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1.
Am J Trop Med Hyg ; 109(4): 811-819, 2023 10 04.
Article in English | MEDLINE | ID: mdl-37580035

ABSTRACT

To provide information to guide considerations of declaring interruption of transmission of human schistosomiasis due to Schistosoma mansoni on St. Lucia, we undertook an island-wide survey in June-July 2022 to determine the presence of Biomphalaria snails, the intermediate hosts of S. mansoni, and their infection status. Snail surveys were carried out at 58 habitats to determine presence of Biomphalaria snails followed by examination of the collected snails for evidence of infection with S. mansoni. Furthermore, water samples were collected at the snail habitats and screened for presence of S. mansoni DNA using an eDNA approach. We found B. glabrata present in one habitat (Cul de Sac) where it was abundant. Specimens provisionally identified as Biomphalaria kuhniana were recovered from 10 habitats. None of the Biomphalaria specimens recovered were positive for S. mansoni. None of the eDNA water samples screened were positive for S. mansoni. Experimental exposures of both field-derived and laboratory-reared St. Lucian B. glabrata and B. kuhniana to Puerto Rican and Kenyan-derived S. mansoni strains revealed B. glabrata to be susceptible to both and B. kuhniana proved refractory from histological and snail shedding results. We conclude, given the current rarity of B. glabrata on the island and lack of evidence for the presence of S. mansoni, that transmission is unlikely to be ongoing. Coupled with negative results from recent human serological surveys, and implementation of improved sanitation and provision of safe water supplies, St. Lucia should be considered a candidate for declaration of interruption of human schistosomiasis transmission.


Subject(s)
Biomphalaria , Schistosomiasis mansoni , Schistosomiasis , Animals , Humans , Schistosoma mansoni , Kenya , Saint Lucia , Snails , Schistosomiasis mansoni/epidemiology
2.
Perfil de carga de enfermedad por diabetes 2023OPS/NMH/NV/23-0026.
Monography in Spanish | PAHO-IRIS | ID: phr-57847

ABSTRACT

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.


Subject(s)
Diabetes Mellitus , Kidney Diseases , Sanitary Profiles , Saint Lucia
3.
Behav Sci (Basel) ; 13(7)2023 Jun 27.
Article in English | MEDLINE | ID: mdl-37503982

ABSTRACT

Suicide poses a debilitating threat to adolescents' lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals.

4.
Article in English | MEDLINE | ID: mdl-36429595

ABSTRACT

This paper describes the results that have been obtained in a real case study of a hybrid constructed wetlands system, which has been in continuous operation for over 11 years. The main aim of the study was to understand the long-term operation and efficiency of the system (which is situated in the municipality of Santa Lucía, Gran Canaria, Spain), which comprises two vertical-flow and one horizontal-flow constructed wetlands for the treatment of urban wastewater. The system, which was originally designed to treat a flow rate of 12.5 m3/day, with a load of 100 equivalent inhabitants, has been operating since its inauguration (July 2008), with a flow rate of almost 35 m3/day and a load of 400 equivalent inhabitants. Despite this, the mean total removal efficiencies during the study period (2014-2019) are optimal for a system of these characteristics, as follows: 92% for 5-day biochemical oxygen demand (BOD5), 89% for the chemical oxygen demand (COD), and 97% for the total suspended solids (TSS). The system efficiency, with respect to nutrient removal, was somewhat lower, resulting in 48% for total N and 35% for NH4. It has been confirmed with this study that this type of system is an appropriate, robust, resilient nature-based solution for the treatment of the wastewater that is generated in small communities, especially in zones with a warm climate, stable mean temperatures, and mild winters.


Subject(s)
Water Purification , Wetlands , Wastewater , Waste Disposal, Fluid/methods , Spain , Water Purification/methods
5.
Rev Panam Salud Publica ; 46: e128, 2022.
Article in English | MEDLINE | ID: mdl-36071919

ABSTRACT

Objective: To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods: From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results: Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions: The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

6.
Rev Panam Salud Publica ; 46, 2022. Special Issue HEARTS
Article in English | PAHO-IRIS | ID: phr-56270

ABSTRACT

[ABSTRACT]. Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia’s Ministry of Health, with support of the Pan Ameri- can Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technol- ogy, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.


