Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South

BACKGROUND

The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South.

METHODS

We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically.

RESULTS

Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality.

CONCLUSION

The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.

Antibody Seroprevalence to Spotted Fever Group Rickettsiae in Miraflores, Colombia: A Cross-Sectional Study in Humans and Dogs

Tick-borne disease burdens are increasing globally, impacting mostly rural and vulnerable communities. Among the most important emerging tick-borne pathogens are the Rickettsia species within the spotted fever group (SFGR) because of their genetic diversity and high lethality rate. Colombia is highly affected by SFGR despite not being reportable diseases; thus, research and clinical management are neglected. Although some departments have demonstrated high seroprevalence rates, in others, such as Boyacá Department, seroprevalence is unknown. Rickettsioses have not been described in Boyacá since 1943, and conversations with local physicians raised suspicions of recent undiagnosed disease compatible with rickettsiosis in some rural areas of the department, warranting epidemiological investigation. Using biobanked human and canine samples from a previous 2021 vector-borne disease study in Miraflores municipality, Boyacá, we had an opportunity to unearth SFGR's exposure in the region. Samples were evaluated using IgG indirect fluorescent assays against SFGR and complemented by survey questionnaires evaluating associated factors. Findings yielded first-time SFGR serological evidence in Boyacá with a 26.5% seroprevalence among dogs and a 20.4% among humans. Human and dog seroprevalences were positively associated, suggesting the presence of domestic transmission. Owning a greater number of domestic animals (prevalence ratio adjusted for all measured factors [aPR], 1.52) and living near crop fields (aPR, 7.77) were associated with an increased likelihood of household seropositivity. Our findings are consistent with the literature in Colombia, uncovering a suspected region where the disease is endemic. Future studies are warranted to continue defining high-risk areas to determine public health intervention plans.

Human spotted fever group Rickettsia seroprevalence and associated epidemiologic factors among diverse, marginalized populations in South Carolina

Illness caused by spotted fever group Rickettsia (SFGR) is increasing nationally, with affluent, white residents most likely to be diagnosed. The common under-representativeness of marginalized populations in research studies and these vulnerable populations' health inequities make veritable epidemiologic risk factor profiling challenging, which inhibits equitable public health intervention. The current study leveraged 749 banked sera and associated surveys from a cross-sectional minority-represented COVID-19 study to perform an SFGR seroprevalence investigation. SFGR titers (1:64, 1:128, 1:256, 1:512, and 1:1024) were measured using commercially available indirect fluorescent antibody slides-SFGR positive cases were defined as titers ≥1:128. Multivariable logistic regression and Getis-Ord-Gi* hotspot analyses were used to identify seropositivity-associated factors and determine seropositive clusters. Among a mostly minority and lower socioeconomic population, a 3.4 % SFGR seropositivity was noted at the ≥1:128 titer level. Male gender (Odds Ratio (OR): 3.20; adjusted Odds Ratio (aOR)s: 3.73), age (aOR: 1.05), any frequency of tick bite (OR: 2.29), and spending time working outdoors (OR: 5.05) were associated with SFGR IgG seropositivity. Moreover, the geospatial analysis showed clusters of seropositivity in areas where previous case reports occurred, suggesting potential endemic foci.

Is It Safe for Me to Get It? Factors Influencing COVID-19 Vaccination Decision-Making among Postpartum Women Who Are Black and Hispanic in Deep South

BACKGROUND

COVID-19 vaccination is vital for ending the pandemic, yet safety concerns persist among pregnant and postpartum women, especially those who are Black and Hispanic. This study aims to explore factors that influence postpartum women's vaccination decision-making during pregnancy and postpartum through women's lived experiences and maternal care providers' (MCPs) observations.

METHODS

From January to August 2022, we conducted semi-structured interviews with postpartum women who are Black and Hispanic and with MCPs. Participants were recruited from obstetric and pediatric clinics in South Carolina and had given birth in 2021. Thematic analysis was employed for data analysis.

RESULTS

The study involved 19 Black and 20 Hispanic women, along with 9 MCPs, and revealed both barriers and facilitators to COVID-19 vaccination. The factors that influence pregnant and postpartum women's decision about COVID-19 vaccine uptake included: 1) awareness of health threats associated with COVID-19 vaccines, 2) vaccine availability and accessibility, 3) vaccine-related knowledge and exposure to misinformation, 4) concerns regarding pre-existing health conditions and potential side effects of COVID-19 vaccines, 5) emotional factors associated with vaccination decision-making processes, 6) concerns about the well-being of infants, 7) cultural perspectives, and 8) encouragement by trusted supporters.

CONCLUSION

The findings suggest that reliable information, social support, and trusted MCPs' advice can motivate COVID-19 vaccination among pregnant and postpartum women who are Black and Hispanic. However, barriers such as misinformation, mistrust in the health care system, and fears of potential side effects impede vaccination uptake. Future interventions should address these barriers, consider health disparities, involve trusted MCPs, and initiate conversations about vaccines to promote vaccination among these populations.

Factors influencing COVID-19 vaccination decision-making among African American and Hispanic pregnant and postpartum women in Deep South

Background

COVID-19 vaccination is vital for ending the pandemic but concerns about its safety among pregnant and postpartum women, especially among African American (AA) and Hispanic women, persist. This study aims to explore factors that influence vaccination decision-making among AA and Hispanic pregnant and postpartum women through women's experiences and maternal care providers' (MCPs) observations.

