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Rivera D, Santos D, Carmant L, García HH, Pimentel R, Wiebe S, Aponte V, González L, Castillo JC, Matos B, Paliza JM, Fermín R, Stoeter P, Pérez-Then E. [Diagnosis of neurocysticercosis in patients with epilepsy living in the south-western Dominican Republic]. Rev Neurol 2024; 78:109-116. [PMID: 38349319 DOI: 10.33588/rn.7804.2023289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Neurocysticercosis (NCC), a possible cause of epilepsy with limited epidemiological data in the Dominican Republic, is endemic in four provinces in the country's south-western region. This study aimed to determine the association between NCC and epilepsy among people living in these endemic regions, and to obtain preliminary data on the prevalence of NCC in these provinces. PATIENTS AND METHODS A case-control design was used, consisting of 111 patients with epilepsy with unknown causes, and 60 controls without epilepsy or NCC. The diagnosis of NCC was based on computed tomography and magnetic resonance imaging of the skull, as well as Western immunoblotting for serum antibodies using Taenia solium, following the criteria of Del Brutto et al. RESULTS. NCC was found in 27% of the epileptic patients (n = 30/111) and in 5% of the controls (n = 3/60); the probability of the epileptic patients having NCC was seven times higher than the controls (odds ratio = 7.04, 95% confidence interval: 2.04-24.18; p < 0.001). The participants' sociodemographic characteristics, including their age, sex, level of education, occupation, and province of residence presented no statistical significance in terms of their association with NCC. CONCLUSIONS This study suggests that NCC is strongly associated with epilepsy in the south-western region of the Dominican Republic, and highlights the need for public health measures to improve the prevention, diagnosis and treatment of both diseases.
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Affiliation(s)
- D Rivera
- Universidad Nacional Pedro Henríquez Ureña, Santo Domingo, República Dominicana
- Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina, Santo Domingo, República Dominicana
| | - D Santos
- Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
- Hospital Dr. Luis Eduardo Aybar, Santo Domingo, República Dominicana
| | - L Carmant
- Ministerio de Salud y Asuntos Sociales, Québec, Canadá
| | - H H García
- Universidad Peruana Cayetano Heredia, Lima, Perú
| | - R Pimentel
- Centro de Educación Médica de Amistad Dominico-Japonesa, Santo Domingo, República Dominicana
| | - S Wiebe
- University of Calgary, Calgary, Canadá
| | - V Aponte
- Sistema Nacional de Salud, Madrid, España
| | - L González
- Hospital Pedro Emilio de Marchena, Monseñor Nouel, República Dominicana
| | - J C Castillo
- Two Oceans in Health, Santo Domingo, República Dominicana
| | - B Matos
- Centro Médico Anacaona, San Juan, República Dominicana
| | - J M Paliza
- Neurorradiología Diagnóstica SA, Santo Domingo, República Dominicana
| | - R Fermín
- Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina, Santo Domingo, República Dominicana
| | - P Stoeter
- Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina, Santo Domingo, República Dominicana
| | - E Pérez-Then
- Two Oceans in Health, Santo Domingo, República Dominicana
- Universidad Dominicana, Santo Domingo, República Dominicana
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Japa I, Ahmed D, Fernandez A, Alvarez A, Japa SS, Cordero R, Acosta F, Steenhoff AP, Lowenthal ED. Etiologies of Mild and Moderate Diarrheal Illness among Children in Consuelo, Dominican Republic. Am J Trop Med Hyg 2024; 110:339-345. [PMID: 38167390 PMCID: PMC10859810 DOI: 10.4269/ajtmh.23-0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/17/2023] [Indexed: 01/05/2024] Open
Abstract
Since the rotavirus vaccine was included in the Dominican Republic's national immunization schedule in 2012, the microbiologic etiologies of acute gastroenteritis have not been described. This study aimed to determine the contribution of rotavirus as an etiology of acute gastroenteritis over a 12-month period in children under 5 years of age in both an inpatient and an outpatient setting in Consuelo, Dominican Republic. All children who were seen at Niños Primeros en Salud clinic or admitted to Hospital Municipal Dr. Angel Ponce Pinedo for acute gastroenteritis during January 2021-April 2022 were enrolled in the study. Stools were evaluated for rotavirus, enteric parasites, and pathogenic bacteria. Pathogen detection was compared between outpatients and inpatients and on the basis of child's vaccination status. From 181 children enrolled, 170 stool samples were collected, 28 (16.5%) from inpatients and 142 (83.5%) from outpatients. Rotavirus was the most commonly detected pathogen and was proportionately more common among hospitalized children, with nine (32.1%) cases among hospitalized children and 16 (11.3%) among outpatient children. (Pearson χ2 = 8.1, P = 0.004). Among patients with a positive rotavirus result, vaccination rate was lower among moderate (hospitalized) (three of six; 50%) compared with mild (outpatient) diarrhea patients (12 of 15; 80%). Giardia lamblia (10%) was the next most prevalent pathogen detected in both inpatients and outpatients using standard laboratory measures. Despite the availability of rotavirus vaccination, rotavirus remains a common cause of gastrointestinal illness among children under 5 years of age in our cohort. Incomplete vaccination status was associated with hospitalization for gastrointestinal illness.
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Affiliation(s)
- Ingrid Japa
- Niños Primeros en Salud, Consuelo, Dominican Republic
- Campus Universidad Central del Este, San Pedro de Macorís, Dominican Republic
| | - Derartu Ahmed
- University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia Global Health Center, Philadelphia, Pennsylvania
| | - Anabel Fernandez
- Niños Primeros en Salud, Consuelo, Dominican Republic
- Children’s Hospital of Philadelphia Global Health Center, Philadelphia, Pennsylvania
| | - Angie Alvarez
- Niños Primeros en Salud, Consuelo, Dominican Republic
- Campus Universidad Central del Este, San Pedro de Macorís, Dominican Republic
| | - Shirley Sabino Japa
- Niños Primeros en Salud, Consuelo, Dominican Republic
- Campus Universidad Central del Este, San Pedro de Macorís, Dominican Republic
| | | | | | - Andrew P. Steenhoff
- University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia Global Health Center, Philadelphia, Pennsylvania
| | - Elizabeth D. Lowenthal
- University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia Global Health Center, Philadelphia, Pennsylvania
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Hudson M, Matos JA, Alvarez B, Safstrom J, Torres F, Premjee S, Bonilla L, Park B, Bancroft E, Garcia M. Deaths of U.S. Citizens Undergoing Cosmetic Surgery - Dominican Republic, 2009-2022. MMWR Morb Mortal Wkly Rep 2024; 73:62-65. [PMID: 38271279 PMCID: PMC10824547 DOI: 10.15585/mmwr.mm7303a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Although infections resulting from cosmetic surgery performed outside the United States have been regularly reported, deaths have rarely been identified. During 2009-2022, 93 U.S. citizens died after receiving cosmetic surgery in the Dominican Republic. The number of deaths increased from a mean of 4.1 per year during 2009-2018 to a mean of 13.0 during 2019-2022 with a peak in of 17 in 2020. A subset of post-cosmetic surgery deaths occurring during peak years was investigated, and most deaths were found to be the result of embolic events (fat emboli or venous thromboembolism) for which a high proportion of the patients who died had risk factors, including obesity and having multiple procedures performed during the same operation. These risk factors might have been mitigated or prevented with improved surgical protocols and postoperative medical care, including prophylactic measures against venous thromboembolism. U.S. citizens interested in receiving elective cosmetic surgery outside the United States should consult with their health care professionals regarding their risk for adverse outcomes. Public health authorities can support provider education on the importance of preoperative patient evaluation and the potential danger of performing multiple cosmetic procedures in one operation.
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Savage V, Gomez H, Perez M, Donastorg Y, Kerrigan D, Barrington C. Trajectories of HIV management among virally suppressed and unsuppressed female sex workers in the Dominican Republic: A comparative qualitative analysis. Int J Qual Stud Health Well-being 2023; 18:2164947. [PMID: 36681941 PMCID: PMC9869989 DOI: 10.1080/17482631.2023.2164947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Despite suboptimal HIV outcomes among female sex workers (FSW), limited research has been conducted on factors that impact viral suppression among this population. Examining narratives of HIV management, we examined how experiences of diagnosis, treatment initiation, and ongoing care behaviours shaped viral suppression outcomes over time. METHODS We conducted 20 in-depth interviews with FSW in Santo Domingo, Dominican Republic. Using narrative and thematic qualitative approaches, we developed analytic summaries and matrices to compare trajectories of managing HIV between suppressed and unsuppressed participants. RESULTS Regardless of suppression status, participants described similar narratives of overcoming initial challenges to HIV management through personal resilience and social support. Unsuppressed participants identified more delays in initiating antiretroviral therapy and more lapses in adherence due to less active acceptance of their HIV status and more persistent experiences of economic hardship and HIV stigma. CONCLUSIONS We found that individual, interpersonal and structural factors, including stigma and economic precarity, differentiated trajectories towards viral suppression among FSW indicating the importance of multilevel interventions. Improved access to mental health services and social support could promote greater early acceptance of HIV status and progress towards viral suppression among FSW.
