搜索结果：Puerto Rico health sciences journal

Health professionals, including physicians and mental health workers, experience higher rates of burnout compared to the general U.S. population and other industries. These risks intensify in disaster contexts, threatening workforce well-being and sustainability. Between 2017 and 2020, Puerto Rico faced three compounding disasters: Hurricane Maria, a historic earthquake sequence, and the COVID-19 pandemic. Yet, no prior studies have examined multilevel factors contributing to burnout amid such compounding events. This study aimed to explore burnout-related stressors and resources among health professionals across task, social, and organizational levels during these disasters in Puerto Rico. Using an exploratory-descriptive qualitative design informed by the Resources, Emotions/Experiences and Demands model of burnout, semistructured interviews were conducted with 25 health professionals from diverse backgrounds. Thematic analysis revealed six key stressors: (1) cumulative stress, (2) intersecting patient health needs, (3) difficulty separating personal and professional life, (4) emotionally charged work environments, (5) collapsed health systems, and (6) insufficient economic support. Correspondingly, six multilevel resources addressed these stressors: (1) financial security, (2) authentic support, (3) dismantling power hierarchies and redistributing roles, (4) adaptive workspace overhauls, (5) onsite provisions, and (6) flexible expectations and professional autonomy. Findings underscore the compounded stress health professionals face navigating multiple disasters and emphasize the importance of leveraging resources across multiple levels to mitigate burnout risk. These insights inform strategies to support and sustain the health workforce in disaster-affected settings, particularly in the context of overlapping events. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Assess home health care (HHC) agency coverage in Puerto Rico (PR), a U.S. territory, and compare PR agencies with those in the U.S. (excluding PR) and in a subset of counties outside of PR with high Puerto Rican populations (CHPRPs). PR HHC coverage was mapped using data from 2020 U.S. Census ZIP Code Tabulation Area (ZCTA) and publicly available Centers for Medicare and Medicaid Services (CMS) files. Descriptive statistics on HHC agencies, patients and Medicare beneficiaries were calculated from publicly available CMS data. Pearson's χ2, Fisher's exact, or t tests were used to compare PR agencies with U.S. (excluding PR) and CHPRP agencies. Nearly all PR ZCTAs were served by ≥7 HHC agencies. Compared with U.S. and CHPRP agencies, those in PR have higher nonprofit ownership, higher Medicare Advantage (MA) enrollment, and better fall prevention and quality of patient care, but lower performance in timely HHC initiation, patient influenza vaccination, and patient experience. PR HHC agencies excel in patient improvement metrics, with opportunities to strengthen patient experience and preventive care. Future research should examine factors underlying observed differences, and MA enrollee access to and use of HHC.

Preterm birth (PTB) is a leading worldwide cause of morbidity and mortality among children less than five years old. In 2006, Puerto Rico reported a PTB rate of 19.9%, the highest in the United States that year. Health care factors did not explain the high rate, leading to environmental exposures as potential risk factors. The PROTECT Center studied the role of diverse chemicals in the risk of PTB and other pregnancy outcomes by recruiting and following up a cohort of pregnant persons in northwest Puerto Rico. Study participants had high levels of phthalates, pesticides, metals, and most chemicals tested, and most were associated with PTB and other adverse pregnancy outcomes. Drinking water, personal care, and household products were major sources of exposure. PROTECT also delved into the biological mechanisms underlying PTB. Inflammation and oxidative stress emerged as key mechanisms leading to adverse pregnancy outcomes through endocrine disruption of several hormones. Reporting results back to PROTECT participants was integral to the PROTECT center, which developed diverse approaches to share results. PTB rates in Puerto Rico declined to 12.2% by 2024. Further studies are needed to examine the role that common chemicals used in consumer products may play in adverse pregnancy outcomes. Reducing the impact of environmental chemicals on pregnancy outcomes must be a priority. Efforts to reduce levels of chemicals among persons of reproductive age should start before conception to further reduce the PTB rate in Puerto Rico and the United States.