Methods

From January and August 2022, we conducted semi-structured interviews with AA and Hispanic women and MCPs. Participants were recruited from obstetric and pediatric clinics in South Carolina, and all births took place after March 2020. Thematic analysis was employed for data analysis.

Results

The study involved 19 AA and 20 Hispanic women, along with 9 MCPs, and revealed both barriers and facilitators to COVID-19 vaccination. The factors that influence pregnant and postpartum women's decision about COVID-19 vaccine uptake included: 1) awareness of health threats associated with COVID-19 vaccines, 2) vaccine availability and accessibility, 3) vaccine-related knowledge and exposure to misinformation, 4) concerns regarding pre-existing health conditions and potential side effects of COVID-19 vaccines, 5) emotional factors associated with vaccination decision-making processes, 6) concerns about the well-being of infants, 7) cultural perspectives, and 8) encouragement by trusted supporters.

Conclusion

Findings suggest that reliable information, social support, and trusted doctors' advice can motivate COVID-19 vaccination. However, barriers such as misinformation, mistrust in the health care system, and fears related to potential side effects impede vaccination uptake among AA and Hispanic pregnant and postpartum women. Future interventions should target these barriers, along with health disparities, involve trusted doctors in outreach, and initiate vaccine conversations to promote vaccination among this population.

Multilevel determinants of racial/ethnic disparities in severe maternal morbidity and mortality in the context of the COVID-19 pandemic in the USA: protocol for a concurrent triangulation, mixed-methods study

INTRODUCTION

The COVID-19 pandemic has affected communities of colour the hardest. Non-Hispanic black and Hispanic pregnant women appear to have disproportionate SARS-CoV-2 infection and death rates.

METHODS AND ANALYSIS

We will use the socioecological framework and employ a concurrent triangulation, mixed-methods study design to achieve three specific aims: (1) examine the impacts of the COVID-19 pandemic on racial/ethnic disparities in severe maternal morbidity and mortality (SMMM); (2) explore how social contexts (eg, racial/ethnic residential segregation) have contributed to the widening of racial/ethnic disparities in SMMM during the pandemic and identify distinct mediating pathways through maternity care and mental health; and (3) determine the role of social contextual factors on racial/ethnic disparities in pregnancy-related morbidities using machine learning algorithms. We will leverage an existing South Carolina COVID-19 Cohort by creating a pregnancy cohort that links COVID-19 testing data, electronic health records (EHRs), vital records data, healthcare utilisation data and billing data for all births in South Carolina (SC) between 2018 and 2021 (>200 000 births). We will also conduct similar analyses using EHR data from the National COVID-19 Cohort Collaborative including >270 000 women who had a childbirth between 2018 and 2021 in the USA. We will use a convergent parallel design which includes a quantitative analysis of data from the 2018-2021 SC Pregnancy Risk Assessment and Monitoring System (unweighted n>2000) and in-depth interviews of 40 postpartum women and 10 maternal care providers to identify distinct mediating pathways.

ETHICS AND DISSEMINATION

The study was approved by institutional review boards at the University of SC (Pro00115169) and the SC Department of Health and Environmental Control (DHEC IRB.21-030). Informed consent will be provided by the participants in the in-depth interviews. Study findings will be disseminated with key stakeholders including patients, presented at academic conferences and published in peer-reviewed journals.

Nighttime sleep and physical activity in 6-7 month-old infants

This study examined associations between objectively-measured nighttime sleep duration and physical activity in a sample of 6-7 month-old infants (N=93). The study also investigated relationships between infant sleep and demographic and environmental characteristics. Cross-sectional relationships were assessed using linear regression analyses. Nighttime sleep duration was positively associated with physical activity levels. Nighttime sleep duration was greater when infants had a consistent bedtime, slept in a separate room, were male, and had mothers who reported having a college education or greater. These findings can inform the development of interventions that aim to improve infant sleep.

Elevated Pediatric Chagas Disease Burden Complicated by Concomitant Intestinal Parasites and Malnutrition in El Salvador

The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children.

A Contribution to Measure Partnership Trust in Community-Based Participatory Research and Interventions With Latinx Communities in the United States

Given the growing diversity in the United States, responsiveness to the needs of diverse communities is paramount. Latinx communities in the United States often state mistrust in outside institutions because of adverse experiences. Community-based participatory research (CBPR) is considered a trust-building process and is one approach to understand disparities. However, the conceptualization and evaluation of trust as a CBPR outcome are understudied. This article summarizes a community-engaged research process conducted for the cultural and linguistic refinement of a partnership trust survey tool to assess partnership trust as an outcome of CBPR (CBPR-PTS), by using Perinatal Awareness for Successful Outcomes (PASOs) as a case study and cross-cultural cognitive interviewing (CCCI) methodology. The participants were 21 diverse stakeholders of PASOs, a community-based health organization that serves the Latinx population in South Carolina. A modified version of the multidimensional measure of trust model informed instrument development. The team analyzed the CCCI data using compiling informal analysis to identify which survey items' wordings must be changed or adapted based on the participants' accounts. Sixteen of 28 questions subjected to CCCI required modifications due to translation errors, culturally specific errors, or general cognitive problems. The new survey instrument has 19 scales and 195 items categorized into nine dimensions of the modified multidimensional measure of trust model. CCCI was a useful tool to address the cross-cultural understanding issues of the CBPR-PTS. Measurement instruments should be able to capture the socioeconomic, cultural, and geographic/environmental variability of community stakeholders to help understand the diversity of the comprehension and views of the communities involved in disparities' reduction efforts.

