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

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

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

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

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

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

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

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

The current state of prostate cancer in Antigua & Barbuda-2021.

Antigua and Barbuda is a twin-island nation within the Caribbean where the men are predominantly of African descent. The burden of prostate cancer is therefore expected to be similar to regional counterparts. There has been very little research done on prostate cancer in this nation. Few published peer-reviewed and non-peer reviewed documents exist to guide prostate cancer management and policy. A review of the available literature and the author's experience managing prostate cancer in the country was used to provide a synopsis of prostate cancer management in the country. All aspects of the prostate cancer care pathway exist in Antigua and Barbuda from public awareness and screening campaigns to external beam radiotherapy, abiraterone acetate and hospice care. There are still limitations to accessing some aspects of the care pathway such as prostate biopsies, radical prostatectomies and newer imaging modalities for staging. Data collection and analysis will help to provide objective and quantitative evidence of the nation's prostate cancer management capabilities. Other developing nations will face many of the same challenges managing prostate and other cancers and this shared experience may be particularly useful for comparing and contrasting purposes. It also provides a documented milestone on which future plans can be made to improve care and shape national policy.

A new species of planthopper in the genus Patara (Hemiptera: Derbidae) on coconut palm (Cocos nucifera) from the island of Barbuda.

The island of Barbuda was recently surveyed for the presence of Haplaxius crudus to establish the risk of Lethal Yellowing to palms on the island. After extensive collecting, H. crudus was not found on the island. A new species of Patara Westwood was found on coconut palms on the southwest portion of Barbuda. Herein, we describe the new species as Patara cooki sp. n. and provide DNA sequence data for cytochrome c oxidase subunit I (COI) and 18S genes for it and Patara guttata Westwood. Patara cooki differed from Patara guttata sp. n. by 1.8% for 18S and 7.8% for COI, similar to intrageneric differences reported for other taxa. A phylogenetic analysis of available Otiocerinae near Patara using found Patara cooki sp. n. nested among other Patara species. We also offer commentary regarding the interpretation of forewing venation in Patara.

Population increase and changes in behavior and morphology in the Critically Endangered Redonda ground lizard (Pholidoscelis atratus) following the successful removal of alien rats and goats.

Redonda is a small volcanic Caribbean island that is home to at least 4 endemic lizard species, including the Critically Endangered ground lizard (Pholidoscelis atratus). Black rats (Rattus rattus) and domestic goats (Capra hircus) were introduced to the island at some time after its discovery by Europeans in the late 1500s. They had a devastating effect on the island, resulting in the loss of nearly all trees and most of the ground vegetation. Point count surveys of P. atratus in 2012 indicated low densities, and the invasive rats were observed hunting and preying on the lizards. Both populations of rats and goats were successfully removed in 2017 as part of an ecological restoration program, and native vegetation and invertebrate populations have increased rapidly since. Population surveys in 2017, 2018, and 2019 show the lizard population has increased by more than sixfold. In 2017, as rats and goats were being removed, we evaluated the morphology and escape behavior of this species and repeated these measurements 1 year later. We observed that P. atratus had become bolder, with a reduced flight distance. We also detected changes in limb morphology related to locomotion and suggest possible explanations that will need to be further investigated in the future. These results show how the removal of invasive species can rapidly affect lizard population recovery and behavior, potentially restoring island ecosystems to their pre-human interference dynamics.

An unpleasant souvenir: Endoscopic finding of Trichuris trichiura (Nematoda: Trichuridae).

Whipworms are responsible for up to 500 million cases of trichuriasis worldwide, with higher endemicity in tropical and sub-tropical countries. In non-endemic countries, trichuriasis can be accidentally diagnosed upon colonoscopy, often in the presence of negative microscopy. Here, we describe an incidental diagnosis of trichuriasis in an HIV patient residing in a non-endemic area (i.e., Turin, Italy), six months after his return from Antigua. The species-level diagnosis was made thanks to PCR-based molecular identification of Trichuris sp. following optical microscopy detection. Overall, this case highlights the importance of improving parasitic diseases diagnosis through cutting-edge clinical and laboratory diagnostic tools alongside advanced training of specialists in the area of parasitology.

Schistosoma mansoni Vector Snails in Antigua and Montserrat, with Snail-Related Considerations Pertinent to a Declaration of Elimination of Human Schistosomiasis.

Investigations leading to a WHO-validated declaration of elimination of schistosomiasis transmission are contemplated for several countries, including Caribbean island nations. With assistance from the Pan American Health Organization, we undertook freshwater snail surveys in two such nations, Antigua and Barbuda, and Montserrat in September and October 2017. Historically, the transmission of Schistosoma mansoni supported by the Neotropical vector snail Biomphalaria glabrata occurred in both countries. Transmission on the islands is thought to have been interrupted by the treatment of infected people, improved sanitation, introduction of competitor snails, and on Montserrat with the eruption of the Soufrière volcano which decimated known B. glabrata habitats. Guided by the available literature and local expertise, we found Biomphalaria snails in seven of 15 and one of 14 localities on Antigua and Montserrat, respectively, most of which were identified anatomically and molecularly as Biomphalaria kuhniana. Two localities on Antigua harbored B. glabrata, but no schistosome infections in snails were found. For snail-related aspects of validation of elimination, there are needs to undertake basic local training in medical malacology, be guided by historical literature and recent human schistosomiasis surveys, improve and validate sampling protocols for aquatic habitats, enlist local expertise to efficiently find potential transmission sites, use both anatomical and molecular identifications of schistosomes or putative vector snail species found, if possible determine the susceptibility of recovered Biomphalaria spp. to S. mansoni, publish survey results, and provide museum vouchers of collected snails and parasites as part of the historical record.

