Fish (eggs) out of water: evolutionary divergence in terrestrial embryonic plasticity in Trinidadian killifish.

Externally laid eggs are often responsive to environmental cues; however, it is unclear how such plasticity evolves. In Trinidad, the killifish (Anablepsoides hartii) is found in communities with and without predators. Here, killifish inhabit shallower, ephemeral habitats in sites with predators. Such shifts may increase the exposure of eggs to air and lead to possible desiccation. We compared egg-hatching plasticity between communities by rearing eggs terrestrially on peat moss or in water. The timing of hatching did not differ between communities when eggs were reared in water. Eggs from sites with predators responded to terrestrial incubation by hatching significantly earlier compared with water-reared eggs. These responses were weaker in sites with no predators. Such divergent trends show that the presence of predators is associated with evolutionary shifts in hatching plasticity. Our results provide evidence for local adaptation in embryonic plasticity at the population scale.

Intersectoral collaboration in the COVID-19 response in Latin America and the Caribbean.

World Health Organization (WHO) / Pan American Health Organization (PAHO) encouraged the utilization of whole-of-society and whole-of-government strategic approaches to increase countries' resilience towards mitigating the impact of the COVID-19 pandemic. Strategies included the implementation of multi-sectoral, multi-partner and multi-stakeholder planning, coordination, consultation, and action. We reviewed the experiences of three Latin American and Caribbean countries, related to the implementation of collaborative strategies in tackling COVID-19, specifically the nature of the collaboration, the dynamics and the stakeholders involved.A systematic literature review identified relevant publications and content analysis was conducted to determine the collaborative strategies. Colombia, Costa Rica, and Trinidad and Tobago were selected as case studies since they were from different LAC subregions and because of the accessibility of relevant literature.In the three countries, the pandemic response was coordinated by a national executive committee, led by the Ministry of Health. Intersectoral collaboration was evident in each, with the key stakeholders being public sector agencies, the private/corporate sector, private/non-profit, academic institutions, and international agencies. It was used primarily to facilitate data-driven, evidenced-informed decision-making and guidelines; to expand clinical care capacity and strengthen the national medical response; and to provide support for the most vulnerable populations.While the institutionalization of intersectoral collaboration can be recommended for the health sector beyond the pandemic, research is needed to evaluate the impact of specific collaborative strategies as well as barriers and facilitators.

The EQ-5D-5L valuation study for Trinidad and Tobago.

PURPOSE: The 2016 EQ-5D-3L value set for Trinidad and Tobago (T&T) allows for the calculation of EQ-5D-5L values via the crosswalk algorithm. The 2016 value set was based on methods predating the EQ-VT protocol, now considered the gold standard for developing EQ-5D value sets. Furthermore, direct elicitation of EQ-5D-5L is preferred over crosswalked values. This study aimed to produce an EQ-5D-5L value set for T&T. METHODS: A representative sample (age, sex, geography) of adults each completed 10 composite Time Trade-Off (cTTO) tasks and 12 Discrete Choice Experiment (DCE) tasks in face-to-face interviews. The cTTO data were analyzed using a Tobit model that corrects for heteroskedasticity. DCE data were analyzed using a mixed logit model. The cTTO and DCE data were combined in hybrid models. RESULTS: One thousand and seventy-nine adults completed the valuation interviews. Among the modelling approaches that were explored, the hybrid heteroskedastic Tobit model produced all internally consistent, statistically significant coefficients, and performed best in terms of out-of-sample predictivity for single states. Compared to the existing EQ-5D-5L crosswalk set, the new value set had a higher number of negative values (236 or 7.6% versus 21 or 0.7%). The mean absolute difference was 0.157 and the correlation coefficient between the two sets was 0.879. CONCLUSION: This study provides a value set for the EQ-5D-5L for T&T using the EQ-VT protocol. We recommend this value set for QALY computations relating to T&T.

