiencing hunger was negatively and high peer and parent support were positively associated with meeting 3-4 ideal CVHB metrics. Conclusion: The proportion of meeting 3-4 ideal CVHB metrics was low among adolescents in four Caribbean countries. Both high-risk and school-wide intervention programmes should be implemented in aiding to improve CVHB in Caribbean countries. Several factors associated with ideal CVHB were identified, which can be targeted in school health interventions.

3.
Zootaxa ; 4958(1): zootaxa.4958.1.37, 2021 Apr 14.
Article in English | MEDLINE | ID: mdl-33903484

ABSTRACT

The E. ovina group of species is proposed here to include Edessa ovina Dallas, 1851 from Trinidad and Tobago, Colombia, Paraguay, Brazil, Argentina (new records) and Guyana; E. impura Bergroth, 1891 from Brazil and Argentina (new record); E. sahlbergii Stål, 1872 restricted to Brazil; and E. graziae sp. nov. from Brazil and Argentina. The E. ovina group can be identified by the apex of the second pair of wings narrowing distally and by a tumid area on the ventral surface of the pygophore (male genitalia) projected posteriorly. Descriptions, measurements, and illustrations of the metasternal process, external and internal genitalia of male and female are provided. A map with the distribution of the species is presented. The holotype of Edessa ovina is designated here. Edessa argali Breddin, 1903 is considered a junior synonym of E. impura. Females of E. ovina and E. impura, and male of E. sahlbergii are described for the first time.

4.
Zootaxa ; 4964(1): zootaxa.4964.1.12, 2021 Apr 21.
Article in English | MEDLINE | ID: mdl-33903537

ABSTRACT

The Neotropical genus Scinax Wagler currently comprises 127 species of small treefrogs distributed from southern Mexico to Argentina and Uruguay, including some islands such as Trinidad and Tobago, and St. Lucia (Frost 2020). Two major clades are recognized within Scinax, the S. catharinae and the S. ruber clades. The former is composed of two species groups, the S. catharinae and the S. perpusillus groups (Faivovich 2002; Faivovich et al. 2005). The S. perpusillus species group currently comprises 13 species: S. alcatraz (Lutz); S. arduous Peixoto; S. atratus (Peixoto); S. belloni Faivovich, Gasparini Haddad; S. cosenzai Lacerda, Peixoto Feio; S. faivovichi Brasileiro, Oyamaguchi Haddad; S. insperatus Silva Alves-Silva; S. littoreus (Peixoto); S. melloi (Peixoto), S. peixotoi Brasileiro, Haddad, Sawaya Martins; S. perpusillus (Lutz Lutz); S. tupinamba Silva Alves-Silva; and S. v-signatus (Lutz). These species are endemic of the Brazilian Atlantic Forest and are recognized by their intimate association with bromeliads (Fig. 1), in which adults breed and lay their eggs, and tadpoles develop (Peixoto 1987, 1995; Alves-Silva Silva 2009).

5.
Arch Virol ; 2021 Apr 03.
Article in English | MEDLINE | ID: mdl-33811529

ABSTRACT

Zucchini yellow mosaic virus (ZYMV) is a member of the genus Potyvirus that is becoming a serious pathogen of pumpkin and other cucurbits in Trinidad and Tobago and the entire Caribbean region. In this study, four ZYMV isolates infecting pumpkin in Trinidad and Tobago were characterized by complete genome sequencing. Phylogenetic analysis showed 5.9-6.0% nt and 7.7-7.9% aa sequence divergence in comparison to the most closely related isolates NAT and AG from Israel and SE04T from Slovakia. Based on the variations in the complete genome sequence as well as individual gene sequences, a new genotype, designated ZYMV-Trini, is proposed for these isolates. Among the gene sequences of ZYMV-Trini isolates, the greatest variation was observed in the HC-Pro gene, with 20.8% aa sequence divergence from their closest relatives, whereas the least variation was observed in the NIb, P3, and CP genes, with 1.8-2.2% aa sequence divergence. This study also showed that transmission of ZYMV can occur through seeds, but this was less common than transmission via the aphid Aphis gossypii. The progression of ZYMV in pumpkin seedlings was quantified by RT-qPCR, which showed a rapid surge in viral load after 37 days. From recombination analysis, it could be concluded that the isolates SE04T from Slovakia, NAT from Israel, and AG from Israel have made major contributions to the genome architecture of ZYMV-Trini isolates.