Small area estimation of county-level U.S. HIV-prevalent cases

PURPOSE

Recent trends of HIV in the United States have indicated that the epidemic is no longer an urban issue; however, HIV data in rural settings are incomplete. Our objective was to estimate HIV prevalence in U.S. counties using small area estimation techniques (SAE) to better assess the burden of HIV nationally.

METHODS

We performed SAE modeling to predict the reported number of HIV cases across the continental United States, including unreported counties using source data from the CDC National HIV Surveillance System. Our model borrowed strength from auxiliary HIV risk-indicator data, including geospatial information. Cross-validation was conducted to identify and assess the precision of the estimates.

RESULTS

Our findings showed that most of the 677 unreported counties had low HIV prevalence levels (quintiles 1-2). Estimates in the South had high levels of HIV (quintile 4-5). Cross-validation techniques indicated good precision of the estimates, as 42% of the residuals were within ±10 HIV cases.

CONCLUSIONS

HIV was highest along the coastlines and in the U.S. South. Cross-validation techniques provided sufficient support of our model. Our study provides a more complete picture of the burden of HIV across the United States and identifies communities in need of future targeted interventions.

Linking Activity, Nutrition, and Child Health (LAUNCH): protocol for a longitudinal cohort study of children as they develop from infancy to preschool age

BACKGROUND

Physical activity is known to provide important health benefits in children ages 3 years and above, but little is known about the effects of physical activity on health in very young children under age 3. LAUNCH (Linking Activity, Nutrition, and Child Health) is a study designed to expand the body of knowledge on development of physical activity behavior and associations between physical activity and other health characteristics as children transition from infancy to preschool age.

METHODS

Physical activity and sedentary behavior will be measured objectively in young children over a period of 30 months. Each child will complete a measurement protocol at 6, 12, 18, 24, 30 and 36 months of age. The following factors will be measured at each time point: physical activity, sedentary behavior, anthropometric characteristics, and motor developmental status. Objectively-measured sleep behavior will be included as an optional component of the protocol. Parents will provide information on demographic factors, parenting behaviors, home and childcare characteristics, and the child's dietary and sleep behaviors.

DISCUSSION

LAUNCH will employ a longitudinal study design and objective measures of physical activity, sedentary behavior and sleep in examining developmental trends for those characteristics in children between the ages of 6 and 36 months. Associations among physical activity, sedentary behavior, sleep, and weight status will be examined. Findings will inform public health guidance and intervention strategies for very young children.

HIV Knowledge Among Pregnant Latinas in Rural South Carolina

To inform and strengthen culturally-tailored HIV perinatal prevention, we assessed HIV knowledge among pregnant Latinas receiving prenatal care in rural South Carolina. We administered an 11 item HIV knowledge scale (n = 171). Women who answered 8 of 11 (73 %) items correctly were categorized as having "high" knowledge; <8 items correct was categorized as "low" knowledge. Seventy-six percent of participants had low HIV knowledge; only 37 % knew that there is medicine to prevent mother-to-child HIV transmission. In multivariate analyses, high HIV knowledge was more likely among women who had ≥high school education compared with women with elementary school education only (Adjusted Odds Ratio 10.5, 95 % Confidence Interval 3.3-33.6). These findings highlight the need for targeted educational interventions to better inform Latinas regarding perinatal HIV prevention and transmission risks. Enhancing efforts with patients and providers is aligned with national goals for HIV prevention and elimination of perinatal transmission.

Gas hydrate dissociation off Svalbard induced by isostatic rebound rather than global warming

Methane seepage from the upper continental slopes of Western Svalbard has previously been attributed to gas hydrate dissociation induced by anthropogenic warming of ambient bottom waters. Here we show that sediment cores drilled off Prins Karls Foreland contain freshwater from dissociating hydrates. However, our modeling indicates that the observed pore water freshening began around 8 ka BP when the rate of isostatic uplift outpaced eustatic sea-level rise. The resultant local shallowing and lowering of hydrostatic pressure forced gas hydrate dissociation and dissolved chloride depletions consistent with our geochemical analysis. Hence, we propose that hydrate dissociation was triggered by postglacial isostatic rebound rather than anthropogenic warming. Furthermore, we show that methane fluxes from dissociating hydrates were considerably smaller than present methane seepage rates implying that gas hydrates were not a major source of methane to the oceans, but rather acted as a dynamic seal, regulating methane release from deep geological reservoirs.

Methane seepage from continental slopes has been attributed to gas hydrate dissociation induced by anthropogenic bottom water warming. Here, the authors show that hydrates dissociated before the Anthropocene when the isostatic rebound induced by deglaciation of the Arctic ice sheet outpaced eustatic sea-level rise.

