Analysis of drug consumption in medical service for Dominica and Dominican in Harmonious Mission -2018 / 药学实践杂志

Objective To analyze the drug consumption in medical service for Dominica and Dominican in Harmonious Mission -2018, and provide reference for future drug supply services in similar countries. Methods Data of the drugs used during the medical service of the two countries were extracted from the computer system, which were summarized and analyzed. Results Ranking first in drug consumption in medical service for Dominica and Dominican was external drugs. Chinese traditional medicines were very popular in both two countries. There were great similarities and unique characteristics in the drug consumption during medical service between the two countries, orthopedic drugs, digestive system drugs, ophthalmic drugs and dermatological drugs were frequently used drugs. Conclusion The drug consumption in medical service was closely associated with the national conditions. Therefore, in order to prepare medicines reasonably in future overseas medical service, disease distribution of the country which would be visited and drug consumption in the similar country which had been visited before should be concerned.

First reported enterovirus D68 infection in pediatric patients from the Caribbean region: evidence of spread from the U.S. outbreak / Primeros casos notificados en el Caribe de infección por enterovirus D68 en pacientes pediátricos: pruebas de la propagación del brote de los Estados Unidos

ABSTRACT The 2014 enterovirus D68 (EV-D68) outbreak in the United States raised concerns about the introduction of the virus in the Caribbean region. The objective of this study was to provide rapid evidence of the introduction of EV-D68 strains in the Caribbean region during the 2014 outbreak in the United States, using a relatively simple phylogenetic approach. From October 2014 to May 2015, four EV-D68 cases from two countries (Bermuda and Dominica) were detected at the regional referral laboratory at the Caribbean Public Health Agency (Port of Spain, Trinidad and Tobago) based on molecular testing of respiratory specimens. All cases were children presenting to hospitals with moderate respiratory distress. No cases of acute flaccid paralysis were detected. Phylogenetic analysis of the Caribbean strains showed more than 99% similarity with the 2014 U.S.-outbreak strain, providing evidence of the introduction and circulation of the virus in the region.(AU)

RESUMEN El brote de enterovirus D68 (EV-D68) registrado en el 2014 en los Estados Unidos suscitó preocupación acerca de la introducción del virus en el Caribe. El objetivo de este estudio fue aportar pruebas rápidas, mediante la adopción de un enfoque filogénico relativamente sencillo, de que durante ese brote ingresaron en el Caribe cepas del EV-D68. Entre octubre del 2014 y mayo del 2015, el laboratorio regional de referencia ubicado en el Organismo de Salud Pública del Caribe (Puerto España, Trinidad y Tabago) detectó cuatro casos de EV-D68 provenientes de dos países (Bermudas y Dominica) mediante el análisis molecular de muestras respiratorias. Todos los casos correspondían a niños que acudieron al hospital con dificultad respiratoria moderada. No se detectó ningún caso de parálisis flácida aguda. El análisis filogénico de las cepas encontradas en el Caribe demostró una semejanza superior al 99 % con la cepa responsable del brote del 2014 en los Estados Unidos, lo que demuestra la introducción y la circulación del virus en la región.(AU)

Knowledge management strategy for advancing the national health agenda in Dominica / Estrategia de gestión del conocimiento para impulsar el programa nacional de salud de Dominica

ABSTRACT The Ministry of Health and Environment (MoHE) of the Commonwealth of Dominica identified the need for a knowledge management strategy to advance the country's national health agenda. The Pan American Health Organization and the MoHE conducted a rapid situation analysis of knowledge management in July 2015. The findings, analysis, and recommendations were developed jointly with a core team of the MoHE within the context of the strategic plan for health, "Investing in Health - Building a Safer Future." The situation analysis described the overall status of the understanding and implementation of information and knowledge management activities, projects, products, and practices. The analysis also aimed to identify what critical knowledge is needed to support overall organizational goals and individual and team activities. The MoHE expects patient outcomes and quality of care to improve as a result of having a knowledge management strategy that boosts the Ministry's efficiency and productivity.(AU)