Glyphosate and its primary metabolite, aminomethylphosphonic acid (AMPA), are widespread environmental contaminants with potential endocrine-disrupting properties. Despite near-universal glyphosate and AMPA exposure, human studies evaluating their association with maternal hormonal regulation during gestation remain scarce. To assess associations between urinary glyphosate and AMPA concentrations and repeated measures of maternal hormone levels during pregnancy and explore effect modification by gestational timing and fetal sex. We analyzed data from 752 pregnancies in the PROTECT birth cohort in Puerto Rico. Glyphosate and AMPA were measured in up to three urine samples per participant collected at 18 ± 2-, 22 ± 2-, and 26 ± 2-weeks' gestation. Serum concentrations of sex steroid (estriol, progesterone, testosterone), thyroid (T3, T4, fT4, TSH), and stress-related (CRH) hormones were assessed at two periods. Linear mixed effects models estimated differences in serum hormone levels associated with interquartile range (IQR) increases in urinary glyphosate/AMPA, adjusting for demographic, biological, and technical covariates. Glyphosate and AMPA were associated with lower estriol concentrations across pregnancy. Each IQR increase in AMPA was associated with 10.6% lower estriol (95% CI: -18.1%, -2.4%), while glyphosate was associated with 8.3% lower estriol (95% CI: -14.6%, -1.4%). AMPA was associated with 4.0% higher T3 (95% CI: 0.9%, 7.0%). In sensitivity analyses, AMPA was linked to 7.9% higher TSH at 26 ± 2-weeks' gestation (95% CI: 0.5%, 15.9%), while glyphosate was associated with 9.5% higher CRH at this time point (95% CI: 1.5%, 18.2%). Stratified models revealed stronger associations among participants carrying female versus male fetuses. This study provides first evidence of associations between prenatal glyphosate and AMPA exposure and disruption of multiple maternal hormonal pathways during pregnancy. Findings suggest these contaminants may interfere with estrogenic, thyroid, and stress hormone systems critical for pregnancy maintenance and fetal development, with implications for understanding mechanisms underlying adverse birth outcomes. This study provides the first human evidence that glyphosate and AMPA, ubiquitous environmental contaminants detected in 75-95% of pregnant women, disrupt multiple maternal hormonal pathways during pregnancy. Among 752 participants in a Puerto Rico birth cohort, we demonstrate significant reductions in estriol (8-11% decreases) and alterations in thyroid and stress hormones associated with glyphosate exposure. These findings illuminate potential biological mechanisms underlying previously observed associations between glyphosate exposure and adverse birth outcomes, including preterm birth and altered fetal growth. Given the widespread use of glyphosate-based herbicides globally, our results have significant implications for public health policy and regulatory decision-making. The hormonal disruptions we identified suggest that pregnant populations may be particularly vulnerable to glyphosate exposure, supporting the need for enhanced protective measures and exposure reduction strategies during critical windows of fetal development.

The representativeness and timeliness of sentinel surveillance for endemic and emerging arboviral and respiratory diseases in low-resource settings are understudied. We compared laboratory-confirmed epidemic dengue, non-epidemic dengue, Zika, chikungunya, and COVID-19 (pre-Omicron and Omicron periods) cases reported in Puerto Rico's Sentinel Enhanced Dengue Surveillance System (SEDSS) with island-wide trends reported by the Department of Health's passive disease surveillance system (PADSS). We plotted trends over time to assess representativeness and used lagged cross-correlations to determine whether SEDSS reporting preceded PADSS. SEDSS trends were representative of island-wide trends for all pathogens. SEDSS preceded reporting in PADSS by up to three, eight, and two weeks for epidemic dengue, Zika, and pre-Omicron COVID-19, respectively. Increasing case trends for chikungunya occurred at broadly similar times in both systems, while temporal concordance was lower for non-epidemic dengue. In Puerto Rico, sentinel surveillance was representative of island-wide trends and could provide early warning for dengue epidemics and emerging diseases, such as Zika and COVID-19.

Physical inactivity and sleep disturbances can affect health and quality of life in people with inflammatory bowel disease (IBD). This study aimed to describe physical activity (PA) and sleep characteristics in adults with IBD in Puerto Rico. Forty-eight participants (24 women, 24 men; mean age, 42.1 ± 14.1 years), 73% with Crohn's disease (CD) and 27% with ulcerative colitis (UC), completed anthropometric measures and wore an accelerometer on the non-dominant wrist for 7 days to assess PA and sleep characteristics. The Pittsburgh Sleep Quality Index and the Inflammatory Bowel Disease Questionnaire were also used in a subsample(n = 43). On average, patients with IBD met PA recommendations (≥150 min/week) but had short sleep duration. Patients with CD were significantly younger than patients with UC, but no differences were found in PA, body mass index (BMI), or sleep duration. Men were taller and heavier than women, but BMI, PA, and sleep characteristics were similar, except that men had more sleep interruptions. Physical activity peaked in the afternoon and evening. No significant correlations were found between PA and sleep quality. However, sleep duration was inversely correlated with BMI, and PA was positively correlated with BMI. Patients with IBD were generally overweight and physically active and had short sleep duration. Monitoring PA, sleep, and BMI may inform targeted health interventions in this population.

