Santo Domingo.- The Dominican Republic has enacted a new decree aimed at enhancing pig production within the country. This measure is designed to provide a robust legal framework for the registration, surveillance, and early detection of diseases that could impact this vital sector. Additionally, the decree outlines the essential requirements for the management of waste and by-products in pig production.

In line with this decree, the Ministry of Agriculture is directed to prepare and issue regulations in accordance with Law no. 4030, dated January 13, 1955. These regulations will be specifically tailored to ensure compliance with article 1 of the decree, thereby facilitating better management and development of the pig production industry in the Dominican Republic. This move represents a significant step towards strengthening a key sector in the nation’s economy and ensuring the health and sustainability of its livestock.

CAIRO, Ga. — Zita Magloire carefully adjusted a soft measuring tape across Kenadie Evans’ pregnant belly.

Determining a baby’s size during a 28-week obstetrical visit is routine. But Magloire, a family physician trained in obstetrics, knows that finding the mother’s uterus and, thus, checking the baby, can be tricky for inexperienced doctors.

“Sometimes it’s, like, off to the side,” Magloire said, showing a visiting medical student how to press down firmly and complete the hands-on exam. She moved her finger slightly to calculate the fetus’s height: “There she is, right here.”

Evans smiled and later said Magloire made her “comfortable.”

The 21-year-old had recently relocated from Louisiana to southeastern Georgia, two states where both maternal and infant mortality are persistently high. She moved in with her mother and grandfather near Cairo, an agricultural community where the hospital has a busy labor and delivery unit. Magloire and other doctors at the local clinic where she works deliver hundreds of babies there each year.

Scenes like the one between Evans and Magloire regularly play out in this rural corner of Georgia despite grim realities mothers and babies face nationwide. Maternal deaths keep rising, with Black and Indigenous mothers most at risk; the number of babies who died before their 1st birthday climbed last year; and more than half of all rural counties in the United States have no hospital services for delivering babies, increasing travel time for parents-to-be and causing declines in prenatal care.

There are many reasons labor and delivery units close, including high operating costs, declining populations, low Medicaid reimbursement rates, and staffing shortages. Family medicine physicians still provide the majority of labor and delivery care in rural America, but few new doctors recruited to less populated areas offer obstetrics care, partly because they don’t want to be on call 24/7. Now, with rural America hemorrhaging health care providers, the federal government is investing dollars and attention to increase the ranks.

“Obviously the crisis is here,” said Hana Hinkle, executive director of the Rural Training Track Collaborative, which works with more than 70 rural residency training programs. Federal grants have boosted training programs in recent years, Hinkle said.

In July, the Department of Health and Human Services announced a nearly $11 million investment in new rural programs, including family medicine residencies that focus on obstetrical training.

Nationwide, a declining number of primary care doctors — internal and family medicine — has made it difficult for patients to book appointments and, in some cases, find a doctor at all. In rural America, training family medicine doctors in obstetrics can be more daunting because of low government reimbursement and increasing medical liability costs, said Hinkle, who is also assistant dean of Rural Health Professions at the University of Illinois College of Medicine in Rockford.

In the 1980s, about 43% of general family physicians who completed their residencies were trained in obstetrics. In 2021, the American Academy of Family Physicians’ annual practice profile survey found that 15% of respondents had practiced obstetrics.

Yet family doctors, who also provide the full spectrum of primary care services, are “the backbone of rural deliveries,” said Julie Wood, a doctor and senior vice president of research, science, and health of the public at the AAFP.

In a survey of 216 rural hospitals in 10 states, family practice doctors delivered babies in 67% of the hospitals, and at 27% of the hospitals they were the only ones who delivered babies. The data counted babies delivered from 2013 to 2017. And, the authors found, if those family physicians hadn’t been there, many patients would have driven an average of 86 miles round-trip for care.

Mark Deutchman, the report’s lead author, said he was “on call for 12 years” when he worked in a town of 2,000 residents in rural Washington. Clarifying that he was exaggerating, Deutchman explained that he was one of just two local doctors who performed cesarean sections. He said the best way to ensure family physicians can bolster obstetric units is to make sure they work as part of a team to prevent burnout, rather than as solo do-it-all doctors of old.

