Caribbean Countries Research Articles

Molecular epidemiology of Kaposi sarcoma virus in Spain.

Since human herpesvirus 8 (HHV-8) infection may be underestimated and HHV-8 subtype circulation in Spain remains unknown, a molecular epidemiologic study is highly desirable. This study aimed to analyse HHV-8 subtype diversity and their distribution in Spain. The study included 142 HHV-8 infected patients. A nested PCR was developed in order to permit Sanger sequencing of HHV-8 K1 ORF directly from clinical samples received at the CNM from 2013 to 2021. Phylogenetic characterization was performed. Genotypes A and C comprised 55.6% and 42.3% of strains. Regarding subtypes, 25.4% of strains were C3, 19.7% were A3, 14.1% were A5, and C2, A1, A4, C1, A2, C7 were 11.3%, 11.3%, 8.5%, 4.2%, 2.1% and 1.4%, respectively. Subtype E1, E2 and B1 were found in only one patient each (0.7%). The Madrid region accounted for 52.1% of patients and showed a significantly different subtype distribution compared to the others (P = 0.018). Subtypes B1, E1, and E2 were observed to appear sporadically, although overall genotypes A and subtype C3 remained the most frequent and unwavering. Subtype A3 presented the highest diversity as displayed by the highest number of clusters in phylogenetic analysis. Non-significant differences in viral loads between genotypes were found, but significantly higher viral loads in subtype C2 compared to subtype C3 was found, while no significant subtype differences were observed between subtypes within genotype A. Infections with HHV-8 were detected in 94 (66.2%) patients without KS and compared to patients with KS non-significant differences in subtype distribution were found. Subtype prevalence and regional distribution followed a similar pattern compared to other western European countries. Our study is the first to report HHV-8 subtypes E1 and E2 circulating in Europe that might be reflective of migration of population from Caribbean countries. Our study suggests that infection by HHV-8 is underestimated, and wider screening should be recommended for risk groups.

Technological change and labour market trends in Latin America and the Caribbean: a task content approach

The aim of this paper is to analyse employment profile trends in the Latin American and Caribbean countries according to the task content of workers’ jobs. This analysis seeks to approximate the impact of technological change on the labour market. The paper uses the definitions of an indicator that captures the relative importance of four types of tasks, namely cognitive versus manual and routine versus non-routine tasks, based on information from the Occupational Information Network (O*NET) and household surveys. The analysis finds that there has been growing demand for workers over the last two decades in occupations which are intensive in cognitive abilities, with higher remuneration than for occupations which are intensive in manual tasks. Cognitive skills are therefore a key variable for improving participation in current and future labour markets.

A Comparison of Circle and J Hook Performance Within the Grenadian Pelagic Longline Fishery

The use of circle hooks in pelagic longline fisheries has often been proposed as a minimally disruptive means to minimize bycatch mortality. However, most studies have been in large scale fisheries, not the small-vessel fleets seen in many Caribbean countries. Size 16/0 circle hooks and 9/0 J hooks were alternated over 26 sets to assess the performance of circle hooks in the Grenadian pelagic longline fishery. Catch, mortality, hook location, length, and grade of fish were compared between hook types. No species-specific differences in at-vessel mortality rate or yellowfin tuna grade were found between hook types. However, significantly fewer billfish collectively (t = 2.36, p = 0.028), and sailfish specifically (t = 3.04, p = 0.005), were caught on circle hooks. Additionally, tunas caught with circle hooks had a 69% greater chance of external hooking compared to J hooks (χ2 = 4.38, p = 0.036). All other species analyzed had similar catch rates regardless of hook type (p < 0.05), including yellowfin tuna. The results of this study suggest that the Grenadian pelagic longline fishery – and other Caribbean fleets, by extension – could reduce impacts on billfish stocks by using 16/0 circle hooks without incurring negative effects on yellowfin tuna catch rate or grade. With many bycatch species populations at depressed levels, these results also provide further evidence that circle hooks should be the recommended terminal gear type when using a bycatch mitigation approach to manage pelagic longline fisheries while maintaining target catches for local and export markets.

High Rates of Detection and Molecular Characterization of Porcine Adenovirus Serotype 5 (Porcine mastadenovirus C) from Diarrheic Pigs.