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Affiliation(s)
- Virginia Savage
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- CONTACT Virginia Savage Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 35 Dauer Drive, CB #7440, Chapel Hill, NC27599, USA
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, District of Columbia, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Maclin BJ, Wang Y, Rodriguez-Diaz C, Donastorg Y, Perez M, Gomez H, Barrington C, Kerrigan D. Comparing typologies of violence exposure and associations with syndemic health outcomes among cisgender and transgender female sex workers living with HIV in the Dominican Republic. PLoS One 2023; 18:e0291314. [PMID: 37695770 PMCID: PMC10495030 DOI: 10.1371/journal.pone.0291314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
Violence against women research largely excludes transgender women's experiences and violence from perpetrators other than intimate partners. This study compares patterns of violence exposure among cisgender and transgender female sex workers (FSWs) and the associations with syndemic health outcomes. We used cross-sectional surveys from samples of cisgender and transgender FSWs living with HIV in the Dominican Republic (N = 211 and 100, respectively). We used latent class analysis to identify patterns of emotional, physical, and sexual violence and harassment by partners, clients, and police. We assessed sociodemographic and occupational predictors in relation to class membership, and class membership in relation to health (HIV continuum of care outcomes, mental health, substance use), using logistic regression. Two classes were identified in cisgender sample: Low Reported Violence Exposure (Class 1) and Sex Work-related Police Harassment (Class 2). Class 2 participants had greater odds of scoring abnormal or borderline abnormal anxiety on the Hospital Anxiety and Depression Scale (HADS-A) (adjusted OR = 3.97, p<0.01), moderate-to-severe depression per the Patient Health Questionnaire-9 (PHQ-9) (aOR = 5.74, p<0.01), and any illicit drug use in the past six months (aOR = 3.06, p<0.05), compared to Class 1. The transgender sample produced three classes: Low Reported Violence Exposure (Class 1); Sex Work-related Police Harassment (Class 2); and Sex Work-related Violence and Harassment (Class 3). Class 3 participants had greater odds of having anxiety (aOR = 6.65, p<0.01) and depression (aOR = 4.45, p<0.05), while Class 2 participants had greater odds of perfect ART adherence during the previous four days (aOR = 2.78, p<0.05), compared to Class 1. The more diverse and extreme violence patterns uncovered for the transgender sample show this group's heightened risk, while similar patterns across groups regarding police abuse highlight a need for police-focused violence prevention interventions. Each sample's highest violence class was associated with poor mental health, underscoring the need for mental health interventions for all FSWs.
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Affiliation(s)
- Beth J. Maclin
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Carlos Rodriguez-Diaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
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Molina R, Enriquez M. Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes. Sci Diabetes Self Manag Care 2023; 49:281-290. [PMID: 37313730 DOI: 10.1177/26350106231178838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.
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Affiliation(s)
- Rosalia Molina
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Maithe Enriquez
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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Gonzalez-Bautista E, Llibre-Guerra JJ, Sosa AL, Acosta I, Andrieu S, Acosta D, Llibre-Rodríguez JDJ, Prina M. Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study. Age Ageing 2023; 52:afad137. [PMID: 37517058 PMCID: PMC10387229 DOI: 10.1093/ageing/afad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND intrinsic capacity (IC) is a construct encompassing people's physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains. OBJECTIVES to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes. METHODS secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity. RESULTS amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel's C = 0.73 (95%CI 0.72;0.74)). CONCLUSIONS half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.
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Affiliation(s)
- Emmanuel Gonzalez-Bautista
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Institute on Aging, Toulouse University Hospital (CHU), Gerontopole, Toulouse, France
- Department of Health Service & Population Research, King’s College London, Institute of Psychiatry, Psychology &Neuroscience, London, UK
| | | | - Ana L Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Isaac Acosta
- Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Sandrine Andrieu
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Daisy Acosta
- Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | | | - Matthew Prina
- Department of Health Service & Population Research, King’s College London, Institute of Psychiatry, Psychology &Neuroscience, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Wang Y, Karver TS, Berg CJ, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, Galai N, Kerrigan D. Substance Use and Depression Impede ART Adherence Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2023; 27:2079-2088. [PMID: 36477652 PMCID: PMC10225324 DOI: 10.1007/s10461-022-03940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
Female sex workers (FSW) have worse HIV outcomes in part due to lower anti-retroviral therapy (ART) adherence. Substance use and depression are important barriers to ART adherence, yet few studies have assessed these relationships among FSW in longitudinal studies. Cross-Lagged Panel Models and autoregressive mediation analyses assessed substance use (illicit drug use and alcohol use disorders) in relation to ART non-adherence and the mediation role of depressive symptoms among 240 FSW living with HIV in the Dominican Republic. In annual visits (T1, T2, T3), the majority (70%, 66%, and 53%) reported at-risk drinking and 15%, 13% and 9% used illicit drug during the past 6 months. Most FSW (70%, 62% and 46%) had mild-to-severe depression. Illicit drug use predicted later ART non-adherence. This relationship was not mediated via depressive symptoms. Integrated substance use and HIV care interventions are needed to promote ART adherence and viral suppression among FSW.
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Affiliation(s)
- Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Arps S. Body composition and nutritional status of school-aged Haitian children living in urban and peri-urban areas of Puerto Plata, Dominican Republic. Am J Hum Biol 2023; 35:e23873. [PMID: 36708069 DOI: 10.1002/ajhb.23873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES This study examines body composition and nutritional status of Haitian children and adolescents living in urban and peri-urban communities in the Dominican Republic to provide estimates of stunting, underweight, overweight, and obesity for this under-researched population. METHODS Anthropometric measures including height, weight, mid-upper arm circumference, and skinfold thicknesses (triceps and subscapular) were obtained for Kreyòl-speaking school-aged children (n = 105, males = 51, females = 54, ages 4-17). Z-scores for height, body mass index (BMI), and upper arm muscle area by height were used to classify children's nutritional status. Variation among sex and age groups was assessed. RESULTS Relatively low rates of stunting (4.8%) and thinness (2.9%) were identified. The total prevalence of overweight was 5.7% and 2.9% of children were classified as having obesity. Girls had a higher prevalence of overweight/obesity and risk of overweight (16.7%) than boys (3.9%, p = .033). CONCLUSIONS The prevalence of overweight and obesity (8.6%) suggests that Haitian children in these urban and peri-urban communities are experiencing the nutrition transition. Interventions should address the development of excess weight, especially among girls, as well as persisting undernutrition and stunting.
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Affiliation(s)
- Shahna Arps
- Department of Sociology and Anthropology, University of Toledo, Toledo, Ohio, USA
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Paulino-Ramírez R, López P, Mueses S, Cuevas P, Jabier M, Rivera-Amill V. Genomic Surveillance of SARS-CoV-2 Variants in the Dominican Republic and Emergence of a Local Lineage. Int J Environ Res Public Health 2023; 20:ijerph20085503. [PMID: 37107785 PMCID: PMC10138544 DOI: 10.3390/ijerph20085503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that evolves over time, leading to new variants. In the current study, we assessed the genomic epidemiology of SARS-CoV-2 in the Dominican Republic. A total of 1149 SARS-CoV-2 complete genome nucleotide sequences from samples collected between March 2020 and mid-February 2022 in the Dominican Republic were obtained from the Global Initiative on Sharing All Influenza Data (GISAID) database. Phylogenetic relationships and evolution rates were analyzed using the maximum likelihood method and the Bayesian Markov chain Monte Carlo (MCMC) approach. The genotyping details (lineages) were obtained using the Pangolin web application. In addition, the web tools Coronapp, and Genome Detective Viral Tools, among others, were used to monitor epidemiological characteristics. Our results show that the most frequent non-synonymous mutation over the study period was D614G. Of the 1149 samples, 870 (75.74%) were classified into 8 relevant variants according to Pangolin/Scorpio. The first Variants Being Monitored (VBM) were detected in December 2020. Meanwhile, in 2021, the variants of concern Delta and Omicron were identified. The mean mutation rate was estimated to be 1.5523 × 10-3 (95% HPD: 1.2358 × 10-3, 1.8635 × 10-3) nucleotide substitutions per site. We also report the emergence of an autochthonous SARS-CoV-2 lineage, B.1.575.2, that circulated from October 2021 to January 2022, in co-circulation with the variants of concern Delta and Omicron. The impact of B.1.575.2 in the Dominican Republic was minimal, but it then expanded rapidly in Spain. A better understanding of viral evolution and genomic surveillance data will help to inform strategies to mitigate the impact on public health.
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Affiliation(s)
- Robert Paulino-Ramírez
- Instituto de Medicina Tropical y Salud Global, Universidad Iberoamericana, Research Hub, Santo Domingo 22333, Dominican Republic
- Correspondence:
| | - Pablo López
- RCMI Center for Research Resources, Ponce Research Institute, Ponce, PR 00716-2348, USA (V.R.-A.)
| | - Sayira Mueses
- Instituto de Medicina Tropical y Salud Global, Universidad Iberoamericana, Research Hub, Santo Domingo 22333, Dominican Republic
| | - Paula Cuevas
- Instituto de Medicina Tropical y Salud Global, Universidad Iberoamericana, Research Hub, Santo Domingo 22333, Dominican Republic
| | - Maridania Jabier
- Instituto de Medicina Tropical y Salud Global, Universidad Iberoamericana, Research Hub, Santo Domingo 22333, Dominican Republic
- Servicio Nacional de Salud (SNS), Ministry of Health, Santo Domingo 10201, Dominican Republic
| | - Vanessa Rivera-Amill
- RCMI Center for Research Resources, Ponce Research Institute, Ponce, PR 00716-2348, USA (V.R.-A.)
- Basic Sciences Department, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716-2348, USA
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Nilles EJ, de St Aubin M, Dumas D, Duke W, Etienne MC, Abdalla G, Jarolim P, Oasan T, Garnier S, Iihoshi N, Lopez B, de la Cruz L, Puello YC, Baldwin M, Roberts KW, Peña F, Durski K, Sanchez IM, Gunter SM, Kneubehl AR, Murray KO, Lino A, Strobel S, Baez AA, Lau CL, Kucharski A, Gutiérrez EZ, Skewes-Ramm R, Vasquez M, Paulino CT. Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022. Emerg Infect Dis 2023; 29:723-733. [PMID: 36848869 PMCID: PMC10045678 DOI: 10.3201/eid2904.221628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.
