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.

Critical medical ecology and SARS-COV-2 in the urban environment: a pragmatic, dynamic approach to explaining and planning for research and practice.

BACKGROUND: Practitioners and researchers in the midst of overwhelming coronavirus disease 2019 (COVID-19) outbreaks are calling for new ways of looking at such pandemics, with an emphasis on human behavior and holistic considerations. Viral outbreaks are characterized by socio-behaviorally-oriented public health efforts aimed at reducing exposure and prevention of morbidity/mortality once infected. These efforts involve different points-of-view, generally, than do those aimed to understand the virus' natural history. Rampant spread of SARS-CoV-2 infection in cities clearly signals that urban areas contain conditions favorable for rapid transmission of the virus. MAIN TEXT: The Critical Medical Ecology model is a multidimensional, multilevel way of viewing pandemics comprehensively, rooted simultaneously in microbiology and in anthropology, with shared priority for evolution, context, stressors, homeostasis, adaptation, and power relationships. Viewing COVID-19 with a Critical Medical Ecological lens suggests three important interpretations: 1) COVID-19 is equally - if not more - a socially-driven disease as much as a biomedical disease, 2) the present interventions available for primary prevention of transmission are social and behavioral interventions, and 3) wide variation in COVID-19 hospitalization/death rates is not expected to significantly be attributable to a more virulent and rapidly-evolving virus, but rather to differences in social and behavioral factors - and power dynamics - rather than (solely) biological and clinical factors. Cities especially are challenged due to logistics and volume of patients, and lack of access to sustaining products and services for many residents living in isolation. CONCLUSIONS: In the end, SARS-CoV-2 is acting upon dynamic social human beings, entangled within structures and relationships that include but extend far beyond their cells, and in fact beyond their own individual behavior. As a comprehensive way of thinking, the Critical Medical Ecology model helps identify these elements and dynamics in the context of ecological processes that create, shape, and sustain people in their multidimensional, intersecting environments.

A woman's worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa.

BACKGROUND: Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for "timely access to emergency obstetric care." This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region. Access, however, is a complicated notion and is part of a larger framework of care delivery that constitutes the approachability of the proposed service, its acceptability by the target user, the perceived availability and accommodating nature of the service, its affordability, and its overall appropriateness. Without contextualizing each of these aspects of access to healthcare services within communities, utilization and sustainability of any EC intervention-be it ambulances or simple toll-free numbers to dial and activate EMS-will be futile. MAIN TEXT: In this article, we propose an access framework that integrates the Three Delays Model in maternal health, with emergency care interventions. Within each of the three critical time points, we provide reasons why intended interventions should be contextualized to the needs of the community. We also propose measurable benchmarks in each of the phases, to evaluate the successes and failures of the proposed EC interventions within the framework. At the center of the framework is the pregnant woman, whose life hangs in a delicate balance in the hands of personal and health system factors that may or may not be within her control. CONCLUSIONS: The targeted SDGs for reducing maternal mortality in sub-Saharan Africa are unlikely to be met without a tailored integration of maternal health service delivery with emergency medicine. Our proposed framework integrates the fields of maternal health with emergency medicine by juxtaposing the three critical phases of emergency obstetric care with various aspects of healthcare access. The framework should be adopted in its entirety, with measureable benchmarks set to track the successes and failures of the various EC intervention programs being developed across the African continent.

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.

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.

Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries.

BACKGROUND: Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. METHODS: We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. RESULTS: Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. CONCLUSION: Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs.

Attitudes and practices towards micronutrient supplementation among pregnant women in rural Tibet.

The objective of this study was to identify trends and change in micronutrient supplementation (MNS) knowledge across pregnancy and post-partum and to assess the impact of MNS knowledge (MNS-k) on practice in pregnancy in rural Tibet, an area with endemic micronutrient deficiency. A prospective cohort with repeated measures at early, late and after pregnancy in a rural area in the Tibetan Autonomous Region included women receiving care by community workers. Key messages about MNS-k and optimal MNS practice were communicated through health worker encounters with pregnant women. Outcomes included MNS consumption practice, knowledge and attitudes. The proportion of women in the highest MNS-k category increased by 35% from early to late pregnancy (37.5-50.7%, respectively; p < .005). MNS-k was associated with MNS consumption in a dose-response manner over pregnancy (trend X2 p-value < .0001), with increasing knowledge associated with increased MNS consumption. By late pregnancy, 32.5% of women had never consumed an MNS in this pregnancy, and 51.5% had not consumed an MNS on the assessed day or the day before. Sustained knowledge of MNS improved in pregnancy and post-partum. Best practice around MNS consumption increased though remained sub-optimal.

In-hospital neonatal mortality and the role of consanguinity.

