MHRT Poster Session 2021

Background: Human milk is the main source of nutrition for most neonates as well as a source of components important for neonatal immunity. Neonates have a delay in development of robust immune responses and their immune system is supplemented via milk while the neonatal immune system continues to develop. Eventually, the neonatal immune system begins to function independently of mothers milk and placentally transferred IgG. Aside from missing nutritional benefits, infants who are not breastfed are at a higher risk of developing necrotizing enterocolitis (NEC), pneumonia, and sudden infant death syndrome. While the benefits of human milk in regard to neonatal health are established, the current pandemic brings to question whether or not breastfeeding can prevent disease acquisition in nursing infants. SARS-CoV-2 virus has been detected in human milk however vertical transmission of SARS-CoV-2 appears to be uncommon. Determination of the binding potential of maternal antibodies in the human milk can help us understand how milk can function to protect neonates from SARS-CoV-2 infection.

Objectives: To profile the SARS-CoV-2 binding breadth of IgG in milk from vaccinated women on the island of Oahu, Hawaii.

Materials and Methods: An Institutional Review Board application was submitted and approved by the University of Hawaii Human Studies Program (Protocol number 2021-00090). Participants were given a survey and a human milk collection kit. Fat was removed from milk samples and the skim milk was assessed for IgG composition. Binding towards SARS-CoV-2, SARS-CoV, SARS-CoV-2 variants, and non-pandemic coronavirus antigens was assessed via multiplexed immunoassay.

Conclusion: Using multiplexed immunoassays, we detect antibodies capable of binding to SARS-CoV-2 Spike of prototype virus as well as novel virus variants which arose through dissemination of wild type SARS-CoV-2 in various geographical spaces during the course of the pandemic. Here we demonstrate that immunization with an emergency use authorization (EUA) SARS-CoV-2 vaccine yields antigen specific and cross-reactive antibody titers within the human milk which may be passed on to nursing infants.

Background: Documenting the characteristics associated with the sharing of needles and drug injection equipment among people who inject drugs has important implications for monitoring drug-related trends. Since the inception of needle exchange programs in the U.S. in 1988, previous reviews on sharing and injection risk behaviors have been restrictive in either scope, population, interest, and/or context (PICo).

Objective: To document and aggregate existing literature on reports of needle and/or drug injection equipment sharing behaviors, as well as other injection-related HIV/HCV risk behavior in the U.S. in the era of needle exchange programs (i.e.,1988 to 2019).

Methods: To be included in the review, eligible sources must have been published between January 1988 and December 2019, written in English, limited geographically to the United States, and included people aged 18 years or older. Eligible sources were collected from online databases and must have also reported one or more of the prespecified 10 data items and outcomes. Additionally, an online survey of syringe exchange programs participating in the North American Syringe Exchange Network (NASEN) was included.

Results: Of 9,925 identified sources, 2,486 were eligible for full review. Of these, n=354 unique research studies from 39 U.S. states were eligible for inclusion. For the 10 data items and outcomes, preliminary findings have tallied: 1) syringe sharing (n=289); 2) non-syringe drug injection equipment sharing (n=146); 3) syringe cleaning practices (n=84); 4) syringe-mediated drug sharing (n=69); 5) speedball and/or goofball injection (n=136); 6) sharing partner (n=35); 7) injection partner (n=41); 8) shooting gallery attendance (n=104); 9) HIV/HCV serosorting (n=8); and 10) syringe reuse (n=30). These findings represent 29.3% of the total data screening and extraction processes to be done.

Conclusions: Researchers, health-policy leaders, and health services providers may utilize this summarization of syringe sharing and other HIV/HCV injection risk behavior to enhance the understanding of injection-related behaviors with the goal of optimizing the provision of harm reduction services to persons who inject drugs.

Background: Despite an overall increase in insurance coverage in the Tri-County Charleston Metropolitan Area (Tri-County Area) in South Carolina, the number of premature deaths increased between the years of 2015 to 2020. In addition, racial and ethnic disparities in health outcomes and deaths persist.