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Perdomo A, Webb HE, Bugarel M, Friedman CR, Francois Watkins LK, Loneragan GH, Calle A. First Known Report of mcr-Harboring Enterobacteriaceae in the Dominican Republic. Int J Environ Res Public Health 2023; 20:5123. [PMID: 36982034 PMCID: PMC10049167 DOI: 10.3390/ijerph20065123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Colistin is a last-resort antibiotic used to treat infections caused by multidrug-resistant Gram-negative bacteria. People with a history of travel to the Dominican Republic have become sick with pathogenic bacteria carrying the mobile colistin resistance gene, mcr-1, during and after traveling. This investigation aimed to identify mcr genes in Enterobacteriaceae isolated from food animal sources in the Dominican Republic. Three hundred and eleven samples were tested, from which 1354 bacterial isolates were obtained. Real-time PCR tests showed that 70.7% (220 out of 311) of the samples and 3.2% (44 out of 1354) of the isolates tested positive for the mcr gene. All RT-PCR presumptive mcr-positive isolates (n = 44) and a subset (n = 133) of RT-PCR presumptive mcr-negative isolates were subjected to whole-genome sequencing. WGS analysis showed that 39 isolates carried the mcr gene, with 37 confirmed as positive through RT-PCR and two as negative. Further, all of the mcr-positive genomes were identified as Escherichia coli and all contained a IncX4 plasmid replicon. Resistant determinants for other antibiotics important for human health were found in almost all isolates carrying mcr genes.
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Affiliation(s)
- Angela Perdomo
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79409, USA
| | - Hattie E. Webb
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Marie Bugarel
- Division of Research and Development Resources, BioMérieux, 69795 Lyon, France
| | - Cindy R. Friedman
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Louise K. Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Guy H. Loneragan
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79409, USA
| | - Alexandra Calle
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79409, USA
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Derose KP, Han B, Armenta G, Palar K, Then-Paulino A, Jimenez-Paulino G, Sheira L, Acevedo R, Lugo C, Veloz I, Donastorg Y, Wagner G. Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic. AIDS Care 2022; 34:1234-1242. [PMID: 34581230 PMCID: PMC8958167 DOI: 10.1080/09540121.2021.1981218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.
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Affiliation(s)
- Kathryn P. Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
- Department of Health Promotion and Policy, University of Massachusetts, Amherst
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA
| | | | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Claudio Lugo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
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Gainor K, Castillo Fortuna Y, Alakkaparambil AS, González W, Malik YS, Ghosh S. Detection and Complete Genome Analysis of Porcine Circovirus 2 (PCV2) and an Unclassified CRESS DNA Virus from Diarrheic Pigs in the Dominican Republic: First Evidence for Predominance of PCV2d from the Caribbean Region. Viruses 2022; 14:v14081799. [PMID: 36016421 PMCID: PMC9415081 DOI: 10.3390/v14081799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
We report here high rates (47.5%, 48/101) of detection of porcine circovirus 2 (PCV2) in diarrheic pigs from three pig farms in the Dominican Republic. Seventeen of the PCV2 positive samples, representing the three pig farms, different age groups and sampling periods (2020–2021), were amplified for the complete PCV2 genome. Based on analysis of open reading frame 2 and complete genome sequences, the 17 PCV2 strains were assigned to the PCV2d genotype. Significant differences were observed in PCV2 detection rates between the vaccinated (20% (10/50)) and unvaccinated (62.5% (10/16) and 80% (28/35)) farms, corroborating previous observations that PCV2a-based vaccines confer protection against heterologous PCV2 genotypes. The present study is the first to report detection and molecular characterization of PCV2 from the Dominican Republic, warranting large-scale molecular epidemiological studies on PCV2 in pig farms and backyard systems across the country. For the first time, PCV2d was identified as the predominant PCV2 genotype in a study from the Caribbean region, suggesting that a genotype shift from PCV2b to PCV2d might be happening in the Caribbean region, which mirrored the current PCV2 genotype scenario in many other parts of the world. Besides PCV2, we also identified a pigeon circovirus-like virus, and a circular Replication-associated protein (Rep)-encoding single-stranded (CRESS) DNA virus, which was characterized for the complete genome. The CRESS DNA virus shared a similar genomic organization and was related to unclassified CRESSV2 DNA viruses (belonging to the Order Cirlivirales) from porcine feces in Hungary, indicating that related unclassified CRESS DNA viruses are circulating among pigs in different geographical regions, warranting further studies on the epidemiology and biology of these novel viruses.
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Affiliation(s)
- Kerry Gainor
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre P.O. Box 334, Saint Kitts and Nevis
| | - Yussaira Castillo Fortuna
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre P.O. Box 334, Saint Kitts and Nevis
| | - Angeline Steny Alakkaparambil
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre P.O. Box 334, Saint Kitts and Nevis
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| | - Wendy González
- Epidemiological Surveillance Division, Dirección General de Ganadería, Santo Domingo 10410, Dominican Republic
- School of Veterinary Medicine, Faculty of Agronomic and Veterinary Sciences, Autonomous University of Santo Domingo, Calle Camino de Engombe 10904, Dominican Republic
| | - Yashpal Singh Malik
- College of Animal Biotechnology, Guru Angad Dev Veterinary and Animal Science University, Ludhiana 141012, India
| | - Souvik Ghosh
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre P.O. Box 334, Saint Kitts and Nevis
- Correspondence: or ; Tel.: +1-(869)-4654161 (ext. 401-1202)
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Luft HS, Mersky JP, Choi C, Canario Guzmán JA, Quezada Ortiz MV, Sehi GT, Temple JR. Prevalence of adverse childhood experiences (ACEs) and association with dating violence and symptoms of mental illness among adolescents in the Dominican Republic. Child Abuse Negl 2022; 129:105668. [PMID: 35617753 DOI: 10.1016/j.chiabu.2022.105668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Adolescent dating violence (ADV) and mental illness are highly prevalent, interrelated public health priorities. Increasingly, scholars are looking to adverse childhood experiences (ACEs) to explain risk for these health concerns. OBJECTIVES Determine prevalence of ACEs, ADV perpetration and victimization, and anxiety and depression symptoms among adolescents in the Dominican Republic (DR). Evaluate the association of ACEs with these ADV and mental health outcomes. PARTICIPANTS AND SETTING Cross-sectional survey data were collected from 142 adolescents at middle and high schools in the DR. METHODS We assessed ACEs using the Childhood Experiences Survey, ADV using the Conflict in Dating Relationships Inventory, and depression/anxiety symptoms using Patient-Reported Outcomes Measurement Information System scales. Linear and logistic regressions were performed to test dose-response relationships between a cumulative ACE score and ADV and mental health outcomes while adjusting for age, gender, and rural/urban residence. RESULTS 80.6% of students reported at least one ACE. The most prevalent ACEs reported were physical abuse (49%) and witnessing domestic violence (48%). After adjusting for covariates, cumulative ACE scores were significantly associated with depression symptoms, anxiety symptoms, physical and emotional ADV perpetration, and physical and emotional ADV victimization. CONCLUSIONS Structural and community-based interventions to prevent ADV and promote mental health for adolescents in the DR should address ACEs.
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Affiliation(s)
- Heidi S Luft
- University of Wisconsin-Milwaukee, 1921 E Hartford Ave, Milwaukee, WI 53211, United States of America; University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States of America.
| | - Joshua P Mersky
- University of Wisconsin-Milwaukee, 1921 E Hartford Ave, Milwaukee, WI 53211, United States of America.
| | - Changyong Choi
- Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA 23284, United States of America; Gachon University, 1342, Seongnam-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Julio Arturo Canario Guzmán
- Instituto de Salud Mental y Telepsicología, Plaza Amer, Rómulo Betancourt 1212, Apto 404 A, Dominican Republic.
| | - María Violeta Quezada Ortiz
- Programa SUPERATE de la Presidencia de la República Dominicana, Ave. Leopoldo Navarro #61, Edif. San Rafael, 6to. Nivel. Ensanche San Juan Bosco, Santo Domingo, Dominican Republic.
| | - Gaelle T Sehi
- University of Wisconsin-Milwaukee, 1921 E Hartford Ave, Milwaukee, WI 53211, United States of America.
| | - Jeff R Temple
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States of America.
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16
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Quiñones Z, Li D, McIntosh S, Avendaño E, Sánchez JJ, DiMare-Hering C, Flores-Golfin D, Wang S, Pérez-Ramos JG, Dye TDV, Ossip DJ. Predictors of Secondhand Smoke Exposure During Pregnancy in Costa Rica, the Dominican Republic, and Honduras. Nicotine Tob Res 2022; 24:909-913. [PMID: 35084495 PMCID: PMC9048917 DOI: 10.1093/ntr/ntac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras. METHODS Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings. RESULTS Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes. CONCLUSIONS SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations. IMPLICATIONS The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations.
