Davila was sick enough that staffers at the local hospital gave her 2 liters of IV fluids and prescribed a daily regimen of vitamins and medication. This will be Davila’s third child and she hopes the nausea means it’s another girl.

Davila had moved back to her hometown of Clayton, New Mexico, so her kids could grow up near family — her dad, aunts, uncles, and cousins all live in this remote community of about 2,800 people in the northeastern corner of the state. But Clayton’s hospital stopped delivering babies more than a decade ago.

Aside from being sick, Davila was worried about making the more than 3½-hour round trip to the closest labor and delivery doctors in the state.

“With gas and kids and just work — having to miss all the time,” Davila said. “It was going to be difficult financially, kind of.”

Then, Davila spotted a billboard advertising the use of telehealth at her local hospital.

In rural regions, having a baby can be particularly fraught. Small-town hospitals face declining local populations and poor reimbursement. Those that don’t shutter often halt obstetric services to save money — even as the number of U.S. mothers who die each year while pregnant or shortly after has hit historic highs, particularly for Black women.

More than half of rural counties lack obstetric care, according to a U.S. Government Accountability Office report released last year. Low Medicaid reimbursement rates and a lack of health workers are some of the biggest challenges, the agency reported. New Mexico Medicaid leaders say 17 of the state’s 33 counties have limited or no obstetric care.

Those realities prompted the Federal Office of Rural Health Policy, which is part of the Health Resources and Services Administration, to launch the Rural Maternity and Obstetrics Management Strategies Program, RMOMS. Ten regional efforts nationwide — including one that serves Davila in northeastern New Mexico — have been awarded federal grants to spend on telehealth and creating networks of hospitals and clinics.

“We’ve never done this sort of work before,” said Tom Morris, associate administrator for the office at HRSA. “We were really testing out a concept … could we improve access?”

After joining the telehealth program, Davila didn’t have to take the afternoon off work for a recent prenatal checkup. She drove less than a mile from her job at the county courthouse and parked near the hospital. As she stepped inside a ranch-style yellow-brick clinic building, staffers greeted Davila with hugs and laughter. She then sat on a white-papered exam table facing a large computer screen.

“Hello, everybody,” said Timothy Brininger, a family practice doctor who specializes in obstetrics. He peered out the other side of the screen from about 80 miles away at Miners Colfax Medical Center in Raton, New Mexico.

The visit was a relief — close enough for a lunchtime appointment — and with staff “I’ve known my whole life,” Davila said. She heard her baby’s heartbeat, had her blood drawn, and laughed about how she debated the due date with her husband in bed one night.

“They’re nice,” Davila said of the local staff. “They make me feel comfortable.”

Yet, Davila may be one of the last expectant mothers to benefit from the telehealth program. It is slated to run out of money at the end of August.

‘Oh My God, It Really Made a Difference’

The day after Davila’s prenatal checkup, Brininger sat at his desk in Raton and explained, “The closest OB doctor besides the one sitting in front of you who’s working today is over 100 miles in any direction.”

When the telehealth program runs out of money, Brininger said, he wants to keep devices the grant paid for that enable some patients to home-monitor with blood pressure cuffs, oxygen sensors, and fetal heart rate monitors “so they don’t have to drive to see us.”

The retired military doctor has thoughts about the pilot program ending: “I will hope that our tax dollars have been utilized effectively to learn something from this because otherwise it’s a shame.”

Because of the grant, 1,000 women and their families in northeastern New Mexico have been connected to social services like food assistance and lactation counselors since 2019. More than 760 mothers have used the program for medical care, including home, telehealth, and clinic appointments. In its first year, 57% of the women identified as Hispanic and 5% as Indigenous.

Jade Vandiver, 25, said she feels “like I wouldn’t have made it without them.”

In the early months of her pregnancy, Vandiver slept during the day and struggled with diabetic hypoglycemic episodes. Vandiver’s husband repeatedly rushed her to the Clayton hospital’s emergency room because “we were scared I was going to go into a coma or worse.”

There, hospital staffers suggested Vandiver join the program. She eventually began traveling to specialists in Albuquerque for often weekly visits.