Objective: Employ the 2019 Community Health Needs Assessment Report conducted by Trident United Way in conjunction with the Medical University of South Carolina and Roper St. Francis Hospital to assess differences in access to healthcare and self-reported reasons for limited healthcare access by race and ethnicity.

Methods: Reasons for limited healthcare access included cultural/religious beliefs, not knowing how to access services, not knowing when to see a doctor, fear, lack of trust, lack of available services, no insurance, cost, not knowing how to sign up for insurance, lack of transportation, work schedule, distance or safety to access health services, lack of knowledge, or other. Race and ethnicity was categorized as White, Hispanic, Black and Other. Rao-Scott Chi Square tests were used in Excel to conduct all analyses.

Results: Statistically significant differences between race and ethnicity were found for all but four reasons for limited healthcare access. Significant results indicated a difference by race and ethnicity for the following reasons for limited healthcare access: “Cultural/religious beliefs” (p=<.0001); “I don’t know how to access healthcare services (p=.034); “I do not know when I need to see a doctor” (p=.006); “Fear” (p=.010); “I do not trust doctors'' (p=.003), “I do not have insurance and cannot pay for services (<.001); “I have insurance, but I cannot afford the co-pay or deductibles” (p<.001); “I do not know how to sign up for health insurance” (p<.001); “Lack of transportation” (p<.001); and “Lack of knowledge” (p<.001). No significant difference was found for lack of available healthcare services or distance to healthcare services.

Conclusions: Findings indicate that many disparities exist by race and ethnicity in reasons for limited healthcare access in the Charleston Tri-County area. It is interesting that no differences were found in terms of availability of services or distance to services, indicating that other strategies are needed to increase access to care. Further research with a community-based collaborative approach is needed to address these barriers to care.

Background: Sub-Saharan Africa (SSA) has reported much lower rates of COVID-19 infections compared to the Americas, Europe, and Asia. Numerous socio-economic factors have been proposed as an explanation for these differences, e.g., access to healthcare and COVID-19 testing. However, it has also been hypothesized that high background exposure to other infectious diseases, including other coronaviruses, prior to the COVID-19 pandemic, provides some degree of cross-protection from SARS-CoV-2. Of the seven human coronaviruses (HCoV), the common cold HCoVs cause mild to moderate upper respiratory tract infections and the pandemic HCoVs cause mild to severe upper and lower respiratory tract infections.

Hypothesis: Lower rates of COVID-19 in SSA are due to pre-existing immunity against common cold coronaviruses.

Objectives: This study aims to investigate the prevalence of cross-reactive SARS-CoV-2 and common cold coronaviruses antibodies among plasma samples collected from febrile Cameroonian patients prior to the COVID-19 pandemic.

Methods: We screened 378 plasma samples collected in 2014-2015 from adult and pediatric febrile Cameroonians at three sites - Maroua, Nkolbisson, and Bamenda - for the presence of anti-HCoV spike (S1) and nucleocapsid (N) immunoglobulin G (IgG) antibodies for all seven human coronaviruses using a laboratory developed microsphere immunoassay. These samples were collected prior to the COVID-19 pandemic for previous malaria research studies conducted by Dr. Kenji Obadia.

Results: We found higher levels of cross-reactive anti-SARS-CoV-2 N IgG (73%) as compared to anti-SARS-CoV-2 S1 IgG (10%) among plasma samples collected from febrile Cameroonians prior to the COVID-19 pandemic. When evaluating samples that contained both anti-SARS-CoV-2 and other coronavirus antibodies, cross-reactivity was most apparent among antibodies directed towards HCoV N.

Conclusion: These data suggest pre-existing immunity against common cold coronavirus infections might provide cross-protection against SARS-CoV-2, leading to the low rates of COVID-19 in Cameroon.