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Affiliation(s)
- Zahira Quiñones
- Escuela de Medicina, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santiago de los Caballeros, Santiago, Dominican Republic
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Dongmei Li
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Scott McIntosh
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Esteban Avendaño
- Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - José Javier Sánchez
- Escuela de Medicina, Pontificia Universidad Católica Madre y Maestra (PUCMM), Santiago de los Caballeros, Santiago, Dominican Republic
| | - Carmen DiMare-Hering
- Escuela de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Daniel Flores-Golfin
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
| | - Sijiu Wang
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL, USA
| | - José G Pérez-Ramos
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy D V Dye
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah J Ossip
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NYUSA
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Wang Y, Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, Galai N, Kerrigan D. Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic. J Acquir Immune Defic Syndr 2022; 89:481-488. [PMID: 34974474 PMCID: PMC9058160 DOI: 10.1097/qai.0000000000002901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic and its associated socioeconomic disruptions have disproportionally affected marginalized populations, including people living with HIV. Little is known about how the pandemic has affected populations experiencing multiple forms of stigma, discrimination, and violence, such as female sex workers (FSW) living with HIV. METHODS We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use, and partner abuse on engagement in HIV care and antiretroviral therapy adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes. RESULTS Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one-third of the participants (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were associated with higher odds of negatively affected HIV care, respectively. The relationship between increased emotional partner abuse and negatively affected HIV care was mediated by greater COVID-19-related mental health challenges. CONCLUSIONS FSW living with HIV in the Dominican Republic have been significantly affected by the COVID-19 pandemic. Targeted interventions that address structural (financial security and partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.
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Affiliation(s)
- Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Tahilin Sanchez Karver
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Kingston R, Routledge I, Bhatt S, Bowman LR. Novel Epidemic Metrics to Communicate Outbreak Risk at the Municipality Level: Dengue and Zika in the Dominican Republic. Viruses 2022; 14:v14010162. [PMID: 35062366 PMCID: PMC8781936 DOI: 10.3390/v14010162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/28/2022] Open
Abstract
Arboviruses remain a significant cause of morbidity, mortality and economic cost across the global human population. Epidemics of arboviral disease, such as Zika and dengue, also cause significant disruption to health services at local and national levels. This study examined 2014-2016 Zika and dengue epidemic data at the sub-national level to characterise transmission across the Dominican Republic. For each municipality, spatio-temporal mapping was used to characterise disease burden, while data were age and sex standardised to quantify burden distributions among the population. In separate analyses, time-ordered data were combined with the underlying disease migration interval distribution to produce a network of likely transmission chain events, displayed using transmission chain likelihood matrices. Finally, municipal-specific reproduction numbers (Rm) were established using a Wallinga-Teunis matrix. Dengue and Zika epidemics peaked during weeks 39-52 of 2015 and weeks 14-27 of 2016, respectively. At the provincial level, dengue attack rates were high in Hermanas Mirabal and San José de Ocoa (58.1 and 49.2 cases per 10,000 population, respectively), compared with the Zika burden, which was highest in Independencia and San José de Ocoa (21.2 and 13.4 cases per 10,000 population, respectively). Across municipalities, high disease burden was observed in Cotuí (622 dengue cases per 10,000 population) and Jimani (32 Zika cases per 10,000 population). Municipal infector-infectee transmission likelihood matrices identified seven 0% likelihood transmission events throughout the dengue epidemic and two 0% likelihood transmission events during the Zika epidemic. Municipality reproduction numbers (Rm) were consistently higher, and persisted for a greater duration, during the Zika epidemic (Rm = 1.0) than during the dengue epidemic (Rm < 1.0). This research highlights the importance of disease surveillance in land border municipalities as an early warning for infectious disease transmission. It also demonstrates that a high number of importation events are required to sustain transmission in endemic settings, and vice versa for newly emerged diseases. The inception of a novel epidemiological metric, Rm, reports transmission risk using standardised spatial units, and can be used to identify high transmission risk municipalities to better focus public health interventions for dengue, Zika and other infectious diseases.
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Díaz-Rodríguez A, Feliz-Matos L, Ruiz Matuk CB. Risk factors associated with preterm birth in the Dominican Republic: a case-control study. BMJ Open 2021; 11:e045399. [PMID: 34933854 PMCID: PMC8693088 DOI: 10.1136/bmjopen-2020-045399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/28/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES This study aimed to identify the risk factors associated with preterm birth, and to determine the prevalence of preterm births in the Dominican Republic. DESIGN Case-control study. SETTINGS Seven National Reference Hospitals from different regions of the Dominican Republic. PARTICIPANTS A probabilistic sampling of both cases and controls was performed with a ratio of 2.92:1, and a power analysis was performed with α=0.05, P1 =0.5, P2 =0.6, and β=0.08, to yield a distribution of 394 cases and 1150 controls. Estimation of gestational age was based on neonatologist reports. PRIMARY OUTCOME MEASURES A protocol was created to obtain maternal and obstetric information. RESULTS The main risk factors were a family history of premature births (p<0.001, OR: 14.95, 95% CI 8.50 to 26.29), previous preterm birth (p=0.005, OR: 20.00; 95% CI 12.13 to 32.96), advanced maternal age (over 35 years; p<0.001, OR: 2.21; 95% CI 1.57 to 3.09), smoking (p<0.001, OR: 6.65, 95% CI 3.13 to 13.46), drug consumption (p=0.004, OR: 2.43, 95% CI 1.37 to 4.30), premature rupture of membranes (p<0.001, OR: 2.5) and reduced attendance at prenatal consultations (95% CI 6 to 7, Z=-10.294, p<0.001). CONCLUSION Maternal age greater than 35 years, previous preterm birth, family history of preterm births and prelabour rupture of membranes were independent risk factors for preterm birth. Adolescence, pregnancy weight gain and prenatal consultations, on the other hand, were protective factors for preterm birth. Although the prevalence of premature births in this study was 25%, this could have been biased.
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20
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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21
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Bancalari P, Nicholas C, Halpern M, Stonbraker S, Taylor B, Soriano L, Ljubicic D, Amesty S. High prevalence of rectal chlamydia among pregnant adolescents in La Romana, Dominican Republic warrants extragenital STI testing. Int J STD AIDS 2021; 33:31-37. [PMID: 34565231 DOI: 10.1177/09564624211043082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To our knowledge, there are no studies estimating the prevalence of extragenital sexually transmitted infections (STIs) among pregnant adolescents in the Caribbean. This study sought to fill this gap by assessing the prevalence and correlates of oral, genital, and rectal chlamydia (CT) among a sample of pregnant adolescents in La Romana, Dominican Republic. Two hundred pregnant youths, aged 15-24 years, were recruited by systematic sampling during their first prenatal visit to a maternal care unit. A sociodemographic and behavioral questionnaire was administered and urine and oral/anal swabs were collected and tested for CT. Descriptive analyses and Fisher's exact tests were performed. The prevalence of oral, genital, and rectal CT was 6%, 15%, and 23%, respectively, although less than 5% of participants reported ever engaging in receptive anal intercourse. This discrepancy could be explained by autoinoculation, concurrent transmission during sex, undertreatment of rectal CT, or underreporting of anal sex. Almost half of CT infections would have been missed if only genital samples were collected, as current protocol dictates. More research is needed to understand sexual behaviors and rectal STI risk factors among heterosexual adolescent women. STI screening procedures for pregnant and sexually active adolescents should include routine testing of extragenital sites.
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Affiliation(s)
- Pilar Bancalari
- 33638Columbia University Mailman School of Public Health, New York, NY, USA
| | - Catherine Nicholas
- 12294Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Samantha Stonbraker
- 129263University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Barbara Taylor
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Leidy Soriano
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Dana Ljubicic
- 236434Columbia University School of General Studies, New York, NY, USA
| | - Silvia Amesty
- 33638Columbia University Mailman School of Public Health, New York, NY, USA
- 12294Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- 5798Columbia University Irving Medical Center, New York, NY, USA
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22
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Dunn MG, Lessa FC, Sánchez J, Cordero R, Feris-Iglesias J, Cedano D, Carvalho MDG, Fernández J, Feemster KA. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a Rural Community in the Dominican Republic. J Infect Dis 2021; 224:S237-S247. [PMID: 34469551 PMCID: PMC8409531 DOI: 10.1093/infdis/jiab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Invasive pneumococcal disease (IPD) leads to thousands of pediatric deaths annually. Pneumococcal colonization precedes IPD. In 2013, the Dominican Republic introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into its routine infant immunization program, with doses at ages 2, 4, and 12 months. Prevalence of pneumococcal nasopharyngeal colonization was evaluated post–PCV13 introduction. Methods A prospective cohort study of 125 children aged 2–35 months was conducted in a rural Dominican Republic community November 2016 through July 2017. Nasopharyngeal swabs and clinical and vaccination data were collected at enrollment and 4–6 months later. Serotypes included in PCV13 were defined as vaccine-type. Colonization rates and serotype distribution were compared at baseline and follow-up, and the association between colonization and vaccination status among the entire cohort was evaluated at each time point. Results Of 125 children enrolled, 118 (94%) completed follow-up. Overall and vaccine-type pneumococcal colonization rates were 62% and 25%, respectively, at baseline and 60% and 28% at follow-up. Among children age-eligible for 3 doses, 50% and 51% were fully vaccinated at baseline and follow-up, respectively. At baseline assessment, children up-to-date for age for PCV13 were less likely to be colonized with vaccine-type pneumococci than children not up-to-date, and the same was found for fully vaccinated children (3 doses) compared to those not fully vaccinated (odds ratios [ORs], 0.38 [95% confidence interval {CI}, .18–.79], and 0.14 [95% CI, .04–.45], respectively). The same associations were not found at follow-up assessment. Conclusions Three years post -PCV13 introduction, vaccine-type colonization rates remained high. Low vaccination coverage for 3 PCV13 doses may have contributed. The protective effect of PCV13 on vaccine-type carriage suggests an increase in PCV13 coverage could lead to substantial declines in pneumococcal vaccine-type carriage.