With increasing life expectancy, the elderly population is growing globally and faces unique oral health challenges that impact overall health and quality of life. In the Caribbean, high chronic disease rates prevail, and health care access disparities leave geriatric oral health care underserved. Poor oral health is not inevitable with aging but instead stems from financial constraints, limited specialized services, and poor medical-dental integration. This narrative review synthesizes literature from major databases on the relationships between systemic and oral health in older adults. It identifies geriatric dental barriers, evaluates current strategies, and highlights interdisciplinary collaboration needs. The review presents structured guidelines for the management of older patients in dental clinics and provides evidence-based recommendations, including workforce training, teledentistry, and integration of dental care into general health care. By addressing these gaps, this work aims to guide Caribbean policymakers and health care providers in improving geriatric oral health services, ultimately enhancing quality of life for the region's aging population.

Biomarkers can be measured in various media, including urine or blood, which represent different biological compartments and toxicokinetic pathways, resulting in potential biases when estimating the internal dose of an environmental exposure. Integrating measurements across multiple media as a multimedia biomarker (MMB) may better characterize an exposure, allowing for improved assessment of exposure-outcome relationships. This study utilized concentrations of 10 metals in urine, blood, and as MMBs, integrated using intraclass correlation coefficients (MMBICC) and weighted quantile sum regression (MBBWQS), to investigate associations with child neurodevelopment, using the Child Behavior Checklist (CBCL). We examined log-transformed geometric mean prenatal metal concentrations (in urine, blood, or as MMBs) in association with repeatedly measured CBCL scores for ages 1.5-5 years, in 284 mother-child pairs in the PROTECT birth cohort in Puerto Rico. Summary scores were modeled as log(CBCL&#x2009;+&#x2009;1). Associations were assessed as single-pollutants and as a mixture, using linear mixed-effects models, adaptive elastic net, and Bayesian kernel machine regression, adjusted for sex, maternal education level, maternal age, and child age at assessment. In single-pollutant models, prenatal urinary As and Co; blood Cd and Mn; MMBICC Cd and Co; and MMBWQS Cd, Co, and Mn were associated with higher emotional and behavioral problems in children. For example, Cd was associated with 0.24 (0.08, 0.41) higher CBCL total problem scores per interquartile range (IQR) increase in blood, 0.19 (0.07, 0.31) in MMBICC, and 0.19 (0.06, 0.31) in MMBWQS (all p&#x2009;<&#x2009;0.05; q&#x2009;<&#x2009;0.1 for blood and MMBWQS). The effects of the cumulative mixture of MMB metals were not consistently&#xa0;more strongly associated with CBCL scores&#xa0;compared to blood media. The results of this study can inform future research on optimizing biomarker assessment and reducing measurement error to assess the effect of metal mixtures on child neurodevelopment. Combining multiple biomarker media may better capture health effects compared to single-media biomarker analyses, especially for the effects of exposure to metals with varied toxicokinetic properties. Our findings provide insight to potential approaches for combining blood and urine biomarkers and to the selection of preferred media for toxic and essential metals, with the goal of reducing measurement error and accounting for toxicokinetics. Future research should explore the integration of other commonly utilized biomarkers to compare their performance and efficacy as integrated MMBs in larger sample sizes.

To investigate female sexual function and its association with sociodemographic factors and comorbidities among Hispanic women in Puerto Rico (PR). The study consisted of 2 phases. Phase 1 validated a Spanish version of the Female Sexual Function Index (FSFI) questionnaire with added sections that elicited sociodemographic information and medical history. Phase 2 involved a cross-sectional study in which the validated questionnaire was distributed at multiple gynecology clinics. The domains assessed included Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain and were scored using the FSFI. Descriptive statistics characterized participant profiles, and we analyzed relationships with total FSFI scores using Wilcoxon-Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests. Among 311 participants who completed the questionnaire, the prevalence of female sexual dysfunction (FSD) was 45.34% (n = 141), similar to estimates reported in the US(not including PR). Most of the participants were younger than 40 years (56%, 173) and reported having partners (63%, 195). Desire was the most affected domain. Correlations were observed between FSD and both medical history (particularly ovarian insufficiency) and medication use (particularly beta-blocker use). The high FSD prevalence in PR highlights the need for screening to improve characterization and treatment, ultimately enhancing patients' quality of life.