6.
BMJ Open ; 11(4): e044397, 2021 04 13.
Article in English | MEDLINE | ID: mdl-33849850

ABSTRACT

OBJECTIVES: To determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic. DESIGN: Cross-sectional online survey. SETTING: HCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago. PARTICIPANTS: 395 HCWs aged ≥18 years. MAIN OUTCOME MEASURES: Depression, anxiety and stress scores. RESULTS: Among the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI -5.233 to -1.692) and stress, p<0.001 (95% CI -5.364 to -1.591). CONCLUSIONS: This study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.


Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Health Personnel/psychology , Occupational Stress/epidemiology , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics , Prevalence , Surveys and Questionnaires , Trinidad and Tobago/epidemiology
7.
AIDS Res Ther ; 18(1): 20, 2021 Apr 23.
Article in English | MEDLINE | ID: mdl-33892747

ABSTRACT

BACKGROUND: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. METHODS: Two Social Workers were trained as patient tracers and hired for 15 months (April 2017-June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016-May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. RESULTS: Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care-89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07-1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26-2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90-3.24). Persons initiated on ART for 4-6 years (OR, 3.09; 95% CI 1.13-8.48,), 7-9 years (OR, 3.97; 95% CI 1.39-11.31), > 10 years (OR, 5.99; 95% CI 1.74-20.64 were more likely to be retained in care. CONCLUSIONS: Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.

8.
Article in English | MEDLINE | ID: mdl-33835281

ABSTRACT

PURPOSE: The aim of this study is to determine the demographic, pathological, and treatment-related factors that predict recurrence and survival in a Trinidadian cohort of breast cancer patients. METHODS: The inclusion criteria for this study were female, over 18 years, and with a primary breast cancer diagnosis confirmed by a biopsy report occurring between 2010 and 2015 at Sangre Grande Hospital, Trinidad. Univariate associations with 5-year recurrence-free survival and 5-year overall survival were calculated using the Kaplan-Meier method for categorical variables and Cox Proportional Hazards for continuous variables. A multivariate model for prediction of recurrence and survival was determined using Cox regression. RESULTS: For the period 2010-2015, 202 records were abstracted. Five-year overall survival and recurrence-free survival rates were found to be 74.3% and 56.4%, respectively. Median times from first suspicious finding to date of biopsy report, date of surgery, and date of chemotherapy were 63 days, 125 days, and 189 days, respectively. In the univariate analysis, age (p = 0.038), stage (p < 0.001), recurrence (p = 0.035), surgery (p = 0.016), ER (p < 0.001) status, PR status (p < 0.001), and subtype (p < 0.001) were significantly associated with survival. Additionally, stage (p = 0.004), N score (p = 0.002), ER (p = 0.028) status, PR (p = 0.018) status, and subtype (p = 0.025) were significantly associated with recurrence. In the Cox multivariate model, Stage 4 was a significant predictor of survival (HR 6.77, 95% CI [0.09-2.49], p = 0.047) and N3 score was a significant predictor of recurrence (HR 4.47, 95% CI [1.29-15.54], p = 0.018). CONCLUSION: This study reports a 5-year breast cancer survival rate of 74.3%, and a recurrence-free survival rate of 56.4% in Trinidad for the period 2010-2015.

