Insights into the Geographical Origins of the Cabo Verde Green Monkey

The green monkey Chlorocebus sabaeus, L. 1766, native to West Africa, was introduced to the Cabo Verde Archipelago in the 16th century. Historical sources suggest that, due to the importance of Cabo Verde as a commercial entrepôt in the Atlantic slave trade, establishing the precise place of origin of this introduced species is challenging. Non-invasive fecal samples were collected from feral and captive green monkey individuals in Cabo Verde. Two mitochondrial fragments, HVRI and cyt b, were used to confirm the taxonomic identification of the species and to tentatively determine the geographic origin of introduction to the archipelago from the African continent. By comparing the new sequences of this study to previously published ones, it was shown that Cabo Verde individuals have unique haplotypes in the HVRI, while also showing affinities to several populations from north-western coastal Africa in the cyt b, suggesting probable multiple sources of introduction and an undetermined most probable origin. The latter is consistent with historical information, but may also have resulted from solely using mtDNA as a genetic marker and the dispersal characteristics of the species. The limitations of the methodology are discussed and future directions of research are suggested.

non-practitioners of sports

BACKGROUND

There are few or even rare studies conducted in Cabo Verde (Republic of Cabo Verde) that address the issue of physical fitness and body composition in the juvenile population. This investigation aims to study the physical fitness in children in Cabo Verde: differences between gender, eutrophic, and overweight subjects, between practitioners and non-practitioners of sports.

METHODS

The sample consisted of 93 individuals aged between 10 and 15 years, from the 2nd and 3rd cycles and secondary school of the Portuguese College based in Cabo Verde. The instruments used for data collection were the FITescola® test battery (Lisboa, Portugal), and the questionnaire Quantification de l'activite physique en altitude chez les enfants (QAPACE) for assessment of physical activity level. Regarding the statistical analysis using the SPSS 23.0 software (SPSS Inc., Chicago, IL, USA), the first analysis was performed to verify the distribution of the sample (Kolmogorov-Smirnov Test and Shapiro-Wilk Test). Then, for variables with normal distribution we used the t-test and for the remaining variables with non-normal distribution we used the Mann-Whitney Test, with a significance level of 5%.

RESULTS

Gender differences were found, in which the male gender obtained more favorable mean values in the "sit-ups," "push-ups," "horizontal impulsion," "shuttle" and "agility" variables, while the females showed superiority in the variables "sit and reach;" differences between the eutrophic and overweight group where, as expected, more favorable mean values for eutrophics than the overweight group in all PF tests. Finally, differences between practitioners and non-practitioners of sports, with the best results being attributed to practitioners of sports.

CONCLUSIONS

We concluded that male subjects have greater proficiency in strength and aerobic fitness tests while female subjects have greater flexibility. High BMI values in overweight children have been found to be associated with increased abdominal fat as well as a reduction in overall PF. As expected, sports practitioners show better results in motor performance on PF tests.

Lost and found: Patterns of marine litter accumulation on the remote Island of Santa Luzia, Cabo Verde

Santa Luzia, an uninhabited island in the archipelago of Cabo Verde, serves as a natural laboratory and important nesting site for loggerhead turtles Carettacaretta. The island constitutes an Integral Natural Reserve and a Marine Protected Area. We assessed marine litter accumulation on sandy beaches of the island and analysed their spatial patterns using two sampling methods: at a fine scale, sand samples from 1 × 1 m squares were collected, identifying debris larger than 1 mm; at a coarse scale, drone surveys were conducted to identify visible marine debris (>25 mm) in aerial images. We sampled six points on three beaches of the island: Achados (three points), Francisca (two points) and Palmo Tostão (one point). Then, we modelled the abundance of marine debris using topographical variables as explanatory factors, derived from digital surface models (DSM). Our findings reveal that the island is a significant repository for marine litter (>84% composed of plastics), with up to 917 plastic items per m2 in the sand samples and a maximum of 38 macro-debris items per m2 in the drone surveys. Plastic fragments dominate, followed by plastic pellets (at the fine-scale approach) and fishing materials (at the coarse-scale approach). We observed that north-facing, higher-elevation beaches accumulate more large marine litter, while slope and elevation affect their spatial distribution within the beach. Achados Beach faces severe marine debris pollution challenges, and the upcoming climate changes could exacerbate this problem.

Suicidal behaviour among adults in Cabo Verde in 2020

BACKGROUND

The aim of the investigation was to evaluate past 12-month suicidal behaviour (PSB) among adults in Cabo Verde.

METHODS

Data from 4,563 adults (mean age 41.4 years) that participated in the 2020 Cabo Verde STEPS survey were analysed.

RESULTS

Results indicate that the proportion of PSB (attempt 0.6%, plan 1.5% and ideation 3.3%) was 3.7% (2.4% men/5.0% women). In adjusted logistic regression analysis, younger age, female sex, unemployed, widowed or divorced, alcohol family problem, heart attack, angina or stroke, current smokeless tobacco use and low fruit/vegetable intake were associated with PSB.

CONCLUSION

Almost 4% of participants had PSB and several associated factors were identified that can guide public health interventions.

Compulsory treatment in Portuguese-speaking countries: An analysis and comparison of the legal framework

BACKGROUND

Compulsory treatment involves the hospital admission of individuals with mental disorders in appropriate facilities through judicial decisions. However, limited information is available regarding the similarities and differences in compulsory treatment legislation in Portuguese-speaking countries.

AIMS

To analyse the commonalities and differences in compulsory treatment legislation in Portuguese-speaking countries, where Portuguese is the primary official language, including Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Mozambique, Portugal, and São Tomé and Príncipe.

METHODS

A comparative analysis of the specific legislation on compulsory treatment in Portuguese-speaking countries was conducted. National development plans were analysed in countries lacking legislation. A purposive sampling of mental health professionals was contacted to gather information on the countries under study.

RESULTS

Among the eight Portuguese-speaking countries examined, specific legislation regarding compulsory treatment was found only in Brazil, Cape Verde, and Portugal. These countries, with the lowest poverty rates, exhibited a notable degree of homogeneity in the criteria supporting compulsory treatment, ensuring the protection of individual rights. In contrast, in Angola, East Timor, Guinea-Bissau, Mozambique, and São Tomé and Príncipe, compulsory treatment primarily relies on mental health development plans, resulting in significant variations in the presented criteria.

CONCLUSIONS

The significant disparities in compulsory treatment policies among Portuguese-speaking countries, with only Brazil, Cape Verde, and Portugal having specific legislation, underscore the need for a collective effort to establish more consistent procedures and safeguard individual rights.

Human biomonitoring of inorganic elements in a representative sample of the general population from Cape Verde: Results from the PERVEMAC-II study

Inorganic elements such as heavy metals and other potentially toxic elements are frequently detected in humans. The aim of the present study was to analyze the blood concentrations of 49 inorganic elements in a cohort of 401 subjects from Cape Verde. The study was performed in the frame of the Pesticide Residues in Vegetables of the Macaronesia project (PERVEMAC-II). Concentration of inorganic elements, including elements in the ATSDR's priority pollutant list and rare earth elements (RREs) were measured by ICP-MS in the whole blood of participants. A total of 20 out of 49 elements (40.8%) were detected in ≥20% of participants. Arsenic, copper, mercury, lead, selenium, strontium and zinc were detected in ≥99% of samples. Among the REEs, 7 showed detection frequencies above 20%. The median number of different elements detected was 15. In the present series, 77.0, 99.2 and 33.4% of the participants showed values of arsenic, mercury and lead higher than Reference Values 95%. These percentages were much higher than those reported in similar studies. Niobium and tantalum showed the highest median concentrations: 1.35 and 1.34 ng/mL, suggesting an environmental source of these valuable REEs in Cape Verde. Age appeared as the most important factor influencing the blood levels of inorganic elements. Lifestyle had an effect on the concentration of some of these elements. Those subjects whose water source was pond water had significantly higher arsenic levels. The concentration of ∑REEs was significantly higher among individuals who purchase their food in supermarkets (P = 0.013). These variables are of relevance since they can be controlled individually to reduce exposure to these contaminants. Our results may be useful for the implementation of public health measures by the competent authorities.

