Empowering medical students through collaborative writing sessions.

BACKGROUND: Scientific writing and critical appraisal of the literature are fundamental skills for future physicians. However, these skills have been inconsistently prioritised across medical curricula, leaving medical trainees to seek these skills through continuing education courses. APPROACH: We conducted a series of complementary collaborative writing sessions (introductory workshop with 3-month practical sessions) with direct supervision to medical trainees (medical students and recent medical graduates) in the Dominican Republic between 2017 and 2020. We also examined medical trainees' perceptions of  these collaborative writing sessions, as a mechanism to advance technical writing and critical analysis skills for their professional training and personal growth. EVALUATION: Participants described the perceived enabling factors of the collaborative writing sessions that led to their publications as: (1) detailed agenda; (2) direct mentorship; (3) effective teamwork; (4) personal investment and dedication; and (5) future vision. IMPLICATIONS: These collaborative writing sessions, consisting of a viable agenda and timeline, direct mentorship with timely feedback, and team dynamics, are recognised as an innovative model for medical trainees in the Dominican Republic. This academic model and approach can be adapted to meet the specific needs of health professional students across the globe. By mastering these fundamental written communication skills, medical trainees can contribute to research and policy development, lead health education initiatives, advocate for best clinical practices in patient care, and mentor the next generation of trainees.

Cholera in Haiti: A public health challenge in the Dominican Republic and Americas Region

[EXTRACT] Vibrio cholerae is a bacterium that can causes watery diarrhea, and if untreated, severe dehydration can lead to death. The World Health Organization (WHO) describes the global chol- era burden with 1.3−4 million cases and 21 000−143 000 deaths, noting that underreporting remains a significant challenge. A comprehensive approach to cholera elimination – Ending Chol- era – A Global Roadmap to 2030 (reduce cholera deaths by 90% and eliminate cholera in 20 countries by 2030) – integrates sur- veillance activities, water and sanitation interventions, social mobilization efforts, and pharmacological (including preven- tive vaccine) management With four concurrent challenges in Haiti – cholera outbreak, fuel shortages, gang violence, and political instability – an urgent call to action will be essential to curb cholera transmis- sion on Hispaniola. Binational and regional cooperation will be imperative to strengthen cholera prevention and control efforts. Moving forward, the Ending Cholera: Global Roadmap to 2030 coupled with the One Health Joint Plan of Action (2022- 2026) offer a holistic approach toward cholera elimination and improved water and sanitation practices, as part of Sustainable Development Goals 3 and 6.

Integrating One Health topics to enhance health workers' leadership in health promotion activities.

Moving into the next decade, the global health workforce can lead efforts to identify emerging health threats and develop immediate action plans to mitigate adverse effects on community health and well-being. To prepare health workers in their delivery of health education activities, the authors propose three didactic ('train the trainers') approaches: essential 'learning moments', critical analyses of One Health challenges, and the use of innovative real-time visualizations. Health workers' leadership is vital to achieve the targets of the 2030 Agenda for Sustainable Development, to safeguard population health, and ultimately to strengthen global health security.

Cholera in Haiti: A public health challenge in the Dominican Republic and Americas Region

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Lessons Learned During the COVID-19 Pandemic to Strengthen TB Infection Control: A Rapid Review.

