Leucaena interspecific hybrid 'KX4-Hawaii' as a source of agricultural biomass in a water-scarce small island developing state.

Background: Leucaena leucocephala is a useful multipurpose tree species for agroforestry systems, but traditional seeded cultivars often become weedy and invasive. A seedless hybrid cultivar, 'KX4-Hawaii', offers a potential solution to this problem. However, relevant agronomic information and information on the performance of 'KX4-Hawaii' under varying growth conditions is required. The goal of this research was to evaluate 'KX4-Hawaii' as a source of agricultural biomass in Barbados, a small island developing state with limited arable land. Methods: 'KX4-Hawaii' air layers were imported into Barbados to create stock trees. Air layering was used to create propagation material and a field study was established with a 'KX4-Hawaii' hedgerow planted as a field border. Three plant spacings (50, 75, and 100 cm) were evaluated and data on the growth and biomass yields of the trees were collected at 4-month intervals. Precipitation data were used to investigate climatic effects on 'KX4-Hawaii' productivity. Results: 'KX4-Hawaii' was successfully propagated via air layers and could be planted directly in the field with irrigation. All recorded growth and biomass yields were correlated with precipitation. However, the woody (lignified stems and branches) biomass was more responsive to precipitation than the green (leaves and green tender stems) biomass and made up a large fraction of the total biomass produced. 'KX4-Hawaii' was productive even under drought conditions and biomass yields per meter of hedgerow increased with closer spacings. Of the tested spacing treatments, 75 cm was optimum for a 4-month pruning interval under the conditions seen in Barbados as it produced similar yields to the 50 cm spacing treatment but would require less propagation material.

Plantocratic patriarchal culture, violence against women and girls and the failures of the global health system: an interview with Marsha Hinds Myrie and Anya A. A. Lorde.

Like other parts of the world, women and girls in the Commonwealth Caribbean (CC) experience high and escalating rates of physical and sexual violence. The interview presented outlines some factors that underscore the gendered disparities of violence against women in the Caribbean as well as how healthcare responses are not developed for marginalised women and girls. The interview explores the invisibility of women and girls within healthcare and broader national healthcare structures responses through case details analysis of a Barbadian strategic litigation case. The interview calls for transdisciplinary approaches to analysing the effectiveness of the global health system that make space for not just traditional research approaches but also lived experiences 'from below' and input of advocates and activists. Despite Barbados being a signatory to a range of global health initiatives to improve healthcare responses to gender-based violence, the country does not have a formalised, comprehensive national plan to inform prevention and intervention measures. The interview shows the connections between plantocratic patriarchal culture (PPC) and the existing gaps that cause harm to women and girls who experience various types of gendered violence.

The Beneficial, Formative Role of Lifetime Exposures across Cognitive Domains in Barbados Using Data from the SABE Study.

This study tested the hypothesis that within older Barbadian adults, sex, education, and occupation type lessen age-related cognitive decline. The analyses used a cross-sectional data set from 1325 people collected in the 2006 SABE Study (Health, Well-being, and Aging). Cognition was assessed as scores in each subdomain of the Mini-Mental State Exam. The loss of a single point in each subdomain was predicted by sex, years of education, job type, and their interactions with age. Results demonstrated that age and protective factors affect each cognitive domain differently. High education combined with mentally complex employment helped maintain cognitive performance in later life. Beneficial lifetime exposures are additive, providing combined benefits. Findings provide insight into public policy aiming to minimize the number of adults with cognitive decline and dementia in Barbados and the Caribbean.

Clinging fauna associated with nearshore pelagic sargassum rafts in the Eastern Caribbean: Implications for coastal in-water harvesting.

