Long term detection and quantification of SARS-CoV-2 RNA in wastewater in Bahrain.

Wastewater-based epidemiology is a corroborated environmental surveillance tool in the global fight against SARS-CoV-2. The analysis of wastewater for detection of SARS-CoV-2 RNA may assist policymakers to survey a specific infectious community. Herein, we report on a long-term quantification study in Bahrain to investigate the incidence of the SARS-CoV-2 RNA in wastewater during the COVID-19 pandemic. The ∼260,000 population of Muharraq Island in Bahrain is served by a discrete sewerage catchment, and all wastewater flows to a single large Sewage Treatment Plant (STP) with a capacity of 100,000 m3/day. The catchment is predominately domestic, but also serves several hospitals and Bahrain's international airport. Flow-weighted 24-h composite wastewater samples for the period February 2020 to October 2021 were analyzed for the presence of SARS-CoV-2 N1, N2 and E genes. A Spearman rank correlation demonstrated a moderate correlation between the concentration of SARS-CoV-2 N1, N2 and E genes in the wastewater samples and the number of COVID-19 cases reported on the same day of the sampling. SARS-CoV-2 viral genes were detected in wastewater samples shortly after the first cases of COVID-19 were reported by the health authorities in Bahrain by reverse transcription-polymerase chain reaction (RT-qPCR). The viral genes were detected in 55 of 65 samples (84.62%) during the whole study period and the concentration range was found to be between 0 and 11,508 RNA copies/mL across the viral genes tested (in average N1: 518.4, N2: 366.8 and E: 649.3 copies/mL). Furthermore, wastewater samples from two COVID-19-dedicated quarantine facilities were analysed and detected higher SARS-CoV-2 gene concentrations (range 27-19,105 copies/mL; in average N1: 5044, N2: 4833 and E: 8663 copies/mL). Our results highlight the potential use of RT-qPCR for SARS-CoV-2 detection and quantification in wastewater and present the moderate correlation between concentration of SARS-CoV-2 genes with reported COVID-19 cases for a specified population. Indeed, this study identifies this technique as a mechanism for long term monitoring of SARS-CoV-2 infection levels and hence provides public health and policymakers with a useful environmental surveillance tool during and after the current pandemic.

Appetite for change? Facilitators and barriers to nutrition guideline implementation in Canadian recreational facilities.

As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect healthy eating guidelines. This study sought to describe facilitators and barriers to implementing provincial nutrition guidelines in recreation and sports facilities in three Canadian provinces with nutrition guidelines. Semi-structured interviews were analysed thematically to identify facilitators and barriers to implementing provincial nutrition guidelines. Facilitators and barriers were then categorised using a modified "inside out" socio-ecological model that places health-related and other social environments at the centre. A total of 32 semi-structured interviews were conducted at two time-points across the three guideline provinces. Interview participants included recreation staff managers, facility committee or board members and recreation volunteers. Eight facilitators and barriers were identified across five levels of the inside out socio-ecological model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Findings reinforce the importance of top down (clear expectations regarding guideline implementation at the time of approval) and bottom up (need for buy-in from multiple stakeholders) approaches to ensure successful implementation of nutrition guidelines. The application of a modified socio-ecological model allowed for a more nuanced understanding of leverage points to support successful guideline implementation. Lay summary Healthy eating is an important behaviour for preventing chronic diseases. Supporting people to access healthy foods in places where they live, learn, work or play is a public health priority. Recreation and sports facilities are a setting where people can be physically active. Unfortunately, the food environment in these settings may not reflect nutrition guidelines. In this study, we interviewed key stakeholders from recreation and sports facilities in three Canadian provinces who had put guidelines for healthy eating in place. We used a specific framework to do this called the inside out socio-ecological model. Eight facilitators and barriers were identified using this model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Our findings can help people working in recreation and sports facilities to identify issues that may help or hinder healthy food provision in these settings.

A case study exploring the 'real world' process of 'naturalizing' school playgrounds.