Since the first report on isolation of porcine adenovirus serotype 5 (PAdV-5, species Porcine mastadenovirus C (PAdV-C)) from pigs with respiratory illness in Japan in 1987, PAdV-5 have been detected in a few fecal samples from healthy pigs and in some environmental samples. To date, only a single PAdV-5 strain (isolate HNF-70 from 1987) has been analyzed for the complete genome. We report here high detection rates of PAdV-5 (25.74%, 26/101 fecal samples) in diarrheic pigs at 3 different farms in the Caribbean country of Dominican Republic. After a long gap, the complete deduced amino acid sequences of the DNA-dependent DNA polymerase (pol) and hexon of two PAdV-5 strains (GES7 and Z11) were determined, revealing >99% sequence identities between PAdV-5 strains (HNF-70, GES7 and Z11) detected in different parts of the world and during different time periods (1987, and 2020–2021). By phylogenetic analysis, the putative hexon and pol of HNF-70, GES7 and Z11 exhibited similar clustering patterns, with the PAdV-5 strains forming a tight cluster near ruminant AdVs, distinct from the species PAdV-A and -B. GES7 and Z11 retained the various conserved features present in the putative pol and major late promoter region of HNF-70. Considering the paucity of data on current epidemiological status and genetic diversity of PAdV in porcine populations, our findings warrant similar studies on PAdV-5 and other PAdVs in clinically ill and healthy pigs. To our knowledge, this is the first report on detection and molecular characterization of PAdV-5 (PAdV-C) from diarrheic pigs.

Latin American Civil Resistance and Brazilian Landless Workers Movement: The Concept of Gandhian Nonviolence and Its Uses

Latin America and the Caribbean countries of a total of 33 countries spread over the southern longitude are great example of diversity. These countries are witness to many and many types of experience socially, economically and politically. Politically, these countries have gained many experiences from the historical point of view. It also includes the existence of violent and non-violent fight for political democracy. In some countries a fight also fought for social and economic justice in democracies. In the present article, the study of non-violent fighting in the mass movement in Latin America has been done. Apart from this, a special study has been done on the technology of landless workers’ movement of Brazil’s 1984, important in Latin American countries.in this article, this important and comprehensive mass movement has been studied from the perspective of Gandhi’s technic of movement.

Epidemiologic trends of multiple sclerosis in Puerto Rico (2013–2020)

BackgroundPrevious studies have demonstrated higher multiple sclerosis (MS) incidence and prevalence in Puerto Rico (PR) than in other Caribbean and Latin American countries. Our objectives are to update the epidemiologic trends in MS incidence and prevalence rates for PR from 2017 through 2020 and compare them to prior rate data from 2013 to 2016. MethodsWe used the Puerto Rico MS Foundation's registry (PRMS Registry) data to identify all newly diagnosed MS cases between January 2017 and December 2020. The study population included 568 MS patients, 406 women and 162 men living in PR. All individuals were 18 years and older and met the 2017 revised McDonald criteria for MS diagnosis. In addition, age- and sex-standardized incidence rates were estimated. ResultsA total of 568 new MS cases were diagnosed in Puerto Rico between 2017 and 2020. The 2020 MS cumulative prevalence for Puerto Rico was 95.3/100,000 (95% CI: 91.6, 99.1), higher than previously reported. The age- and sex-standardized MS incidence rate for Puerto Rico decreased from 6.5/100,000 (2017) to 6.3/100,000 (2020). The annual age-standardized MS incidence rates declined for females: from 9.5/100,000 (2017) to 8.2/100,000 (2020) but increased for males from 3.6/100,000 to 4.6/100,000 during the same period. ConclusionThese incidence and prevalence rates are among the highest reported among Caribbean and Latin American countries. A peak in the age- and sex-standardized MS incidence rate was observed after hurricane María (2018) and a decline during the first year of the COVID-19 pandemic (2020). Further investigation is needed to determine whether there was a causal relationship between the fluctuations observed and those natural events.

