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UTMB Global Health
Do
Dominican Republic
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p
UTMB Global Health
University of Texas Medical Branch at Galveston
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UTMB Global Health in the DR
6 weeks in the Dominican Republic
3 main goals:
The Prevalence and Effects of Depression and Anxiety
in Patients Receiving Maintenance Care in the DialysisUnit of Buen Samaritano Hospital
Prevalence of water borne illnesses with respect toinstallation of water filters
Field epidemiology course at El Universidad Centraldel Este
Rotation at Hospital El Buen Samaritano
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The Prevalence and Effects of
Depression and Anxiety in Patients
Receiving Maintenance Care in the
Dialysis Unit of Buen Samaritano
Hospital
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Study/ Objective
For the last 6 weeks we have been conductinga study on the prevalence of depression andanxiety in the dialysis patients at Buen
Samaritano Hospital. Objective: Investigate the levels of depression
and anxiety in 11 patients between the agesof 27 and 77 with chronic renal insufficiencyundergoing hemodialysis at Buen SamaritanoHospital.
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Inclusion Criteria
Subjects were all adults.
Subjects must have the physical and mental
capacity to respond to the questions given in
the study.
Patients must have been in dialysis for at least
6 months to be considered for the study.
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Materials
Hospital, ansiedad y depresin (HAD) questionnaire
Eadg56: escala de ansiedad y depresin de Goldberg(Versin adaptada al castellano por A. Lobo ycolaboradores.)
Both of these questionnaires have been translated intoSpanish and the Goldberg has been shortened.
The revised version has been peer reviewed andapproved as an effective tool in the diagnosis ofdepression and anxiety in Spanish speakingpopulations.
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Methods HAD
Patients were asked 14 questions from the HAD. Fouranswer choices were provided for each question andlabeled 0-3 based on their likelihood of representing asymptom of anxiety or depression.
To ensure no bias in the study due to a patientsinability to read the questions a researcher dictated thequestions to them and recorded their answers.
After the patient had answered all of the questions
their total score was calculated and used to determineif the patient was a high risk for anxiety or depression.
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Methods HAD
Scores of 7 or below were considered low risk
for depression and anxiety.
Scores ranging from 8-10 are considered
possible risks for depression and anxiety
Scores of 11 or high are considered a very
likely indicator of depression and anxiety.
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Methods-Goldberg
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En la Unidad de Dilisis del Hospital General El Buen Samaritano, el Departamento
de Investigacin Medica de la mano con la Universidad de Texas desarrollo un
proyecto de investigacin para determinar los niveles de ansiedad y depresin en
los pacientes de dicha unidad, con la finalidad de ejecutar un programa que
mejore su calidad de vida y por ende reduzca la morbilidad en dichos pacientes.
La muestra estuvo integrada por un total de 11 pacientes para un 100%.
En cuanto al sexo que mayor proporcin se present en la unidad fue el femenino
con 6 mujeres para un 54% y el masculino 5 pacientes para un 44%.
Con respecto a la edad de los pacientes, lo dividimos en 3 grupos. En el primer
grupo de 25-40 aos tuvimos 2 pacientes para un 17%; en el segundo grupo de 41-
55 aos tuvimos 5 pacientes para un 44%; en el tercer grupo tuvimos 2 pacientespara un 17%.
En cuanto al estado civil de los pacientes, 5 estn casados para un 44%, 3 solteros
para un 26% y 3 viudos para un 26%.
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Con respecto al nivel educativo, 5 de los pacientes tienen un nivel educativo bsico
para un 44%; en el nivel medio hay 5 pacientes para un 44% y 1 paciente
profesional para un 12%.
En cuanto a la situacin laboral 2 de los pacientes en estudio estn activos para un
17% y el resto (9 pacientes) se encuentran inactivos para un 83%.