The Effectiveness of Telemedicine in the Management of Chronic Diseases (Diabetes, Hypertension, and Coronary Heart Disease) at Primary Care Facilities in Eastern Trinidad During the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, Trinidad and Tobago's government implemented lockdowns and limited the availability of outpatient clinics to curb virus transmission. Subsequently, telemedicine via telephone calls was utilized to address infection control and continuity of care for chronic disease patients. Methods: An observational study was conducted at three primary care facilities in Eastern Trinidad using convenience sampling to review retrospectively telemedicine patients' medical records from October 2019 to February 2020 (before telemedicine) and from March 2020 to September 2020 (during telemedicine) for comparative analysis. Data were analyzed using IBM SPSS Statistics 28.0 software and Microsoft Excel. Results: A total of 199 patient files were analyzed; 57.3% of these were female; 52.3% were 60 years and older. A Wilcoxon signed-rank test demonstrated no statistically significant differences between random blood sugar (RBS) readings (0.355), weight (0.621), or systolic and diastolic blood pressure (BP; 0.239 and 0.232, respectively) before and during the 6-month period of telemedicine consultation. Patients compliant with medication before the use of telemedicine were 14 times more likely to attain target BPs. There was no significant association between compliance with prescribed therapy and BP control (0.335) during the period of telemedicine. Discussion: The findings support the use of telemedicine to manage chronic diseases such as hypertension, diabetes mellitus, and coronary heart disease, as the standard of care was preserved, and no inferiority of recorded outcomes was demonstrated. Although there was an overall decrease in compliance during the telemedicine period compared with before, comparative analysis exhibited no statistically significant differences in BP or RBS readings.

Prevalence and Pattern of Tooth Impaction: A Radiographic Study in a Trinidadian Population.

OBJECTIVE: The aim of this retrospective study was to determine the prevalence and patterns of impacted third molars in a Trinidadian population. METHODS: A total of 1500 orthopantomograms (OPG) taken at the School of Dentistry, University of the West Indies, from 2008 to 2019 in patients between 15 and 67 years old were evaluated. From the data collected, the prevalence of third molar impaction, the parameters of gender, angulation, level of impaction, and associated pathologies were evaluated. Other types of impacted teeth were also recorded. RESULTS: Of the 1500 OPG viewed, 408 (27.2%) of the study sample presented with at least one impacted third molar. 161 (39.5%) were males and 247 (60.5%) were females, with a male-to-female ratio of 1:1.5. There was a greater incidence of mandibular third molars versus maxillary third molars, which had a frequency of 77.9% and 22.1%, respectively. The most common type of impaction (Winter's classification) was horizontal in the mandible and distoangular in the maxilla. The most common level of impaction in the mandible (Pell and Gregory classification) was level 1A. The total number of impacted teeth was 775, and of these, 75 (9.7%) showed other impacted teeth besides the third molars. Canines and second premolars were the most prevalent with 7.6% and 1.5%, respectively. Caries on the second molar (49.3%) and third molars (40%) were the most frequently associated pathologies identified. CONCLUSION: The prevalence of impacted wisdom teeth in this study was 27%. These results raise awareness and provide insight among dental professionals in Trinidad as to the prevalence of impacted third molars, their patterns, as well as commonly associated pathologies, and the need for screening within the population.

Phylogenetic characterization of Orthobunyaviruses isolated from Trinidad shows evidence of natural reassortment.

The genus Orthobunyavirus is a diverse group of viruses in the family Peribunyaviridae, recently classified into 20 serogroups, and 103 virus species. Although most viruses within these serogroups are phylogenetically distinct, the absence of complete genome sequences has left several viruses incompletely characterized. Here we report the complete genome sequences for 11 orthobunyaviruses isolated from Trinidad, French Guiana, Guatemala, and Panama that were serologically classified into six serogroups and 10 species. Phylogenetic analyses of these 11 newly derived sequences indicate that viruses belonging to the Patois, Capim, Guama, and Group C serocomplexes all have a close genetic origin. We show that three of the 11 orthobunyaviruses characterized (belonging to the Group C and Bunyamwera serogroups) have evidence of histories of natural reassortment through the M genome segment. Our data also suggests that two distinct lineages of Group C viruses concurrently circulate in Trinidad and are transmitted by the same mosquito vectors. This study also highlights the importance of complementing serological identification with nucleotide sequencing when characterizing orthobunyaviruses.

