A cross-sectional analysis of investigator needs for non-communicable disease research at the University of the West Indies, Mona.

OBJECTIVE: To describe the needs of academic staff conducting non-communicable disease (NCD) research at the University of the West Indies, Mona Campus in Jamaica. METHODS: Utilizing a cross-sectional design an online survey was created using the research electronic data capture application (REDCap); it was disseminated via email to 708 academic staff members in the Faculties of Medical Sciences and Science & Technology between September and November 2018. Participants were asked to indicate their level of access to expertise, training and equipment for conducting research. Descriptive analysis was conducted using STATA version 14. RESULTS: Most respondents were women (74.2%), predominantly scientists (33.1%) or specialist physicians (22.6%). Less than 2/3 of respondents reported publishing research findings in peer reviewed journals, with a quarter not disseminating their research findings in any medium. Resources for field research/data collection, epidemiological methods and principles, and data management/data analysis were generally available. However, there was limited access to training, expertise and equipment in emerging techniques for NCD research such as metabolomics, bioinformatics/analysis of large-scale data sets and health economics. Additional challenges included limited access to financing for research, inadequate workspace and poor administrative support for conducting research. CONCLUSIONS: There is a need for more local research seed funding, stronger administrative support for researchers, and opportunities for training in cutting edge NCD research techniques. Jamaican researchers could benefit from being part of a regional research centre of excellence with critical research skills and equipment that builds research networks and strengthens the NCD research response.

Drinking rainwater: a double-blinded, randomized controlled study of water treatment filters and gastroenteritis incidence.

OBJECTIVES: We examined whether drinking untreated rainwater, a practice that is on the rise in developed countries because of water shortages, contributes to community gastroenteritis incidence. METHODS: We conducted a double-blinded, randomized controlled trial in Adelaide, Australia. Sham or active water treatment units were installed, and participants recorded incidences of illness in a health diary for 12 months. The primary outcome was highly credible gastroenteritis (HCG; characterized by a specified number of loose stools or vomiting alone or in combination with abdominal pain or nausea in a 24-hour period), and we used generalized estimating equations to account for correlations between numbers of HCG events for individuals in the same family. RESULTS: Participants reported 769 episodes during the study (0.77 episodes/person/year), with an HCG incidence rate ratio (active vs sham) of 1.05 (95% confidence interval [CI] = 0.82, 1.33). Blinding of the participants was effective (index = 0.65; 95% CI = 0.58, 0.72). CONCLUSIONS: Our results suggest that consumption of untreated rainwater does not contribute appreciably to community gastroenteritis. However, our findings may not be generalizable to susceptible and immunocompromised persons because these groups were specifically excluded from the study.

An Evaluation of Regional Cardiovascular Disease and Cancer Research Needs Using Conference Abstracts.

Background: Despite cardiovascular diseases and cancer being the leading causes of premature mortality in the Caribbean region, there is limited local research available to guide a comprehensive response to this epidemic. Objective: To evaluate cardiovascular disease and cancer research in the Caribbean using abstracts presented at the Caribbean Public Health Agency's (CARPHA) meeting - the longest running annual research conference in the region. Method: Study data (population, intervention/exposure, comparison and outcome) were extracted from abstracts published for the 2006 to 2018 meetings. Additionally, institutional affiliation and geographic location of the first author, countries involved, sample size, study design and use of specialized testing/biomarkers were also extracted. Data were analysed using STATA version 14. Findings: A total of 1,512 abstracts, 728 posters and 784 oral presentations were reviewed. Research on cancer and cardiovascular disease comprised approximately 15% of all abstracts published annually over the review period. Most of the cardiovascular disease studies had cross sectional or survey designs (46%), with very few laboratory-based studies (<2%) and no intervention studies/clinical trials. For cancer research, 30% were cross-sectional studies/audits, 11% were case control studies, 5% were lab based and there were no clinical trials. Almost a quarter of the cardiovascular disease / cancer abstracts over the period originated from Trinidad and Tobago (26%), with Jamaica and Barbados contributing 18% and 15% respectively. Conclusion: These finding highlight the need for additional studies that can provide evidence for interventions and policy to address the region's high cardiovascular disease and cancer burden. A Regional Centre of Research Excellence could support capacity development to facilitate this process.

Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers.

BACKGROUND: Community-based recruitment is challenging particularly if the sampling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. METHODS: Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. RESULTS: A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. CONCLUSION: The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies.

The Australian Electoral Commission Roll has good utility for 'niche' household recruitment in population health studies.

OBJECTIVE: To investigate the recruitment of 'niche' household populations, defined by their household characteristics and/or water supply type for health studies. METHODS: The Australian Electoral Commission (AEC) database was used to recruit households for participation in two health-related studies, the first, a recycled water usage study and the second, an epidemiological study investigating household rainwater use. RESULTS: The AEC database facilitated the identification and recruitment of households using a particular water supply from among the general household population. CONCLUSIONS: The good utility of the AEC roll in household recruitment was associated with its coverage, accuracy and the ability to delimit the sampling frame according to the geographical area(s) and household characteristics of interest. Its use also allowed personalised contact to be made with potential survey participants by mail, contact that is not otherwise possible using existing telephone and on-line databases. IMPLICATIONS: The AEC database is a valuable resource for household recruitment in a diversity of health and environmental exposure surveys.

Antibiotic Use in Poultry Production in Grenada.

OBJECTIVE: Research is often lacking in low-income countries to substantiate the regulation of antibiotics in poultry production. Nonregulation of antibiotics in food animal industries has implications for human health. This study was conducted to provide an understanding of farmers' knowledge, attitudes, and practices regarding the use of antibiotics in poultry production in Grenada. METHOD: A cross-sectional study was conducted in August-September, 2016, surveying 30 poultry farmers each having 500 or more chickens grown for commercial purposes. RESULTS: More than 1000 birds were kept on 18 (60.0%) farms. Antibiotics were used on the majority of farms (25, 83.3%). More than half of the respondents, 19 (63.3%), stated they were only somewhat aware of issues related to the use of antibiotics and the majority, 21 (70.0%), were also unable to define antimicrobial resistance. There was inconsistency in the farmers' knowledge about how and when to use antibiotics. There was also a high level of noncompliance with manufacturers' recommendations for use of antibiotics. The respondents were not aware of local programs to monitor antibiotic use or manage antibiotic resistance in the poultry industry. CONCLUSION: Generally, the farmers' knowledge and practices were inconsistent with recommendations by the World Health Organization for antibiotic stewardship. While low-income countries, such as Grenada, are challenged with the lack of resources to undertake research and implement responsive actions, this research highlights the need for some immediate measures of remedy, such as education of farmers and monitoring procurement and use of antibiotics, to reduce risk to public health.

Occurrence of selected foodborne pathogens on poultry and poultry giblets from small retail processing operations in Trinidad.

We conducted a study to determine quantitatively and qualitatively the presence of Campylobacter spp., Escherichia coli, staphylococci, total coliforms, total aerobic bacteria, and Salmonella on broiler carcasses from selected small retail processors in Trinidad. We used standard media and procedures for detection and quantification. All carcass and weep samples were positive for aerobic bacteria, E. coli, total coliforms, and staphylococci. Significant differences in the mean counts of aerobic bacteria were observed for samples of carcass (P = 0.001), weep (P = 0.038), and liver and heart (P = 0.017). There was a significant difference (P < 0.05) in the prevalence of E. coli and Campylobacter for liver and heart samples and gizzard samples across various areas (health divisions) in Trinidad and for Campylobacter jejuni and Campylobacter coli for offal samples. The prevalence of Salmonella in carcass, drip, gizzard, and liver and heart samples was 7.3, 3.1, 2.1, and 1.0%, respectively, and three serotypes, Salmonella Kiambu (53.8%), Salmonella Kentucky (38.5%), and Salmonella Mbandaka (7.7%) were isolated. Of the six groups of microbes considered with respect to sale activity, the differences in the prevalence of Campylobacter in medium-activity sale shops (95.8%) and low-activity sale shops (83.3%) and the mean counts of staphylococci for medium-activity sale shops (5.5 +/- 0.9) and low-activity sale shops (5.1 +/- 0.8) were statistically significant (P < 0.05). Carcasses rinsed in a stagnant system had a significantly higher (P < 0.05) prevalence (92.3%) and mean count per milliliter (3.1 +/- 0.7) for Campylobacter compared with 77.8% and 2.7 +/- 0.7 for shops that rinsed with constantly running water. The frequency of rinse water change significantly (P = 0.04) affected the prevalence of Salmonella on carcasses. It is recommended that a quality control system be introduced for these shops, particularly with respect to evisceration and rinsing practices.

