Pretest-post-test evaluation with lay midwives in remote Guatemala after educational activities about COVID-19.

INTRODUCTION: Guatemalan lay midwives are well-respected community leaders in a country that lacks the institutional capacity to meet healthcare needs related to pregnancy, newborns, and COVID-19. Thus, Guatemalan lay midwives, who attend the majority of births in their country and who attend most births at home, are in an optimal position to offer frontline support to pregnant women and newborns regarding the global pandemic. The primary objective of this program of study was to dispel myths about COVID-19 and to provide culturally relevant educational activities to low-literacy Guatemalan lay midwives about issues related to the virus, such as signs and symptoms, risks to the mother and fetus, which patients are most vulnerable, appropriate responses, benefits and side-effects of the vaccine, timing of the vaccine, how the virus interacts with breastfeeding, and breastfeeding recommendations. METHODS: In a partnership among the Guatemalan Ministry of Health, expert faculty at the University of Utah College of Nursing, and Madre y Niño, a non-profit organization from the US, evidence-based educational activities about COVID-19 were offered orally in the native language of participants. Two hundred and ten lay midwives attended educational sessions at 11 locations throughout the remote Peten department. Educational activities included repetition, storytelling, and role plays. A pretest-post-test evaluation of 10 questions with 24 correct answers was used to determine if the educational activities changed lay midwife knowledge about COVID-19. Participants were given essential birth supplies and laminated COVID Reminder Cards, which were designed to increase visual literacy, to encourage knowledge retention after the educational sessions. RESULTS: Participants showed a significant increase in knowledge scores (possible 0-24) from prescores 7.09 (standard deviation (SD)=3.06) to 15.20 (SD=4.61), Student's t-test p<0.001. In addition, a significantly higher proportion of participants mistakenly thought COVID-19 passed through breast milk on the pretest (70.1%) compared to post-test (8.4%) (McNemar test, p<0.001). Regarding breastfeeding, 12.6% of participants knew on the pretest that women with COVID-19 who breastfeed should wear a mask and wash their hands compared to 74.3% of participants who knew these recommendations on the post-test (Wilcoxon signed-rank test, p<0.001). Finally, 2% of participants knew on the pretest that pregnant women with COVID-19 should take a low-dose aspirin compared to 67% of participants on the post-test (χ² (1)=194.7, p<0.001). CONCLUSION: These essential primary care providers misunderstood many critical issues related to COVID-19, pregnancy, and newborns. Culturally relevant educational activities provided orally in the native language of participants dispelled myths about the virus and significantly improved lay midwife knowledge. Providing evidence-based educational activities in a culturally relevant format is critical to protecting remote, vulnerable populations, such as pregnant Guatemalan women and newborns, during a global pandemic.

The utilisation of ion chromatography and tandem mass spectrometry (IC-MS/MS) for the multi-residue simultaneous determination of highly polar anionic pesticides in fruit and vegetables.

A robust and sensitive method utilising a hybrid ion chromatography tandem mass spectrometry system (IC-MS/MS) for the simultaneous determination of nine (9) highly polar anionic pesticides (chlorate, ethephon, fosetyl aluminium, glufosinate, glyphosate, N-acetyl AMPA, N-acetyl glyphosate, perchlorate and phosphonic acid) in fruit and vegetables is described. Mean recoveries (n = 6) at two fortification levels ranged from 83 to 112% with %CVs in the range 3-14%. The linearity range was 0.005-0.4 mg kg-1 and R2 values were >0.99 and the sensitivity of the method allowed (20× or 30×) dilution of samples. Provision of qualitative determination of aminomethylphosphonic acid (AMPA) was also facilitated via minor modification of the chromatographic conditions. Compliance with method validation criteria, survey results from the statutory UK/EU Pesticide Residues in Food 2018 programmes i.e. pea, pineapple, melon and successful z-scores for a UK proficiency testing scheme sample (ethephon in pineapple) demonstrate successful application of this IC-MS/MS method.

C/EBPß LIP and c-Jun synergize to regulate expression of the murine progesterone receptor.

CCAAT/enhancer binding protein ß (C/EBPß) is required for murine mammary ductal morphogenesis and alveologenesis. Progesterone is critical for proliferation and alveologenesis in adult mammary glands, and there is a similar requirement for progesterone receptor isoform B (PRB) in alveologenesis. We examined C/EBPß regulation of PR expression. All three C/EBPß isoforms, including typically inhibitory LIP, transactivated the PR promoter. LIP, particularly, strongly synergized with c-Jun to drive PR transcription. Endogenous C/EBPß and c-Jun stimulated a PR promoter-reporter and these two factors showed promoter occupancy on the endogenous PR gene. Additionally, LIP overexpression elevated endogenous PR protein expression. In pregnancy, both PRB and the relative abundance of LIP among C/EBPß isoforms increase. Consistent with a role in PRB expression, in vivo C/EBPß and PR isoform A expression showed mutually exclusive localization in mammary epithelium, while C/EBPß and PRB largely co-localized. We suggest a critical role for C/EBPß, particularly LIP, in PRB expression.