Widespread methane seepage along the continental margin off Svalbard - from Bjørnøya to Kongsfjorden

Numerous articles have recently reported on gas seepage offshore Svalbard, because the gas emission from these Arctic sediments was thought to result from gas hydrate dissociation, possibly triggered by anthropogenic ocean warming. We report on findings of a much broader seepage area, extending from 74° to 79°, where more than a thousand gas discharge sites were imaged as acoustic flares. The gas discharge occurs in water depths at and shallower than the upper edge of the gas hydrate stability zone and generates a dissolved methane plume that is hundreds of kilometer in length. Data collected in the summer of 2015 revealed that 0.02-7.7% of the dissolved methane was aerobically oxidized by microbes and a minor fraction (0.07%) was transferred to the atmosphere during periods of low wind speeds. Most flares were detected in the vicinity of the Hornsund Fracture Zone, leading us to postulate that the gas ascends along this fracture zone. The methane discharges on bathymetric highs characterized by sonic hard grounds, whereas glaciomarine and Holocene sediments in the troughs apparently limit seepage. The large scale seepage reported here is not caused by anthropogenic warming.

Crustal fluid and ash alteration impacts on the biosphere of Shikoku Basin sediments, Nankai Trough, Japan

We present data from sediment cores collected from IODP Site C0012 in the Shikoku Basin. Our site lies at the Nankai Trough, just prior to subduction of the 19 Ma Philippine Sea plate. Our data indicate that the sedimentary package is undergoing multiple routes of electron transport and that these differing pathways for oxidant supply generate a complex array of metabolic routes and microbial communities involved in carbon cycling. Numerical simulations matched to pore water data document that Ca(2+) and Cl(1-) are largely supplied via diffusion from a high-salinity (44.5 psu) basement fluid, which supports the presence of halophile Archean communities within the deep sedimentary package that are not observed in shallow sediments. Sulfate supply from basement supports anaerobic oxidation of methane (AOM) at a rate of ~0.2 pmol cm(-3) day(-1) at ~400 mbsf. We also note the disappearance of δ-Proteobacteria at 434 mbsf, coincident with the maximum in methane concentration, and their reappearance at 463 mbsf, coinciding with the observed deeper increase in sulfate concentration toward the basement. We did not, however, find ANME representatives in any of the samples analyzed (from 340 to 463 mbsf). The lack of ANME may be due to an overshadowing effect from the more dominant archaeal phylotypes or may indicate involvement of unknown groups of archaea in AOM (i.e., unclassified Euryarchaeota). In addition to the supply of sulfate from a basement aquifer, the deep biosphere at this site is also influenced by an elevated supply of reactive iron (up to 143 μmol g(-1)) and manganese (up to 20 μmol g(-1)). The effect of these metal oxides on the sulfur cycle is inferred from an accompanying sulfur isotope fractionation much smaller than expected from traditional sulfate-reducing pathways. The detection of the manganese- and iron-reducer γ-Proteobacteria Alteromonas at 367 mbsf is consistent with these geochemical inferences.

Racial differences in gestational weight gain and pregnancy-related hypertension

PURPOSE

The aim of the study was to examine racial differences in gestational weight gain (GWG) and pregnancy-related hypertension.

METHODS

Logistic regression models tested racial differences in adequacy of GWG and pregnancy-induced hypertension in all singleton live births from the South Carolina 2004-2006 birth certificates.

RESULTS

Compared with white women, black and Hispanic women had 16%-46% lower odds of gaining weight above the recommendations. However, the odds of inadequate GWG was ∼50% higher in black and Hispanic women with a pregnancy body mass index (BMI) less than 25 kg/m(2). Furthermore, compared with women with adequate GWG, women with excessive GWG had higher odds of pregnancy-related hypertension (underweight: 2.35, 95% confidence interval [CI; 1.66, 3.32]; normal: 2.05, 95% CI [1.84, 2.27]; overweight: 1.93, 95% CI [1.64, 2.27]; obese: 1.46, 95% CI [1.30, 1.63]). Among women with a BMI less than 25 kg/m(2), black women had higher odds of pregnancy-related hypertension than white women (underweight: 1.64, 95% CI [1.14, 2.36]; normal weight: 1.28, 95% CI [1.15, 1.42]), whereas among women with a BMI less than 25 kg/m(2), Hispanic women had 40% lower odds.

CONCLUSIONS

Programs are needed to curb excessive GWG in all racial groups and to help some sub-groups ensure adequate GWG. Maternal obesity and GWG are two factors that should be used in combination to reduce racial differences in pregnancy-related hypertension.

Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina

Maternal and Child Health (MCH) experts emphasize the importance of preconception health (PCH) in achieving healthy pregnancies and positive birth outcomes. Research demonstrates that Latinas face significant PCH disparities, yet no comprehensive PCH promotion strategy exists to reach them. As a trusted community-based organization that uses culturally competent strategies to promote MCH in the Latino community, PASOs is well-positioned to address PCH among Latinos in South Carolina. With the input and support of Latino community members, PASOs is pioneering a PCH strategy using its successful model of education, outreach, partnerships and resource navigation.

Latina voices in childhood obesity: a pilot study using Photovoice in South Carolina

BACKGROUND

South Carolina has one of the highest rates of obesity in the nation and, proportionately, more Latino children aged 2-5 years are obese compared to black and white children in the state.

PURPOSE

Latina mothers will identify the barriers and opportunities for physical activity for Latino children in West Columbia SC and propose policy recommendations.

METHODS

This is a qualitative pilot study with 12 Latina mothers using Photovoice to identify barriers and opportunities for physical activity for their children. Community stakeholder and school staff interviews (eight) also were conducted. Latinas discussed the data collected and developed potential solutions to the problems. Data collection and analysis took place in the city of West Columbia during 2010-2011. Content analysis of focus groups and interview transcripts were conducted using descriptive qualitative coding techniques.