Behavioural and biological risk factors of non-communicable diseases among adults in Cabo Verde: a repeated cross-sectional study of the 2007 and 2020 national community-based surveys

OBJECTIVE

The aim of the study is to estimate trends in the prevalence and associated factors of non-communicable disease (NCD) risk factors in adults from 2007 to 2020 in Cabo Verde.

DESIGN

Population-based cross-sectional study.

SETTING

Nationally representative samples of adult population in Cabo Verde from the 2007 and 2020 STEPwise approach to NCD risk factor surveillance (STEPS) surveys.

PARTICIPANTS

The sample included 1760 adults in 2007 and 3721 in 2020.

OUTCOME MEASURES

Included fruit/vegetable consumption, low physical activity, sedentary behaviour, current tobacco use, hazardous alcohol use, diabetes, total elevated cholesterol, hypertension and overweight/obesity. Logistic regressions adjusted for sociodemographic factors were applied to estimate predictors of each of the nine NCD risk factors.

RESULTS

Compared with participants in the study year 2007, participants in the study year 2020 had a significantly higher prevalence of low physical activity (adjusted OR (AOR): 2.21, 95% CI: 1.15 to 4.25) and overweight/obesity (AOR: 1.68, 95% CI: 1.26 to 2.23) and significantly lower rate of hypertension (AOR: 0.77, 95% CI: 0.64 to 0.93). Low physical activity (AOR: 1.61, 95% CI: 1.23 to 2.10), overweight/obesity (AOR: 2.59, 95% CI: 2.10 to 3.20), current tobacco use (AOR: 1.94, 95% CI: 1.36 to 2.75), hypertension (AOR: 5.45, 95% CI: 4.24 to 7.00), diabetes (AOR: 8.40, 95% CI: 4.65 to 15.18) and elevated total cholesterol (AOR: 4.58, 95% CI: 2.83 to 7.39) were more common among the 50-64-year-olds. Being male increased the odds of current tobacco use (AOR: 3.64, 95% CI: 2.75 to 4.81) and hazardous alcohol use (AOR: 4.79, 95% CI: 3.15 to 7.27), and decreased the odds of low physical activity (AOR: 0.48, 95% CI: 0.39 to 0.58) and overweight/obesity (AOR: 0.47, 95% CI: 0.40 to 0.56).

CONCLUSIONS

Of the nine NCD risk factors evaluated from 2007 to 2020 in Cabo Verde, two increased (overweight/obesity and low physical activity) and one decreased (hypertension). Several associated variables were identified for each individual NCD risk factor that can help in guiding interventions.

First isolation of Echinococcus granulosus sensu lato genotype 7 in the archipelago of Cape Verde

There are no scientific data available on the occurrence of the Echinococcus granulosus sensu lato (s.l.) cluster in definitive hosts (domestic dogs), intermediate hosts (domestic livestock) nor humans in Cape Verde. In this pilot study, environmental dog fecal samples (n = 369) were collected around food markets, official slaughterhouses, as well as home and small business slaughter spots in 8 of the 9 inhabited islands from the Cape Verde archipelago, between June 2021 and March 2022. Additionally, during the same period, 40 cysts and tissue lesions were opportunistically collected from 5 islands, from locally slaughtered cattle (n = 7), goats (n = 2), sheep (n = 1) and pigs (n = 26). Genetic characterization by a multiplex polymerase chain reaction assay targeting the 12S rRNA gene confirmed the presence of E. granulosus s.l. in fecal and tissue material. In total, 17 cyst samples from Santiago (n = 9), Sal (n = 7) and São Vicente (n = 1) and 8 G6/G7-positive dog fecal samples from Santiago (n = 4) and Sal (n = 4) were identified as E. granulosus s.l. G7 by sequence analysis (nad2, nad5 and nad1 genes). This study discloses the transmission of E. granulosus s.l. G7, in pig, cattle and dog in Cape Verde.

Characterization and biofouling potential analysis of two cyanobacterial strains isolated from Cape Verde and Morocco

Cyanobacteria are new sources of value-added compounds but also ubiquitous and harmful microfoulers on marine biofouling. In this work, the isolation and identification of two cyanobacterial strains isolated from Cape Verde and Morocco, as well as their biofilm-forming ability on glass and Perspex under controlled hydrodynamic conditions, were performed. Phylogenetic analysis revealed that cyanobacterial strains isolated belong to Leptothoe and Jaaginema genera (Leptothoe sp. LEGE 181153 and Jaaginema sp. LEGE 191154). From quantitative and qualitative data of wet weight, chlorophyll a content and biofilm thickness obtained by optical coherence tomography, no significant differences were found in biofilms developed by the same cyanobacterial strain on different surfaces (glass and Perspex). However, the biofilm-forming potential of Leptothoe sp. LEGE 181153 proved to be higher compared with Jaaginema sp. LEGE 191154, particularly at the maturation stage of biofilm development. Three-dimensional biofilm images obtained from confocal laser scanning microscopy showed different patterns between both cyanobacterial strains and also among the two surfaces. Because standard methodologies to evaluate cyanobacterial biofilm formation, as well as two different optical imaging techniques, were used, this work also highlights the possibility of integrating different techniques to evaluate a complex phenomenon like cyanobacterial biofilm development.

The burden of mortality due to injury in Cabo Verde, 2018

External causes continue to be one of the main causes of mortality in the world and Cabo Verde is no exception. Economic evaluations can be used to demonstrate the disease burden of public health problems such as injuries and external causes and support prioritization of interventions aimed at improving the health of the population. The objective of this study was to estimate the indirect costs of premature mortality in 2018 due to injuries and other consequences of external causes in Cabo Verde. Years of potential life lost, years of potential productive life lost and human capital approach were used to estimate the burden and indirect costs of premature mortality. In 2018, 244 deaths were registered due to injury and other consequences of external causes. Males were responsible for 85.4% and 87.73% of years of potential life lost and years of potential productive life lost, respectively. The cost of productivity lost due to premature death caused by injury was 4,580,225.91 USD. The social and economic burden due to trauma was substantial. There is a need for more evidence on the burden of disease due to injuries and their consequences, to support the implementation of targeted multi-sectoral strategies and policies for the prevention, management, and reduction of costs due to injuries in Cabo Verde.

Essential Metals and Trace Elements in Cereals and Their Derivatives Commercialized and Consumed in Cape Verde

Cereals and their derivatives are basic foods in the human diet and a source of minerals, but the content of elements may vary depending on the type of cereal or its processing. The levels of Na, K, Ca, Mg, Fe, Cu, Zn, Mo, Co, and Mn have been determined in 126 samples of cereals and cereal derivatives (rice, corn gofio, corn flour, wheat flour, corn, and wheat) commercialized and consumed in Cape Verde using an inductively coupled plasma-optical emission spectrometer (ICP-OES) after a wet microwave digestion process. Some elements stand out in products such as corn gofio (K), wheat (Mg), and wheat flour (Fe). Negative correlations were found between Mo-Na and Na-Zn that could suggest interference between these elements. Bearing in mind the dietary intake evaluation and the guideline values provided by EFSA (European Food Safety Authority) or FAO (Food Authority Organization), the consumption of wheat (100 g/day) provides a notable contribution of Mo, Mn, Fe, and Mg. Considering the nutritional value of the analyzed essential and trace elements, the consumption of different cereals and their derivatives should be promoted.

