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BACKGROUND: The clinical burden of Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other post-infectious fatiguing illnesses (PIFI) is increasing. There is a critical need to advance understanding of the effectiveness and sustainability of innovative approaches to clinical care of patients having these conditions. METHODS: We aim to assess the effectiveness of a Long COVID and Fatiguing Illness Recovery Program (LC&FIRP) in a two-arm, single-blind, pragmatic, quality improvement, professional cluster, randomized controlled trial in which 20 consenting clinicians across primary care clinics in a Federally Qualified Health Center system in San Diego, CA, will be randomized at a ratio of 1:1 to either participate in (1) weekly multi-disciplinary team-based case consultation and peer-to-peer sharing of emerging best practices (i.e., teleECHO (Extension for Community Healthcare Outcomes)) with monthly interactive webinars and quarterly short courses or (2) monthly interactive webinars and quarterly short courses alone (a control group); 856 patients will be assigned to participating clinicians (42 patients per clinician). Patient outcomes will be evaluated according to the study arm of their respective clinicians. Quantitative and qualitative outcomes will be measured at 3- and 6-months post-baseline for clinicians and every 3-months post assignment to a participating clinician for patients. The primary patient outcome is change in physical function measured using the Patient-Reported Outcomes Measurement Information System (PROMIS)-29. Analyses of differences in outcomes at both the patient and clinician levels will include a linear mixed model to compare change in outcomes from baseline to each post-baseline assessment between the randomized study arms. A concurrent prospective cohort study will compare the LC&FIRP patient population to the population enrolled in a university health system. Longitudinal data analysis approaches will allow us to examine differences in outcomes between cohorts. DISCUSSION: We hypothesize that weekly teleECHO sessions with monthly interactive webinars and quarterly short courses will significantly improve clinician- and patient-level outcomes compared to the control group. This study will provide much needed evidence on the effectiveness of a technology-enabled multi-disciplinary team-based care model for the management of Long COVID, ME/CFS, and other PIFI within a federally qualified health center. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05167227 . Registered on December 22, 2021.

Purpose To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, 'Starting Out Right' (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation. Description The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate. Assessment Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began. Conclusion These results suggest that participation in SOR was associated (p [less than or equal to] 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p [less than or equal to] 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens., Author(s): Allison D. Root [sup.1] , Laura A. Pedersen [sup.2] , Christina A. Cutshaw [sup.1] , Leslie V. Farland [sup.1] , Douglas L. Taren [sup.1] [sup.3] Author Affiliations: (1) grid.134563.6, [...]

ObjectiveTo examine the impacts of a Solar Market Garden 1-year solar-powered drip irrigation (SMG) programme in Kalalé district of northern Benin on mothers' nutritional status and micronutrient levels.DesignUsing a quasi-experimental design, sixteen villages were assigned to four groups: (i) SMG women's groups (WG); (ii) comparison WG; (iii) SMG non-WG (NWG); and (iv) comparison NWG. Difference-in-differences (DID) estimates were used to assess impacts on mothers' food consumption, diversity, BMI, prevalence of underweight (BMI < 18·5 kg/m2) and anaemia, and deficiencies of iron (ID) and vitamin A (VAD).SettingKalalé district, northern Benin.ParticipantsNon-pregnant mothers aged 15-49 years (n 1737).ResultsThe SMG programme significantly increased mothers' intake of vegetables (DID = 25·31 percentage points (pp); P < 0·01), dietary diversity (DID = 0·74; P < 0·01) and marginally increased their intake of flesh foods (DID = 10·14 pp; P < 0·1). Mean BMI was significantly increased among SMG WG compared with the other three groups (DID = 0·44 kg/m2; P < 0·05). The SMG programme also significantly decreased the prevalence of anaemia (DID = 12·86 pp; P < 0·01) but no impacts were found for the prevalence of underweight, ID and VAD.ConclusionsImproving mothers' dietary intake and anaemia prevalence supports the need to integrate gender-based agriculture to improve nutritional status. However, it may take more than a year, and additional nutrition and health programmes, to impact the prevalence of maternal underweight, ID and VAD.