Tropical Atlantic blooms of pelagic Sargassum species are associated with severe inundation events along the coasts of Caribbean and West African nations that cause extensive ecological and socioeconomic harm. The use of in-water harvesting as a management strategy avoids the plethora of challenges associated with shoreline inundations. Moreover, with a growing interest in the valorisation of this raw material, in-water harvesting provides the best opportunity to collect substantial amounts of 'fresh' sargassum that can be used in a variety of applications. However, in-water harvesting of sargassum will remove organisms associated with the floating habitat, resulting in loss of biodiversity, thus creating a potential management dilemma. To address this management concern, we assessed the clinging fauna associated with sargassum rafts at various distances from shore. From a total of 119 dipnet samples of sargassum, we recorded 18 taxa, across 6 phyla (Arthropoda, Mollusca, Chordata, Platyhelminthes, Nemathelminthes, Annelida) with the phylum Arthropoda being the most speciose (n = 10). Our multivariate and model selection analyses support that distance from shore and season are the most important drivers of variability in community composition and that season is the most important driver of individual abundance and number of taxa across samples. Overall, rafts within 0-3000 m of the shoreline of Barbados harbored low biodiversity and were dominated by small invertebrates (mean size: 5.5 mm) of no commercial value. Results suggest that biodiversity trade-offs associated with in-water sargassum harvesting in coastal areas are likely to be negligible.

Plasticizer concentration effect on films and coatings based on poly(vinyl alcohol) and cationic starch blends.

Films based on poly(vinyl alcohol) (PVA) and cationic starch (CS) were combined with different percentages of sorbitol (S; 15.0, 22.5, and 30.0% w v-1) to assess the effect of plasticizer on the films. Spectroscopic analyses confirmed the interaction between them. However, micrographs indicated the formation of sorbitol crystals on the surface of the films, especially at higher sorbitol concentrations. The blends presented low water vapor transmission rate values, reaching (7.703 ± 0.000) g h-1 m-2 (PVA75CS25S15), and low solubility values for the films containing higher CS amounts. The lack of statistical differences in most parameters suggests that no significant gain comes from increasing the amount of sorbitol at percentages higher than 15%. As a coating, the blend PVA75CS25S15 successfully decreased the loss of moisture content in acerolas by 1.15 times (compared to the control), confirming the suitability of this matrix as a fruit coating.

Comparative evaluation of estrus synchronization protocols on reproductive performance and estrus behavior in Barbados Black Belly sheep.

Background and Aim: Estrus synchronization of ewes has been accomplished using several protocols with various degrees of success in improving reproductive efficiency and obtaining the most effective protocol used in sheep farming. This study aimed to compare the effectiveness of three treatment protocols and to record the intensity and duration of estrus signs and pregnancy rate in Barbados Black Belly (BBB) sheep. Materials and Methods: Thirty-two primipara BBB ewes aged 18-24 months were equally divided into three treatment groups. T1: the ewes were injected intramuscularly with 2 mL Lutalyse (PGF2α) (10 mg) on days 0 and 10. T2: 1 mL Fertiline (50 µg; Gonadorelin acetate) on day 0 and 2 mL lutalyse (10 mg) on day 7. T3: 1 mL fertiline (50 µg) on day 0, 2 mL lutalyse (10 mg) on day 7, and 1 mL Fertiline (50 µg) on day 9. Estrus response was assessed using naturally mating rams and ewes. Pregnancy was determined using ultrasonography between 55 and 80 days after the last hormonal injection. The following estrus signs were noted: Swollen vulva, mucus discharge, sniffing, excitement, loss of appetite, mounting, and rapid tail movement. Results: Of the expressed signs, swollen vulva was most frequent, whereas loss of appetite and mucus discharge were the least overt signs recorded. The estrus response (%), onset (%), and duration (h) in ewe synchronization of the three treatment protocols were 100%, 58.3 ± 23.4%, and 48.0 ± 18.2 h (T1), 100%, 61.7 ± 41.2%, and 45.0 ± 27.0 h (T2), and 37.5%, 32.1 ± 1.7%, and 29.2 ± 1.25 h (T3), respectively. The pregnancy rates were 87.5%, 87.5%, 37.5%, and 50.0% in T1, T2, T3, and T4, respectively. Conclusion: Prostaglandin F2α+PGF2α and GnRH+PGF2α synchronization protocols were more effective in the fertilization of BBB ewes with better expression of estrus signs compared with the GnRH+PGF2α+GnRH (OVS) protocol.