How, when and where? A systematic review on abortion decision making in legally restricted settings in sub-Saharan Africa, Latin America, and the Caribbean

BackgroundWith increasing global availability of medication abortion drugs, a safer option exists for many women to terminate a pregnancy even in legally restrictive settings. However, more than 22,000 women die each year from unsafe abortion, most often in developing countries where abortion is highly legally restricted. We conducted a systematic review to compile existing evidence regarding factors that influence women’s abortion-related decision making in countries where abortion is highly legally restricted.MethodsWe searched ten databases in two languages (English and Spanish) for relevant literature published between 2000 and 2019 that address women’s decision-making regarding when, where and how to terminate a pregnancy in sub-Saharan African, Latin American and the Caribbean countries where abortion is highly legally restricted.ResultsWe identified 46 articles that met the review’s inclusion criteria. We found four primary factors that influenced women’s abortion-related decision-making processes: (1) the role of knowledge, including of laws, methods and sources; (2) the role of safety, including medical, legal and social safety; (3) the role of social networks and the internet, and; (4) cost affordability and convenience.ConclusionsThe choices women make after deciding to terminate a pregnancy are shaped by myriad factors, particularly in contexts where abortion is highly legally restricted. Our review catalogued the predominant influences on these decisions of when, where and how to abort. More research is needed to better understand how these factors work in concert to best meet women’s abortion needs to the full limit of the law and within a harm reduction framework for abortions outside of legal indications.

Sex and age differences in mortality trends of gastric cancer among Hispanic/Latino populations in the United States, Latin America, and the Caribbean

An up-to-date analysis of gastric cancer mortality among Hispanic/Latino populations is required for estimating disease burden and assessing the effectiveness of clinical and preventive strategies. We retrieved gastric cancer deaths between 1997 and 2017 (as available) from the Surveillance, Epidemiology, and End Results Program (United States Hispanics) and the World Health Organization databases (Puerto Rico, 16 Latin American and Caribbean countries). Joinpoint regression analysis was used to examine trends in age-standardized mortality rates (ASMR; per 100 000 person-years) and calculate average annual percent changes (AAPCs) by country (or territory), age group (25-49 and ≥50 years), and sex. Trends were compared to assess slope parallelism. In 2017, Chile (31·8), Colombia (24·3) and Costa Rica (24·3) had the highest ASMR of gastric cancer for men, while Guatemala (17·2), Peru (13·5), and Costa Rica (13·3) had the highest ASMR for women. Small-to-moderate mortality declines (AAPCs ranged -4 to -0.5%) were observed between 1997 and 2017. In almost all countries, trends decreased among individuals aged ≥50 years. However, age-specific trends were not parallel (p-values <0.05) in Brazil, Colombia, Mexico, the United States, and Venezuela for both men and women, and in five additional countries for only women; with a few countries showing stable or slightly increasing trends for individuals aged 25-49 years. Overall gastric cancer mortality rates in Hispanics/Latinos declined in the last two decades. However, there was a notable variation in trends by country, sex, and age group. Continued and targeted prevention efforts are needed to reduce the disease burden in these vulnerable populations. Universidad Cientifica del Sur, Peru, and National Cancer Institute, United States.

Latin American women in chemical engineering: Challenges and opportunities on process intensification in academia/research

In the last years, different entities have developed programs to incentivize and involve women in Science, Technology, Engineering, and Mathematics (STEM) fields. In Europe, Asia, and Africa, only 30% of all professionals working on engineering research are women. In Latin American and the Caribbean countries, the panorama is more encouraging, nearly 50%. In this sense, this paper aims to analyze and highlight the woman's role in chemical and process engineering, especially in the process intensification area in the Latin American context. Initially, the document presents some historical data about relevant women. Then, statistic information is discussed on female researchers in the world, as well as in Latin American countries. The current work areas are also analyzed where there is a particular emphasis on intensified distillation configurations, biofuels and sustainable processes. Finally, some researchers that participated in the special issue solved a survey about their academic experiences. As noticed from the recovered answers, it is possible to claim that successful scientific women stimulate and inspire other women to exemplify transcendence. All academic family trees start with male mentors, but women have gained a relevant place in STEM fields; therefore, the structure will change and be more equitable in the future.

Prostate cancer incidence among immigrant men in Ontario, Canada: a population-based retrospective cohort study.

