University of the West Indies at Cave Hill, Barbados

Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.

Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations. Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Importance Breast cancer (BC) is commonly diagnosed among Caribbean women. Shifts in reproductive patterns modify the incidence of BC diagnosis and age at BC diagnosis in population-based studies; however, reproductive patterns in Caribbean women remain understudied. Objective To describe the temporal trends in reproductive patterns and age at BC diagnosis in Caribbean-born women. Design, Setting, and Participants A cross-sectional observational study—the Caribbean Women’s Cancer Study—was conducted, with data on reproductive patterns known to affect BC risk collected in The Bahamas, Barbados, Cayman Islands, Dominica, Haiti, Jamaica, and Trinidad and Tobago. Participants were recruited prospectively. The sample included women born in Caribbean countries and diagnosed with invasive BC and/or ovarian cancer from June 1, 2010, to June 30, 2018, and was divided into 4 birth cohorts (born before 1950, 1950-1959, 1960-1969, and in or after 1970). Data were analyzed between August 1, 2023, and July 31, 2024. Exposures Receipt of a BC diagnosis and birth in a Caribbean country. Main Outcomes and Measures Change in reproductive patterns between birth cohorts, including age at BC diagnosis, family history of cancer, age at first pregnancy, number of pregnancies, number of full-term pregnancies, number of siblings, age at menarche and menopause, estrogen receptor status, and germline pathogenic/likely pathogenic variants. Results Of 1015 participants diagnosed with BC and ovarian cancer, 995 women (mean [SD] age, 46.6 [10.8] years; 605 [81.8%] Afro-Caribbean, 98 [13.2%] East Indian, 22 [3.0%] White, and 12 [1.6%] >1 race) received a diagnosis of invasive BC. Comparison from older to younger birth cohorts (presented in the order of born before 1950, 1950-1959, 1960-1969 and in or after 1970) showed an increased proportion of women experiencing menarche at age 12 years or younger (33.0% vs 47.3% vs 45.5% vs 57.9%; P < .001), women with no pregnancies (6.8% vs 6.8% vs 10.5% vs 22.8%; P < .001), and nulliparous women (8.6% vs 9.2% vs 13.9% vs 27.6%; P < .001). Younger age at BC diagnosis was observed in women experiencing menarche at age 12 years or younger (mean [SD], 45.0 [10.5] years) vs 15 years or older (mean [SD], 49.1 [11.2] years) and in nulliparous women (mean [SD], 42.1 [11.2] years) vs 3 or more full-term pregnancies (mean [SD], 49.9 [10.6] years; P < .001). For every year of first pregnancy delay, women had a 4% increased chance of being diagnosed with estrogen receptor–positive tumors (odds ratio, 1.04; 95% CI, 1.01-1.08; P = .02). Conclusions and Relevance In this cross-sectional study, between each 10-year birth cohort, women diagnosed with BC had a lower age at menarche, number of pregnancies, and number of full-term pregnancies. These findings suggest that interventions targeting other BC risk factors need to be implemented.

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.

Climate change is no longer a hypothetical problem in the Caribbean but a new reality to which regional public health systems must adapt. One of its significant impacts is the increased transmission of infectious diseases, such as dengue fever, which is endemic in the region, and the presence of the Aedes aegypti mosquito vector responsible for transmitting the disease. (1) Methods: To assess the association between climatic factors and human dengue virus infections in the Caribbean, we conducted a systematic review of published studies on MEDLINE and Web of Science databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. (2) Results: In total, 153 papers were identified, with 27 studies selected that met the inclusion criteria ranging from the northern and southern Caribbean. Rainfall/precipitation and vapor pressure had a strong positive association with dengue incidence, whereas the evidence for the impact of temperatures was mixed. (3) Conclusions: The interaction between climate and human dengue disease in the Caribbean is complex and influenced by multiple factors, including waste management, infrastructure risks, land use changes, and challenged public health systems. Thus, more detailed research is necessary to understand the complexity of dengue within the wider Caribbean and achieve better dengue disease management.