INTRODUCTION: Over the past 5 years, substantial global investment has resulted in reduced TB incidence rates by 9% and mortality rates by 14%. However, the coronavirus disease (COVID-19) pandemic has hindered access and availability of TB services to maintain robust TB control. The objective of this rapid review was to describe the challenges to be addressed and recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic. METHODS: Five databases were used to systematically search for relevant articles published in 2020. The 5-step framework proposed by Arskey and O'Malley and adapted by Levac et al. guided the review process. Thematic analysis with grounded theory principles was used to summarize themes from selected articles and integrate analyses with barriers reported from authors' previous TB research. RESULTS: Of the 218 peer-reviewed articles, 20 articles met the inclusion criteria. Four emerging themes described challenges: (1) unprepared health system leadership and infrastructure, (2) coexisting health priorities, (3) insufficient health care workforce support for continued training and appropriate workplace environments, and (4) weak connections to primary health centers hindering community engagement. Four recommendations were highlighted: (1) ensuring leadership and governance for sustainable national health budgets, (2) building networks of community stakeholders, (3) supporting health care workforce training and safe workplace environments, and (4) using digital health interventions for TB care. CONCLUSIONS: National health systems must promote patient-centered TB care, implement ethical community interventions, support operational research, and integrate appropriate eHealth applications. TB program managers and primary care practitioners can serve as instrumental leaders and patient advocates to deliver high-quality and sustainable TB care that leads to achieving the targets of the End TB Strategy.

Health care workers’ recommendations for strengthening tuberculosis infection control in the Dominican Republic

[ABSTRACT]. Objective. To describe health care workers’ practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. Methods. In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers’ recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. Results. Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. Conclusions. Future efforts may combine the health care workers’ recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

[RESUMEN]. Objetivo. Definir las recomendaciones prácticas de los trabajadores de salud para consolidar la adhesión a las prácticas de control de la infección por Mycobacterium tuberculosis en instituciones de salud y otros lugares de la República Dominicana. Métodos. En este estudio cualitativo, se organizaron 10 grupos de debate, con un total de 40 trabajadores clínicos (24 médicos, 16 enfermeras), en dos instituciones de nivel terciario de la República Dominicana en el 2016. El análisis para ampliar las recomendaciones de los trabajadores de salud a fin de estimular a los trabajadores clínicos a adherirse a las prácticas de control de la infección por M. tuberculosis se basó en teoría fundamentada. Para garantizar la fiabilidad y validez de los resultados, los autores analizaron los datos e incorporaron el asesoramiento sobre el diseño y el análisis del estudio a cargo de expertos cualitativos y la verificación de la información con los participantes sobre los temas finales. Resultados. Se encontraron seis temas emergentes: 1) educación y capacitación; 2) política administrativa; 3) política de infraestructura; 4) asignaciones económicas; 5) investigación; y 6) política de salud pública. Conclusiones. En iniciativas futuras para el control de la infección por M. tuberculosis en entornos de escasos recursos, se pueden combinar las recomendaciones de los trabajadores de salud con estrategias basadas en evidencia. De esta forma se podría allanar el camino para llevar a cabo intervenciones que ayuden a los trabajadores de salud a aplicar las medidas de control de la infección por M. tuberculosis en la práctica clínica.

[RESUMO]. Objetivo. Descrever as recomendações dos profissionais da saúde para reforçar a adesão às práticas de controle de infecção por Mycobacterium tuberculosis nas instituições de saúde e outros locais na República Dominicana. Métodos. Estudo qualitativo realizado com 10 grupos de discussão, ao todo 40 profissionais da área clínica (24 médicos, 16 enfermeiros), em duas instituições de nível terciário na República Dominicana em 2016. A análise foi baseada em teoria fundamentada para expandir as recomendações dos profissionais da saúde a fim de habilitar o pessoal da área clínica a aderir às práticas de controle da infecção por M. tuberculosis. Para assegurar a confiabilidade e a validade dos dados, os autores analisaram as informações e incluíram um processo de revisão com especialistas em pesquisa qualitativa (peer debriefing) e observações ou validação dos participantes sobre os temas finais. Resultados. Seis temas emergentes foram descritos: 1) educação e capacitação, 2) política administrativa, 3) política de infraestrutura, 4) alocações financeiras, 5) pesquisa e 6) política de saúde pública. Conclusões. Iniciativas futuras podem combinar as recomendações dos profissionais da saúde com estratégias baseadas em evidências para o controle de infecção por M. tuberculosis em locais com poucos recursos. Isso poderia abrir o caminho para intervenções que habilitam os profissionais da saúde a empregar medidas de controle de infecção por M. tuberculosis na prática clínica.

