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1.
Am J Trop Med Hyg ; 102(6): 1172-1174, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32358952

RESUMEN

The first case of novel coronavirus disease (COVID-19) in the Dominican Republic coincided with a period of political crisis. Distrust in governmental institutions shaped the critical phase of early response. Having a weak public health infrastructure and a lack of public trust, the Ministry of Health (MoH) began the fight against COVID-19 with a losing streak. Within 45 days of the first reported case, the political crisis and turmoil caused by "fake news" are limiting the capacity and success of the MoH response to the pandemic.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Medios de Comunicación Sociales/ética , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/provisión & distribución , Azitromicina/provisión & distribución , Azitromicina/uso terapéutico , Betacoronavirus/efectos de los fármacos , Desórdenes Civiles , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/economía , Disentimientos y Disputas , República Dominicana/epidemiología , Reposicionamiento de Medicamentos , Humanos , Hidroxicloroquina/provisión & distribución , Hidroxicloroquina/uso terapéutico , Ivermectina/provisión & distribución , Ivermectina/uso terapéutico , Pandemias/economía , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/economía , Política , Salud Pública/economía , Salud Pública/tendencias , Confianza/psicología
2.
Lancet ; 395(10234): 1434-1443, 2020 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-32197107

RESUMEN

BACKGROUND: An unmet clinical need remains for an effective tetravalent dengue vaccine suitable for all age groups, regardless of serostatus. We assessed the immunogenicity and safety of three different dose schedules of a tetravalent dengue vaccine (TAK-003) over a 48-month period in children living in dengue-endemic countries. METHODS: We did a large, phase 2, double-blind, placebo-controlled trial at three sites in the Dominican Republic, Panama, and the Philippines. Healthy participants aged 2-17 years were randomly assigned 1:2:5:1 using an interactive web response system with stratification by age to receive either a two-dose primary series (days 1 and 91), one primary dose (day 1), one primary dose plus booster (days 1 and 365), or placebo. Participants and relevant study personnel were masked to the random assignment until completion of the study at month 48. To maintain masking, TAK-003 recipients were administered placebo doses when appropriate. The primary objective was assessment of neutralising geometric mean titres for each serotype to month 48 assessed in the per-protocol immunogenicity subset. Secondary safety endpoints included proportions of participants with serious adverse events and symptomatic virologically confirmed dengue. This study is registered with ClinicalTrials.gov, NCT02302066. FINDINGS: Between Dec 5, 2014, and Feb 13, 2015, 1800 children were randomly assigned to the following groups: two-dose primary series (n=201), one primary dose (n=398), one primary dose plus 1-year booster (n=1002), and placebo (n=199). Of them, 1479 (82%) participants completed the 48-month study. Immunogenicity endpoints were assessed in 562 participants enrolled in the immunogenicity subset, of whom 509 were included in the per-protocol subset. At month 48, antibody titres remained elevated in all TAK-003 groups compared with placebo, irrespective of baseline serostatus. At month 48, geometric mean titres were 378 (95% CI 226-632) in two-dose, 421 (285-622) in one-dose, 719 (538-960) in one-dose plus 1-year booster, and 100 (50-201) in placebo recipients against DENV 1; 1052 (732-1511), 1319 (970-1794), 1200 (927-1553), and 208 (99-437) against DENV 2; 183 (113-298), 201 (135-298), 288 (211-392), and 71 (37-139) against DENV 3; and 152 (97-239), 164 (114-236), 219 (165-290), and 46 (26-82) against DENV 4; and tetravalent seropositivity rate was 89% (79-96), 86% (80-92), 97% (93-99), and 60% (47-72), respectively. Virologically confirmed dengue was recorded in 37 (2%) TAK-003 and 13 (7%) placebo participants, with a relative risk of 0·35 (0·19-0·65). No vaccine-related serious adverse events or severe dengue virus disease were reported. INTERPRETATION: TAK-003 elicited antibody responses against all four serotypes, which persisted to 48 months post-vaccination, regardless of baseline serostatus. No important safety risks were identified. We observed a long-term reduction in risk of symptomatic dengue virus disease in vaccinees. Results from this study provide a long-term safety database and support assessment of the vaccine in the ongoing phase 3 efficacy study. FUNDING: Takeda Vaccines.


