Pesticide Exposure in the Caribbean: A Case From Nutmeg Processing

Many developed countries around the world have implemented regulations to phase out or greatly restrict the use of pesticides. Pesticides are still utilized with minimal restrictions, however, in fumigating agricultural commodities in developing countries such as Grenada. This special report presents the case of a nutmeg factory worker in Grenada who worked with various pesticides including methyl bromide, magnesium phosphide (magtoxin), and aluminum phosphide (phostoxin) without the proper awareness and utilization of health and safety measures. The nutmeg factory worker later developed metastatic bladder cancer, which may have been triggered by a combination of individual risk factors along with long-term occupational exposure to these pesticides. In this special report, the occupational health importance of prevention in a work environment with significant exposure to pesticides is highlighted as well as some of the fundamental deficiencies in awareness among workers in developing nations concerning the deleterious effects of frequent exposure to pesticides

Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean

Background Potential Drug–Drug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-income countries. Objective To compare the incidence of drug–drug interactions and polypharmacy in older and younger patients attending the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micromedex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of ≥5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275 (42.3%) were ≥65 years and 381 (58.7%) were female. There were 814 DDIs, of which 6 (.7%) were contraindications and 148 (18.2%) were severe. Polypharmacy was identified in 244 (37.6%) patients. Older patients were more likely to have potential DDI (67.5 vs 48.9%) and polypharmacy (56 vs 24.1%). Herbal products, OTC and combination drugs were present in 8, 36.7 and 22.2% of patients, respectively. On multivariate analysis, polypharmacy and the presence of hypertension and ischaemic heart disease were associated with an increased risk of potential DDI. Conclusion Polypharmacy and potential drug–drug interactions are common in ED patients in the Caribbean. Older patients are particularly at risk, especially as they are more likely to be on multiple medications. The association between herbal medication and polypharmacy needs further investigation. This study indicates the need for a more robust system of drug reconciliation in the Caribbean

Zoonoses and One Health: A Review of the Literature

Background. One health is a concept that was officially adopted by international organizations and scholarly bodies in 1984. It is the notion of combining human, animal, and environmental components to address global health challenges that have an ecological interconnectedness. Methods. A cross-sectional study of the available literature cited was conducted from January 1984 when the one health concept was adopted till December 2012 to examine the role of the one health approach towards zoonoses. Inclusion criteria included publications, professional presentations, funding allocations, official documentation books, and book chapters, and exclusion criteria included those citations written outside the period of review. Results. A total of 737 resources met the inclusion criteria and were considered in this review. Resources showed a continuous upward trend for the years from 2006 to 2012. The predominant resources were journal publications with environmental health as the significant scope focus for one health. There was also an emphasis on the distribution of the work from developed countries. All categories of years, resources, scopes, and country locale differed from the means ( = 0.000). Year of initiative, scope, and country locale showed a dependent relationship ( = 0.022, = 0.003, and = 0.021, resp.). Conclusion. Our findings demonstrate the rapid growth in embracing the concept of one health, particularly in developed countries over the past six years. The advantages and benefits of this approach in tackling zoonoses are manifold, yet they are still not seemingly being embraced in developing countries where zoonoses have the greatest impact

Assessment of Current Occupational Safety and Health Regulations and Legislation in the Caribbean

Neglecting occupational safety and health (OSH) can have adverse and even deadly consequences. While OSH is important in any nation, the issue is particularly concerning in developing countries, including ones in the Caribbean. The purpose of this study, which was carried out in 2012 and 2013, was to examine the reasons for an apparent fundamental lack of awareness of OSH in the Caribbean. We conducted a descriptive study, in which a questionnaire was administered, via telephone, to key policy-making representatives from six English-speaking Caribbean nations, in order to assess the current OSH environment in their countries. We also did a situational analysis of current OSH regulations and legislation within the six countries. We found that that some of the countries’ OSH laws are out of date or are limited to a certain type of industry. We also found that there is very little documentation on research on exposure to and risks from hazards and on psychological and reproductive health as related to OSH. It is recommended that these Caribbean countries both increase national OSH awareness and strengthen enforcement of OSH regulations. Additionally, further assistance and a more coordinated effort from intergovernmental bodies could help build and fortify OSH systems in the Caribbean

Clinical, Serological, and Molecular Observations from a Case Series Study during the Asian Lineage Zika Virus Outbreak in Grenada during 2016

This paper describes the spatial and temporal distribution of cases, demographic characteristics of patients, and clinical manifestations of Zika virus (ZIKV) during the 2016 outbreak in Grenada. The first reported case was recorded in St. Andrew Parish in April, and the last reported case was seen in November, with peak transmission occurring in the last week of June, based on test results. Data were collected from a total of 514 patients, of whom 207 (40%) tested positive for ZIKV. No evidence was found that testing positive for ZIKV infection was related to age, gender, or pregnancy status. Clinical presentation with rash (OR = 2.4, 95% CI = 1.5 to 3.7) or with lymphadenopathy (OR = 1.7, 95% CI = 1.0 to 2.9) were the only reported symptoms consistent with testing positive for ZIKV infection. During the Zika outbreak, the infection rate was 20 clinical cases per 10,000 in the population compared to 41 cases per 10,000 during the chikungunya outbreak in Grenada in 2014 and 17 cases per 10,000 during the dengue outbreak in 2001-2002. Even though the country has employed vector control programs, with no apparent decrease in infection rates, it appears that new abatement approaches are needed to minimize morbidity in future arbovirus outbreaks

Females in Veterinary Medicine: Why the Choice?