A next generation targeted amplicon sequencing method to screen for insecticide resistance mutations in Aedes aegypti populations reveals a rdl mutation in mosquitoes from Cabo Verde

Aedes mosquito vectors transmit many viruses of global health concern, including dengue, chikungunya and Zika. These vector-borne viral diseases have a limited number of treatment options, and vaccines vary in their effectiveness. Consequently, integrated vector management is a primary strategy for disease control. However, the increasing emergence and spread of insecticide resistance is threatening the efficacy of vector control methods. Identifying mutations associated with resistance in vector populations is important to monitor the occurrence and evolution of insecticide resistance and inform control strategies. Rapid and cost-effective genome sequencing approaches are urgently needed. Here we present an adaptable targeted amplicon approach for cost-effective implementation within next generation sequencing platforms. This approach can identify single nucleotide polymorphisms (SNPs) and small insertions and deletions (indels) in genes involved in insecticide resistance in Aedes aegypti mosquitoes. We designed and tested eleven amplicons, which included segments of the ace-1 (carbamate target), the Voltage-Gated Sodium Channel (vgsc; pyrethroids, DDT and organochlorines), and rdl (dieldrin) genes; thereby covering established knockdown resistance (kdr) mutations (e.g., S989P, I1011M/V, V1016G/I and F1534C), with the potential to identify novel ones. The amplicon assays were designed with internal barcodes, to facilitate multiplexing of large numbers of mosquitoes at low cost, and were sequenced using an Illumina platform. Our approach was evaluated on 152 Ae. aegypti mosquitoes collected in Cabo Verde, an archipelago with a history of arbovirus outbreaks. The amplicon sequence data revealed 146 SNPs, including four non-synonymous polymorphisms in the vgsc gene, one in ace-1 and the 296S rdl mutation previously associated with resistance to organochlorines. The 296S rdl mutation was identified in 98% of mosquitoes screened, consistent with the past use of an organochlorine compound (e.g., DDT). Overall, our work shows that targeted amplicon sequencing is a rapid, robust, and cost-effective tool that can be used to perform high throughput monitoring of insecticide resistance.

Enhanced mosquito vectorial capacity underlies the Cape Verde Zika epidemic

The explosive emergence of Zika virus (ZIKV) across the Pacific and Americas since 2007 was associated with hundreds of thousands of human cases and severe outcomes, including congenital microcephaly caused by ZIKV infection during pregnancy. Although ZIKV was first isolated in Uganda, Africa has so far been exempt from large-scale ZIKV epidemics, despite widespread susceptibility among African human populations. A possible explanation for this pattern is natural variation among populations of the primary vector of ZIKV, the mosquito Aedes aegypti. Globally invasive populations of Ae. aegypti outside of Africa are considered effective ZIKV vectors because they are human specialists with high intrinsic ZIKV susceptibility, whereas African populations of Ae. aegypti across the species’ native range are predominantly generalists with low intrinsic ZIKV susceptibility, making them less likely to spread viruses in the human population. We test this idea by studying a notable exception to the patterns observed across most of Africa: Cape Verde experienced a large ZIKV outbreak in 2015 to 2016. We find that local Ae. aegypti in Cape Verde have substantial human-specialist ancestry, show a robust behavioral preference for human hosts, and exhibit increased susceptibility to ZIKV infection, consistent with a key role for variation among mosquito populations in ZIKV epidemiology. These findings suggest that similar human-specialist populations of Ae. aegypti in the nearby Sahel region of West Africa, which may be expanding in response to rapid urbanization, could serve as effective vectors for ZIKV in the future.

During 2015-2016, Cape Verde experienced the only documented large-scale Zika virus outbreak in Africa. This study provides an explanation for this puzzling exception by showing that Aedes aegypti mosquitoes in Cape Verde display atypical features, with substantial human-specialist ancestry, robust preference for humans, and enhanced Zika virus susceptibility.

Sustaining surveillance as an intervention during the COVID-19 pandemic in Cabo Verde and implications for malaria elimination

Cabo Verde reported the first case of COVID-19 on March 19, 2020. Containment measures were quickly implemented and over 80,000 COVID-19 tests were performed in 2020 with 11,840 confirmed infections (2% of the population) and 154 deaths. In a setting where the last locally acquired malaria case was reported in January 2018, any interruptions to malaria care-seeking have the potential for infections to go untreated and transmission re-establishing. This work aims to determine whether there was any change in the number of people seeking care or being tested for malaria and, using an interrupted time series analysis, identify if any change was associated with implemented COVID-19 measures. Routinely collected surveillance data for outpatient visits, testing for malaria and COVID-19 were aggregated by month for each health facility (outpatient and malaria) or by municipality (COVID-19) from 2017 through 2020. The timeline of COVID-19 measures was generated based on when and where they were implemented. Results show that there was a marked shift in care-seeking in Cabo Verde. Overall, the mean number of observed outpatient visits decreased from 2,057 visits per month during 2017-2019 to 1,088 in 2020, an estimated 28% reduction. However, malaria testing rates per 1,000 outpatient visits after the pandemic began increased by 8% compared to expected trends. Results suggest that the pandemic impacted care-seeking but led to a non-significant increase in testing for malaria per 1,000 outpatient visits. With the cessation of international travel, the risk of imported infections seeding new transmission declined suggesting the risk of undetected transmission was low. It is important for countries to understand their specific malaria risks and vulnerabilities in order to ensure that any progress towards the interruption of malaria transmission can be sustained.

Recreation and Alcohol Consumption in Sub-Saharan Africa: Addressing Gender and Age Differences in Urban Areas-Praia, Cabo Verde

BACKGROUND

Reducing alcohol consumption and improving urban planning in African cities are public health priorities. The aim of this study was to explore gender and age differences in recreational activity participation and its link with self-reported alcohol consumption in three urban areas of Praia.

METHODS

A questionnaire was applied to a probabilistic sample of 1912 adults, with a median age of 35.0 (IQR: 26.0-48.8) years, living in informal, transition, and formal areas of the capital of Cabo Verde.

RESULTS

More than 80% of the participants reported rarely or never participating in recreational activities. Going daily or weekly to the café was the most reported recreational activity, regardless of the urban area. Participation in recreational activities was higher in men than women, decreasing with age in both cases. Alcohol consumption was significantly higher in men than women (72.4% versus 47.4%, p < 0.001). Multiple logistic regression models showed that going at least once to the bar/nightclub (for men and women) and going to the café (for women) were associated with alcohol consumption. Furthermore, age (for women), in a protective way, and having children (for men) appeared to be associated with alcohol consumption.

CONCLUSIONS

This study provides new data on the recreational environment in Praia and can contribute to the development of local and national public health policies and interventions in line with several SDGs to reduce alcohol consumption, enhance healthy leisure/recreation practices, and promote better living conditions for its inhabitants.

Human biomonitoring of persistent and non-persistent pollutants in a representative sample of the general population from Cape Verde: Results from the PERVEMAC-II study

International Public Health authorities recommend biomonitoring studies to assess the exposure to chemicals in the general population. The aim of the present study was to analyze the blood concentrations of a total 360 pollutants, including 230 pesticides in current or recent use, 59 persistent organochlorine pollutants (POPs), 11 anticoagulant rodenticides and 60 pharmaceutical active compounds (PhACs), in a cohort of 403 subjects from Cape Verde. The study was performed in the frame of the Pesticide Residues in Vegetables of the Macaronesia project (PERVEMAC-II). A total of 60 out of 360 toxic compounds (16.7%) were detected, at least, in one participant. The three most frequently detected substances were p,p'-DDE (100%), phenanthrene (94.0%) and hexachlobenzene (35.9%). 2-Phenylphenol and imidacloprid were detected in 29.0 and 14.4% of the population. The three substances with the highest serum concentrations were PhACs: naproxen (249.1 ng/mL), metronidazole (115.6 ng/mL) and acetaminophen (25.2 ng/mL). Median blood concentration of p,p'-DDE, HCB and phenanthrene were 1.87, 0.08 and 0.36 ng/mL. Blood concentrations of POPs were influenced by age, although both gender and body mass index may exert an influence in the presence of these substances. Lifestyle has an effect on the concentration of these substances, especially in terms of dietary habits. Both the frequency of detection and the concentration of the studied substances are similar to those of other biomonitored populations. This is the first biomonitoring study carried out in Cape Verde. Our results may be useful for the implementation of public health measures by the competent authorities.