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Affiliation(s)
- Maria G Dunn
- Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Correspondence: Maria Dunn, DO, Children’s Hospital of Philadelphia Global Health Center, 2716 South St, Seventh Floor #7410, Philadelphia PA 19146, USA ()
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline Sánchez
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Ramona Cordero
- Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | | | - Doraliza Cedano
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Maria da Glória Carvalho
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Josefina Fernández
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Kristen A Feemster
- Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Madsen Beau De Rochars VE, Keys H, Samuels SK, Jo A, Noland GS, Gonzales M, Blount S, Mainous AG. Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic. Am J Trop Med Hyg 2021; 104:2241-2250. [PMID: 33872205 PMCID: PMC8176474 DOI: 10.4269/ajtmh.19-0942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/11/2021] [Indexed: 01/03/2023] Open
Abstract
This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country's three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7-6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2-11.8%) and 20.4% (95% CI, 17.9-23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2-96 years), and 10.0% (95% CI, 7.2-13.8%) and 20.0% (95% CI, 17.4-23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.
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Affiliation(s)
- Valery E. Madsen Beau De Rochars
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Hunter Keys
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- The Carter Center, Atlanta, Georgia
| | - Shenae K. Samuels
- Memorial Healthcare System, Office of Human Research, Hollywood, Florida
| | - Ara Jo
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | | | - Manuel Gonzales
- Centro Nacional para el Control de Enfermedades Tropicales (CENCET), Santo Domingo, Dominican Republic
| | | | - Arch G. Mainous
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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24
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Derose KP, Fulcar MA, Acevedo R, Armenta G, Jiménez-Paulino G, Bernard CL, del Rosario LEP, Then-Paulino A. An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic. AIDS Educ Prev 2021; 33:187-201. [PMID: 34014110 PMCID: PMC8274817 DOI: 10.1521/aeap.2021.33.3.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.
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Affiliation(s)
- Kathryn P. Derose
- RAND Corporation, Santa Monica, CA, USA
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Gipsy Jiménez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
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25
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Eusebio-Ponce E, Candel FJ, Paulino-Ramirez R, Serrano-García I, Anguita E. Seroprevalence and Trends of HTLV-1/2 among Blood Donors of Santo Domingo, Dominican Republic, 2012-2017. Rev Esp Quimioter 2021; 34:44-50. [PMID: 33305921 PMCID: PMC7876899 DOI: 10.37201/req/117.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/28/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Being a Caribbean country, the Dominican Republic is considered endemic for HTLV-1. Viral screening in blood banks is recommended for this blood borne infection. The purpose of this work is to analyze the seroprevalence and trends of HTLV-1/2 in the Dominican Republic blood donors; it is focused on Santo Domingo, the capital of the country, which has the largest blood donation activity. We also aim at comparing our findings with published data from neighboring countries. METHODS We performed a retrospective cross-sectional study of 10 blood centers of Santo Domingo, which reported HTLV and the other blood-transmitted infections in full. They represent more than 40% of the province's blood donations. Annual seroprevalence of HTLV-1/2, period prevalence (2012-2017), and time trend were determined. RESULTS A total of 352,960 blood donations were evaluated. The HTLV-1/2 period prevalence was 0.26% (929/352,960)(95% CI: 0.24-0.28%). We also found a marked predominance of replacement donation (90.4%) in comparison to voluntary contributions (9.6%). Therefore, this blood donor study may provide clues on the general prevalence of the infection. CONCLUSIONS Seroprevalence of HTLV-1/2 in blood donors of Santo Domingo, Dominican Republic, showed a relatively low and steady trend in the studied period.
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Affiliation(s)
| | | | | | | | - E Anguita
- Eduardo Anguita, Hematology Department, Hospital Clínico San Carlos, IML, IdISSC. Medicine, UCM. Profesor Martín Lagos s/n, 28040 Madrid, Spain.
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26
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Petrone ME, Earnest R, Lourenço J, Kraemer MUG, Paulino-Ramirez R, Grubaugh ND, Tapia L. Asynchronicity of endemic and emerging mosquito-borne disease outbreaks in the Dominican Republic. Nat Commun 2021; 12:151. [PMID: 33420058 PMCID: PMC7794562 DOI: 10.1038/s41467-020-20391-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
Mosquito-borne viruses threaten the Caribbean due to the region's tropical climate and seasonal reception of international tourists. Outbreaks of chikungunya and Zika have demonstrated the rapidity with which these viruses can spread. Concurrently, dengue fever cases have climbed over the past decade. Sustainable disease control measures are urgently needed to quell virus transmission and prevent future outbreaks. Here, to improve upon current control methods, we analyze temporal and spatial patterns of chikungunya, Zika, and dengue outbreaks reported in the Dominican Republic between 2012 and 2018. The viruses that cause these outbreaks are transmitted by Aedes mosquitoes, which are sensitive to seasonal climatological variability. We evaluate whether climate and the spatio-temporal dynamics of dengue outbreaks could explain patterns of emerging disease outbreaks. We find that emerging disease outbreaks were robust to the climatological and spatio-temporal constraints defining seasonal dengue outbreak dynamics, indicating that constant surveillance is required to prevent future health crises.
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Affiliation(s)
- Mary E Petrone
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA.
| | - Rebecca Earnest
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - José Lourenço
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Robert Paulino-Ramirez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Santo Domingo, Dominican Republic.
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Ono T, Cruz M, Nagashima H, Subsomwong P, Akada J, Matsumoto T, Uchida T, Suzuki R, Hosking C, Abreu JAJ, Yamaoka Y. Discovery of unique African Helicobacter pylori CagA-multimerization motif in the Dominican Republic. World J Gastroenterol 2020; 26:7118-7130. [PMID: 33362372 PMCID: PMC7723664 DOI: 10.3748/wjg.v26.i45.7118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/10/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) colonizes the human stomach and is a major cause of peptic ulcer disease and gastric cancer. However, although the prevalence of H. pylori is high in Africa, the incidence of gastric cancer is low, and this phenomenon is called to be African enigma. The CagA protein produced by H. pylori is the most studied virulence factor. The carcinogenic potential of CagA is associated with the Glu-Pro-Ile-Tyr-Ala (EPIYA) patterns and CagA-multimerization (CM) motifs.
AIM To better understand the EPIYA patterns and CM motifs of the cagA gene.
METHODS Gastric mucosal biopsy specimens were obtained from 258 patients with dyspepsia living in the Dominican Republic, from which 120 H. pylori strains were cultured. After the bacterial DNA extraction, the EPIYA pattern and CM motif genotypes were determined using a polymerase chain reaction-based sequencing. The population structure of the Dominican Republic strains was analyzed using multilocus sequence typing (MLST). Peptic ulcer disease and gastric cancer were identified via endoscopy, and gastric cancer was confirmed by histopathology. Histological scores of the gastric mucosa were evaluated using the updated Sydney system.
RESULTS All CagA-positive strains carried the Western-type CagA according to the identified EPIYA patterns. Twenty-seven kinds of CM motifs were observed. Although the typical Western CM motif (FPLKRHDKVDDLSKVG) was observed most frequently, the typical East Asian CM motif (FPLRRSAAVNDLSKVG) was not observed. However, “FPLRRSAKVEDLSKVG”, similar to the typical East Asian CM motif, was found in 21 strains. Since this type was significantly more frequent in strains classified as hpAfrica1 using MLST analysis (P = 0.034), we termed it Africa1-CM (Af1-CM). A few hpEurope strains carried the Af1-CM motif, but they had a significantly higher ancestral Africa1 component than that of those without the Af1-CM motif (P = 0.030). In 30 cagA-positive strains, the "GKDKGPE" motif was observed immediately upstream of the EPIYA motif in the EPIYA-A segment, and there was a significant association between strains with the hpAfrica1 population and those containing the “GKDKGPE” motif (P = 0.018). In contrast, there was no significant association between the CM motif patterns and histological scores and clinical outcomes.
CONCLUSION We found the unique African CM motif in Western-type CagA and termed it Africa1-CM. The less toxicity of this motif could be one reason to explain the African enigma.
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Affiliation(s)
- Takaaki Ono
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
- Criminal Investigation Laboratory, Oita Prefectural Police Headquarters, Oita 870-1117, Japan
| | - Modesto Cruz
- Institute of Microbiology and Parasitology, IMPA, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo 10103, Dominican Republic
- Department of Biomedical Research, National Institute of Medicine and Diagnostic Imaging, Santo Domingo 10107, Dominican Republic
| | - Hiroyuki Nagashima
- Department of Gastroenterology, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Phawinee Subsomwong
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
| | - Junko Akada
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
| | - Takashi Matsumoto
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu 879-5593, Japan
| | - Rumiko Suzuki
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
| | - Celso Hosking
- Institute of Microbiology and Parasitology, IMPA, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo 10103, Dominican Republic
| | - José A Jiménez Abreu
- Dominican-Japanese Digestive Disease Center, Dr Luis E. Aybar Health and Hygiene City, Santo Domingo 10302, Dominican Republic
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX 77030, United States
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Daskalopoulou C, Wu YT, Pan W, Giné Vázquez I, Prince M, Prina M, Tyrovolas S. Factors related with sarcopenia and sarcopenic obesity among low- and middle-income settings: the 10/66 DRG study. Sci Rep 2020; 10:20453. [PMID: 33235211 PMCID: PMC7686337 DOI: 10.1038/s41598-020-76575-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia and sarcopenic obesity research in low- and middle- income countries (LMICs) is limited. We investigated sarcopenia and sarcopenic obesity prevalence and sociodemographic, bio-clinical and lifestyle factors in LMICs settings. For the purposes of this study, the 10/66 Dementia Research Group follow-up wave information from individuals aged 65 and over in Cuba, Dominican Republic, Peru, Mexico, Puerto Rico, China, was employed and analysed (n = 8.694). Based on indirect population formulas, we calculated body fat percentage (%BF) and skeletal muscle mass index (SMI). Sarcopenia prevalence ranged from 12.4% (Dominican Republic) to 24.6% (rural Peru); sarcopenic obesity prevalence ranged from 3.0% (rural China) to 10.2% (rural Peru). Odds ratios (OR) with 95% confidence intervals (CI) for sarcopenia were higher for men 2.82 (2.22-3.57) and those with higher %BF 1.08 (1.07-1.09), whereas higher number of assets was associated with a decreased likelihood 0.93 (0.87-1.00). OR of sarcopenic obesity were higher for men 2.17 (1.70-2.76), those reporting moderate alcohol drinking 1.76 (1.21-2.57), and those with increased number of limiting impairments 1.54 (1.11-2.14). We observed heterogeneity in the prevalence of sarcopenia and sarcopenic obesity in the 10/66 settings. We also found a variety of factors to be associated with those. Our results reveal the need for more research among the older population of LMICs.