There needs to be a core group of physicians, nurses, and a supportive hospital administration to share the workload “so that somebody isn’t on call 365 days a year,” said Deutchman, who is also associate dean for rural health at the University of Colorado Anschutz Medical Campus School of Medicine. The school’s College of Nursing received a $2 million federal grant this fall to train midwives to work in rural areas of Colorado.

Nationwide, teams of providers are ensuring rural obstetric units stay busy. In Lakin, Kansas, Drew Miller works with five other family physicians and a physician assistant who has done an obstetrical fellowship. Together, they deliver about 340 babies a year, up from just over 100 annually when Miller first moved there in 2010. Word-of-mouth and two nearby obstetric unit closures have increased their deliveries. Miller said he has seen friends and partners “from surrounding communities stop delivering just from sheer burnout.”

In Galesburg, Illinois, Annevay Conlee has watched four nearby obstetric units close since 2012, forcing some pregnant people to drive up to an hour and a half for care. Conlee is a practicing family medicine doctor and medical director overseeing four rural areas with a team of OB-GYNs, family physicians, and a nurse-midwife. “There’s no longer the ability to be on 24/7 call for your women to deliver,” Conlee said. “There needs to be a little more harmony when recruiting in to really support a team of physicians and midwives.”

In Cairo, Magloire said practicing obstetrics is “just essential care.” In fact, pregnancy care represents just a slice of her patient visits in this Georgia town of about 10,000 people. On a recent morning, Magloire’s patients included two pregnant people as well as a teen concerned about hip pain and an ecstatic 47-year-old who celebrated losing weight.

Cairo Medical Care, an independent clinic situated across the street from the 60-bed Archbold Grady hospital, is in a community best known for its peanut crops and as the birthplace of baseball legend Jackie Robinson. The historical downtown has brick-accented streets and the oldest movie theater in Georgia, and a corner of the library is dedicated to local history.

The clinic’s six doctors, who are a mix of family medicine practitioners, like Magloire, and obstetrician-gynecologists, pull in patients from the surrounding counties and together deliver nearly 300 babies at the hospital each year.

Deanna Buckins, a 36-year-old mother of four boys, said she was relieved when she found “Dr. Z” because she “completely changed our lives.”

“She actually listens to me and accepts my decisions instead of pushing things upon me,” said Buckins, as she held her 3-week-old son, whom Magloire had delivered. Years earlier, Magloire helped diagnose one of Buckins’ older children with autism and built trust with the family.

“Say I go in with one kid; before we leave, we’ve talked about every single kid on how they’re doing and, you know, getting caught up with life,” Buckins said.

Magloire grew up in Tallahassee, Florida, and did her residency in rural Kansas. The smallness of Cairo, she said, allows her to see patients as they grow — chatting up the kids when the mothers or siblings come for appointments.

“She’s very friendly,” Evans said of Magloire. Evans, whose first child was delivered by an OB-GYN, said she was nervous about finding the right doctor. The kind of specialist her doctor was didn’t matter as much as being with “someone who cares,” she said.

As a primary care doctor, Magloire can care for Evans and her children for years to come.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

The study, a cross-sectional analysis involving 4650 primary school children aged 9–10 years in the UK, predominantly from South Asian, black African Caribbean, and white European backgrounds, examined the relationship between circulating vitamin D (25-hydroxyvitamin D) concentrations and markers of insulin resistance.

This study was published in the Journal Of Epidemiology & Community Health by Angela Donin and colleagues. The study revealed that lower levels of circulating vitamin D were observed, particularly among girls and children from South Asian and black African Caribbean ethnicities. After adjusting for age, sex, month, ethnic group, and school, researchers noted an inverse relationship between circulating vitamin D levels and markers of insulin resistance:

Association with Insulin Resistance: For every increase in 1 nmol/L of 25(OH)D, there was a corresponding decrease in fasting insulin levels by 0.38%, HOMA insulin resistance by 0.39%, and fasting glucose by 0.03%.

Ethnic Disparities: Differences in fasting insulin and insulin resistance, which were notably higher in South Asian and black African Caribbean children, were reduced by over 40% after accounting for circulating 25(OH)D concentrations.

The findings underscore the potential impact of vitamin D levels on insulin resistance in children across different ethnicities. Importantly, the study suggests that lower vitamin D concentrations among South Asian and black African Caribbean children could contribute to their higher levels of insulin resistance.

The study's authors highlight the need for further investigation into whether vitamin D supplementation could mitigate the emerging risk of type 2 diabetes, especially in children with lower circulating vitamin D levels.