Asunto(s)
Vacunas contra el Dengue/efectos adversos , Virus del Dengue/inmunología , Dengue/prevención & control , Inmunogenicidad Vacunal/inmunología , Adolescente , Niño , Preescolar , Dengue/inmunología , Dengue/virología , Vacunas contra el Dengue/administración & dosificación , Virus del Dengue/genética , República Dominicana/epidemiología , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Inmunización Secundaria/métodos , Masculino , Panamá/epidemiología , Filipinas/epidemiología , Placebos/administración & dosificación , Seguridad , Serogrupo , Vacunación/métodos
3.
Lancet ; 395(10234): 1423-1433, 2020 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-32197105

RESUMEN

BACKGROUND: A substantial unmet need remains for safe and effective vaccines against dengue virus disease, particularly for individuals who are dengue-naive and those younger than 9 years. We aimed to assess the efficacy, safety, and immunogenicity of a live attenuated tetravalent dengue vaccine (TAK-003) in healthy children aged 4-16 years. METHODS: We present data up to 18 months post-vaccination from an ongoing phase 3, randomised, double-blind trial of TAK-003 in endemic regions of Asia and Latin America (26 medical and research centres across Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). Healthy children aged 4-16 years were randomly assigned 2:1 (stratified by age and region) to receive two doses of TAK-003 or two doses of placebo, 3 months apart. Investigators, participants and their parents or guardians, and sponsor representatives advising on trial conduct were masked to trial group assignments. Participants presenting with febrile illness were tested for virologically confirmed dengue (VCD) by serotype-specific RT-PCR. In timeframes beginning 30 days post-second dose, the primary endpoint (overall vaccine efficacy) was assessed in the first 11 months, and the secondary endpoints (efficacy by baseline serostatus, serotype, hospitalised dengue, and severe dengue) in the first 17 months. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS: 20 099 participants were randomly assigned and vaccinated between Sept 7, 2016, and Aug 18, 2017; 19 021 (94·6%) were included in the per protocol analysis, and 20 071 (99·9%) in the safety set. The primary endpoint was achieved with an overall vaccine efficacy of 80·2% (95% CI 73·3 to 85·3; 61 cases of VCD in the TAK-003 group vs 149 cases of VCD in the placebo group). In the secondary endpoint assessment timeframe, an overall vaccine efficacy of 73·3% (95% CI 66·5 to 78·8) was observed. Analysis of secondary endpoints showed efficacies of 76·1% (95% CI 68·5 to 81·9) in individuals who were seropositive at baseline, 66·2% (49·1 to 77·5) in individuals who were seronegative at baseline, 90·4% (82·6 to 94·7) against hospitalised dengue, and 85·9% (31·9 to 97·1) against dengue haemorrhagic fever. Efficacy varied by individual serotypes (DENV 1, 69·8% [95% CI 54·8 to 79·9]; DENV 2, 95·1% [89·9 to 97·6]; DENV 3, 48·9% [27·2 to 64·1]; DENV 4, 51·0% [-69·4 to 85·8]). Cumulative rates of serious adverse events were similar in TAK-003 (4·0%) and placebo (4·8%) recipients, and were consistent with expected medical disorders in the study population. Infection was the most frequent reason leading to serious adverse events. 20 participants (<0·1% of the safety set) were withdrawn from the trial due to 21 adverse events by the end of part two; 14 of these participants received TAK-003 and six received placebo. INTERPRETATION: TAK-003 was well tolerated and efficacious against symptomatic dengue in children regardless of serostatus before immunisation. Vaccine efficacy varied by serotype, warranting continued follow-up to assess longer-term vaccine performance. FUNDING: Takeda Vaccines.


Asunto(s)
Vacunas contra el Dengue/efectos adversos , Virus del Dengue/inmunología , Dengue/prevención & control , Vacunación/efectos adversos , Adolescente , Brasil/epidemiología , Niño , Preescolar , Colombia/epidemiología , Vacunas contra el Dengue/uso terapéutico , Virus del Dengue/genética , República Dominicana/epidemiología , Método Doble Ciego , Hospitalización/estadística & datos numéricos , Humanos , Nicaragua/epidemiología , Panamá/epidemiología , Filipinas/epidemiología , Placebos/administración & dosificación , Serogrupo , Índice de Severidad de la Enfermedad , Sri Lanka/epidemiología , Tailandia/epidemiología , Resultado del Tratamiento , Vacunación/métodos
4.
PLoS One ; 14(7): e0219250, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31291297