A cross-sectional analysis of investigator needs for non-communicable disease research at the University of the West Indies, Mona / Análisis transversal de las necesidades de los investigadores de las enfermedades no transmisibles en la Universidad de las Indias Occidentales en Mona / Uma análise transversal das carências dos pesquisadores envolvidos em pesquisa de doenças não transmissíveis na Universidade das Índias Ocidentais, Mona

ABSTRACT Objective. To describe the needs of academic staff conducting non-communicable disease (NCD) research at the University of the West Indies, Mona Campus in Jamaica. Methods. Utilizing a cross-sectional design an online survey was created using the research electronic data capture application (REDCap); it was disseminated via email to 708 academic staff members in the Faculties of Medical Sciences and Science & Technology between September and November 2018. Participants were asked to indicate their level of access to expertise, training and equipment for conducting research. Descriptive analysis was conducted using STATA version 14. Results. Most respondents were women (74.2%), predominantly scientists (33.1%) or specialist physicians (22.6%). Less than 2/3 of respondents reported publishing research findings in peer reviewed journals, with a quarter not disseminating their research findings in any medium. Resources for field research/data collection, epidemiological methods and principles, and data management/data analysis were generally available. However, there was limited access to training, expertise and equipment in emerging techniques for NCD research such as metabolomics, bioinformatics/analysis of large-scale data sets and health economics. Additional challenges included limited access to financing for research, inadequate workspace and poor administrative support for conducting research. Conclusions. There is a need for more local research seed funding, stronger administrative support for researchers, and opportunities for training in cutting edge NCD research techniques. Jamaican researchers could benefit from being part of a regional research centre of excellence with critical research skills and equipment that builds research networks and strengthens the NCD research response.

RESUMEN Objetivo. Describir las necesidades del personal académico que investiga las enfermedades no transmisibles (ENT) en el Campus de Mona de la Universidad de las Indias Occidentales, en Jamaica. Métodos. Mediante un diseño transversal, se elaboró una encuesta en línea con RedCap, una aplicación para la captura de datos electrónicos para la investigación, y se divulgó por correo electrónico a los 708 miembros del personal académico de las Facultades de Ciencias Médicas y Ciencia y Tecnología entre septiembre y noviembre del 2018. Se pidió a los participantes que indicaran su nivel de acceso a conocimientos, capacitación y equipo para llevar a cabo investigaciones. El análisis descriptivo se realizó con STATA, versión 14. Resultados. La mayoría de los entrevistados fueron mujeres (74,2%), predominantemente científicas (33,1%) o médicas especialistas (22,6%). Menos de dos terceras partes de los entrevistados informó que publicaban los resultados de sus investigaciones en revistas arbitradas y una cuarta parte declaró que no divulgaba los resultados de sus investigaciones en ningún medio. Por lo general, tenían a su disposición recursos para la investigación de campo o la recopilación de datos, métodos y principios epidemiológicos, así como para la gestión y el análisis de datos. Sin embargo, tenían poco acceso a conocimientos, capacitación y equipo en las técnicas emergentes para la investigación sobre ENT como la metabolómica, la bioinformática o el análisis de conjuntos de datos a gran escala y economía de la salud. Otros retos incluyeron poco acceso al financiamiento para la investigación, espacios de trabajo inadecuados y un apoyo administrativo deficiente para investigar. Conclusiones. Se necesita más capital inicial destinado a la investigación local, un mayor respaldo administrativo a los investigadores y oportunidades de capacitación en las técnicas más recientes de investigación de ENT. Los investigadores jamaiquinos podrían sacar provecho de formar parte de un centro regional de excelencia para la investigación con el equipo y las capacidades de investigación fundamentales para contribuir a la formación de redes de investigación y fortalecer la respuesta investigadora a las ENT.