[RESUMEN]. Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esencia- les, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la inter- vención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.


[RESUMO]. Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-pi- loto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capaci- tação foi a base de todas as mudanças.


Subject(s)
Hypertension , Clinical Protocols , Arterial Pressure , Primary Health Care , Saint Lucia , Hypertension , Clinical Protocols , Arterial Pressure , Primary Health Care , Saint Lucia , Hypertension , Arterial Pressure , Primary Health Care , COVID-19
7.
Article in English | MEDLINE | ID: mdl-35682118

ABSTRACT

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.


Subject(s)
Cancer Survivors , Neoplasms , Adult , Female , Health Resources , Humans , Neoplasms/therapy , Saint Lucia , Self-Help Groups , Social Support , Survivors
8.
Zookeys ; 1089: 125-167, 2022.
Article in English | MEDLINE | ID: mdl-35586602

ABSTRACT

The new species and the first halictid bees documented from Saint Lucia Habralictusreinae, Lasioglossum (Dialictus) luciae, and L. (Habralictellus) delphiae are described. A fourth species, L. (D.) dominicense, is tentatively recorded from the island. The species are illustrated and compared to similar ones from the Lesser Antilles. Lasioglossum and Habralictus from neighbouring Saint Vincent and the Grenadines are reviewed and a key to Lasioglossum provided, including the description of another new species, L. (Dialictus) gemmeum. Trigonanigrocyanea Ashmead and Dufoureasubcyanea Ashmead are synonymised under Lasioglossumcyaneum (Ashmead). Notes on the obscure Lasioglossum (Dialictus) minutum (Fabricius) are provided. A new name, Lasioglossum (Homalictus) minuens, is provided for a secondary homonym Homalictusminutus Pauly. The potential for additional species richness in Saint Lucia and the Lesser Antilles is briefly discussed.

9.
Environ Monit Assess ; 194(3): 225, 2022 Feb 26.
Article in English | MEDLINE | ID: mdl-35217908

ABSTRACT

The Sustainable Development Goal 6 calls for global progress by 2030 in treating domestic wastewater and providing access to adequate sanitation facilities. However, meeting these goals will be a challenge for most Small Island Developing States, including Caribbean island nations. In the nearshore zone of the Soufriere region on the Caribbean island of St. Lucia, there is a history of high levels of bacteria of fecal origin. Possible land-based sources of microbial contamination in the Soufriere Bay include discharges from the Soufriere River and transport of wastewater, including fecal material from the town of Soufriere. This area is an important tourist destination and supports a local fishery. To identify the sources of microbial contamination in Soufriere Bay, a range of monitoring methods were employed in this study. In grab samples of surface water collected from the Soufriere River, counts of total coliforms and Escherichia coli were elevated above water quality guidelines. However, the spikes in concentrations of these indicator organisms in the river did not necessarily coincide with the spikes in the levels of total coliforms and E. coli detected in samples collected on the same dates in Soufriere Bay, indicating that there are other sources of pollution in the Bay besides discharges from the river. Monitoring for chemical indicators of wastewater (i.e., caffeine, sucralose, fluconazole) in the Soufriere River indicated that there are inputs of sewage or human fecal material throughout the watershed. However, analysis of Bacteroidales 16S rRNA genetic markers for fecal bacteria originating from humans, bovine ruminants, or other warm-blooded animals indicated that the majority of microbial contamination in the river was not from humans. Monitoring for chemical indicators of wastewater using passive samplers deployed in Soufriere Bay indicated that there are two "hot spots" of contamination located offshore of economically depressed areas of the town of Soufriere. This study indicates that efforts to control contamination of Soufriere Bay by fecal microorganisms must include management of pollution originating from both sewage and domestic animals in the watershed.