RESUMEN

The study examines the potential influence of sub-regional variations in climate, and specifically heavy rain events, in determining relative vulnerabilities of locations in twelve Caribbean countries. An aggregate vulnerability index, referred to as the Caribbean Vulnerability Score (CVS), is created using historical demographic and socioeconomic data and climate data representing extreme rain events. Four scenarios are explored. Firstly, comparative vulnerabilities are determined when heavy rainfall is incorporated in CVS versus when it is excluded. The impact of climate change is also investigated using future climate data derived from statistical downscaling but holding demographic and socioeconomic sub-indices constant. The analysis is repeated with projections of future demographic structure from the Shared Socioeconomic Pathway data (SSP3), future climate projections and constant socioeconomic. Finally, the sensitivity of the results is examined with respect to applying different weights i.e. versus using equal weights for the climate and non-climatic components of CVS as is done for the first three scenarios. Results suggest that the inclusion of historical susceptibility to rainfall extremes influences relative vulnerabilities within the Caribbean when compared to the rankings of vulnerability derived using only socioeconomic and demographic inputs. In some cases significant increases in relative rankings are noted. Projected changes in the intensity of rain events across the Caribbean region in the 2030s and 2050s, do not significantly alter the top and lowest ranked vulnerable locations when demographic and socioeconomic indices are held constant. Changes may however occur in the order of the top ranked locations dependent on scenario and time slice. In general, future shifts in relative vulnerabilities were found to be dependent on (i) changes in both future climate and demographic scenarios, (ii) the time horizons being considered, and (iii) the weighting assigned to climate in the future.


Asunto(s)
Cambio Climático , Demografía , Factores Socioeconómicos , Belice/epidemiología , Región del Caribe/epidemiología , Cuba/epidemiología , República Dominicana/epidemiología , Guyana/epidemiología , Humanos , Humedad , Jamaica/epidemiología , Lluvia
6.
Int J Gynaecol Obstet ; 146(3): 296-301, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31152595

RESUMEN

OBJECTIVE: To assess the association between intimate partner violence (IPV) and pregnancy termination in Latin America. METHODS: Demographic and Health Survey (DHS) data were analyzed for Honduras, the Dominican Republic, Colombia, Peru, and Guatemala. Women were asked about their experiences with violence by partners and pregnancy termination. The association between IPV and risk for termination was assessed using adjusted odds ratios (OR) with correction for intracluster correlations. RESULTS: The average prevalence of IPV across the five countries was 31.8%. Women who reported IPV had 1.4 times the odds of experiencing pregnancy termination OR 1.41 (95% CI, 1.32-1.50). A positive dose-response relationship was observed between IPV and termination; a woman who reported three types of IPV showed three times the odds of experiencing pregnancy termination compared with a woman who did not report IPV. Elimination of exposure to IPV in all five countries was associated with 167 743 fewer pregnancy terminations. CONCLUSION: IPV is a risk factor for pregnancy termination. Reduction or elimination of IPV is associated with substantial decline in pregnancy terminations in Latin America. Routine prenatal screening for IPV and counseling could potentially avert a substantial number of pregnancy terminations in these settings.


Asunto(s)
Aborto Inducido/estadística & datos numéricos , Violencia de Pareja/estadística & datos numéricos , Adolescente , Adulto , Colombia/epidemiología , Estudios Transversales , República Dominicana/epidemiología , Femenino , Guatemala/epidemiología , Encuestas Epidemiológicas , Honduras/epidemiología , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Perú/epidemiología , Embarazo , Prevalencia , Factores de Riesgo , Adulto Joven
7.
Acta Odontol Latinoam ; 32(1): 36-43, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31206573

RESUMEN

Several studies have tried to associate the presence of different pathogens with the onset and progression ofperiodontitis, reporting a wide variety of results from different populations and environments. The aim of this study was to determine the main periodontal pathogens present in the subgingival biofilm of Dominican patients with periodontitis, by using specific microbiological culturing techniques. Periodontitis patients were selected after a full-mouth periodontal evaluation, and assigned to different periodontitis groups based on percentage of affected locations. Subgingival samples were collected and analyzed by means of specific culture techniques. Anaerobic counts, frequency of detection and proportions of target pathogens were calculated. Variables were analyzed by means of Student's T-test or chi-square test. Twenty-nine subjects were recruited, of whom 17 were diagnosed with generalized periodontitis (GenP) and 12 with localized periodontitis (LocP). The most prevalent bacterial species in both groups was Prevotella intermedia (94.1% in GenP and 91.7% in LocP), followed by Porphyromonas gingivalis (88.2% in GenP and 83.3% in LocP). Total microbiota in subgingival samples was 1.3 x107 colony-forming units (CFU)/mL (standard deviation, SD=1.5 x107) and 9.6x10s CFU/mL (SD=1.1 x107) in GenP and LocP subjects, respectively, though differences were not statistically significant (p=0.222). The highest counts were observed for P gingivalis in both groups, with mean concentration 2.5x10s CFU/mL (6.1x10s) in GenP and 2.9x10s CFU/mL (5x10s) in LocP, with no statistically significant difference (p=0.879). These results suggest that relevant periodontal pathogens are found with diversity and abundance in the subgingival microbiota of adult Dominican patients with periodontitis.


