Differential Mental Health Impact of COVID-19 Lockdowns on Persons with Non-Communicable Diseases in Trinidad and Tobago.

Persons with chronic non-communicable diseases (NCDs) were identified as particularly at risk of severe morbidity and mortality during the COVID-19 pandemic. Little is written about the impact of COVID-19 on this sub-population in the Caribbean, where the prevalence of NCDs is disproportionately high. This study aimed to ascertain COVID-related concerns, and the mental health impact of the pandemic among persons with and without NCDs in Trinidad and Tobago, during the acute period of COVID-19 lockdowns early in the pandemic. An anonymous online survey collected cross-sectional data from a convenience sample nationwide. Of 1287 respondents, 219 self-identified as having an NCD. Findings suggest that the pandemic was experienced unequally by persons with NCDs, who were more likely to be concerned about health and wellbeing and to report health inequalities-unemployment, social isolation and negative effects of government restrictions. Compared to those without NCDs, they were more likely to increase use of marijuana during the lockdown period, and to report severe anxiety/depression that can result in exacerbation of NCDs. Interventions for persons with NCDs must address the mental health consequences of any pandemic, including increased drug use, and also address social inequalities to reduce sustained post-pandemic mental health impact and negative health outcomes.

Early COVID-19 response in two small island developing states: Maldives and Trinidad and Tobago.

Problem: Coronavirus disease 2019 (COVID-19) was declared a pandemic on 11 March 2020. Severe illness requires intensive care facilities, which are limited in smaller, resource-constrained settings. Context: Maldives and Trinidad and Tobago are small island developing states with comparable climates. Similar to island nations in the Western Pacific Region, they are prone to natural disasters and so engage in planning and preparedness activities on an ongoing basis. This paper describes the initial measures taken by both countries during the first wave of COVID-19, from March to May 2020. Action: In both countries, multisectoral high-level leadership allowed for timely and decisive actions. Early school closures, early border closures and early lockdowns were enforced. Mandatory mask wearing and physical distancing were instituted. Cases and contacts were isolated in facilities away from public sector hospitals, and isolation was implemented at the government's expense. Volunteers were trained to manage dedicated hotlines. Additionally, the governments held daily press briefings. Outcome: During the first wave, Maldives contained its epidemic to one geographical cluster; Trinidad and Tobago successfully avoided community spread, thus averting an overwhelmed health system. Discussion: Diligent contact tracing with quarantine implemented at the government's expense successfully minimized spread in both countries. Small countries need volunteers to help with activities such as contact tracing, and recruiting and training volunteers before a health emergency occurs is key. Lessons learned from the experience of Maldives and Trinidad and Tobago could serve as a model for other small island developing states, including those in the Western Pacific Region.

The Knowledge, Attitudes and Practices of Mask Use for COVID-19 Among the Students of the University of the West Indies in Trinidad and Tobago

⮚ Coronavirus Disease 2019 was declared a pandemic on March 11, 2020. ⮚ Facemasks are recommended by the WHO to prevent droplet and aerosol transmission even in vaccinated persons ⮚ The study aims to investigate the knowledge, attitudes, and practices of mask use for COVID-19 among the student population of The University of West Indies, St. Augustine.

Global health diplomacy at the intersection of trade and health in the COVID-19 era.

Global health diplomacy has gained significant importance and undoubtedly remained high on the agendas of many nations, regional and global platforms amid the coronavirus disease 2019 (COVID-19) pandemic. Many countries have realized the importance of the health sector and the value of a healthy workforce. However, there is little control on issues related to trade that impact on human health due to the dominance of profit-oriented business lobbies. A balance, however, needs to be struck between economic profits and a healthy global population. This paper aimed to highlight the importance of building capacity in global health diplomacy, especially during the COVID-19 pandemic so that health personnel may effectively negotiate on the multisectoral stage to secure the resources they need. The recent proposal to waive off certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement for the prevention, containment and treatment of COVID-19 by India and South Africa at the World Trade Organization (WTO) presents an important opportunity for all governments to unite and stand up for public health, global solidarity, and equitable access at the international level so that both developed and developing nations may enjoy improved health outcomes related to the COVID-19 pandemic.

Need for BCG Vaccination to Prevent TB in High-Incidence Countries and Populations.

An estimated one quarter of persons worldwide are infected with Mycobacterium tuberculosis. In 2018, the World Health Organization issued revised guidance on BCG vaccine for high-risk groups. The World Health Organization should consider guiding countries on a case-by-case basis in developing appropriate BCG policies to deliver equitable healthcare and protect public health.

An Evaluation of a Modified CTAS at an Accident and Emergency Department in a Developing Country.

OBJECTIVES: To review the modified Canadian Triage and Acuity Scale used in an accident and emergency department in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional study was carried out. Times from assignment of triage category to being seen by a physician were collected from the patient notes on the days of presentation and compared to the reference standards. Times from decision to admit to obtaining a bed were also recorded. RESULTS: 200 patients were included in the study. The median waiting time for patients in the immediate/blue category was 3 minutes (range = 3); for the red category, it was 31.2 minutes (range = 121.8); in the yellow category, it was 61.8 minutes (range = 805.2). The overall admission rate was 30.5%, with an admission rate of 25% for the blue category; 20% of patients in the red category waited more than 4 hours for a hospital bed. CONCLUSION: The patients assigned to the blue category were being seen almost immediately. Less critical persons wait longer than the reference times and this may be due to structural factors such as staffing. The admission rates per category highlighted a low admission rate for the blue category (25%), which is unusual. This study highlights the need for a further study to review clinical presentation, assignment to triage category, and outcomes.