Para validar que el paciente padece de insuficiencia renal crnica decidimos
utilizar como parmetro los niveles de urea y creatinina. De los pacientes enestudio, 10 presentaron niveles elevados de urea para un 90%, siendo el valor
mnimo en este grupo 35.0mg/dl y el mximo 145.6mg/dl. En cuanto a los niveles
de creatinina 10 de los pacientes en estudio presentaron niveles elevados para un
90%, siendo el valor mnimo 4.3mg/dl y el mximo 14.6mg/dl. Fue de inters para
esta investigacin tomar en cuenta el hematocrito de estos pacientes para validar
la presencia de anemia en los mismos, 3 de estos pacientes presentaron unhematocrito
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Con respecto al HAD, dentro del grupo de 0-7 (no indica caso) tuvimos 4 pacientes
para un 35%, en el grupo de 8-10 (caso dudoso) tuvimos 3 pacientes para un 26%,
dentro del grupo de >11 (paciente en una de las sub-escalas de Goldberg) tuvimos
4 pacientes para 36%.
En cuanto al Goldberg de los 4 pacientes que entraron este grupo, todospresentaron ansiedad para un 36% y 3 presentaron depresin para un 26% de la
poblacin en estudio.
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Results
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Results
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Depression andAnxiety
Depression Only
Anxiety only
Neither Depression or Anxiety
Percent Prevalence of Depression and Anxiety in Dialysis Patients at Buen Samaritano Hospitall
Depression andAnxiety
Depression Only
Anxiety only
Neither Depression or Anxiety
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Conclusion
With over half of the patients in dialysis possiblysuffering from depression, anxiety, or both it is highlyprobable that developing a program of treatment forthese conditions would improve the health of thepatients undergoing chronic dialysis.
A possible bias of the study is its extremely smallsample size. Collaboration with other hospitals anddoing similar studies in other dialysis wards couldprovide a large sample population and further validatethe results of this study.
Further research would greatly benefit ourunderstanding of the effects of depression and anxietyin patients in a dialysis setting in the DominicanRepublic and allow for the creation of treatment plansfor these conditions.
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Water Filtration Study: Background
According to the World Health Organization(WHO) 1.8 million people die every year fromdiarrheal diseases (including cholera) 90% are children under 5, mostly in developing
countries 88% of diarrheal disease are attributed to unsafe
water supply and inadequate sanitation
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Water Filtration Study: Background
Improved water supply reduces diarrhea
morbidity by 21%. Improved sanitation
reduces diarrhea morbidity by 37.5%
Additional improvement of drinking-waterquality, such as point of use disinfection,
would lead to a reduction of diarrhea
episodes of 45%. UTMB/ Hospital El Buen Samaritano study of
the prevalence of water borne disease before
and after date of installation
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Water Filtration Study: Methods
Interviewed 2 communities, BateyEl 80 and Batey Juaquincito
Administered questionnaire toeach household (44) that held a
water filter Questionnaire consisted of:
Personal and filter identifyinginformation
Questions regarding the usage ofwater filter
Prevalence of water bornediseases in relation to the waterfilter installation date
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ID Name Age Sex# of
Filter Batey
Levelof
Education
Employme
nt Q1 Q2 Q3 Q4 Q5 Q6a Q6b Q6c Q6d Q6e Q6f Q7
WRK01 MV 22 2 46919 El 80 1 2 11 1 1 4 4 4 4 4 4 4 1
WRK02 RM 46 1 99999 El 80 1 2 1 11 1 4 4 4 4 4 4 4 4 1
WRK03 MO 42 1 99999 El 80 1 1 1 1 1 3 4 4 4 4 4 4 4 1
WRK04 YR 28 1 99999 El 80 1 2 1 1 1 1 4 4 4 4 1 4 4 1
WRK0
5 AC 46 1 99999 El 80 1 1 1 1 1 1 4 4 4 4 3 4 4 1
Water Filtration Study: Methods
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WRK24 MB 22 1 41395
Juaquincito 1 1 1 9999 1 2 4 2 4 4 2 4 4 1
WRK25 YF 19 1 99999
Juaquincito 1 2 1 11 2 5 4 4 4 1 4 1 4 1
WRK26 LC 24 1 99999
Juaquincito 1 2 1 11 1 2 10 4 4 4 1 4 4 1
WRK27 RM 28 2 41415
Juaquincito 1 2 1 11 2 3 4 4 4 1 1 1 4 1
WRK
28 MG 80 1 41412
Juaqu