Pathogenic free-living amoebae from water sources in Cape Verde

Free-living amoebae (FLA) are protozoa which have been reported in different countries worldwide from diverse sources (water, soil, dust, air), contributing to the environmental microbiological contamination. Most of the FLA species present a life cycle with two different phases: an active vegetative and physiologically form named trophozoite, and an extremely resistant phase called cyst. Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris, Sapinia pedata, Vahlkampfia spp., Paravahlkampfia spp. and Vermamoeba vermiformis have been reported not only as causal agents of several opportunistic diseases including fatal encephalitis or epithelial disorders, but also as capable to favour the intracellular survival of common pathogenic bacteria, which could avoid the typical water disinfection systems, non-effective against FLAs cysts. Even though Santiago Island possesses high levels of humidity compared to the rest of the archipelago of Cape Verde, the water resources are scarce. Therefore, it is important to carry out proper microbiological quality controls, which currently do not contemplate the FLA presence in most of the countries. In the present work, we have reported the presence of Acanthamoeba spp. (69.2%); Vannella spp. (15.4%); Vermamoeba vermiformis (7.7%) and the recently discovered Stenamoeba dejonckheerei (7.7%) in different water sources of Santiago Island.

Round-trip migration and energy budget of a breeding female humpback whale in the Northeast Atlantic

In the northern hemisphere, humpback whales (Megaptera novaeangliae) typically migrate between summer/autumn feeding grounds at high latitudes, and specific winter/spring breeding grounds at low latitudes. Northeast Atlantic (NEA) humpback whales for instance forage in the Barents Sea and breed either in the West Indies, or the Cape Verde Islands, undertaking the longest recorded mammalian migration (~ 9 000 km). However, in the past decade hundreds of individuals have been observed foraging on herring during the winter in fjord systems along the northern Norwegian coast, with unknown consequences to their migration phenology, breeding behavior and energy budgets. Here we present the first complete migration track (321 days, January 8^th, 2019—December 6^th, 2019) of a humpback whale, a pregnant female that was equipped with a satellite tag in northern Norway. We show that whales can use foraging grounds in the NEA (Barents Sea, coastal Norway, and Iceland) sequentially within the same migration cycle, foraging in the Barents Sea in summer/fall and in coastal Norway and Iceland in winter. The migration speed was fast (1.6 ms^-1), likely to account for the long migration distance (18 300 km) and long foraging season, but varied throughout the migration, presumably in response to the calf’s needs after its birth. The energetic cost of this migration was higher than for individuals belonging to other populations. Our results indicate that large whales can modulate their migration speed to balance foraging opportunities with migration phenology, even for the longest migrations and under the added constraint of reproduction.

"Ancient DNA" reveals that the scientific name for an extinct tortoise from Cape Verde refers to an extant South American species

We examined the type material of the extinct tortoise species Geochelone atlantica López-Jurado, Mateo and García-Márquez, 1998 from Sal Island, Cape Verde, using aDNA approaches and AMS radiocarbon dating. High-quality mitochondrial genomes obtained from the three type specimens support that all type material belongs to the same individual. In phylogenetic analyses using mitochondrial genomes of all species groups and genera of extant and some recently extinct tortoises, the type material clusters within the extant South American red-footed tortoise Chelonoidis carbonarius (Spix, 1824). Our radiocarbon date indicates that the tortoise from which the type series of G. atlantica originates was still alive during 1962 and 1974. These results provide firm evidence that the type material of G. atlantica does not belong to the Quaternary tortoise bones excavated on Sal Island in the 1930s, as originally thought. Thus, the extinct tortoise species remains unstudied and lacks a scientific name, and the name G. atlantica has to be relegated into the synonymy of C. carbonarius. The circumstances that led to this confusion currently cannot be disentangled.

Temporal evolution of imposex and butyltin contamination in Gemophos viverratus from São Vicente (Cabo Verde) - a countercurrent trend on the world scenario

Organotin (OT) based Antifouling Systems (AFS) were globally banned by the AFS Convention since 2008, but the Republic of Cabo Verde did not ratify this Convention, nor did it develop a national legislation to control OT-AFS. Gemophos viverratus imposex and butyltin tissue contamination were assessed around the São Vicente Island (Cabo Verde) in 2019 and compared with the data available from 2012. The vas deferens sequence index (VDSI), the relative penis length (RPL), the percentage of females with imposex (%I) and the percentage of sterilized females (%S) in 2019 ranged from 0 to 4.0, 0-84.4%, 0-100% and 0-5.1%, respectively, whilst TBT reached maximum values of ≈30 ng TBT-Sn g^-1 dw in the whelk tissues. These values are very similar to those registered in 2012, which indicates that TBT pollution has not decreased over the years, in contrast to the declining trend observed worldwide.

Genomic Epidemiology of 2015-2016 Zika Virus Outbreak in Cape Verde

During 2015–2016, Cape Verde, an island nation off the coast of West Africa, experienced a Zika virus (ZIKV) outbreak involving 7,580 suspected Zika cases and 18 microcephaly cases. Analysis of the complete genomes of 3 ZIKV isolates from the outbreak indicated the strain was of the Asian (not African) lineage. The Cape Verde ZIKV sequences formed a distinct monophylogenetic group and possessed 1–2 (T659A, I756V) unique amino acid changes in the envelope protein. Phylogeographic and serologic evidence support earlier introduction of this lineage into Cape Verde, possibly from northeast Brazil, between June 2014 and August 2015, suggesting cryptic circulation of the virus before the initial wave of cases were detected in October 2015. These findings underscore the utility of genomic-scale epidemiology for outbreak investigations.

Genetic Characterization of a New HIV-1 Sub-Subtype A in Cabo Verde, Denominated A8

Previous molecular characterization of Human immunodeficiency virus (HIV-1) samples from Cabo Verde pointed out a vast HIV-1 pol diversity, with several subtypes and recombinant forms, being 5.2% classified as AU-pol. Thus, the aim of the present study was to improve the characterization of these AU sequences. The genomic DNA of seven HIV-1 AU pol-infected individuals were submitted to four overlapping nested-PCR fragments aiming to compose the full-length HIV-1 genome. The final classification was based on phylogenetic trees that were generated using the maximum likelihood and bootscan analysis. The genetic distances were calculated using Mega 7.0 software. Complete genome amplification was possible for two samples, and partial genomes were obtained for the other five. These two samples grouped together with a high support value, in a separate branch from the other sub-subtypes A and CRF26_A5U. No recombination was verified at bootscan, leading to the classification of a new sub-subtype A. The intragroup genetic distance from the new sub-subtype A at a complete genome was 5.2%, and the intergroup genetic varied from 8.1% to 19.0% in the analyzed fragments. Our study describes a new HIV-1 sub-subtype A and highlights the importance of continued molecular surveillance studies, mainly in countries with high HIV molecular diversity.

Toxic Metals in Cereals in Cape Verde: Risk Assessment Evaluation

Consumption of cereals and cereal-based products represents 47% of the total food energy intake in Cape Verde. However, cereals also contribute to dietary exposure to metals that may pose a risk. Strengthening food security and providing nutritional information is a high-priority challenge for the Cape Verde government. In this study, toxic metal content (Cr, Ni, Sr, Al, Cd, and Pb) is determined in 126 samples of cereals and derivatives (rice, corn, wheat, corn flour, wheat flour, corn gofio) consumed in Cape Verde. Wheat flour samples stand out, with the highest Sr (1.60 mg/kg), Ni (0.25 mg/kg) and Cr (0.13 mg/kg) levels. While the consumption of 100 g/day of wheat would contribute to 13.2% of the tolerable daily intake (TDI) of Ni, a consumption of 100 g/day of wheat flour would contribute to 8.18% of the tolerable weekly intake (TWI) of Cd. Results show relevant Al levels (1.17-13.4 mg/kg), with the highest level observed in corn gofio. The mean Pb average content in cereals is 0.03-0.08 mg/kg, with the highest level observed in corn gofio. Al and Pb levels are lower in cereals without husks. Without being a health risk, the consumption of 100 g/day of wheat contributes to 17.5% of the European benchmark doses lower confidence limit (BMDL) of Pb for nephrotoxic effects; the consumption of 100 g/day of corn gofio provides an intake of 1.34 mg Al/day (13.7% of the TWI) and 8 µg Pb/day (20% of the BMDL for nephrotoxic effects). A strategy to minimize the dietary exposure of the Cape Verdean population to toxic metals from cereals should consider the continuous monitoring of imported cereals on arrival in Cape Verde, the assessment of the population's total diet exposure to toxic metals and educational campaigns.

