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1.

Out-of-pocket expenditures for HIV in the Dominican Republic: findings from a community-based participatory survey Claire

Chaumont, Claire; Oliveira, Carlo; Chavez, Enrique; Valencia, Jaime; Villalobos Dintrans, Pablo
| Idioma(s): Inglés
[ABSTRACT]. Objectives. The aim of this study was to estimate out-of-pocket expenditures incurred by individuals with HIV in the Dominican Republic. The study utilized different definitions and components for these expenditures and differentiated the results by wage ranges. Methods. Data was obtained from an in-person survey of people living with HIV. The study was developed and implemented in collaboration with Dominican grassroots organizations and networks of people with HIV, through a process of community-based participatory research. Results. The mean HIV-related expenditure reported by individuals in the sample in the last six months prior to the survey was in US$ 181; 15.4% of this total was spent for transportation and housing and costs to access the HIV facility. The mean expenditure reported by individuals for their current visit to an HIV center was US$ 10. These outof- pocket expenditures exhibited regressivity, with lower-wage patients spending proportionally more to receive care. The results highlight the importance of considering other resources required to access treatment, such as lodging expenses and the time needed to travel to an HIV center and then to wait to be seen by a care provider. Conclusions. There should be more focus on expenditures made directly by people with HIV in the Dominican Republic so that these payments do not become a barrier to accessing health care. Using a community-based participatory design can ensure that such data can be leveraged to address the specific barriers to care that are faced by individuals with HIV. [RESUMEN]. Objetivos. El objetivo de este estudio fue estimar los gastos directos de bolsillo que enfrentan las personas con VIH en la República Dominicana, utilizando diferentes definiciones y componentes para estos gastos y desglosando los resultados por rangos salariales. Métodos. Los datos se obtuvieron a partir de una encuesta presencial a personas con infección por el VIH. El estudio se llevó a cabo en colaboración con organizaciones comunitarias locales y redes de personas con infección por el VIH, mediante un proceso de investigación participativa comunitaria. Resultados. El gasto directo promedio en los seis meses anteriores a la encuesta para las personas con VIH que conformaban la muestra fue de US$ 181; el 15,4% del gasto directo total se dedicó a transporte, vivienda y otros costos para acceder al establecimiento de salud. El gasto promedio informado por las personas para su cita actual en el establecimiento de salud fue de US$ 10. El gasto directo presentó regresividad: los pacientes de salario inferior gastaban proporcionalmente más para recibir atención. Los resultados destacan la importancia de considerar otros recursos necesarios para obtener acceso al tratamiento, como los gastos de alojamiento y el tiempo invertido en desplazarse a un centro de atención del VIH y esperar a ser atendido por un prestador de atención. Conclusiones. Es necesario centrar más la atención en el gasto directo de las personas con VIH en la República Dominicana, para que estos costos no se conviertan en un obstáculo al acceso a la atención de salud. Un enfoque participativo comunitario propiciaría el uso de estos datos para abordar los obstáculos específicos que enfrentan las personas con VIH a la hora de obtener atención. [RESUMO]. Objetivos. Estimar as despesas desembolsadas por pessoas com HIV na República Dominicana segundo diferentes definições e itens para estas despesas e a diferenciação dos resultados por faixas salariais. Métodos. Os dados foram obtidos em uma pesquisa presencial com pessoas com HIV. O estudo foi elaborado e executado em colaboração com organizações locais dominicanas e redes de pessoas com HIV por meio de um processo da pesquisa participativa baseada na comunidade. Resultados. A despesa média relacionada ao HIV nos seis meses anteriores à pesquisa informada pelos participantes na amostra estudada foi de US$ 181, sendo que 15,4% deste montante foram gastos com transporte e moradia e custos de acesso ao serviço de HIV. A despesa média informada pelos participantes para a consulta corrente ao centro de assistência de HIV foi de US$ 10. A despesa desembolsada apresentou regressividade, com os pacientes pertencentes à faixa de menor salário gastando proporcionalmente mais para obter atendimento. Estes resultados indicam a importância de considerar outros recursos necessários para obter acesso ao tratamento, como despesas de alojamento e o tempo necessário para ir a um centro de assistência de HIV e aguardar o atendimento por um profissional. Conclusões. É preciso atentar mais às despesas incorridas diretamente pelas pessoas com HIV para que estes gastos não se convertam em barreiras ao acesso à assistência de saúde na República Dominicana. O design participativo baseado na comunidade do estudo permite que os dados sejam aproveitados para examinar as barreiras específicas ao atendimento de saúde enfrentadas por pessoas com HIV.
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2.