Reference: Donin, A., Nightingale, C. M., Sattar, N., Fraser, W. D., Owen, C. G., Cook, D. G., & Whincup, P. H. Cross-sectional study of the associations between circulating vitamin D concentrations and insulin resistance in children aged 9–10 years of South Asian, black African Caribbean and white European origins. Journal of Epidemiology and Community Health, jech-2023-220626,2023. https://doi.org/10.1136/jech-2023-220626

This
year, Google users in the United States wanted to know more about strep throat, how to lower cholesterol and what helps with bloating.

Those were just some of the top-trending health-related questions searched on Google in the United States from January 1 to November 27, according to the technology company.

"The data reflects top trending searches, which means the 'trending' queries are the searches that had a high spike in traffic over a sustained period in 2023 as compared to 2022," Google spokesperson Sarah Armstrong said in an e-mail.

Here are the 10 top trending health questions that had people Googling in 2023, and some of their answers.

1. How long is strep contagious?

Strep infections in the United States surged in early 2023, leaving many people with questions about how contagious the illness is and for how long. Strep infections in the US surged this winter, up nearly 30 per cent from pre-pandemic peak. In February, the share of health-care visits for strep throat or a related diagnosis was nearly 30 per cent higher than during the previous peak in 2017. Although viruses cause most sore throats, strep throat is an infection in the throat and tonsils caused by group A streptococcus bacteria — and these bacteria are very contagious. People treating strep throat with antibiotics become less contagious over 24 to 48 hours, according to Johns Hopkins Medicine, but a person with untreated strep can infect others for about two or even three weeks. Symptoms of strep throat can include fever, pain when swallowing, red and swollen tonsils, and swollen lymph nodes. According to the Centers for Disease Control and Prevention (CDC), less-common symptoms may include vomiting and headache — but not a cough or a runny nose.

2. How contagious

Typically, an infected person can spread the bacteria to others through their respiratory droplets when talking, coughing or sneezing, or through direct contact, such as if someone touches sores on the skin caused by the bacteria, according to the US CDC. It usually takes two to five days for someone who has been exposed to group A strep bacteria to become ill with strep throat. Strep throat is more common in children, as up to three in 10 children with a sore throat have strep throat, according to the CDC, compared with about 1 in 10 adults with a sore throat.

3. How to lower cholesterol

A growing body of research suggests that consuming a plant-based, vegetarian or vegan diet can help lower cholesterol. One study, published in the European Heart Journal in May, found that in adults following a plant-based diet, levels of LDL or low-density lipoprotein cholesterol — often called "bad" cholesterol — dropped 10 per cent and total cholesterol declined 7 per cent compared with adults who eat both meat and plants.

People can lower or control their cholesterol by limiting the amount of saturated and trans fats they eat. Saturated fats are found primarily in red meat and full-fat dairy products, and trans fats are often used in margarines and store-bought cookies, crackers and cakes.

Foods rich in omega-3 fatty acids — such as salmon and flaxseeds — have heart-healthy benefits, and soluble fibre — found in foods like oatmeal, apples and Brussels sprouts — can help reduce the absorption of cholesterol into the bloodstream.

Exercising regularly, not smoking, losing weight and not drinking too much alcohol all can be helpful in improving cholesterol levels.

4. What helps

There are several common causes of abdominal bloating, including constipation, irritable bowel syndrome, lactose intolerance, overeating and even certain medications — but there are some steps people can take to help care for bloating at home. According to the National Library of Medicine, it may help to avoid chewing gum and carbonated drinks, as well as foods that can produce gas, such as Brussels sprouts, cabbage, beans and lentils. Stopping smoking and not eating too quickly also can help. Fibre supplements, such as psyllium or 100 per cent bran, may make symptoms worse, but certain medicines like simethicone can be helpful. Contact a medical professional if, along with bloating, you have abdominal pain, blood in the stool, diarrhoea, worsening heartburn, vomiting or weight loss.

5. What causes low

When blood pressure dips too low — to a reading of less than 90/60 mm Hg — the condition is called hypotension. According to the American Heart Association, low blood pressure can occur with prolonged bed rest, depression, Parkinson's disease or pregnancy. When someone loses large amounts of blood, that can cause low blood pressure, as well as certain medications, including diuretics, beta blockers and tricyclic antidepressants. Chronically low blood pressure may lead to symptoms such as dizziness or light-headedness, nausea, fainting, fatigue, headache, blurred vision, and heart palpitations.