Diabetes distress in a Barbadian population with type 2 diabetes: A pilot test.

One in five Barbadians has diabetes, suggesting that there is a severe burden of the disease. Objective: To assess the psychometric properties of the Diabetes Distress Scale, in order to determine the feasibility, practicality, internal consistency and criterion validity of the instrument when used with Barbadians living with Type 2 Diabetes. Methods: Patients with type 2 diabetes, (n = 106. 60% females, 40% males; mean age = 65.2, 11.3 years) attending a private clinic in Barbados were assessed for diabetes distress, depression, glycated hemoglobin (HbA1C) and blood pressure (BP).A self-report questionnaire that included: clinical and demographic questions; the Diabetes Distress Scale (DDS); the Patient Health Questionnaire (PHQ-9); and the Problem Areas In Diabetes (PAID-5) scale. Glycated haemaglobin (HbA1C) and Blood pressure (BP) were also measured. Results: Of the 110 persons who participated, 106 persons completed the questionnaire. The Cronbach alpha coefficient of the PAID was 0.92 and the DDS was 0.92. Concurrent validity was demonstrated in a strong consistent relationship between the scores on the DDS and PAID-5, with a strong positive correlation, r = 0.70, n = 86, p < 0.001. There was a significant difference in the DDS scores between males (M = 1.26, SD = 0.37) and females (M = 1.50, SD = 0.73), t(73.31) = -1.99, p = 0.05 two tailed. Conclusion: The DDS is shown to be a valid and reliable measure within this Caribbean context. Thus, researchers and clinicians desirous of a tool to assess Diabetes Distress may be assured of the strong psychometric properties demonstrated thus far.

Real-World Data and Paper-Based Disease Registries in the Small Island Developing State of Barbados During the COVID-19 Pandemic.

Significant data is being produced on the impact of COVID-19 on aspects of clinical care. However, less is known about the impact on real-world health data. The US Food and Drug Administration defines real-world data as "data relating to patient health status and/or the delivery of health care routinely collected from a variety of sources," including disease registries.1 The methodology used by the Barbados National Registry (BNR)-active pursuit of first-hand clinical data using paper-based charts from multiple sources-makes it an ideal example of real-world data. Real-world data can overcome the barriers to clinical trials often present in small island developing states. This paper reviews the impact of the COVID-19 pandemic on the data of the BNR within the context of the real-world data cycle. Data collected retrospectively for 2016-2018, undergoing traceback during the pandemic, demonstrated a greater reliance on death certificate registration. A 38% reduction in the collection of new cases was noted in the postpandemic period compared to data collected in previous periods. The lack of access to source data delayed cancer registry reporting. We conclude that, given the challenges highlighted during the COVID-19 pandemic, more effort should be placed on providing timely access to real-world data for public health decision-making, particularly in small island developing states.

An analysis of arsenic concentrations associated with sargassum influx events in Barbados.

Tropical Atlantic blooms of pelagic Sargassum spp. present major socioeconomic and ecological challenges for Caribbean and West African nations. Valorisation of sargassum provides an opportunity to ameliorate some of the damage to national economies; however, the active uptake of arsenic by pelagic sargassum creates significant barriers to its use. When defining valorisation pathways, it is important to understand arsenic speciation in pelagic sargassum, given the different levels of toxicity associated with different arsenic species. In this study, we assess the temporal variability of total arsenic and inorganic arsenic in pelagic sargassum arriving in Barbados; and test whether arsenic concentrations are linked to oceanic sub-origins. Results indicate that inorganic arsenic, the most toxic form, represents a consistent and substantial percentage of the total arsenic present in pelagic sargassum, and that variability in arsenic concentration does not appear to be driven by sample months, years or oceanic sub-origins/transport pathways.