The program covered travel and hotel costs for the family. After months of checkups, she had a planned delivery of Ezra, who’s now a healthy 6-month-old. The boy watched his mother’s smile as she talked.

Without the program, Vandiver likely would have delivered at home and been airlifted out — possibly to the smaller Raton hospital.

Raton’s Miners Colfax is a small critical access hospital that recently closed its intensive care unit. The hospital sits just off Interstate 25, less than 10 miles south of the Colorado border, and its patients can be transient, Chief Nursing Officer Rhonda Moniot said. Maintaining the hospital’s obstetric program “is not easy, financially it’s not easy,” she said.

Moms from the area “don’t always seek care when they need to,” she said. Substance use disorders are common, she said, and those babies are often delivered under emergency conditions and prematurely.

“If we can get them in that first trimester … we have healthier outcomes in the end,” Moniot said, pulling up a spreadsheet on her computer.

At Raton’s hospital, 41% of mothers who gave birth before the RMOMS program began failed to show up for their first-trimester prenatal exams. But over two years — even as the covid-19 pandemic scared many patients away from seeking care — the number dropped to only 25% of mothers missing prenatal checkups during their first three months of pregnancy.

“I was, like, oh my God, it really made a difference,” said Moniot, who helped launch the program at Miners Colfax in 2019.

‘Let’s Not Let It Die’

Just a few weeks before Davila’s checkup in Clayton, the New Mexico program’s executive director, Colleen Durocher, traveled nearly 1,600 miles east to Capitol Hill to lobby for money.

Durocher said she cornered HRSA’s Morris at an evening event while in Washington, D.C. She said she told him the program is working but that the one year of planning plus three years of implementation paid for by the federal government was not enough.

“Let’s not let it die,” Durocher said. “It would be a real waste to let those successes just end.”

By April, Sen. Martin Heinrich (D-N.M.) said he was impressed by the program’s “lifesaving” work and asked for $1 million in the federal budget for fiscal year 2024. But the money, if approved, would likely not arrive before Durocher runs out of funding in late summer.

As the August deadline looms, Durocher said one obvious option would be to simply extend the grant. HRSA spokesperson Elana Ross said the agency cannot extend funding for the program. Each site, though, can reapply by offering to target a new population, include new hospitals or clinics, or provide services in a new area.

Of the 10 regional programs across the country, the one in New Mexico and two others are slated to end their pilots this year. Seven other programs — from Minnesota to Arkansas — are scheduled to end in 2025 or 2026. During their first two years, the 2019 awardees reported more than 5,000 women received medical care, and all three recorded a decrease in preterm births during the second year of implementation, according to HRSA.

The three initial programs also expanded their patient navigation programs to connect “hundreds of women to emotional support, insurance coverage, and social services, such as transportation and home visiting,” agency spokesperson Ross wrote in an email.

New Mexico Medicaid’s interim Director Lorelei Kellogg said her agency would like to “emulate” the program’s care coordination among hospitals and health staff in other areas of the state but also alter it to work best for different Indigenous and tribal cultures as well as African American partners.

There is money in the state’s budget to pay for patient navigators or community health workers, but there are no funds dedicated to support the maternity program, she said.

In the meantime, the program’s funding is set to run out just days before Davila’s baby is due in early September. In the coming months, Davila, like many mothers with an uncomplicated pregnancy, will have monthly prenatal telehealth visits, then biweekly and, as her due date nears, weekly.

“It’s nicer to be able to just pop in,” she said, adding that “it would be harder for the community” if the program didn’t exist.

Still, Davila may be one of the last moms to benefit from it.

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.

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This story can be republished for free (details).

Some years ago there was a baby girl born to an anxious mother waiting for her precious daughter. The baby was born with significant birth defects and had to be immediately rushed from Mandeville to the University Hospital of the West Indies (UHWI). The weather was bad, so although she should have been airlifted she had to be transported by car, wrapped in cotton and foil to keep her warm, carried by a nurse and her aunts. She very quickly had surgery done but remained in hospital for almost three weeks. Her hair was shaved off and IV's placed on the side of her head. They even had to cut both her ankles to get to her veins. By the time her mother was well enough to visit her in hospital she could hardly look at her baby because all the tubes and wires broke her heart. The baby girl eventually went home and grew into a cute, chubby little one with a beautiful head of hair.