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Affiliation(s)
- Christina Daskalopoulou
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - Yu-Tzu Wu
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - William Pan
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
- Global Health Institute, Duke University, Durham, NC, 27708, USA
| | - Iago Giné Vázquez
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Monforte de Lemos 3-5. Pabellón 11, 28029, Madrid, Spain
| | - Martin Prince
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - Matthew Prina
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Monforte de Lemos 3-5. Pabellón 11, 28029, Madrid, Spain.
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Chung DH, Gomez DR, Vargas JM, Amador BL, Torchetti MK, Killian ML, Swayne DE, Lee DH. Low Pathogenicity Avian Influenza (H5N2) Viruses, Dominican Republic. Emerg Infect Dis 2020; 26:3094-3096. [PMID: 33219794 PMCID: PMC7706952 DOI: 10.3201/eid2612.200268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Low pathogenicity avian influenza (H5N2) virus was detected in poultry in the Dominican Republic in 2007 and re-emerged in 2017. Whole-genome sequencing and phylogenetic analysis show introduction of an H5N2 virus lineage from Mexico into poultry in the Dominican Republic, then divergence into 3 distinct genetic subgroups during 2007–2019.
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Grant-McAuley W, Fogel JM, Galai N, Clarke W, Breaud A, Marzinke MA, Mbwambo J, Likindikoki S, Aboud S, Donastorg Y, Perez M, Barrington C, Davis W, Kerrigan D, Eshleman SH. Antiretroviral drug use and HIV drug resistance in female sex workers in Tanzania and the Dominican Republic. PLoS One 2020; 15:e0240890. [PMID: 33119663 PMCID: PMC7595323 DOI: 10.1371/journal.pone.0240890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 02/04/2023] Open
Abstract
Objective Female sex workers (FSW) have increased risk of HIV infection. Antiretroviral treatment (ART) can improve HIV outcomes and prevent HIV transmission. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-positive FSW in the Dominican Republic and Tanzania. Methods Plasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance. ARV drug testing was performed using a qualitative assay that detects 22 ARV drugs in five classes. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System. Phylogenetic analyses were performed to determine HIV subtype and assess transmission clusters. Results Among 410 FSW, 144 (35.1%) had viral loads >1,000 copies/mL (DR: n = 50; Tanzania: n = 94). ARV drugs were detected in 36 (25.0%) of 144 samples. HIV genotyping results were obtained for 138 (95.8%) cases. No transmission clusters were observed in either country. HIV drug resistance was detected in 54 (39.1%) of 138 samples (31/35 [88.6%] with drugs detected; 23/103 [22.3%] without drugs detected); 29/138 (21.0%) had multi-class resistance (MCR). None with MCR had integrase strand transfer inhibitor resistance. In eight cases, one or more ARV drug was detected without corresponding resistance mutations; those women were at risk of acquiring additional drug resistance. Using multivariate logistic regression, resistance was associated with ARV drug detection (p<0.001), self-reported ART (full adherence [p = 0.034]; partial adherence [p<0.001]), and duration of HIV infection (p = 0.013). Conclusions In this cohort, many women were on ART, but were not virally suppressed. High levels of HIV drug resistance, including MCR, were observed. Resistance was associated with detection of ARV drugs, self-report of ART with full or partial adherence, and duration of HIV infection. These findings highlight the need for better HIV care among FSW to improve their health, reduce HIV drug resistance, and decrease risk of transmission to others.
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Affiliation(s)
- Wendy Grant-McAuley
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jessica M. Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mark A. Marzinke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- Unidad de Investigacion de Vacunas, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Unidad de Investigacion de Vacunas, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Wendy Davis
- Center on Health, Risk and Society, American University, Washington, District of Columbia, United States of America
| | - Deanna Kerrigan
- Center on Health, Risk and Society, American University, Washington, District of Columbia, United States of America
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Hearld KR, Budhwani H, Martínez-Órdenes M, Altaf A, Hasbun J, Waters J. Female Sex Workers' Experiences of Violence and Substance Use on the Haitian, Dominican Republic Border. Ann Glob Health 2020; 86:105. [PMID: 32874936 PMCID: PMC7442172 DOI: 10.5334/aogh.2889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Female sex workers (FSW) are socially and economically marginalized, and this vulnerability can be exacerbated when they hold the intersectional identity of also being an immigrant, such as in the case of Haitian FSWs in the Dominican Republic. Objective Considering that half of migratory young women and girls relocating across the Latin American and Caribbean region do so without their families, increasing the likelihood of experiencing abuses, our primary objective was to test the hypothesis that Haitian FSWs in the Dominican Republic have higher odds of being physically abused by sexual partners compared to Haitian FSWs in Haiti. Methods We conducted bivariate analyses and multivariate analyses on 2014 Hispaniola Sex Workers Study (N = 232). Findings Approximately 80% of Haitian FSWs in the Dominican Republic reported experiencing violence by a regular partner (80.3%), compared with 60.0% of Haitian FSWs in Haiti (χ2 = 11.34, p < 0.001). Controlling for socio-demographics, substance use, childhood abuse, and sexual behaviors, Haitian FSWs in Haiti maintained lower odds of experiencing violence by a regular partner (OR:0.37, p < 0.01) and higher odds of experiencing violence from a coworker (OR:6.38, p < 0.001) compared to FSWs in the Dominican Republic. Using sex to avoid arrest is associated with higher odds of experiencing violence by a client and violence by a coworker (OR:2.18, p < 0.05; OR:3.74, p < 0.001; respectively). Accepting payment in the form of drugs/alcohol is associated with higher odds of experiencing physical violence by a regular partner but lower odds of experiencing violence by a client (OR:3.99, p < 0.05; OR:0.43, p < 0.05; respectively). Conclusions Assuming health is a human right, then practitioners and scholars must actively collaborate to fortify vulnerable populations against injurious structural and sociocultural forces examining the intersectionality and compound effects of multiple stigmatized identities, in this study being an FSW and an immigrant, that moderate the potential positive effects of public health interventions.
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Affiliation(s)
| | | | | | | | | | - John Waters
- Caribbean Vulnerable Communities Coalition, JM
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Nazif-Munoz JI, Puello A, Williams A, Nandi A. Can a new emergency response system reduce traffic fatalities? The case of the 911-emergency response system in the Dominican Republic. Accid Anal Prev 2020; 143:105513. [PMID: 32470640 DOI: 10.1016/j.aap.2020.105513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In May 2014, the Dominican Republic introduced the 911-emergency response system (ERS) in Santo Domingo. Before its introduction, more than 40 phone numbers were available to report emergencies. The objective of this work is to assess whether this new emergency response system was effective in reducing traffic fatalities. METHODS Weekly numbers of traffic fatalities per population and per vehicle fleet from January 2013 to December 2015 were obtained from the Ministry of Health and the National Institute of Statistics. A hybrid time-series difference-in-difference analysis using multivariable negative binomial regression models were used to compare trends in rates of traffic fatalities in Santo Domingo to La Romana and Santiago, before and after the introduction of the 911-ERS. RESULTS Estimates from negative binomial models suggest that the introduction of the 911-ERS in Santo Domingo relative to Santiago-La Romana was associated with a 17% reduction in the Incidence Rate Ratio (IRR) of traffic fatalities per 1 000 000 population (IRR = 0.83, 95% confidence interval [CI]: 0.67; 1.03) and with a 20% reduction in the IRR of weekly traffic fatalities per 1 000 000 vehicle fleet (IRR = 0.80, 95% CI:0.67; 0.99). DISCUSSION Our findings suggest that transitioning from multiple to one unique emergency phone number should be considered more attentively. Furthermore, the case of the Dominican Republic calls for more theoretical and methodological research to understand how to assess these road safety policies more accurately. Since various studies suggest that 911-ERS mature in the long run, how these systems evolve over time and other related variables should be carefully considered.
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Affiliation(s)
- José Ignacio Nazif-Munoz
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada; Department of Environmental Health-T. H Chan School of Public Health, Harvard University, Boston, USA.
| | - Adrián Puello
- Escuela De Salud Pública, Universidad Autónoma De Santo Domingo, Santo Domingo, Dominican Republic
| | - Augusta Williams
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
| | - Arijit Nandi
- Department of Epidemiology, Faculty of Medicine, McGill University, Montreal, Canada
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Abstract
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.