Health care workers' recommendations for strengthening tuberculosis infection control in the Dominican Republic.

OBJECTIVE: To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. METHODS: In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. RESULTS: Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. CONCLUSIONS: Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

Health care workers' recommendations for strengthening tuberculosis infection control in the Dominican Republic / Recomendaciones de los trabajadores de salud para fortalecer el control del contagio de la tuberculosis en la República Dominicana / Recomendações dos profissionais da saúde para reforçar o controle de infecção pelo bacilo da tuberculose na República Dominicana

ABSTRACT Objective To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. Methods In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. Results Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. Conclusions Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

RESUMEN Objetivo Definir las recomendaciones prácticas de los trabajadores de salud para consolidar la adhesión a las prácticas de control de la infección por Mycobacterium tuberculosis en instituciones de salud y otros lugares de la República Dominicana. Métodos En este estudio cualitativo, se organizaron 10 grupos de debate, con un total de 40 trabajadores clínicos (24 médicos, 16 enfermeras), en dos instituciones de nivel terciario de la República Dominicana en el 2016. El análisis para ampliar las recomendaciones de los trabajadores de salud a fin de estimular a los trabajadores clínicos a adherirse a las prácticas de control de la infección por M. tuberculosis se basó en teoría fundamentada. Para garantizar la fiabilidad y validez de los resultados, los autores analizaron los datos e incorporaron el asesoramiento sobre el diseño y el análisis del estudio a cargo de expertos cualitativos y la verificación de la información con los participantes sobre los temas finales. Resultados Se encontraron seis temas emergentes: 1) educación y capacitación; 2) política administrativa; 3) política de infraestructura; 4) asignaciones económicas; 5) investigación; y 6) política de salud pública. Conclusiones En iniciativas futuras para el control de la infección por M. tuberculosis en entornos de escasos recursos, se pueden combinar las recomendaciones de los trabajadores de salud con estrategias basadas en evidencia. De esta forma se podría allanar el camino para llevar a cabo intervenciones que ayuden a los trabajadores de salud a aplicar las medidas de control de la infección por M. tuberculosis en la práctica clínica.

RESUMO Objetivo Descrever as recomendações dos profissionais da saúde para reforçar a adesão às práticas de controle de infecção por Mycobacterium tuberculosis nas instituições de saúde e outros locais na República Dominicana. Métodos Estudo qualitativo realizado com 10 grupos de discussão, ao todo 40 profissionais da área clínica (24 médicos, 16 enfermeiros), em duas instituições de nível terciário na República Dominicana em 2016. A análise foi baseada em teoria fundamentada para expandir as recomendações dos profissionais da saúde a fim de habilitar o pessoal da área clínica a aderir às práticas de controle da infecção por M. tuberculosis. Para assegurar a confiabilidade e a validade dos dados, os autores analisaram as informações e incluíram um processo de revisão com especialistas em pesquisa qualitativa (peer debriefing) e observações ou validação dos participantes sobre os temas finais. Resultados Seis temas emergentes foram descritos: 1) educação e capacitação, 2) política administrativa, 3) política de infraestrutura, 4) alocações financeiras, 5) pesquisa e 6) política de saúde pública. Conclusões Iniciativas futuras podem combinar as recomendações dos profissionais da saúde com estratégias baseadas em evidências para o controle de infecção por M. tuberculosis em locais com poucos recursos. Isso poderia abrir o caminho para intervenções que habilitam os profissionais da saúde a empregar medidas de controle de infecção por M. tuberculosis na prática clínica.

The Role of Powerlessness Among Health Care Workers in Tuberculosis Infection Control.