Abstract Although development organizations agree that reliable access to energy and energy services—one of the 17 Sustainable Development Goals—is likely to have profound and perhaps disproportionate impacts on women, few studies have directly empirically estimated the impact of energy access on women’s empowerment. This is a result of both a relative dearth of energy access evaluations in general and a lack of clarity on how to quantify gender impacts of development projects. Here we present an evaluation of the impacts of the Solar Market Garden—a distributed photovoltaic irrigation project—on the level and structure of women’s empowerment in Benin, West Africa. We use a quasi-experimental design (matched-pair villages) to estimate changes in empowerment for project beneficiaries after one year of Solar Market Garden production relative to non-beneficiaries in both treatment and comparison villages (n = 771). To create an empowerment metric, we constructed a set of general questions based on existing theories of empowerment, and then used latent variable analysis to understand the underlying structure of empowerment locally. We repeated this analysis at follow-up to understand whether the structure of empowerment had changed over time, and then measured changes in both the levels and likelihood of empowerment over time. We show that the Solar Market Garden significantly positively impacted women’s empowerment, particularly through the domain of economic independence. In addition to providing rigorous evidence for the impact of a rural renewable energy project on women’s empowerment, our work lays out a methodology that can be used in the future to benchmark the gender impacts of energy projects.

ObjectiveTo identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.DesignCross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies.SettingKalalé district, northern Benin.SubjectsMother-child pairs (n 767): non-pregnant women of reproductive age (15-49 years) and children 6-59 months old.ResultsIn women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women's group participation and source of information. Finally, age had a significant effect in children, with those aged 6-23 months having the highest risk for anaemia and those aged 12-23 months at risk for ID and IDA.ConclusionsAnaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.

The limited resilience of agricultural and food systems has become an agenda in the time of more extreme natural hazards. The impact of such events is extensive, and the level of damage and recovery strongly depends on ecosystem services, including their own resilience capacity. Most of the time, ecosystems themselves can offer mitigation measures based on the benefits people get from nature, including cultivated and wild biomass for nutrition, materials, or energy; pest and disease control; and regulation of baseline flows, among others. The 27th Conference of the Parties to the United Nations Framework Convention on Climate Change, held in Sharm el-Sheikh, Egypt, addressed issues related to crop production, food security, and nutrition. The information garnered from this conference provided impetus for actions that we believe can ensure a future with the resources needed for sustainable development and that support the health and nutrition for all the inhabitants on Earth. [ABSTRACT FROM AUTHOR]

This research describes the proportion of children in four low‐ and middle‐income countries with adequate dietary practices at 6, 12, 18 and 24 months of age and how these practices changed over time using the World Health Organisation and UNICEF's infant young child feeding (IYCF) indicators. The associations between the IYCF indicators and anthropometric z‐scores from 6 to 24 months, and between the IYCF indicators and the family care indicators (FCIs) at 24 months are described. This was a longitudinal study of offspring from participants in the Women First Preconception Maternal Nutrition Trial conducted in Sud‐Ubangi, Democratic Republic of Congo; Chimaltenango, Guatemala; Belagavi, North Karnataka, India; and Thatta, Sindh Province, Pakistan. The frequency of the minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum adequate diet (MAD) increased between 6 and 24 months, but even at 24 months MAD remained below 50% at all sites. MDD (β = 0.12; 95% CI = 0.04−0.22) and MMF (β = 0.10; 95% CI = 0.03−0.17) were positively associated with length‐for‐age z‐score at 24 months. All IYCF indicators were positively associated with mean total FCI score: MDD (proportion ratio [PR] = 1.04; 95% CI = 1.02−1.07), MMF (PR = 1.02; 95% CI = 1.01−1.04), MAD (PR = 1.05; 95% CI = 1.02−1.08). Although there are multiple barriers to young children having an adequate diet, our results support a positive association between familial interactions and improved IYCF feeding practices. Key messages: Minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum adequate diet (MAD) increased from 6 to 24 months of age, but MAD remained below 50% frequency at all sites at 24 months.MDD and MMF were positively associated with length‐for‐age z‐scores at 24 months.The total family care indicator score was positively associated with all three infant young child feeding indicators at 24 months. [ABSTRACT FROM AUTHOR]

Editor's Note: NEHA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature this column on environmental health services from the Centers for Disease Control and Prevention (CDC) in every issue of the Journal. In these columns, authors from CDC's Water, Food, and Environmental Health Services Branch, as well as guest authors, will share insights and information about environmental health programs, trends, issues, and resources. The conclusions in these columns are those of the author(s) and do not necessarily represent the official position of CDC., The Need for Water Management Program Training The number of reported Legionnaires' disease (LD) cases increased by more than 250% over the past decade, with at least 8,400 cases reported [...]

Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Methods: Two 24 h dietary records were collected for 558 children, 2–8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children's Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. Results: AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. Conclusions: Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence. [ABSTRACT FROM AUTHOR]