The 2nd Alarm Project: Bridging Social Work and Public Health to Improve Mental Wellness in the Fire Service.

Firefighters are trained to respond to a wide range of emergencies, and over the course of responding to emergencies, are exposed to a variety of potentially traumatic events. Repeated exposure to traumatic events may adversely impact firefighters' mental health. Combined with stigma surrounding help-seeking, lack of systematic resources and referral programs, and other barriers to care, firefighters do not routinely receive a continuum of trauma informed, assessment and treatment services from trained professionals. The purpose of this paper is to describe an evidence-informed approach to a reciprocal, collaborative model among social work and public health practice, policy, and research; and to offer a framework for researchers, clinicians, and policy advocates to more effectively achieve goals of preventing and treating trauma exposure in firefighters. This paper provides a comprehensive literature review, as well as describes a case study of a successful public health intervention for mitigating exposure to trauma among a population of firefighters. The significant contribution of mental health issues to the burden of disease among our firefighters is a matter of considerable public health concern. Effective approaches to mitigating behavioral health needs must bridge both mental health disciplines and public health to minimally, include access to evidence-based assessment and treatment, peer support capacity building, widely available mental health education, and leadership development to promote culture change. When considering a model for services with firefighters, reciprocal collaboration among researchers, health care professionals, first responder organizations, families, and other relevant community stakeholders is essential for success.

Breastfeeding among Hispanic and Black Women: Barriers and Support.

We describe barriers and supports for the practice of breastfeeding, with particular focus on Black and Hispanic women in the United States. We note that breastfeeding patterns reported by WIC agencies is highly variable across the country and within states. The global campaign to support breastfeeding, Baby Friendly Hospital Initiative, and its implementation in the US is described, as well as Healthy People goals and the mixture of policies across the US that provide incomplete support for breastfeeding mothers.

Disparities in Infant Nutrition: WIC Participation and Rates of Breastfeeding in Florida.

Being cognizant of the pronounced health advantages of breastfeeding for both the nursing mother and her infant, the breastfeeding dyad, we examined breastfeeding rates among Floridian women who gave birth from 2012 to 2014 (N = 639,052). We investigated the associations between breastfeeding initiation and WIC-based breastfeeding support (the Special Supplemental Nutrition Program for Women, Infants, and Children), education level, and race and ethnicity. We compared the percentage of breastfeeding mothers between those in the WIC program and those who were not, and we compared breastfeeding rates across racial and ethnic groups. Consistent with previous reports, black newborns in this study were breastfed at lower rates than other racial groups, and WIC program participants were less likely to breastfeed than non-WIC program participants. However, by breaking down the data by education level and race, and ethnicity, we see a significantly increased rate of breastfeeding due to WIC participation for both Hispanic and black women with less than a high school education. Further, we assessed differences by insurance type, race, and WIC participation. In multivariable logistic regression, we showed that the WIC program has a significant positive impact on breastfeeding rates for all but white non-Hispanic mothers, independent of sociodemographic and geographic variables. We also note a trend of increasing breastfeeding rates over the study period (p-value < 0.0001), which has positive public health implications.

Physician Training Related to Environmental Hazards near Ash Superfund Sites.

Physicians do not receive formal environmental health training in medical schools. The objectives of this study were to provide health care providers with basic environmental medicine training to better advise, treat or refer patients in the community and to observe any differences in the environmental medicine learning gains pre/post- test assessment. To rectify the problem of the lack of physicians' training related to environmental hazards, we conducted an environmental health workshop which targeted physicians living near Health Zone 1, Superfund ash sites. Fifty health care providers from both St. Vincent Family Medicine and Department of Health, Duval County Health Department (DOH-Duval) participated in a pre-test survey before the training and a post-test survey following the training. We used a non-parametric Wilcoxon Signed-Rank test to compare pre- and post- knowledge of training participants. At the 10% level of significance, the number of incorrect answers significantly declined in the post-training survey compared to the pre-training survey for all participants from both facilities combined (p=0.083). Site-specific analysis show, while a significant difference was found for participants from the St. Vincent's site (p=0.084), the difference for participants from the DOH-Duval site was not significant (p = 0.102), although the number of incorrect answers declined. The training resulted in learning gains for the 50 participants and the evaluations were very positive with 100% of physicians recommending this training to other health care providers. Additionally, training participants gave a high mark for the environmental medicine pocket guide. In 2019, the ash sites are 90% remediated and cleanup is expected to be completed in 2022. There is still a need for additional training for physicians due to other active sites (i.e., Kerr-McGee) in the community. This study highlights the importance of providing environmental hazards training to physicians and the approach by which it could be delivered effectively.