Chikungunya virus has previously caused outbreaks in U.S. territories. Recent chikungunya vaccine availability has expanded prevention options. We conducted a cross-sectional analysis of the acceptability of a hypothetical chikungunya vaccine provided at low or no cost among residents of Ponce, Puerto Rico. Among 2437 survey participants, 70.7% indicated they would get the vaccine, 22.6% would not, and 6.7% were unsure. Multivariable logistic regression showed that, after accounting for sex, vaccine acceptance was lower for participants aged 31-50&#xa0;years (adjusted Odds Ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.37-0.69) and&#xa0;>&#xa0;50&#xa0;years (aOR: 0.67, 95% CI: 0.47-0.95) compared with younger adults, and for people completing some higher education (aOR: 0.45, 95% CI: 0.26-0.78) compared with those with less than high school education. The most common reason for being uninterested or unsure was wanting to know about vaccine safety and side effects, emphasizing the importance of education and communication efforts to improve vaccine uptake.

Evidence-based modifications to antineoplastic therapy regimens are common. The reasons for those changes are varied and include dose rounding, adjustments based on organ function or changes in weight of the patient, and adverse reactions. Given this complexity, proper documentation, and use of computerized provider order entry (CPOE) systems are essential in promoting optimal decision making and patient outcomes. The objective of this study is to explore common reasons for therapeutic regimen modification and their documentation. This was a descriptive, retrospective study. Patients who received services at the infusion clinics of a specialized oncology hospital during May 2023, and whose regimen was modified between the months of August 2022 and May 2023 were included. Changes were recorded with their explanations, as detailed by physicians. Physical records from the Department of Pharmacy were also verified. The most documented reason for changes in therapeutic regimens of patients, by both physicians and pharmacy, was dose rounding (31.61% and 45.48%, respectively). Adverse effects recorded by physicians included neurotoxicity and gastrointestinal toxicity (5.16% and 3.55%, respectively). In the evaluated documentation, 14.19% of changes showed discrepancies in both records and 2.6% were not justified in either. Dose rounding was the most common reason for antineoplastic regimen modifications documented by physicians and pharmacists. Record reviews showed opportunities to improve consistency and clarity of data. Strengthening standardized documentation and interprofessional collaboration may optimize clinical decision-making.

The adoption of Community-Based Participatory Research (CBPR) approaches has increased due to its potential to reduce health disparities through Community-Academic Partnerships (CAP). Providing community members (CM) capacity-building opportunities is a way of empowering communities and promoting social change. To support the development of CAPs, the Community Training Institute for Health Disparities (CTIHD) was created in southern Puerto Rico to capacitate community leaders in the CBPR approach and basic research knowledge through the CTIHD-Community Research Program (CRP). In 2019, six syllabi-led courses were developed and implemented utilizing a problem-based curriculum design and competency-based learning model, with 12 community members enrolled. A mixed methodology assessed satisfaction, acceptance, feasibility, retention rate, and knowledge change from cognitive debriefing with semi-structured questions (qualitative), course evaluations, attendance, program documents, and pre-and post-tests (quantitative). Results indicate high levels of satisfaction from courses and retention rates of 100% and 91%, respectively. Post-course evaluation scores exceeded 70% in five (5) of six (6) courses, with two courses demonstrating statistically significant results (p < 0.05). Cognitive debriefing results indicate the feasibility and acceptability of the curriculum with suggested modifications in practical applications, itinerary of courses, and research proposal development. The outcomes of the program include the formation of four partnerships and the development of three research proposals. Capacity-building efforts, such as those of the CTIHD-CRP, are essential to increase community participation in health research, foster the formation of Community-Academic Partnerships (CAPs), and support the development of research on health disparities in the long-term.