BACKGROUND: Consanguinity which increases the risk of genetic disorders has been implicated at times in infant mortality. The aim of this study was to determine the association between consanguinity and in-hospital mortality in newborns. METHODS: Data was collected prospectively on all births from 26 hospitals in Lebanon from January 2004 to December 2008 and admitted to the National Collaborative Perinatal Neonatal Network. Secondary analysis was done on 65,402 singletons, after exclusion of stillbirths, infants of multiple gestation and infants of second cousin progeny. RESULTS: In-hospital mortality was 6.7 per 1000 live births (439/65,402). The rate of first cousin marriage was 9.9%. Consanguinity was significantly associated with in-hospital mortality (odds ratio 2.4; 95% confidence interval (CI): 1.8, 3.1); consanguinity remained a significant predictor of mortality (odds ratio 1.8 [95% CI: 1.2, 2.9]) after adjusting for maternal age and education, crowding index, history of abortion, prenatal care, mode of delivery, gender, birthweight and apgar score at 5 minutes. CONCLUSIONS: This association of consanguinity with in-hospital mortality points to potential genetic factors leading to this increased risk. Designing public health interventions, including raising the awareness and taking into consideration such risks in neonatal mortality studies are indicated.

A qualitative assessment of beliefs, attitudes, and behaviors related to diarrhea and water filtration in rural Kenya.

OBJECTIVES: We qualitatively assessed beliefs, attitudes, and behaviors related to diarrhea and water filtration in rural Kenya. METHODS: A public health campaign was conducted in rural western Kenya to give community members a comprehensive prevention package of goods and services, including a personal water filter or a household water filter (or both). Two months after the campaign, we conducted qualitative interviews with 34 campaign attendees to assess their beliefs, attitudes, and behaviors related to diarrhea and use of the filtration devices. RESULTS: Participants held generally correct perceptions of diarrhea causation. Participants provided positive reports of their experiences with using filters and of their success with obtaining clean water, reducing disease, and reducing consumption of resources otherwise needed to produce clean water. Several participants offered technical suggestions for device improvements, and most participants were still using the devices at the time of the assessment. CONCLUSIONS: Novel water filtration devices distributed as part of a comprehensive public health campaign rapidly proved acceptable to community members and were consistent with community practices and beliefs.

A mixed-method assessment of beliefs and practice around breast cancer in Ethiopia: implications for public health programming and cancer control.

A large proportion of breast cancer patients in Ethiopia present for biomedical care too late, or not at all, resulting in high mortality. This study was conducted to better learn of beliefs and practices among patients accessing breast cancer services in a large referral centre in Ethiopia. Using a mixed-method design, we interviewed 69 breast cancer patients presenting for care at Tikur Anbessa Hospital in Addis Ababa, Ethiopia, about their beliefs, experiences and perspectives on breast cancer. Awareness of breast cancer is low in Ethiopia and even among those who are aware of the disease, a sense of hopelessness and fatalism is common. Early signs/symptoms are frequently ignored and patients often first present to traditional healers. Breast cancer is perceived as being caused typically from humoral anomalies or difficulties resulting from breast feeding, and study participants indicate that stigmatisation and social isolation complicate discussion and action around breast cancer. Consistent with other studies, this study shows that traditional beliefs and practices are common around breast cancer and that numerous barriers exist to identification and treatment in Ethiopia. Integrating health beliefs and practice into public health action in innovative ways may reduce stigma, increase awareness and promote survivability among breast cancer patients.

Migraine and the environment.

UNLABELLED: Migraineurs often describe environmental triggers of their headaches, such as barometric pressure change, bright sunlight, flickering lights, air quality, and odors. Environmental aspects of indoor space and workplaces are also implicated in migraine experience. Comprehensive migraine treatment programs emphasize awareness and avoidance of trigger factors as part of the therapeutic regimen. As migraine has a substantial economic impact, remediation of correctable environmental triggers may benefit employee attendance and productivity among migraineurs. Few controlled studies in the literature, however, confirm environmental influences on migraine and headaches. Although some are controversial, migraineurs worldwide consistently report similar environmental triggers. This article addresses commonly mentioned environmental triggers with a discussion of their pathophysiology and proposed preventive measures. OBJECTIVE: To examine the epidemiological evidence for commonly-mentioned environmental migraine triggers, discuss their possible role in the pathophysiology of migraine and propose preventive measures to avoid or minimize exposure. BACKGROUND: Migraineurs often describe environmental triggers of their headaches, such as barometric pressure change, bright sunlight, flickering lights, air quality and odors. Environmental aspects of indoor space and workplaces are also implicated in the migraine experience. As migraine has a substantial economic impact, remediation of correctable environmental triggers may improve attendance and productivity among migraineurs in the workplace. METHODS: We reviewed the literature addressing indoor and outdoor environmental factors which are commonly implicated as migraine triggers. RESULTS: Although some factors are controversial, migraineurs worldwide consistently report similar environmental triggers. However, few studies confirm environmental influences on migraine and headaches. Research to date indicates that migraineurs have lower thresholds for light-induced discomfort, sine grating distortion and illusions, noise tolerance and olfactory sensitivity compared to the general population. CONCLUSION: There are conflicting studies supporting the validity of patient-reported environmental migraine triggers. Prospective studies are needed to determine the extent that external stimuli influence the migraine process. Decreased thresholds for light, noise, olfactory and visual stimuli in migraineurs may be minimized by modifying the work, home and classroom settings.