RESUMEN El Ministerio de Salud y Medioambiente del Commonwealth de Dominica determinó la necesidad de definir una estrategia de gestión del conocimiento para impulsar el programa nacional de salud del país. En julio del 2015, la Organización Panamericana de la Salud y el Ministerio de Salud y Medioambiente llevaron adelante un análisis rápido de la situación de la gestión del conocimiento. Los resultados, el análisis y las recomendaciones fueron elaborados conjuntamente con un equipo básico del Ministerio dentro del contexto del plan estratégico de salud Investing in Health: Building a Safer Future [invertir en la salud para forjar un porvenir más seguro]. En el análisis de la situación se describe el estado general del conocimiento y el desarrollo de actividades, la ejecución de proyectos, la elaboración de productos y la aplicación de prácticas de gestión de la información y el conocimiento. Dicho análisis además tuvo como objetivo definir el conocimiento fundamental que se necesita para apoyar la consecución de todas las metas institucionales y la realización de las actividades tanto individuales como grupales. El Ministerio de Salud y Medioambiente espera que mejoren los resultados de los pacientes y la calidad de la atención al contar una estrategia de gestión del conocimiento que le permita impulsar su eficiencia y productividad.(AU)

Primary care performance in Dominica / Desempeño de la atención primaria en Dominica

Objective. To document the structure and functions of primary care (PC) in the country of Dominica using the Primary Care Assessment Tools (PCAT), a set of questionnaires that evaluate PC functions. Methods. This cross-sectional study combined data from two surveys. The systems PCAT (S-PCAT) survey gathered national-level data from key informants about health system characteristics and PC performance. The provider version (P-PCAT) survey collected data on PC performance from health providers (nurses and physicians) at all PC facilities in the country. Provider-level data were aggregated to obtain national and district-level results for PC domains scored from 0.00 (worst) to 1.00 (best). Results. From the systems perspective, results showed several knowledge gaps in PC policy, financing, and structure. Key informants gave “Good” (adequate) ratings for “first-contact” care (0.74), continuity of care (0.77), comprehensive care (0.70), and coordinated care (0.78); middling scores for family-centered care and community-oriented care (0.65); and low scores for access to care (0.57). PC providers assessed access to care (which included “first-contact” care, in the P-PCAT surveys) (0.84), continuity of care (0.86), information systems (0.84), family-centered care (0.92), and community-oriented care (0.85) as “Very Good”; comprehensive care as “Good” (0.79); and coordinated care as “Reasonable” (0.68). Overall, the scores for the country's health districts were good, although the ratings varied by specific PC domain. Conclusions. The assessments described here were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving PC, and identification of priority areas for further investigation. This two-staged approach could be adapted and used in other countries.

Objetivo. Documentar la estructura y las funciones de la atención primaria (AP) en la república insular de Dominica con los cuestionarios PCAT (Primary Care Assessment Tools o instrumentos para evaluar la atención primaria), un conjunto de cuestionarios que evalúan las funciones de la AP. Métodos. En este estudio transversal se combinaron los datos de dos series de encuestas. La realizada con los PCAT sobre los sistemas (S-PCAT) recopiló, a partir de informadores relevantes, datos de ámbito nacional sobre las características del sistema sanitario y el desempeño de la AP. La versión para profesionales (P-PCAT) recopiló datos sobre el desempeño de la AP a partir de los profesionales sanitarios (enfermeras y médicos) en todos los centros de AP del país. Se combinaron los datos relativos a los profesionales para obtener resultados correspondientes a los niveles de distrito y del país sobre los dominios de la AP calificados con una puntuación de entre 0,00 (peor) y 1,00 (mejor). Resultados. Desde la perspectiva de los sistemas, los resultados demostraron varias brechas en el conocimiento de las políticas, el financiamiento y la estructura de la AP. Los informantes clave otorgaron puntuaciones “buenas” (suficientes) a la atención durante el “primer contacto” (0,74), a la continuidad de la atención (0,77), a la atención integral (0,70) y a la atención coordinada (0,78); puntuaciones medias a la atención centrada en la familia y orientada a la comunidad (0,65); y puntuaciones bajas al acceso a la atención (0,57). Los profesionales consideraron que el acceso a la atención (incluida la de “primer contacto”, en las encuestas P-PCAT) (0,84), la continuidad de la atención (0,86), los sistemas de información (0,84), la atención centrada en la familia (0,92) y la atención orientada a la comunidad (0,85) son “muy buenos”; que la atención integral es “buena” (0,79); y que la atención coordinada es “correcta” (0,68). En general, las puntuaciones relativas a los distritos sanitarios del país son buenas, aunque las puntuaciones varían según el dominio de la AP. Conclusiones. Las evaluaciones descritas, que conllevaron un gasto relativamente bajo, constituyen un aporte importante a la planificación estratégica, las estrategias para mejorar la AP y la identificación de áreas prioritarias para ulteriores investigaciones. El enfoque en dos etapas podría adaptarse y aplicarse en otros países.