Subject(s)
Environmental Monitoring , Escherichia coli , Animals , Cattle , Environmental Monitoring/methods , Escherichia coli/genetics , Feces/microbiology , Humans , RNA, Ribosomal, 16S/genetics , Rivers/chemistry , Saint Lucia , Water Microbiology , Water Pollution/analysis
10.
Heart Rhythm O2 ; 3(6Part B): 827-832, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36588990

ABSTRACT

Background: Delivery of electrophysiology (EP) care in developing nations and underserviced populations faces many hurdles, including the lack of local expertise and knowledge creation. The West Indies has experienced a paucity of local EP expertise. The University of Toronto has undertaken a unique collaborative educational effort with the University of the West Indies. Objective: We describe the effects of equity, diversity, and inclusion (EDI) in EP training at Toronto General Hospital in Canada by quantifying the impact of training the first female electrophysiologists to practice in Jamaica and Saint Lucia. Methods: Data from the ministries of health in Jamaica and Saint Lucia were reviewed. The number of arrhythmia clinic patients seen, EP studies and ablations performed, pacemaker clinic patients seen, and implantable devices, permanent pacemakers (PPMs), and implantable cardioverter-defibrillators (ICDs) implanted were assessed. Results: One hundred one arrhythmia consults were seen by the new electrophysiologist in Jamaica after her return from training in 2020. She has since performed 19 EP studies/catheter ablations at a newly established ablation laboratory. Three cases of left ventricular (LV) dysfunction due to tachy-cardiomyopathy were treated successfully with catheter ablation with immense improvement in LV ejection fraction. Thirteen PPMs, 1 ICD, and 3 LV leads were implanted, after which no early complications were identified. In Saint Lucia, where there is no dedicated electrophysiology laboratory, 2 patients who required catheter ablation for tachycardia-mediated LV dysfunction were identified by the electrophysiologist since her return to the island in 2018. The patients were appropriately referred, resulting in restoration of normal LV function. Six PPMs also were implanted in Saint Lucia. Knowledge translation has been limited by the lack of accessibility to the required devices, catheters, and specialized equipment and accessories, mainly because of their costs. Conclusion: Training the first female electrophysiologists from Jamaica and Saint Lucia led to a quantifiable impact on EP care in both of these Caribbean countries. EDI strategies in EP training programs provide much needed benefits to developing nations, but more support is needed to allow new electrophysiologists to fully utilize their EP training to care for underserviced populations.

11.
Rev. panam. salud pública ; 46: e128, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1431993

ABSTRACT

ABSTRACT Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.


RESUMEN Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esenciales, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la intervención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.


RESUMO Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-piloto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capacitação foi a base de todas as mudanças.

12.
Prehosp Disaster Med ; 36(6): 797-802, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34556194

ABSTRACT

This paper provides a field report on a hospital fire at the St. Jude hospital in the Eastern Caribbean Island of Saint Lucia. The hospital was completely destroyed by the fire and three deaths were recorded. This paper analyses the emergency response to this hospital fire and discusses the lessons learned from this experience. This is a valuable lesion for developing countries in the Caribbean, especially since there have been four hospital fires reported in the Caribbean within the past decade.


Subject(s)
Fires , Caribbean Region , Hospitals , Humans , Saint Lucia , West Indies
13.
Article in English | MEDLINE | ID: mdl-33947123

ABSTRACT

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19-86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.


Subject(s)
Cancer Survivors , Neoplasms , Delivery of Health Care , Female , Humans , Islands , Male , Neoplasms/therapy , Pilot Projects , Saint Lucia
15.
Article in English | PAHO-IRIS | ID: phr-53059