RESULTS

Latina mothers positively described their neighborhoods as their homes but also identified several environmental barriers to physical activity including lack of transportation, not being able to speak English, lack of knowledge of their children's opportunities at school, and feelings of discrimination due to anti-immigration sentiments in the state. Mothers also proposed to improve their family diets, advocate for better equipment in public parks, building of community sidewalks, and increasing neighborhood police presence.

CONCLUSIONS

Latina mothers demonstrated knowledge about factors related to childhood obesity and proposed solutions to the problems and worked to organize their communities to present alternatives to policymakers. This study underscores the importance of including community input when planning programs addressing childhood obesity.

Structural anomalies related to changes in the conduction mechanisms of α-Sm2(MoO4)3

Polycrystalline samples of α-phase samarium molybdate were prepared by solid-state synthesis and used for x-ray diffraction (from 300 to 1000 K) and dielectric spectroscopy (from 500 to 900 K and from 10(2) to 10(6) Hz). The electrical conductivity follows the universal dielectric response, and three different regimes of conduction (with semiconductor, polaronic, and ionic characteristics) were ascribed. The polaronic mechanism in the range from 600 to 810 K was probed using the overlapping large polaron model. Above 810 K, the application of scaling laws suggests an ionic conductivity. The thermal dependence of the lattice parameter a shows three different trends in correspondence with the three conduction regimes observed. An analysis using adapted symmetry modes facilitated the Rietveld refinement and the study of the thermal dependence of the distortion arising from the oxygen displacements. We suggest that the transversal displacements of oxygen atoms in Sm-O-Mo bridges joined to the elongation of tetrahedra can help to explain this anomalous behavior. From the calculated bond-valence contour maps, new sites for the oxygen atoms, at higher temperatures, were detected which favor oxygen motion and would then be related to the ionic conduction. This correlation has been compared and extended to α-Eu(2)(MoO(4))(3).

Reducing Maternal and Child Health Disparities among Latino Immigrants in South Carolina Through a Tailored, Culturally Appropriate and Participant-Driven Initiative

Newly arrived Latino immigrants in South Carolina (SC), especially Latina mothers, experience many health related barriers including a general lack of health services information. The PASOs program, which means “steps” in Spanish, uses education, outreach, partnerships and advocacy to empower Latino families to utilize available health care services throughout SC. PASOs is a community-based program conducted by college trained bilingual/bicultural facilitators with the support from community health care workers (promotores de salud). Participants (n=523) were expectant mothers with an average age of 27 (SD=6) years, mostly from Mexico (69%), with an average of 9 (SD=4) years of education and 7 (SD=5) years living in the US. Repeated measures analyses from pre-test to post-test indicated significant knowledge improvement (p

Written and spoken narratives about health and cancer decision making: a novel application of photovoice

Photovoice is a community-based participatory research method that researchers have used to identify and address individual and community health needs. We developed an abbreviated photovoice project to serve as a supplement to a National Cancer Institute-funded pilot study focusing on prostate cancer (PrCA) that was set in a faith-based African American community in South Carolina. We used photovoice for three reasons: (a) to enhance communication between study participants and researchers, (b) to empower African American men and women to examine their health decisions through photographs, and (c) to better understand how participants from this community make health-related decisions. The 15 individuals participating in the photovoice project were asked to photograph aspects of their community that informed their health-related decisions. Participants provided written and oral narratives to describe the images in a small sample of photographs. Four primary themes emerged in participants' photographs and narratives: (a) food choices, (b) physical activity practices, (c) community environment and access to care, and (d) influences of spirituality and nature on health. Although written and audio-recorded narratives were similar in content, the audio-recorded responses were more descriptive and emotional. Results suggest that incorporating audio-recorded narratives in community photovoice presentations may have a greater impact than written narratives on health promotion, decision making, and policy makers because of an increased level of detail and personalization. In conclusion, photovoice strengthened the parent study and empowered participants by making them more aware of factors influencing their health decisions.

HIV testing among midlife women in the deep south: an analysis of the 2008 Behavioral Risk Factor Surveillance System survey data

OBJECTIVE AND BACKGROUND

Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy.

METHODS

Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50-64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics.

RESULTS

More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50-54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those 60-64 years old (adjusted odds ratio [AOR] 0.62, 95% confidence interval [CI] 0.45-0.84). Population characteristics, such as race/ethnicity, family poverty status, and urbanization, as well as HIV exposure risk, were all potential confounders of this relationship.

CONCLUSIONS

Routine HIV testing is underused among women during their postreproductive years. HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population.

Pap test and HIV testing behaviors of South Carolina women 18-64 years old

BACKGROUND

Pap tests are used to detect abnormal cell growth in the cervix. Early detection of precancerous cells increases the likelihood of treatment success. In fact, the Pap test is one of only a few cancer screening procedures that can prevent cancer by virtue of identifying and intervening upon abnormal precancerous cells in the early stages. There has been a growing prevalence of cervical cancer among HIV-positive women. Early diagnosis is essential to improving survival outcomes of women living with HIV/AIDS. The purpose of this study was to describe Pap test behaviors among women in South Carolina and examine its relationship with HIV testing.

METHODS

Behavioral Risk Factor Surveillance System (BRFSS) data from 2008 were analyzed. Chi-square tests and logistic regression analyses were performed to describe Pap test behaviors among our sample (n=3,404) of non-Hispanic White and non-Hispanic Black women (18–64 years old).