The preconception health status of nongravid women aged 18 to 45 years in Arima, Trinidad: a cross-sectional study.

BACKGROUND: Preconception care (PCC) is the term used for activities and interventions designed to address and prevent problems related to pregnancy, the neonatal period and childhood. This study assessed maternal health status prior to conception in Trinidad by means of a screening tool, physical measurements, and laboratory samples. METHODS: A cross-sectional study was conducted among women aged 18-45 years at a primary care centre in Arima, Trinidad. A de novo PCC screening tool was used to assess 13 domains of high-risk pregnancy in participants. These domains included dietary details, gynaecological and obstetric histories, and genetic and vaccination histories, among others. Blood pressure, weight, height, and waist circumference were recorded, and a capillary blood sample was used to determine random blood glucose and HbA1c levels. All data were coded and entered into SPSS ver. 21. RESULTS: A total of 400 nongravid participants were recruited, of whom 366 were included in the final analysis. Most (96.7%) had one or more risk factors for adverse pregnancy outcomes. These included overweight (27%), obesity (35%), central obesity (69.4%), and impaired glucose tolerance/diabetes mellitus (IGT/DM) (26.2%). Additionally, a sedentary lifestyle and diet high in processed food/fats were self-reported by 74.9% and 88.8% of participants, respectively. Only 13.1% had planned to conceive, and of those who had no immediate plans to conceive, 76.4% were currently sexually active, and many (60.7%) did not use birth control techniques. More than half (57.1%) had never had a pap smear. On the other hand, 86.3% knew their HIV status. Self-reported percentages for vaccination were as follows: MMR (100%), tetanus (17.5%), hepatitis B (11.5%) and influenza (2.7%). The majority (82.8%) of participants had not visited the dentist in the past year, with 35.9% of these individuals reporting symptoms of periodontitis. Segments of the population had multiple risk factors; for example, 23.7% of participants were overweight or obese and had an elevated HbA1c level. CONCLUSIONS: Unexpectedly, most participants had a risk factor for an adverse pregnancy outcome, and many had multiple risk factors. There is a strong case for enhanced preconception care for women in Trinidad.

Insights into the genetic landscape and presence of Cochliomyia hominivorax in the Caribbean.

The New World screwworm, Cochliomyia hominivorax, is a major parasite that causes myiasis in livestock, humans, and other warm-blooded animals in the western hemisphere. There is a permanent biological border that is maintained between Panama and Colombia, as it has been eradicated from North and Central America. However, it still exists in much of the Caribbean and South America causing an estimated annual loss of $3.6 billion dollars in South America alone. Less information is available for C. hominivorax in the Caribbean. Thus, here we examined its presence and genetic landscape in order to gain insights into this fly's distribution in this region. First, through sampling efforts, novel GPS (Global Positioning System) coordinates were collected. Second, the environmental correlates of those presence points were examined. Next, samples were sequenced in order to obtain a pairwise ΦIT genetic distance matrix. And lastly, this matrix was used to create a genetic landscape of divergence. The results of the genetic landscape show flies as more diverse in Trinidad and Tobago and less diverse in the Dominican Republic. This is perhaps due to the proximity of Trinidad to Venezuela and gene flow may be occurring between these two areas. This information will aid in screwworm surveillance and control programs by providing environmental correlates and a view into the distribution of these flies.

Qualitative Evidence on the Implementation of Cure Violence in Trinidad and Tobago.

Violence is a significant social problem in many cities throughout the world. In seeking to prevent or control violence, communities have put in place a variety of interventions. Many of these rely on the formal criminal justice process to arrest, prosecute, and imprison offenders. However, formal social control is well known to be an incomplete solution to violence. As a result, some communities have experimented with community-based solutions. One such approach is Cure Violence, an initiative that treats violence as a public health issue. Based on methods used to prevent the spread of infectious disease, Cure Violence seeks to stop the spread of violence within communities. This study presents qualitative results on the implementation of Cure Violence in Trinidad and Tobago, a two-island nation in the southeastern Caribbean near Venezuela. We conducted 36 in-depth semi-structured interviews and two focus groups with a variety of stakeholders, including program staff, residents, family members of victims, and police. Our findings suggest that the implementation of Cure Violence in Trinidad and Tobago led to educational and employment support for community members and a reduction in violence, particularly retaliation killings in the target communities. Our results are useful for understanding the factors that shape the implementation of community-based violence reduction initiatives like Cure Violence.