I was that little baby.

Growing up, my family referred to me as the "miracle baby" because of all that I went through.

I was told by my family that I was born without the umbilical cord (navel string) attached to me; there was a big hole in my belly that the surgeons closed. It was this story that drove me to become a doctor. Since I was four years old I would say, "I'm going to be a baby doctor so I can help babies, just like how the doctors helped me." I have always been VERY proud of my story and would show off my scar where my belly button should be.

In medical school I would almost boast about how sick I was at birth, and that I was "born without an umbilical cord". Fortunately for me, I was able to trace my docket in the Health Records section at UHWI. I discovered that I was born with a rare condition. I was, in fact, born with an umbilical cord, contrary to what I had always believed. After learning my actual diagnosis I can only imagine how foolish I came across to my colleagues and teachers!

I'm sure there are many people who misunderstand their diagnoses and go about telling others they have "xyz" when it really is "wxy". This may seem trivial to some but to your doctor those two may be very different. It's important to know the correct diagnosis because you want your doctor to treat you appropriately by prescribing the relevant medications and ordering useful tests and investigations. No one wants to do an ultrasound when what you really needed was a simple blood test.

If you or your child has a chronic illness that requires frequent doctor visits for check-ups and necessitates you being on medications long-term, it is VERY important to know the names AND doses of the medications you are on, and whether you take them correctly. We need to know the doses of the medications to evaluate if they are working well for your condition. Do we keep the same dosage because it's effectively keeping your blood pressure down? Or do we increase the dosage? We can't increase the dosage if we don't know the dosage you are currently taking.

There have been many occasions when, while I am seeing a parent and child, I formulate my diagnosis and treatment plan, and tell the parent the diagnosis. When I ask if he/she understands the answer is, "Yes, doc". Then, a few minutes later, a nurse comes to me asking me to explain to this parent what is wrong with their child.

I get it. There are countless reasons you may want to leave my office — you've been there for hours, you want to catch the pharmacy before they close, your ride is waiting on you, or you just don't want to admit that you don't understand — but please let us know if you are confused or have any questions. We want you to be aware of what is going on with your health. We want you to understand why you need this blood test, and these four medications. We want you to feel confident that our treatment plan will help you.

I try as much as I can to follow up with questions like "Do you have any questions?" "Tell me what you understand based on what I told you", "Do you want me to go over anything?"

Speak up if you don't understand. There is no shame in enquiring about the health status of yourself or your loved one. Write down your questions you want to ask and bring it to your appointment. Ask for the diagnosis and medications to be written down (legibly). Bring a trusted relative or friend along as a second ear. Ask why you need to see this specialist when we refer you.

While I can't promise that we can answer every single question you may have, I can promise that we will try.

Dr Tal's Tidbit

It is important to know and understand your diagnosis and medications. If you misquote your diagnosis to your health-care provider it may affect your treatment course (to your detriment). Feel comfortable to ask your health-care provider any questions you may have about your health.

Dr Taleya Girvan has over a decade's experience treating children at the Bustamante Hospital for Children, working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the health-care system in Jamaica. Dr Tal's Tidbits is a series in which she speaks to patients and caregivers providing practical advice that will improve health care for the general population. Email: dr.talstidbits@gmail.com IG @dr.tals_tidbits

While hypertension affects 180 million people in the region (18 per cent of adults), it "often has absolutely no symptoms nor signs and is therefore frequently undiagnosed and untreated", Dr Barbosa said during a media briefing today.

"This is serious because undiagnosed and uncontrolled hypertension can lead to heart attack, heart failure or stroke," he added.

Hypertension, or high blood pressure, is the primary risk factor for cardiovascular disease, which is the main cause of premature deaths in the region and is responsible for around 2 million lives lost each year.

Yet in the Americas over one third of men and a quarter of women with hypertension (aged 30 to 79 years) are unaware they have the condition. And of those who are aware they have hypertension and receive treatment, only a third (36 per cent) have it under control.