Structural stressors (SS) or mutually reinforcing systems that prevent groups of individuals from accessing opportunities and resources, can impact one's health. Indicators of SS include area-level group differences in income, education and exposure to violence. SS are fundamental causes of health disparities and can be indexed by area-level measures. Area-level SS may influence substance use risk in adolescents and future substance use disorders (SUDs). SUDs often start during adolescence, a critical risk period and an ideal time for prevention and intervention efforts. Since SUD risk can be influenced by the experience of the prior generation, it is important to take into account familial risk when trying to understand the role of SS on substance use risk. Improved understanding of the relationship between SS and neurocognitive mechanisms of substance use risk could inform novel approaches to prevention and intervention. We will enroll participants who are part of the Boricua Youth Study (BYS), an intergenerational, representatively sampled cohort of Puerto Rican families living in the South Bronx, New York and San Juan, Puerto Rico that has been followed for 20+ years. Working with BYS will allow us to control for familial SUD risk with prospectively captured parental SUD data and examine the how SS is related to substance use risk in two disadvantaged contexts. This article describes a pilot study focused on providing proof of the concept that specific area-level indicators of SS, including measures of income, education and exposure to violence, relate to neurocognitive mechanisms of substance use risk, including steeper delay discounting and reduced reward-related neural activity in reward-sensitive brain regions. Analyses will test a relationship between SS and neurocognitive mechanisms of substance use risk. Results will reflect associations between area-level, substance use-relevant SS and neurocognitive mechanisms of substance use risk in adolescents. If proof of concept is obtained, the next phase of the study will examine structural and family-level factors that may buffer the negative impact of SS. The goal of this research is to guide novel approaches to structural-, family- and individual-level prevention of SUD. https://clinicaltrials.gov/study/NCT06221839, identifier: NCT06221839.

Background: Vaping has become one of the most prevalent risk behaviors among adolescents and young adults worldwide. Although electronic cigarettes (ECs) are often perceived as safer than conventional tobacco, concerns regarding their impact on oral health are increasing. This systematic review aimed to critically evaluate and synthesize the available evidence regarding the association between e-cigarette use and oral health outcomes in adolescents and young adults. Methods: A systematic search of PubMed/MEDLINE, EMBASE, Scopus, and EBSCOhost databases was conducted for observational studies published within the last ten years. Studies evaluating oral health outcomes among adolescents and young adults were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies, and certainty of evidence was graded using the GRADE approach. Results: Eight observational studies met the inclusion criteria and were included in the qualitative synthesis. E-cigarette use was associated with increased caries risk, higher prevalence of gingival inflammation, alterations in salivary flow and pH, changes in oral microbiota-including increased levels of Porphyromonas gingivalis-and elevated frequencies of micronuclei in oral mucosal cells. Four studies were rated as having low risk of bias and four as moderate risk. The overall certainty of evidence was low for all outcomes due to methodological limitations, heterogeneity in outcome assessment, and inadequate control of confounding factors, including dual use of combustible tobacco products. Conclusions: Current evidence may suggest a possible association between e-cigarette use and adverse oral health alterations in adolescents and young adults. However, given the low certainty of evidence, residual confounding, and the predominance of cross-sectional designs, causal relationships cannot be established. Well-designed longitudinal studies that clearly differentiate exclusive e-cigarette users from dual users and adequately adjust for behavioral confounders are required to clarify the independent impact of vaping on oral health in this vulnerable population.

Depression and anxiety are common among younger adults and contribute to adverse physical and social outcomes. Evidence suggests a potential bidirectional relationship between common mental disorders (CMDs) and cardiovascular health (CVH). However, this has not been directly established. This review examined the relationship between CVH and CMDs in individuals aged 15-50 years. MEDLINE (PubMed), APA PsycINFO, Web of Science, and CINAHL (EBSCO) were searched from inception to 4 November 2024. Observational studies reporting depressive or anxiety symptoms and CVH defined by Life's Simple 7, Life's Essential 8, or adapted composite indices were eligible. Study quality was appraised using the Newcastle-Ottawa Scale and a narrative synthesis was conducted. Of 25 full-text articles assessed, 11 studies (n&#x2009;=&#x2009;731,650; mean age 22-48 years) met the inclusion criteria. Nine were conducted in the United States, one in China, and one in Puerto Rico. Seven cross-sectional studies reported an inverse association between CVH and CMDs, with higher CVH associated with lower odds or prevalence of depressive and anxiety symptoms. Four studies, including one cohort, found that CMDs were associated with lower CVH, reflected by higher odds of suboptimal CVH, lower prevalence of ideal CVH, and reduced CVH scores. Findings suggest a potential bidirectional relationship between CVH and CMDs among adults, though this is inferred from separate analyses rather than directly established using the same studies. Integrated strategies promoting physical activity, a healthy diet, and stress management, alongside primary care initiatives incorporating behavioural support and screening for cardiovascular and mental health risks, may benefit both conditions. Interpretation is limited by the predominance of cross-sectional studies and heterogeneity in study designs, with most studies conducted in high-income settings. Future research should prioritise longitudinal designs and apply diverse analytical methods to better clarify directionality. PROSPERO (CRD42024621494).