Asunto(s)
Infecciones Bacterianas/microbiología , Técnicas de Cultivo/métodos , Bacterias Gramnegativas/aislamiento & purificación , Periodontitis/microbiología , Adulto , Aggregatibacter actinomycetemcomitans/aislamiento & purificación , Infecciones Bacterianas/epidemiología , Biopelículas , Estudios Transversales , República Dominicana/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodontitis/clasificación , Periodontitis/epidemiología , Porphyromonas gingivalis/aislamiento & purificación , Prevalencia , Prevotella intermedia/aislamiento & purificación
8.
Diabetes Metab Syndr ; 13(3): 1727-1732, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31235085

RESUMEN

AIM: To identify the demographic and clinical characteristics of Dominican adults admitted to a diabetic foot clinic and compare these characteristics by sex to better characterize and understand the severity of diabetes in the Dominican Republic. METHODS: We conducted a retrospective medical chart review of Dominican adults admitted to the National Institute of Diabetes, Endocrinology, and Nutrition's (INDEN) diabetic foot clinic between January 1st, 2015 and December 31st, 2015. We generated descriptive statistics and compared results by sex. RESULTS: We assessed 447 medical charts of patients admitted in 2015. More men visited the clinic than women (65% vs. 35%). The average duration of diabetes was 14.4 ±â€¯8.9 years. Abscess was the most common foot problem (74% in men, 68% in women, p = 0.164). A slightly smaller proportion of men received amputations than women (46% vs. 51%, p = 0.390). Women were older (p < 0.001), less educated (p = 0.004), and less likely to be married (p < 0.001). Women also exhibited higher rates of obesity (p = 0.003), hypertension (p = 0.005), cardiovascular disease (p = 0.011), ischemic foot (p = 0.008), and above the knee amputations (p = 0.002). CONCLUSION: Implementation of diabetes education programs, introduction of proper foot care, and improved resources for lifestyle management are needed to increase awareness and subsequently decrease diabetes and its negative impact on the health and economy of the Dominican Republic. Our findings suggest that various risk factors and comorbidities important to the development of diabetes may be disproportionately affecting women. Interventions should focus on women and their behaviors that increase risk for diabetes.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Amputación/estadística & datos numéricos , Pie Diabético/epidemiología , Pie Diabético/patología , Hospitalización/estadística & datos numéricos , Adulto , Anciano , Demografía , República Dominicana/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
9.
Infect Dis Poverty ; 8(1): 39, 2019 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-31130142

RESUMEN

BACKGROUND: The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural 'company towns' called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease. METHODS: From March to April 2016, a cross-sectional, cluster survey was conducted across Dominican bateyes stratified into three regions: southwest, north and east. A household questionnaire (n = 776), captured demographics, ethnic origin, mobility patterns, malaria intervention coverage, and knowledge, and recent fever and treatment-seeking. Two individuals per household (n = 1418) were tested for malaria parasites by microscopy and rapid diagnostic test (RDT) and LF antigen by filariasis test strip (FTS). Population-level estimates and confidence intervals (CI) were computed adjusting for the survey design. Two-sided t-tests compared differences in knowledge scores. RESULTS: No (0%) blood sample was Plasmodium-positive by microscopy or RDT. Six individuals were FTS-positive (0.5%; 95% CI: 0.2-1.5), but none (0%) of these were microfilariae-positive. Most batey residents were born in the DR (57.8%), documented (85.0%), and permanent residents (85.1%). Very few respondents (9.4%) reported travel to Haiti in the past year. Overall, half (53.8%) of respondents owned a bed net, and 82.3% of net owners reported using it the previous night. Indoor residual spraying (IRS) differed by region (range: 4.7%-61.2%). Most of those with recent fever sought care (56.0%), yet only 30.5% of those seeking care were tested for malaria. Compared to Dominican-born populations, Haitian-born respondents more frequently reported recent fever, did not seek care for the fever, had not heard of malaria, and could not name symptoms or prevention methods. CONCLUSIONS: Malaria and LF transmission appear absent or extremely low in Dominican bateyes, which are a mixture of Haitian and Dominican residents. Travel to Haiti is rare, meaning risk of malaria and LF importation is low. Addressing identified gaps in intervention coverage, malaria knowledge, treatment seeking and service delivery will improve the quality of surveillance for these diseases, particularly among marginalized populations and promote island-wide elimination.


