Promoting Policy and Environmental Change in Faith-Based Organizations: Organizational Level Findings From a Mini Grants Program

Background: High rates of heart disease, cancer, and stroke exist in rural South Georgia, where Emory’s Cancer Prevention and Control Research Network provided mini-grants and technical assistance to six faith-based organizations to implement policy and environmental changes to promote healthy eating (HE), physical activity (PA), and tobacco use prevention (TUP). Drawing from a Social Ecological Framework, we hypothesized that church members would perceive an increase in messages, programs, and the availability of facilities to support HE, PA, and TUP over a 1-year period. Methods: Members (N=258) completed self-administered questionnaires that assessed perceptions of the existing church health promotion environment relative to HE, PA, and TUP policies, as well as their eating behavior and intention to use PA facilities at church at baseline and 1-year follow-up. Results:Members at three of the six churches perceived increases in delivery of HE messages via sermons, church bulletins, and food labels, and increased availability of programs that support HE (p Conclusions: Community mini-grants may be a viable mechanism for promoting environmental change supporting HE, PA, and TUP policies in church environments

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3–5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity

Minigrants to Local Health Departments: An Opportunity to Promote Climate Change Preparedness

Context: Human health is threatened by climate change. While the public health workforce is concerned about climate change, local health department administrators have reported insufficient knowledge and resources to address climate change. Mini-grants from state to local health departments (LHDs) have been used to promote a variety of local public health initiatives. Objective: To describe the mini-grant approach used by state health departments implementing the Centers for Disease Control and Prevention’s (CDC) Building Resilience Against Climate Effects (BRACE) framework; to highlight successes of this approach in promoting climate change preparedness at LHDs, and to describe challenges encountered Design: Cross-sectional survey and discussion. Intervention: State-level recipients of CDC funding issued mini-grants to local public health entities to promote climate change preparedness, adaptation, and resilience. Main Outcome Measures: The amount of funding, number of local health departments funded per state, goals, selection process, evaluation process, outcomes, successes, and challenges of the mini-grants programs. Results: Six state-level recipients of CDC funding for BRACE framework implementation awarded mini-grants ranging from $7,700 to$28,500 per year to 44 unique local jurisdictions. Common goals of the mini-grants included capacity-building, forging partnerships with entities outside of health departments, incorporating climate change information into existing programs, and developing adaptation plans. Recipients of mini-grants reported increases in knowledge, engagement with diverse stakeholders, and the incorporation of climate change content into existing programs. Challenges included addressing climate change in regions where the topic is politically sensitive, as well as the uncertainty about the long-term sustainability of local projects beyond the term of mini-grant support. Conclusions: Mini-grants can increase local public health capacity to address climate change. Jurisdictions that wish to utilize mini-grant mechanisms to promote climate change adaptation and preparedness at the local level may benefit from the experience of the six states and 44 local health programs described

LINFOHISTIOCITOSIS HEMOFAGOCÍTICA ASOCIADA AL DENGUE GRAVE

La linfohistiocitosis hemofagocítica (LHH) es una enfermedad que afecta al sistema inmunitario, a través de la activación macrofágica descontrolada, con falla en las funciones de las células asesinas natural killer (NK) y los linfocitos T citotóxicos. El dengue es la arbovirosis de mayor impacto en salud pública, que se presenta en áreas tropicales del mundo. El objetivo de esta investigación fue analizar la asociación de la linfohistiocitosis hemofagocítica a la severidad del dengue, síntomas y diagnóstico. Se aplicó una metodología con diseño documental con revisión sistemática de la bibliografía en las bases de datos científicas y buscadores PubMed, Medline, Scielo, Elsevier y Google Académico, utilizando las palabras clave: síndrome hemofagocítico, linfohistiocitosis hemofagocítica, virus dengue, dengue grave, natural killer e inflamación. Se seleccionaron 85 artículos bajo criterios de inclusión y exclusión, tanto en inglés como en español, publicados entre los años 2010-2021. El síndrome hemofagocítico es el responsable de los síntomas que en determinado momento prolongan o complican el dengue grave, se caracteriza por una activación inmune patológica, con signos y síntomas de inflamación excesiva, donde sus principales manifestaciones clínicas son fiebre, citopenias, esplenomegalias, hemofagocitosis, hipertrigliceridemia e hipofibrinogenemia, teniendo encuentra que el problema principal en esta patología es el diagnóstico oportuno, dado que su presentación generalmente esta enmascarada por la enfermedad viral que usualmente se convierte en el desencadenante, y la persistencia o progresión de los síntomas suele ser pasada por alto. La LHH asociada al dengue se encuentra descrita como una forma inusual y grave, lo que da como resultado una tormenta de citocinas liberadas durante la enfermedad. La asociación entre ambas entidades causa manifestaciones clínicas amplias que pueden iniciar desde lo menos grave hasta lo hemorrágico, el cuadro febril, dolor abdominal y dificultad respiratoria, entre otras manifestaciones clínicas, resaltan, lo cual debe orientar al diagnóstico oportuno y evitar la muerte del paciente. Palabras clave: síndrome hemofagocítico linfohistiocitosis, virus dengue, dengue grave, dengue severo, natural killer.   ABSTRACT Hemophagocytic lymphohistiocytosis (HHL) is a disease that affects the immune system, through uncontrolled macrophage activation, with failure of natural killer (NK) cells and cytotoxic T lymphocytes. Dengue is the arbovirus with the greatest impact on public health, occurring in tropical areas of the world. The objective of this research was to analyze the association of hemophagocytic lymphohistiocytosis with the severity of dengue, symptoms and diagnosis. A documentary design methodology was applied with a systematic review of the bibliography in the scientific databases and search engines PubMed, Medline, Scielo, Elsevier and Google Scholar, using the key words: hemophagocytic syndrome, hemophagocytic lymphohistiocytosis, dengue virus, severe dengue, natural killer and inflammation. 85 articles were selected under inclusion and exclusion criteria, both in English and Spanish, published between 2010-2021. Hemophagocytic syndrome is responsible for the symptoms that at a certain time prolong or complicate severe dengue, it is characterized by pathological immune activation, with signs and symptoms of excessive inflammation, where its main clinical manifestations are fever, cytopenias, splenomegaly, hemophagocytosis, hypertriglyceridemia and hypofibrinogenemia, having found that the main problem in this pathology is timely diagnosis, since its presentation is generally masked by the viral disease that usually becomes the trigger, and the persistence or progression of symptoms is often overlooked. Dengue-associated LHH is described as an unusual and severe form, resulting in a storm of cytokines released during the disease. The association between both entities causes wide clinical manifestations that can start from the less severe to the hemorrhagic, the feverish picture, abdominal pain and respiratory distress, among other clinical manifestations, they highlight, which should guide the timely diagnosis and avoid the death of the patient. Keywords: hemophagocytic lymphohistiocytosis syndrome, dengue virus, severe dengue, severe dengue, natural killer