Distribution, Burden, and Impact of Acute Gastroenteritis in Dominica, 2009-2010.

Acute gastroenteritis (AGE) is an important public-health issue in Dominica. To determine the burden of AGE in Dominica, a retrospective, cross-sectional population survey was conducted in March-April 2009 and October 2010 (low- and-high-AGE seasons) and a laboratory survey from April 2009 to March 2010. The overall monthly prevalence of self-reported AGE was 8.6 % (95% CI 7.0-10.6); the incidence rate was 1.1 episodes/person-year and 79,157.1 episodes of AGE for the total population/year. Monthly prevalence of AGE was the highest in the 1-4 year(s) age-group (25.0%), higher in females (10.8%) and also varied by health district, with the highest monthly prevalence of AGE being reported in the Portsmouth district (13.1%). This difference in gender and across the health region was statistically significant. The estimated underreporting of syndromic AGE to the Ministry of Health was 83.3%. Furthermore, for every reported laboratory-confirmed case of AGE and foodborne disease (FBD), there was an estimated underreporting factor of 280. Overall, 47% of AGE specimens tested were positive for FBD pathogens. The predominant pathogens isolated were norovirus, followed by Giardia, Salmonella, and Shigella. The total annual estimated cost of AGE was US$ 1,371,852.92, and the total cost per capita due to AGE was US$ 19.06, indicating an economic burden of AGE-related illness on a small island of Dominica.

The distribution of seagrasses in Dominica, Lesser Antilles

Seagrass beds are the largest organism-built marine habitat in Dominica, yet have only been surveyed since 2007. Standardized examinations along a depth gradient between 0 and 24m, focusing on magnoliophyte species composition and benthic cover of shoots at 17 seagrass bed sites, were carried out between September 10 and December 7, 2008. The Cymodoceaceae Syringodium filiforme (Kuetzing 1860) and Halodule wrightii (Ascherson 1868), as well as the Hydrocharitaceae Halophila decipiens (Ostenfeld 1902), H. stipulacea (Fosskal & Ascherson 1867) and Thalassia testudinum (Banks ex König 1805) displayed distinct regional and horizontal distribution patterns. Syringodium filiforme is the island’s dominant seagrass along the western and northern coasts, occurring at depths between 2 and 18m and with a mean benthic cover ranging from 0.9-10% along the West coast. Along the North coast it grew between 0.2 and 1m depth with a mean maximum benthic cover of 48.9%. Halodule wrightii grew along the North and West coasts, in depths between 1 and 14m in areas of recent and chronic disturbances. Its delicate morphology and sparse benthic cover (<0.1%) did not constitute seagrass beds. Halophila decipiens grew along the deep, shallow and lateral margins of west coast S. filiforme beds and monospecifically in depths between 3 and 24m. Halophila stipulacea, an invasive species, was widespread along 45km of the West coast and was found in depths between 5 and 24m. Both Halophila species formed extensive beds at depths beyond the survey limit of 24m thus playing a potentially important role in the resettlement of shallow areas after storms. H. decipiens and H. stipulacea are currently the second and third most common seagrasses on the island respectively, despite their absence along the North coast. T. testudinum was confined to North coast’s sheltered reef flats at depths 1m or less with mean a benthic cover ranging from 2 to 76%. It grew monospecifically in the most turbulent and in the calmest locations, yet intermixed with S. filiforme in areas of moderate turbulence. Strong surge along the West coast (October 15-16, 2008), associated with Hurricane Omar, caused uprooting and burial of seagrass beds in varying degrees, in particular along the shallow margins between 2 and 10m depth. This event also demonstrated the dynamic nature of Dominica’s shallow seagrass bed margins and the resistance level of individual beds to storm disturbances. Rev. Biol. Trop. 58 (Suppl. 3): 89-98. Epub 2010 October 01.