Asunto(s)
Filariasis Linfática/epidemiología , Filariasis Linfática/psicología , Conocimientos, Actitudes y Práctica en Salud , Malaria/epidemiología , Malaria/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos Helmínticos , Antígenos de Protozoos , Niño , Preescolar , Estudios Transversales , República Dominicana/epidemiología , Filariasis Linfática/sangre , Femenino , Haití/etnología , Humanos , Malaria/sangre , Malaria/prevención & control , Masculino , Administración Masiva de Medicamentos , Persona de Mediana Edad , Mosquiteros , Aceptación de la Atención de Salud/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Migrantes , Adulto Joven
10.
PLoS One ; 14(3): e0213868, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30917150

RESUMEN

The prevalence of Helicobacter pylori resistance to levofloxacin and metronidazole was high in the Dominican Republic. We used two-fold agar dilution method to determine the minimum inhibitory concentration of five alternative antibiotics in 63 Dominican strains. We also assessed the genetic mutations associated with the antibiotic resistance using next-generation sequencing. We revealed that all 63 strains were sensitive towards sitafloxacin, furazolidone, and rifabutin. In contrast, the prevalence of rifaximin and garenoxacin resistance were high (82.5% and 34.9%, respectively). Patients more than or equal to 60 years old had the highest risk of double-antibiotic resistance (7/9, 77.8%, OR = 31.5, P = 0.009) and garenoxacin resistances (8/9, 88.9%, OR = 45.33, P = 0.002) with an increasing risk simultaneously by age (P = 0.004, r = 0.357). Almost all rifaximin resistant strains possessed multiple mutations with more than three mutations within rpoB including the most frequent novel mutations of S352L, I2726L, and V2465A. There was a significant association between vacA genotype and rifaximin resistance (P = 0.042). Among 23 levofloxacin-resistant strains, 82.6% (19/23, P <0.001) were also resistant to garenoxacin, and 39.1% (9/23) had a high minimal inhibitory concentration ≥8 µg/mL with positive trend correlation (P = <0.001, r = 0.84). Among 19 garenoxacin resistant strains, 16 (84.2%) contained mutations at D91 and N87 of gyrA. In conclusion, sitafloxacin, rifabutin, and furazolidone might be considered as alternative antibiotics to be included in H. pylori eradication regimen in regions with high prevalence of levofloxacin and metronidazole resistance, such as the Dominican Republic.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Helicobacter pylori/fisiología , Levofloxacino/farmacología , Metronidazol/farmacología , Adulto , Antibacterianos/uso terapéutico , Proteínas Bacterianas/genética , ARN Polimerasas Dirigidas por ADN/genética , República Dominicana/epidemiología , Farmacorresistencia Bacteriana Múltiple/genética , Femenino , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/epidemiología , Helicobacter pylori/efectos de los fármacos , Humanos , Levofloxacino/uso terapéutico , Masculino , Metronidazol/uso terapéutico , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mutación , Prevalencia , Virulencia/genética
11.
Indian J Dent Res ; 30(1): 87-93, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30900663

RESUMEN

Background: The purpose of the study was to gain integrative knowledge on oral hygiene behaviors and daily habits affecting caries experience among rural people in India and Dominican Republic (DR). Materials and Methods: Participants were recruited in two countries: La Esquina community, Province Maria Trinidad Sanchez in DR and in Ramgarh, district Chhindwara in the state of Madhya Pradesh in India. A total of 104 participants (18-80 years) were in the DR sample while 202 participants (18-85 years) were in the Indian sample. Face-to-face interviews collected information on oral hygiene behaviors, daily habits, and dental care. The caries experience was quantified using decayed, missing, and filled teeth (DMFT) index. Results: There were significant differences in a few oral hygiene behaviors, daily habits, and levels of caries experience between the Dominican and Indian subgroups. Use of toothbrush (χ2 = 65.2; P < 0.001), self-reported use of fluoridated toothpaste (χ2 = 94.04; P < 0.001), use of tobacco (χ2 = 32.4; P < 0.001), dental visit (χ2 = 24.84; P < 0.001), attitude toward seeking professional dental care (χ2 = 85.07; P < 0.001), and DMFT scores (F = 13.3; P < 0.001) were significantly different between the two countries. The caries experience was higher in the Dominicans (9.6 ± 8.0 vs. 4.0 ± 5.7) than India's rural. Conclusions: Oral health practices varied considerably between rural populations in these two countries. Caries prevalence was significantly higher in Dominicans despite higher consumption of tobacco and lesser use of toothbrush among rural Indians in the subcontinent.