Introduction Peripheral arterial disease (PAD) indicates generalised atherosclerotic disease but is often asymptomatic. The prevalence and potential risk factors of PAD were studied in ECHORN cohort study participants. Methods Representative samples of community-dwelling people ≥40 years of age residing in Barbados, Puerto Rico, Trinidad, and the USVI were recruited. The survey included questions on diabetes, hypertension, heart disease and smoking status. Body Mass Index, HbA1c, blood glucose and lipids were determined. Ankle brachial index (ABI) was evaluated in one leg. An oscillometric device measured arm and leg systolic BP simultaneously. ABI classifications were PAD ≤0.90, borderline 0.91 to 0.99, normal 1.00 to 1.40, and non-compressible >0.40. Multivariable logistic regression tested associations of potential risk factors with PAD. Results Of 2772 participants (mean age 57.3, 65.2% female), 35.8% were overweight, 38.1% obese, 32.4% had diabetes, 60% hypertension, and 15.4% reported heart. ABI prevalence (95% CI) by category was PAD 4.4% (3.6%, 5.1%), borderline 5.2% (4.4%, 6.1%), normal 87.0% (85.8%, 88.3%) and noncompressible 3.4% (2.7%, 4.0%). Female sex (OR 1.72, 95% CI 1.07 to 2.77), diabetes (OR 2.23, 95% CI 1.47 to 3.4), heart disease history (OR 1.74, 95% CI 1.07 to 2.83) and less than high school education vs having a university degree (OR 2.49, 95% CI 1.19 to 5.22) were independently associated with PAD. Conclusions Testing one leg only would underestimate PAD prevalence. Increasing the ABI cutoff for identifying PAD to <1.0 when using oscillometric devices is suggested by some studies but would more than double the estimated prevalence. Guidelines need to address this issue. Female sex and lower educational attainment are important considerations when screening. While diabetes and a history of heart disease were confirmed as risk factors, the lack of association of increasing age and cigarette smoking with PAD was unexpected.

Policy and practical efforts to reduce vulnerability, strengthen resilience and drive desirable environmental attitudes or behavior ought to be informed by an understanding of the contextual and compositional factors that shape people’s perceptions of environmental phenomena. The objective of this study was to determine the contextual and compositional factors that significantly influence the perceived importance of environmental change and livelihood sectors in three Caribbean countries. A cross-sectional survey was conducted with 441 households in eight coastal communities in Belize, Dominican Republic, and Suriname. The sample included male (247) and female (194) participants. Inferential and ordinary least squares regression were applied to examine relationships between predictor (relevant contextual and compositional factors) and outcome variables (perceived importance of environmental change in relation to livelihood sectors or activities) at community and household scales. Univariate analysis of the predictors and other socio-demographic variables was done using Pearson’s chi-square statistics. Bivariate analysis was initially performed to examine zero-order relationships between the outcome variables and theoretically relevant predictor variables. Further, multivariate models were estimated to explore the net effects of the predictor variables using the stepwise selection approach. Results indicate complex and differentiated interactions between predictor and outcome variables at community and household scales. We found ethnicity, community, and country as strong predictors of the outcome variable across the models. This is followed by education and income. Generally, increase in education and income was associated with significant decrease in the perceptions of the outcome variable and might have contributed to a recognition-threat gap. Still at the multivariate level, there was no statistically significant difference between women and men in the perception of the outcome variables but women were associated with decreased perception at the bivariate level. Different age groups had similar self-reported perceptions of environmental change and livelihoods. Overall, respondents in different livelihood sectors expressed different perceptions on the importance of environmental change and livelihoods for community and household resilience. This suggests varied experiences and/or perceptions of vulnerability, undergirded by the contextual and compositional factors that influence subjective evaluation of exposure, which must seriously inform policies and practical interventions. More of such studies are needed in the Caribbean.