RESULTS

The majority of participants (97%) reported ever having a Pap test. Participants who reported never having a Pap test were 50% less likely to have ever been tested for HIV.

CONCLUSIONS

The participants in our study met the Healthy People 2010 target of ever having a Pap test. However, less than half of participants (42%) had ever been tested for HIV. A larger proportion of women who have had a Pap test had also been tested for HIV.

PRACTICE IMPLICATIONS

Our findings suggest that offering women an HIV test during routine Pap tests may present an opportunity to increase the number of women in South Carolina who know their HIV serostatus.

Acculturation, physical activity, and obesity among Hispanic adolescents

OBJECTIVE

Little is known about how acculturation may influence participation in leisure-time physical activity and obesity among adolescents. The objective of this study was to examine these associations among Hispanic adolescents.

DESIGN

Data were drawn from the 2003 National Survey of Children's Health, restricted to Hispanic adolescents aged 10-17 (n=4704). Acculturation was assessed by proxy measures (generation status and language spoken at home). Adolescents who were not reported to engage in physical activity lasting at least 20 minutes, that was vigorous enough to cause sweating and hard breathing, for at least three days per week were defined as failing to meet physical activity requirements. Obesity was defined as gender and age-specific body mass index values at or above the 95th percentile of the reference population. Multiple logistic regressions were performed to adjust for confounders.

RESULTS

Of the Hispanic adolescents studied, 25.2%, 43.8%, and 31.1% were first, second, and third generation or more, respectively. English was the primary language in the home for 42.8% of these adolescents. Compared with adolescents in the third generation, adolescents from immigrant families had higher odds for not obtaining recommended physical activity (first generation: adjusted odds ratio [AOR] = 1.50, 95% conference intervals [CI]: 1.09, 2.05; second generation: AOR = 1.29, 95% CI: 0.99, 1.69). Living in homes where English was not the primary language, vs. English-speaking homes, was also associated with not obtaining recommended physical activity (AOR = 1.36, 95% CI: 1.06, 1.75). The unadjusted prevalence of obesity was higher in homes where English was not the primary language (22.5% vs. 16.1%; p<0.01), but this difference disappeared after adjusting for family socioeconomic status. Generational status was not a significant correlate of obesity.

CONCLUSIONS

Findings suggest that future public health interventions that aim to increasing physical activity among Hispanic adolescents should be tailored based on generational status and English-language use.

Epidemiological characterization of individuals with newly reported HIV infection: South Carolina, 2004-2005

OBJECTIVES

We used statewide data to assess HIV disease stage at initial diagnosis and laboratory indications for initiating antiretroviral therapy among South Carolina residents with newly diagnosed HIV infection.

METHODS

Initial CD4+ counts and viral loads among individuals diagnosed with HIV between May 2004 and April 2005 were categorized according to current staging and treatment guidelines.

RESULTS

Of 759 individuals who had a CD4+ count reported, 34% and 56% had counts of 200 cells/mm(3) or below and 350 cells/mm(3) or below, respectively. CD4+ counts of 200 cells/mm(3) or below were significantly associated with male gender (adjusted odds ratio [AOR] = 2.07; 95% confidence interval [CI] = 1.36, 3.16), age above 29 years (AOR = 2.45; 95% CI = 1.51, 3.96), and hospital-reported patients (AOR = 2.17; 95% CI = 1.41, 3.36). The same characteristics were significant risk factors for elevated viral loads.

CONCLUSIONS

At least in South Carolina, HIV diagnoses are delayed in a significant percentage of patients. New testing strategies need to be implemented to encourage earlier HIV diagnoses, and future studies should evaluate the effects of expanded routine testing on earlier detection.

Gender-specific association between iron status and the history of attempted suicide: implications for gender paradox of suicide behaviors

PURPOSE

Iron deficiency (ID) has been linked with high impulsivity, and an increased risk of ID was reported among suicide attempters. We hypothesized that poor iron status might be prevalent among suicide attempters, who have high impulsivity.

METHODS

As a part of the third National Health and Nutrition Examination Survey (1988-1994), a set of iron indices were measured in 2598 men and 2975 women aged 17-39 years, who completed a mental disorder diagnostic interview.

RESULTS

Using non-attempters as reference within each gender, we observed a gender-dependent association between poor iron status and the history of attempted suicide. For male attempters (n=74), the prevalence ratios (PR) of abnormal serum ferritin, serum iron and protoporphyrin were 18.3 (95%CI=3.3-101.7), 3.2 (1.1-9.4) and 5.4(1.8-15.6). In contrast, the PR of abnormal serum ferritin for female attempters (n=217) was 0.3 (0.1-0.6). The hematological indices did not differ significantly between attempters and non-attempters among either men or women. Compared with non-attempters, male attempters were prone to a higher odds [17.5 (4.2-72.4)] while female attempters to a lower odds [0.6 (0.3-1.1)] of ID.

CONCLUSION

These data suggest new opportunities for exploring biological bases of gender paradox of suicidal behaviors and a novel way to enhance therapeutic and preventive interventions against suicide.

How does a suicide attempter eat differently from others? Comparison of macronutrient intakes

OBJECTIVE

Issues of the subtle effects of diet and nutrition on suicidal behaviors are rarely examined. This study describes the differences in dietary intakes of macronutrients between individuals who had ever made a suicide attempt and those who never had.