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by chronic airway inflammation and progressive lung injury. The inflammatory profile and systemic involvement remain poorly defined. We applied integrated multi omics (transcriptomics, proteomics, and metagenomics) to characterize inflammatory signatures and explore saliva as a noninvasive marker of systemic inflammation. These findings may support improved disease characterization and inform therapy and monitoring. This cross sectional, multicenter study included participants with PCD and healthy controls from Houston, Texas; Puerto Rico; and Mexico. Demographic and clinical data were collected in the absence of acute infection. Oral swabs underwent a bulk inflammatory transcriptomic profiling of 590-genes using NanoString nCounter&#xae; and microbiome evaluation via metagenomic sequencing. High sensitivity NULISA&#x2122; proteomic profiling of 250-proteins was performed on both saliva and plasma, with results correlated across omic layers. Pathway and gene set analyses were conducted using nSolver Advanced Analysis. Seventy-six participants were enrolled: 51 with PCD and 25 healthy controls. PCD patients, especially those older than 10&#x2009;years and those with microtubular defects, showed markedly elevated inflammatory gene and protein expression in saliva and plasma. Five inflammatory endotypes were identified: Neutrophilic protease dominant, Dipeptidyl Peptidase 1(DPP&#x2011;1) profile (78%); neutrophilic recruiting, high&#x2011;Th17 (71%); eosinophilic dominant, high&#x2011;Th2 (51%); Th2/Th17&#x2011;high (47%), and Th2/Th17&#x2011;low (25%). PCD demonstrated increased neutrophil, and CD45&#x2011;related gene expression and activation of ten inflammatory pathways, including NF&#x2011;&#x3ba;B, oxidative stress, T&#x2011;cell-receptor, TREG, Th17, TNF, Th1, Th2, TGF-B signaling, and TLR (P&#x2009;<&#x2009;.01). Saliva and plasma showed strong molecular concordance. Microbiome analysis revealed significant shifts in diversity and abundance linked to inflammatory pathways. These findings show that PCD is characterized by baseline inflammatory activity with marked endotypic heterogeneity, most frequently involving neutrophilic-immune pathways driven by DPP1-associated protease activity and Th17-mediated neutrophil recruitment, while a distinct subset of patients demonstrates a Th2-predominant inflammatory endotype. Salivary inflammatory profiling, which closely mirrors plasma, may offer a practical, non-invasive approach to capturing this patient-level heterogeneity and monitoring systemic immune activity and treatment response, especially with the new anti-inflammatory medications for bronchiectasis.

SOMOS Alianza is a strategic alliance of HIV service implementers, HIV researchers, and community members from three jurisdictions: Miami, Florida, Orlando, Florida, and San Juan, Puerto Rico. Because of high HIV incidence among Latino men who have sex with men (LMSM), improved implementation of evidence-based HIV services is needed. We sought to identify determinants influencing the reach of HIV services to LMSM in these jurisdictions. Using the Consolidated Framework for Implementation Research 2.0 and rapid qualitative analysis, we identified facilitators and barriers across jurisdictions. Common implementation facilitators were client-centered resources and culturally grounded engagement strategies. Unique barriers included state policy affecting members from Florida, and the impact of Puerto Rico's colonial status on limiting the autonomy and distribution of health-related funds. These findings underscore the need for shared and tailored implementation strategies to address the multilevel drivers of HIV-related disparities among LMSM in these regions. SOMOS Alianza es una alianza estrat&#xe9;gica que re&#xfa;ne a implementadores de servicios de VIH, investigadores de VIH y miembros de la comunidad de tres jurisdicciones: Miami (Florida), Orlando (Florida) y San Juan (Puerto Rico). Debido a la alta incidencia del VIH entre los hombres latinos que tienen sexo con hombres (HLSH), se require fortalecer la implementaci&#xf3;n de servicios de VIH basados en evidencia. Nuestro objetivo fue identificar los determinantes que influyen en el alcance de los servicios de VIH para los HLSH en estas jurisdicciones. Utilizando el Consolidated Framework for Implementation Research 2.0 y an&#xe1;lisis cualitativo r&#xe1;pido, identificamos facilitadores y barreras en todas las jurisdicciones. Los facilitadores comunes incluyeron recursos centrados en el cliente y estrategias de participaci&#xf3;n culturalmente relevantes. Las barreras &#xfa;nicas incluyeron pol&#xed;ticas estatales que afectan a los miembros de Florida y el impacto del estatus colonial de Puerto Rico en la autonom&#xed;a y distribuci&#xf3;n de fondos relacionados con la salud. Estos resultados resaltan la necesidad de estrategias de implementaci&#xf3;n compartidas y adaptadas para abordar los factores multinivel que contribuyen a las disparidades relacionadas con el VIH entre los HLSH en estas regiones.