RESUMO Objetivo. Descrever as carências enfrentadas pelo grupo acadêmico que realiza pesquisa em doenças não transmissíveis (DNT) na Universidade das Índias Ocidentais, campus de Mona, Jamaica. Métodos. Uma pesquisa transversal online foi desenvolvida com o uso da plataforma de captura eletrônica de dados de pesquisa (RedCap) e distribuída por e-mail a 708 integrantes dos grupos acadêmicos nas Faculdades de Ciências Médicas e de Ciência e Tecnologia entre setembro e novembro de 2018. Foi pedido aos participantes que informassem o grau de acesso a conhecimento especializado, capacitação e equipamentos para a realização de pesquisa. Uma análise descritiva foi realizada com o uso do software STATA versão 14. Resultados. Participaram, na sua maioria, mulheres (74,2%), com o predomínio de pesquisadores científicos (33,1%) ou médicos especialistas (22,6%). Menos de 2/3 informaram publicar os resultados de suas pesquisas em periódicos científicos com avaliação por pares e 25% disseram que não divulgavam seus resultados em nenhum veículo. Afirmaram que, em geral, havia recursos para realizar pesquisa de campo/coleta de dados, métodos e procedimentos básicos epidemiológicos e gerenciamento/análise de dados. Porém, era limitado o acesso a capacitação, conhecimentos especializados e equipamentos para empregar métodos emergentes de pesquisa de DNT como metabolômica, bioinformática/processamento em larga escala de grandes conjuntos de dados e economia da saúde. Outras dificuldades citadas foram limitação de financiamento para pesquisa, inadequação dos locais de trabalho e apoio administrativo deficiente à realização de pesquisas. Conclusões. Faz-se necessário mais financiamento para projetos iniciantes locais, firme apoio administrativo aos pesquisadores e oportunidades para capacitação em métodos de ponta de pesquisa de DNT. A situação dos pesquisadores jamaicanos poderia melhorar se fizessem parte de um centro de excelência regional com recursos e equipamentos essenciais para a realização de pesquisa que lhes permitisse formar redes de pesquisadores e fortalecer a resposta da pesquisa de DNT.

Prevalence of antimicrobial residues in table eggs in Trinidad.

The prevalence of antimicrobial residues in pooled table eggs from layer farms, shopping malls, and supermarkets in Trinidad was determined. A total of 23 layer farms and 14 shopping malls were sampled twice, 1 month apart, whereas 102 supermarkets were each sampled once. For each farm, 25 eggs were randomly collected and pooled to constitute a composite sample, whereas six eggs from each farm source available at sale outlets were randomly sampled from malls and supermarkets to constitute a composite sample. Questionnaires were administered at the farms to determine the occurrence of risk factors for contamination of antimicrobial residues in eggs and at sale outlets to determine storage conditions. The Charm II test was used to qualitatively detect antimicrobial residues (beta-lactams, macrolides, sulfonamides, and tetracyclines). Of 46 composite eggs tested from farms, 3 (6.5%) were contaminated with residues compared with 5 (16.1%) of 31 and 16 (15.0%) of 107 mall and supermarket eggs, respectively, but the difference was not statistically significant (P > 0.05). The residues detected were as follows: sulfonamides, 12 (6.5%) of 184; macrolides, 7 (3.8%) of 184; tetracycline, 5 (2.7%) of 184; and beta-lactam, 0 (0.0%) of 184. The difference was statistically significant (P < 0.05). The use of medicated feeds on farm, claim of adherence to the antimicrobial withdrawal period, and temperature of egg storage did not significantly (P > 0.05) affect the prevalence of residues in eggs. It was concluded that the presence of antimicrobial residues, particularly sulfonamides, in table eggs could be of public health significance to the consumer.

