Progress in Community Health Partnerships: Research, Education, and Action
: Background: Mental health care is a top clinical concern for modern Puerto Rico, especially giv... more : Background: Mental health care is a top clinical concern for modern Puerto Rico, especially given a dramatically changing economic landscape paired with recurrent natural disasters. Youth are particularly at-risk due to long-term impacts of toxic stress and adverse childhood experiences on health and development. Objectives: Here we present a novel clinician–community-educator–scientist partnership to address Puerto Rican youth mental well-being and wellness. We deployed pilot health workshops within the Boys & Girls Clubs of Puerto Rico to build youth mental health conceptual understanding and competencies in stress recognition and management. The work in progress herein evaluates acceptability and feasibility of our curricular model. Methods: Dialogue with community stakeholders guided curricular design of workshops for youth ages 6 to 13 and older. Prior to implementation, educators and volunteers attended a 1-day training on educational strategies. Workshop success was evaluated using qualitative approaches (i.e., narrative feedback, educator and volunteer reflections, youth Talking Drawings) to assess youth engagement, youth conceptual health understanding, and educator/volunteer impressions of feasibility and impact. Results: Initial findings indicate high acceptability and feasibility of our curricular model. Youth engagement and enthusiasm were noted in educator feedback and continue to be sustained post-workshop. Preliminary analysis shows accompanying increases in youth conceptual mental health understanding, particularly for 6- to 12-year-olds in recognition of stress and healthy coping mechanisms. Reciprocal gains were observed for volunteers. Conclusions: Activities have evolved into a formal partnership called Semilla , which features expanded analysis of mental well-being and wellness outcomes. Our collaborative model continues to engage Puerto Rican youth in the science of their well-being.
Objective: Assess the association between early infant feeding practices and rapid weight gain du... more Objective: Assess the association between early infant feeding practices and rapid weight gain during the next months among infants’ participants of the WIC Program in Hawaii and Puerto Rico. Design: Secondary analysis of data collected in WIC clinics in Puerto Rico and Hawaii. A total of 202 caregivers of infants 0 month to 2 months were recruited and followed for 4 months. Data were collected on the following: socio-demographics, infant feeding patterns (frequency of placing the infant to sleep with a bottle of milk, using the spoon or bottle to feed solids, distractions while feeding infant and frequency of adding foods to the bottle), and infant’s weight and length. Simple logistic regression was conducted to evaluate the associations between early infant feeding patterns with weight rapid weight gain in the next 4 months. The models were adjusted for caregiver’s education, infant’s gender, and site. Results: A total of 161 infants had complete data; 6.2% were overweight/obese at baseline which increased to 24.8% after 4 months follow-up, with excessive weight gain during this period in 59.0%. There was a significantly lower risk of overweight at follow-up when caregivers encouraged infants to drink more or all of the bottle (p < 0.001) but a significantly higher risk with the use of the bottle to feed solid foods compared to using the spoon (OR: 4.93; 95% CI 1.257, 1.931; p < 0.05) in the unadjusted models. Conclusions: Adding foods to the bottle may increase the risk of overweight in infancy. Longer studies are needed to understand the impact of these practices in weight later in childhood.
ObjectiveTo calculate micronutrient adequacy among infants based on the Estimated Average Require... more ObjectiveTo calculate micronutrient adequacy among infants based on the Estimated Average Requirements (or Adequate Intake) as established by the Institute of Medicine and to determine the contribu...
OBJECTIVES/GOALS: Evaluate if exposure to violence is associated with post-partum weight retentio... more OBJECTIVES/GOALS: Evaluate if exposure to violence is associated with post-partum weight retention among WIC participants, which can lead to overweight/obesity due to metabolic adaptations associated to new adapted weight. If confirmed, it would highlight the need for revision of screening for violence exposure as social determinant of health among participants. METHODS/STUDY POPULATION: Nested cohort study among women enrolled in the Baby Act Trial (BAT) who have been enrolled to the active study phase and completed the Accountable Health Communities Health Related Social Needs survey from the Centers for Medicare & Medicaid services as the source of evidence of exposure to violence. BAT recruitment engaged women in their third trimester who were active participants of the Puerto Rico Women, Infants and Children Program (PRWIC), and planned to enroll their infant in the program. Anthropometric measures were documented at the following time points: prior to pregnancy, at delivery, a...