9.
Curr Pharm Teach Learn ; 13(5): 471-478, 2021 May.
Article in English | MEDLINE | ID: mdl-33795098

ABSTRACT

INTRODUCTION: The role of pharmacists in healthcare is undergoing transformation throughout the world. The continuing professional development (CPD) model has motivated pharmacists in developed countries to adopt lifelong learning. This is vital to improve competence and to optimize patient care. This study aimed to explore the existence and understanding of CPD in Ghana, Pakistan, and Trinidad and Tobago, the barriers faced in development of a CPD model, and probable policies needed to build/improve such a model. METHODS: Audiotaped qualitative in-depth interviews were conducted, transcribed, and coded with pharmacy stakeholders, including academics, community pharmacists, and regulatory professionals. A thematic analysis of the transcribed data led to the extraction of the main themes. RESULTS: The findings showed a process of establishment of CPD for pharmacists in Ghana, whereas in Pakistan, Trinidad, and Tobago there was no CPD model. CONCLUSIONS: These findings indicate the need for a realistic, relevant, and mandatory program of CPD in these countries.

10.
Article in English | MEDLINE | ID: mdl-33797503

ABSTRACT

BACKGROUND: The Caribbean is a unique region of islands and cays home to nearly 43 million people. A significant challenge facing this population is the burden of traumatic brain injury, which disproportionately affects younger individuals and carries a significant economic burden. A preventive measure to reduce this burden is consistent wearing of helmets. This study aims to assess TBI prevention through helmet safety in Caribbean nations in order to demonstrate the regional impact of public health solutions. METHODS: We assess the member states of the Caribbean Community (CARICOM) and sought to evaluate CARICOM nations' TBI prevention through helmet safety with relation to public health, policy, laws, infrastructure, and regulations. We produced the Rolle Scoring System (RSS) to ascertain the influence of governance around helmet safety for TBI prevention. The RSS aims to provide a quantifiable method of how well a CARICOM nation is performing in efforts to reduce TBI. The RSS is broken down into 2 categories, with scores ranging from 1 (worst) to 5 (best). The range of possible scores a CARICOM nation could receive was 8 to 40. RESULTS: Fourteen CARICOM nations were ultimately incorporated into our analysis. From the initial cohort, 3 were removed. These nations were Anguilla, Saint Kitts & Nevis, and Montserrat. We analyzed values derived from the RSS, finding a mean Rolle score of 22. We further subdivided the nations into low Rolle score (8-24) and high Rolle score (>24). Trinidad and Tobago had the highest Rolle score at 29. Haiti was found to have the lowest Rolle score at 8. CONCLUSION: Several Caribbean nations have demonstrated leadership pertaining to TBI prevention through helmet safety. The regional momentum of helmet safety in the Caribbean can serve as a model for other geographical regional blocs that share interests and culture to consider comprehensive approaches to public health challenges.

11.
Pathog Glob Health ; 115(3): 188-195, 2021 May.
Article in English | MEDLINE | ID: mdl-33645470

ABSTRACT

Mayaro virus, which can often go undetected due to its clinical manifestations and intimate alignment with dengue and chikungunya viruses, is one of the most neglected arboviruses. The virus has been found in several outbreaks, where a moderate-to-severe and potentially incapacitating joint disease has been observed. MAYV usually circulates in a sylvan cycle of forest mosquitoes and vertebrates, causing sporadic sylvatic infections to humans, and some outbreaks in sub-urban areas. This study focuses on the demonstration of the possible co-circulation of Mayaro virus with chikungunya virus and Zika virus during the outbreaks that occurred in Trinidad and Tobago in 2014 and 2016, respectively. Acute samples from patients who previously tested negative for chikungunya, dengue, and Zika, and specifically exhibiting joint pain were selected and investigated for the presence of Mayaro virus genome using real-time RT-PCR techniques. Nine persons were shown to be positive for Mayaro virus during the chikungunya outbreak of 2014, while no one during the Zika outbreak in 2016. Five results correspond to persons living in highly urbanized areas across Trinidad. These findings provide evidence that multiple arboviral circulations are possible and could easily go undetected especially during outbreak situations. Our study is the first to demonstrate the possible co-circulation of Mayaro and chikungunya viruses and the occurrence of human cases for both diseases during an outbreak in the Caribbean. A possible change in the pattern of distribution of human cases to more urbanized areas is also discussed.