Dietary intake patterns, nutrient adequacy and associated factors in a multi-ethnic Caribbean population.

Background: Diet is a significant contributor to health and wellbeing of individuals. Aim: In this study we investigated patterns of dietary intakes, levels of nutrient inadequacies and associated sociodemographic, anthropometric and lifestyle factors among adults in Trinidad and Tobago. Method: The study was cross-sectional in nature. A convenience sample of 11783 persons from districts throughout Trinidad and Tobago completed a self-administered questionnaire comprising socio-demographic and lifestyle items. Anthropometry was self-reported with 15% of participants having measurements done according to recommended procedures. Dietary patterns were determined by principal component analysis (PCA) while nutrient intakes and adequacy were assessed using the NutriGenie 7.0 software and nutrient adequacy ratio (MAR) respectively. Foods were categorised as unprocessed/minimally processed and processed/ultra-processed. The University of The West Indies Ethics Committee approved the study. Results: Approximately 72.5% of participants met the Goldberg criteria for plausible reporting. The three predominant dietary patterns 'Typical', 'Fruits and Vegetables', and 'High Fat' explained 45% of the total variance in foods consumed. Processed/ultra-processed foods accounted for most of the energy (80%) and nutrients consumed. Nutrient inadequacies were observed for potassium, vitamins B12, D, E, K, fibre, magnesium; and iron among females. The mean adequacy ratio (MAR) for participants was 67%. MAR was positively associated with predominant dietary patterns independent of socioe demographic and lifestyle factors (p < 0.001). Conclusion: Irrespective of their nature, the predominant dietary pattern was associated with nutrient adequacy among participants. Reducing the risk of inadequate nutrient intakes may be addressed by increasing availability, access and consumption of appropriate sources of these micronutrients.

Estimations of future reservoir volumes under different climate scenarios for a tropical reservoir in a small Caribbean Island, Trinidad.

Freshwater resources supply has always presented challenges and considering a changing climate quantifying the available water in the future is important. In the Caribbean, based on projections it is likely that the island of Trinidad would receive less intense rainfall, experience more dry days, become drier and warmer, and the water resources be decreased. In this study, the impact of a changing climate on the Navet Reservoir in Trinidad was investigated and reservoir volumes were quantified for the period 2011-2099. This period was subdivided into three time periods, 2011-2040, 2041-2070, and 2071-2099, and evaluated under the representative concentration pathways (RCPs): RCPs 2.6, 4.5, 6.0, and 8.5. Utilizing a calibrated/validated Soil Water Assessment Tool (SWAT) model for the Navet Reservoir together with projections from five general circulation models (GCMs), future monthly and seasonal reservoir volumes were estimated. The GCM precipitation and temperature data were bias-corrected using linear scaling and variance scaling methods. It was found that reservoir volumes are likely to be the lowest during the period 2041-2070 at the Navet Reservoir. Additionally, the projected reservoir volumes are reliable, resilient, and not vulnerable. These results may be used by water managers in the adaptation and mitigation of the impacts of a changing climate, thus, building resilience in the water sector.

Positive influences of the COVID-19 pandemic on community dwelling adults in Trinidad and Tobago: a cross sectional study.

BACKGROUND: Since the onset of the coronavirus (COVID-19) pandemic its negative effects have been highlighted globally. There is little literature that examines the positive impact on daily living. AIMS: To examine the positive influences of government-imposed COVID-19 public health restrictions on adults throughout Trinidad and Tobago (TT) and their associated factors. METHOD: A cross-sectional study, using an adapted pretested online survey instrument, was conducted amongst non-institutionalised, community-dwelling adults using convenience sampling. RESULTS: Of 1287 completed and weighted responses, the mean age (S.D.) was 39.2 (14.6) years, 49% were males, and 61% completed secondary level education. The top 5 positive experiences were more time spent with family (80%), more down-time (78%), learning new skills (68%), more time for hobbies (66%), self-care (57%), more time spent with friends (55%) and eating healthier (50%). The importance of religion, working from home, and an increase in marijuana use emerged as positive correlates for certain positive experiences, while participants with chronic illness, and a positive anxiety or depression screen, were negatively associated with most positive experiences. CONCLUSIONS: Despite the negative consequences of the COVID19 pandemic, several positives were highlighted in this study. These findings have implications for social policies toward building resilience within the community.