The PAHO director highlighted that countries must "intensify the scale-up and ensure equitable access to care for hypertension", and provide training to ensure that the latest approaches for diagnosis and treatment are practised in primary health clinics across the Americas.

These include the PAHO HEARTS initiative, a model of care for cardiovascular risk management which is currently being implemented in around 3,000 clinics across the region.

The director also urged countries to implement interventions to promote healthy diets, such as front-of-package warning labels on processed and ultra-processed food products, and measures to reduce salt intake.

Ensuring that primary health-care clinics have clinically validated blood pressure measurement devices is also key to accurately diagnosing and managing hypertension, Dr Barbosa added. Yet many lack vital equipment.

Countries can access these devices, as well as quality-assured, anti-hypertensive medications at competitive prices via the PAHO Strategic Fund, a pooled procurement mechanism for essential medicines and health technologies.

Lifestyle changes and lifelong use of anti-hypertensive medications are also key to reducing and controlling the condition.

World Hypertension Day is observed on May 17 each year to raise awareness of the urgent need to promote the prevention, detection and control of hypertension. The theme this year is 'Measure Your Blood Pressure Accurately, Control It, Live Longer!'

Researchers have found in a new research that Topical beta-glucan plus nanofractional radiofrequency and magnetic nanofractional radiofrequency effective treatment of stretch marks. 

The new study has been published in the journal Dermatology and Therapy.

Stretch marks are common atrophic dermal scars with significant physical and psychological effects. Therefore, there is a need for effective cosmetics and procedures for stretch mark treatment.Stretch marks affect over half of pregnant women and can lead to a negative self-image, thus impacting their quality of life. Many risk factors that cause stretch marks are difficult to control during pregnancy; therefore, an effective and tolerable treatment modality is required.

Several treatment strategies have been investigated, including the topical application of various creams or oils , superficial dermabrasion [18], trichloroacetic acid peel , platelet-rich plasma , radiofrequency (RF) and laser therapy .

This study aimed to evaluate the efficacy and safety of a novel treatment for stretch marks that is made up of topical formulations containing beta-glucan combined with nanofractional radiofrequency.

This randomized, blinded control trial enrolled 64 Chinese women aged 20–45 years at > 6 months after delivery with obvious white or silver abdominal stretch marks. Participants were randomly allocated to group A (blank group), group B (topical product group), group C (product combined with nanofractional radiofrequency), and group D (vehicle combined with nanofractional radiofrequency). The stretch mark width, skin elasticity, skin color, skin thickness, and collagen density were noninvasively measured. Two trained assessors evaluated the severity, color, outline, and relaxation of the striae.

Results

Group C showed the best treatment efficacy, with no adverse effects observed during the study period.

The findings indicate that stretch mark treatment using topical formulations containing beta-glucan, combined with nanofractional radiofrequency plus magnetic nanofractional radiofrequency, is tolerable and effective.

Reference:

Shu, X., Huo, W., Zou, L. et al. Treatment of Stretch Marks Using a New Formulation Combining Nanofractional Radiofrequency Plus Magnetic Nanofractional Radiofrequency. Dermatol Ther (Heidelb) (2023). https://doi.org/10.1007/s13555-023-00926-y

Gynecologist and laparoscopic surgeon Dr. Kalpana Bhatt and the Anaesthetist Dr. Rakesh Doshi have challenged the March order by the State Commission, which had directed the doctors to pay Rs 33,70,000 as compensation to the patients.

Medical Dialogues had earlier reported about the case that goes back to 2014, the patient had been suffering from abdominal pain and for this she had consulted Dr Bhatt. After examination, a tumor was discovered and the doctor had advised removal of tumor through laparoscopy.

On January 2, 2015, the operation was conducted and the condition of the patient became serious during the operation. The complainant, husband of the patient was informed that the patient had suffered shock during the procedure and it caused serious problems to her heart and lungs requiring shifting of the patient to the Critical Care Unit.