Prostate cancer incidence has been associated with various sociodemographic factors, such as race, income and age, but the association with immigrant status in Canada is unclear. In this population-based study in Ontario, Canada, we compared age-standardized incidence rates for immigrant males from various regions of origin with the rates of long-term residents. In this retrospective cohort study, we linked several provincial-level databases available at ICES, an independent, non-profit research institute. We included all males aged 20 years and older in the province of Ontario eligible for health care for each fiscal year (Apr. 1 to Mar. 31) in 2008-2016. We determined age-standardized prostate cancer incidence rates, stratifying by immigrant status (a binary variable) and region of origin. We used a log-binomial model to estimate adjusted incidence rate ratios, with long-term residents (Canadian-born Ontarians as well as those who immigrated before 1985, when available data on immigration starts) as the reference group. We included age, neighbourhood income and time since landing in the models. Additional models limited to immigrant males in the cohort included immigration admission category (economic class, family class, refugee, other) and time since landing in Canada. There were 74594 incident cases of prostate cancer in the study period, 6742 of which were among immigrant males. Males who had immigrated from West Africa and the Caribbean had significantly higher incidence of prostate cancer than other immigrants and long-term residents: adjusted rate ratios of 2.71 (95% confidence interval [CI] 2.41-3.05) and 1.91 (95% CI 1.78-2.04), respectively. Immigrants from other regions, including East Africa and Middle-Southern Africa, had lower or similar incidence rates to long-term residents. Males from South Asia had the lowest adjusted rate ratio (0.47, 95% CI 0.45-0.50). The age-standardized incidence rate of prostate cancer from 2008 to 2016 was consistently and significantly higher among immigrants from West African and Caribbean countries than among other immigrants and long-term residents of the province. Future research in Canada should focus on further understanding heterogeneity in prostate cancer risk and epidemiology, including stage of diagnosis and mortality, for immigrants.

Pap Smear Screening: Deterrents among the At-Risk Population in Trinidad

Cervical cancer is a condition that affects many women globally. The WHO recommends Papanicolaou (Pap) smear screening, a method by which abnormal cervical cells can be detected and aid in preventing malignant progression. However, despite the availability of this test, uptake remains low among many Caribbean countries, including Trinidad. Objective: A literature review on cervical cancer screening and barriers to getting tested in Trinidad. Study Design: The study design chosen was a narrative literature review. This paper sought to assess available literature centered around reasons for lack of screening and how it may contribute to the current prevalence rates of cervical cancer. Methods: Data was obtained from online articles via Google Scholar, Pubmed, ScienceDirect, and Scopus from 1987 to 2022. The focus was on publications detailing lifestyle and factors influencing Pap smear testing and follow-up. Results: Results showed that personal understanding, accessibility, physician perception, and socioeconomic disadvantages can deter pap smear screening. Conclusions: Addressing these issues and how they can influence screening uptake is key to increasing detection and decreasing cervical cancer deaths.

Exports from developing countries and outward foreign direct investment: An empirical analysis

This empirical study investigates how exports from developing countries are influenced by outward foreign direct investment. By classifying developing economies into subgroups based on income (low-income countries, lower-middle-income countries, upper-middle-income countries), as well as at the regional level (Africa, Asia, Latin America, and the Caribbean), this study also tries to analyze the variation in this association at different levels of development and across different geographical regions. The study uses imbalanced panel data from 64 developing countries spanning the years 1990 to 2019 for estimation purposes and employs panel estimation techniques of fixed and random effects model. The results suggest that at the aggregate level, outward foreign direct investment has a complementary impact on the home country export performance of developing countries. Moreover, middle and upper middle-income groups of developing countries also indicate the complementary effect of investing abroad on home country exports. At the regional level, results indicate that in Asia, this complementary effect is more vital than in any other region of developing countries. It may be due to the high share of outward FDI from Asian developing countries, which leads to more exports of intermediate goods and headquarter activities from home countries. On the contrary, results indicate that OFDI substitutes for home country exports in the group of Latin America and the Caribbean countries, and these countries have a smaller and relatively more volatile share in total world outward FDI. The general complementary type relationship between OFDI and the home country's exports highlights the need to consider OFDI as a part of national development plans to attract much-needed foreign exchange reserves for the growth and development of developing countries.