Background: The aim of this study was to examine the lived experiences of teachers and administrators at two schools (one elementary Kindergarten-Grade 5 and one middle school, grades 6-8) following the 'naturalizing' of a portion of their schoolyard. Methods: A qualitative case study design was used. Focus groups and interviews allowed participants to express their rationale, identify implementation facilitators and barriers and critical processes/steps for realizing their naturalization goals. Researcher questions explored (1) factors which led to naturalizing the schoolyard, (2) key planning and process steps (3) challenges and successes experienced, and, (4) lessons learned. Findings: Six themes were identified as rationale for naturalizing including: re-integration of outdoor play into children's daily lives, pro-active mental health, opportunity for inclusion, nature as a positive space for learning, it fit with our values and principles, we had a need. Implementation was facilitated by having champions and support from multiple levels, adopting a phased approach, resources and having the buy-in to persevere over time. Significant challenges and 'how to' steps were also identified. Conclusions: Naturalizing schoolyards does not happen without a supportive context, significant time and effort. Implementation steps and issues were those commonly found in other school-based health promotion efforts.

Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis.

OBJECTIVES: This study aimed to identify, assess and summarize available scientific evidence on tailored text messaging interventions focused on type 2 diabetes self-management. The systematic review concentrated on message design and delivery features, and tailoring strategies. The meta-analysis assessed the moderators of the effectiveness of tailored text messaging interventions. METHODS: A comprehensive search strategy included major electronic databases, key journal searches and reference list searching for related studies. PRISMA and Cochrane Collaboration's guidelines and recommended tools for data extraction, quality appraisal and data analysis were followed. Data were extracted on participant characteristics (age, gender, ethnicity), and interventional and methodological characteristics (study design, study setting, study length, choice of modality, comparison group, message type, format, content, use of interactivity, message frequency, message timing, message delivery, tailoring strategies and theory use). Outcome measures included diet, physical activity, medication adherence and glycated hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was performed to pool data on the effectiveness of the tailored text messaging interventions and moderator variables. RESULTS: The search returned 13 eligible trials for the systematic review and 11 eligible trials for the meta-analysis. The majority of the studies were randomized controlled trials, conducted in high-income settings, used multi-modalities, and mostly delivered informative, educational messages through an automated message delivery system. Tailored text messaging interventions produced a substantial effect (g = 0.54, 95% CI = 0.08-0.99, p < 0.001) on HbA1C values for a total of 949 patients. Subgroup analyses revealed the importance of some moderators such as message delivery (Q B = 18.72, df = 1, p = 0.001), message direction (Q B = 5.26, df = 1, p = 0.022), message frequency (Q B = 18.72, df = 1, p = 0.000) and using multi-modalities (Q B = 6.18, df = 1, p = 0.013). CONCLUSIONS: Tailored mobile text messaging interventions can improve glycemic control in type 2 diabetes patients. However, more rigorous interventions with larger samples and longer follow-ups are required to confirm these findings and explore the effects of tailored text messaging on other self-management outcomes.

Immunotherapy for hepatitis B in the direct acting antiviral era: Reevaluating the thymosin α1 efficacy trials in the light of a combination therapy approach.

Hepatitis B virus (HBV) causes both acute and chronic hepatitis and infects large numbers of individuals worldwide. Unfortunately, prediction of typical clinical outcome is problematic and there is considerable variability in the frequency, duration and severity of disease progression. The mainstay of HBV treatment is directed towards the suppression of HBV replication by nucleos(t)ide analogs (NUCs). The use of immunomodulators such as α-Interferon and thymosin α1 can, in select patients, results in elimination of both HBsAg and HBeAg. Given the observation that viral clearance is most effective in the presence of a strong immune response, this review summarizes data suggesting that the use of a combination of an immune modulator such as Tα1 with a highly effective NUC may result in a more successful therapeutic approach in patients with chronic hepatitis B (CHB). Results from small studies using combination Tα1 and NUCs are encouraging, and ongoing clinical trials combining entecavir with Tα1 are anticipated to provide important data assessing the use of a combination of Tα1 with a NUC to achieve resolution of CHB.

