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1.

Informe anual 2020. La salud universal y la pandemia. Sistemas de salud resilientes. República Dominicana

Organización Panamericana de la Salud
| Idioma(s): Español
Establecida en 1902 como el organismo independiente especializado en salud del sistema interamericano, la Organización Panamericana de la Salud (OPS) ha desarrollado competencias y experiencia ampliamente reconocidas al brindar cooperación técnica a sus Estados Miembros para combatir las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, en su calidad de oficina regional de la Organización Mundial de la Salud, la OPS participa activamente en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible (ODS) a nivel de país. En este informe anual se presenta la cooperación técnica de la OPS a nivel de país en el 2020, mediante la aplicación de la estrategia de cooperación con el país, la respuesta a las necesidades y prioridades nacionales, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la Organización y los ODS. En consonancia con el tema general de "la salud universal y la pandemia: sistemas de salud resilientes", se pone de relieve la respuesta de la OPS a la pandemia de COVID-19, así como sus esfuerzos continuos en esferas prioritarias como las enfermedades transmisibles, las enfermedades no transmisibles, la salud mental, la salud a lo largo del curso de vida y las emergencias de salud. También se presenta un resumen financiero del ejercicio examinado.
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2.

Salud y cambio climático. Perfil de país 2021: República Dominicana

Organización Panamericana de la Salud
| Idioma(s): Español
Este perfil de la República Dominicana sobre la salud y el cambio climático ofrece un resumen de la información sobre los riesgos climáticos, las vulnerabilidades en materia de salud, las repercusiones sobre la salud y los avances logrados hasta la fecha gracias a los esfuerzos del sector de la salud para establecer un sistema de salud resiliente al clima. El proyecto de perfiles de países sobre la salud y el cambio climático de la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS) y la Convención Marco de las Naciones Unidas sobre el Cambio Climático (CMNUCC) hace un seguimiento de los efectos del cambio climático en la salud y de los avances en la creación de sistemas de salud resistentes al clima. Mediante la publicación de perfiles nacionales actualizados cada cuatro años, el proyecto no solo proporciona un panorama sobre una serie de indicadores nacionales de salud y cambio climático, sino que también crea un mecanismo para seguir los efectos en la salud y las respuestas del sector de la salud relacionados con el clima a lo largo del tiempo. En el 2015, durante el primer ciclo del proyecto, se publicaron casi 50 perfiles de países. El número de perfiles de países se ha ampliado de manera considerable en el segundo ciclo. Los perfiles de países se elaboran en estrecha colaboración con las oficinas regionales y nacionales de la OMS, las autoridades de salud nacionales y otras partes interesadas del sector de la salud. Los objetivos generales del proyecto son los siguientes: 1) aumentar la concienciación sobre los efectos en la salud del cambio climático, 2) apoyar la toma de decisiones basada en evidencia con vistas a reforzar la resiliencia de los sistemas de salud, 3) apoyar la participación del sector de la salud en los procesos nacionales e internacionales relacionados con el clima y 4) promover acciones que mejoren la salud al tiempo que reducen las emisiones de gases de efecto invernadero.
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3.

Health and climate change: country profile 2021: Dominican Republic

World Health Organization; United Nations Framework Convention on Climate Change
| Idioma(s): Inglés; Español
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4.

Perceived discrimination in bateyes of the Dominican Republic: results from the Everyday Discrimination Scale and implications for public health programs.

Keys, Hunter M; Noland, Gregory S; De Rochars, Madsen Beau; Taylor, Thomas H; Blount, Stephen; Gonzales, Manuel
| Idioma(s): Inglés
BACKGROUND: Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural 'company towns,' often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts. METHODS: In March-April 2016, a stratified, multi-stage cluster survey that included the 9-item Everyday Discrimination Scale (EDS) was conducted among residents (n = 768) of bateyes across the Dominican Republic. Exploratory factor analysis, differential item functioning, and linear and logistic regression were used to assess associations between EDS scores, ethnic group status, reasons for discrimination, and healthcare-seeking behavior. RESULTS: Three ethnic groups were identified in the population: Haitian-born persons (42.5%), Dominican-born persons with Haitian descent (25.5%), and Dominican-born persons without Haitian descent (32.0%). Mean EDS scores (range 0-45) were highest among persons born in Haiti (18.2, 95% confidence interval [CI] = 16.4-20.1), followed by persons with Haitian descent (16.5, 95% CI = 14.9-18.0), and those without Haitian descent (13.3, 95% CI = 12.1-14.5). Higher EDS scores were significantly associated with Haitian birth (ß = 6.8, 95% CI = 4.2-9.4; p < 0.001) and Haitian descent (ß = 6.1, 95% CI = 3.2-9.0; p < 0.001). Most respondents (71.5%) had scores high enough to elicit reasons for their discrimination. Regardless of ethnic group, poverty was a common reason for discrimination, but Haitian-born and Haitian-descended people also attributed discrimination to their origin, documentation status, or skin color. EDS scores were not significantly associated with differences in reported care-seeking for recent fever (ß = 1.7, 95% CI = - 1.4-4.9; p = 0.278). CONCLUSION: Perceived discrimination is common among batey residents of all backgrounds but highest among Haitian-born people. Discrimination did not appear to be a primary barrier to care-seeking, suggesting other explanations for reduced care-seeking among Haitian populations. Public health community engagement strategies should avoid exacerbating stigma, build active participation in programs, and work towards community ownership of disease control and elimination goals.
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5.