Due to their occupational exposure in health care settings, health care workers (HCW) have increased risk of Mycobacterium tuberculosis infection. They face challenges to remain up-to-date with evidence-based clinical practices and translate educational information into actions in infection control practices. Our purpose was to examine this "knowledge-action" gap about how HCWs understand their occupational M. tuberculosis risk and use recommended infection control measures in clinical practices in the Dominican Republic (DR). We conducted 10 focus groups with 40 physicians and nurses at two tertiary-level DR institutions. Using grounded theory methods, we developed a theoretical model to describe the decision-making process related to adherence to M. tuberculosis infection control measures in clinical practice. Findings highlight intrinsic and extrinsic factors that influenced the observed knowledge-action gap related to M. tuberculosis infection control practices in two DR health institutions.

Perceived Barriers to Adherence to Tuberculosis Infection Control Measures among Health Care Workers in the Dominican Republic.

INTRODUCTION Health care workers have an increased risk of infection due to occupational Mycobacterium tuberculosis exposure, including multidrug-resistant strains. Health care workers' risk of developing tuberculosis is greater than that of the general population, whether in low-, intermediate- or high-incidence countries. Adherence to infection control measures (administrative controls, environmental controls, and personal respiratory protection) is essential to reduce risk of disease transmission between suspected tuberculosis patients and health care workers, but for different reasons, both objective and subjective, adherence is low. Identifying the causes of low adherence is a prerequisite to effective programming to reduce risk. OBJECTIVE Identify perceived barriers to adherence to tuberculosis infection control measures among health care workers in the Dominican Republic. METHODS During August 2014, a qualitative study was conducted in two tertiary-level hospitals in different regions of the Dominican Republic. A semi-structured interview guide of nine questions was developed, based on the scientific literature and with consensus of clinical experts. Nine semi-structured interviews were conducted with a purposive sample of seven physicians (five men, two women) and two baccalaureate nurses (both women) working in the emergency medicine, internal medicine or nursing departments of those institutions. Question topics included clinical experience of M. tuberculosis infection and disease; knowledge of disease transmission and preventive practices; clinical management strategies; and perceptions of effectiveness of directly observed treatment, short-course, and disease coping strategies. RESULTS Perceived barriers were described as: 1) sense of invincibility of health care workers; 2) personal beliefs of health care workers related to direct patient communication; 3) low provider-to-patient ratios in hospitals; 4) absence of tuberculosis isolation units for patients within hospitals; and 5) limited availability of protective masks for health care workers. CONCLUSIONS Our results highlight that perceived barriers at the individual or institutional level may hinder how health care workers understand and comply with preventive strategies to reduce risk of tuberculosis transmission. Addressing these barriers by strengthening infection control program infrastructure and implementing educational interventions within institutions may reduce risk of nosocomial tuberculosis transmission to health care workers. KEYWORDS Health care providers, infection control, infectious disease transmission, health care associated infection, nosocomial infection, Mycobacterium tuberculosis occupational exposure, occupational health, qualitative research, tuberculosis, Dominican Republic.

Fascitis necrotizante secundaria a inserción de sonda de gastrostomía endoscópica percutánea / Necrotizing fascitis secondary to percutaneous endoscopic gastrostomy

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Conducta sexual incestuosa en una población de estudiantes de Santo Domingo / Incestuos sexual behavior in a population of students from Santo Domingo

Estudio descriptivo, de corte transversal realizado con el objetivo de determinar la prevalencia de incesto en una muestra aleatoria sistemática estratificada de 386 estudiantes de bachillerato en dos centros de estudios secundarios de Santo Domingo, República Dominicana, 1993. El sexo femenino predominó con 59.1//y el 67.9//de todos los estudiantes reportó haber tenido experiencias sexuales (262 casos) y de este grupo el 18.1//(70 casos) relaciones incestuosas, principalmente entre primos para un 60//(42 casos) y en segundo lugar con tíos o tías. El 70//de los estudiantes con experiencias incestuosas (490 casos) no comentó el hecho con ninguna persona