It was alleged that during procedure, patient had become unconscious and was requiring support of ventilator. Finally, the doctors advised shifting the patient to Sterling Hospital at Rajkot. During all the efforts, the patient died the next day.

Also Read:Death due to CO2 embolism during Laparoscopy procedure: Surgeon, Anesthetist ordered to pay Rs 33 lakh compensation

The discharge summary issued by Surgeon showed that there was anesthetic problem during the procedure and as a result of it, the patient went into shock. The Complainant alleged that when the patient had encountered problem during surgery, she should have been transferred to Critical Care Unit immediately. However, the doctors killed time in trying through general surgery. Alleging gross negligence against the treating doctors, the Complainant approached the State Consumer Court and filed a complaint seeking compensation.

On the other hand, the doctors denied negligence on their part and submitted that all pre-operative and post-operative checklist had been followed and after obtaining informed consent, the patient had been treated as per standard medical practice.

The surgeon submitted that the patient had developed pulmonary edema when the tumor was removed from bed through laparoscopic procedure, which is a known "complication" in laparoscopic surgery. Despite giving best possible treatment and medical assistance, the patient could not be saved.

Further, the doctor informed the State Commission that the patient had tumor in the broad ligament of uterus and to confirm it Color Doppler was also done and the report revealed that the tumor was non-cancerous. However, since it was painful to the patient, it was decided to remove the same. 

The doctors also submitted that live demonstration of surgical procedure was arranged so that relatives can see the entire procedure even outside the theatre. However, just after the tumor was dissected out of bed, patient developed pulmonary edema. It was argued by the doctors that when known complication occurs, Surgeon cannot be made liable.

While considering the matter, the State Commission opined

"Ordinarily, it is the complainant who has to prove his case of negligence with all evidences. But the facts mentioned herein above categorically suggest that incidence has taken place inside the operation theatre where complainant cannot have any access. In these circumstances, the explanation as to happening of events inside the theatre must come from the persons who are in possession of personal knowledge as to facts. It can be seen from the overall view of the facts that at relevant point of time (i.e. during surgery) only surgeon and anesthetist were in charge of treatment apart from the assisting staff."

Referring to the Discharge Summary given by the Surgeon, the State Consumer Court noted that "severe Pulmonary edema took place" immediately after the tumor was removed from the bed. The Discharge Summary further categorically mentioned that the surgeon was informed prior to removal of the tumor that the patient had developed ETCO2 level and she was requested to stop surgery.

At this outset, the bench observed, "Dr. Doshi, in his reply said that when he saw an increased level of ETCO2, he had requested he Surgeon to stop surgery. Thus, facts that can be said proved is problem of ETCO2 observed first and as a result thereof “Pulmonary edema” took place. Unless it is shown that increase of ETCO2 has any direct nexus with removal of the tumor from bed, it cannot be said pulmonary edema had taken place because of known complication. If increase of ETCO2 is not treated timely, it leads to Pulmonary edema as it mentioned in the medical literature which will be discussed herein after. It is in this circumstance, “Pulmonary Edema” caused to patient not because complication of laparoscopy surgery but because of no timely treatment to ETCO2 which is an independent cause. Thus, anesthetist is duty bound to give a plausible explanation for the occurrence of increase of the ETCO2 level and timely treatment for the same."

The State Consumer Court also referred to study material titled “ Carbon Dioxide Embolisms during Laparoscopic Surgery”, which opines that "Anesthesia providers play a crucial role in prompt recognition and treatment of carbon dioxide embolisms to provide life-saving measures to patients undergoing laparoscopic surgery. Communication between the anesthesia provider and the surgeon is an important step providing prompt, efficient, and safe interventions to adequately resuscitate a patient suffering from a carbon dioxide embolism. If left unrecognized and untreated, carbon dioxide emboli can have devastating effects, including death."

Discussing the role of the anesthetist, the commission observed that Dr. Doshi stated in his reply that “during intra-operative period, patient developed Hypertension which was controlled with Inj. Nitroglycerine infusion at the rate of 5 microgram / minute as continuous IV infusion. Then patient’s BP came to 130/84 mm of hg. After enucleating suddenly patient developed Hypercapnia and ventilator settings suggestive of high inspiratory pressure so the surgeon was asked to stop surgery and remove the Pneumoperitonium so CO2 insufflations stopped.”