Diabetes self-management and social support during the COVID-19 pandemic: Perspectives of older adults living in Barbados.

Purpose: Diabetes mellitus (diabetes) is a major health concern in Barbados. In 2013, the reported prevalence (18.7%) was double global levels, with diabetes accounting for 10.4% of total deaths in 2016. Barbados has a rapidly aging population and older adults living with diabetes are more at risk of developing complications. Poorly managed diabetes represents a high burden for individuals and society due to direct healthcare costs for treatment, and to indirect costs due to loss of productivity from disability and premature mortality. Good diabetes self-management promotes glycemic control. Self-management is enhanced by social support and challenged by external shocks. This study explored the role of social support in diabetes self-management among older people in Barbados during the COVID-19 pandemic. Methods: Qualitative secondary thematic analysis of semi-structured individual telephone interviews with adults aged 65-84 years living with diabetes in Barbados during a partial COVID-19 lockdown period. Sampling was purposive, aided by gatekeepers who provide services to elderly people. Verbatim interview transcripts coded using an inductive method were subjected to thematic analysis by three qualitative researchers using NVIVO software. Results: Four organising themes: "Balance", "Social Capital", "Resilience", and "Adaptations to COVID-19", informed the global theme "Adaptive Diabetes Self-Management Response", which captures resilience mechanisms of older adults who balanced facilitators including self-reliance and religious faith, and barriers such as perceived ageist discrimination in workplace policies designed to reduce COVID-19 exposure. Accordingly, elderly Barbadians living with diabetes were resilient, selectively incorporating available social support mechanisms to maintain self-management and overall well-being during the COVID-19 pandemic. Conclusion: The emergent evidence for resilience among older persons in this setting is important for informing health system interventions to improve quality of life for PLWD. The views of the elderly should be explicitly considered in policies designed to enhance the self-management of chronic health conditions.

Incidence, prevalence, and potential risk factors for diabetic foot ulceration: A retrospective review at a multidisciplinary centre in Barbados.

OBJECTIVE: Diabetes and lower extremity amputation rates in Barbados are among some of the highest globally, with peripheral neuropathy and peripheral vascular disease found to be independent risk factors for this population. Despite this, there is currently a lack of research evidence on rates of diabetic foot ulceration, which has amputation as its sequela. We aimed to evaluate the incidence and prevalence rates of active ulceration in a population of people with diabetes in Barbados. Secondly, we explored the risk factors for new/recurrent ulceration. RESEARCH DESIGN AND METHODS: Data were extracted from the electronic medical records for the period January 1, 2019 to December 31, 2020 for a retrospective cross-sectional study for patients of a publicly-funded diabetes management programme. Eligible records included people aged 18 years and above with a diagnosis of type 1 or 2 diabetes. Potential risk factors were explored using univariable logistic regression models. RESULTS: A total of 225 patients were included in the study (96% type 2 diabetes, 70.7% female, 98.7% Black Caribbean). The 1-year period prevalence of diabetic foot ulceration was 14.7% (confidence interval [CI]: 10.5, 20.1). Incidence of ulceration in the same period was 4.4% (CI: 4.4, 4.5). Risk factors associated with diabetic foot ulceration included: retinopathy (OR 3.85, CI: 1.24, 11.93), chronic kidney disease (OR 9.86, CI: 1.31, 74.22), aspirin use (OR 3.326, CI: 1.02, 10.85), and clopidogrel use (OR 3.13, CI: 1.47, 6.68). CONCLUSION: This study provided some insight into potential risk factors for foot ulceration in this population, which previous studies have shown to have higher rates of lower extremity amputations. Further research in this understudied group through a larger prospective cohort would allow more meaningful associations with risk factors and would be useful for the creation of risk prediction models.