Pastos marinos son los ambientes más grandes constituidos por organismos en Dominica. Sin embargo, sólo se han examinado desde 2007. Entre el 10 de septiembre y 9 de diciembre 2008, se examinaron la composicion de especies y la densidad de magnoliofitas en profundidades de 0 a 24m. Los Cymodoceaceae: Syringodium filiforme y Halodule wrightii, tal como los Hydrocharitaceae: Halophila decipiens, H. stipulacea y Thalassia testudinum, mostraron una distribución regional y horizontal muy distinta. Syringodium filiforme fue la especie dominante en las costas del oeste y del norte de la isla. Se encontró en profundidades de 2 a 18m y con un promedio de cobertura béntica de 0.9-10% en la costa del oeste. En las costas del norte creció entre 0.2 y 1m de profundidad con un pormedio de cobertura béntica de 48.9%. Halodule wrightii creció en las costad del norte y oeste, en profundidades de 1 a 14m en áreas de perturbaciones recientes o crónicas. Su morfología delicada y su baja cobertura béntica (<0.1%) no constituyeron pastos. Halophila decipiens creció en los márgenes profundos, llanos y laterales de pastos dominados por S. filiforme, pero también en forma mono-específica entre 3 y 24m. Halophila stipulacea, una especie invasora, se encontró comúnmente a lo largo de 45km de la costa del oeste en profundidades entre 5 y 24m. Ambas especies de Halophila formaron pastos extensos en profudidades mayores al límite de este estudio y puden ser importantes en la recolonización de áreas llanas después de tormentas destructivas. H. decipiens y H. stipulacea ahora son las especies más comunes después de S. filiforme, a pesar de su ausencia en la costa del norte. T. testudinum, sólo creció en la costa del norte, encima de áreas arrecifales con un pormedio de cobertura béntica entre 2 y 76%, en aguas con 1m o menos de profundidad. Crecieron mono-específicamente en áreas de turbulencia máxima y mínima, pero entre S. filiforme en áreas de turbulencia moderada. Oleaje fuerte en la costa del oeste (octubre 16), asociado con el Huracán Omar, causó la erosión y el enterramiento variado de las márgenes llanas de pastos marinos, particularmente entre 2 y 10m de profundidad. Este evento demostró la dinámica en las márgenes llanas de pastos marinos de Dominica y el nivel de resistencia a perturbaciones de pastos individuales.

The effects of a coral disease on the reproductive output of Montastraea faveolata (Scleractinia: Faviidae)

The direct impacts of coral diseases on coral populations have been assessed by quantifying coral tissue loss and colony mortality, but the determination of the indirect effects of diseases, such as disruptions in life history functions (e.g. reproduction, growth and maintenance), are more difficult to ascertain and have been scant. This study involved a comparison of various measures of reproductive output from histological slides of healthy tissue samples of Montastraea faveolata and tissue samples from colonies with white plague (WP) infections in Dominica (West Indies). Although the variability in the reproductive data was high, WP had significant negative impacts on the percentage of reproductive polyps per cm2, the percentage of reproductive mesenteries within a polyp, oocyte quantity per polyp, mean oocyte volume (mm3), and fecundity (oocyte volume per cm2 of tissue). However, these effects were only observed in the tissue directly impacted by the WP disease "band" and were not observed in tissue samples taken 20 cm away from the lesion. Therefore, the effects of a coral disease (WP) on reproductive output are localized and not expressed colony-wide. Rev. Biol. Trop. 58 (Suppl. 3): 99-110. Epub 2010 October 01.