"All these admissions on the part of opponents suggest that CO2 embolism had taken place is also established. As it mentioned in the aforesaid literature, CO2 embolism starts with beginning when procedure starts with placement of veress needle. It is therefore necessary for the Surgeon and Anesthetist to prove on record that before entering the veress needle all reasonable care and caution was taken regarding confirmation of site where it was to put. To prove this fact there is no evidence except bare statements that they followed standard line of treatment. Obviously, these facts were only within the personal knowledge of the opponents and despite that none of them has proved it through corroboration that they have taken such care. Thus, the opponents have failed to adduce best available evidence to discharge their burden," the Commission observed at this outset.

"Merely because “known complication” has taken place, it cannot be said responsibility of the treating doctors ceases. There are ways and measures to meet with eventual condition but doctor must come with true facts that these steps have been taken and despite that this has happened. Surprisingly, none of the opponents have produced on record any of their case papers," it further noted.

"The anesthetist, in his reply narrated facts but to support those facts, no documents have been produced. Being anesthetist, he is supposed to prepare a note regarding the actions taken during surgery. However, no such anesthetist’s note have been produced on record and therefore presumption also can be drawn that note is suppressed for the reasons best known to them," the Commission observed.

The State Consumer Court further noted that Carbon Dioxide Embolism is subject matter of anesthetist to take care of. However, there was nothing on record to give complete accounts of events from the anesthetist. 

"In absence of any such information it cannot be believed that he acted diligently just because he states on oath. Having accepted the patient for treatment, it is for the doctor to explain what preventive actions have been taken using reasonable “foresights” to minimize the effects of the known complications. The above literature also canvassed that presence of another anesthesia provider in the room all times to encounter Carbon Dioxide Embolism. In the instant case, no other anesthetist was present. Therefore this is a fit case, where presumptions can be made for absence of care on the part of doctors applying the aforesaid rule of “Res Ipsa Loquitur”," the State Consumer Court opined.

Holding the surgeon and the anaesthetist guilty of medical negligence, the Commission had observed,

"Thus, the doctors failed to convince this Commission that diligent efforts have been made during treatment and therefore I have no hesitation in holding that Surgeon and Anesthetist are liable for not providing efficient services to the patient Joshnaben. Their action lead to irreversible condition of patient and died on next day suggests that it is direct nexus with the cause of death of patient."

With this observation, the top consumer court directed the doctors to pay Rs 33,70,000 compensation to the Complainant along with interest at the rate of 10% from the date of complaint in 2015.

As per the latest media report by Indian Express, now the doctors have challenged the order before the NCDRC bench, which has admitted their appeal on Thursday. In their appeal, the doctors have submitted that the State Commission erred in holding them guilty of medical negligence.

They claimed that the State Consumer Court had passed the order "only on sympathy grounds" and also submitted that the State Commission have no expertise in the field of medical science and the Commission should have appointed a panel of medical experts to provide assistance to the Commission to arrive at a conclusion. The doctors argued that if such a panel had been formed, they would have been exonerated from the charges of medical negligence.

Further, the doctors have submitted that the State Commission did not consider that “a complication by itself does not constitute negligence” and also the fact that there is a “big difference between an adverse or untoward event and negligence”, and that there’s a “growing tendency to accuse the doctor of an adverse or untoward event”.

“A medical professional cannot be held liable simply because things went wrong from mischance or misfortune,” stated the appeal.

In their plea, the doctors have further relied on medical literature suggesting that there is risk associated with laparoscopic surgery and acute pulmonary edema after carbon dioxide embolism during Laparoscopic Ovarian Cystectomy as was the case with the deceased patient, who ultimately died.

While commenting on the doctors' appeal before the Apex Consumer Court, their counsel Advocate Nimit Shukla added that the appeal will now be heard on merits.

