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Introduction: In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers. Methods: An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers. Results: Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016-August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and "other." A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020. Discussion/Conclusions: Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.

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A 2009 community needs assessment highlighted the health care gap facing Hispanic residents in Hampton, Virginia, one of the major cities served by Eastern Virginia Medical School (EVMS). Survey respondents indicated the following as health care barriers: language, lack of knowledge, and lack of a community health center. EVMS students worked to bridge the health care gap between existing needs and services by establishing and maintaining the Clínica Comunitaria Esperanza, a culturally and linguistically competent student-run free clinic serving uninsured Hispanics in the Hampton Roads area. This article provides a model for engaging effectively with a priority population through partnerships that facilitate understanding of the community concerns, values, culture, and existing local resources that serve as determinants of health. This article further illustrates how the integration of two preexisting EVMS programs, the HOPES (Health Outreach Partnership of EVMS Students) Clinic and the Medical Spanish program, has supported the development and sustainability of Clínica Comunitaria Esperanza. The HOPES Clinic is a student-run free clinic that provides both general and specialty care to uninsured patients. EVMS' Medical Spanish program is a longitudinal service learning initiative composed of medical students, faculty, and staff dedicated to providing inclusive health care to meet the needs of the local Spanish-speaking community.

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This article was migrated. The article was marked as recommended. The sustained service four-year longitudinal framework for medical school service-learning is introduced and defined. Framework benefits include: students can engage deeply over time with both the people they serve and their colleagues, they are immersed in the social determinants of health in authentic contexts, and they grow in the expertise required to perform their service over time. The approach starts with a sophisticated community needs assessment that relies on systematic inclusion of community voices, community leader inputs, and systematic and data-saturated inputs. This needs assessment should result in a six to eight item list of the community's priority needs. All student service is then focused on the primary needs identified in the assessment. Goals of the framework are described: to make a difference with the community's priority needs; to grow the identity, skills and paradigms required of a community-responsive physician; and to strengthen student credentials through objective qualifications related to their sustained service. The culminating activity is a Capstone research project that focuses on the served population and gives students an opportunity to synthesize their experience. Initial results describing the community impact of service, the focus of service hours, and candid student reactions to the approach are presented. Discussions of findings and conclusions are offered.

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BACKGROUND: Neonatal mortality accounts for 45% of under-5 mortality worldwide, with 98% of newborn deaths occurring in developing countries. The Dominican Republic (DR) demonstrates one of the highest neonatal mortality rates in Latin America despite broad access to care. Strategies to support professional capacity building and strengthen the local health care system are needed to improve neonatal outcomes in the DR. RATIONALE: Helping babies breathe (HBB) and essential care for every baby (ECEB) are evidence-based newborn resuscitation and essential care training programs that have been shown to improve providers' confidence, knowledge, and clinical skills. Lack of professional support and infrequent resuscitation skills practice are commonly cited as barriers to skill retention after HBB training, while establishment of program mentoring and regular skills refreshers are associated with retention of clinical knowledge and skills and improved clinical performance and outcomes. Global partnerships to facilitate implementation of a comprehensive newborn resuscitation and essential care training program with ongoing clinical and program mentorship in the DR should have a lasting impact on workforce capacity, quality of care, and clinical outcomes. METHODS: A multidisciplinary, international group of clinicians partnered with the Ministry of Health to design and implement a comprehensive newborn health initiative in the DR. A train-the-trainer model structured the regional rollout of a combined HBB/ECEB program with integrated quality improvement (QI) initiatives and systems for ongoing program monitoring, reinforcement, and mentorship. Cognitive, affective, behavioral, and clinical outcomes are being measured. RESULTS: Seventeen local champions representing six hospitals participated in the HBB/ECEB master trainer course and design of a QI tool for site-specific clinical performance monitoring. One hundred seventy-eight and 171 providers participated in HBB and ECEB courses, respectively, at pilot sites during the following year. Participants completed prior training need assessment, pre-/post-knowledge assessments and course evaluations. Program mentorship and monitoring of continuing education and clinical performance are ongoing. The Ministry of Health has assumed responsibility for program sustainability and current scale-up, including integration of maternal resuscitation training. CONCLUSION: International partnerships facilitated the collaborative implementation of scalable, locally sustainable newborn resuscitation and essential care training in the DR, mobilizing local resources and empowering the workforce to capably pursue improved care of an exceedingly vulnerable community.