Rapid adaptation to malaria facilitated by admixture in the human population of Cabo Verde

Humans have undergone large migrations over the past hundreds to thousands of years, exposing ourselves to new environments and selective pressures. Yet, evidence of ongoing or recent selection in humans is difficult to detect. Many of these migrations also resulted in gene flow between previously separated populations. These recently admixed populations provide unique opportunities to study rapid evolution in humans. Developing methods based on distributions of local ancestry, we demonstrate that this sort of genetic exchange has facilitated detectable adaptation to a malaria parasite in the admixed population of Cabo Verde within the last ~20 generations. We estimate that the selection coefficient is approximately 0.08, one of the highest inferred in humans. Notably, we show that this strong selection at a single locus has likely affected patterns of ancestry genome-wide, potentially biasing demographic inference. Our study provides evidence of adaptation in a human population on historical timescales.

In situ observations show vertical community structure of pelagic fauna in the eastern tropical North Atlantic off Cape Verde

Distribution patterns of fragile gelatinous fauna in the open ocean remain scarcely documented. Using epi-and mesopelagic video transects in the eastern tropical North Atlantic, which features a mild but intensifying midwater oxygen minimum zone (OMZ), we established one of the first regional observations of diversity and abundance of large gelatinous zooplankton. We quantified the day and night vertical distribution of 46 taxa in relation to environmental conditions. While distribution may be driven by multiple factors, abundance peaks of individual taxa were observed in the OMZ core, both above and below the OMZ, only above, or only below the OMZ whereas some taxa did not have an obvious distribution pattern. In the eastern eropical North Atlantic, OMZ expansion in the course of global climate change may detrimentally impact taxa that avoid low oxygen concentrations (Beroe, doliolids), but favour taxa that occur in the OMZ (Lilyopsis, phaeodarians, Cydippida, Colobonema, Haliscera conica and Halitrephes) as their habitat volume might increase. While future efforts need to focus on physiology and taxonomy of pelagic fauna in the study region, our study presents biodiversity and distribution data for the regional epi- and mesopelagic zones of Cape Verde providing a regional baseline to monitor how climate change may impact the largest habitat on the planet, the deep pelagic realm.

Impact of traffic emissions on air quality in Cabo Verde

Air quality degradation due to road traffic emissions is one of the topics of major interest for the scientific community and urban planners worldwide. Cabo Verde does not have regulations for traffic emission control or air quality guidelines, although the number of road vehicles has grown steadily over the past decade. Moreover, studies focusing on the impact of road transport on air quality in this archipelago are sparse. In this study, we present a first detailed air pollutant inventory of road traffic emissions through a bottom-up methodology, along with snapshots of the state of air quality on the islands of Santiago, São Vicente, and Sal. For the year 2017, emission estimates for the main island (Santiago) are 654 tons of CO, 35 tons of PM₁₀, 562 tons of NO_x, and 84 tons of NMVOCs. The air quality assessment was carried out using the TAPM model for a period of 6 months from January to July 2017. The results showed that the mean concentration values for Sao Vicente, Sal, and Santiago Islands ranged between 2.0 and 18 μg m^-3 for NO₂ and 3.8 and 5.6 μg m^-3 for PM₁₀. NO₂ concentrations show an increasing trend from January to July in Santiago and Sal, and no clear trend in São Vicente Island. The simulated PM₁₀ concentrations showed values in the same range over the year, even though they appeared slightly higher in July than in January. It was observed that both NO₂ and PM₁₀ average concentrations have been consistently above healthful levels, according to air quality guidelines fixed by the WHO.

The impact of social structure on breeding strategies in an island bird

The social environment is a key factor determining fitness by influencing multiple stages of reproduction, including pair formation, mating behavior and parenting. However, the influence of social structure across different aspects of breeding is rarely examined simultaneously in wild populations. We therefore lack a consolidation of the mechanisms by which sociality impacts reproduction. Here we investigate the implications of the social environment before and during breeding on multiple stages of reproduction in an island population of the ground nesting shorebird, the Kentish plover (Charadrius alexandrinus). We utilise information on mating decisions, nest locations and nesting success across multiple years in combination with social network analysis. Sociality before breeding was connected with patterns of pair formation. In addition, site fidelity and personal breeding experience was associated with the spatial organisation of breeding pairs. Our results provide evidence that, while differential social interactions at localised scales influence patterns of reproductive pairing, site fidelity and personal breeding experience influence the structure of populations at the landscape scale. Our results underline the tight link between the social structure of populations and patterns of mating, while revealing that the relative influence of sociality, breeding experience and local ecology are dynamic across different facets of reproduction.

Bats Out of Africa: Disentangling the Systematic Position and Biogeography of Bats in Cabo Verde

Cabo Verde Archipelago presents one of the largest knowledge gaps in the distribution and taxonomy of bats in the world. Old works indicated that there are five species classified as European taxa. We have conducted an integrative taxonomy to revise the systematic position and distribution of Cabo Verdean bats with molecular, morphological, and ecological data, to test their native or exotic origin, and infer possible colonization patterns based on fieldwork and museum samples. Results showed that Cabo Verde Hypsugo is closely related to those from the Canary Islands, in which the taxonomic status is under debate, presenting unique mitochondrial and nuclear haplotypes. We also expanded the distribution of Taphozous nudiventris for Fogo Island through pellets and acoustic identification, showed unique haplotypes for this species, and that Miniopterus schreibersii shared a haplotype with European, North African, and Western Asian specimens. The morphological and acoustic identification of Cabo Verdean specimens was challenging because of the lack of modern morphological descriptions and similarity of echolocation calls within the same genus. More studies are definitely needed to access the systematic of bat species in the archipelago, but this work is the first step for the establishment of conservation actions of the probable only native Cabo Verdean mammals.

Susceptibility of mosquito vectors of the city of Praia, Cabo Verde, to Temephos and Bacillus thuringiensis var israelensis

Many vector-borne diseases circulate in the Republic of Cabo Verde. These include malaria during the colonization of the archipelago by the Portuguese explorers and several arboviruses such as yellow fever (now eradicated), dengue and zika.

To control these vector-borne diseases, an integrated vector control program was implemented. The main targeted mosquito vectors are Aedes aegypti and Anopheles arabiensis, and in a lesser extent the potential arbovirus vector Culex pipiens s.l. The main control strategy is focused on mosquito aquatic stages using diesel oil and Temephos. This latter has been applied in Cabo Verde since 1979. Its continuous use was followed by the emergence of resistance in mosquito populations.

We investigated the current susceptibility to Temephos of the three potential mosquito vectors of Cabo Verde through bioassays tests. Our results showed various degrees of susceptibility with 24h post-exposure mortality rates ranging from 43.1% to 90.9% using WHO diagnostic doses. A full susceptibility was however observed with Bacillus thurigiensis var israelensis with mortality rates from 99.6% to 100%.

A five-year retrospective study shows increasing rates of antimicrobial drug resistance in Cabo Verde for both Staphylococcus aureus and Escherichia coli

OBJECTIVES

Data on baseline drug resistance important in informing future antimicrobial stewardship programs. So far, no data on the antimicrobial drug resistance of clinical isolates available for the African archipelago of Cabo Verde.

METHODS

We performed a retrospective analysis over years (2013-17) of the drug susceptibility profiles of clinical isolates in the two main hospitals of Cabo Verde. For Escherichia coli and Staphylococcus aureus, representing 47% and 26% of all clinical isolates, the antimicrobial drug resistance profile was reported for six representative drugs.

RESULTS

For E. coli we detected an increase in resistance to ampicillin, amoxicillin/clavulanic acid, ceftriaxone, ciprofloxacin and trimethoprim-and for S. aureus to methicillin, erythromycin and trimethoprim-sulfamethoxazole. This increase in both the most commonly isolated bacterial pathogens is alarm as it might compromise empirical treatment in a setting with limited access to laboratory testing.

