Suicide, fatal injuries and drowning among the crews of United Kingdom and Bermuda registered cruise and passenger ships from 1976 to 2018.

BACKGROUND: Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. MATERIALS AND METHODS: A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. RESULTS: One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified: from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction: 4.3%; 95% confidence interval: 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction: 1.2% confidence interval: -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. CONCLUSIONS: The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.

Molecular characterization of vancomycin-resistant Enterococcus faecium isolates from Bermuda.

Molecular characteristics of vancomycin resistant enterococci isolates from Bermuda Island is currently unknown. This study was conducted to investigate phenotypic and genotypic characteristics of VRE isolates from Bermuda Island using the chromogenic agar, E-tests, polymerase chain reaction (PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Eighteen E. faecium isolates were completely analyzed and were all resistant to vancomycin, susceptible to linezolid and quinupristin/dalfopristin, positive for vanA and esp genes. The MLST analysis confirmed most isolates were of the sequence types linked to clonal complex 17 (CC17) that is widely associated with outbreaks in hospitals. Infection control measures, antibiotic stewardship, and surveillance activities will continue to be a priority in hospital on the Island.

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)

Cancer incidence and mortality rates in Bermuda / Incidencia del cáncer y tasas de mortalidad en Bermuda

OBJECTIVE: To describe cancer and mortality rates in Bermuda and to compare such rates to those of the United States of America (USA). METHODS: Age-adjusted race-specific cancer incidence rates for Bermuda were calculated using the Bermuda Cancer Registry. These rates were then compared to USA cancer rates published by the National Cancer Institute. RESULTS: Overall age-adjusted incidence rate was 495 cases per 100 000for Blacks and 527 cases per 100 000 for Whites. Incident cases were more frequent among men than women in both races. For Blacks, the highest incidences were prostate for men and breast for women, followed by colon/rectum and lung cancer. For Whites, if we exclude benign skin cancers, the picture was similar with the notable exception of lung cancer being more frequent than colon/rectum in White males. When Bermuda's rates were compared to those of the USA, overall cancer rates were similar in both countries. Rates in Bermuda were higher for cancer of the mouth, ovarian cancer (Black women), melanoma (Whites), colorectal cancer (White women) and breast cancer (White women). Lung and colorectal cancers were less frequent in Bermuda s Black population. CONCLUSION: Further epidemiological studies are needed to identify potential risk factors that could contribute to these differences. Screening and prevention strategies could be adjusted accordingly.

OBJETIVO: Describir las tasas de cáncer y mortalidad en la Bermudas y comparar estas tasas con las de los Estados Unidos de América (EE. UU.). MÉTODOS: Las tasas de incidencia de cáncer específicas por raza y ajustadas por edad en Bermuda, se calcularon usando el Registro de Cáncer de Bermuda. Estas tasas fueron comparadas con las tasas de cáncer en los EE. UU. publicadas por el Instituto Nacional del Cáncer. RESULTADOS: La tasa general de incidencia ajustada por edad fue de 495 casos por 100 000 negros y 527 casos por 100 000 blancos. Los casos incidentes fueron más frecuentes entre los hombres que entre las mujeres en ambas razas. En el caso de los negros, las incidencias más altas estuvieron en la próstata para los hombres y en las mamas para las mujeres, seguidas por el cáncer de colon y recto, y el cáncer de pulmón. En el caso de los blancos, si se excluyen los cánceres benignos de la piel, el cuadro fue similar con la excepción notable de que el cáncer pulmonar fue más frecuente que el cáncer de colon y recto en los varones blancos. Cuando las tasas de Bermudas se compararon con las de EE.UU., las tasas generales de cáncer resultaron ser similares en ambos países. Las tasas en Bermuda fueron más altas para el cáncer de la boca, el cáncer ovárico (mujeres negras), el melanoma (blancos), el cáncer del colorectal (mujeres blancas), y el cáncer de mamas (mujeres blancas). Los cánceres de pulmón y colorectal fueron menos frecuentes en la población negra de Bermudas. CONCLUSIÓN: Se necesita continuar los estudios epidemiológicos a fin de identificar los factores de riesgo potenciales que podrían contribuir a estas diferencias. Las estrategias de pesquisaje y prevención podrían ajustarse en consecuencia con ello.

Cancer incidence and mortality rates in Bermuda.