Asunto(s)
Caries Dental/epidemiología , Caries Dental/psicología , Hábitos , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Higiene Bucal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Índice CPO , Atención Odontológica , República Dominicana/epidemiología , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural/estadística & datos numéricos , Fumar Tabaco/epidemiología , Cepillado Dental/estadística & datos numéricos , Adulto Joven
12.
Infect Genet Evol ; 70: 131-139, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30790700

RESUMEN

Entomopathogenic nematodes (EPNs) form specific mutualistic associations with bioluminescent enterobacteria. In Heterorhabditidis indica, Ochrobactrum spp. was identified beside the symbiont Photorhabdus luminescens but its involvement in the symbiotic association in the EPNs remains unclear. This study describe the population structure and the diversity in Ochrobactrum natural populations isolated from EPNs in the Caribbean basin in order to question the existence of EPN-specialized clones and to gain a better insight into Ochrobactrum-EPNs relationships. EPN-associated Ochrobactrum and Photorhabdus strains were characterized by multi-locus sequence typing, Pulsed-Field Gel Electrophoresis fingerprinting and phenotypic traits. Population study showed the absence of EPN-specialized clones in O. intermedium and O. anthropi but suggested the success of some particular lineages. A low level of genetic and genomic diversification of Ochrobactrum isolated from the natural population of Caribbean nematodes was observed comparatively to the diversity of human-associated Ochrobactrum strains. Correspondences between Ochrobactrum and P. luminescens PFGE clusters have been observed, particularly in the case of nematodes from Dominican Republic and Puerto Rico. O. intermedium and O. anthropi associated to EPNs formed less biofilm than human-associated strains. These results evoke interactions between Ochrobactrum and the EPN symbiotic system rather than transient contamination. The main hypothesis to investigate is a toxic/antitoxic relationship because of the ability of Ochrobactrum to resist to antimicrobial and toxic compounds produced by Photorhabdus.


Asunto(s)
Nematodos/microbiología , Ochrobactrum/genética , Animales , Región del Caribe/epidemiología , República Dominicana/epidemiología , Genética de Población , Humanos , Tipificación de Secuencias Multilocus , Photorhabdus , Filogenia , Puerto Rico/epidemiología , Simbiosis
13.
Glob Public Health ; 14(6-7): 963-976, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30810480

RESUMEN

The emergent Dominican LGBT movement in Santo Domingo, Dominican Republic, has been embedded in local and global structures and discourses related to HIV/AIDS, women's health, and identity. This article explores how ongoing sociocultural changes, increased international HIV funding, and elite support facilitated a surge of collective actions and the institutional reconfiguration of the movement. However, the entry of new cohorts of leaders and the alignment of leaders with global discourses of gender and human rights exposed some rifts within the movement, including over the framing of identity, confrontational tactics, and the role of health issues. While creating political opportunities, international HIV/AIDS funding also consolidated the social movement around HIV at the expense of other issues. The rapid consolidation of the LGBT movement towards HIV issues in the Dominican Republic raises questions about the role of international health funding and health-related NGOs on a movement's discourses, strategies, and consolidation, and about the recruitment of social movement leaders as public health professionals. I suggest that the trajectories of new movements, when social and political opportunities arise, are ultimately defined by their ability to bridge over generational and ideological rifts, engage in a broader spectrum of strategies, and embrace intersectional collective actions.


Asunto(s)
Infecciones por VIH , Derechos Humanos , Minorías Sexuales y de Género , Cambio Social , República Dominicana/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Cooperación Internacional , Política
14.
Diabetes Res Clin Pract ; 148: 212-221, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30641164

RESUMEN

AIMS: To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. METHODS: Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. RESULTS: 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m2, HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. CONCLUSIONS: Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Mejoramiento de la Calidad , Servicios de Salud Rural , Adulto , Anciano , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/normas , Diabetes Mellitus Tipo 2/complicaciones , República Dominicana/epidemiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/normas , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/normas , Población Rural/estadística & datos numéricos
15.
Emerg Infect Dis ; 25(2): 247-255, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30666928