Resistance to antimicrobial agents among Salmonella isolates recovered from layer farms and eggs in the Caribbean region.

This investigation determined the frequency of resistance of 84 isolates of Salmonella comprising 14 serotypes recovered from layer farms in three Caribbean countries (Trinidad and Tobago, Grenada, and St. Lucia) to eight antimicrobial agents, using the disc diffusion method. Resistance among isolates of Salmonella was related to the country of recovery, type of sample, size of layer farms, and isolate serotype. Overall, all (100.0%) of the isolates exhibited resistance to one or more of seven antimicrobial agents tested, and all were susceptible to chloramphenicol. The resistance detected ranged from 11.9% to sulphamethoxazole-trimethoprim (SXT) to 100.0% to erythromycin. The difference was, however, not statistically significant (P = 0.23). Across countries, for types of samples that yielded Salmonella, significant differences in frequency of resistance were detected only to SXT (P = 0.002) in Trinidad and Tobago and to gentamycin (P = 0.027) in St. Lucia. For the three countries, the frequency of resistance to antimicrobial agents was significantly different for ampicillin (P = 0.001) and SXT (P = 0.032). A total of 83 (98.8%) of the 84 isolates exhibited 39 multidrug resistance patterns. Farm size significantly (P = 0.032) affected the frequency of resistance to kanamycin across the countries. Overall, among the 14 serotypes of Salmonella tested, significant (P < 0.05) differences in frequency of resistance were detected to kanamycin, ampicillin, and SXT. Results suggest that the relatively high frequency of resistance to six of the antimicrobial agents (erythromycin, streptomycin, gentamycin, kanamycin, ampicillin, and tetracycline) tested and the multidrug resistance detected may pose prophylactic and therapeutic concerns for chicken layer farms in the three countries studied.

Survey of Salmonella contamination in chicken layer farms in three Caribbean countries.

This study was conducted to investigate the demography, management, and production practices on layer chicken farms in Trinidad and Tobago, Grenada, and St. Lucia and the frequency of risk factors for Salmonella infection. The frequency of isolation of Salmonella from the layer farm environment, eggs, feeds, hatchery, and imported day-old chicks was determined using standard methods. Of the eight risk factors (farm size, age group of layers, source of day-old chicks, vaccination, sanitation practices, biosecurity measures, presence of pests, and previous disease outbreaks) for Salmonella infection investigated, farm size was the only risk factor significantly associated (P = 0.031) with the prevalence of Salmonella; 77.8% of large farms were positive for this pathogen compared with 33.3 and 26.1% of medium and small farms, respectively. The overall isolation rate of Salmonella from 35 layer farms was 40.0%. Salmonella was isolated at a significantly higher rate (P < 0.05) from farm environments than from the cloacae. Only in Trinidad and Tobago did feeds (6.5% of samples) and pooled egg contents (12.5% of samples) yield Salmonella; however, all egg samples from hotels, hatcheries, and airports in this country were negative. Salmonella Anatum, Salmonella group C, and Salmonella Kentucky were the predominant serotypes in Trinidad and Tobago, Grenada, and St. Lucia, respectively. Although Salmonella infections were found in layer birds sampled, table eggs appear to pose minimal risk to consumers. However, the detection of Salmonella -contaminated farm environments and feeds cannot be ignored. Only 2.9% of the isolates belonged to Salmonella Enteritidis, a finding that may reflect the impact of changes in farm management and poultry production in the region.