Companions' Chronicles: Experiences of Home Care Workers in the Community Elder Care (Companion) Program in Barbados.

The home care workforce contributes significantly to older adults' health and well-being. The Community Elder Care (Companion) Program in Barbados employs Companions to engage with socially isolated older adults in their homes for a few hours per day. In this qualitative study we explored Companions' experiences in the program 1 year since its commencement. Opportunity to earn, love and concern for older adults, and previous caregiving experiences were among the factors which motivated participants to seek employment in the program. They commonly reported going beyond the scope of their duties to meet clients' critical needs. While they saw themselves as positively impacting their clients, some noted that they too benefitted from the engagement. Better compensation packages and training were seen as necessary actions for program improvement. Our findings can be incorporated in a comprehensive program review and can inform home care workforce development and Companion Program structure and delivery.

Diabetes distress in Barbadian adults with type 2 diabetes.

Purpose: Psychological disorders such as diabetes distress may negatively influence how patients effectively manage their illness. Therefore, discernment of such influential psychosocial components could be pertinent in promoting competent diabetes management. The vital psychosocial aspect of diabetes distress in diabetes management within the Caribbean context remains unexplored. The purpose of this study therefore was to investigate the prevalence and distribution of diabetes distress (DD), and explore its relationship to socio-demographic and clinical characteristics in Barbadian adults with type 2 diabetes(T2DM). Methods: A cross-sectional survey was conducted with adults (n = 509) ages 20-80 years with T2DM. The survey comprised, a profile section, and a standardized questionnaire-the Diabetes Distress Scale (DDS). In addition, biological (A1C and blood pressure measurements were also collected. Results: The sample comprised 30.8% males and 69.2% females. Moderate to high DD identified in 17% of the patients (9.4% moderate distress, 7.2% high distress). Moderate distress was more frequent in unmarried persons; younger persons had high DD. There was no difference in rates of moderate to high DD in women (16.7%) compared to men (16.2%) and, as age and years lived with diabetes increased, diabetes distress decreased. Conclusions: The results emphasized the need for considerations that must be given to Barbadian diabetes patients' mental well-being. In recognition of the role DD plays in the patients' experiences, screening should be incorporated into clinical care.

Personal protective equipment (PPE) related adverse skin reactions among healthcare workers at the main COVID-19 isolation center in Barbados.

Background: The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods: A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results: Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion: The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.

Retrospective analysis of endometrial cancer among Afro-Caribbean women in Barbados 2008-2017.

Endometrial cancer data amongst Barbadian women was collected, to inform screening and management in this under-studied population. We analysed all recorded primary cases between January 1st 2008, and December 31st, 2017. Age-specific incidence, and crude mortality rates were calculated. Descriptive statistics characterized demographics, risk factors, prescription data and histopathology. Log-rank tests assessed simple group differences by EC type. Survival analysis based on tumour type was plotted using Kaplein-Meir curves. There were 270 recorded cases of EC, averaging 66 (8.8) years old (SD 8.75), with parity of 3.60 (2.3). Cases were postmenopausal with 257 (95%) experiencing postmenopausal bleeding. Of the 270 cases, 113 (42%) had type 1 tumours and 157(58%) had type 2 tumours. Weak evidence suggests the latter imparted worse survival (log rank test = 0.02). Estimated crude incidence rate was 18.64 per 100,000 women. Crude mortality rate from EC between January 1st, 2008 and December 31st, 2019 was 27%.

Influence of Harvest Time on the Chemical Profile of Pereskia aculeate Mill. Using Paper Spray Mass Spectrometry.

