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

en

Economic analysis of an educational human security model in southwestern bateyes of the Dominican Republic / Análisis económico de un modelo educativo de seguridad humana en los bateyes del suroeste de la República Dominicana

Objetivos: realizar un análisis económico para evaluar los costos de una intervención educativa, utilizando los principios de un modelo de seguridad humana en Bateyes del suroeste de la República Dominicana. Métodos: se consideraron cuatro recursos de intervención, incluyendo la capacitación del personal, los incentivos mensuales, la supervisión de las actividades de campo y el costo total asociado al tratamiento anual de la diarrea aguda. El gasto se comparó entre el programa estándar de atención (Batey Control) y la intervención con el modelo de seguridad humana (Batey Caso). Resultados: el ahorro del costo total anual para el Ministerio de Salud de República Dominicana asociado con la reducción de la incidencia de episodios de diarrea aguda fue de US$252,399. Si se extrapolan a los 300 Bateyes de República Dominicana, se podría ahorrar aproximadamente US$75 millones en prevención de enfermedades infecciosas. Conclusiones: el modelo de seguridad humana luce ser un método eficaz para mejorar el conocimiento sobre la prevención de enfermedades y aumentar el empoderamiento de la comunidad para la movilización de recursos. Aplicada a otros entornos, la intervención podría tener una incidencia beneficiosa en las poblaciones de refugiados e indocumentados bajo el impacto de la violencia estructural.

Objectives: To conduct an economic analysis to evaluate the costs of an educational intervention, using the human security model, and potential sources of economic benefits, in Southwestern Bateyes in the Dominican Republic. Methods: Four intervention resources were considered, including staff training, monthly incentives, supervision of field activities, and total cost associated with annual treatment for acute diarrhea. The expenditure was compared between the standard program of care and the intervention using the human security model. Results: The total annual cost saving to the Dominican Republic Ministry of Health, associated with reducing the incidence of acute diarrhea episodes, was US$252,399. If this is extrapolated to the 300 Bateyes of the Dominican Republic, the Ministry of Health could save approximately US$75 million in infectious disease prevention by implementing this intervention model in these isolated rural communities. Conclusions: The educational intervention, which incorporated a human security approach, appeared to be an effective method to enhance knowledge about disease prevention and to increase empathy among community members for resource mobilization and local empowerment. Applied to other settings, the intervention could have a beneficial impact on refugee and undocumented populations under the

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.

One Health and veterans' post-deployment health.

Since 2001, more than 3.3 million US service members have been deployed to operations Iraqi Freedom, Enduring Freedom, New Dawn, Inherent Resolve and Freedom's Sentinel. Visible and invisible war wounds from direct combat experiences, coupled with environmental exposures to harmful substances, can complicate veterans' health throughout their lifespan. While promoting a holistic view of health, health professionals should be attentive for potential risks associated with environmental or animal exposures (One Health concept). During deployment, infectious and non-infectious environmental exposures and harmful substances in the air, on the land and in the water may result in immediate- or long-term health effects. Veterans can also face psychosocial health risks when home that may impact their concentration, emotional responses and social interactions. To strengthen health professions education, the authors recommend that curricula incorporate a comprehensive overview of veterans' physical and psychosocial health risks as a result of their deployment. They describe four specific curriculum topics, competencies and didactic methods that can reinforce veteran-specific content for clinical education and training. By applying the One Health concept, health professionals can document harmful environmental exposures during deployment, report gaps in clinical practice, and provide support for veterans' physical and psychosocial health needs when returning to civilian life.

A survey on the effectiveness of WhatsApp for teaching doctors preparing for a licensing exam.

INTRODUCTION: The use of WhatsApp for health professional education is not novel and is described increasingly in literature as an affordable, familiar, and convenient tool for collaboration. Social media technologies for health practitioner education allow the use of text and audio-visual aids, peer-to-peer based learning, and problem-based learning. This study presents a survey on the effectiveness of WhatsApp in doctors' preparation for a medical licensing exam. METHODS: A cross-sectional study was conducted among one hundred and ninety-four participants of a WhatsApp group preparing for the PLAB exam over a three-month period. A twenty-item questionnaire designed on Google Form was completed by consenting participants on the publication of exam results. RESULTS: Of the one hundred and ninety-four participants, one hundred and fourteen met the eligibility criteria, 57.9 percent were male and 42.1 percent were female, aged between twenty-four and forty-three years of age ([Formula: see text] years). A total of 88.6 percent of participants passed the exam in contrast to the global average pass rate of 69 percent, while the average score among participants was 131.5 compared to a global average score of 128. Passing the exam was significantly associated with combining the WhatsApp group with the online question bank Plabable (p = 0.001). While the mean age of those who passed the PLAB exam was lower than those who did not pass the exam, the number of years post-graduation had no significant association with passing the exam. A total of 93.8 percent stated that moderators were knowledgeable, 83.3 percent reported that the platform increased their motivation to learn, 72.8 percent felt that the session were organised and easy-to-follow, and 97.4 percent of participants reported they would recommend the PLAB network. CONCLUSION: WhatsApp can be an effective tool for health professional education, using a pre-defined curriculum coupled with organizational structure. This study reported both subjective and objective measures of effectiveness and demonstrated that the use of multiple e-learning resources can lead to improved learning outcomes.

Timing of treatment interruption among latently infected tuberculosis cases treated with a nine-month course of daily isoniazid: findings from a time to event analysis.

BACKGROUND: Treatment of latent tuberculosis infection (LTBI) in high-risk groups is an effective strategy for TB control and elimination in low incidence settings. A nine-month course of daily isoniazid (INH) has been the longest prescribed therapy; however, completion rates are suboptimal. We need data to guide TB program outreach efforts to optimize LTBI treatment completion rates. METHODS: We pooled seven (2009-2015) years of LTBI treatment outcome data. We computed the probability of INH treatment disruption over time by patient demographic and clinical risk factors. We used log-rank tests and Cox proportional hazards models to assess the risk factors for treatment disruption. RESULTS: We analyzed data from 12,495 persons with complete data on INH treatment initiation. Pediatric cases (0-17 years), recent contacts of active TB patients, and non-U.S.-born adults living in the United States ≤5 years represented 25.2, 13.0, and 59.2% of the study population, respectively. Overall, 48.4% failed to complete therapy. The median treatment duration was 306 days (95% CI: 297, 315). A significant drop in adherence could be observed around day 30 of treatment initiation. Indeed, by day 30 of treatment, 17.0% (95% CI: 16.4, 17.7) of patients had defaulted on therapy. Pediatric patients (HR = 0.83, 95% CI: 0.78, 0.89), recent contacts (HR = 0.74, 95% CI: 0.68, 0.81), patients with diabetes (HR = 0.77, 95% CI: 0.60, 0.98), and patients with HIV (HR = 0.39, 95% CI: 0.30, 0.51) had a lower risk of treatment default. However, black patients (HR = 1.57, 95% CI: 1.44, 1.70), Hispanic patients (HR = 1.54, 95% CI: 1.43, 1.66), and non-U.S.-born persons living in the United States ≤5 years (HR = 1.25, 95% CI: 1.18, 1.32) were significantly more likely to default on therapy. CONCLUSIONS: In this analysis of INH treatment outcome, we see high levels of treatment discontinuation. On average, patients defaulted on their prescribed nine-month daily INH therapy within 30 days of initiating treatment, and those at increased risk of progression to active disease were most likely to do so. We highlight the need to introduce patient-centered programs to increase treatment adherence in this population.