Veterinary Medicine as a profession has undergone a change from a male-oriented one, to being predominantly female. The increase in female students is a reflection of the increasing interest in veterinary medicine by females. This study focused on reasons for the specific choice of veterinary medical education among female veterinary students. A life history approach was applied in order to explore the lives of six female veterinary students from St. George’s University, School of Veterinary Medicine in Grenada. This methodology involved using interviews to collect personal accounts of students’ life experiences that provided data about the reasons for the choice of female students to pursue veterinary medical education. The theoretical framework that served as the base for this thesis was grounded theory. Interviews were transcribed, exerted to concept identification, data reduction, and thematic representations for analysis. The study revealed that life experiences as well as socio-cultural realities surrounding the lives of the students were crucial in understanding the influences and reasons for their choice of veterinary medicine. A Life Stages Theory emerged from the use of grounded theory approach to data analysis which identified personal, financial and academic needs as primary to create interest in veterinary medicine. The experiential enquiry into the students’ lives also recognized pet ownership, exposure to knowledge of veterinary medicine as well as positive perceptions of veterinarians and veterinary medical practice as reasons for the choice of veterinary medicine. The final choice of veterinary medicine by females was found to be based on their personal interests, their ability to overcome financial and academic barriers and receive opportunities of alternative academic pathways. The new insights created on reasons for the choice of veterinary medicine can be applied to student career advisement and review of applicants for admission into veterinary schools

Zoonoses and One Health: A Review of the Literature

Background. One health is a concept that was officially adopted by international organizations and scholarly bodies in 1984. It is the notion of combining human, animal, and environmental components to address global health challenges that have an ecological interconnectedness. Methods. A cross-sectional study of the available literature cited was conducted from January 1984 when the one health concept was adopted till December 2012 to examine the role of the one health approach towards zoonoses. Inclusion criteria included publications, professional presentations, funding allocations, official documentation books, and book chapters, and exclusion criteria included those citations written outside the period of review. Results. A total of 737 resources met the inclusion criteria and were considered in this review. Resources showed a continuous upward trend for the years from 2006 to 2012. The predominant resources were journal publications with environmental health as the significant scope focus for one health. There was also an emphasis on the distribution of the work from developed countries. All categories of years, resources, scopes, and country locale differed from the means (P=0.000). Year of initiative, scope, and country locale showed a dependent relationship (P=0.022, P=0.003, and P=0.021, resp.). Conclusion. Our findings demonstrate the rapid growth in embracing the concept of one health, particularly in developed countries over the past six years. The advantages and benefits of this approach in tackling zoonoses are manifold, yet they are still not seemingly being embraced in developing countries where zoonoses have the greatest impact

Premature Puberty in Obese Female Children Aged 5-17 in the United States for 2013-2014

The prevalence of obesity in female children in the Unites States has increased from 5% to 17.1% from 1965 to 2015 and the prevalence of premature puberty has increased as well. Increased weight is correlated with premature puberty in females and interestingly, different studies have shown that there has been a gradual decline of age for onset of puberty. Early sexual maturation in female children are associated with many negative consequences such as increased risk of adult obesity, type 2 diabetes, increased aggression, increased adolescent risk taking behaviors, increased sexual activity, and breast cancer. The target population for this study is obese female children in the United States in the past 5 years. Using the primary data from the National Health and Nutrition Examination Survey (NHANES), the specific study population of obese females aged 5 through 17 years in the United States recorded during the period January 2013 - December 2014. The results of this study also showed a mean BMI of 21.1 which was higher than the 2015 average of 17.1 while a mean age of puberty was found to be 11.3 which is higher than the 2015 average of 9. The strength of correlation was found with Spearman’s Rho. In this study, the results have shown a contrasting view and have shown a negative weak association between the two variables with a rho value of -.089. Efforts towards a reduction of obesity is expected to yield a lowered incidence of premature puberty

Spectrum of microbial growth and antimicrobial usage in an intensivecare unit of a tertiarycare hospital in Trinidad West Indies

Background. Intensive-care units (ICUs) are a source of multidrug-resistant organisms, owing to the indiscriminate usage of broad-spectrum antimicrobial drugs. In such settings, one must be aware of the spectrum of microbes and pattern of antibiotic usage.Objectives. To evaluate the spectrum, susceptibility and resistance patterns of microbes found in ICU patients in a tertiary-care teaching hospital in Trinidad, and to quantify antimicrobial usage.Methods. All adult patients (≥15 years of age) admitted to the ICU for ≥48 h who developed nosocomial infections conforming to the Centers for Disease Control and Prevention criteria were included. Demographic data and clinical data, including specimens sent, isolates grown, antimicrobial sensitivity and resistance patterns, the usage of antimicrobials and patient outcomes, were recorded. Variables such as age, admission white blood cell count, duration of first antibiotic used, length of ICU stay, length of hospital stay, organ support and total comorbidities were analysed. Antimicrobial usage was quantified as the defined daily dosage per 1 000 patient-days.Results. A total of 153 patients with 287 microbiological specimens were studied. The mean patient age was 48.4 years, and the mean ICU length of stay was 7.9 days. The most common admitting diagnoses were sepsis and multiple trauma. Staphylococcus aureus was the most common isolate from blood and central venous lines, and Pseudomonas aeruginosa from tracheal aspirates and wound swabs. Non-survivors had significantly higher age, leucocyte count and organ support requirements, and shorter lengths of stay. Cefuroxime was the most-used antimicrobial in the unit.Conclusion. The usage pattern of antimicrobials did not correlate with susceptibility in most instances. There is a need to improve antimicrobial usage by implementing antimicrobial-stewardship programmes to establish an  antimicrobial protocol and guidelines for usage in the ICU