6. What causes warts?

Most common warts on the skin are caused by the human papillomavirus or HPV, a group of more than 150 viruses, and it can spread through various ways. Most forms of the virus are spread through skin-to-skin contact or shared objects, such as towels or wash cloths, according to Mayo Clinic. The virus usually spreads through breaks in the skin, and although warts most commonly appear on the hands, they can also affect the feet, face, genitals and knees.

7. Why do I feel nauseous?

While pregnancy or the stomach flu are some common causes of feeling nauseated, chronic nausea also can be a symptom of disorders related to the digestive system, such as gastroesophageal reflux disease or peptic ulcer disease. Some people may have an increased risk of nausea due to certain medications or treatments they may be taking, such as cancer patients who are undergoing radiation therapy or chemotherapy.

Pregnant people also are at an increased risk of feeling nauseated during their first trimester, which is commonly referred to as "morning sickness". According to the Cleveland Clinic, researchers estimate that about 50 per cent to 90 per cent of pregnant people have nausea, while 25 per cent to 55 per cent have vomiting.

8. What causes preeclampsia?

Pre-eclampsia — which can lead to eclampsia when someone with pre-eclampsia has seizures — is a condition that causes high blood pressure after the 20th week of pregnancy or after giving birth. Globally, between 10 per cent and 15 per cent of deaths due to pregnancy or childbirth are caused by pre-eclampsia and associated complications, such as eclampsia.

In the United States, preeclampsia affects between 5 per cent and 8 per cent of pregnancies, according to the maternal and infant health nonprofit March of Dimes, and in most cases, it leads to preterm birth. Yet the exact causes of preeclampsia remain unknown. People can be at higher risk of pre-eclampsia if they had preeclampsia in a previous pregnancy, are pregnant with twins or triplets or more, or already have high blood pressure, diabetes, kidney disease or an autoimmune disease like lupus or antiphospholipid syndrome.

9. How to stop snoring?

Lifestyle changes may help treat snoring, such as losing weight, avoiding alcohol before bedtime, treating nasal congestion, getting enough sleep and not sleeping on your back, according to Mayo Clinic. Some studies also show that sleeping at an incline has the potential to reduce snoring. Sometimes, wearing a nasal strip or an oral appliance during sleep can help lower the chances of snoring. In severe cases, health care providers may recommend surgery to treat severe snoring. Snoring often can be a sign of a sleep disorder called obstructive sleep apnoea, a condition that causes people to pause breathing during sleep.

10. How long does food poisoning last?

Often, food poisoning may last about a day or two, but depending on the germ causing the sickness, it could last 10 days or more, according to Cleveland Clinic. Food poisoning is caused by consuming certain germs, such as Salmonella or E coli. Symptoms can range from mild to serious, according to the CDC. The most common symptoms of food poisoning are diarrhoea, stomach pain, nausea and fever. See a doctor for any symptoms that are severe, including bloody diarrhoea, diarrhoea that lasts more than three days, a high fever of more than 102 degrees, vomiting so much that liquids can't be kept down, and signs of dehydration.

This article first appeared on
CNN
website: https://edition.cnn.com/2023/12/29/health/trending-health-questions-2023...

Also, scandals linked to the death of 34 newborns at the San Lorenzo de Los Mina Maternity Hospital, the abduction and subsequent recovery of a newborn baby girl, and the discovery of newborn corpses scattered in a cemetery in Santo Domingo East captured the public’s attention. They caused the country’s maternity centers to be under scrutiny.

At least six epidemiological alerts were issued this year, including one in May and another in November linked to the risk of diseases arising from flooding as a consequence of atmospheric phenomena; two for an increased incidence of respiratory viruses, including one at the end of December for the presence of the new JN-1 variant of COVID-19; others for advanced cases of measles and chikungunya in the region, although the country did not register any of both cases.

Non-communicable diseases

Non-communicable diseases, such as cardiovascular diseases, diabetes, obesity, traffic events, and mental health conditions, continued to increase in the country amidst voices of concern from specialists.

As part of the actions aimed at strengthening prevention and health promotion and encouraging healthy living and thus impacting these indicators, the Minister of Health intensified his strategy of the “Ruta de la Salud: cambia tu estilo de vida” (Health Route: change your lifestyle), which takes medical and educational care to the different provinces of the country.