Plan de salud de Centroamérica y República Dominicana 2016-2020/ Health Plan for Central America and the Dominican Republic 2016-2020

Consejo de Ministros de Salud de Centroamérica y República Dominicana (COMISCA)
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| Idioma(s): Español
La articulación entre el enfoque poblacional y la estrategia de Promoción de la Salud son consideradas como un ejercicio simbiótico orientado a desarrollar el potencial de salud de las personas, familias, comunidades y sociedades de los países miembro del SICA. Lograr esa potenciación supone la intervención y la modificación (eliminación, reducción y reforzamiento) de los factores que determinan la salud y que perviven en la Región, incrementando progresivamente un capital de salud en pos de alcanzar un determinado potencial expresado en un mejor estado del mismo de las poblaciones. Las acciones en salud planteadas e implementadas desde una perspectiva regional estarán orientadas a dar respuestas a los Objetivos de Desarrollo Sostenible (ODS), a partir de los avances logrados en el marco de los Objetivos de Desarrollo del Milenio (ODM). Ello connota responder a las aspiraciones colectivas, mediante la entrega de bienes y servicios gubernamentales valorados de acuerdo a las expectativas de las poblaciones de la región del Sistema de la Integración Centroamericana (SICA), organizando y gestionando la rendición de cuentas de los recursos y los resultados regionales alcanzados, presentando proyecciones futuras sobre la mejora del estado de salud de la ciudadanía tanto a representantes políticos y sociales como a organismos de cooperación técnica y humanitaria internacional. (AU)
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3.

VIII Encuentro de la Comisión Técnica de Desarrollo de Recursos Humanos en Salud de Centroamérica y República Dominicana/ VIII Meeting of the Technical Commission for the Development of Human Resources in Health of Central America and the Dominican Republic

Comisión Técnica de Desarrollo de Recursos Humanos en Salud de Centroamérica y República Dominicana
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| Idioma(s): Español
INTRODUCCIÓN: Los días 18 y 19 de febrero de 2016, en Antigua, Guatemala, se desarrolló el "VIII Encuentro de la Comisión Técnica de Desarrollo de Recursos Humanos en Salud de Centroamérica y República Dominicana", evento coordinado por el Ministerio de Salud de Honduras como Secretaría Pro témpore, la Secretaría Ejecutiva del Consejo de Ministros de Salud de Centroamérica y República Dominicana (SE-COMISCA), la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS), con el apoyo de la Escuela Andaluza de Salud Pública (EASP) y la Unión Europea en el marco de la acción "Migración de Profesionales de Salud: Oportunidades para el desarrollo compartido" (MPDC), COMISCA y OPS/OMS. OBJETIVO: Revisar y aprobar el Plan Operativo para la implementación del Plan de Salud de Centroamérica y República Dominicana 2016-2020: objetivo estratégico 7, Resultado estratégico 7.1 y 7.2. (AU)
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4.

International service learning in the Dominican Republic: An asynchronous pilot in interprofessional education.