Community-Based Participatory Research at Jacksonville Florida Superfund Ash Site: Toxicology Training to Improve the Knowledge of the Lay Community.

Until the late 1960's, Jacksonville, Florida incinerated its solid waste with the resultant ash deposited in landfills or used to fill flood-prone areas. These filled areas were later developed into parks, school sites and residential areas. Lead in soil at these sites was the major toxicant of concern and driver of clean-up actions. During the period of assessment of lead-levels in soil, there were no established lines of communication between the City and residents of affected neighborhoods resulting in mistrust in the community. To address communication issues, a community-based, culturally sensitive Community Environmental Toxicology Curriculum (CETC) and a short video were developed for community stakeholders to inform them of risks, health effects, remediation processes and preventive measures. Pre-and post-tests were developed to measure knowledge gained from the toxicology training. Learning gains averaged 47% and 24% for the community leaders and residents respectively. Most participants strongly agreed that the community toxicology curriculum was a useful tool for promoting awareness of environmental risks in their community and addressing the gap in trust between residents and agencies involved in site remediation.

Community perceptions of black infant mortality: a qualitative inquiry.

Infant mortality is a key public health concern in the United States. Although infant mortality rates (IMRs) have declined, the rates among blacks are more than twice those of other racial/ethnic groups. Some Florida counties have black IMR more than four times the white IMR. The purpose of this study was to explore community awareness and perceptions of the rising Black IMR in Gadsden County, Florida. Sixty-four black men and women participated in eight focus groups. Data were transcribed then analyzed using NVivo 8. Many of the respondents discussed issues dealing with access to health care services, trust in providers, and perceived differential treatment. Inequities in health care may contribute to a culture in which blacks are resistant to seek care thus resulting in poorer outcomes. Overall, participants identified awareness and education as the most effective ways to address the higher rates of infant mortality among Blacks.

Community-based internships to address environmental issues: a model for effective partnerships.

BACKGROUND: Previous studies have shown that environmental burdens tend to be inequitably borne by poor and minority populations. Statistics indicate that these populations suffer disproportionately from adverse health effects associated with polluting facilities in their community. To address these problems, public health officials and researchers should pay close attention to the experiences of individuals in local communities. METHODS: The aims of the Community-Based Internship Program were to (1) provide a graduate internship that gives students the opportunity to utilize their didactic skills in a community-based setting on important environmental issues and (2) educate and empower the community with the tools needed to address their environmental concerns and protect their health. Graduate students from various disciplines participated in a 12-week internship program that involved community-based organizations (CBOs) working on environmental health and justice issues. RESULTS: A total of 22 graduate interns were given projects that assisted the CBOs in creating environmental health awareness and educating communities about environmental issues. Each internship represented a unique partnership between a university, an environmental law firm, and CBOs. This equitable partnership fostered co-learning and capacity building among all partners. CONCLUSION: The opportunity to collaborate as partners on a community-based initiative resulted in benefits for all partners. The graduate internship program was implemented effectively because of each partner's contribution and dedication to the success of the program. It is hoped that the lessons learned from this program can assist others with the development of similar partnerships that benefit underserved communities.

The biochemical and cellular basis for nutraceutical strategies to attenuate neurodegeneration in Parkinson's disease.