Voluntary nutrition guidelines to support healthy eating in recreation and sports settings are ineffective: findings from a prospective study.

Interventions to support healthy eating among populations are needed to address diet-related chronic disease. Recreation and sport settings are increasingly identified as ideal settings for promoting overall health, particularly for children, through creation of environments that support positive health behaviours. These publicly funded settings typically support health through physical activity promotion. However, the food environment within them is often not reflective of nutrition guidelines. As more jurisdictions release nutrition guidelines in such settings, the purpose of this study was to assess whether voluntary nutrition guidelines, released in 2015 in the Canadian province of Nova Scotia, had any impact on food environments in these settings. Baseline and follow-up audits of food environments were conducted one year before (in 30 facilities) and one year after guideline release (in 27 facilities). Audits involved classifying all foods and beverages within vending machines and concessions as Do Not Sell, Minimum, Moderate, or Maximum nutrition, using criteria provided in the guidelines. The proportion of items within each category was calculated, and differences from pre- to post-guideline release were assessed using Chi-squared statistics. Results indicated limited change in food and beverage provision from pre- to post- guideline release. In fact, from pre- to post-guideline release, the proportion of Do Not Sell vending beverages and concession foods increased significantly, while Maximum concession beverages decreased, suggesting a worsening of the food environment post-guideline release. Findings suggest that voluntary guidelines alone are insufficient to improve food environments in recreation and sport settings. For widespread changes in the food environment of these settings to occur, more attention needs to be paid to reducing social, cultural, political and economic barriers to change (real and perceived) that have been identified in these settings, alongside developing leadership and capacity within facilities, to ensure that positive changes to food environments can be implemented and sustained.

Territoriality in the tompot blenny Parablennius gattorugine from photographic records.

The behaviour of the tompot blenny Parablennius gattorugine was studied from a long-term underwater photographic record from two sites on the south-west coast of the U.K. Repeated observations of individually identifiable P. gattorugine during 112 dives revealed that male P. gattorugine may guard eggs in a particular crevice over subsequent breeding seasons, reside in the same location for up to 4 years and recover from injuries received in disputes over territory. Further observations included resident males wiping eggs with greatly expanded anal glands, adult-type fighting between juveniles and unusual behaviour where a large male manipulated an empty mollusc shell for the attention of two smaller conspecifics.

The Influence of Epoch Length on Physical Activity Patterns Varies by Child's Activity Level.

PURPOSE: Patterns of physical activity (PA) and sedentary time, including volume of bouted activity, are important health indicators. However, the effect of accelerometer epoch length on measurement of these patterns and associations with health outcomes in children remain unknown. METHOD: We measured activity patterns in 308 children (52% girls, age range = 8-11 years) using ActiGraph GT1M accelerometers with 15-s epochs and reintegrated to 60-s epochs. We calculated the volume (minutes per day) of moderate-to-vigorous PA (MVPA), sedentary time, light, moderate, and vigorous PA, as well as bouted MVPA and sedentary time (0-5 min, 5-10 min, 10-20 min, and > 20 min). RESULTS: The difference between 15-s and 60-s epochs was statistically significant for all outcomes; however, effect sizes were small or negligible in 30% of comparisons. Bias ranged from 1.9 min/day (total MVPA) to 102.7 min/day (0-5 min sedentary bouts). Regression-based estimates of bias and 95% limits of agreement illustrated that the magnitude, and in some cases, the direction, of between-epoch differences varied with activity level. Correlations with body mass index and cardiovascular fitness were similar for 15-s (r = -.19 to .20) and 60-s (r = -.16 to .29) epochs. Estimated 15-s data (predicted from 60-s) were similar to measured data and had similar relationships with health outcomes. CONCLUSION: Epoch length influences measurement of PA and sedentary patterns and the effect is modified by activity level. However, associations with health outcomes were similar and epoch differences can be adjusted. Future research should clarify the accuracy of different epoch lengths for measuring bouted activity and evaluate whether epoch length alters relationships with additional health outcomes.

Racial diversity in mortality and morbidity in urban patients with hepatitis C.