Background: Microbiota that resides in the human body plays a crucial role in development, physiology, immunity, and nutrition. The microbiota of the vagina and the ectocervix serves as a biochemical interface between the host and the environment, being a gatekeeper from foreign microbial invasion and preventing infections. Despite HPV vaccination efforts cervical cancer remains a significant public health problem in Puerto Rico. The characterization of the microbiota in Puerto Ricans has been described previously, however, no study has included the effect of pregnancy and viral infections on the microbiota in this population.

Hypothesis: During pregnancy, the changes in the hormonal cervicovaginal milieu and the immune response may favor persistence of HPV infections furthering the risk to develop cancer and promote changes in the microbial community composition of the cervicovaginal microbiota.

Objective: Characterize cervicovaginal microbiome and identify changes in HPV infection persistence in pregnant and non-pregnant Hispanic women in Puerto Rico

Materials and Methods: We conducted a cross-sectional study to characterize the cervicovaginal microbiota in pregnant and non-pregnant women in San Juan, Puerto Rico. Cervical swabs were collected from 345 Hispanic women (n=38 pregnant, n=307 non-pregnant) attending a clinic. Genomic DNA was extracted from these samples using standard human protocols and typed for HPV using the LiPA25 kit. Clinical history and demographic variables were obtained from questionnaires (e.g., BMI, age range, pregnancy status, gestational stage). Genomic DNA underwent sequencing with the Illumina MiSEQ pipeline. QC, alpha, beta analyses and taxonomic profiling were done using QIITA/QIIME pipelines.

Results: The expected results for our study is to observe changes in cervicovaginal microbiota composition in terms of Lactobacillus species proportion, richness, and diversity among the pregnant cohort and changes associated with HPV infection status. We found that 71% of the pregnant and 71% of the non-pregnant study participants tested positive for HPV infection.

Conclusions and Future Plan: In future we plan to examine association of the cervicovaginal microbiota with pregnancy outcomes (c-section, preterm birth, miscarriage, low birth weight, etc.) and explore the benefits of probiotics that promote a healthy cervicovaginal microbiome over pregnancy outcomes and HPV infection.

Background: Months after being infected with COVID-19, 10% to 30% of people still experience debilitating symptoms. The characteristics of Post-Acute SARS-CoV-2 Syndrome (PASC) in the state of Hawaii are currently unknown. Native Hawaiian Pacific Islanders (NHPI) were reported to be most likely affected by COVID-19.

Objective: Our aim is to i) describe the symptomatic characteristics, rates and severity of PASC in individuals presenting with PASC in Hawaii, ii) to compare the ethnicity distribution of PASC in Hawaii in the H054 cohort to the ethnic breakdown of cases of acute COVID-19 in Hawaii published by the CDC, and iii) to explore the relationship between chronic co-morbidities and the development of PASC.

Methods: Data were collected from the COVID-19 Seroprevalence Study conducted at JABSOM and the Queen’s Medical Center. Participants were interviewed in person and information was collected on their demographics, medical history, and the severity of their COVID-19 symptoms during the acute infection phase and >4 weeks post symptoms onset. Odds ratios, and 95% Confidence Intervals (CI) were used in data analysis for this cohort. Further, we reviewed and compared reported acute COVID-19 cases from the Hawaii Department Health to our study conducted at the and Hawaii Center for AIDS, John A. Burns School of Medicine.

Results: Of the 76 participants enrolled in the study 36 (47%) had PASC. The most experienced symptoms were dyspnea, cough, and other respiratory symptoms (86%), brain fog (55%), fatigue (34%), and joint, muscle pain or rash (33%). The most common comorbidities were cardiovascular diseases (OR=2.406; CI=0.632-9.155; p=0.189), diabetes (OR=1.98; CI=0.504-7.774; p=0.322), hypertension (OR=2.615; CI=0.444-15.393; p=0.274), respiratory diseases (OR=1.231; CI=0.321-4.716; p=0.274); high cholesterol (OR=1.80; CI=0.293-12.008; p=0.501); malignancies (OR=1.74; CI=0.359-8,479, p=0.501), and musculoskeletal diseases (OR=6.923; CI=0.763-62.825; p=0.052). For recovered COVID-19 cases and PASC, there was no difference between age, gender, ethnicity or education.