Barriers and facilitators to establishing a national public health observatory / Barreras y facilitadores para el establecimiento de un observatorio de salud pública nacional

OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

OBJETIVO:Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. MÉTODOS: Se realizó un estudio descriptivo basado en 15 entrevistas a informantes clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. RESULTADOS: La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. CONCLUSIONES: Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.

Barriers and facilitators to establishing a national public health observatory / Barreras y facilitadores para el establecimiento de un observatorio de salud pública nacional

Objective. To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. Methods. A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. Results. The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. Conclusions. Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

Objetivo. Determinar las barreras y los facilitadores percibidos por los interesados directos para crear un observatorio de salud pública (OSP) nacional en Trinidad y Tabago. Métodos. Se realizó un estudio descriptivo basado en 15 entrevistas a informants clave llevadas a cabo de abril a septiembre del 2013. Los informantes clave trabajaban en el sector de la atención de la salud en Trinidad y Tabago. Mediante el empleo de una guía de entrevista semiestructurada, se recopiló información sobre conocimientos, actitudes y creencias acerca de la creación de un OSP; barreras y facilitadores para crear y mantener un OSP; consideraciones legales; y necesidades en cuanto a recursos humanos y tecnología de la información. Se determinaron los temas comunes de las respuestas. Resultados. La mayor parte de los participantes brindaron apoyo a la creación de un OSP nacional, reconocieron su valor para fundamentar su trabajo e indicaron que un OSP nacional podría 1) suministrar información para brindar apoyo a la toma de decisiones basada en la evidencia a efectos de política sanitaria y planificación estratégica; 2) facilitar el manejo de datos mediante el establecimiento de políticas, procedimientos y estándares de datos; 3) incrementar la utilización de los datos mediante la síntesis y la difusión de la información; y 4) proporcionar datos para la evaluación comparativa. Sin embargo, se indicaron varias barreras, incluidas 1) la percepción de que la recopilación de datos no se evalúa; 2) la inoportunidad de la disponibilidad de los datos; 3) las limitaciones en la síntesis, difusión y utilización de los datos para fundamentar la toma de decisiones; y 4) las dificultades relacionadas con la asignación de recursos humanos y de la tecnología de la información existente. Conclusiones. Los informantes clave brindan apoyo al desarrollo de un OSP nacional en Trinidad y Tabago. Los resultados se alinean bien dentro de los componentes del marco conceptual para establecer observatorios de salud nacionales. Se recomienda un método progresivo para establecer un OSP nacional en Trinidad y Tabago, empezando por los componentes estructurales y siguiendo con los componentes funcionales. Un OSP nacional en Trinidad y Tabago podría servir de modelo para otros países del Caribe.

Barriers and facilitators to establishing a national public health observatory.

OBJECTIVE: To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS: A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS: The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS: Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.

Multiple outbreaks of Salmonella braenderup associated with consumption of iceberg lettuce.

The aim of this study was to describe the findings from an outbreak investigation following several apparently unrelated community outbreaks of gastroenteritis. Epidemiological, environmental, laboratory and traceback investigations were used to identify the source of the outbreak. We enrolled 23 (of 29) laboratory confirmed cases and 24 neighbourhood case-nominated controls in a case-control study which revealed that illness was associated with consumption of iceberg lettuce (matched odds ratio 8.0 (95% CI 1.1-355) contaminated with Salmonella braenderup. Several eating establishments were affected and the lettuce was traced back to a single producer in Spain. This is the first UK report implicating S. braenderup in an outbreak due to lettuce. The results highlight the need to increase attention to the various stages in the farm-to-fork process to reduce produce-associated outbreaks related to the global food trade.

An outbreak of mumps in the metropolitan area of Walsall, UK.

OBJECTIVE: To describe the epidemiology of excessive mumps cases during the year 2000, within the metropolitan area of Walsall, UK; to assess the impact of the mumps outbreak on morbidity; and to inform future communicable disease control strategy. METHODS: Demographic records, school attendance, uptake of the measles-mumps-rubella (MMR) vaccine, and mumps-associated admission to hospital, were reviewed for all Walsall residents diagnosed and notified with mumps during the year 2000. RESULTS: There were 200 mumps notifications in 2000 (76.6 per 100,000), representing the highest incidence in England. Only 91 of the notified cases were salivary antibody positive for mumps IgM, and 32 were negative, although 77 were not tested. Since 1990, annual totals have never previously exceeded 20. Over 90% of patients were <20 years old, with a peak age group of 10-14 years; 88% attended schools located within Walsall. The pattern of spread suggested that the outbreak proceeded through schools from north to south in the more deprived western half of the metropolitan area. Most cases (136, 68%) had received one (99, 49.5%) or two (37, 18.5%) doses of MMR vaccine; cases > or =20 years old had never received MMR. Six cases (aged 4-14 years) were admitted to hospital, all with a successful outcome, including one male with meningitis and one female with pancreatitis. Current uptake of the MMR vaccine at 24 months has dropped to below 90% in recent years, as in most parts of the UK. CONCLUSIONS: Future mumps outbreaks in schools, and among older age groups, can be predicted, since most older children and young adults have received only one dose of MMR vaccine or no vaccination at all. Primary vaccine failure is well described in mumps, and cases during outbreaks can include recipients of two MMR vaccine doses. It was fortunate that no severe morbidity was associated with this outbreak (prior to MMR, two to four mumps deaths occurred annually in England and Wales). Measures to restore the uptake of MMR to the previous levels of above 90-95% will be necessary to reduce the risk of the mumps virus circulating within communities. Older children are susceptible, and it may be advisable to ensure second-dose MMR uptake while they are still at or when they leave school, or when they enter college, university or the military.