METHODS

We examined the data of 7631 non-institutionalized adults ages 17 to 39 y who completed a mental disorder diagnostic interview and a 24-h dietary recall as a part of the Third National Health and Nutrition Examination Survey, 1988 to 1994. Multivariable adjusted means of daily caloric intake and energy percentage from macronutrients were calculated for individuals who had a history of lifetime suicide attempt(s) (n = 408) and compared with those who did not.

RESULTS

After adjustment for covariates, including socioeconomic indicators, health risk factors, and history of medical and psychiatric illnesses, we observed that the means of daily caloric intake, cholesterol, and energy percentages from carbohydrate, total fat, saturated fat, monounsaturated fat, and protein did not differ significantly between attempters and non-attempters. However, energy percentage from polyunsaturated fat was lower in attempters than in non-attempters. Mean percentages +/- standard error for smoking attempters, non-smoking attempters, smoking non-attempters, and non-smoking non-attempters were 5.5 +/- 0.4 (P = 0.01), 6.7 +/- 0.2 (P = 0.02), 7.5 +/- 1.4 (P = 0.78), and 7.2 +/- 0.1 (reference), respectively, in men, and 6.3 +/- 0.4 (P = 0.01), 7.2 +/- 0.2 (P = 0.07), 7.3 +/- 1.0 (P = 0.89), and 7.5 +/- 0.1 (reference), respectively, in women. Dietary fiber intake was also lower in attempters than in non-attempters. These differences were independent of daily caloric intake.

CONCLUSIONS

Individuals with a history of suicide attempt have low intakes of polyunsaturated fat and fiber. Potential deleterious effects of low intake of polyunsaturated fat and fiber among suicide attempters merit further investigation.

Automatic detection of slight parameter changes associated to complex biomedical signals using multiresolution q-entropy

It is well known that, from a dynamical point of view, sudden variations in physiological parameters which govern certain diseases can cause qualitative changes in the dynamics of the corresponding physiological process. The purpose of this paper is to introduce a technique that allows the automated temporal localization of slight changes in a parameter of the law that governs the nonlinear dynamics of a given signal. This tool takes, from the multiresolution entropies, the ability to show these changes as statistical variations at each scale. These variations are held in the corresponding principal component. Appropriately combining these techniques with a statistical changes detector, a complexity change detection algorithm is obtained. The relevance of the approach, together with its robustness in the presence of moderate noise, is discussed in numerical simulations and the automatic detector is applied to real and simulated biological signals.

Periconceptional multivitamin folic acid use, dietary folate, total folate and risk of neural tube defects in South Carolina

PURPOSE

To investigate whether dietary folate or multivitamin folic acid taken 3 months before conception and during the first 3 months of pregnancy reduces the risk of isolated occurrent neural tube defect (NTD)-affected pregnancies.

METHODS

This population-based case control study conducted between 1992 and 1997 included 179 women with NTD-affected pregnancies and 288 randomly selected controls. Women completed a food frequency questionnaire and were interviewed about lifestyle behaviors, pregnancy histories and use of multivitamins.

RESULTS

Use of 0.4 mg or more of multivitamin folic acid at least 3 times per week during the periconceptional period showed no statistically significant reduction in NTD risk [adjusted odds ratio (AOR) = 0.55, 95% confidence interval (CI) = 025, 1.22]. After adjusting for covariates, protective effects for NTDs were observed at the highest quartiles of dietary folate and total folate (daily dietary folate plus daily multivitamin folic acid); the respective odds ratios were 0.40 (95% CI = 0.19, 0.84) and 0.35 (95% CI = 0.17, 0.72).

CONCLUSIONS

This study illustrates some of the difficulties in determining effects of folic acid and dietary folate in a population where the consumption of foods rich in folate and the use of multivitamins are increasing and the rate of NTDs is declining. Studies are needed to monitor future changes in folate levels and their effect on health.

Elongational Flow of Solutions of Poly(ethylene oxide) and Sulfonated Surfactants

In this work, the elongational flow behavior of aqueous solutions of poly(ethylene oxide) (PEO) was studied in the presence of sulfonated surfactants. The technique of opposed-jets flow was used to generate an elongational flow field in which pressure drops were measured as a function of strain rates. The surfactants used were sodium dodecyl benzene sulfonate (SDBS) and an alpha-olefin sulfonate (AOS). Solutions of PEO and other flexible polymers exhibit extension thickening in opposed-jets flow due to the formation of transient networks of entangled molecules. This effect is present at concentrations below the static coil overlap concentration, due to the changes in molecular conformation induced by the flow. When SDBS or AOS are added to PEO solutions at low concentrations, the extension thickening weakens due to an increase in PEO intramolecular interactions that lead to coil contraction. This occurs until the surfactant concentration is close to the critical aggregation concentration reported in the literature. Further addition of surfactant induces the formation of intermolecular interactions as the PEO molecules are expanded by the electrostatic repulsion between attached micellar aggregates, with an associated strengthening of extension thickening. Intramolecular effects were not seen beyond a specific PEO concentration.