OBJECTIVE: To describe cancer and mortality rates in Bermuda and to compare such rates to those of the United States of America (U.S.A.). METHODS: Age-adjusted race-specific cancer incidence rates for Bermuda were calculated using the Bermuda Cancer Registry. These rates were then compared to U.S.A. cancer rates published by the National Cancer Institute. RESULTS: Overall age-adjusted incidence rate was 495 cases per 100,000 for Blacks and 527 cases per 100,000 for Whites. Incident cases were more frequent among men than women in both races. For Blacks, the highest incidences were prostate for men and breast for women, followed by colon/rectum and lung cancer. For Whites, if we exclude benign skin cancers, the picture was similar with the notable exception of lung cancer being more frequent than colon/rectum in White males. When Bermuda's rates were compared to those of the U.S.A., overall cancer rates were similar in both countries. Rates in Bermuda were higher for cancer of the mouth, ovarian cancer (Black women), melanoma (Whites), colorectal cancer (White women) and breast cancer (White women). Lung and colorectal cancers were less frequent in Bermuda's Black population. CONCLUSION: Further epidemiological studies are needed to identify potential risk factors that could contribute to these differences. Screening and prevention strategies could be adjusted accordingly.

Gender differences in perceptions of weight and body image and comparison to recommended weight among adult Bermudians.

The objective of this study was to determine adult Bermudians' perceptions of ideal weight, overweight, and body image and to decide if a discrepancy exists between their perceptions and World Health Organization standards. A cross-sectional survey of body weight perceptions was administered to 462 men (n = 207) and women (n = 255), 18-65 years of age and various body weights, living on the Island of Bermuda. Additionally, measurement of height, and weight was collected. There was a significant difference in mean current body mass index (BMI) between men (M = 28.6, SD = 5.82), and women (M = 30.1, SD = 6.80) (p < .05). Significant gender differences were evident in mean self-perceived BMI, ideal BMI, and perceived body image. The data presented have important implications for understanding perceptions, knowledge, and beliefs concerning body weight and body image. Public health programs must stress to adults the correct definition of overweight and obesity acceptable by medical standards.

Outbreak of Norwalk virus in a Caribbean island resort: application of molecular diagnostics to ascertain the vehicle of infection.

In 1998, an outbreak of gastroenteritis affected at least 448 persons including 122 staff at a resort hotel in Bermuda. A survey among staff indicated that gastroenteritis was associated with eating or drinking at the hotel (OR = 60, 95% CI = 2.4-15.1). Multiple specimens of drinking water had elevated faecal coliform levels and Escherichia coli present, suggestive of faecal contamination. Stools from 18 of the 19 persons with gastroenteritis that were tested were positive for genogroup-II Norwalk-like viruses (NLVs). RT-PCR analysis of a 31 specimen of water produced a genogroup-II NLV genome with a sequence identical to that of NLVs in the stools of three ill persons. This outbreak shows the value of new molecular diagnostics to link illness with a contaminated source through the use of sequence analysis. The risk of outbreaks such as these could be reduced in tourism dependent regions like Bermuda and the Caribbean by regular evaluation of data from the inspection and monitoring of drinking water supplies and waste water systems, by ensuring the chlorination of supplemental drinking water supplies and by establishing food-safety initiatives.

Motorbike injuries in Bermuda: a risk for tourists.

STUDY OBJECTIVE: To describe the incidence of injuries associated with motorbike use in Bermuda and discuss prevention strategies. METHODS: We conducted a population-based study of all incident of traffic accidents involving motorbikes. Demographic characteristics and mechanisms, rates, and outcomes of injury for tourists and residents were compared. RESULTS: We identified 657 cases of road trauma that occurred between July and September 1993. Of these cases, 538 (81.9%) involved motorbikes. The tourist rate of motorbike-related injury was 94.1/1,000 person-years at risk, whereas that of the local population was 16.6/1,000. The injury rate among residents was highest for young males, whereas among tourists it was highest among older persons. The relative risk (RR) of injury for tourists was 5.6 (95% confidence interval [CI], 4.8 to 6.7). Tourists also had an increased risk of fracture (RR, 1.43; 95% CI, 1.22 to 1.67). CONCLUSION: Tourists visiting Bermuda are at high risk of injury from motorbike use, with rates of injury much higher than the local population. Prevention strategies, particularly for older tourists, should be developed and implemented.

Motorcycle injuries in Bermuda.

Tourists who hire mopeds or motorcycles for personal use have a risk for accident. The incidence of tourist accidents in Bermuda was 1.57 accidents/1000 tourists evaluated over a 6-month period. The accident incidence increased as the tourist population got larger. Tourists of more than 40 years of age had the greatest increase in incidence for accident during this period. The risk of an injury requiring hospital stay was one patient for every 16,000 tourists visiting the island, and usually involved the fracture of an extremity. All accidents, major or minor, resulted in some form of skin injury.