RESUMEN

Zika virus infection during pregnancy may result in birth defects and pregnancy complications. We describe the Zika virus outbreak in pregnant women in the Dominican Republic during 2016-2017. We conducted multinomial logistic regression to identify factors associated with fetal losses and preterm birth. The Ministry of Health identified 1,282 pregnant women with suspected Zika virus infection, a substantial proportion during their first trimester. Fetal loss was reported for ≈10% of the reported pregnancies, and 3 cases of fetal microcephaly were reported. Women infected during the first trimester were more likely to have early fetal loss (adjusted odds ratio 5.9, 95% CI 3.5-10.0). Experiencing fever during infection was associated with increased odds of premature birth (adjusted odds ratio 1.65, 95% CI 1.03-2.65). There was widespread morbidity during the epidemic. Our findings strengthen the evidence for a broad range of adverse pregnancy outcomes resulting from Zika virus infection.


Asunto(s)
Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/virología , Virus Zika , Adolescente , Adulto , Niño , Estudios Transversales , Brotes de Enfermedades , República Dominicana/epidemiología , Epidemias , Femenino , Historia del Siglo XXI , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/historia , Resultado del Embarazo , Vigilancia en Salud Pública , Factores de Riesgo , Adulto Joven , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/historia
16.
Int J STD AIDS ; 30(1): 64-71, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30170526

RESUMEN

This cross-sectional study examines the relationship between social cohesion with consistent condom use (CCU) and sexually transmitted infections (STIs) among the Abriendo Puertas (Opening Doors) cohort of female sex workers (FSWs) living with human immunodeficiency virus (HIV) in the Dominican Republic (n = 228). Using data from the follow-up survey of the cohort, we conducted multivariate logistic regression to explore these dynamics. Social cohesion was significantly associated with CCU between FSWs living with HIV and their clients in the last month (adjusted odds ratio [AOR] = 1.65, 95% confidence interval [CI]: 1.11-2.45) and STI prevalence among FSWs (AOR: 3.76, CI: 1.159-12.162). Social cohesion was not associated with CCU between FSWs living with HIV and their steady partners. However, both illicit drug use in the past six months (AOR = 0.11, CI: 0.023-0.57) and pregnancy intentions (AOR = 0.11; CI: 0.02-0.42) were significantly associated with CCU with steady partners. Findings highlight the differential role of social cohesion on condom use outcomes between FSWs living with HIV and their paying clients versus steady partners. Research on the pathways via which cohesion influences condom use among sex workers and their clients is merited, as is research regarding the role of drug use and pregnancy intentions on condom use with steady partners.


Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/epidemiología , Relaciones Interpersonales , Trabajo Sexual/estadística & datos numéricos , Trabajadores Sexuales/psicología , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Estudios Transversales , República Dominicana/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Sexo Seguro/estadística & datos numéricos , Trabajadores Sexuales/estadística & datos numéricos , Factores Socioeconómicos
17.
Arthritis Care Res (Hoboken) ; 71(10): 1379-1386, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-30171806

RESUMEN

OBJECTIVE: Persons who reside in low- and middle-income countries often have insufficient resources to pay for treatments prescribed for their medical conditions. The aim of this study was to determine, using qualitative methods, how patients with arthritis in the Dominican Republic manage the costs associated with chronic illnesses. METHODS: We conducted individual interviews with 17 Dominican adults with advanced arthritis who were undergoing total knee replacement or total hip replacement at a hospital in Santo Domingo, Dominican Republic. Interviewers followed a moderator's guide with questions pertaining to the financial demands of arthritis treatment and the strategies participants used to pay for treatments. Interviews were audio recorded, transcribed verbatim, and translated into English. We used thematic analysis to identify salient themes. RESULTS: The thematic analysis suggested that health system factors (such as the extent of reimbursement for medications available in the public health care system) along with personal factors (such as disposable income) shaped individuals' experiences of managing chronic illness. These systemic and personal factors contributed to a sizeable gap between the cost of care and the amount most participants were able to pay. Participants managed this resource gap using a spectrum of strategies ranging from acceptance (or, "making do with less") to resourcefulness (or, "finding more"). Participants were aided by strong community bonds and religiously oriented resilience. CONCLUSION: This qualitative study illuminates the range of strategies Dominican individuals with limited resources use to obtain health care and manage chronic illness. The findings raise hypotheses that warrant further study and could help guide provider-patient conversations regarding treatment adherence.