ABSTRACT

[ABSTRACT]. Objective. To describe the epidemiology of human leptospirosis cases in Saint Lucia from 2010 to 2017 and determine whether there was a relationship between cases and rainfall and temperature. Methods. A retrospective analytical study was undertaken to describe the seasonal patterns of human leptospirosis cases reported to the Ministry of Health of Saint Lucia between 2010 and 2017. Confirmed cases of leptospirosis were analyzed according to age, sex, seasonality, and geographical distribution. Disease incidence was calculated and the association of cases with geographical distribution, rainfall, and temperature was investigated. Results. A total of 353 leptospirosis cases were reported between 2010 and 2017 and of these, 145 (40.6%) were laboratory confirmed. Cases were aged 7 to 73 years (mean 34 years; median 30 years) with a male to female ratio of 4.2:1. Six deaths were reported during the period, with an overall case fatality rate of 4.1%. There was no relationship between location (district) and incidence of leptospirosis in Saint Lucia. There was a weak correlation between rainfall and leptospirosis cases during the 8-year period (rs = 0.25, p = 0.015) but the correlation between cases and seasons was not statistically significant (dry season rs = 0.13, p = 0.42; wet season rs = 0.23, p = 0.08). There was no correlation between leptospirosis cases and temperature (rs = 0.07, p = 0.49). Conclusions. Leptospirosis has a seasonal distribution in Saint Lucia, with outbreaks during periods following increased rainfall and flooding, such as in the aftermath of tropical storms and hurricanes. Saint Lucia and other Caribbean countries should enhance surveillance for leptospirosis given the likelihood of increased flooding following frequent and intense rainfall due to climate change.


[RESUMEN]. Objetivo. Describir las características epidemiológicas de los casos de leptospirosis humana en Santa Lucía entre el año 2010 y el año 2017, y determinar si hubo un vínculo entre el número de casos, las precipitaciones y la temperatura. Métodos. Se llevó a cabo un estudio analítico retrospectivo para describir el patrón estacional de los casos de leptospirosis humana notificados al Ministerio de Salud de Santa Lucía entre el año 2010 y el año 2017. Los casos confirmados de leptospirosis se analizaron según la edad, el sexo, el carácter estacional y la distribución geográfica. Se calculó la incidencia de la enfermedad y se evaluó la relación entre el número de casos y la distribución geográfica, las precipitaciones y la temperatura. Resultados. Se notificaron 353 casos de leptospirosis entre el 2010 y el 2017, entre ellos, 145 (40,6%) casos confirmados mediante pruebas de laboratorio. Los casos se presentaron en personas de 7 a 73 años (media de 34 años; mediana de 30 años) con una razón hombre:mujer de 4,2:1. Se notificaron 6 muertes durante el mismo período y una tasa de letalidad general de 4,1%. No se encontró un vínculo entre la ubicación (distrito) y la incidencia de la leptospirosis en Santa Lucía. Se estableció una correlación débil entre las precipitaciones y el número de casos de leptospirosis durante el período de 8 años (rs = 0,25, p = 0,015); la correlación entre el número de casos y las estaciones no fue estadísticamente significativa (estación seca, rs = 0,13, p = 0,42; estación húmeda, rs = 0,23, p = 0,08). No se estableció una correlación entre el número de casos de leptospirosis y la temperatura (rs = 0,07, p = 0,49). Conclusiones. La leptospirosis presenta una distribución estacional en Santa Lucía, con brotes que surgen tras períodos de aumento de las precipitaciones e inundaciones; por ejemplo, después de tormentas y huracanes tropicales. Santa Lucía y otros países del Caribe deben mejorar la vigilancia de la leptospirosis dado que el cambio climático aumenta la probabilidad de inundaciones tras períodos de precipitaciones frecuentes e intensas.