Hurricane Maria was the worst recorded natural disaster to affect Puerto Rico. Increased stress i... more Hurricane Maria was the worst recorded natural disaster to affect Puerto Rico. Increased stress in pregnant women during and in the aftermath of the hurricane may have induced epigenetic changes in their infants, which could affect gene expression. Stage of gestation at the time of the event was associated with significant differences in DNA methylation in the infants, especially those who were at around 20–25 weeks of gestation when the hurricane struck. Significant differences in DNA methylation were also associated with maternal mental status assessed after the hurricane, and with property damage. Hurricane Maria could have long lasting consequences to children who were exposed to this disaster during pregnancy.
Zika virus (ZIKV) compromises placental integrity, infecting the fetus. However, the mechanisms a... more Zika virus (ZIKV) compromises placental integrity, infecting the fetus. However, the mechanisms associated with ZIKV penetration into the placenta leading to fetal infection are unknown. Cystatin B (CSTB), the receptor for advanced glycation end products (RAGE), and tyrosine-protein kinase receptor UFO (AXL) have been implicated in ZIKV infection and inflammation. This work investigates CSTB, RAGE, and AXL receptor expression and activation pathways in ZIKV-infected placental tissues at term. The hypothesis is that there is overexpression of CSTB and increased inflammation affecting RAGE and AXL receptor expression in ZIKV-infected placentas. Pathological analyses of 22 placentas were performed to determine changes caused by ZIKV infection. Quantitative proteomics, immunofluorescence, and western blot were performed to analyze proteins and pathways affected by ZIKV infection in frozen placentas. The pathological analysis confirmed decreased size of capillaries, hyperplasia of Hofbau...
Summary Background Early microbiota perturbations are associated with disorders that involve immu... more Summary Background Early microbiota perturbations are associated with disorders that involve immunological underpinnings. Cesarean section (CS)-born babies show altered microbiota development in relation to babies born vaginally. Here we present the first statistically powered longitudinal study to determine the effect of restoring exposure to maternal vaginal fluids after CS birth. Methods Using 16S rRNA gene sequencing, we followed the microbial trajectories of multiple body sites in 177 babies over the first year of life; 98 were born vaginally, and 79 were born by CS, of whom 30 were swabbed with a maternal vaginal gauze right after birth. Findings Compositional tensor factorization analysis confirmed that microbiota trajectories of exposed CS-born babies aligned more closely with that of vaginally born babies. Interestingly, the majority of amplicon sequence variants from maternal vaginal microbiomes on the day of birth were shared with other maternal sites, in contrast to non-pregnant women from the Human Microbiome Project (HMP) study. Conclusions The results of this observational study prompt urgent randomized clinical trials to test whether microbial restoration reduces the increased disease risk associated with CS birth and the underlying mechanisms. It also provides evidence of the pluripotential nature of maternal vaginal fluids to provide pioneer bacterial colonizers for the newborn body sites. This is the first study showing long-term naturalization of the microbiota of CS-born infants by restoring microbial exposure at birth. Funding C&D, Emch Fund, CIFAR, Chilean CONICYT and SOCHIPE, Norwegian Institute of Public Health, Emerald Foundation, NIH, National Institute of Justice, Janssen.
OBJECTIVES/GOALS: Determine if exposure to violence at different life stages (childhood versus re... more OBJECTIVES/GOALS: Determine if exposure to violence at different life stages (childhood versus recent exposure) in postpartum women is associated to increased risk of weight retention more than 1 year and no more than 2 years after delivery, thus increasing health risk in short and long term. METHODS/STUDY POPULATION: Participants will be recruited from a cohort of post-partum women who received services from the Puerto Rico Women and Children Program (PR WIC) during pregnancy and postpartum period as per PR WIC established criteria. Families that have completed their participation in a Lifestyle intervention trial will be paired 2:1 with eligible nonparticipants that fulfill trial enrollment criteria. Language, culture validated instruments will be used to document maternal violence exposure in childhood and recent exposure, defined as within the last 12 months. To asses weight retention, pre-pregnancy weight will be compared to actual weight at the moment of evaluation, anthropome...