CONCLUSIONS

When compared to the published low resistance rates in carriage isolates, the more alarming situation in clinical isolates for S. aureus might encourage antimicrobial stewardship programs to reduce in hospital settings, possibly as part of the Cabo Verdean national plan against antimicrobial drug resistance.

Abundance and Updated Distribution of Aedes aegypti (Diptera: Culicidae) in Cabo Verde Archipelago: A Neglected Threat to Public Health

Background: Mosquito-borne viruses, such as Zika, dengue, yellow fever, and chikungunya, are important causes of human diseases nearly worldwide. The greatest health risk for arboviral disease outbreaks is the presence of the most competent and highly invasive domestic mosquito, Aedes aegypti. In Cabo Verde, two recent arbovirus outbreaks were reported, a dengue outbreak in 2009, followed by a Zika outbreak in 2015. This study is the first entomological survey for Ae. aegypti that includes all islands of Cabo Verde archipelago, in which we aim to evaluate the actual risk of vector-borne arboviruses as a continuous update of the geographical distribution of this species. Methods: In order to assess its current distribution and abundance, we undertook a mosquito larval survey in the nine inhabited islands of Cabo Verde from November 2018 to May 2019. Entomological larval survey indices were calculated, and the abundance analyzed. We collected and identified 4045 Ae. aegypti mosquitoes from 264 positive breeding sites in 22 municipalities and confirmed the presence of Ae. aegypti in every inhabited island. Results: Water drums were found to be the most prevalent containers (n = 3843; 62.9%), but puddles (n = 27; 0.4%) were the most productive habitats found. The overall average of the House, Container, and Breteau larval indices were 8.4%, 4.4%, and 10.9, respectively. However, 15 out of the 22 municipalities showed that the Breteau Index was above the epidemic risk threshold. Conclusion: These results suggest that if no vector control measures are considered to be in place, the risk of new arboviral outbreaks in Cabo Verde is high. The vector control strategy adopted must include measures of public health directed to domestic water storage and management.

Compensatory Mutations in GI and ZTL May Modulate Temperature Compensation in the Circadian Clock

Circadian systems share the three properties of entrainment, free-running period, and temperature compensation (TC). TC ensures nearly the same period over a broad range of physiologically relevant temperatures; however, the mechanisms behind TC remain poorly understood. Here, we identify single point mutations in two key elements of the Arabidopsis circadian clock, GIGANTEA (GI) and ZEITLUPE (ZTL), which likely act as compensatory substitutions to establish a remarkably constant free-running period over a wide range of temperatures. Using near-isogenic lines generated from the introgression of the Cape Verde Islands (Cvi) alleles of GI and ZTL into the Landsberg erecta (Ler) background, we show how longer periods in the Cvi background at higher temperatures correlate with a difference in strength of the GI/ZTL interaction. Pairwise interaction testing of all GI/ZTL allelic combinations shows similar affinities for isogenic alleles at 22°C, but very poor interaction between GI (Cvi) and ZTL (Cvi) at higher temperature. In vivo, this would result in lower ZTL levels at high temperatures leading to longer periods in the Cvi background. Mismatched allelic combinations result in extremely strong or weak GI/ZTL interactions, indicating how the corresponding natural variants likely became fixed through epistatic selection. Additionally, molecular characterization of GI (Cvi) reveals a novel functional motif that can modulate the GI/ZTL interaction as well as nucleocytoplasmic partitioning. Taken together, these results identify a plausible temperature-dependent molecular mechanism, which contributes to the robustness of TC through natural variation in GI and ZTL alleles found on the Cape Verde Islands.

Characterization of the First Conotoxin from Conus ateralbus, a Vermivorous Cone Snail from the Cabo Verde Archipelago

Conus ateralbus is a cone snail endemic to the west side of the island of Sal, in the Cabo Verde Archipelago off West Africa. We describe the isolation and characterization of the first bioactive peptide from the venom of this species. This 30AA venom peptide is named conotoxin AtVIA (δ-conotoxin-like). An excitatory activity was manifested by the peptide on a majority of mouse lumbar dorsal root ganglion neurons. An analog of AtVIA with conservative changes on three amino acid residues at the C-terminal region was synthesized and this analog produced an identical effect on the mouse neurons. AtVIA has homology with δ-conotoxins from other worm-hunters, which include conserved sequence elements that are shared with δ-conotoxins from fish-hunting Conus. In contrast, there is no comparable sequence similarity with δ-conotoxins from the venoms of molluscivorous Conus species. A rationale for the potential presence of δ-conotoxins, that are potent in vertebrate systems in two different lineages of worm-hunting cone snails, is discussed.

The Amazon River: A Major Source of Organic Plastic Additives to the Tropical North Atlantic?

The release of emerging organic contaminants is identified among the most critical hazards to the marine environment, and plastic additives have received growing attention due to their worldwide distribution and potential deleterious effects. Here, we report dissolved surface water concentrations of two important families of plastic additives (organophosphate esters (OPEs) and bisphenols) and other related organic compounds (perfluorinated chemicals) measured in the North Atlantic from Cape Verde to the West Indies. We found that OPEs were the most abundant contaminants, reaching remarkably high concentrations in open ocean waters (1200 km offshore of the American Coast, at the location of the Amazon river plume during the sampling period), with up to 1.3 μg L^-1 (Σ₉OPEs). A Lagrangian analysis confirmed that these high concentrations of contaminants originated from the Amazon River plume and were transported more than 3000 km by the North Brazil Current and its retroflection. We thus consider the Amazon River as a major source of organic contaminants of emerging concern to the tropical North Atlantic Ocean and suggest that medium-/long-range contaminant transport occurs, most certainly facilitated by the highly stratified conditions offered by the river plume.

Shortcomings of Phylogenetic Studies on Recent Radiated Insular Groups: A Meta-Analysis Using Cabo Verde Biodiversity

Over the previous decades, numerous studies focused on how oceanic islands have contributed to determine the phylogenetic relationships and times of origin and diversification of different endemic lineages. The Macaronesian Islands (i.e., Azores, Madeira, Selvagens, Canaries, and Cabo Verde), harbour biotas with exceptionally high levels of endemism. Within the region, the vascular plants and reptiles constitute two of the most important radiations. In this study we compare relevant published phylogenetic data and diversification rates retrieved within Cabo Verde endemic lineages and discuss the importance of choosing appropriate phylogeny-based methods to investigate diversification dynamics on islands. From this selective literature-based review, we summarize the software packages used in Macaronesian studies and discuss their adequacy considering the published data to obtain well-supported phylogenies in the target groups. We further debate the importance of Next Generation Sequencing (NGS), to investigate the evolutionary processes of diversification in the Macaronesian Islands. Analysis of genomic data provides phylogenetic resolution for rapidly evolving species radiations, suggesting a great potential to improve the phylogenetic signal and divergence time estimates in insular lineages. The most important Macaronesian reptile radiations provide good case-studies to compare classical phylogenetic methods with new tools, such as phylogenomics, revealing a high value for research on this hotspot area.

[Optimizing Patients' Pathways in International Cooperation, by Doing Value Based Healthcare (VBHC)]

n/a.

Chemical characterization of vines grown in incipient volcanic soils of Fogo Island (Cape Verde)

Climate and rich volcanic soils of Fogo Island (Cape Verde) are optimal conditions for grape agriculture. This study aims a first evaluation of the bioaccumulation of essential and non-essential elements in different parts of vines of the same variety (Vitis vinifera L.), grown on recent pyroclasts and lahar deposits. Chemical composition was obtained by instrumental neutron activation analysis. A general decrease of the chemical contents occurs in the following order: barks, leaves, and grapes. Lower chemical contents were found in the grapes cultivated on the lahar deposit, except for barium. Potassium and bromine are the most accumulated. A tendency for lower transfer coefficients and enrichment factors (EF) of the chemical elements studied occur in vines grown in lahar. Significant EF of the majority of the elements studied were observed, particularly in leaves and grapes. Among the rare earth elements (REE), the heavy ones are significantly enriched in grapes. Slight positive Eu anomalies occur, which can be explained as inherited from the soil, and by a preferential uptake of Eu²⁺, replacing Ca²⁺. Among potential harmful chemical elements, significant EF (> 10) for Cr, As, Sb, W, and U in the two vines occur. Although its low concentration, the results obtained point to U bioavailability. The bioaccumulation of some chemical elements in vines from Fogo Island may be due to several factors of geogenic/natural origin, namely soil composition, airborne fine particles, and the climatic conditions of aridity with a potential availability when raindrops fall.