12.
PLoS One ; 16(3): e0246829, 2021.
Article in English | MEDLINE | ID: mdl-33661928

ABSTRACT

We examine, for the first time, biogeographic patterns in a series of tropical montane coastal systems in northern South America. We use amphibians and reptiles, which constitute the most critical communities based upon the prevalence of endemic taxa, to assess the region's biodiversity. The montane coastal system spans an east-west distance of 925 km. It includes peaks ranging from 549 m to 2765 m above sea level and encompasses the montane complexes of northern Venezuela (including Isla de Margarita), an outlier at Santa Marta (Colombia), and ranges on the islands Trinidad and Tobago. The area supports 14 family level amphibian clades and 23 family level reptile clades. Fieldwork, museum specimen surveys, and a literature review suggest that biodiversity decreases at higher elevations. Here we examine the biogeographic patterns in the region to assess the role of the montane systems as possible refugia. We also look at the possible island and sky island effects using data from altitudes >200 m. At lower elevations, we tabulated 294 species, comprising 112 amphibians and 182 reptiles. About 45% of these taxa are endemic or exclusive to different sub-regions. At mid-elevation montane cloud forests, we find a much-reduced biodiversity with a total of 125 species (66 amphibians and 59 reptiles) exclusive or restricted to the region, and few species shared between systems. We find that biogeographical patterns follow a natural topographic disposition above 200 m in elevations. At the lower elevation cut off, there are 118 species (26 amphibians and 92 reptiles) shared among two or more of the studied mountain systems, suggesting a common origin and dispersal events, despite what seem to be topographic barriers. Biogeographical relationships support a topographic disposition of the region with close associations between the islands of Trinidad and Tobago, the Paria Range and the Turimiquire Massif, and close associations between the Sierra Nevada de Santa Marta and the Sierra de San Luis. Overall, the biogeographic relationships between amphibians and reptiles are similar. Species diversity in the eastern Caribbean region is less rich than in the west. This study includes the first herpetological surveys at the two easternmost mountains (Cerro La Cerbatana and Campeare) belonging to the Paria Range biogeographic unit, and aims to contribute to a better understanding of the rich biodiversity of the region.

13.
Syst Parasitol ; 98(3): 277-283, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33786729

ABSTRACT

Trinidad and Tobago, a neotropical country, has 38 reported chigger species. Of these species, 18 were parasitizing bats. Here, we describe a new genus and species parasitizing a ghost-faced bat in this country.

14.
Am J Clin Pathol ; 2021 Mar 13.
Article in English | MEDLINE | ID: mdl-33712837

ABSTRACT

OBJECTIVES: Global health education is important during residency training in exposing doctors to conditions that are not common in the United States and developing their awareness of global health care disparities. Most medical decisions are based on results from anatomic or clinical pathology laboratories, which are essential services for appropriate medical care in international settings. Nevertheless, US pathology residency trainees have limited global health exposure and thus are rarely exposed to diagnostic services in these settings. Moreover, literature documenting what is needed to create a global health elective in pathology is limited. METHODS: We designed an international pathology elective in Trinidad and Tobago involving one main public hospital site and several off-site laboratories. Objectives and goals were established before the rotation. Apart from daily mentor-led education sessions, the trainee participated in teaching, quality improvement projects, and cultural experiences. Engagement with medical officers, personnel staff, and people in the community was encouraged.Results: Challenges encountered included funding, transportation, limited laboratory resources, medical registration, and malpractice insurance. These were mitigated through carefully planned steps, including communicating with registration bodies and liaising with pathology organizations for funding. CONCLUSIONS: Overall, the global health rotation was successful. We provide a detailed roadmap for other pathology training programs interested in establishing similar global health electives.