Progress in Community Health Partnerships: Research, Education, and Action
: Background: Mental health care is a top clinical concern for modern Puerto Rico, especially giv... more : Background: Mental health care is a top clinical concern for modern Puerto Rico, especially given a dramatically changing economic landscape paired with recurrent natural disasters. Youth are particularly at-risk due to long-term impacts of toxic stress and adverse childhood experiences on health and development. Objectives: Here we present a novel clinician–community-educator–scientist partnership to address Puerto Rican youth mental well-being and wellness. We deployed pilot health workshops within the Boys &amp; Girls Clubs of Puerto Rico to build youth mental health conceptual understanding and competencies in stress recognition and management. The work in progress herein evaluates acceptability and feasibility of our curricular model. Methods: Dialogue with community stakeholders guided curricular design of workshops for youth ages 6 to 13 and older. Prior to implementation, educators and volunteers attended a 1-day training on educational strategies. Workshop success was evaluated using qualitative approaches (i.e., narrative feedback, educator and volunteer reflections, youth Talking Drawings) to assess youth engagement, youth conceptual health understanding, and educator/volunteer impressions of feasibility and impact. Results: Initial findings indicate high acceptability and feasibility of our curricular model. Youth engagement and enthusiasm were noted in educator feedback and continue to be sustained post-workshop. Preliminary analysis shows accompanying increases in youth conceptual mental health understanding, particularly for 6- to 12-year-olds in recognition of stress and healthy coping mechanisms. Reciprocal gains were observed for volunteers. Conclusions: Activities have evolved into a formal partnership called Semilla , which features expanded analysis of mental well-being and wellness outcomes. Our collaborative model continues to engage Puerto Rican youth in the science of their well-being.
Objective: Assess the association between early infant feeding practices and rapid weight gain du... more Objective: Assess the association between early infant feeding practices and rapid weight gain during the next months among infants’ participants of the WIC Program in Hawaii and Puerto Rico. Design: Secondary analysis of data collected in WIC clinics in Puerto Rico and Hawaii. A total of 202 caregivers of infants 0 month to 2 months were recruited and followed for 4 months. Data were collected on the following: socio-demographics, infant feeding patterns (frequency of placing the infant to sleep with a bottle of milk, using the spoon or bottle to feed solids, distractions while feeding infant and frequency of adding foods to the bottle), and infant’s weight and length. Simple logistic regression was conducted to evaluate the associations between early infant feeding patterns with weight rapid weight gain in the next 4 months. The models were adjusted for caregiver’s education, infant’s gender, and site. Results: A total of 161 infants had complete data; 6.2% were overweight/obese at baseline which increased to 24.8% after 4 months follow-up, with excessive weight gain during this period in 59.0%. There was a significantly lower risk of overweight at follow-up when caregivers encouraged infants to drink more or all of the bottle (p < 0.001) but a significantly higher risk with the use of the bottle to feed solid foods compared to using the spoon (OR: 4.93; 95% CI 1.257, 1.931; p < 0.05) in the unadjusted models. Conclusions: Adding foods to the bottle may increase the risk of overweight in infancy. Longer studies are needed to understand the impact of these practices in weight later in childhood.
ObjectiveTo calculate micronutrient adequacy among infants based on the Estimated Average Require... more ObjectiveTo calculate micronutrient adequacy among infants based on the Estimated Average Requirements (or Adequate Intake) as established by the Institute of Medicine and to determine the contribu...
OBJECTIVES/GOALS: Evaluate if exposure to violence is associated with post-partum weight retentio... more OBJECTIVES/GOALS: Evaluate if exposure to violence is associated with post-partum weight retention among WIC participants, which can lead to overweight/obesity due to metabolic adaptations associated to new adapted weight. If confirmed, it would highlight the need for revision of screening for violence exposure as social determinant of health among participants. METHODS/STUDY POPULATION: Nested cohort study among women enrolled in the Baby Act Trial (BAT) who have been enrolled to the active study phase and completed the Accountable Health Communities Health Related Social Needs survey from the Centers for Medicare & Medicaid services as the source of evidence of exposure to violence. BAT recruitment engaged women in their third trimester who were active participants of the Puerto Rico Women, Infants and Children Program (PRWIC), and planned to enroll their infant in the program. Anthropometric measures were documented at the following time points: prior to pregnancy, at delivery, a...