Asunto(s)
Artritis/economía , Enfermedad Crónica/economía , Costos de la Atención en Salud , Recursos en Salud/economía , Investigación Cualitativa , Adulto , Anciano , Anciano de 80 o más Años , Artritis/epidemiología , Artritis/terapia , Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/economía , Artroplastia de Reemplazo de Rodilla/métodos , Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , República Dominicana/epidemiología , Femenino , Costos de la Atención en Salud/normas , Recursos en Salud/normas , Humanos , Masculino , Persona de Mediana Edad
18.
Int Health ; 11(2): 108-118, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30285112

RESUMEN

BACKGROUND: While progress has been made in the elimination of lymphatic filariasis, challenges that call for innovative approaches remain. Program challenges are increasingly observed in 'hard-to-reach' populations: urban dwellers, migrant populations, those living in insecurity, children who are out of school and areas where infrastructure is weak and education levels are low. 'Business-as-usual' approaches are unlikely to work. Tailored solutions are needed if elimination goals are to be reached. This article focuses on mass drug administrations (MDAs) in urban settings. METHODS: We selected the urban poor area of Santo Domingo, Dominican Republic. With three rounds of MDA and with good coverage, elimination was achieved. We wanted to understand contributing factors to achieving good coverage. A qualitative study analyzed context, barriers and facilitators using a predefined framework based on review of the literature. RESULTS: Results show that barriers commonly reported in urban settings were present (population density, lack of organization in household layout, population mobility, violence, shortage of human resources and challenges in monitoring treatment coverage). Tactics used included strong visibility in the community leading to high levels of awareness, the use of laminated photo sheets during house-to-house visits and a 1:4 supervision strategy. The importance of working through community leadership structures and building relationships with the community was evident. DISCUSSION: The approach developed here has applications for large-scale treatment programs for lymphatic filariasis and other diseases in urban settings.


Asunto(s)
Erradicación de la Enfermedad/métodos , Filariasis Linfática/prevención & control , Áreas de Pobreza , Población Urbana , República Dominicana/epidemiología , Filariasis Linfática/epidemiología , Humanos , Administración Masiva de Medicamentos , Investigación Cualitativa
19.
Glob Public Health ; 14(1): 135-146, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29484919

RESUMEN

Type 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.


Asunto(s)
Diabetes Mellitus Tipo 2/psicología , Población Rural , Apoyo Social , Adulto , Anciano , Diabetes Mellitus Tipo 2/epidemiología , República Dominicana/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Servicios de Salud Rural , Población Rural/estadística & datos numéricos
20.
Burns ; 45(2): 471-478, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30573295

RESUMEN

OBJECTIVE: Pediatric burns are preventable with legislative and infrastructural changes. Although retrospective audits of many low- and middle-income countries have aided preventative efforts, the epidemiological status of burns in the Caribbean is not known. This study characterizes pediatric burns in the Dominican Republic (DR) and compares these to age-matched North American records captured by the National Burn Repository. METHODS: A retrospective audit of 1600 patients admitted to the Unidad de Niños Quemados Dra. Thelma Rosario Hospital, the island's only major pediatric burn center, between January 2010 to March 2017 was performed. Epidemiological variables analyzed included age, gender, burn mechanism, year, month, city, admission duration, nationality, mortality, and %TBSA. RESULTS: Pediatric burn patients in the DR sustained larger burns (8.2% vs. 6.5% TBSA) and spent more days in the hospital (10 vs. 6 days). Females were overrepresented (M:F=1:1.5) and mortality amongst admitted patients was 4-fold higher (2.8% vs. 0.7%). Electrical burns were significantly overrepresented in DR (21%) compared to age-matched North American patients (2%). Although electrical burns were smaller (4% TBSA), compared to scald (14% TBSA), and flame (19% TBSA), these burns preferred hands and had a high mortality rate (3%). No significant seasonality in burn mechanisms were observed. Finally, we report geographical and age group differences in the distribution of burn mechanisms and highlight particularly vulnerable subpopulations. CONCLUSION: This investigation identifies a demographical profile where electrical burns account for a significant percentage of the burn population. This provides a basis for concentrating preventative efforts in vulnerable populations.


Asunto(s)
Quemaduras por Electricidad/epidemiología , Traumatismos de la Mano/epidemiología , Adolescente , Distribución por Edad , Superficie Corporal , Unidades de Quemados , Quemaduras/epidemiología , Niño , Preescolar , República Dominicana/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Mortalidad , América del Norte , Pediatría , Estudios Retrospectivos , Estaciones del Año , Distribución por Sexo
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