Defining mortality for Caucasians and African American patients with chronic hepatitis C with respect to racial diversity is critical for counselling patients on therapy options. The objective of this study was to define racial diversity influence on mortality and morbidity of 3724 consecutive hepatitis C virus (HCV)-infected patients seen in an urban clinic between 1995 and 2008. Mortality, as of 2011, was defined using the SSA National Death Index and correlated with early visit medical information. The HCV chronically infected patient population consisted of 2879 African Americans (AA), 758 Caucasians and 87 other, and the majority were not treated for their infection prior to 2011. The average time to death from first visit was 5 years, the average age at death was 55 years, and despite racial diversity, AA were just as likely to be reported dead as Caucasians (23% AA vs 22% Caucasians). Cirrhosis and fibrosis (liver biopsy, AST Platelet Ratio Index or Fibrosis-4) at first visit as well as low albumin, diabetes, renal impairment and cardiac symptoms were associated with increased mortality. Treated patients who cleared the virus (sustained viral response (SVR); AA = 59; Caucasians = 40) had lower mortality than patients who were not treated (AA: 5% vs 27%; Caucasians 5% vs 26%). Hence, we find that race is not a factor in the early mortality of patients with chronic HCV infection and achieving a SVR reduced mortality. Unexpectedly, nonresponding AA also benefited by a lower mortality. African American patients with kidney disease and low albumin were at highest risk and should be treated as soon as identified.

Rigid sphere room impulse response simulation: algorithm and applications.

Simulated room impulse responses have been proven to be both useful and indispensable for comprehensive testing of acoustic signal processing algorithms while controlling parameters such as the reverberation time, room dimensions, and source-array distance. In this work, a method is proposed for simulating the room impulse responses between a sound source and the microphones positioned on a spherical array. The method takes into account specular reflections of the source by employing the well-known image method, and scattering from the rigid sphere by employing spherical harmonic decomposition. Pseudocode for the proposed method is provided, taking into account various optimizations to reduce the computational complexity. The magnitude and phase errors that result from the finite order spherical harmonic decomposition are analyzed and general guidelines for the order selection are provided. Three examples are presented: an analysis of a diffuse reverberant sound field, a study of binaural cues in the presence of reverberation, and an illustration of the algorithm's use as a mouth simulator.

The impact of Action Schools! BC on the health of Aboriginal children and youth living in rural and remote communities in British Columbia.

OBJECTIVES: The aim of the study was to determine the short-term impact of a 7-month whole-school physical activity and healthy eating intervention (Action Schools! BC) over the 2007-2008 school year for children and youth in 3 remote First Nations villages in northwestern British Columbia. STUDY DESIGN: A pre-experimental pre/post design was conducted with 148 children and youth (77 males, 71 females; age 12.5±2.2 yrs). METHODS: We evaluated changes in obesity (body mass index [wt/ht(2)] and waist circumference z-scores: zBMI and zWC), aerobic fitness (20-m shuttle run), physical activity (PA; physical activity questionnaire and accelerometry), healthy eating (dietary recall) and cardiovascular risk (CV risk). RESULTS: zBMI remained unchanged while zWC increased from 0.46±1.07 to 0.57±1.04 (p<0.05). No change was detected in PA or CV risk but aerobic fitness increased by 22% (25.4±15.8 to 30.9±20.0 laps; p<0.01). There was an increase in the variety of vegetables consumed (1.10±1.18 to 1.45±1.24; p<0.05) but otherwise no dietary changes were detected. CONCLUSIONS: While no changes were seen in PA or overall CV risk, zWC increased, zBMI remained stable and aerobic fitness improved during a 7-month intervention.

The challenge of low physical activity during the school day: at recess, lunch and in physical education.