Future therapeutic intervention that could effectively decelerate the rate of degeneration within the substantia nigra pars compacta (SNc) could add years of mobility and reduce morbidity associated with Parkinson's disease (PD). Neurodegenerative decline associated with PD is distinguished by extensive damage to SNc dopaminergic (DAergic) neurons and decay of the striatal tract. While genetic mutations or environmental toxins can precipitate pathology, progressive degenerative succession involves a gradual decline in DA neurotransmission/synaptic uptake, impaired oxidative glucose consumption, a rise in striatal lactate and chronic inflammation. Nutraceuticals play a fundamental role in energy metabolism and signaling transduction pathways that control neurotransmission and inflammation. However, the use of nutritional supplements to slow the progression of PD has met with considerable challenge and has thus far proven unsuccessful. This review re-examines precipitating factors and insults involved in PD and how nutraceuticals can affect each of these biological targets. Discussed are disease dynamics (Sections 1 and 2) and natural substances, vitamins and minerals that could impact disease processes (Section 3). Topics include nutritional influences on α-synuclein aggregation, ubiquitin proteasome function, mTOR signaling/lysosomal-autophagy, energy failure, faulty catecholamine trafficking, DA oxidation, synthesis of toxic DA-quinones, o-semiquinones, benzothiazolines, hyperhomocyseinemia, methylation, inflammation and irreversible oxidation of neuromelanin. In summary, it is clear that future research will be required to consider the multi-faceted nature of this disease and re-examine how and why the use of nutritional multi-vitamin-mineral and plant-based combinations could be used to slow the progression of PD, if possible.

Blueprint for communicating risk and preventing environmental injustice.

Toxic environmental emissions have the potential to harm already susceptible populations living in close proximity to industries with pollutant emissions such as coal-fired electrical power plants. The organized dissemination of information in communities that find themselves susceptible to occupation by industries with pollutant emissions is a crucial step in the long and arduous process of preventing such harm. Here, we present a blueprint that can be used by community organizations to prevent industries that pollute the environment from locating in communities that are already disproportionately exposed to pollution (referred to here as environmental justice communities). We base this blueprint on a specific case in Taylor County, Florida, where the steps outlined successfully prevented the Taylor Energy Center (TEC) consortium from obtaining the necessary permits for the operation of a proposed coal-fired electrical power plant, thereby minimizing the risks of additional toxicant exposure to the affected community.

Vaginal douching among university women in the southeastern United States.

OBJECTIVE: The authors assessed the knowledge, beliefs about, and practices of vaginal douching among women attending 2 universities in the southeastern United States. PARTICIPANTS: There were 416 participants in this study; 46.9% were black and 44.5% were white. METHODS: The authors administered a 30-item questionnaire to women enrolled in health-related and social science courses at 2 southeastern universities. RESULTS: Approximately 38% of participants reported vaginal douching, mostly for hygienic reasons (70.7%). Most women first learned about douching from their mother. Douching was more common and more frequent among black women (48%) than among white women (27%). Age of first douche correlated positively with age of first sexual intercourse and age of first period. CONCLUSION: Women who had been informed not to douche by a healthcare professional were less likely to have douched within the past 6 months than were women who were not given this information. Misconceptions about douching are common and should be addressed by healthcare professionals.

Enhanced cystatin C and lysosomal protease expression following 6-hydroxydopamine exposure.

6-Hydroxydopamine (6-OHDA) is a selective neurotoxin used to induce apoptosis in catecholamine-containing neurons. Although biochemical products and reactive oxygen species (ROS) of 6-OHDA have been well documented, the activation of cellular pathways following exposure are not well understood. Apoptosis in PC12 (Pheochromocytoma) cells was induced by 6-OHDA in a dose (10-150 microM) and time-dependent (24-72 h) manner compared to experimental controls (no treatment). PC 12 cells exposed to 50 microM 6-OHDA demonstrated the involvement of caspase 3 and lysosomal protease alterations. Following 6-OHDA exposure, the caspase 3-like inhibitor Ac-DEVD-CHO significantly decreased 6-OHDA induced cell death. In addition, alterations in expression of the lysosomal cysteine and aspartic proteases, cathepsin B (CB) and cathepsin D (CD) and the endogenous cysteine protease inhibitor cystatin C were observed utilizing immunocytochemical analysis at 24, 48, and 72 h following 6-OHDA exposure. Furthermore, CB and CD and cystatin C immuno-like reactivity was more pronounced in TUNEL positive cells. Moreover, Western blot analysis confirmed a significant increase in protein expression for CB and CD at 72 h and a temporal and concentration dependent increase in cystatin C in response to 6-OHDA. Cells treated with pepstatin A, an inhibitor for CD, showed a significant decrease in cell death, however, CA-074ME, a specific inhibitor for CB, failed to protect cells from 6-OHDA induced cell death. Thus, these results suggest that apoptosis induced by 6-OHDA exposure is mediated in part through caspase 3 activation and lysosomal protease CD.