To read the State Commission's order, click on the link below:

https://medicaldialogues.in/pdf_upload/state-consumer-court-order-209664.pdf

Also Read: Leg amputated after botched procedure, delay in referral: Doctor absolved of negligence, Hospital asked to pay Rs 10 lakh compensation to patient

“Several nurses attached to the Princess Royal Hospital and clinics were presented with certificates for their service”

View the full post Nurses recognised on International Nurses Day on NOW Grenada.

Santo Domingo.- Benny Metz, the Vice Minister of Relations with Civil Society, has stated that the government is actively promoting the amendment of the Sports Law and the development of a legislative compendium aimed at safeguarding the health of children and young athletes.

Metz emphasized the need to update the Sports Law, which currently dates back to 2005 and is considered outdated. He asserted that the law should serve as the fundamental legal framework, providing general regulations that would subsequently lead to specific regulations for different sports and criminal offenses. The proposed amendments aim to address the evolving needs and challenges faced by athletes, particularly in relation to health and well-being.

These statements come in response to concerns raised by specialists regarding cases of acute renal failure in adolescents associated with the misuse of steroids. Metz characterized such behavior as voluntary homicide, stressing that the use of steroids without proper medical guidance or prescription is a serious offense.

To tackle this issue, the government is seeking to amend the existing Sports Law and establish a collaborative platform involving the Ministry of Public Health and the National Drug Council (CND). This platform aims to provide the necessary support to the Office of the Attorney General of the Republic, enabling them to effectively fulfill their role as legal prosecutors.

Metz further disclosed that several specific cases related to steroid misuse have already been reported to the Attorney General (Miriam Germán), and investigations are set to commence. The government is committed to addressing these cases and taking appropriate legal action to ensure accountability and protect the health and well-being of young athletes.

The proposed amendments to the Sports Law, along with the collaborative efforts of relevant institutions, reflect the government’s commitment to safeguarding the physical and mental well-being of children and young athletes in the Dominican Republic.

Santiago.- Experts consulted by Listin Diario have issued warnings about the greater harm caused by electronic cigarettes, or vapes, specifically on the bodies and behavior of young people compared to traditional cigarettes. In Santiago, where these devices have become increasingly prevalent among students, concerns have been raised regarding the potential risks associated with their widespread use. Pulmonologist Benjamín Hernández has even gone so far as to state that vapes are causing more damage than conventional cigarettes. Similarly, Dr. Samuel Ramos has highlighted that vaping can lead to brain immaturity, an increased risk of addiction, and changes in neurons among adolescents.

Dr. Ramos, the President of the Dominican Foundation for Obesity and Cardiovascular Prevention, has expressed concerns about the composition of vapes, which not only contain tobacco but also perfumes, glycerin, flavorings, and other substances that could have long-term cancer risks. He explains that nicotine, like any other drug, has a higher chance of causing addiction and long-term damage to brain cells in adolescents. Furthermore, young people are particularly susceptible to respiratory system damage due to their underdeveloped lungs, making them more prone to developing asthma at an early age or experiencing complications from pre-existing respiratory conditions.

Dr. Ramos emphasizes that autopsies have revealed short- and medium-term damage resulting from the accumulation of substances associated with vaping. Hernández adds that the continuous use of e-cigarettes can trigger bronchospasms, pulmonary infections, and significant damage to the pulmonary system. The constant exposure to these devices can also cause a crisis in bronchospasm and lead to inflammatory processes in the lungs, as well as the potential for extensive destruction of the pulmonary system.

Dr. Ramos further explains that not only individuals who vape themselves but also those who are exposed to secondhand vapor are at risk. He describes the aerosol produced by vaping as harmful, and even children can be affected by it to a lesser degree. He emphasizes that the consequences of widespread vaping among young people will extend beyond the immediate health impacts, potentially leading to a rise in hospitalizations, complications, intensive care admissions, intubations, and even deaths in cases of influenza, pneumonia, and other lung diseases.

The specialist warns that it is essential to address the issue promptly rather than waiting for the next pandemic to realize the increased risks faced by young individuals. Recognizing the higher likelihood of complications from lung diseases among this demographic, Dr. Ramos calls for preventative measures and proactive management to safeguard the health and well-being of young people.