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1.

Understanding internalized HIV/AIDS-related stigmas in the Dominican Republic: a short report.

Rael, Christine Tagliaferri; Hampanda, Karen
| Idioma(s): Inglés
HIV/AIDS-related stigmas can become internalized, resulting in declines in physical and mental health. Pathways to internalized HIV-related stigma (IS), characterized by persistently negative, self-abasing thoughts, are not well established among women living with HIV/AIDS (WLWHA) in the Dominican Republic (DR). Identifying factors involved in self-directed shaming and blaming is important, given the high HIV prevalence in the DR's most vulnerable populations. The present study sheds light on factors involved in negative and self-abasing thoughts in WLWHA in the DR by examining the relationship between depression, perceived HIV-related stigma from the community (PSC), perceived HIV-related stigma from family (PSF), and IS. The Internalized AIDS-Related Stigma Scale (IA-RSS), the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and an instrument designed to measure perceived HIV-related stigma from the community and family was administered to 233 WLWHA in Puerto Plata, DR. Data were analyzed using descriptive statistics and ordered multiple logistic regression. Results showed that depression (OR = 1.60; p < .05), PSC (OR = 3.68; p < .001), and PSF (OR = 1.60; p < .01) were positively associated with IS. These findings indicate that IS-reducing interventions should address HIV-related depression. Additionally, HIV-related treatment and care services should work with WLWHA to adopt healthier attitudes about how community members view people living with HIV/AIDS in the DR.
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2.

A Pilot Study to Examine the Disparities in Water Quality between Predominantly Haitian Neighborhoods and Dominican Neighborhoods in Two Cities in the Dominican Republic.

Rogers-Brown, Jessica; Johnson, Ryan; Smith, Dominique; Ramsey-White, Kim
| Idioma(s): Inglés
Worldwide, diarrheal disease is a leading cause of death affecting over 1.7 million individuals annually. Much of this can be attributed to lack of clean water, sanitation and hygiene. Nearly all of these deaths occur in countries with developing economies. This public health problem is apparent in the island of Hispaniola; the island that is shared by Haiti and the Dominican Republic. Significant gaps in income between the countries have resulted in Haitians migrating into the Dominican Republic. While there has been increased migration into the Dominican Republic, many of the neighborhoods remain segregated. A cross-sectional analysis was conducted at 49 sites in the Dominican Republic. Samples were classified as being from a Haitian neighborhood or Dominican neighborhood and analyzed for microbial contamination. Overall, Haitian neighborhoods were found to have statistically significantly higher levels of contamination of both coliform and E. coli. The odds of having E. coli contaminated water in Haitian neighborhoods are 4.25 times as high as Dominican neighborhoods. The odds of having coliform contaminated water in Haitian neighborhoods are 4.78 times as high as Dominican neighborhoods. This study provides evidence of the disparity in access to clean drinking water for Haitian immigrants and highlights the need for further investigation.
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3.

Heterosexual transmission of HIV in the Dominican Republic: gendered indicators are associated with disparities in condom use.