Introduction Evidence suggests that when adjusted for age and other factors such as Body Mass Index, age of first pregnancy, years since last pregnancy and alcohol consumption, Black women are three times more likely to suffer from fibroids compared with the general population. When compared with the general population, Black women experience larger uterine fibroids with an earlier onset and more frequent and severe symptoms debilitating symptoms. Reported symptoms include pelvic pain, bladder issues, and heavy and/or abnormal menstrual bleeding. For Black women in perimenopause or menopause, uterine fibroids are more likely to continue growing rather than slow or cease. To design empirical research that addresses the issue of uterine fibroids among Black people of African descent, it is important to understand the current state of literature on this issue. The objectives of this scoping review are to understand and describe the extent and type of literature available regarding Black people of African descent with uterine fibroids globally, to identify the gaps within existing literature, and to provide recommendations for future research. Methods and analysis This scoping review will be conducted in accordance with JBI scoping review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. Eligibility criteria for this review include sources that involve Black people of African descent who have uterine fibroids. This review is global in context and does not include jurisdictional, geographical, regional or study setting restrictions. A comprehensive search strategy developed in collaboration with a health sciences librarian will be used to identify and retrieve relevant peer-reviewed and grey literature. Databases including CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), Gender Studies Database (EBSCO), Scopus (Elsevier) and LILACS (VHL) will be searched from inception to January 2024. Unpublished studies and grey literature searches will include The Society for Women’s Health Research, Black Women’s Health Imperative, ProQuest Dissertations and Theses Global (ProQuest), Open Access Theses and Dissertations (OATD.org) and Google search. All relevant sources will be uploaded to Covidence and undergo title and abstract screening by two independent team members. Selected sources will then undergo full-text review by two independent team members. Sources meeting the eligibility criteria will undergo extraction by two independent team members. Thematic analysis will be used to classify the extracted data points into categories according to the purpose or objective of the source, the methods used, the geographical region or jurisdiction of the source, key findings and recommendations. The synthesis of results will align with the review objective and question using charts or tables where necessary. Ethics and dissemination This scoping review does not require ethical approval. Dissemination of the review results includes the publication of a full report in a peer-reviewed journal as well as presenting the review results at local, national and international conferences. The results of the scoping review will also be disseminated through community events and social media using infographics and brochures.

Objective The aim of this study is to develop a systems thinking framework to describe the common complexities of childhood obesity in the Caribbean region and identify potential areas of intervention. Methods Group model building (GMB) is a form of systems science. Trained GMB facilitators in Puerto Rico, the US Virgin Islands, Barbados, and Trinidad and Tobago convened a group of multi-disciplinary stakeholders in a series of virtual meetings in 2021 to elaborate a hypothesis of the system driving childhood obesity represented by causal loop diagrams (CLD). Commonalities and differences between the CLDs from each island were identified and reconciled to create a synthesized CLD. Results A single explanatory CLD across the islands was developed and includes nine reinforcing loops. These loops addressed the interconnected role of schools, policy, commercial determinants, community and the personal experience of the child in rising childhood obesity rates. Conclusions Despite differences across settings, there is a core system driving childhood obesity in the Caribbean, as described by stakeholders in GMB workshops. Policy solutions to the problem must be multi-faceted and multi-level to address the interlinked reinforcing loops of the complex system and reduce rates of childhood obesity.

Systemic lupus erythematosus (SLE) is a complex autoimmune condition that disproportionately impacts non-White ethnic and racial groups, particularly individuals in the African diaspora who experience heightened incidence, prevalence, and adverse outcomes. Genetic and epigenetic factors play significant roles in SLE risk, however these factors neither explain the whole of SLE risk nor the stark racial disparities we observe. Moreover, our understanding of genetic risk factors within African ancestry populations is limited due to social and environmental influences on research participation, disease presentation, and healthcare access. Globally, the African diaspora faces barriers in accessing essential SLE diagnostic tools, therapeutics, healthcare practitioners, and high-quality clinical and translational research studies. Here, we provide insights into the current state of genetic studies within African ancestry populations and highlight the unique challenges encountered in SLE care and research across countries of varying income levels. We also identify opportunities to address these disparities and promote scientific equity for individuals affected by SLE within the global African diaspora.

Standardized and/or centralized proactive research governance can lessen tensions