Hurricane Maria was the worst recorded natural disaster to affect Puerto Rico. Increased stress i... more Hurricane Maria was the worst recorded natural disaster to affect Puerto Rico. Increased stress in pregnant women during and in the aftermath of the hurricane may have induced epigenetic changes in their infants, which could affect gene expression. Stage of gestation at the time of the event was associated with significant differences in DNA methylation in the infants, especially those who were at around 20–25 weeks of gestation when the hurricane struck. Significant differences in DNA methylation were also associated with maternal mental status assessed after the hurricane, and with property damage. Hurricane Maria could have long lasting consequences to children who were exposed to this disaster during pregnancy.
Zika virus (ZIKV) compromises placental integrity, infecting the fetus. However, the mechanisms a... more Zika virus (ZIKV) compromises placental integrity, infecting the fetus. However, the mechanisms associated with ZIKV penetration into the placenta leading to fetal infection are unknown. Cystatin B (CSTB), the receptor for advanced glycation end products (RAGE), and tyrosine-protein kinase receptor UFO (AXL) have been implicated in ZIKV infection and inflammation. This work investigates CSTB, RAGE, and AXL receptor expression and activation pathways in ZIKV-infected placental tissues at term. The hypothesis is that there is overexpression of CSTB and increased inflammation affecting RAGE and AXL receptor expression in ZIKV-infected placentas. Pathological analyses of 22 placentas were performed to determine changes caused by ZIKV infection. Quantitative proteomics, immunofluorescence, and western blot were performed to analyze proteins and pathways affected by ZIKV infection in frozen placentas. The pathological analysis confirmed decreased size of capillaries, hyperplasia of Hofbau...
Summary Background Early microbiota perturbations are associated with disorders that involve immu... more Summary Background Early microbiota perturbations are associated with disorders that involve immunological underpinnings. Cesarean section (CS)-born babies show altered microbiota development in relation to babies born vaginally. Here we present the first statistically powered longitudinal study to determine the effect of restoring exposure to maternal vaginal fluids after CS birth. Methods Using 16S rRNA gene sequencing, we followed the microbial trajectories of multiple body sites in 177 babies over the first year of life; 98 were born vaginally, and 79 were born by CS, of whom 30 were swabbed with a maternal vaginal gauze right after birth. Findings Compositional tensor factorization analysis confirmed that microbiota trajectories of exposed CS-born babies aligned more closely with that of vaginally born babies. Interestingly, the majority of amplicon sequence variants from maternal vaginal microbiomes on the day of birth were shared with other maternal sites, in contrast to non-pregnant women from the Human Microbiome Project (HMP) study. Conclusions The results of this observational study prompt urgent randomized clinical trials to test whether microbial restoration reduces the increased disease risk associated with CS birth and the underlying mechanisms. It also provides evidence of the pluripotential nature of maternal vaginal fluids to provide pioneer bacterial colonizers for the newborn body sites. This is the first study showing long-term naturalization of the microbiota of CS-born infants by restoring microbial exposure at birth. Funding C&D, Emch Fund, CIFAR, Chilean CONICYT and SOCHIPE, Norwegian Institute of Public Health, Emerald Foundation, NIH, National Institute of Justice, Janssen.
OBJECTIVES/GOALS: Determine if exposure to violence at different life stages (childhood versus re... more OBJECTIVES/GOALS: Determine if exposure to violence at different life stages (childhood versus recent exposure) in postpartum women is associated to increased risk of weight retention more than 1 year and no more than 2 years after delivery, thus increasing health risk in short and long term. METHODS/STUDY POPULATION: Participants will be recruited from a cohort of post-partum women who received services from the Puerto Rico Women and Children Program (PR WIC) during pregnancy and postpartum period as per PR WIC established criteria. Families that have completed their participation in a Lifestyle intervention trial will be paired 2:1 with eligible nonparticipants that fulfill trial enrollment criteria. Language, culture validated instruments will be used to document maternal violence exposure in childhood and recent exposure, defined as within the last 12 months. To asses weight retention, pre-pregnancy weight will be compared to actual weight at the moment of evaluation, anthropome...
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