Immediate predation risk alters the relationship between potential and realised selection on male traits in the Trinidad guppy Poecilia reticulata.

Imminent predation risk affects mating behaviours in prey individuals in a multitude of ways that can theoretically impact the strength of sexual selection, as well as its operation on traits. However, empirical studies of the effects of imminent predation risk on sexual selection dynamics are still scarce. Here we explore how perceived predation affects: (1) the relationship between the opportunity for selection and the actual strength of selection on male traits; and (2) which traits contribute to male fitness and the shape of selection on these traits. We simulate two consecutive reproductive episodes, under control conditions and perceived predation risk using experimental populations of Trinidad guppies. The opportunity for selection is higher under predation risk compared to the control condition, but realised selection on traits remains unaffected. Pre- and postcopulatory traits follow complex patterns of nonlinear selection in both conditions. Differences in selection gradients deviate from predictions based on evolutionary and non-lethal effects of predation, the most notable being strong disruptive selection on courtship rate under predation risk. Our results demonstrate that sexual selection is sensitive to imminent predation risk perception and reinforce the notion that both trait-based and variance-based metrics should be employed for an informative quantification.

Detection and diversity of the mannosylerythritol lipid (MEL) gene cluster and lipase A and B genes of Moesziomyces antarcticus isolated from terrestrial sites chronically contaminated with crude oil in Trinidad.

BACKGROUND: Mannosylerythritol lipids (MELs) belong to the class of glycolipid biosurfactants and are produced by members of the Ustilago and Moesziomyces genera. Production of MELs is regulated by a biosynthetic gene cluster (MEL BGC). Extracellular lipase activity is also associated with MEL production. Most microbial glycolipid-producers are isolated from oil-contaminated environments. MEL-producing yeast that are capable of metabolizing crude oil are understudied, and there is very limited data on indigenous strains from tropical climates. Analysis of the MEL BGC and lipase genes in Trinidad M. antarcticus strains, using a gene-targeted approach, revealed a correlation between their intrinsic capability to degrade crude oil and their adaptation to survive in a chronically polluted terrestrial environment. RESULTS: M. antarcticus was isolated from naturally-occurring crude oil seeps and an asphaltic mud volcano in Trinidad; these are habitats that have not been previously reported for this species. Genus identification was confirmed by the large-subunit (LSU) and the small-subunit (SSU) sequence comparisons and species identification was confirmed by ITS sequence comparisons and phylogenetic inference. The essential genes (Emt1, Mac1, Mac2, Mmf1) of the MEL BGC were detected with gene-specific primers. Emt1p, Mac1p and Mmf1p sequence analyses confirmed that the Trinidad strains harboured novel synonymous amino acid (aa) substitutions and structural comparisons revealed different regions of disorder, specifically for the Emt1p sequence. Functionality of each protein sequence was confirmed through motif mining and mutation prediction. Phylogenetic relatedness was inferred for Emt1p, Mac1p and Mmf1p sequences. The Trinidad strains clustered with other M. antarcticus sequences, however, the representative Trinidad M. antarcticus sequences consistently formed a separate, highly supported branch for each protein. Similar phylogenetic placement was indicated for LipA and LipB nucleotide and protein sequences. The Trinidad strains also demonstrated lipolytic activity in culture, with an ability to utilize different carbon sources. Comparative evolution of MEL BGC and LipA gene suggested early and late duplication events, depending on the gene, followed by a number of speciation events within Ustilaginaceae. M. antarcticus and M. aphidis were separated from all other members of Ustilaginaceae and two gene homologues were detected, one for each species. CONCLUSIONS: Sequence analyses was based on a novel gene-targeted approach to analyze the essential genes of the MEL BGC and LipA and LipB genes of M. antarcticus strains from Trinidad. The findings indicated that these strains accumulated nucleotide mutations to a threshold level that did not affect the function of specific proteins encoded by the MEL BGC and LipA and LipB genes. The biosurfactant and lipase enzymes secreted by these Trinidad M. antarcticus strains facilitated their survival in oil-contaminated terrestrial environments. These findings suggest that the Trinidad strains should be explored as promising candidates for the commercial production of MEL biosurfactants and lipase enzymes.