Conclusion: Cardiovascular diseases was the most common comorbidity amongst PASC participants followed by diabetes and respiratory diseases. Dyspnea, cough, and other respiratory symptoms were the most common PASC symptoms. Further study and understanding of these symptoms may help in the treatment of PASC.

Background: Women who develop gestational diabetes (GDM) during pregnancy, irrespective of their pre-existing conditions, have an increased likelihood of developing diabetes postpartum compared to normoglycemic pregnancies. Studies indicate 50% of mothers with a history of GDM are 7 times more likely to develop type 2 diabetes (DM), and a positive association to cardiovascular disease (CVD). Type 1 or type 2 diabetes diagnosed before pregnancy increases an infant's risk of congenital anomalies such as: stillbirth and fetal macrosomia. In addition to already known risk factors, sleep deficiency is a relatively new and emerging risk factor associated with GDM complications. However, little is known about sleep interventions to improve sleep during postpartum in women with a history of gestational diabetes.

Scoping review question: What is the evidence regarding sleep interventions during postpartum in women with a history of GDM?

Objective: Examine literature on sleep interventions in postpartum women with a history of GDM.

Materials and Methods: Joanna Briggs Institution (JBI) methodology for scoping reviews reflects the background, scoping review question, and inclusion criteria. Sources published in English from 2010 to present will be screened in the study as evidence. Additional gray literature sources will include Cochrane Library, Scopus, Embase, and Emcare. Critical appraisal of the literature will be conducted and tabulated, accompanying narrative summaries that will be presented in the final review. Main elements and key concepts of the literature articles were conceptualized for the background.

Inclusion criteria: Eligible studies will include postpartum women with a history of GDM, with participants ranging in age from 18 to 45 years old. All sleep intervention research studies are considered during the postpartum period.

Conclusion: Sleep deprivation has gradually become a significant risk factor for GDM and DM. Mothers appear to be more vulnerable to the effects of sleep deprivation on cardiometabolic risk and mortality. Examples of studies that met our inclusion criteria include "Ethnic Differences in Perinatal Outcome of Gestational Diabetes Mellitus," "Sleep Health: Can we Define it? Does it Matter?" and "Prevalence of Healthy Sleep Duration among Adults- United States 2014".

Background: In Hawai`i it is projected that 10% of people aged 65+ will be diagnosed with Alzheimer’s disease and related dementias (ADRD) by 2025. Nationwide, Native Hawaiians and Pacific Islanders (NHPIs) are more likely to experience early-onset ADRD than other racial and ethnic groups. NHPIs also have a higher prevalence of hypertension, obesity, diabetes, and dyslipidemia than other US racial/ethnic groups, increasing the likelihood of ADRD. Interventions that promote physical activity, healthy diet, and social and cognitive activities can prevent or slow cognitive decline. Notably, dancing can preserve or improve cognitive functioning and neuroimaging parameters, while reducing vascular risk factors.

Objective: To adapt our existing hula-based intervention to target vascular risk factors for dementia and cognitive functioning as well as to optimize its salience, implementation, and adherence in NHPIs with subjective or mild cognitive impairment by modifying an ADRD resiliency questionnaire.

Methods: During the pending University of Hawaii Institutional Review Board review, we conducted focus group training as well as expert and hula instructor interview training with mentors. An ADRD resiliency questionnaire was pilot tested with a convenience sample (N=16) of Native Hawaiians ≥ 50 years of age to ensure face validity, clarity, readability, and timing of potential participants taking the questionnaire.

Results: Study participants had common concerns regarding the applicability of some questions, the impact of COVID-19 on daily activities, and minor formatting recommendations. The feedback received from the pilot test of the questionnaire will be used to modify the questionnaire for our ‘IKE Kupuna project while awaiting IRB approval.

Conclusions: Pilot testing of research instruments and procedures with those who are of similar background to our target population are essential to culturally adapt and tailor our methods and strategies using community feedback and opinions.