Introduction In 2015, the World Health Organization (WHO) estimated that 80% of the 110 to 190 million people living with disabilities resided in developing nations. This includes more than 90 million children. They also estimated that, by 2010, over 25 million people worldwide would need prosthetic or orthotic devices to best function in society. Many of these patients lack access to prosthetic devices due to poverty, high prosthetic costs, and technician shortages. This study was a prospective cohort to take place in the time frame of 2014 to 2017. The purpose of this study was to explore the hypothesis that a newly designed prosthetic leg, which costs less than $100 to manufacture, can assist persons with amputation by increasing their ability to gain employment—thus improving their quality of life. The specific criteria to accept the hypothesis is that greater than 50% of the participants with amputation who previously reported they were unable to work would be able to obtain a paying job as a direct result of using the prosthetic leg used in this research. Materials and Methods This study was approved by the Edward Via College of Osteopathic Medicine (institutional review board number 2014–033). Persons with amputation older than the age of 17 years were seen at the James Moody Adams (JMA) Clinic at Baxter Institute in Tegucigalpa, Honduras. They received an approved consent form before participating in an investigational prosthetic leg research, and their medical history was collected. Each patient was assessed by a medical doctor and board-certified prosthetist for their ability to safely use the newly designed prosthesis called the Johnson prosthetic leg (JPL). Persons with amputation received a prosthetic leg at no cost if found to be an appropriate candidate. Participants were followed by a physician, and a follow-up survey was administered after using the prosthetic device for a minimum of 6 months. Results In this study, 306 persons with amputation were surveyed and 149 had transtibial amputations. Amputation due to diabetic infection was most prevalent with 118 (38%), whereas traumatic injuries accounted for 95 (31%). Participants received the JPL, and surveys were obtained after prosthetic use of 6 to 27 months. It was found that 64/66 participants (96.9%) reported wearing their prosthesis 6 to 7 days a week. Before this research, 38/66 participants (57.6%) had some ability to perform a paying job. After having the ability to walk using the JPL, 59/66 patients (89%) reported an ability to obtain employment and provide financially for themselves and their families. This indicated that 21 (75%) of the 28 patients, who previously reported the inability to work, were able to obtain a job after receiving the JPL. Conclusions The research hypothesis was accepted based on a criterion of greater than 50% of the participants who were previously unable to work had an increased ability to obtain employment after using the JPL. It was also noted that 65/66 patients (98.48%) self-reported improved self-esteem using a researcher-developed survey and would recommend this prosthetic device to other individuals with amputation. By greatly reducing financial barriers, the $100 JPL is a potential cost-effective solution to help persons with amputation living in developing nations acquire prosthetic legs. This successful pilot study provides justification for continuation and monitoring for any additional refinement. Further, it provides the basis for future studies, in additional countries, to determine efficacy to assist persons with amputation living in poverty.

Objectives There are differences in documented nutrition sensitive conditions and different barriers to obtaining adequate nutrition influencing health in the Dominican Republic, El Salvador and Honduras. Methods The research protocol is to be conducted in permanent osteopathic medical clinics in the Dominican Republic, El Salvador and Honduras with a pilot and time series study performed over 18 months. The baseline data collected general demographic information, nutrition knowledge scores, food frequency responses and use of nutrition physical assessments and ICD-10 codes documented when available by clinical students. A sample size of 120 clinic patients was determined for each country as per a power analysis (0.95) for a single variable, mean baseline body mass index (BMI). The pilot test period conducted during the three week mission trips (Fall 2018) allowed for adjustments in Qualtrics survey design, major steps forward in multi-country communication with ZOOM technology, editing survey instruments to strengthen network collaborations and accommodate culturally appropriate questions regarding demographic information, food frequencies, and health status documentation. Results The pilot surveys (approximately n = 40) were beneficial to refine the protocol implementation and improve data quality. Preliminary results from 133 respondents revealed a greater concern for overweight/obese (>80% of respondents) than underweight nutrition status. Examples of nutrition knowledge quiz responses indicated that approximately 68% correctly identified that maintaining a healthy weight can prevent heart diseases and some forms of cancer. Most respondents (80%) identified saturated fat as the dietary factor most responsible for raising serum cholesterol. Nearly 60% or respondents recognized a healthy weekly weight loss of 1–2 pounds. Quantitative data analyses will be performed using SPSS for country comparisons at the completion of the study. Conclusions Preliminary findings confirm nuances in food preferences between countries that influence food frequency responses. Responses to selected questions indicated variable levels of nutrition knowledge and literacy levels. These findings will inform future nutrition education modules and improve the efficacy of future intervention programs, policy development and overall health specific to the Dominican, Salvadoran and Honduran communities. Funding Sources Internal funding was provided by the institutional Office of Research.

Objectives To determine differences in nutritional status to guide the culturally specific education interventions. Methods Pilot training occurred in each country using consistent equipment and measurement protocols. The IRB approved protocol for pretesting and educational interventions was conducted daily for a month at each location. Descriptive statistics and Pearson 2-tailed correlations were performed. Results Subjects, all non-pregnant, non-lactating women (n = 126 DR, n = 101 ES, n = 132 HN), ranged in age from 18 to 78 yrs with 30% in their 30’s; mean ages 32.9 DR, ES 37.0, HN 42.8 (all differed, P ≤ 0.05). Most reported their ethnicity as Hispanic/Latino-Americano. At pre-testing, subjects (%) with normal BMI distributions = DR 5.6, ES 18.8, HN 15.9; obese/overweight = DR 88.8, ES 75.3, HN 62.9 (all differed, P ≤ 0.05). Mean (SD) for WC (in) = DR 38.3 ± 5.6, ES 37.4 ± 5.1, HN 36.3 ± 5.7; waist: height ratios in HN 14% lower than mean measures for DR and ES. BMI and WC were closely correlated (r = 0.70, P ≤ 0.01). Self-reported data on physical activity, weekly household income, health insurance and level of education provided insight on factors contributing to nutritional status. Conclusions BMI and WC measures were convenient, noninvasive, inexpensive and available for comparative assessments. Pre-testing data indicate subjects, the majority in their 20’s and 30’s in all three countries, had BMI and waist measures higher than recommended indicating greater risk for disease. Physical activity and socioeconomic factors highlight disparities, particularly the lack of health insurance. Our findings support the need for country specific educational interventions in future research protocols to support weight management programs. This study highlights the valuable uniqueness of the VCOM international service area clinic model. Funding Sources VCOM REAP Program FY19.