Université Notre Dame d'Haïti

Background Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in the United States, with risk driven by the clustering of modifiable factors such as hypertension, diabetes, obesity, dyslipidemia, and smoking. Prescription pain medication use is common among adults with chronic conditions, yet its relationship with cardiovascular risk burden is not well-characterized. Objective The objective of this study is to evaluate the association between prescription pain medication use and cardiovascular risk burden among adults in the United States. Methods This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020 prepandemic cycle. Adults aged 18 years and older were included. The exposure was prescription pain medication use. The outcome was a composite cardiovascular risk burden score categorized into low, moderate, and high risk. Survey-weighted logistic regression was used to examine the association with high cardiovascular risk, adjusting for demographic and socioeconomic factors. The final analytic sample included 6,662 participants, corresponding to a weighted population of 195,893,244 US adults. Results Prescription pain medication use was associated with higher odds of high cardiovascular risk factor burden (adjusted odds ratio, 1.54; 95% confidence interval (CI), 1.15-2.07; p = 0.005). Increasing age was associated with higher odds (adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03; p = 0.003). A higher income-to-poverty ratio was associated with lower odds (adjusted odds ratio, 0.92; 95% confidence interval, 0.85-0.99; p = 0.029). Physical activity was associated with lower odds (adjusted odds ratio, 0.53; 95% confidence interval, 0.39-0.74; p < 0.001). Conclusion Prescription pain medication use is associated with a higher cardiovascular risk factor burden among US adults. These findings support the need for integrated cardiovascular risk assessment in individuals receiving pain medications.

Standard postoperative care following elective craniotomy traditionally includes close monitoring in an ICU setting, use of opioid-based analgesia, delayed initiation of oral intake, and prolonged bed rest. These practices may contribute to a longer recovery period, a higher risk of complications such as infections or deep vein thrombosis (DVT), and lower patient satisfaction. On the other hand, Enhanced Recovery After Surgery (ERAS) protocols offer a more structured and proactive approach. It incorporates preoperative counseling, carbohydrate loading (if appropriate), avoidance of prolonged fasting, and standardized anesthetic techniques that prefer shorter-acting agents. Postoperatively, ERAS prioritizes early removal of catheters and drains, early enteral diet, and rapid mobilization - all designed to help patients recover more efficiently. Across the literature reviewed here, ERAS is associated with concrete gains over standard care: postoperative nausea and vomiting falling from roughly 28.0% to 9.2% in one cohort, a Karnofsky Performance Status improvement of approximately 10 points sustained at 30 days (pooled mean difference 6.68 points), patient satisfaction of 92.2% versus 86.8%, ICU length of stay reduced to under one day, and per-patient cost reductions of $1,044-$4,026. Hospitals must undertake protocol development, arrange training, and ensure flexibility to adapt ERAS elements to each patient's clinical needs; implementation remains uneven across economic and resource settings, particularly in low- and middle-income countries. As interest in ERAS grows, further research and education will be essential to support wider and more effective practice across neurosurgical practices.

BACKGROUND AND OBJECTIVE:Birth defects occur more often in low-income and middle-income countries. This study delineates the epidemiology of myelomeningocele (MMC) patients presenting to the Bernard Mevs Hospital (HBM) in Haiti. METHODS:Pediatric patients with MMC at HBM between 2018 and 2022 were reviewed, and statistical analyses were performed. RESULTS:The study included 54 spina bifida patients with a mean age of 1.2 ± 2.4 months, predominantly male (64.8%, n = 35). The prevalence from 2018 to 2022 was approximately 0.4 cases per 10 000 live births. Half of the patients (50.0%, n = 27) had a birth weight of 2500 to 4000 g. Hydrocephalus was commonly associated, present in 55.6% (n = 30) of patients. Lumbar defects were most frequent, found in 63% (n = 34) of cases. The average hospital stay was 31.3 ± 43.5 days, with 94.4% (n = 51) showing clinical improvement; there were 3 deaths (5.6%). Regarding timing of intervention, 25.9% (14/54) underwent early repair and 74.1% (40/54) late repair. Hydrocephalus was present in 64.3% of the early group and 52.5% of the late group (P = .652). Favorable postoperative results were slightly lower in the early group (85.7% vs 97.5%, P = .328). Folate supplementation was reported in 44.4% (n = 24) of mothers, and unemployment was common among parents, with 42.6% of mothers and 31.5% of fathers being unemployed. CONCLUSION:The study highlights the epidemiology of MMC at HBM, with a high prevalence of hydrocephalus and lumbar defects. Shorter postoperative stays were linked to better outcomes. The findings highlight the need for improved prenatal care, folate supplementation, and addressing socioeconomic challenges to improve outcomes.

We investigate the paradox of financial sector growth amid institutional collapse in Haiti - one of the lowest-ranked countries in global governance indices. Despite persistent declines in the rule of law, judicial independence, and anti-corruption enforcement, Haiti's banking sector expanded significantly between 2003 and 2023. Drawing on institutional theory and property rights theory, we analyse how deficiencies in legal infrastructure and regulatory capacity distort core elements of corporate governance. Using Varieties of Democracy (V-Dem) indicators, the study reveals that institutional fragility creates systemic risks for multinational enterprises, rendering formal governance mechanisms ineffective. Our findings highlight a process of governance substitution and institutional co-production wherein informal mechanisms compensate for formal institutional decay. This research challenges conventional agency-based models and emphasises the importance of context-sensitive strategies for firms operating in fragile states. The study contributes to business theory by advancing a nuanced framework for governance under conditions of institutional disintegration.

This paper challenges prevailing models of governance and state capacity by examining how civic participation functions as a survival mechanism in contexts of institutional collapse. Using Haiti as a focal case, we analyse the role of expressive freedoms in maintaining governance under conditions of state failure. Drawing on cross-national data from Varieties of Democracy and the World Bank's World Governance Indicators, we find that expressive civic engagement - not formal civil society participation - is significantly associated with governance quality across fragile regimes. We propose the concept of 'civic substitution', where non-state actors partially fill governance voids through non-institutionalised mechanisms. These findings contribute to debates in comparative politics and development studies by highlighting new modes of resilience in the Global South.