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Continuous monitoring of perinatal women in a descriptive case study allowed us the opportunity to examine the time during which the COVID-19 infection led to physiological changes in two low-income pregnant women. An important component of this study was the use of a wearable sensor device, the Oura ring, to monitor and record vital physiological parameters during sleep. Two women in their second and third trimesters, respectively, were selected based on a positive COVID-19 diagnosis. Both women were tested using the polymerase chain reaction method to confirm the presence of the virus during which time we were able to collect these physiological data. In both cases, we observed 3-6 days of peak physiological changes in resting heart rate (HR), heart rate variability (HRV), and respiratory rate (RR), as well as sleep surrounding the onset of COVID-19 symptoms. The pregnant woman in her third trimester showed a significant increase in resting HR (p = 0.006) and RR (p = 0.048), and a significant decrease in HRV (p = 0.027) and deep sleep duration (p = 0.029). She reported experiencing moderate COVID-19 symptoms and did not require hospitalization. At 38 weeks of gestation, she had a normal delivery and gave birth to a healthy infant. The participant in her second trimester showed similar physiological changes during the 3-day peak period. Importantly, these changes appeared to return to the pre-peak levels. Common symptoms reported by both cases included loss of smell and nasal congestion, with one losing her sense of taste. Results suggest the potential to use the changes in cardiorespiratory responses and sleep for real-time monitoring of health and well-being during pregnancy.

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BACKGROUND: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. OBJECTIVE: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. METHODS: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. RESULTS: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=-0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. CONCLUSIONS: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

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BACKGROUND: Antibiotic resistance is a major contributing factor to global morbidity and mortality and is associated with inappropriate medication use. However, the level of antibiotic consumption and knowledge about antibiotic resistance in Ghana is inadequately quantified. Our study identifies strategies for improved stewardship of antibiotics to prevent the proliferation of resistant pathogens by assessing the level of antibiotic knowledge, attitudes, and consumption behaviors by region, gender, age, and education in rural and urban Ghana. METHODS: A cross-sectional study was conducted in 12 communities in the urban Greater Accra and rural Upper West regions of Ghana. A questionnaire survey was administered to 400 individuals aged 18 years and older in selected locations during September-October 2018 to collect data on individual knowledge, attitudes, and practices concerning antibiotics and antibiotic resistance. Multivariate analysis was used to investigate the association between demographic characteristics and knowledge, attitudes, and related behaviors. RESULTS: Over 30% (125/400) had not received a doctor's prescription during their last illness. Seventy percent (278/400) had taken at least one antibiotic in the year prior to the survey. The top five frequently used antibiotics were Amoxicillin, Amoxicillin-clavulanic acid, Ampicillin, Ciprofloxacin, and Metronidazole. Women and older adults had higher knowledge compared to their respective counterparts (p < 0.01). Furthermore, prudent antibiotic use was significantly more prevalent in women than men (p < 0.05). Although no regional differences were found in overall knowledge, compared to urban residents, individuals residing in rural settings exhibited higher knowledge about the ineffectiveness of antibiotics for viruses like the cold and HIV/AIDS (p < 0.001). Two hundred and fifty-two (63%) respondents were unaware of antibiotic resistance. There was generally a low level of self-efficacy among participants regarding their role in preserving the effectiveness of antibiotics. CONCLUSION: Antibiotic knowledge, attitudes, and use varied significantly across demographics, suggesting a context-specific approach to developing effective community interventions.

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Most households and workplaces all over the world possess furnishings and electronics, all of which contain potentially toxic flame retardant chemicals to prevent fire hazards. Indoor dust is a recognized repository of these types of chemicals including polybrominated diphenyl ethers (PBDEs) and non-polybrominated diphenyl ethers (non-PBDEs). However, no previous U.S. studies have differentiated concentrations from elevated surface dust (ESD) and floor dust (FD) within and across microenvironments. We address this information gap by measuring twenty-two flame-retardant chemicals in dust on elevated surfaces (ESD; n=10) and floors (FD; n=10) from rooms on a California campus that contain various concentrations of electronic products. We hypothesized a difference in chemical concentrations in ESD and FD. Secondarily, we examined whether or not this difference persisted: (a) across the studied microenvironments and (b) in rooms with various concentrations of electronics. A Wilcoxon signed-rank test demonstrated that the ESD was statistically significantly higher than FD for BDE-47 (p=0.01), BDE-99 (p=0.01), BDE-100 (p=0.01), BDE-153 (p=0.02), BDE-154 (p=0.02), and 3 non-PBDEs including EH-TBB (p=0.02), BEH-TEBP (p=0.05), and TDCIPP (p=0.03). These results suggest different levels and kinds of exposures to flame-retardant chemicals for individuals spending time in the sampled locations depending on the position of accumulated dust. Therefore, further research is needed to estimate human exposure to flame retardant chemicals based on how much time and where in the room individuals spend their time. Such sub-location estimates will likely differ from assessments that assume continuous unidimensional exposure, with implications for improved understanding of potential health impacts of flame retardant chemicals.

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