This study evaluated the physicochemical characteristics and the production of bioactive compounds of Pereskia aculeata Mill. at different harvest times. Here, we performed a qualitative evaluation of the chemical profile by paper spray mass spectrometry (PSMS), the phenolic acid and flavonoid profile by high-performance liquid chromatography (HPLC), antioxidant activity, total carotenoids, total phenolic compounds, total flavonoids, total anthocyanins, color characteristics, total soluble solids (TSS), total solids (TS), pH, and total titratable acidity (TTA). The chemical profile was not affected, with the exception of 4,5-dimethyl-2,6-octadiene and azelaic acid, which was only identified in the leaves harvested during the winter. The content of four phenolic acids and three flavonoids were analyzed; out of these, no significant amounts of ellagic acid and quercetin were detected. There was no difference in production of bioactive compounds between seasons, reflecting the antioxidant activity, which also did not differ. Brightness, chroma, and leaf pH were the only physicochemical characteristics that did not vary between seasons.

Colorectal cancer in an Eastern Caribbean nation: are we missing an opportunity for secondary prevention?

Objective: To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country. Methods: The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had resections for CRC over a five-year period. Early CRC was defined as disease that could be completely resected with no involvement of adjacent organs, lymph nodes, or distant sites. Locally advanced CRC was disease that involved contiguous organs without distant metastases that was still amenable to curative resection. Results: There were 97 patients at a mean age of 64.9 ± 12.2 years treated for CRC, and only 21 (21.6%) had their diagnoses made through screening. Significantly more screening-detected lesions were early-stage CRCs (21.7% vs. 9.3%; p < 0.001). At the time of diagnosis, patients who did not have screening-detected lesions had a greater proportion of locally advanced (42.3% vs. 0) and metastatic (26.8% vs. 0) CRC. Those who did not have screening-detected lesions had a greater incidence of emergency presentations at diagnosis (26.8% vs. 0). Conclusions: The incidence of screening-detected CRC in this Caribbean nation was low. Consequently, most patients presented with locally advanced or metastatic CRC, for which there is less opportunity to achieve a cure. Significantly more screening-detected lesions were early-stage CRCs. It is time for policymakers to develop a national CRC screening program.

Anachronic: Viral Socialities and Project Time among HIV Support Groups in Barbados.

From 2005 to 2015, up to five support groups for people living with HIV (PLHIV) operated in Barbados. However, by early 2020, all but one had disappeared. What caused the demise of these groups and why? What does this demise tell us about the HIV response in Barbados, and more particularly, everyday life for PLHIV? More generally, what does it tell us about "viral socialities" (ties formed between groups of people as they confront the lived effects of infection and discrimination attributable to HIV) and the effects of "project time" (a time frame delimited through the priorities of global HIV/AIDS agencies) on these socialities? Through ethnographic and archival research methods, this article reveals how multiple, unstable project times create and transform viral socialities of Barbadian PLHIV with anachronic effects for some-i.e., a sense of alienation or being "out of time" in relation to the priorities of the global HIV response.

Perceived COVID-19 Vaccine Pressure in the Caribbean: Exploring a New Stressor-Strain Phenomenon in the Pandemic.

This research introduced the new construct of 'perceived COVID-19 vaccine pressure' (i.e., the psychological strain associated with societal demands on vaccine taking) and examined the initial psychometric properties of a newly proposed measure. The study surveyed 411 Barbadian respondents to examine their level of perceived COVID-19 vaccine pressure using an online survey modality. The results revealed strong and robust psychometric properties for the scale and its unidimensionality. Younger and employed respondents as well as those working in the tourism and hospitality and government (public) sectors experienced the greatest internalised vaccine pressure relative to other respondent groups. Only initial/preliminary evidence of the scale's validity and reliability was revealed by this cross-sectional study. A follow-up study (using CFA on a new sample) is needed to provide stronger evidence for its validity and reliability. Understanding the dynamics of perceived or internalised vaccine pressure might help explain the positive or negative effects of societal pressure and its implications for vaccine hesitancy and other vaccine-related attitudes and behaviours. The study is the first to conceptually discuss and empirically examine the mental health strain occasioned by societal demands placed on individuals to take a COVID-19 vaccine.