Realist evaluation of the role of the Universal Health Coverage Partnership in strengthening policy dialogue for health planning and financing: a protocol

INTRODUCTION

In 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries' quest towards universal health coverage (UHC). Entitled 'Universal Health Coverage Partnership', this intervention is intended to strengthen countries' capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries.

METHODS AND ANALYSIS

The researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context-mechanism-outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory.

ETHICS AND DISSEMINATION

The primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.

Enabling Cape Verde to Perform Total Hip Replacement: Cost-Benefit Study

INTRODUCTION

Cape Verde is a middle-income country benefiting from a health agreement with Portugal. The purpose of this study is to conduct a cost-benefit analysis on the enablement of Cape Verde to perform total hip replacement.

MATERIAL AND METHODS

We assessed records from the Orthopaedic Department of Baptista de Sousa Hospital and the Portuguese Directorate-General of Health regarding hip fracture with indication for total hip replacement and hip arthritis cases evacuated to Portugal. We also analysed the direct costs of the treatment, and hypothesised the costs of performing total hip replacement in Cape Verde. We then conducted a cost-benefit analysis.

RESULTS

From 2011 to 2016, 126 patients (135 hips) would have indication for total hip replacement if it was possible to do it in Cape Verde. The performance of the procedure in Cape Verde would have resulted in a global benefit of €80 644.08, and a benefit of €597.36/per patient.

DISCUSSION

Our analysis indicates that the enablement of Cape Verde to autonomously perform total hip replacement on patients with hip fracture and arthritis would have a positive financial return. Total costs were underestimated due to the impossibility to calculate indirect costs. Enabling Cape Verde to perform total hip replacement would provide the recommended treatment for patients and reduce the socio-psychological impact of evacuation.

CONCLUSION

Enabling Cape Verde to perform total hip replacement would represent an expense reduction, and an improvement of the country's quality of healthcare and autonomy.

Heavy Metals of Santiago Island (Cape Verde) Alluvial Deposits: Baseline Value Maps and Human Health Risk Assessment

The chemical composition of surface geological materials may cause metabolic changes and promote endemic diseases (e.g., oncological, gastrointestinal, neurological or cardiovascular diseases). The results of a geochemical survey is presented following the guidelines proposed by the International Project IGCP 259 performed on the alluvium of Santiago Island (Cape Verde) and focused on public health issues. Geochemical mapping is the base knowledge needed to determine critical contents of potential toxic elements and the potentially harmful regions in the planet. This work presents maps of baseline values of potentially toxic elements (As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, V, and Zn) in Santiago alluvium and the assessment of their human health risks. According to the results the Cd, Co, Cr, Ni and V baseline values are above the Canadian guidelines for stream sediments (for any proposal use) and for soils (for agricultural and residential proposal uses) and also above the target values of Dutch guidelines. Hazard indexes (HI) were calculated for children and adults. For children (HI) are higher than 1 for Co, Cr and Mn, indicating potential non-carcinogenic risk. For the other elements and for adults there is no potential non-carcinogenic risk. Cancer risk was calculated for Cd, Cr and Ni exposures, for adults and children, and the results are only slightly higher than the carcinogenic target risk of 1 × 10-6 for adults exposed to Cr by inhalation. However, these results may be underestimated because alluvial contaminants may be indirectly ingested by groundwater and by crop and vegetables consumption.

Marine debris as a barrier: Assessing the impacts on sea turtle hatchlings on their way to the ocean

Marine debris is dispersed worldwide and has a considerable impact on biodiversity. In this study, the effect of marine debris on the time needed for hatchling loggerheads to reach the ocean once they have emerged from the nest was investigated. After a preliminary census of marine debris on different beaches of Boa Vista Island, Cape Verde, a field test was carried out with four different scenarios: low density marine debris, medium density marine debris, high density marine debris, and a control scenario. The time that hatchlings required to cross the different scenarios was recorded (n = 232). The results showed that crawl times were affected by the different marine debris scenarios, with the "high density" scenario specifically showing a significant difference from the control, low density and medium density scenarios. This study provides information on the risks of marine debris for hatchling sea turtles and provides conservation recommendations to reduce this potential risk.

Hepatitis B virus genotypes A1, A2 and E in Cape Verde: Unequal distribution through the islands and association with human flows

Hepatitis B virus (HBV) diversity has not been previously studied in Cape Verde. The archipelago was discovered in 1460 by Portuguese explorers, who brought African slaves to colonise the islands. In this study, we investigated the HBV characteristics from 183 HBsAg-positive Cape Verdean individuals. Phylogenetic analysis of the pre-S/S region and the full-length genomes revealed 54 isolates with HBV/A1 (57%), 21 with HBV/A2 (22%), 19 with HBV/E (20%), and one with HBV/D (1%). HBV genotypes and subgenotypes were unequally distributed through the islands. In São Vicente, the main northern island, most isolates (84%) belonged to the African-originated HBV/A1, with the remaining isolates belonging to HBV/A2, which is prevalent in Europe. Interestingly, the HBV/A1 isolates from São Vicente were closely related to Brazilian sequences into the Asian-American clade, which suggests the dissemination of common African ancestors through slave trade. In contrast, in Santiago and nearby southern islands, where a recent influx from different populations circulates, a higher diversity of HBV was observed: HBV/A1 (40%); HBV/E (32%); HBV/A2 (28%); and HBV/D (1%). HBV/E is a recent genotype disseminated in Africa that was absent in the era of the slave trade. African and European human flows at different times of the history may explain the HBV diversity in Cape Verde. The possible origin and specifics of each HBV genotype circulating in Cape Verde are discussed.

New era / new solutions: The role of alternative tariff structures in water supply projects

Water utilities face different challenges that may force them to seek prioritized objectives. When doing so, particular projects may have to be developed, being important to understand their impact on water tariffs, and thus, on customers. Such consequences may bear an increased relevance in cases stressed with, e.g., resource scarcity, poverty, and the need for infrastructure investments. The resulting cost and revenue variability demand a comprehensive study. If the first may require a stochastic modeling (in major cost components) in order to consider its inherent uncertainty, the second needs to be modeled following context-specific objectives set by the relevant stakeholders. The solutions achieved will likely promote distinct revenue sources, as well as diversified water tariff structures. A multi-objective optimization model (i.e., a Framework for Suitable Prices) is built to deal with those diversified requirements (e.g., stochastic energy costs, affordability, cost recovery, or administrative simplicity). The model is solved through achievement scalarizing functions with several weighting coefficients for a reference point, so as to provide a significant perception of possible revenue options (and their impact) to the decision makers. The proposed method is applied to a case study, Boa Vista Island in Cabo Verde, in which the background characteristics, namely water sources availability (e.g., the adoption of desalination technologies), economic development and other contextual factors were considered. The key role of tariff structure selection is displayed, instead of assuming it a priori, giving important insights regarding project feasibility.

Medical Training Experience and Expectations Regarding Future Medical Practice of Medical Students at the University of Cape Verde

INTRODUCTION

Cape Verde is a small insular developing state. Its first experience of undergraduate medical education began in October 2015. The purpose of this paper is to describe and analyze the professional expectations and profile of the first class of medical students at the University of Cape Verde.

MATERIAL AND METHODS

A piloted, standardized questionnaire, with closed and open-ended questions, was distributed to registered medical students attending classes on the day of the survey. All data were analyzed using SPSS.

RESULTS

Students decided to study medicine in their mid-teens with relatives and friends having had significant influence over their decisions. Other major reasons for choosing medical training include "to take care of other people", "fascination for the subject matters of medicine" and "I have always wanted to". The degree of feminization of the student population is extremely high (20/25; 80.0%). Medical students are in general satisfied with the training program, and have expectations that the training received will allow them to be good professionals. Nevertheless, they consider the course too theoretical. Medical students know that this represents an opportunity for them to contribute to public welfare. Nonetheless, their expectations are to combine public sector practice with private work. Medical students come mostly from Santiago Island where the Capital of the Country is located. They still do not know about their future area of specialization. But all of those who want to specialize want to do so abroad. They mostly expect to follow hospital careers rather than health administration or family and community medicine.