Distribution and size of benthic marine habitats in Dominica, Lesser Antilles

Surveys of benthic marine habitats encompassing 1 814.7ha and lining 90% of Dominica’s shoreline were carried out to build the first composite picture of the distribution and size of the island’s near-shore sublittoral habitats, and the epibenthic communities they harbor. Field survey sites covered areas ranging from 1 425 to 29.6ha, lining the shore in bands ranging between 50 and 250m in width, in waters no deeper than 30m. Thus a total of 755ha of benthos were surveyed in October and November of 2007. The benthic habitat composition of an additional 1 059.7ha was inferred with the help of unpublished data and satellite imagery. Seagrass beds were the most widespread organism-built habitat type with 265ha. Coral reefs covered 72.2ha. Both of these habitats were predominantly established along the West and North coasts, which included the island’s most habitatdiverse regions. Rocky environments (911.5ha) dominated the East and South coast and together with sandy areas (566ha) constituted 81% of the island’s marine benthos. It is apparent that seagrass beds, which include four native and one invasive seagrass species, had not been surveyed as previous distribution reports could not be confirmed. Similarly, the benthic cover of Dominica’s coral reefs is evidently far below the previously reported 7 000ha. Such discrepancies highlight the advantage of environmental assessments based on field surveys and systematic data compilation, particularly in cases like Dominica where a narrow island shelf stages marginal marine resources in spatial proximity to each other and human settlements. This study has demonstrated how low-tech field methods can be applied on an island-wide scale to build an inventory of marine resources in the form of habitat maps and data repositories publicly accessible for future use. In the absence of such efforts, the development of conservation measures and status reports will remain ill founded. Rev. Biol. Trop. 58 (2): 589- 602. Epub 2010 June 02.

Los ambientes béntico-marinos de Dominica, Antillas Menores, incluyen 1 814.7ha y cerca del 90% de la costa. Este es el primer trabajo sobre el tamaño y distribución de los ambientes costeros sublitorales y sus comunidades epibénticas. Los pastos marinos constituyeron el ambiente más extenso, con 265ha. Los arrecifes coralinos presentaron una cobertura de 72.2ha. Ambos tipos de ambientes se encontraron principalmente en la costa oeste y norte, regiones con la mayor diversidad de ambientes marinos. Las áreas rocosas (911.5ha) dominaron las costas este y sur de la isla, y junto con las áreas arenosas (566ha) constituyeron el 81% de los ambientes bénticos. La distribución de pastos marinos, que incluyeron cuatro especies nativas y una invasiva, no se pudo corroborar con los pocos informes previos. La cobertura béntica de los arrecifes coralinos de Dominica fue mucho menor que las 7 000ha que se habían reportado previamente. Estas discrepancias ilustran la ventaja de los estudios ambientales basados en trabajo de campo y la compilación sistemática de datos ambientales, especialmente en casos como Dominica donde por lo angosto de la plataforma insular, los ambientes marinos sublitorales quedan muy cerca de los centros urbanos. Se demuestra que técnicas simples pueden ser utilizadas a gran escala alrededor de una isla para realizar inventarios de los recursos marino-costeros, mediante mapas y repositorios públicos de datos para usos futuros, que permiten el desarrollo de medidas de conservación efectivas.

Spread of phosphine resistance among brazilian populations of three species of stored product insects

The resistance to fumigant insecticides in stored-products insects is often recorded. Several factors influence the evolution of insecticide resistance. Among these, the frequency of applications and the migration of resistant populations are of primary importance for the stored-product insects. The aim of this study was to characterize the spectrum and investigate the status of phosphine resistance in Brazil, in 13 populations of the Coleoptera Tribolium castaneum Herbst (Tenebrionidae), ten populations of Rhyzopertha dominica (Fabr.) (Bostrichidae), and eight populations of Oryzaephilus surinamensis (L.) (Silvanidae). The pattern of resistance dispersion in the populations of these species was also verified. The bioassays for the detection of phosphine resistance followed the FAO standard method. To test the influence of migration in the evolution of the phosphine resistance, the difference of mortality in the discriminating concentration and the geographical distance among each pair wise combination of collection sites were correlated. None of the populations exhibited mortality above 90 percent in the discriminating concentration, for the three species. Mortality in the discriminating concentration increased with the geographical distance for R.dominica and O.surinamensis. However, no significant linear response was observed among the variables for T.castaneum populations. These results suggest that the dispersion of insects and the local selection are relevant in the evolution of the phosphine resistance in populations of R.dominica and O.surinamensis. In contrast, grain trade and local selection are probably the factors that determine the evolution of the phosphine resistance in populations of T. castaneum.