Improving the accuracy of beef cattle methane inventories in Latin America and Caribbean countries

On-farm methane (CH4) emissions need to be estimated accurately so that the mitigation effect of recommended practices can be accounted for. In the present study prediction equations for enteric CH4 have been developed in lieu of expensive animal measurement approaches. Our objectives were to: (1) compile a dataset from individual beef cattle data for the Latin America and Caribbean (LAC) region; (2) determine main predictors of CH4 emission variables; (3) develop and cross-validate prediction models according to dietary forage content (DFC); and (4) compare the predictive ability of these newly-developed models with extant equations reported in literature, including those currently used for CH4 inventories in LAC countries. After outlier's screening, 1100 beef cattle observations from 55 studies were kept in the final dataset (∼ 50 % of the original dataset). Mixed-effects models were fitted with a random effect of study. The whole dataset was split according to DFC into a subset for all-forage (DFC = 100 %), high-forage (94 % ≥ DFC ≥ 54 %), and low-forage (50 % ≥ DFC) diets. Feed intake and average daily gain (ADG) were the main predictors of CH4 emission (g d−1), whereas this was feeding level [dry matter intake (DMI) as % of body weight] for CH4 yield (g kg−1 DMI). The newly-developed models were more accurate than IPCC Tier 2 equations for all subsets. Simple and multiple regression models including ADG were accurate and a feasible option to predict CH4 emission when data on feed intake are not available. Methane yield was not well predicted by any extant equation in contrast to the newly-developed models. The present study delivered new models that may be alternatives for the IPCC Tier 2 equations to improve CH4 prediction for beef cattle in inventories of LAC countries based either on more or less readily available data.

166 Barriers and Facilitators to Emergency Medicine Residency Program Development in Latin America and the Caribbean

Although EM is rapidly expanding in Latin America and the Caribbean, there has been no formal evaluation of the implementation of recently established EM training programs to guide the process in other countries. We aimed to describe the barriers and facilitators of developing an EM residency training program in Latin American and Caribbean countries to identify and disseminate the relevant “lessons learned.” Methods: Semi-structured, virtual, individual qualitative interviews with key stakeholders involved in the development of EM residency programs in Latin America and the Caribbean. Interviews were in English or Spanish, recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) guided the interview and analysis using 5 constructs applied systematically to the varying program implementations: inner setting, outer setting, individuals involved, implementation process, and intervention characteristics. Fourteen interviews were completed with physicians from Nicaragua, Guatemala, Chile, Mexico, Argentina, Haiti, Peru, and Brazil. Inner setting: Major barriers included lack of EM-trained physicians in the teaching faculty, resistance from other specialties, and lack of general support which caused feelings of isolation for the initial EM residents. Facilitators included the formation of national EM associations, cultivation of local EM-trained faculty as residents graduated, adapting curriculum to local needs, and formal feedback processes for program improvement. Outer setting: Barriers included lack of autonomy of the medical schools from the government and limited public and health system awareness of the role of EM. The COVID-19 pandemic was a facilitator as it brought recognition and legitimacy to EM due to the relevant skill sets of Emergency physicians. Financial help and additional educational opportunities from foreign organizations were helpful in some cases. Individuals involved: Key individuals served as champions who advocated for the implementation of the EM specialty and served as the catalyst for the program implementation in their countries. Some non-Emergency physicians were considered a barrier because of discouraging or luring residents away from EM. Implementation process: Barriers included lack of resources (functional equipment, textbooks), lack of program accreditation, and difficulty engaging applicants due to limited exposure of specialty. Facilitators included recognition and program approval from the Ministry of Health and “grandfathering” to establish first local EM faculty. Intervention characteristics: Barriers included the language of the available EM literature and lack of relevant language skills of the volunteer foreign EM faculty. Lack of funding to provide sufficient salary or any salary at all for the initial EM residents was another hurdle. Facilitators included funding from the government or external entities, and a curriculum document outlining EM-specific objectives enabled consistent, targeted training. Countries and organizations planning to initiate new EM training programs in Latin American and the Caribbean may benefit from the shared experience, including common barriers and facilitators to program establishment described by key stakeholders of recently developed programs in the region. Dissemination of these findings will avoid institutions “re-inventing the wheel”.

