Objective. To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 – 2013 . Methods. A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 — 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: “human leptospirosis,” “animal leptospirosis,” “serovars,” “livestock,” “seroprevalence,” “Caribbean countries,” “risk factors,” “confirmed cases,” “suspected cases,” “MAT,” and “ELISA.” Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis . Results. Most cases of leptospirosis occurred during the rainy season (June — December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease . Conclusion. This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a “One Health” multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals .

Background: Childhood obesity is associated with an increased risk of adult obesity and related chronic disease. Our aim was to identify modifiable exposures that are independently associated with obesity in the preschool age group.Methods: A prospective cohort study of 5734 children in New Zealand with anthropometric measurements was completed at age 4.5 years. The modifiable exposures of interest, measured at age 9 months and 2 years, were: food security during infancy; and, at age 2 years, screen time; sleep duration; and takeaway food and soft drink intake. The risk of obesity independently associated with each exposure was determined using Binomial and Poisson regression and described using adjusted risk ratios (RRs) and 95% confidence intervals (CIs), after controlling for confounding variables including gender, ethnicity, birth weight, and mother's age. The probability of obesity given cumulative exposures to the four risk factors and the population attributable fraction (PAF) were estimated.Results: Lower food security during infancy (1 hour/day; RR = 1.22; 95% CI : 1.01-1.48), shorter sleep duration (£11.5 hours/day; RR = 1.30; 95% CI : 1.05-1.61), and weekly to daily consumption of takeaway/soft drink (RR = 1.25, 95% CI : 1.00-1.57) were independently associated with an increased risk of obesity at age 4.5 years. The cumulative PAF for childhood obesity was 42.9%, under an ideal scenario where all risk factors were eliminated.Conclusion: Exposure to modifiable factors by age 2 years is associated with obesity at age 4.5 years. Interventions to prevent childhood obesity need to be effective during infancy.

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