A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States.

OBJECTIVE: To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE: Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA: English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION: Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS: Data were analyzed by the lead investigator and described narratively. RESULTS: Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS: The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.

Prevalence and Factors Associated with Food Insecurity among Older Adults in Sub-Saharan Africa: A Systematic Review.

Food insecurity has been undermining the health and well-being of a growing number of older adults in Sub-Saharan Africa. This review aimed to examine the prevalence of food insecurity and the related contributing factors of food insecurity among older adults in Sub-Saharan Africa. We used PubMed, Scopus, ScienceDirect, and Web of Science Core Collection as our search engines and included 22 articles for data extraction. Prevalence of severe and moderate food insecurity in households with older adults ranged from 6.0 to 87.3% and from 8.3 to 48.5%, respectively. Various socio-economic (e.g., low education level, being widowed, low income, lower wealth position of households, living in a rental house, living in rural areas, lack of social grants or pensions), demographic (e.g., female, Black racial group, larger family size), and health and nutrition status-related (e.g., self-reported poor health status, having a functional and mobility-related disability, psychological disorders) factors influence food insecurity in older adults in Sub-Saharan Africa. The findings of this review can help stakeholders to prioritize the issue of food insecurity, design and implement policies and programs to improve food security among older adults in Sub-Saharan Africa.

Is iodine deficiency still a problem in sub-Saharan Africa?: a review.

Iodine is an essential trace mineral, vital for its functions in many physiological processes in the human body. Both iodine deficiency (ID) and excess are associated with adverse health effects; ID and excess iodine intake have both been identified in sub-Saharan Africa (SSA). The review aims to (1) review the iodine status among populations in SSA until October 2018, and (2) identify populations at risk of excess or inadequate iodine intakes. A systematic search of relevant articles was carried out by a seven-member research team using PubMed, Science Direct and Scopus. A total of twenty-two articles was included for data extraction. Of the articles reviewed, the majority sought to determine the prevalence of iodine status of the study populations; others measured the impact of uncontrolled and unmonitored salt iodisation on iodine excess and tested the effectiveness of water iodisation. Although iodine status varied largely in study populations, ID and excessive iodine intake often coexisted within populations. The implementation of nutrition interventions and other strategies across SSA has resulted in the reduction of goitre prevalence. Even so, goitre prevalence remains high in many populations. Improvements in access to iodised salt and awareness of its importance are needed. The emerging problem of excess iodine intakes, however, should be taken into consideration by policy makers and programme implementers. As excessive iodine intakes may have adverse health effects greater than those induced by iodine deficient diets, more population-based studies are needed to investigate iodine intakes of the different population groups.

Influence of 3D printed porous architecture on mesenchymal stem cell enrichment and differentiation.

The interactions between cells and an underlying biomaterial are important for the promotion of cell adhesion, proliferation, and function. Mesenchymal stem cells (MSCs) have great clinical potential as they are an adult stem cell population capable of multilineage differentiation. The relationship between MSC behavior and several material properties including substrate stiffness and pore size are well investigated, but there has been little research on the influence of porous architecture in a three-dimensional scaffold with a well-controlled architecture. Here, we investigate the impact of two different three-dimensionally printed, pore geometries on the enrichment and differentiation of MSCs. 3D printed scaffolds with ordered cubic pore geometry were supportive of MSC enrichment from unprocessed bone marrow, resulting in cell surface marker expression that was comparable to typical adhesion to tissue culture polystyrene, the gold standard for MSC culture. Results also show that scaffolds fabricated with ordered cubic pores significantly increase the gene expression of MSCs undergoing adipogenesis and chondrogenesis, when compared to scaffolds with ordered cylindrical pores. However, at the protein expression level, these differences were modest. For MSCs undergoing osteogenesis, gene expression results suggest that cylindrical pores may initially increase early osteogenic marker expression, while protein level expression at later timepoints is increased for scaffolds with ordered cubic pores. Taken together, these results suggest that 3D printed scaffolds with ordered cubic pores could be a suitable culture system for single-step MSC enrichment and differentiation. STATEMENT OF SIGNIFICANCE: Mesenchymal stem cells (MSCs) have great therapeutic potential, as they are capable of multilineage differentiation. MSC behavior, including lineage commitment, may be influenced by biomaterial properties including substrate stiffness and pore size. With three-dimensional (3D) printing, we can investigate these relationships in 3D culture systems. Here, we fabricated scaffolds with two different well-controlled pore geometries, and investigated the impact on MSC enrichment and differentiation. Results show that scaffolds with ordered cubic pore geometry were supportive of both MSC enrichment from unprocessed bone marrow as well as MSC differentiation, resulting in increased gene expression during adipogenesis and chondrogenesis. These results suggest that 3D printed scaffolds with ordered cubic pores could be a suitable culture system for single-step MSC enrichment and differentiation.

Development of a dynamic stem cell culture platform for mesenchymal stem cell adhesion and evaluation.

The importance of providing a physiologically relevant environment for cell culture is well recognized. The combination of proper environmental cues which are provided in vivo by the bloodstream and extracellular matrix must be reproduced to properly examine cell response in vitro, and cannot be recapitulated using traditional culture on polystyrene. Here, we have developed a device, the dynamic stem cell culture platform (DSCCP), consisting of a biomimetic scaffold cultured within the dynamic environment of a perfusion bioreactor. By varying scaffold parameters including stiffness and protein inclusion at the material surface, we found that human mesenchymal stem cells (hMSCs) were able to adhere to modified substrates, while still maintaining multipotency. Culture in a perfusion bioreactor showed cell survival and proliferation, particularly on modified substrates. The DSCCP represents a complete platform for cell adhesion and subsequent evaluation, including the response of a cell population to drug treatment.