Predictors of Secondhand Smoke Exposure During Pregnancy in Costa Rica, the Dominican Republic, and Honduras.

INTRODUCTION: Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras. METHODS: Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings. RESULTS: Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes. CONCLUSIONS: SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations. IMPLICATIONS: The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations.

Participation in genetic research among Latinx populations by Latin America birth-residency concordance: a global study.

Latinx populations are underrepresented in DNA-based research, and risk not benefiting from research if underrepresentation continues. Latinx populations are heterogenous; reflect complex social, migration, and colonial histories; and form strong global diasporas. We conducted a global study using a survey tool (Amazon's Mechanical Turk portal) to ascertain willingness to participate in genetic research by Latin America birth-residency concordance. Participants in the global study identified as Latinx (n=250) were classified as the following: (1) born/live outside of Latin America and the Caribbean (LAC), (2) born within/live outside LAC, and (3) born/live within LAC. Latinx were similarly likely to indicated they would participate DNA-based research as their non-Latinx counterparts (52.8% vs. 56.2%, respectively). Latinx born and living in LAC were significantly more willing to participate in DNA-based research than Latinx born and living outside of LAC (OR: 2.5; 95% CI: 1.3, 4.9, p<.01). Latinx indicating they would participate in genetic research were more likely to trust researchers (<.05), believe genetic research could lead to better understanding of disease (<.05), and that genetic research could lead to new treatments (p<.05) when compared with Latinx not interested in participating in genetic research. In summary, significant variation exists in genetic research interest among Latinx based on where they were born and live, suggesting that this context itself independently influences decisions about participation. Cultivating and investing in a research ecosystem that addresses, values, and respects Latinx priorities, circumstances, and researchers would likely increase research participation and, even more importantly, potentially impact the inequitable health disparities disproportionately represented in Latinx communities.

Relationship between perceived social support and postpartum care attendance in three Latin American countries: a cross-sectional analytic study.

BACKGROUND: Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras. METHODS: Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit. RESULTS: Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity). CONCLUSIONS: Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.

Spectral measure of color variation of black-orange-black (BOB) pattern in small parasitoid wasps (Hymenoptera: Scelionidae), a statistical approach.

Small parasitoid wasps are abundant and extremely diverse, yet their colors have not been analyzed. One of the more common color patterns observed in these wasps is a black-orange-black pattern, which is especially common among neotropical species of Scelionidae ranging in size from 2 to 10 mm. Due to the methodological challenges involved in extracting and analyzing pigments from small-sized insects, other methods for examining colors need to be explored. In this work, we propose the use of microspectrophotometry in combination with statistical analysis methods in order to 8 study the spectral properties in such cases. We examined 8 scelionid genera and 1 genus from a distantly related family (Evaniidae), all showing the black-orange-black pattern. Functional Data Analysis and statistical analysis of Euclidean distances for color components were applied to study color differences both between and within genera. The Functional Data Analysis proved to be a better method for treating the reflectance data because it gave a better representation of the physical information. Also, the reflectance spectra were separated into spectral color component contributions and each component was labeled according to its own dominant wavelength at the maximum of the spectrum: Red, Green and Blue. When comparing spectral components curves, the spectral blue components of the orange and black colors, independent of the genera being compared, result almost identical, suggesting that there is a common compound for the pigments. The results also suggest that cuticle from different genera, but with the same color might have a similar chemical composition. This is the first time that the black and orange colors in small parasitoid wasps has been analyzed and our results provide a basis for future research on the color patterns of an abundant but neglected group of insects.

Evaluation of Surgical Bur Deformation and Bone Surface Roughness After Multiple Uses.

PURPOSE: The aim of the present in vitro study was to microscopically evaluate and describe the deformation of Lindeman surgical burs and the bone surface roughness after repeated osteotomies and sterilization cycles. MATERIALS AND METHODS: Twenty-one Lindeman surgical burs were analyzed under scanning electron microscopy (SEM) to evaluate the damage of the bur's integrity after 0, 1, 3, 5, 7, or 9 osteotomies on bovine ribs. Eighteen bone specimens were obtained after osteotomy for roughness analysis using profilometry. One-way analysis of variance was used to compare the mean roughness values across the experimental groups, and P ≤ .05 was considered to indicate statistical significance. RESULTS: Representative SEM images illustrated that all analyzed burs presented with some type of deformation at both the tip and the body, even after their first use. The mean roughness values were independent of the number of uses (P > .05); however, the standard deviation increased with the number of uses of the burs. CONCLUSIONS: These results suggest that even after their first use, rotatory surgical burs will have some type of deformation and that their cutting efficiency on the bone will vary and will be difficult to predict.