A Comparative Analysis of Weighting Methods in Geospatial Flood Risk Assessment: A Trinidad Case Study

The Republic of Trinidad and Tobago is an archipelagic Small Island Developing State (SIDS), situated on the southern end of the chain of Caribbean islands. Several factors such as climate, topography, and hydrological characteristics increase its susceptibility and vulnerability to flooding which results in adverse socio-economic impacts. Many Caribbean islands, including Trinidad and Tobago lack a flood risk assessment tool which is essential for a proactive mitigation approach to floods, specifically in the Caribbean due to the incommensurate flooding events that occur because of the inherent characteristics of SIDS. This research focuses on the problem of flooding using susceptibility analysis, vulnerability analysis and risk assessment for the island of Trinidad, whilst also presenting a repeatable and appropriate methodology to assess these risks in regions that have similar characteristics to Trinidad. This is especially useful in Caribbean countries because of a lack of internal human capacity to support such efforts. Flood hazard indexes (FHI) and vulnerability indexes (VI) were generated for this study using subjective and objective weighting technique models to identify regions that are affected by flooding. These models were Analytical Hierarchy Process (AHP), Frequency Ratio (FR) and Shannon’s Entropy (SE). Comparative analyses of the three models were conducted to assess the efficacy and accuracy of each to determine which is most suitable. These were used to conduct a risk assessment to identify risks associated with each Regional Corporation of Trinidad. Results indicate that FR is the most accurate weighting technique model to assess flood susceptibility and risk assessment in Trinidad, with an Area Under the Curve (AUC) of 0.76 and 0.64 respectively. This study provides an understanding of the most appropriate weighting techniques that can be used in regions where there are challenges in accessing comprehensive data sets and limitations as it relates to access to advanced technology and technical expertise. The results also provide reasonably accurate outcomes that can assist in identifying priority areas where further quantitative assessments may be required and where mitigation and management efforts should be focused. This is critical for SIDS where vulnerability to flooding is high while access to financial and human resources is limited.

Asbestos awareness among the residents of St. Kitts and Nevis: a cross-sectional study

BackgroundHigh levels of public awareness regarding the hazards of asbestos, rights to health, and benefits of an asbestos-free country can increase advocacy and political commitment to a total ban on asbestos. We aimed to investigate asbestos awareness and associated sociodemographic characteristics among the adult population of St. Kitts and Nevis.MethodsIn this cross-sectional study, 1009 participants completed an online questionnaire with questions about sociodemographic data and asbestos awareness. We applied multiple regression models to estimate associations between sociodemographic factors, levels of asbestos knowledge, and attitudes toward asbestos management.ResultsWe found that 70% of residents of St. Kitts and Nevis considered asbestos exposure to be a general public concern and believed the government should prevent it. Of all participants, 54% were in favor of completely banning the use and importation of all asbestos products and materials; those with higher levels of asbestos knowledge were more likely to favor a total ban. Higher proportions and odds of favoring a total asbestos ban were also observed in participants aged ≥ 30 years, women, those with higher education, and those living in St. Kitts (vs. Nevis).ConclusionsThese findings support implementing policies to regulate and outright ban the use of asbestos products and materials in St. Kitts and Nevis. This data can be used to develop tailored campaigns to improve asbestos knowledge among sociodemographic groups with lower asbestos awareness, such as in the wider Caribbean and other under-resourced countries.

Health budgeting and governance responses to COVID-19 in Latin America and the Caribbean: Lessons for improving health systems’ resilience

This paper analyses the budgetary and health governance responses to the COVID-19 pandemic in Latin American and Caribbean (LAC) countries during 2020 and 2021 to identify good practices which could support countries improve the resilience of their health financing systems for future crises.

Balancing water scarcity, food production, and trade imperatives in the Caribbean: Could virtual water analysis help?