Comparison of surveillance trapping methods to monitor Culicoides biting midge activity in Trinidad, West Indies.

Culicoides biting midges (Diptera: Ceratopogonidae) are biting nuisances and arbovirus vectors of both public health and veterinary significance in Trinidad. We compared sampling methods to define the behaviour and bionomics of adult Culicoides populations at a commercial dairy goat farm. Three static trap designs were compared: (a) Centre for Disease Control (CDC) downdraft UV trap; (b) CDC trap with an incandescent bulb and (c) CDC trap with semiochemical lure consisting of R-(-)-1-octen-3-ol and CO2 (no bulb). Sweep netting was used to define diel periodicity. A total of 30,701 biting midges were collected using static traps, dominated by female Culicoides furens (>70% of trap collections across all three designs). There was no significant difference in the Margalef's index between the three traps; however, trap designs A and C collected a significantly greater number of individuals than trap B, and trap C gained highest species richness. The greatest species richness and abundance of Culicoides collected by sweep net was observed between 6:00 and 6:15 pm and notable differences in the crepuscular activity pattern of several species were identified. Comparative data on Culicoides species richness, abundance, sex and reproductive status is discussed and can be used to improve surveillance strategies, research designs and risk management.

Characterization of Beta-Lactam Resistance Genes and Virulence Factors Associated with Multidrug-Resistant Klebsiella pneumoniae Isolated from Patients at Major Hospitals in Trinidad, West Indies.

Accurate species identification and antibiotic resistance profiling are essential for the effective management of infections caused by bacterial pathogens. In this study, 373 clinical isolates of K. pneumoniae from major hospitals in Trinidad, West Indies, were characterized for resistance against beta-lactam antibiotics and the presence of genes encoding important virulence factors. Most of the isolates showed extended spectrum ß-lactamase (ESBL) activity but few also displayed carbapenemase or 'ESBL + carbapenemase' activities. Polymerase chain reaction analysis revealed the presence of genes for ESBL subtypes blaTEM, blaSHV, and blaCTX-M that were dominant in isolates with the ESBL phenotype as well as those that did not show ESBL or carbapenemase activities. The carbapenem resistance gene, blaKPC, and the metallo-ß-lactamase (MBL) gene, blaNDM-1, were also detected in some of the isolates. Multiple virulence genes were also detected, but the fimH-uge was the most common combination found among the local isolates. The findings of this study represent the first comprehensive study on the prevalence of ESBL, KPC and MBL genes and virulence profiling in antibiotic-resistant K. pneumoniae in Trinidad. Furthermore, the occurrence of multiple resistant phenotypes and gene combinations were revealed, though at low prevalence rates. This work emphasizes the need to implement molecular-based techniques in diagnostic workflows for rapid and accurate species identification and profiling of resistance and virulence genes in K. pneumoniae in Trinidad and Tobago.

Piscine mycobacteriosis in the ornamental fish trade in Trinidad and Tobago.

