Despite public health initiatives, childhood vaccination coverage remains incomplete in the Dominican Republic (DR), with approximately 15% of children not fully immunized according to WHO and UNICEF. Vaccine hesitancy (VH) among caregivers has emerged as a potential barrier to achieving optimal immunization rates. The objective of this study was to elucidate the determinants of VH among parents and caregivers, with a particular focus on identifying socioeconomic and informational factors. A cross-sectional survey was conducted among 186 parents and caregivers at a national pediatric referral hospital in the DR. Participants completed digital and printed versions of the Parent Attitudes about Childhood Vaccines (PACV) survey. Additional items were included to collect demographic and socioeconomic data. Descriptive and inferential statistics were performed using JASP software. Of the 186 respondents, 165 were mothers, with a mean age of 30 years (SD = 8.9). Most families reported having 2-3 children (56.45%), with 63.98% of participants having less than a high school education and 60.22% reporting a monthly household income < 333 USD. Despite these socioeconomic challenges, 96.77% of participants exhibited favorable attitudes (FA) toward childhood vaccination (mean PACV score: 18.38, SD = 14.55). FA were significantly associated with a reduced likelihood of being influenced by vaccine misinformation on social media (χ2 = 3.956, df = 1, p = 0.047) and were more common among not formally employed caregivers (χ2 = 10.165, df = 3, p = 0.017). Monthly household income and educational attainment were not significantly associated with vaccination attitudes (p > 0.05). Low educational attainment and limited income were prevalent but did not significantly predict vaccine hesitancy. Contrary to initial hypotheses, most of the parents and caregivers demonstrated FA towards vaccination, particularly those not formally employed. These findings suggest that barriers to full immunization coverage in the DR may extend beyond socioeconomic determinants, implicating broader structural, didactic and cultural influences. Targeted interventions addressing misinformation and improving healthcare access are warranted to close existing immunization gaps. All Authors: No reported disclosures
The field of neurosurgery in the Caribbean has long been shaped by systemic limitations in infrastructure, training opportunities, and gender representation. Despite these challenges, a small group of pioneering women have broken through traditional barriers to become leaders in Caribbean neurosurgery. This narrative review highlights the contributions and career trajectories of female neurosurgeons across the region, offering historical and contemporary perspectives on their clinical, academic, and leadership roles. Through a combination of literature review and direct outreach, we document the stories of the first female neurosurgeons in Curaçao, Trinidad and Tobago, Jamaica, Guyana, Saint Lucia, the Dominican Republic, Cuba, and Puerto Rico. Their achievements span advanced surgical innovations, including the introduction of percutaneous transforaminal endoscopic discectomy in the Caribbean, establishment of local neurosurgical departments, and leadership in academic and global neurosurgery initiatives. The article also examines persistent disparities in neurosurgical training and representation, particularly among women and underrepresented minorities. These stories underscore the critical importance of resilience, mentorship, and advocacy in driving progress in a traditionally male-dominated field. By documenting these contributions, we aim to amplify the visibility of Caribbean female neurosurgeons and inspire further efforts to promote equity and diversity in neurosurgery, both regionally and globally.
Standardized quality metrics are critical to evaluate guideline adherence and outcomes, yet these are rarely tracked outside of time-limited research studies in resource-constrained settings. We describe the early implementation of the Global Fever Registry (FEVEREG), an electronic registry designed to collect local quality indicators and support implementation of a clinical guideline for fever with neutropenia in children with cancer. Between 2021 and 2023, the registry was introduced at six referral hospitals in Central America and the Caribbean. We assessed the feasibility of a cohort-based implementation model through descriptive analysis of the duration of key implementation steps, delays in data entry, completion of required data fields, and center participation. Over 2 years, 619 febrile episodes from 472 children were recorded. The all-site median delay from episode onset to database entry was over 30 days, but two centers had median delays of > 4 months; one subsequently discontinued registry use. Audits at 14 and 24 months after registry activation demonstrated 89
Abstract Disclosure: L.D. Rojas Rodríguez: None. M.J. Mateo Pérez: None. L.C. López Sención: None. V.T. San Martin: None. A. Grullón: None. Background: Overweight and obesity can be detrimental to the health of children with congenital heart disease, potentially leading to or contributing to other chronic medical conditions such as hypertension. This, in turn, may increase the cardiovascular demands of these patients whose lives are already affected by a defective heart anatomy. Objective: To determine the prevalence of overweight and obesity in Dominican children with congenital heart disease. Methods: An observational cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with congenital heart disease attending the Pediatric Cardiology Department at Children's Hospital (Santo Domingo, Dominican Republic), from July to December 2022. The study population was classified into categories of underweight, normal weight, overweight or obesity using the CDC Body Mass Index-for-age growth chart (2022), based on their age, weight, height, and sex. The parents of the patients were interviewed to gather information about their children’s medical history, as well as their diet type and level of physical activity. Diet type was assessed through a questionnaire about daily meals; diets in which processed foods and simple carbohydrates were predominant were categorized as unhealthy, while those with a predominance of proteins and complex carbohydrates were categorized as healthy. Physical activity levels were measured using the Assessment of Physical Activity Level Questionnaire (APALQ). Additionally, blood pressure values were categorized as normal or elevated/high based on the American Academy of Pediatrics Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents (2017). Results: A total of 84 patients with congenital heart disease were analyzed, with 11.9% (10/84) categorized as having overweight and 23.8% (20/84) categorized as having obesity. Among patients with overweight or obesity, unhealthy eating habits predominated in 66.7% (20/30), while a sedentary level of physical activity was reported in 56.7% (17/30). Additionally, among patients with overweight or obesity, 36.7% (11/30) had elevated/high blood pressure. Conclusion: About one-third of Dominican patients with congenital heart disease were found to have overweight or obesity. Additionally, about one-third of those with excess weight were found to have elevated/high blood pressure. These findings stress the need for urgent implementation of personalized interventions and educational programs focused on fostering healthier lifestyles. The ultimate goal is to reduce cardiovascular risks and improve the overall well-being of children living with congenital heart disease. Presentation: 6/1/2024