DISCUSSION

This study contributes to the growing body of knowledge about medical students' difficulties and expectations regarding medical schools or curriculums in lusophone countries. The decision to invest in the training of local physicians is justified by the need to be less dependent on foreigners. Local postgraduate medical training programs are already considered a priority for the immediate future.

CONCLUSION

Cape Verde is pursuing a bold strategy to deal with a shortage of medical doctors. The problems experienced by medical students provide an important insight to help the new medical school to provide a better learning environment for students. The fact that students are not sure about their future area of specialization is an opportunity to guide them towards the areas of the health system with pressing needs. The current feminization of the medical workforce will be sustained with the profile of the present intake, hence the need to take this into account in workforce planning.

Evaluation of Novel Routes for NOx Formation in Remote Regions

Photochemical cycling of nitrogen oxides (NO_x) produces tropospheric ozone (O₃), and NO_x is traditionally considered to be directly emitted. The inability of current global models to accurately calculate NO_x levels, and concurrently, difficulties in performing direct NO_x measurements in low-NO_x regimes (several pptv or several tens of pptv) globally introduce a large uncertainty in the modeling of O₃ formation. Here, we use the near-explicit Master Chemical Mechanism (MCM v3.2) within a 0D box-model framework, to describe the chemistry of NO_x and O₃ in the remote marine boundary layer at Cape Verde. We explore the impact of a recently discovered NO_x recycling route, namely photolysis of particulate nitrate, on the modeling of NO_x abundance and O₃ formation. The model is constrained to observations of long-lived species, meteorological parameters, and photolysis frequencies. Only a model with this novel NO_x recycling route reproduces levels of gaseous nitrous acid, NO, and NO₂ within the model and measurement uncertainty. O₃ formation from NO oxidation is several times more efficient than previously considered. This study highlights the need for the inclusion of particulate nitrate photolysis in future models for O₃ and for the photolysis rate of particulate nitrate to be quantified under variable atmospheric conditions.

Chemical element accumulation in tree bark grown in volcanic soils of Cape Verde-a first biomonitoring of Fogo Island

Barks from Prosopis juliflora (acacia) were collected in 12 sites of different geological contexts over the volcanic Fogo Island (Cape Verde). Elemental contents of Ba, Br, Co, Cr, Fe, K, Na, Zn and some rare earth elements (REE)-La, Ce, Sm, Eu, Tb, Yb, and Lu, were obtained for biological samples and topsoils by using k ₀-standardized and comparative method of instrumental neutron activation analysis (INAA), aiming the evaluation of chemical elements uptake by acacia bark. This first biomonitoring study of Fogo Island showed that, in general, significant accumulations of trace elements present in high amounts in these soils occur. This can be partially explained by the semi-arid climate with a consequent bioavailability of chemical elements when rain drops fall in this non-polluted environment. REE enrichment factors (EFs) increase with the decrease of ionic radius. Heavy REE (HREE) are significantly enriched in bark, which agrees with their release after the primary minerals breakdown and the formation of more soluble compounds than the other REE, and uptake by plants. Among the potential harmful chemical elements, Cr appears to be partially retained in nanoparticles of iron oxides. The high EFs found in tree barks of Fogo Island are certainly of geogenic origin rather than anthropogenic input since industry and the use of fertilizers is scarce.

[Implementation of Telemedicine in Cape Verde: Influencing Factors]

INTRODUCTION

Telemedicine is the provision of health services, where distance is a critical factor, using information and communication technologies. Cape Verde has bet on using this tool to increase access of the population of its islands to specialized care.

MATERIAL AND METHODS

Qualitative study, covering the period between 2013 and 2014. It uses document analysis, semi-structured interviews and focus groups to collect data and analysis of content for their analysis. The participant population includes doctors, nurses and professionals from some institutions related to telemedicine.

RESULTS

The priorities of the National Telemedicine Program are set, the cores and reference centers are operational, with trained personnel and equipment installed. Several other policy instruments and conditioning factors and facilitators of the program have been identified.

DISCUSSION

Telemedicine is contributing to the reduction of inequalities in access to health, in Cape Verde. However, the full adoption of a service based on a new technology depends on conditioning factors and facilitators, and several success factors of telemedicine, identified in the literature, are not observed and in conjunction with other existing weaknesses affect the overall development of the National Telemedicine Program. However the strengths and capabilities are highlighted opportunities to act.

CONCLUSION

Despite the progress, some telemedicine success factors highlighted on the literature are not seen in the country.

Population size, breeding biology and on-land threats of Cape Verde petrel (Pterodroma feae) in Fogo Island, Cape Verde

Cape Verde petrel (Pterodroma feae) is currently considered near threatened, but little is known about its population size, breeding biology and on land threats, jeopardizing its management and conservation. To improve this situation, we captured, marked and recaptured (CMR) birds using mist-nets over 10 years; measured and sexed them; monitored up to 14 burrows, deployed GPS devices on breeders and analyzed activity data of geolocators retrieved from breeders in Fogo (Cape Verde). We set cat traps over the colony and investigated their domestic/feral origin by marking domestic cats from a nearby village with transponders, by deploying GPS devices on domestic cats and by performing stable isotope analyses of fur of the trapped and domestic cats. The population of Fogo was estimated to be 293 birds, including immatures (95% CI: 233–254, CMR modelling). Based on geolocator activity data and nest monitoring we determined the breeding phenology of this species and we found biometric differences between sexes. While monitoring breeding performance, we verified a still ongoing cat predation and human harvesting. Overall, data gathered from trapped cats without transponder, cats GPS trips and the distinct isotopic values between domestic and trapped cats suggest cats visiting the colony are of feral origin. GPS tracks from breeders showed birds left and returned to the colony using the sector NE of the islands, where high level of public lights should be avoided specially during the fledging period. Main threats for the Cape Verde petrel in the remaining breeding islands are currently unknown but likely to be similar to Fogo, calling for an urgent assessment of population trends and the control of main threats in all Cape Verde Islands and uplisting its conservation status.

The evolution of the medical workforce in Cape Verde since independence in 1975

BACKGROUND

Cape Verdean doctors have always graduated abroad. The first experience of pre-graduate medical education in Cape Verde begun in October 2015. Counting how many doctors Cape Verde has, knowing who they are, and knowing how they are distributed are very important to help fine-tune the medical training. The aim of this study is to analyze the evolution of the medical workforce in Cape Verde to support medical education implementation.

METHODS

Secondary data on doctors, from July 1975 until December 2014, collected from the Ministry of Health, were entered into an SPSS 20 database and studied by a simple descriptive statistical analysis.

RESULTS

The database included data on 401 medical doctors. There was a predominance of females (n = 218; 54.4%). The overwhelming majority (n = 378; 94.3%) graduated from 5 of the 17 countries that contributed to the training of Cape Verdean doctors. All the islands of this archipelago country contributed to the 324 (80.8%) doctors born in the country. Of the 272 doctors still active in December 2014, 119 (43.6%) were general practitioners and 153 (56.4%) had specialized in one of the 31 specialties. The national ratio of doctors per 10 000 inhabitants was 5.25, but the reality varied significantly among islands. About one third of the doctors (n = 86; 32%) were at the primary care level, 38 (14%) at the secondary care level, and 144 (52%) in central hospitals. In 2053, all active physicians in 2014 will already be retired.

CONCLUSIONS

This is a unique study of the evolution of the medical workforce of a country over 40 years, from the first day of independence. The study illustrates the importance of international collaborations, particularly of Cuba, in sustaining the medical workforce in Cape Verde. It is an example of how this collaboration was used to equip the country with doctors in an increasingly more equitable distribution across all islands. The study further illustrates the progressive feminization of the medical workforce. The study clarifies the effort required from the emerging medical faculty to supply the national health system with the needed number of doctors.