The National Research Mentoring Network (NRMN) aims to enhance capacity in the biomedical research workforce through mentorship, professional development, and networking. This study focuses on the Strategic Empowerment Tailored for Health Equity Investigators (NRMN-SETH) program, which supports early-stage investigators (ESIs), including those from underrepresented groups, in developing grant-writing skills. Using a realist evaluation framework, this study explores the contexts, mechanisms, and outcomes contributing to the program's effectiveness. A directed content analysis approach was employed, guided by the realist evaluation framework. Data sources included speaker slides, moderator notes, and participant observations from the 2024 RCMI NRMN-SETH session. Context-mechanism-outcome configurations were analyzed to identify key stakeholders, enabling factors, and barriers to success. Five key mechanisms emerged: social support, peer accountability, knowledge of grant-writing strategies, technical grant-writing knowledge, and access to mentoring. Critical contexts included protected time for grant writing, access to subject-matter experts, and participant readiness. Institutional leadership support and cross-institutional collaborations were identified as essential for sustainability. The NRMN-SETH program effectively supports ESIs through mentorship and technical guidance, fostering equitable participation in biomedical research. Future efforts should focus on institutional investment in mentorship, grant readiness, and expanded access to subject-matter experts to enhance the program's scalability and long-term impact.

The vaginal mycobiome, though a minor component of the cervicovaginal ecosystem, plays a crucial role in reproductive health and disease. However, its composition and interactions with bacterial communities remain poorly understood, particularly among Hispanic women, who experience disproportionately high rates of human papillomavirus (HPV) infection and cervical cancer. We characterized the vaginal mycobiota across reproductive stages and examined its associations with cervical disease, HPV status, and bacterial community state types (CSTs) in 86 Hispanic participants from Puerto Rico using ITS1 amplicon sequencing. Amplicon sequence variants were inferred with QIIME2/DADA2 and taxonomically classified using the UNITE database, with diversity and discriminant taxa analyses applied to explore clinical and microbial associations. We detected 173 fungal species hypotheses, dominated by Candida albicans, Agaricomycetes sp., Scopuloides dimorpha, and Hortaea werneckii. While fungal composition did not differ significantly by reproductive stage, non-pregnant individuals exhibited greater inter-individual variability. Alpha diversity was reduced in high-grade squamous intraepithelial lesions compared with low-grade or normal cytology, and Candida parapsilosis prevalence was elevated in low-grade lesions. CST III, characterized by Lactobacillus iners dominance, showed greater dispersion variance than other CSTs. Collectively, these findings reveal a diverse vaginal mycobiome with stage- and disease-specific features and a notable contribution of environmental fungi that may influence cervical pathogenesis. This work provides foundational insight into cervicovaginal fungal ecology in a high-risk Hispanic population and highlights the importance of integrating bacteriome-mycobiome analyses in women's health research.IMPORTANCEThis study demonstrates that environmental fungi may play an important role in shaping the vaginal microbiome and influencing cervical disease progression in Hispanic women. While most prior research has focused on bacterial communities, our findings highlight fungi as significant yet underexplored contributors to reproductive health. By linking environmental fungal exposures to shifts in the vaginal mycobiome, this work expands understanding of how external factors may affect disease risk. These results underscore the need to include fungal communities in human microbiome research and support more comprehensive approaches to women's health. Ultimately, this study may inform improved risk assessment, prevention strategies, and the development of targeted interventions in diverse populations.