A recent increase in the abundance of the echinoid Diadema antillarum in Dominica (Lesser Antilles): 2001-2005 / Un aumento reciente en la abundancia del equinoideo Diadema antillarum en Dominica (Antillas Menores): 2001-2005

Diadema antillarum populations at many Caribbean locations have failed to recover from the pathogen-induced mortality events of the 1980s. It has become clear that the massive decline of this herbivorous urchin and the wide-spread absence of a population recovery lead to numerous long-term ecological consequences and reef degradation. While few quantitative studies on pre-mortality exist, great effort has been put forth to monitor remaining populations and their recovery. However, the patchy distribution of D. antillarum coupled with paucity of long-term studies based on the same methods applied at the same locations undermines the value of local as well as regional comparisons. In Dominica, ongoing quantitative assessments of D. antillarum began in 2001. Surveys of D. antillarum abundance are being carried out in 4-month intervals at six 100 m² sites; spread over 38 km along the west coast. The density of D. antillarum has differed significantly between sites, ranging from 0.81(SD= 0.04) to 3.13 m-2 (SD= 2.10), and increased by 61.11% during the first five years of this study. Seasonal fluctuations, possibly related to spawning aggregations, are also evident. The current abundance of D. antillarum on Dominican reefs contrasts that of Caribbean locations with recorded incidents of mass mortality events, and in some cases resembles pre-mortality densities from the early 1970s. Prior to this study, no systematic quantitative assessments of D. antillarum were carried out in Dominica. It is thus unclear in what way Dominica’s D. antillarum were affected by the mass mortality events observed elsewhere in the 1980s. The increase in D. antillarum density so far observed may thus be the recovery from a pathogen-induced disturbance or from Hurricane Lenny in November 1999. Locally, D. antillarum is important grazer on Dominican’s reefs, where over-fishing has drastically reduced the number of herbivorous fishes. On a regional scale, the island’s D. antillarum may represent a source of larvae for downstream islands, given the duration of the echinoplutei stage and a range of larval dispersal of hundreds of kilometers. Rev. Biol. Trop. 54 (Suppl. 3): 97-103. Epub 2007 Jan. 15.

Las poblaciones de Diadema antillarum de muchas localidades del Caribe, no se han recuperado después de los eventos de mortandad, inducidos por un patógeno, en la década de 1980. Se ha podido demostrar que la muerte masiva de este erizo herbívoro y la ausencia de recuperación, han tenido consecuencias ecológicas que han producido la degradación de los arrecifes. Existen pocos estudios pre-mortalidad, pero se han realizado grandes esfuerzos para monitorear las poblaciones restantes y su recuperación. Sin embargo, la distribución en parches de D. antillarum combinado con pocos estudios a largo plazo usando la misma metodología en los mismos sitios, mina la posibilidad de comparaciones locales y regionales. En Dominica, el monitoreo cuantitativo de D. antillarum empezó en 2001. Cada cuatro meses se realizan determinaciones de abundancia de D. antillarum en seis sitios de 100 m²; distribuidos a lo largo de 38 km de la costa oeste. La densidad de D. antillarum, fue significativamente diferente entre sitios, con ámbitos de 0.81 (SD= 0.04) a 3.13 m-2 (SD= 2.10), y aumentó 61.11% durante los primeros cinco años de estudio. Fluctuaciones estacionales, posiblemente relacionadas con agregaciones reproductivas, son evidentes. La abundancia actual de D. antillarum en los arrecifes de Dominica contrasta con otros sitios en el Caribe que sufrieron mortandades masivas y en algunos casos se parece a densidades pre-mortalidad de inicios de la década de 1970. Antes de este trabajo, no se había realizado ningún estudio sistemático de Diadema en Dominica, por lo que no es claro como fueron afectadas las poblaciones en este sitio. El aumento en la densidad de D. antillarum observado hasta ahora puede deberse a recuperación tras una perturbación por un patógeno o por el Huracán Lenny de noviembre 1999. Localmente, D. antillarum es un herbívoro importante en los arrecifes de Dominica donde la sobrepesca ha disminuido el número de peces herbívoros. En escala regional, las poblaciones de D. antillarum de la isla de Dominica pueden representar una fuente de larvas corriente abajo, dada la duración de estadio equiinopluteo y el ámbito de dispersión de las larvas, que es de cientos de kilómetros.