[RESUMO]. Objetivo. Descrever a epidemiologia dos casos de leptospirose humana em Santa Lúcia de 2010 a 2017 e determinar se houve uma relação entre a ocorrência de casos e precipitação e temperatura. Métodos. Um estudo retrospectivo analítico foi realizado para descrever o padrão sazonal dos casos de leptospirose humana notificados ao Ministério da Saúde de Santa Lúcia entre 2010 e 2017. Os casos confirmados de leptospirose foram analisados por idade, sexo, sazonalidade e distribuição geográfica. A incidência da doença foi calculada e a associação entre a ocorrência de leptospirose e distribuição geográfica dos casos, precipitação e temperatura foi pesquisada. Resultados. Ao todo, 353 casos de leptospirose foram registrados entre 2010 e 2017. Destes, 145 (40,6%) tiveram confirmação laboratorial. Os casos ocorreram em indivíduos entre 7 e 73 anos de idade (média 34 anos; mediana 30 anos) com uma proporção de 4,2:1 entre os sexos masculino e feminino. Houve seis mortes durante o período estudado, com uma taxa de letalidade global de 4,1%. Não foi verificada uma relação entre localização geográfica (distrito) e incidência de leptospirose em Santa Lúcia. Foi observada uma fraca correlação entre a ocorrência de casos e precipitação no período considerado de 8 anos (rs = 0,25, p = 0,015), mas a correlação entre casos da doença e estações do ano não foi estatisticamente significativa (estação seca rs = 0,13, p = 0,42; estação chuvosa rs = 0,23, p = 0,08). Não foi verificada correlação entre leptospirose e temperatura (rs = 0,07, p = 0,49). Conclusões. A leptospirose tem distribuição sazonal em Santa Lúcia, com a ocorrência de surtos nos períodos que se seguem ao aumento da precipitação e às enchentes, como após tempestades tropicais e furacões. Santa Lúcia e os outros países do Caribe devem intensificar a vigilância da leptospirose diante da possibilidade de maior ocorrência de enchentes com as chuvas intensas e mais frequentes decorrentes da mudança climática.


Subject(s)
Leptospirosis , Saint Lucia , Caribbean Region , Saint Lucia , Caribbean Region , Leptospirosis , Saint Lucia , Caribbean Region
16.
Am J Trop Med Hyg ; 103(1_Suppl): 50-57, 2020 07.
Article in English | MEDLINE | ID: mdl-32400344

ABSTRACT

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato-Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications.


Subject(s)
Antigens, Helminth/immunology , Glycoproteins/immunology , Helminth Proteins/immunology , Schistosoma/immunology , Schistosomiasis/diagnosis , Animals , Biomarkers , Burundi/epidemiology , Child , Diagnostic Tests, Routine , Feces/parasitology , Female , Humans , Immunologic Tests , Male , Models, Animal , Papio/parasitology , Parasite Egg Count , Prevalence , Rwanda/epidemiology , Saint Lucia/epidemiology , Schistosoma/isolation & purification , Schistosoma haematobium/immunology , Schistosoma haematobium/isolation & purification , Schistosoma japonicum/immunology , Schistosoma japonicum/isolation & purification , Schistosoma mansoni/immunology , Schistosoma mansoni/isolation & purification , Schistosomiasis/epidemiology , Sensitivity and Specificity , Tanzania/epidemiology , Urine/parasitology
17.
Article in English | MEDLINE | ID: mdl-32230803

ABSTRACT

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women's rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings.


Subject(s)
Health Personnel , Social Stigma , Wounds and Injuries , Adult , Caribbean Region , Female , Health Personnel/education , Humans , Islands , Male , Middle Aged , Saint Lucia , Survivors , West Indies , Young Adult
18.
Am J Trop Med Hyg ; 102(4): 827-831, 2020 04.
Article in English | MEDLINE | ID: mdl-32043449

ABSTRACT

Saint Lucia at one time had levels of schistosomiasis prevalence and morbidity as high as many countries in Africa. However, as a result of control efforts and economic development, including more widespread access to sanitation and safe water, schistosomiasis on the island has practically disappeared. To evaluate the current status of schistosomiasis in Saint Lucia, we conducted a nationally representative school-based survey of 8-11-year-old children for prevalence of Schistosoma mansoni infections using circulating antigen and specific antibody detection methods. We also conducted a questionnaire about available water sources, sanitation, and contact with fresh water. The total population of 8-11-year-old children on Saint Lucia was 8,985; of these, 1,487 (16.5%) provided urine for antigen testing, 1,455 (16.2%) provided fingerstick blood for antibody testing, and 1,536 (17.1%) answered the questionnaire. Although a few children were initially low positives by antigen or antibody detection methods, none could be confirmed positive by follow-up testing. Most children reported access to clean water and sanitary facilities in or near their homes and 48% of the children reported contact with fresh water. Together, these data suggest that schistosomiasis transmission has been interrupted on Saint Lucia. Additional surveys of adults, snails, and a repeat survey among school-age children will be necessary to verify these findings. However, in the same way that research on Saint Lucia generated the data leading to use of mass drug administration for schistosomiasis control, the island may also provide the information needed for guidelines to verify interruption of schistosomiasis transmission.