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. [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. [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.
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6.

Strategies for Managing the Costs of Chronic Illness in the Context of Limited Financial Resources: A Qualitative Study in Dominican Persons With Arthritis.

Nascimben, Julia; Cubbison, Caroline; Lape, Emma C; Katz, Jeffrey N
| Idioma(s): Inglés
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.
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7.

Cross-border spatial accessibility of health care in the North-East Department of Haiti.

Mathon, Dominique; Apparicio, Philippe; Lachapelle, Ugo
| Idioma(s): Inglés
BACKGROUND: The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border. METHODS: To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios. RESULTS: The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans. CONCLUSION: The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.
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8.

Financial Implications of Atypical Mycobacterial Infections After Cosmetic Tourism: Is It Worth the Risk?

Lee, James C; Morrison, Kerry A; Maeng, Michelle M; Ascherman, Jeffrey A; Rohde, Christine H
| Idioma(s): Inglés
BACKGROUND: Cosmetic tourism has become increasingly popular despite many associated risks. The economic impact of atypical mycobacterial infections in cosmetic tourism is poorly defined in the literature. We sought to investigate the costs and clinical course of patients with these infections. METHODS: A retrospective review of all patients managed by the Plastic Surgery Division at Columbia University Medical Center from 2013 to 2014 with atypical mycobacterial surgical site infections after cosmetic surgery outside the United States was performed. Data including patient demographics, procedure costs, clinical course, impact on daily life, and costs associated with complications were collected using hospital billing information, patient questionnaires, telephone interviews, and clinical charts. Cost analysis was done to identify the personal and societal costs of these complications. RESULTS: Data from 10 patients were collected and analyzed. Management of mycobacterial infections cost an average of $98,835.09 in medical charges. The indirect cost of these infections was $24,401 with a mean return to work time of 6.7 months. Total patient savings from cosmetic tourism was $3419. The total cost of a mycobacterial infection was greater than $123,236.47. Although the incidence of mycobacterial infection abroad is unknown, the potential cost of an infection alone outweighs the financial benefits of cosmetic tourism if the risk exceeds 2.77%. CONCLUSIONS: Atypical mycobacterial infections as a result of cosmetic tourism come at considerable cost to patients and the health care system. When our results are taken into consideration with other risks of cosmetic tourism, the financial risks likely far outweigh the benefits.
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9.

The impact of a private sector living wage intervention on consumption and cardiovascular disease risk factors in a middle income country.

Rehkopf, David H; Burmaster, Katharine; Landefeld, John C; Adler-Milstein, Sarah; Flynn, Emily P; Acevedo, Maria Cecilia; Jones-Smith, Jessica C; Adler, Nancy; Fernald, Lia C H
| Idioma(s): Inglés
BACKGROUND: A positive association of socioeconomic position and health is well established in high-income countries. In poorer nations, however, higher income individuals often have more cardiovascular risk factors (including obesity) than do those with less income. Our study goal was to estimate the effects of receiving a living wage (340% higher income) on short-term changes in consumption and cardiovascular risk factors among low-wage workers in a middle-income country. METHODS: This cross-sectional study matched workers at an apparel factory (n=105) in the Dominican Republic with those at a similar factory (n=99) nearby, 15 months after the intervention factory introduced a substantially higher living wage. Statistical matching on non-time varying individual characteristics (childhood health, childhood living conditions, work experience, demographic factors) strengthened causal inference. Primary outcomes were blood pressure (systolic and diastolic), pulse rate, body mass index and waist circumference. Secondary outcomes were dietary consumption and spending on services, consumables and durable goods. RESULTS: Receiving the living wage was associated with increased consumption of protein, dairy, soda and juice and sugars, but not with cardiovascular risk factors. Intervention factory workers spent more on grocery items and household durable goods. CONCLUSIONS: While having a higher income in a middle-income country might be expected to increase obesity and its associated health risks, the current study found no short-term negative associations. There may be possible longer-term negative health consequences of increases in consumption of soda, juice and sugars, however. It is important to consider complementary interventions to support healthy dietary intake in areas with increasing wages.
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10.

Mental health services in the Dominican Republic from the perspective of health care providers.

Caplan, Susan; Little, Tariana V; Reyna, Patricia; Sosa Lovera, Angelina; Garces-King, Jasmine; Queen, Kaila; Nahar, Ritu
| Idioma(s): Inglés
This study examines mental health services in five different regions of the Dominican Republic (DR) from the perspectives of health care providers. The purpose of this research was to (1) examine existing mental health care services; (2) identify barriers to treatment and mental health services delivery; and (3) explore potential strategies to improve mental health services delivery. Thirty-seven health care workers including physicians, nurses, psychologists, governmental administrators, and non-governmental community health workers were part of five focus groups and subsequent follow-up interviews. Transcripts were coded and analysed to obtain the most parsimonious categories of themes. Results indicated that there is insufficient funding allocated to mental health. The unreliable distribution of psychiatric medications precludes care for patients with severe chronic mental illness. Stigmatising attitudes among health care providers influences the quality of care. The prevalence of domestic violence is a significant public health problem contributing to mental illness. In conclusion, our study findings call for a re-examination of priority public health foci, with special attention to mental health and domestic violence in the DR. From a policy perspective, mental health care should be integrated into primary care and coupled with provider and patient education to reduce stigma. A social determinants approach could ameliorate systemic factors contributing to mental illness.
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