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Socioeconomic inequalities cause different tobacco consumption patterns. The purpose of this study was to examine the relationship between educational level and smoking behaviour, including type of tobacco consumption, in lung cancer patients. To this end, epidemiological analyses of 801 lung cancer patients recruited for a case-control study in four public hospitals in Asturias, Spain, between October 2000 and April 2006 were carried out. Smoking behaviour and educational level data were obtained through personal interview. Analyses indicated that the probability of heavy smoking among low educational-level patients was approximately twice as high as for high educational-level patients (RRR>31.2 packs/years=2.04; CI 95%=1.15-3.62; RRR>52packs/years=2.14; CI 95%=0.98-4.64). Low-educated patients were more than three times as likely to be long-time smokers (RRR>40 years=3.30; CI 95%=1.43-7.62). The probability of smoking exclusively black tobacco was almost four times greater in low educational-level patients (RRRblack only=3.72; CI 95%=1.23-11.19). The results show that there are broad educational inequalities with regard to the quantity, duration and type of tobacco consumption among lung cancer patients in Northern Spain.

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Socioeconomic inequalities cause different tobacco consumption patterns. The purpose of this study was to examine the relationship between educational level and smoking behaviour, including type of tobacco consumption, in lung cancer patients. To this end, epidemiological analyses of 801 lung cancer patients recruited for a case-control study in four public hospitals in Asturias, Spain, between October 2000 and April 2006 were carried out. Smoking behaviour and educational level data were obtained through personal interview. Analyses indicated that the probability of heavy smoking among low educational-level patients was approximately twice as high as for high educational-level patients (RRR>31.2packs/years = 2.04; CI 95%= 1.15-3.62; RRR>52packs/years= 2.14; CI 95%= 0.98-4.64). Low-educated patients were more than three times as likely to be long-time smokers (RRR>40years= 3.30; CI 95%= 1.43-7.62). The probability of smoking exclusively black tobacco was almost four times greater in low educational-level patients (RRRblack only= 3.72; CI 95%= 1.23-11.19). The results show that there are broad educational inequalities with regard to the quantity, duration and type of tobacco consumption among lung cancer patients in Northern Spain(AU)

Las desigualdades socioeconómicas causan diferentes patrones de consumo tabáquico. El objetivo de este estudio fue examinar la relación entre el nivel educativo y el hábito tabáquico en pacientes con cáncer de pulmón. Para ello se llevaron a cabo análisis epidemiológicos en 801 casos de cáncer de pulmón reclutados en un estudio caso-control de Asturias, entre octubre de 2000 y abril de 2006. Los datos relativos al hábito tabáquico y al nivel educativo fueron obtenidos mediante entrevista personal. La probabilidad de ser gran fumador entre pacientes de bajo nivel educativo es aproximadamente dos veces mayor que en pacientes con nivel educativo alto (RRR>31,2paquetes-año = 2,04; IC95% = 1,15-3,62; RRR>52paquetes-año= 2,14; IC95%= 0.98-4.64). Los pacientes con bajo nivel educativo fumaban durante más tiempo (RRR>40años= 3,30; IC95%= 1,43-7,62) y tenían cuatro veces más probabilidades de fumar exclusivamente tabaco negro (RRRsolo tabaco negro= 3,72; IC95%= 1,23-11,19). Los resultados indican que existen grandes desigualdades educativas en relación a la cantidad, duración y tipo de tabaco consumido entre los pacientes de cáncer de pulmón en Asturias(AU)

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