The freshwater ornamental fish trade represents a major contributor to the livelihoods of many producers in Trinidad and Tobago, with stocks destined for local, regional and international markets. A review of clinical cases presented to the Aquatic Animal Health Unit at the University of the West Indies, School of Veterinary Medicine for the period September 2010 to December 2012 suggested that piscine mycobacteriosis may be widespread throughout the local ornamental fish industry. Thus, to determine the prevalence of mycobacteriosis in ornamental fish sold in pet stores, a total of 122 specimens were sourced from 24 retail suppliers across Trinidad. Fish were killed and internal organs were examined for lesions suggestive of granulomas. All wet-mount slides were acid-fast stained, regardless of the presence or absence of observed granuloma-like lesions. Histological analysis was performed on one randomly selected whole specimen from each facility. Mycobacterium sp. was identified using real-time PCR detecting the 16S rRNA gene in tissue samples. Associations between parasitism, facility biosecurity and presence of positive animals were determined. The prevalence of Mycobacterium sp. infection was 61 ± 7% (74/122), with positive specimens being acquired from 54.2% (13/24) of facilities examined. Further, 100% of facilities did not employ optimum biosecurity measures.

'You don't just do it because someone else said so': Menstrual practices and women's agency in the Hindu diaspora of Trinidad.

Meanings of menstruation are deeply embedded in culture and religion. The current dominant narrative presents menstrual practices as restrictions and often describes Hindu women as 'subjected to' these practices, characterising them as the oppressed victims of their religion. This article seeks to complicate this oversimplified narrative by exploring women's motivations, choices and decisions related to menstrual practices in a small-scale study based on semi-structured interviews and focus groups with women in the Hindu-Trinidadian diaspora. Our findings indicate that the women we interviewed exercise agency in the cognitive, emotional, religious and socio-cultural spheres. Many of them accept the ritual 'impurity' but overwhelmingly restrict this label to the spiritual sphere and separate it from their menstruating bodies. Many reject the idea that the practices are restrictive or stigmatising. They do not understand religion as the source of menstrual stigma but instead value or accept menstrual practices as part of what it means to be a Hindu woman-motivated by religious observance and/or the desire to be part of a community that upholds tradition. These varied manifestations of women's agency challenge the understanding of menstrual practices as necessarily-and-always oppressive and call for acknowledging the nuance and complexity of women's lives.

Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad.

Even though easily accessible and cost-effective healthcare is a fundamental human right, many persons with disabilities experience healthcare barriers and poor health outcomes. We explore the healthcare barriers among working-age persons with disabilities in Trinidad using a qualitative descriptive approach. Semi-structured interviews with 26 participants reveal barriers at the personal, healthcare facility, and societal levels. The findings indicate the need for a nation-wide integrated digitalized system and increased intersectoral collaborations to support adequate healthcare among persons with disabilities in Trinidad. Increased consultation with persons with disabilities and transformation of the disability discourses within the healthcare system and at the national level are also recommended as part of the humanisation of their care.

Socio-demographic factors in relation to habitual sodium and potassium intakes among adults in Trinidad and Tobago.

BACKGROUND: Approximately one-third of adults in Trinidad and Tobago have high blood pressure (hypertension). Excessive consumption of sodium (Na+) is a known risk factor for hypertension. AIM: We investigated Na+ and potassium (K+) intakes and their correlates in a multi-ethnic Caribbean population. METHOD: Volunteers completed a self-administered questionnaire comprising socio-demographic items, physical activity (PA) and a semiquantitative food frequency questionnaire. Foods eaten were classified by level of processing using the NOVA classification system and analysed for Na+ and K+ levels using appropriate dietary analysis software. The study was approved by the University of the West Indies at Saint Augustine Ethics Committee. RESULTS: 11,783 adults participated in the study. Approximately 83.2% of total calories, 79% of Na+ and 40% of K+ was derived from the consumption of highly processed foods. Median daily Na+ and K+ intakes were 2759 mg and 2853 mg, respectively. Na+ intakes showed significant nonlinear increases with age (p < 0.001) and body mass index (BMI) (p < 0.001), and non-linear decreases with educational attainment (p < 0.001). K+ intakes showed significant nonlinear decreases with age (p < 0.001) and BMI (p < 0.001), and linear increases with educational attainment (p < 0.001). Males had higher intakes of Na+ and K+ than females. Na+: K+ was lower among persons participating in moderate to high intensity PA ≥ 150 minutes/week compared to those participating in such activities < 150 minutes/week. CONCLUSION: Socio-demographic factors were significantly correlated with Na+ and K+ intakes among participants and must be considered in strategies aimed at achieving healthy intakes of these nutrients.