Jimenez, Michelle M; Andrade, Flavia C D; Raffaelli, Marcela; Iwelunmor, Juliet
| Idioma(s): Inglés
BACKGROUND: Gendered dynamics in heterosexual relationships compromise women's self-efficacy and increase their vulnerability to acquiring HIV. This study examines the impact of socioeconomic determinants, media exposure, and sexual expectations on sexual behaviors of men and women in the Dominican Republic (DR). METHODS: We analyzed cross-sectional data from 51,018 adults in the Dominican Republic age 15 to 45 years collected by the Demographics and Health Survey (DHS) in 2007. Measures included demographic and socioeconomic indicators, social exposures, sexual expectations and sexual behaviors. Logistic regression models explored gender differences in condom use. RESULTS: Study findings indicated that women were less likely to use a condom at last intercourse than men (odds ratio [OR] = 0.29; 95 % CI = 0.27, 0.31). Among men, secondary (OR = 1.43; 95 % CI = 1.16, 1.76) and higher education (OR = 1.58; 95 % CI = 1.25, 2.00), being in the richest quintile (OR = 1.25; 95 % CI = 1.07, 1.47), and living in a female-headed household (OR = 1.13; 95 % CI 1.03, 1.23) increased the likelihood of condom use. Compared to never married men, currently and formerly married men were less likely to use condoms (OR = 0.03; 95 % CI = 0.03, 0.04 and OR = 0.67; 95 % CI = 0.60, 0.75, respectively). The odds of condom use increased for young women 15-19 years old in comparison with women age 30-34 years, but decreased as they grew older. For women, being in the richer quintile (OR = 1.28; 95 % CI = 1.06, 1.54), living in a female-headed household (OR = 1.26; 1.12, 1.41), and having good access to media (OR = 1.24; 95 % CI = 1.12, 1.42) increased the likelihood of condom use. Being currently married or formerly married and living in rural areas decreased such likelihood among women. CONCLUSIONS: Study findings provide evidence that, in the DHS, socioeconomic and cultural differences between men and women affects condom use. Efforts to reduce HIV transmission within heterosexual relationships in the DR call for tailored, gender-specific interventions that take into account gender differences of power and sexual behaviors.
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4.

Health care workers' knowledge, attitudes and practices on tobacco use in economically disadvantaged dominican republic communities.

Prucha, Michael G; Fisher, Susan G; McIntosh, Scott; Grable, John C; Holderness, Heather; Thevenet-Morrison, Kelly; de Monegro, Zahíra Quiñones; Sánchez, José Javier; Bautista, Arisleyda; Díaz, Sergio; Ossip, Deborah J
| Idioma(s): Inglés
Tobacco use is increasing globally, particularly in low and middle-income countries like the Dominican Republic (DR) where data have been lacking. Health care worker (HCW) interventions improve quit rates; asking patients about tobacco use at each visit is an evidence-based first step. This study provides the first quantitative examination of knowledge, attitudes and practices of DR HCWs regarding tobacco use. All HCWs (N = 153) in 7 economically disadvantaged DR communities were targeted with anonymous surveys. Approximately 70% (N = 107) completed the primary outcome item, asking about tobacco use at each encounter. Despite >85% strongly agreeing that they should ask about tobacco use at each encounter, only 48.6% reported doing so. While most (94.39%) strongly agreed that smoking is harmful, knowledge of specific health consequences varied from 98.13% for lung cancer to 41.12% for otitis media. Few received training in tobacco intervention (38.32%). Exploratory analyses revealed that always asking even if patients are healthy, strongly agreeing that tobacco causes cardiac disease, and always advising smoke-free homes were associated with always asking. Overall, results demonstrate a disconnect between HCW belief and practice. Though most agreed that always asking about tobacco was important, fewer than half did so. Gaps in HCW knowledge and practices suggest a need for education and policy/infrastructure support. To our knowledge, this is the first reported survey of DR HCWs regarding tobacco, and provides a foundation for future tobacco control in the DR.
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5.

Service, training and outreach--the EARS Inc. Model for a self sustainable hearing program in action.

Carkeet, Donna; Pither, David; Anderson, Margaret
| Idioma(s): Inglés
PURPOSE: EARS Inc. is a faith based not-for-profit organization established in 1998. As an organization, it has consistently maintained a goal to provide both short-term and long-term projects in low and middle income countries. One specific project undertaken by EARS Inc involved developing a hearing health program in the Dominican Republic. METHODS: This article is a review of the challenges and successes encountered on the road to establishing improved access and affordability of hearing aid technology for the hearing impaired in Domincan Republic. RESULTS: Despite the challenges, after 12 years of local programming, the hearing health services in the Dominican Republic were successfully implemented. The development of these services included the simultaneous development of a training program, earmould laboratory, hearing aid repair services as well as calibration services and sales of batteries and accessories. CONCLUSIONS: As demonstrated in this review, it is possible to develop sustainable and comprehensive diagnostic and rehabilitation hearing services in a developing country. It is clear that training, equipping and empowering local staffs are instrumental to the success of the program. IMPLICATIONS FOR REHABILITATION: A good hearing aid fitting is more than supplying technology. Patient education and the clinician fitting the hearing aid are important. Access to follow-up services including battery supplies, hearing aid adjustments and hearing aid repairs is essential for a hearing aid fitting program in low and middle income countries to be sustainable. Check the WHO guidelines for hearing aid provision in developing countries when planning a program. When working in a country, co-ordinate with local professionals involved in hearing health where available.
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6.