Subject(s)
Antibodies, Helminth/blood , Schistosomiasis/epidemiology , Schistosomiasis/transmission , Child , Female , Humans , Male , Risk Factors , Saint Lucia/epidemiology , Sanitation , Schistosomiasis/prevention & control , Serologic Tests , Surveys and Questionnaires
19.
Environ Sci Pollut Res Int ; 27(14): 15944-15958, 2020 May.
Article in English | MEDLINE | ID: mdl-30900124

ABSTRACT

Santa Lucía peloid is a sediment used in pelotherapy in Cuban primary health care services. Therefore, in addition to physicochemical regulated parameters, other analyses are required to complement their physicochemical characterization and understand potential element mobility, radiological risk, and toxicity as well as likely bioactive compounds present in Santa Lucía peloid. For these purposes, inorganic and organic elements and compounds were considered to evaluate Santa Lucía peloid's quality. This was accomplished through an integral approach that included (1) determination of physicochemical parameters (pH, electrical conductivity, oxidation-reduction potential, temperature, dissolved oxygen, elemental C, H, and N analyses, organic matter, and hexane removable substances content); (2) determination of total concentration of elements with biological and toxicological importance (i.e., Na, K, Ca, Mg, Fe, Mn, Cr, Cu, Ni, Pb, and Zn), as well as their distribution in operationally defined solid phases, mineralogy, particle size distribution, and total content of radionuclides and radiological dose calculations; and (3) its organic characterization. Results from this study showed that Santa Lucía peloid was non-contaminated and showed low metal mobility and acceptable radiological dose levels, being safe for therapeutic uses. Additionally, these results contribute to the understanding of the organic composition of peloides, provide strong evidences to scientifically explain the therapeutic action of peloids in the treatment of inflammatory diseases, and set a new frame to improve peloid guidelines in Cuba and other countries.


Subject(s)
Metals, Heavy/analysis , Metals/analysis , Cuba , Environmental Monitoring , Oxygen/analysis , Sodium Chloride , Sodium Chloride, Dietary
20.
Wellcome Open Res ; 5: 149, 2020.
Article in English | MEDLINE | ID: mdl-33869790

ABSTRACT

Background. Outbreaks of mosquito-borne arboviral diseases including dengue virus (DENV), Zika virus (ZIKV), yellow fever virus (YFV) and chikungunya virus (CHIKV) have recently occurred in the Caribbean. The geographical range of the principal vectors responsible for transmission, Aedes (Ae.) aegypti and Ae. albopictus are increasing and greater mosquito surveillance is needed in the Caribbean given international tourism is so prominent. The island of Saint Lucia has seen outbreaks of DENV and CHIKV in the past five years but vector surveillance has been limited with the last studies dating back to the late 1970s. Natural disasters have changed the landscape of Saint Lucia and the island has gone through significant urbanisation. Methods. In this study, we conducted an entomological survey of Ae. aegypti and Ae. albopictus distribution across the island and analysed environmental parameters associated with the presence of these species in addition to screening for medically important arboviruses and other flaviviruses. Results. Although we collected Ae. aegypti across a range of sites across the island, no Ae. albopictus were collected despite traps being placed in diverse ecological settings. The number of Ae. aegypti collected was significantly associated with higher elevation, and semi-urban settings yielded female mosquito counts per trap-day that were five-fold lower than urban settings. Screening for arboviruses revealed a high prevalence of cell-fusing agent virus (CFAV). Conclusions. Outbreaks of arboviruses transmitted by Ae. aegypti and Ae. albopictus have a history of occurring in small tropical islands and Saint Lucia is particularly vulnerable given the limited resources available to undertake vector control and manage outbreaks. Surveillance strategies can identify risk areas for predicting future outbreaks. Further research is needed to determine the diversity of current mosquito species, investigate insect-specific viruses, as well as pathogenic arboviruses, and this should also be extended to the neighbouring smaller Caribbean islands.

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