Photonic Crystal Characterization of the Cuticles of Chrysina chrysargyrea and Chrysina optima Jewel Scarab Beetles.

A unified description involving structural morphology and composition, dispersion of optical constants, modeled and measured reflection spectra and photonic crystal characterization is devised. Light reflection spectra by the cuticles of scarab beetles (Chrysina chrysargyrea and Chrysina optima), measured in the wavelength range 300-1000 nm, show spectrally structured broad bands. Scanning electron microscopy analysis shows that the pitches of the twisted structures responsible for the left-handed circularly polarized reflected light change monotonically with depth through the cuticles, making it possible to obtain the explicit depth-dependence for each cuticle arrangement considered. This variation is a key aspect, and it will be introduced in the context of Berreman's formalism, which allows us to evaluate reflection spectra whose main features coincide in those displayed in measurements. Through the dispersion relation obtained from the Helmholtz's equation satisfied by the circular components of the propagating fields, the presence of a photonic band gap is established for each case considered. These band gaps depend on depth through the cuticle, and their spectral positions change with depth. This explains the presence of broad bands in the reflection spectra, and their spectral features correlate with details in the variation of the pitch with depth. The twisted structures consist of chitin nanofibrils whose optical anisotropy is not large enough so as to be approached from modeling the measured reflection spectra. The presence of a high birefringence substance embedded in the chitin matrix is required. In this sense, the presence of uric acid crystallites through the cuticle is strongly suggested by frustrated attenuated total reflection and Raman spectroscopy analysis. The complete optical modeling is performed incorporating the wavelength-dependent optical constants of chitin and uric acid.

A globally networked hybrid approach to public health capacity training for maternal health professionals in low and middle income countries.

BACKGROUND: MundoComm is a current NIH-funded project for sustainable public health capacity building in community engagement and technological advances aimed at improving maternal health issues. Two to four teams are selected annually, each consisting of three healthcare professionals and one technical person from specific low and middle income countries (LMICs) including Costa Rica, Dominican Republic, Honduras, and other LMICs. MundoComm is a course with three parts: in-person workshops, online modules, and mentored community engagement development. Two annual 1-week on-site "short courses" convened in Costa Rica are supplemented with six monthly online training modules using the Moodle® online platform for e-learning, and mentored project development. The year-long course comprises over 20 topics divided into the six modules - each module further segmented into 4 week-long assignments, with readings and assigned tasks covering different aspects of community-engaged interventions. The content is peer reviewed by experts in the respective fields from University of Rochester, UCIMED in Costa Rica, and faculty from Costa Rica and the Dominican Republic who maintain regular contact with the trainees to mentor learning and project progress. The purpose of this paper is to report the first year results of the MundoComm project. METHODS: Both quantitative and qualitative feedback (using online data capturing forms) assess baseline and post-training knowledge and skills in public health project strategies. RESULTS: The course currently has one team each in Costa Rica, the Dominican Republic, and Honduras for a total of 12 trainees. The course and modules include best practices in information and communication technologies (ICTs), ethical reviews, community engagement, evidence-based community interventions, and e-Health strategies. To maximize successful and culturally appropriate training approaches, the multi-media didactic presentations, flexible distance learning strategies, and the use of tablets for offline data collection are offered to trainees, and then feedback from trainees and other lessons learned aid in the refinement of subsequent curricular improvements. CONCLUSIONS: Through remark and discussion, the authors report on 1) the feasibility of using a globally networked learning environment (GNLE) plus workshop approach to public health capacity training and 2) the capacity of LMIC teams to complete the MundoComm trainings and produce ICT-based interventions to address a maternal health issue in their respective regions.

Development and Implementation of Culturally Tailored Offline Mobile Health Surveys.

BACKGROUND: In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. OBJECTIVE: The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. METHODS: In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. RESULTS: Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. CONCLUSIONS: Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs.

Lessons Learned from Twelve Years of Partnered Tobacco Cessation Research in the Dominican Republic.

Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.