Status of coral reefs in Antigua & Barbuda: using data to inform management.

The nation of Antigua and Barbuda has experienced major degradation of its coral reef ecosystems over the past 40+ years. The primary drivers of this degradation are multiple and are highly linked to anthropogenic influences, including over-exploitation and poor management of marine resources. The effectiveness of management actions in marine protected areas (MPAs) has often been hampered by a lack of data to inform management recommendations. This was emphasized by The Nature Conservancy's (TNC) Coral Reef Report Card which highlighted not only the lack of data collection in Antigua and Barbuda and other Caribbean nations, but also illustrated how spatially dispersed available datasets are. The government of Antigua and Barbuda recognized the need for a marine data collection program to better inform the designation and management of MPAs as a tool to improve the health of the marine ecosystems. The Atlantic Gulf Rapid Reef Assessment (AGRRA) protocol has been identified as a means to address planning and management for marine areas. Three AGRRA surveys have been conducted in the years following the TNC 2016 report, in previously established managed areas: North East Marine Management Area (NEMMA) in 2017 and Nelson Dockyard National Park (NDNP) in 2019 as well as areas outlined for future management (Redonda in 2018). Our surveys were conducted to provide updated datasets to inform management for the aforementioned areas. While the results of these surveys mirror the underlying poor coral reef-health conditions, which have been shown to exist within the Caribbean region, they also highlight intra-site variation that exists within each survey location. This knowledge can be crucial in guiding management decisions in these marine areas, through zoning and other management prescriptions. Additionally, the marine surveys conducted around Redonda established useful marine baselines to aid in monitoring the island's recovery following removal of terrestrial invasive species. This article provides an overview of data collected using the AGRRA methodology in marine zones across Antigua and Barbuda which have current or future management prescriptions and provides recommendations to demonstrate the data's future utilization for marine conservation and management.

Managing cancer care during the COVID-19 pandemic-experience at a cancer department in a tertiary hospital in Antigua and Barbuda.

The emergence of corona virus disease 2019 (COVID-19) has caused a global public health emergency and the pandemic has forced the healthcare givers to organise their work differently to provide the same level of care to their patients. Meticulous planning and implementation of robust infection control, proper triage of patients, patient education and awareness and establishment of good command structure has become the norm. In this article we illustrate how the COVID-19 pandemic has affected the oncology department in a tertiary centre in the Caribbean country of Antigua & Barbuda. We describe the changes in treatment decisions for outpatient and inpatient services along with a look at the ethical considerations and the well-being of the oncology team.

A new species of Elaphidion Audinet-Serville, 1834, from Antigua and comparison with E. excelsum Gahan, 1895, from Guadeloupe (Coleoptera: Cerambycidae: Elaphidiini).

A new species of Elaphidion, E. antiguensis sp. nov. is described from Antigua (West Indies). The host plants and larval biology of E. antiguensis are described and compared to those of E. excelsum, Gahan.

Ecological assessment of the marine ecosystems of Barbuda, West Indies: Using rapid scientific assessment to inform ocean zoning and fisheries management.

To inform a community-based ocean zoning initiative, we conducted an intensive ecological assessment of the marine ecosystems of Barbuda, West Indies. We conducted 116 fish and 108 benthic surveys around the island, and measured the abundance and size structure of lobsters and conch at 52 and 35 sites, respectively. We found that both coral cover and fish biomass were similar to or lower than levels observed across the greater Caribbean; live coral cover and abundance of fishery target species, such as large snappers and groupers, was generally low. However, Barbuda lacks many of the high-relief forereef areas where similar work has been conducted in other Caribbean locations. The distribution of lobsters was patchy, making it difficult to quantify density at the island scale. However, the maximum size of lobsters was generally larger than in other locations in the Caribbean and similar to the maximum size reported 40 years ago. While the lobster population has clearly been heavily exploited, our data suggest that it is not as overexploited as in much of the rest of the Caribbean. Surveys of Barbuda's Codrington Lagoon revealed many juvenile lobsters, but none of legal size (95 mm carapace length), suggesting that the lagoon functions primarily as nursery habitat. Conch abundance and size on Barbuda were similar to that of other Caribbean islands. Our data suggest that many of the regional threats observed on other Caribbean islands are present on Barbuda, but some resources-particularly lobster and conch-may be less overexploited than on other Caribbean islands. Local management has the potential to provide sustainability for at least some of the island's marine resources. We show that a rapid, thorough ecological assessment can reveal clear conservation opportunities and facilitate rapid conservation action by providing the foundation for a community-driven policymaking process at the island scale.

PAHO/WHO Multi-Country Cooperation Strategy for Barbados and Eastern Caribbean Countries, 2018-2024

This Strategy for Technical Cooperation with Barbados and the Eastern Caribbean Countries reflects a medium-term vision of the work that the Pan American Health Organization [PAHO/ WHO] and the other levels of the World Health Organization will jointly undertake with the seven countries under the jurisdiction of the PWR-ECC during the period, 2018- 2024. These countries are namely - Antigua and Barbuda, Barbados, Dominica, Grenada, . St. Kitts and Nevis, St. Lucia and St. Vincent and the Grenadines. This is the second such multi-country cooperation framework with these small island states. While the first strategy focused mainly on the establishment of the structures which PAHO/WHO and the Member States had agreed on to better facilitate technical cooperation, this second strategy was developed on the basis of a health situational MESSAGE FROM THE DIRECTOR OF PAHO analysis together with consultations with senior technical officers from the Ministries of Health in the respective countries, with a view to identifying joint health priorities to be addressed in a targeted manner. I am happy to note that in the development of this strategic document, due consideration was given to existing national, sub-regional and global frameworks.