15.
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.

16.
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.

17.
Zootaxa ; 4942(3): zootaxa.4942.3.2, 2021 Mar 15.
Article in English | MEDLINE | ID: mdl-33757056

ABSTRACT

Gamelia bennetti sp. nov. is described from Trinidad, Trinidad and Tobago, West Indies, and compared with members of the Gamelia abas species group: G. abas (Cramer, [1775]), G. berliozi Lemaire, 1967, G. lichyi Lemaire, 1973, G. rubriluna (Walker, 1862) and G. septentrionalis (Bouvier, 1936). A photographic record suggests G. bennetti sp. nov. may also occur in Tobago.


Subject(s)
Lepidoptera , Animals , Trinidad and Tobago
18.
Internet resource in Portuguese | LIS -Health Information Locator | ID: lis-48056

ABSTRACT

“O lado oculto das bebidas açucaradas: doenças, mortes e custos à saúde" é uma pesquisa internacional realizada ao longo de 2020 com o objetivo de estimar as cargas de doenças atribuíveis ao consumo de bebidas açucaradas em países da América Latina. O estudo foi coordenado pelo Instituto de Efectividad Clinica y Sanitária (IECS), e contou com a participação de pesquisadores em saúde de universidades, centros de pesquisa e instituições públicas da Argentina (IECS), Brasil (ACT Promoção da Saúde), El Salvador ( Ministério da Saúde) e Trinidad e Tobago (Universidade das Índias Ocidentais). Um projeto colaborativo, financiado pelo Centro de Desenvolvimento Internacional do Canadá (IDRC).


Subject(s)
Sugar-Sweetened Beverages , Artificially Sweetened Beverages , Diabetes Mellitus
19.
J Hosp Infect ; 110: 122-132, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33524426

ABSTRACT

BACKGROUND: Healthcare-associated infections (HCAIs) and variation in antibiotic prescribing pose a significant public health challenge in hospitals of low-resource countries. AIM: To critically appraise and synthesize the evidence on HCAI and the prescribing of antibiotics in Caribbean Community (CARICOM) states. METHODS: All primary qualitative and quantitative studies that addressed HCAI, and the prescribing of antibiotics in hospitalized patients of CARICOM states were included. Ovid Medline, Embase, Global Health, and regional databases were searched. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Findings were presented in narrative and table formats. FINDINGS: Twenty-one studies met the inclusion criteria for this mixed-methods systematic review (MMSR). Studies were from four different CARICOM states: Trinidad and Tobago, Jamaica, Haiti, and Antigua and Barbuda. Intensive care units (ICUs) had the highest rate of infections (67% over four years). Surgical site infections were discussed by seven studies and ranged from 1.5% to 7.3%. For inpatients with contaminated or infected wounds, rates ranged from 29% to 83%. Empiric and prophylactic therapies were common and inappropriately prescribed. Resources and training for healthcare workers in infection control and antimicrobial stewardship were insufficient. Few qualitative studies existed, so it was not possible to integrate evidence from qualitative and quantitative paradigms. CONCLUSION: Evidence from CARICOM states shows high rates of HCAI and inappropriately prescribed antibiotics, primarily in ICUs. Disease surveillance, infection control, and antimicrobial stewardship programmes require urgent evidence-based improvements.

20.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Feb 23.
Article in English | MEDLINE | ID: mdl-33619923

ABSTRACT

PURPOSE: A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective. DESIGN/METHODOLOGY/APPROACH: A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process. FINDINGS: Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process. RESEARCH LIMITATIONS/IMPLICATIONS: The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender. PRACTICAL IMPLICATIONS: The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings. ORIGINALITY/VALUE: Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.

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