The food system of the Caribbean Community (CARICOM) transitioned from plantation-based agriculture to one based on small-scale production and high food imports. Through the ‘25 in 5 Plan’, the CARICOM hopes to reduce its US$ 5 billion annual food import bill by 25% in the next five years, mainly by import substitution. Virtual water analysis has the potential to reveal water consumption and fluxes in food production and trade in the CARICOM to highlight hydro-concerns for the anticipated food import substitution. This study, therefore, analysed the virtual water flows associated with maize production and trade in the Caribbean to explore the implications of import substitution for sustainable water use and food security. Maize production and trade matrix data for the period 2010–2019 were obtained from FAO databases, and virtual water content was obtained from the Water Footprint Network database. Virtual water flow was estimated as the product of the virtual water content of maize and quantity traded between any two trading partners. Net virtual water flows were estimated as the difference between virtual water of imported commodities and that of exported commodities for each Caribbean country and its trading partners. Additionally, the equivalent water demand for full import substitution was estimated. The results showed that maize import to the Caribbean was about twice the regional production and both intra- and extra-Caribbean trade were highly concentrated in few countries. The equivalent volume of water required to support full import substitution, at current yields and consumption, was larger than the total internal renewable water resources for some countries. It is concluded that, while there is room for import substitution and diversification to reduce both cost and risk, water scarcity considerations are necessary and can limit the scale of import substitution for key commodities such as maize. A regional approach that takes advantage of national differences in water endowments and production potential, while enhancing intra-regional trade and diversifying extra-regional sources of supply, should be given urgent attention.

Evaluation of Bisphenol A in Pregnant Women from 10 Caribbean Countries.

Bisphenol A (BPA), a phenolic chemical incorporated into many plastic products, has been found to act as an endocrine disruptor that potentially is linked to adverse neurodevelopmental outcomes. Prenatal BPA concentration levels were assessed in 10 English-speaking Caribbean countries by randomly selecting 15 maternal urine samples from approximately 50 pregnant women samples collected in each island and then comparing the findings with comparable data from Canada and the U.S. BPA was detected in all samples ranging from a low geometric mean of 1.46 μg/L (St. Lucia) to a high of 4.88 μg/L (St. Kitts & Nevis). All of the Caribbean islands sampled had geometric mean concentration levels that were higher than those recorded in two Canadian biomonitoring surveys (1.26 μg/L and 0.80 μg/L) and the U.S. NHANES survey (1.39 μg/L). This first biomonitoring survey of BPA concentration levels in maternal urine samples taken from Caribbean countries clearly points to the need for Caribbean governments and public health officials to first engage in legislative and regulatory efforts to ban or minimize the importation and use of BPA products used the Caribbean and, second, to continue to conduct biomonitoring surveys so as to ensure that these laws and regulations are indeed leading to a decrease of BPA concentrations in Caribbean populations.

Optimal heat stress metric for predicting warm-season mortality varies from country to country

BACKGROUND AND AIM: While heat combined with high humidity is frequently described as the main driver of heat stress, this remains unclear in epidemiological literature. A range of heat stress metrics, each being a different combination of temperature and humidity and sometimes other variables, are available in the literature. We compared eight heat stress metrics with warm-season mortality, with the aim of finding the optimal metric(s) for predicting mortality. METHODS: We performed a two-stage time-series approach using quasi-Poisson regression with distributed lag nonlinear models to derive warm-season exposure-response associations between each heat stress metric and mortality, over 604 locations in 39 countries within the Multi-Country Multi-City (MCC) Collaborative Research Network. The metrics studied were dry-bulb temperature (Tmean), wet-bulb temperature (Tw), apparent temperature (AT), discomfort index, and swamp cooler temperatures at 20, 40, 60 and 80% efficiencies (Swmp20 to Swmp80). The goodness-of-fit of each exposure-response model was assessed using the Quasi-Akaike Information Criterion (qAIC). For each metric and country, we summed the qAIC values across all locations and identified the metric with the lowest country-level qAIC as the optimal metric. We also compared the heat-mortality fraction for each metric. RESULTS: According to qAIC, AT, a metric combining temperature, humidity and wind speed, is the dominant driver of warm-season mortality, especially in Northern and Eastern Europe. Metrics with no or little humidity modification (Tmean and Swmp20) dominate in Southern and Western Asia, Eastern Asia, and Australia. Tw, a metric with large humidity modification, dominate in Caribbean, Central and South American countries but with large uncertainties. However, using Tmean as the only exposure metric does not result in significantly different attributable fractions compared to using the optimal metric. CONCLUSIONS: There is no one-size-fits-all metric for predicting heat-related mortality, but Tmean is suitable enough for estimating impacts in present-day climate. KEYWORDS: heat stress, mortality