incito 1 1 1 11 2 1 10 1 4 4 4 4 4 1
Water Filtration Study: Methods
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Before
Installation
% Before
Installation
Diminished,
but still
present
after
Installation
%
Diminished,
but still
present
after
installation
After
Installation
% After
Installation Never Present
% Never
Present
Salmonalla Typhi 3
13.0434782
6 0 0 0 0 20 86.95652174
Salmonella
sp/Shigella 1
4.34782608
7 0 0 0 0 22 95.65217391
Colera 4
17.3913043
5 0 0 0 0 19 82.60869565
Entamoeba
histolytica 4
17.3913043
5 1 4.347826087 0 0 18 78.26086957
Contact
Dermatits 2
8.69565217
4 0 0 0 0 21 91.30434783
Urinary Infection 1
4.34782608
7 0 0 0 0 22 95.65217391
Water Filtration Study: El 80 Results
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Water Filtration Study: El 80 Results
0
10
20
30
40
50
60
70
80
90
100
Salmonalla TyphiSalmonella sp/ShigellaColeraEntamoeba histolyticaContact DermatitsUrinary Infection
13.04
4.35
17.39 17.39
8.7
4.35
0 0 0
4.35
0 00 0 0 0 0 0
86.96
9.65
82.61
78.26
91.3
95.65
El 80 Prevalence of Disease (%)
% Before Installation
% Diminished, but still
present after installation
% After Installation
% Never Present
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Before
Instillation %
Diminished,
but still
present
after
instillation %
After
Instillation % Never Present
% Never
Present
Salmonalla Typhi 3
14.2857142
9 1 4.761904762 1
4.76190476
2 16 76.19047619
Salmonella
sp/Shigella 0 0 0 0 0 0 21 100
Colera 1
4.76190476
2 0 0 0 0 20 95.23809524
Entamoeba
histolytica 2
9.52380952
4 0 0 3
14.2857142
9 16 76.19047619
Contact
Dermatits 1
4.76190476
2 0 0 3
14.2857142
9 17 80.95238095
Urinary Infection 0 0 0 0 2
9.52380952
4 19 90.47619048
Water Filtration Study: Juaquincito Results
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Water Filtration Study: Juaquincito Results
0
10
20
30
40
50
60
70
80
90
100
Salmonalla
Typhi
Salmonella
sp/Shigella
Colera Entamoeba
histolytica
Contact
Dermatits
Urinary
Infection
14.29
0
4.76
9.52
4.76
0
4.76
0 0 0 0 0
4.76
0 0
14.29 14.29
9.52
76.19
100
95.24
76.19
80.95
90.476
Juaquincito Prevalence of Disease (%)
% Before Installation
% Diminished, but still
present after installation
% After Installation
% Never Present
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Due to the low number of individuals used inthe study, compounded with recall bias ofindividuals interviewed, the results did notmatch our original hypothesis
However, set up a continuation of the studywith a greater amount ofcommunities/households for a greateramount of time
Demonstrates the importance of datacollection before the installation of waterfilters
Water Filtration Study: Conclusion
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Field Epidemiology
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Field Epidemiology Course
Field Epidemiology course given by Dr. Goldy
Mills at El Universidad Central del Este (UCE)
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Field Epidemiology Course at UCE
Experience, first hand, life in the bateyes and
barrios of the Dominican Republic
Visited 5 bateyes and barrios
Toured the local cemetery
Met with disabled children attending school
for the deaf and mute
Identified health risk factors associated with
living in these communities
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Water Contamination
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Unsanitary Waste Removal
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Impure Drinking Water
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Inadequate Living Conditions
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Cemetery
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School for the Deaf and Mute
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Hospital Rotations
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Hospital Rotations
2-3 days/ week worked in El Buen Samaritano
Met with patients, gained clinical experience
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Surgery
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Surgery
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Special Thanks:
Lic. Moises Sifren
Dr. Liddy Kiaty, MD
Dr. Franklin Bido
Dr. Goldny Mills
Daniel Barett and Filter Group
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Questions?