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Affiliation(s)
- Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Santo Domingo, Dominican Republic
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Diaz-Nicolas J, Silva-Vetri MG, Rivas-Tumanyan S, Toro MJ, Elías-Boneta AR. Prevalence of Dental Caries in 12-Year-Olds in San Pedro de Macorís, DR. P R Health Sci J 2020; 39:210-215. [PMID: 32663920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Dental caries is one of the most prevalent chronic diseases in children. Currently, no data are available on dental caries prevalence in the Dominican Republic. The purpose of this study was to estimate the prevalence of dental caries in schoolattending 12-year-olds in San Pedro de Macorís, Dominican Republic. METHODS A cross-sectional epidemiological study using a probabilistic sample, stratified by type of school (public/private) and gender, was conducted. Two calibrated examiners conducted the evaluations of oral soft/hard tissues. Caries experience was summarized in terms of prevalence; the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS); and the significant caries (SiC) index, in all the participants, and by gender and school type. Logistic and Poisson regression models were used to compare caries experience by sex and school type. RESULTS Four hundred and two 12-year-olds enrolled in 14 public and 11 private schools were evaluated. The overall dental caries prevalence was 73%. The mean DMFS was 3.87, the mean DMFT was 2.64, and the SiC index was 5.07. Girls had significantly higher mean DMFS, DMFT, and SiC indices than did boys. Public school attendees had significantly higher DMFS, DMFT, and SiC indices than did those children attending private schools. The decayed (D) component accounted for 71% of the DMFT value. CONCLUSION The WHO's goal of all 12-year-olds having a DMFT less than or equal to 3 was met by all the participants in our study. Girls and public-school attendees carry the burden of the disease. The high D component of the index suggests that there are unmet dental-caries needs. This information will assist in the design and implementation of future primary and secondary prevention programs.
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Affiliation(s)
- Jomar Diaz-Nicolas
- Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico; Universidad Central del Este, San Pedro de Macorís, Dominican Republic
| | | | - Sona Rivas-Tumanyan
- Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Milagros J Toro
- Office of the Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Augusto R Elías-Boneta
- Professor, Assistant Dean of Research, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Tricou V, Sáez-Llorens X, Yu D, Rivera L, Jimeno J, Villarreal AC, Dato E, Saldaña de Suman O, Montenegro N, DeAntonio R, Mazara S, Vargas M, Mendoza D, Rauscher M, Brose M, Lefevre I, Tuboi S, Borkowski A, Wallace D. Safety and immunogenicity of a tetravalent dengue vaccine in children aged 2-17 years: a randomised, placebo-controlled, phase 2 trial. Lancet 2020; 395:1434-1443. [PMID: 32197107 DOI: 10.1016/s0140-6736(20)30556-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Vianney Tricou
- Takeda Pharmaceuticals International, Zurich, Switzerland.
| | - Xavier Sáez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Panama City, Panama; Sistema Nacional de Investigación, Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama City, Panama
| | - Delia Yu
- De La Salle Health Sciences Institute, Cavite, Philippines
| | - Luis Rivera
- Hospital Universitario Maternidad Nuestra Señora de la Altagracia, Santo Domingo, Dominican Republic
| | - José Jimeno
- Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | | | - Epiphany Dato
- De La Salle Health Sciences Institute, Cavite, Philippines
| | | | | | - Rodrigo DeAntonio
- Sistema Nacional de Investigación, Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama City, Panama; Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | - Sonia Mazara
- Hospital Universitario Maternidad Nuestra Señora de la Altagracia, Santo Domingo, Dominican Republic
| | - Maria Vargas
- Hospital Universitario Maternidad Nuestra Señora de la Altagracia, Santo Domingo, Dominican Republic
| | | | | | - Manja Brose
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - Inge Lefevre
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - Suely Tuboi
- Takeda Pharmaceuticals, Rio de Janeiro, Brazil
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Biswal S, Borja-Tabora C, Martinez Vargas L, Velásquez H, Theresa Alera M, Sierra V, Johana Rodriguez-Arenales E, Yu D, Wickramasinghe VP, Duarte Moreira E, Fernando AD, Gunasekera D, Kosalaraksa P, Espinoza F, López-Medina E, Bravo L, Tuboi S, Hutagalung Y, Garbes P, Escudero I, Rauscher M, Bizjajeva S, LeFevre I, Borkowski A, Saez-Llorens X, Wallace D. Efficacy of a tetravalent dengue vaccine in healthy children aged 4-16 years: a randomised, placebo-controlled, phase 3 trial. Lancet 2020; 395:1423-1433. [PMID: 32197105 DOI: 10.1016/s0140-6736(20)30414-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
| | | | - Luis Martinez Vargas
- Centro de Atención e Investigación Médica, Dominicana, Santo Domingo, Dominican Republic
| | | | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | - Victor Sierra
- Centro de Atención e Investigación Médica, Yopal, Colombia
| | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Gangodawila, Sri Lanka
| | | | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Médico Imbanaco, Cali, Colombia
| | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | | | | | | | | | | | | | - Inge LeFevre
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación at Secretaría Nacional de Ciencia y Tecnología, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
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Abstract
Human immunodeficiency virus (HIV) testing is important for controlling the epidemic in low- and middle-income countries such as the Dominican Republic (DR) – a country in the Caribbean. This study aimed to examine factors associated with HIV testing in the DR. The study used HIV test data in the 2013 DR Demographic and Health Survey. HIV data were collected from 18,614 individuals aged 15–59 years. Wealth status, HIV-related stigma, and knowledge scales were constructed using factor analysis. Survey-weighted logistic regression was used to identify correlates of HIV testing in the DR. Results show that almost two-thirds (62.4%) of the participants reported ever having an HIV test. In the multivariable analysis, older age, higher education, female gender, richest wealth status, health insurance, married, higher HIV-knowledge, and lower HIV-related stigma increased the likelihood of getting an HIV test in the DR. People living in Norte/Cibao, which had a higher HIV prevalence, had a lower chance of having an HIV test than people living in the Este/Sureste region. Although HIV testing has increased in recent times, it is not yet satisfactory in the DR. Specific interventions building HIV awareness targeting specific sub-populations and regions will increase knowledge on HIV and reduce HIV-related stigma, and may increase HIV testing.
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Affiliation(s)
- Mohammad R Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Monique J Brown
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khairul A Siddiqi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Rojas R, Macesic N, Tolari G, Guzman A, Uhlemann AC. Multidrug-Resistant Klebsiella pneumoniae ST307 in Traveler Returning from Puerto Rico to Dominican Republic. Emerg Infect Dis 2019; 25:1583-1585. [PMID: 31310203 PMCID: PMC6649323 DOI: 10.3201/eid2508.171730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report blaKPC-2-harboring carbapenem-resistant Klebsiella pneumoniae in an emerging sequence type 307 lineage in a traveler returning from Puerto Rico to the Dominican Republic. Phylogenetic analyses indicate regional dissemination of this highly drug-resistant clone across the Americas, underscoring the need for adequate surveillance and infection control efforts to prevent further spread.
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Reddy SP, Walsh MS, Paulino-Ramirez R, Florenzán J, Fernández J, Nwariaku FE, Abdelnaby A. Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions. Traffic Inj Prev 2019; 20:690-695. [PMID: 31381379 DOI: 10.1080/15389588.2019.1643016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate-severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.
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Affiliation(s)
- Sumanth P Reddy
- Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas
| | - Maura S Walsh
- Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas
| | - Robert Paulino-Ramirez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
| | - Jomar Florenzán
- School of Medicine, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
| | - Jaime Fernández
- School of Medicine, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
- Department of Surgery, Hospital Traumatológico Dr. Ney Arias Lora , Santo Domingo , Dominican Republic
| | - Fiemu E Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas , Texas
| | - Abier Abdelnaby
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas , Texas
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Abstract
During the epidemic, almost 10% of pregnancies in acute infection resulted in fetal loss; 3 cases of fetal microcephaly were reported. 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.
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Stennett-Brown RK, Stephenson TS, Taylor MA. Caribbean climate change vulnerability: Lessons from an aggregate index approach. PLoS One 2019; 14:e0219250. [PMID: 31291297 PMCID: PMC6619692 DOI: 10.1371/journal.pone.0219250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/19/2019] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Michael A. Taylor
- Department of Physics, The University of the West Indies, Mona, Jamaica, West Indies
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Rapid Response for Diphtheria Control in the Dominican Republic. MEDICC Rev 2018; 20:5. [PMID: 31242154 DOI: 10.37757/MR2018.V20.N3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Corynebacterium diphtheriae is a toxin-producing bacterium that causes respiratory or cutaneous manifestations and, without treatment, can lead to mortality. Key to diphtheria control is prevention by vaccination, which can be a challenge for health leaders in low-resource settings.
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Keys HM, Noland GS, De Rochars MB, Blount S, Gonzales M. Prevalence of malaria and lymphatic filariasis in bateyes of the Dominican Republic. Infect Dis Poverty 2019; 8:39. [PMID: 31130142 PMCID: PMC6535845 DOI: 10.1186/s40249-019-0547-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/07/2019] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Hunter M. Keys
- Department of Anthropology, University of Amsterdam, Building B-REC B 8.01, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
| | | | - Madsen Beau De Rochars
- Health Services Research, Management and Policy Department, University of Florida, 1225 Center Drive, HPNP 3101, Gainesville, FL 32611 USA
| | - Stephen Blount
- The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307 USA
| | - Manuel Gonzales
- Center for Prevention and Control of Vector-borne and Zoonotic Diseases, Av. Juan Pablo Duarte No. 269, 10301 Santo Domingo, Dominican Republic
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Bonilla GA, Hornsby PP, Pannone AF, Case SK, Aviles ES, Carrasco Apolinario ME, Mercedes D, Mota A, Ibrahim A. Demographic and clinical characteristics of dominican adults admitted to a diabetic foot clinic in the Dominican Republic, 2015. Diabetes Metab Syndr 2019; 13:1727-1732. [PMID: 31235085 DOI: 10.1016/j.dsx.2019.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 12/26/2022]
Abstract
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 ± 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.