A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic.

Cavallo, Jaime A; Ousley, Jenny; Barrett, Christopher D; Baalman, Sara; Ward, Kyle; Borchardt, Malgorzata; Thomas, J Ross; Perotti, Gary; Frisella, Margaret M; Matthews, Brent D
| Idioma(s): Inglés
INTRODUCTION: Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at non-profit organization (NPO) costs would lead to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic. METHODS: Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost-savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α = 0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS: The mean cost-savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (n = 13); $332.46 ± $184.09 for bilateral inguinal hernia repair (n = 3); $127.26 ± $13.18 for hydrocelectomy (n = 9); $232.92 ± $56.49 for femoral hernia repair (n = 3); $120.90 ± $30.51 for umbilical hernia repair (n = 8); $36.59 ± $17.76 for minor procedures (n = 26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (n = 7). CONCLUSION: Supply acquisition at NPO costs leads to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for inguinal hernia repair, hydrocelectomy, umbilical hernia repair, minor procedures, and pediatric inguinal hernia repair during a surgical mission in the Dominican Republic. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions.
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8.

Recruitment of Caribbean female commercial sex workers at high risk of HIV infection.

Deschamps, Marie Marcelle; Zorrilla, Carmen D; Morgan, Cecilia A; Donastorg, Yeycy; Metch, Barbara; Madenwald, Tamra; Joseph, Patrice; Severe, Karine; Garced, Sheyla; Perez, Marta; Escamilia, Gina; Swann, Edith; Pape, Jean William
| Idioma(s): Inglés
OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.
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9.

Feasibility of road traffic injury surveillance integrating police and health insurance data sets in the Dominican Republic.

Puello, Adrian; Bhatti, Junaid; Salmi, Louis-Rachid
| Idioma(s): Inglés
OBJECTIVE: To assess the feasibility of semiautomated linking of road traffic injury (RTI) cases in different data sets in low- and middle-income countries. METHODS: The study population consisted of RTI cases in the Dominican Republic in 2010 and were identified in police and health insurance data sets. After duplicates were removed and fatality reporting was corrected by using forensic data, police and health insurance RTI records were linked if they had the same province, collision date, and gender of RTI cases and similar age within five years. A multinomial logistic regression model assessed the likelihood of being in only one of the data sets. RESULTS: One of five records was a duplicate, including 21.1% of 6 396 police and 16.2% of 6 178 insurance records. Health insurance data recorded 43 of 417 deaths as only injured. Capture - recapture estimated that both data sets recorded one of five RTI cases. Characteristics associated with increased likelihood (P < 0.05) of being only in the police data set were female gender [adjusted odds ratio (OR) = 2.5], age ≥ 16 years (OR = 1.7), collision in the regions of Cibao Northeast (OR = 4.1) and Valdesia (OR = 6.4), day of occurrence from Tuesday to Saturday (ORs from 1.5 to 2.9), month of occurrence from October to December (ORs from 1.6 to 4.5), and occupant of four-wheeled vehicles (OR = 5.4) or trucks (OR = 5.3). CONCLUSIONS: Consistent semiautomated linking procedures were feasible to ascertain the RTI burden in the Dominican Republic and could be improved by standardized coding of police and health insurance RTI reporting.
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10.

A cross-national comparison of perceptions of aging and older adults discussion of comparative analysis and findings of the five countries: Part 2.

O'Brien-Suric, Nora
| Idioma(s): Inglés
This international comparative study on perceptions of aging and older people focusing on the predictor variables of Age, Gender, Marital Status, and Income Level has demonstrated that there are similarities and differences among how the participants in the countries view aging and older people. This study is exploratory with the intent to demonstrate that there is much to be gained from investigating the similarities and differences in perceptions of aging among countries.
Resultados  1-10 de 155