Foster, Jennifer; Pullen, Sara
| Idioma(s): Inglés
Despite the logistical barriers of asynchronous academic calendars, university students in nursing and physical therapy in one academic health centre piloted an international, interprofessional, service learning project in the Dominican Republic. Although the nursing students and physical therapy students were not able to be in-country at the same time, they provided care to a common caseload of traumatic injury patients and those with chronic, debilitating conditions. Interprofessional communication occurred with the development of SBAR (Situation, Background, Assessment, Recommendation) reports from the Team Training curriculum of the Agency for Healthcare Research and Quality. Students learned the depth of physical therapy and the breadth of nursing. The pilot led to a more refined design to pair nursing and PT students, requiring them to communicate via mobile phone regarding results of examinations, and suggestions for follow-up by the nursing students, to ensure continuity of care and a more comprehensive approach to services.
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5.

Comparative analysis of dietary guidelines in the Spanish-Speaking Caribbean.

Fuster, Melissa
| Idioma(s): Inglés
OBJECTIVE: Dietary guidelines are important education and policy tools to address local nutrition concerns. The current paper presents a comparative analysis of nutrition messages from three Spanish-speaking Caribbean countries (Cuba, Puerto Rico and Dominican Republic) to explore how these dietary guidelines address common public health nutrition concerns, contextualized in different changing food environments and food culture similarities. DESIGN: Qualitative, comparative analysis of current dietary guideline documents and key recommendations. RESULTS: Key recommendations were categorized into sixteen themes (two diet-based, ten food-based and four 'other'). Only the Cuban dietary guidelines included diet-based key recommendations. Of the ten food-based key recommendations, only four themes overlapped across the three dietary guidelines (the encouragement of fruits and vegetables, addressing protein sources and fat). Other overlaps were found between dietary guideline pairs, except between Cuba and Puerto Rico. Further analysis revealed differences in levels of specificity and acknowledgement of local dietary patterns and issues, as well as the need to revise the guidelines to account for current scientific advances. CONCLUSIONS: The present study underscored the importance of context in the framing of dietary advice and the influence of national socio-economic and political situations on nutrition policy and education efforts. The results contribute to inform efforts to improve nutrition communication in the region and among migrant communities.
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6.

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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7.

The role of teleconferences in global public health education.

Pinzon-Perez, Helda; Zelinski, Christy
| Idioma(s): Inglés
This paper presents a global health education program using a 'Teleconference' approach. It provides examples of how technology can be used to deliver health education at the international level. Two international teleconferences about public health issues were conducted in 2013 and 2014 involving universities and public health institutions in Colombia, Dominican Republic, Costa Rica, Uganda, and the United States. More than 400 students, faculty, and community members attended these educational events. These teleconferences served as the medium to unite countries despite the geographical distances and to facilitate collaborations and networking across nations. Teleconferences are an example of effective technology-based health education and health promotion programs.
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8.

Chikungunya infection in the general population and in patients with rheumatoid arthritis on biological therapy.

Rosario, V; Munoz-Louis, R; Valdez, T; Adames, S; Medrano, J; Paulino, I; Paula, J; Alba-Fériz, R
| Idioma(s): Inglés
Chikungunya infection is a febrile illness, which currently is afflicting the Caribbean islands including the Dominican Republic. We would like to report our experience with Chikungunya-related musculoskeletal manifestations in our arthritis clinics in the Dominican Republic. A total of 514 patients presented for the first time to our arthritis clinic exhibiting musculoskeletal manifestations, 473/514 (92%) exhibiting symmetric polyarthralgias, 344/514 (67%) arthritis, and 385 (75%) skin rash. The great majority 457.46 (89%) exhibited very good clinical response to nonsteroidal anti-inflammatory drugs (NSAIDs), 370 (72%) require low-dose steroids, and only 5 patients (0.97%) required methotrexate therapy. In addition, of a total of 328 patients with rheumatoid arthritis on biological treatment, 53 exhibited Chikungunya-related musculoskeletal manifestations; 51/53 (96.2%) exhibited symmetric polyarthralgias, 25/53 (47.1%) arthritis, and 13/53 (24.5%) tendinopathy. Of most patients, 51/53 responded to NSAIDs, of which, 23 patients only responded partially, and in total 25 (47.1%) required low-dose steroids. Disease-modifying antirheumatic drug (DMARD) therapy including biologics remained unchanged in this population.
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9.

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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10.

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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