This year, 2023, 31 of these activities were completed, and 1,400,000,50 people benefited throughout the country, according to information provided by the Minister of Health, Dr. Daniel Rivera, who heads the activities.

The youngest

The Contact Center “Cuidad tu Salud Mental” of the Ministry of Public Health shows the impact of mental health problems in the country and its attention requirements.

Its latest report indicates that of the 6,377 calls received, 67% are from people between 21 and 40 years old who express sadness, anxiety, anguish, insomnia, and anger, among other ailments, including minors, who constitute 10% of those who demand these services.

Of the calls received at the center, which opened last March 16, to date, 60% correspond to sadness, 50% to anxiety, 49% to anguish, 39% to insomnia, 19% to anger, 17% to lack of appetite, 17% constant worry, 16% suicidal ideation and 14% imitation and feelings of guilt.

Medical conflicts

The conflicts between the Dominican Medical Association (CMD), the authorities of the National Social Security System, and the Health Risk Administrators (ARS) remained latent for a good part of the year.

This led the medical profession to exhaust a calendar of marches, work stoppages, and paralyzations of services to several ARSs, demanding changes in the social security system, including increased health coverage for the population and the rates and fees received for services rendered.

The National Social Security Council (CNSS) recently issued a new resolution increasing coverage and fees.

Last December 8, the CMD changed its board of directors, with Dr. Waldo Ariel Suero assuming the presidency of the guild for the sixth time, replacing Dr. Senén Caba.

Cholera and Covid

The year began with an outbreak of cholera, which spread mainly to different sectors of Greater Santo Domingo. In contrast, in the last quarter, another outbreak was registered in Barahona communities. This year, the country introduced its vaccination with the acquisition of 85 thousand vaccines, which have been applied in high-risk populations through a protocol developed for this purpose.

The COVID-19 virus, although still circulating in the country, maintained a low incidence, except for a slight peak in the number of cases registered this year. At the end of December, the circulation of the new highly contagious JN.1 variant was detected in the country, which prompted the Ministry of Public Health to issue a new epidemiological alert for respiratory viruses.

After over two years of issuing daily information bulletins, the health authorities issued the report once a week last March.

Dengue epidemic

The most significant stress to the hospital system was generated by the dengue epidemic, which continued for several months, especially in Greater Santo Domingo, where the high demand for medical attention exceeded the capacity of the leading pediatric hospitals, forcing the National Health Service (SNS) to set up a network of beds in different health centers.

As of mid-December, corresponding to the 50th epidemiological week, the total number of accumulated suspected cases detected by the system is 24,735, with 23 confirmed deaths, for a case fatality rate of 0.1 percent.

Under surveillance

Reports from the Epidemiology Directorate of the Ministry of Public Health indicate that during the first 11 months of 2023, 116 cases of cholera, 19,467 cases of dengue, 215 cases of malaria, 564 cases of leptospirosis; 23 cases of diphtheria; 29 cases of tetanus in non-neonatal ages; 10 cases of pertussis and six cases of meningococcal disease were reported to the system.

In addition to 150 maternal deaths and 2,700 infant deaths. The National Health Service reports an 11% reduction in neonatal mortality this year compared to 2022, following the implementation of the Neonatal Mortality Reduction Acceleration Plan.

New coverage approved

At the end of the year, the National Social Security Council (CNSS) announced the approval of new coverage, including that of outpatient medicines, which increased from 8,000 to 12,000 pesos per year for members of the Family Health Insurance (SFS) of the Contributive Regime.

Resolution No. 581-03 took this decision, including coverage for 70 new procedures, biopsies, and new approaches to reduce surgical complications and hospital stays.

In addition to an increase in the monthly per capita of the Family Health Insurance (SFS) of the Contributory Regime (RC) of RD$128.08 charged to the People’s Health Care Account, from RD$1,555.14 to RD$1,683.22 and a 50% reduction in the co-payment of the SFS of the Contributory Regime for hospitalization services, cesarean sections, surgeries, renal transplants and other high-cost illnesses.

There was a 40% increase in medical fees for procedures, a 50% increase in inpatient consultations, and a 7% increase in diagnostic tests and examination costs. There was also a 15% increase in the use of rooms, equipment, and rooms in clinics and hospitals.