UTMB Global Health

Do

Dominican Republic

UTMB Global Health

University of Texas Medical Branch at Galveston

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 Dialysis Unit of Buen Samaritano Hospital Prevalence of water borne illnesses with respect to installation of water filters Field epidemiology course at El Universidad Central del Este

Rotation at Hospital El Buen Samaritano

The Prevalence and Effects of Depression and Anxiety in Patients Receiving Maintenance Care in the Dialysis Unit of Buen Samaritano Hospital

Study/ Objective
For the last 6 weeks we have been conducting a study on the prevalence of depression and anxiety in the dialysis patients at Buen Samaritano Hospital. Objective: Investigate the levels of depression and anxiety in 11 patients between the ages of 27 and 77 with chronic renal insufficiency undergoing hemodialysis at Buen Samaritano Hospital.

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.

Materials
Hospital, ansiedad y depresin (HAD) questionnaire Eadg56: escala de ansiedad y depresin de Goldberg (Versin adaptada al castellano por A. Lobo y colaboradores.) Both of these questionnaires have been translated into Spanish and the Goldberg has been shortened. The revised version has been peer reviewed and approved as an effective tool in the diagnosis of depression and anxiety in Spanish speaking populations.

Methods HAD
Patients were asked 14 questions from the HAD. Four answer choices were provided for each question and labeled 0-3 based on their likelihood of representing a symptom of anxiety or depression. To ensure no bias in the study due to a patients inability to read the questions a researcher dictated the questions to them and recorded their answers. After the patient had answered all of the questions their total score was calculated and used to determine if the patient was a high risk for anxiety or depression.

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.

Methods-Goldberg

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 4155 aos tuvimos 5 pacientes para un 44%; en el tercer grupo tuvimos 2 pacientes para 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%.

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 en estudio, 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 un hematocrito <30%, lo que corresponde a un 26% de la poblacin en estudio.

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, todos presentaron ansiedad para un 36% y 3 presentaron depresin para un 26% de la poblacin en estudio.

Results

Results
Percent Prevalence of Depression and Anxiety in Dialysis Patients at Buen Samaritano Hospitall

Neither Depression or Anxiety

Anxiety only

Depression andAnxiety

Depression Only

Depression Only

Anxiety only Neither Depression or Anxiety

Depression andAnxiety

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Conclusion
With over half of the patients in dialysis possibly suffering from depression, anxiety, or both it is highly probable that developing a program of treatment for these conditions would improve the health of the patients undergoing chronic dialysis. A possible bias of the study is its extremely small sample size. Collaboration with other hospitals and doing similar studies in other dialysis wards could provide a large sample population and further validate the results of this study. Further research would greatly benefit our understanding of the effects of depression and anxiety in patients in a dialysis setting in the Dominican Republic and allow for the creation of treatment plans for these conditions.

Water Filtration Study: Background

According to the World Health Organization (WHO) 1.8 million people die every year from diarrheal 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

Water Filtration Study: Background

Improved water supply reduces diarrhea morbidity by 21%. Improved sanitation reduces diarrhea morbidity by 37.5% Additional improvement of drinking-water quality, 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

Water Filtration Study: Methods

Interviewed 2 communities, Batey El 80 and Batey Juaquincito Administered questionnaire to each household (44) that held a water filter Questionnaire consisted of:
Personal and filter identifying information Questions regarding the usage of water filter Prevalence of water borne diseases in relation to the water filter installation date

Water Filtration Study: Methods

Level of Empl # of Educ oyme Sex Filter Batey ation nt Q1

ID

Name Age

Q2

Q3

Q4

Q5

Q6a

Q6b Q6c Q6d

Q6e

Q6f

Q7

WRK0 1 MV

22

46919 El 80

11

WRK0 2 RM

46

99999 El 80

11

WRK0 3 MO

42

99999 El 80

WRK0 4 YR

28

99999 El 80

WRK0 5 AC

46

99999 El 80

Water Filtration Study: Methods

WRK 24 MB 22 1 Juaqu 41395 incito 1 1 1 9999 1 2 4 2 4 4 2 4 4 1

WRK 25

YF

19

Juaqu 99999 incito

11

WRK 26

LC

24

Juaqu 99999 incito

11

10

WRK 27 RM

28

Juaqu 41415 incito

11

WRK 28 MG

80

Juaqu 41412 incito

11

10

Water Filtration Study: El 80 Results

% Diminished, Diminished, but still but still present present Before % Before after after After % After Installation Installation Installation installation Installation Installation Never Present
13.0434782 6 4.34782608 7 17.3913043 5 17.3913043 5 8.69565217 4 4.34782608 7

% Never Present

Salmonalla Typhi Salmonella sp/Shigella

20

86.95652174

22

95.65217391

Colera Entamoeba histolytica Contact Dermatits

19

82.60869565

4.347826087

18

78.26086957

21

91.30434783

Urinary Infection

22

95.65217391

Water Filtration Study: El 80 Results

El 80 Prevalence of Disease (%)
100 91.3 90 80 70 60 50 40 30 20 10 17.39 17.39 8.7 4.35 0 4.35 00 86.96 95.65

82.61
78.26

% Before Installation % Diminished, but still present after installation % After Installation % Never Present
13.04
9.65 4.35 00

00 00 00 0 Salmonalla Salmonella Typhi sp/Shigella Colera Entamoeba histolytica Contact Dermatits Urinary Infection

Water Filtration Study: Juaquincito Results

Diminished, but still present after instillation

Before Instillation

After Instillation

Never Present

% Never Present

Salmonalla Typhi Salmonella sp/Shigella

14.2857142 9

4.761904762

4.76190476 2

16

76.19047619

0 4.76190476 2 9.52380952 4 4.76190476 2 0

21

100

Colera Entamoeba histolytica Contact Dermatits Urinary Infection

0 14.2857142 9 14.2857142 9 9.52380952 4

20

95.23809524

16

76.19047619

1 0

0 0

0 0

3 2

17 19

80.95238095 90.47619048

Water Filtration Study: Juaquincito Results

Juaquincito Prevalence of Disease (%)
100 100 90 80.95 80 70 60 50 40 30 76.19 76.19 95.24 90.476

% Before Installation % Diminished, but still present after installation

% After Installation
% Never Present
14.29 9.52 4.76 4.76 0 0 0 4.76 0 0 Colera 0 Entamoeba histolytica 14.29 4.76 0 Contact Dermatits 0 0 Urinary Infection 14.29 9.52

20
10 0

Salmonalla Typhi

Salmonella sp/Shigella

Water Filtration Study: Conclusion

Due to the low number of individuals used in the study, compounded with recall bias of individuals interviewed, the results did not match our original hypothesis However, set up a continuation of the study with a greater amount of communities/households for a greater amount of time Demonstrates the importance of data collection before the installation of water filters

Field Epidemiology

Field Epidemiology Course

Field Epidemiology course given by Dr. Goldy Mills at El Universidad Central del Este (UCE)

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

Water Contamination

Unsanitary Waste Removal

Impure Drinking Water

Inadequate Living Conditions

Cemetery

School for the Deaf and Mute

Hospital Rotations

Hospital Rotations
2-3 days/ week worked in El Buen Samaritano Met with patients, gained clinical experience

Surgery

Surgery

Special Thanks:
Lic. Moises Sifren Dr. Liddy Kiaty, MD Dr. Franklin Bido Dr. Goldny Mills Daniel Barett and Filter Group

Questions?