Etiology of children's diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates

We studied microorganisms associated with infant diarrhea in a group of 256 children admitted to a public pediatric hospital in Montevideo, Uruguay. Diagnostic procedures were updated to optimize detection of potential pathogens, which were found in 63.8% of cases, and to be able to define their characteristics down to molecular or antigenic type. Coinfection with two or more agents was detected in more than one-third of positive studies. Escherichia coli enteric virotypes, especially enteropathogenic E. coli (EPEC), were shown to be prevalent. Rotavirus, Cryptosporidium, Campylobacter (mainly Campylobacter jejuni), and Shigella flexneri were also often identified. Enterotoxigenic E. coli, Salmonella, and Giardia lamblia were sporadically recognized. Unusual findings included two enteroinvasive E. coli strains, one Shigella dysenteriae 2 isolate, and a non-O:1 Vibrio cholerae culture. EPEC bacteria and S. flexneri (but not Salmonella) showed unusually frequent antimicrobial resistance, especially towards beta-lactam antibiotics, which is the subject of ongoing work.

[Frequency of intraepithelial neoplasia of the cervix and risk factors in women in Mexico City]

Cervical intraepithelial neoplasies (CIN), are very frequent in women with active sexual life who present risk factors. In this paper 220 exfoliative cytology reports from the National Cancer Register of the Direction of Epidemiology, Health Secretory, taken to women from eight Political Delegations in Mexico City, were revised. 134 cases presented CIN. 70.2% were grade III, corresponded to the age group between 26 and 35 years old; more than three pregnancies (47.76%) and more than three births (46.80%). Viral genital infections were related with CIN grades II and III. There are another risk factors that have been poorly analyzed in the national existent literature, therefore, it is necessary to effect further studies to determine the development of CIN in women with active sexual life.

[Safe minor surgery in patients taking anticoagulants]

The effectiveness of a commercial drug containing fibrinogen, thrombin and factor XIL (Tissucol, Immuno) was assessed in 127 patients receiving oral anticoagulant treatment with acenocoumarin who were subjected to 183 minor surgical procedures: 107 exodontia, 53 periodontal procedures, 17 combinations of the former, 4 liver biopsies and 2 skin biopsies. All but the liver biopsies were performed in the outpatient clinic. Mild haemorrhage appeared in 21 instances. None of the patients required systemic administration of coagulation factors, and the maneuvers did not take any longer than in patients with integrity of the coagulation mechanisms. The outstanding benefits of this technique are: less discomfort for patients, who can be subjected to a single procedure while otherwise requiring several sessions; anticoagulation needs not be discontinued, subcutaneous heparin being otherwise necessary; low risk of complications and avoidance of substitutive therapy; lesser economic burden, as no hospital admission is needed.

Effect of proteolysis on the activity of the sodium channel in isolated lobster nerve membrane

The effect of enzymatic proteolysis on structural and functional properties of the isolated lobster nerve membrane was investigated. The membranes were treated with different amounts of either trypsin or unspecific protease. Sodium channel activity was determined by measuring the veratridine-tetrodotoxin-sensitive sodium influx in proteoliposomes prepared with nerve membrane and soybean lipids. The changes in the membrane proteins were followed by electrophoresis in polyacrylamide gradient gels. From the densitometric scan of the gels the relative area for each protein was obtained, and the ratio of enzyme-treated to control areas was evaluated. Under a similar degree of proteolysis catalyzed either by trypsin or by unspecific protease, the sensitive sodium influx is not affected by trypsin, whereas it is about 60% diminished by the unspecific protease. In this condition the zones corresponding to molecular weights of 240,000 and 166,000 daltons appear modified in the electrophoretic gels by both enzymes. The 117,000-dalton range is modified only by the unspecific protease. Increasing trypsin concentration diminishes sodium influx about 60%; and the 240,000-, 166,000-, and 117,000-dalton zones appear modified. A further increase of the protease concentration totally abolishes the sensitive sodium influx and modifies practically all of the membrane proteins. The present results indicate the rather high sensitivity of the membrane sodium channel activity to proteolytic action, and show that the membrane sites that respond to veratridine appear to be highly affected by proteolysis. In contrast, the tetrodotoxin receptor retains its binding capacity even after treatment of the membrane with protease concentrations 1,000 times higher than those affecting the sensitive sodium influx [Benzer and Raftery, 1972; Villegas et al, 1973].

Numerical analysis of the voltage-clamp technique applied to frog neuromuscular junctions

The nonlinear cable equation was solved numerically by means of an implicit procedure. The correlation between end-plate length and fiber diameter was determined in frog (Rana pipiens) sartorius muscles stained with gold chloride (Löwit, 1875). The diameter of the fibers stained by the Löwit method was 80 (74-85) micron (median and its 95% confidence interval for 52 fibers), the length of the end plates in the same fibers was 382 (353-417) micron. The fibers simulated were 80 micron in diameter. To solve the equation the muscle fibers were represented by 500 segments 20 micron long, and the equation was solved in steps of 10 microseconds; a double exponential function was incorporated to the first seven segments to represent the neuromuscular junction. The potential of the first segment of the cable was set to the clamping level and the membrane potential of the remaining segments calculated. The current needed to hold the first segment was estimated by adding the current flowing through the first segment to the current flowing from it to the second segment. Our results indicate that the lack of space clamp in the point voltage-clamp studies of the frog neuromuscular junction introduces serious errors in the estimates of the end-plate conductance value, the kinetics of the conductance changes, and the reversal potential of the end-plate currents. The possibility of an efficient voltage-clamp technique is also explored. Our calculations suggest that the study of end-plate current and conductance is possible with little error if the end-plate potential is controlled at both ends of the synaptic area simultaneously.