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Affiliation(s)
| | | | | | - Samuel K Case
- University of Virginia School of Medicine, United States
| | | | | | - Desideria Mercedes
- National Institute of Diabetes, Endocrinology, and Nutrition, Dominican Republic
| | - Aura Mota
- National Institute of Diabetes, Endocrinology, and Nutrition, Dominican Republic
| | - Ammar Ibrahim
- National Institute of Diabetes, Endocrinology, and Nutrition, Dominican Republic
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Collins JR, Chinea S, Cuello RJ, Florian AP, Palma P, Ambrosio N, Marín MJ, Figuero E, Herrera D. Subgingival microbiological profile of periodontitis patients in Dominican Republic. Acta Odontol Latinoam 2019; 32:36-43. [PMID: 31206573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- James R Collins
- Pontificia Universidad Católica Madre y Maestra (PUCMM), Escuela de Odontología, Departamento de Periodoncia, Santo Domingo, República Dominicana
| | - Sofía Chinea
- Universidad Complutense de Madrid, Facultad de Odontología, Grupo de investigación ETEP (Etiología y Terapéutica de las Enfermedades Periodontales), Departmento de Especialidades Clínicas Odontológicas, Madrid, Spain
| | - Rosanna J Cuello
- Pontificia Universidad Católica Madre y Maestra (PUCMM), Escuela de Odontología, Departamento de Periodoncia, Santo Domingo, República Dominicana
| | - Alba P Florian
- Pontificia Universidad Católica Madre y Maestra (PUCMM), Escuela de Odontología, Departamento de Periodoncia, Santo Domingo, República Dominicana
| | - Patricia Palma
- Universidad de Chile, Escuela de Odontología, Departamento de Patología y Medicina Oral, Santiago, Chile
| | - Nagore Ambrosio
- Universidad Complutense de Madrid, Facultad de Odontología, Grupo de investigación ETEP (Etiología y Terapéutica de las Enfermedades Periodontales), Departmento de Especialidades Clínicas Odontológicas, Madrid, Spain
| | - María J Marín
- Universidad Complutense de Madrid, Facultad de Odontología, Grupo de investigación ETEP (Etiología y Terapéutica de las Enfermedades Periodontales), Departmento de Especialidades Clínicas Odontológicas, Madrid, Spain
| | - Elena Figuero
- Universidad Complutense de Madrid, Facultad de Odontología, Grupo de investigación ETEP (Etiología y Terapéutica de las Enfermedades Periodontales), Departmento de Especialidades Clínicas Odontológicas, Madrid, Spain.
| | - David Herrera
- Universidad Complutense de Madrid, Facultad de Odontología, Grupo de investigación ETEP (Etiología y Terapéutica de las Enfermedades Periodontales), Departmento de Especialidades Clínicas Odontológicas, Madrid, Spain
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Miftahussurur M, Cruz M, Doohan D, Subsomwong P, Abreu JAJ, Hosking C, Waskito LA, Yamaoka Y. Five alternative Helicobacter pylori antibiotics to counter high levofloxacin and metronidazole resistance in the Dominican Republic. PLoS One 2019; 14:e0213868. [PMID: 30917150 PMCID: PMC6436749 DOI: 10.1371/journal.pone.0213868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/01/2019] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Muhammad Miftahussurur
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Modesto Cruz
- Institute of Microbiology and Parasitology, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
- Department of Biomedical Research, National Institute of Medicine and Diagnostic Imaging, Santo Domingo, Dominican Republic
| | - Dalla Doohan
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Phawinee Subsomwong
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - José A. Jiménez Abreu
- Dominican–Japanese Digestive Disease Center, Dr. Luis E. Aybar Health and Hygiene City, Santo Domingo, Dominican Republic
| | - Celso Hosking
- Department of Biomedical Research, National Institute of Medicine and Diagnostic Imaging, Santo Domingo, Dominican Republic
| | - Langgeng Agung Waskito
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, United States of America
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Gonzales M, Baker MC, Celestino A, Santa Morillo D, Chambliss A, Adams S, Gyapong M, Kyelem D. How lymphatic filariasis was eliminated from an urban poor setting in Santo Domingo, Dominican Republic. Int Health 2019; 11:108-118. [PMID: 30285112 PMCID: PMC6398592 DOI: 10.1093/inthealth/ihy059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/11/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
| | - Margaret C Baker
- RTI International, 701 13th Street NW, Suite 750, Washington, DC, USA
| | - Ana Celestino
- Universidad Autónoma de Santo Domingo, Ciudad Universitaria, SD, Dominican Republic
| | | | - Amy Chambliss
- Georgetown University, Department of Global Health, 3700 O St, NW, Washington, DC, USA
| | - Sarah Adams
- George Mason University, 4400 University Drive, Fairfax, VA, USA
| | | | - Dominique Kyelem
- The Taskforce for Global Health, 330 West Ponce de Leon Ave, Decatur, Georgia, USA
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Dethlefs HJ, Walker EA, Schechter CB, Dowd R, Filipi L, Garcia JF, Filipi C. Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic. Diabetes Res Clin Pract 2019; 148:212-221. [PMID: 30641164 PMCID: PMC6394404 DOI: 10.1016/j.diabres.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/28/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Henry J Dethlefs
- One World Community Health Centers, Inc, 4920 S 30th St. Suite 103, Omaha, NE 68107, USA
| | - Elizabeth A Walker
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Clyde B Schechter
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Rachel Dowd
- CHI Creighton University Medical Center, 7500 Mercy Rd., Omaha, NE 68124, USA
| | - Linda Filipi
- Chronic Care International, 12370 Rose Lane, Omaha, NE 68154, USA
| | | | - Charles Filipi
- Creighton University, School of Medicine, Education Building, Suite 105, 7710 Mercy Road, Omaha, NE 68124, USA
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Prina AM, Wu YT, Kralj C, Acosta D, Acosta I, Guerra M, Huang Y, Jotheeswaran AT, Jimenez-Velazquez IZ, Liu Z, Llibre Rodriguez JJ, Salas A, Sosa AL, Prince M. Dependence- and Disability-Free Life Expectancy Across Eight Low- and Middle-Income Countries: A 10/66 Study. J Aging Health 2019; 32:401-409. [PMID: 30698491 PMCID: PMC7322974 DOI: 10.1177/0898264319825767] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this study was to estimate healthy life expectancies in eight low- and middle-income countries (LMICs), using two indicators: disability-free life expectancy (DFLE) and dependence-free life expectancy (DepFLE). Method: Using the Sullivan method, healthy life expectancy was calculated based on the prevalence of dependence and disability from the 10/66 cohort study, which included 16,990 people aged 65 or above in China, Cuba, Dominican Republic, India, Mexico, Peru, Puerto Rico, and Venezuela, and country-specific life tables from the World Population Prospects 2017. Results: DFLE and DepFLE declined with older age across all sites and were higher in women than men. Mexico reported the highest DFLE at age 65 for men (15.4, SE = 0.5) and women (16.5, SE = 0.4), whereas India had the lowest with (11.5, SE = 0.3) in men and women (11.7, SE = 0.4). Discussion: Healthy life expectancy based on disability and dependency can be a critical indicator for aging research and policy planning in LMICs.
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Affiliation(s)
| | | | | | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Isaac Acosta
- National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Mariella Guerra
- Instituto de la Memoria y Desordenes Relacionados, Lima, Perú
| | | | | | | | | | | | - Aquiles Salas
- Universidad Central de Venezuela, Caracas, Venezuela
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
- National Autonomous University of Mexico, Mexico City, Mexico
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Flannagan KS, Ramírez-Zea M, Roman AV, Das AK, Villamor E. Adipose tissue polyunsaturated fatty acids and metabolic syndrome among adult parents and their children. Nutr Metab Cardiovasc Dis 2018; 28:1237-1244. [PMID: 30360954 DOI: 10.1016/j.numecd.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/03/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Polyunsaturated fatty acids (PUFA) may play a role in the etiology of the metabolic syndrome (MetS). The aim of the study was to examine the associations of adipose tissue PUFA biomarkers with MetS among parents and children in Mesoamerica. METHOD AND RESULTS We conducted a cross-sectional study among 468 parents and 201 children aged 7-12 y from the capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, and Belize, and Tuxtla Gutiérrez in Mexico. We measured PUFA biomarkers in gluteal adipose tissue by gas chromatography. In adults, MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III definition. In children, we created an age- and sex-standardized metabolic risk score using abdominal circumference, the homeostasis model of insulin resistance, blood pressure, serum HDL cholesterol, and triglycerides. We estimated prevalence ratios of MetS and mean differences in metabolic score across quartiles of PUFA using multivariable-adjusted Poisson and linear regression models, respectively. Among adults, MetS was associated with low alpha-linolenic acid (ALA), high eicosapentaenoic acid (EPA), and low gamma-linolenic acid (GLA). It was linearly, positively associated with dihomo-gamma-linolenic acid (DGLA) and estimated Δ6-desaturase (D6D) activity. Among children, the metabolic score was positively associated with docosapentaenoic acid (DPA), DGLA, and D6D activity. CONCLUSIONS Among Mesoamerican adults, MetS prevalence is inversely associated with adipose tissue ALA and GLA, and positively associated with EPA, DGLA, and the D6D index. Among children, metabolic risk score is positively associated with DPA, DGLA, and the D6D index.
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Affiliation(s)
- K S Flannagan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - M Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - A V Roman
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - A K Das
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - E Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
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