PURPOSE: To describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines. METHODS: The authors measured PA via accelerometry in 380 children (8-11 years) and examined data representing (1) the whole school day, (2) regular class time, (3) recess, (4) lunch and (5) scheduled physical education (PE). Activity was categorised as sedentary (SED), light physical activity (LPA) or moderate to vigorous physical activity (MVPA) using age-specific thresholds. They examined sex differences across PA intensities during each time period and compliance with recommended guidelines. RESULTS: Girls accumulated less MVPA and more SED than boys throughout the school day (MVPA -10.6 min; SED +13.9 min) recess (MVPA -1.6 min; SED +1.7 min) and lunch (MVPA -3.1 min; SED +2.9 min). Girls accumulated less MVPA (-6.2 min), less LPA (-2.5 min) and more SED (+9.4 min) than boys during regular class time. Fewer girls than boys achieved PA guidelines during school (90.9% vs 96.2%), recess (15.7% vs 34.1%) and lunch (16.7% vs 37.4%). During PE, only 1.8% of girls and 2.9% of boys achieved the PA guidelines. Girls and boys accumulated similar amounts of MVPA, LPA and SED. CONCLUSION: The MVPA deficit in girls was due to their sedentary behaviour as opposed to LPA. Physical activity strategies that target girls are essential to overcome this deficit. Only a very small percentage of children met physical activity guidelines during PE. There is a great need for additional training and emphasis on PA during PE. In addition schools should complement PE with PA models that increase PA opportunities across the school day.

Patterns of physical activity in Spanish children: a descriptive pilot study.

BACKGROUND: The majority of Spanish adults and children do not engage in enough physical activity to be beneficial for health. There is a need for objective and accurate assessment of the proportion of children meeting the physical activity recommendation for health. Assessing patterns of physical activity both between days (during weekdays and weekend days) and within days is of interest to improve our understanding of the variation in Spanish children's physical activity and to provide efficient intervention programmes. METHODS: A sample of 221 children: 136 9-year-old children (68 boys and 68 girls) and 85 15-year-old children (36 girls and 49 boys) from 12 urban public schools in Madrid, Spain entered the study. The variables measured were anthropometric characteristics (height, weight, body mass index) and physical activity measured during four consecutive days using the GT1M accelerometer. RESULTS: Younger children were more active and less sedentary than older ones during week and weekend days. Nine-year-old boys and girls achieved significantly (P < 0.05) more moderate to vigorous physical activity (MVPA) and significantly (P < 0.01) less sedentary time than older 15-year-old children. During weekdays more children achieved physical activity recommendations versus weekend days. Physical activity patterns analyses indicated that boys achieved relatively high values of MVPA from 1100 till 1300 h (school break) and from 1800 till 2000 h in comparison with the rest of the day. Girls were substantially different, with the 9-year-old girls having only two obvious peaks of weekday MVPA at lunch (1300) and after school (1900 h) while the adolescent girls had no clear peak of MVPA. CONCLUSIONS: Few children achieved the level of MVPA recommended for health; at particular risk were adolescent girls. More effort needs to be devoted to promoting appropriate opportunities for Spanish girls across the day and to promoting physical activity during weekends for all children.

Prevention in the first place: schools a setting for action on physical inactivity.

Promoting physical activity has become a priority because of its role in preventing childhood obesity and chronic disease. Ecological approaches that recognise the interaction between individuals and the settings in which they spend their time are currently at the forefront of public health action. Schools have been identified as a key setting for health promotion. An overview of the literature addressed the promotion of physical activity in schools and showed that school-based strategies (elementary or high school) that utilised classroom-based education only did not increase physical activity levels; one notable exception was screen time interventions. Although evidence is sparse, active school models and environmental strategies (interventions that change policy and practice) appear to promote physical activity in elementary schools effectively. There is also strong evidence to support multicomponent models in high schools, particularly models that incorporate a family and community component. An emerging trend is to involve youth in the development and implementation of interventions. In the context of childhood obesity and sedentary lifestyles, modest increases in physical activity levels in school-based trials are important. School initiatives must be supported and reinforced in other community settings. Health professionals play a key role as champions in the community, based on their influence and credibility. Health professionals can lend support to school-based efforts by asking about and emphasising the importance of physical activity with patients, encouraging family-based activities, supporting local schools to adopt an "active school" approach and advocating for support to sustain evidence-based and promising physical activity models within schools.

Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children.

OBJECTIVE: Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors. METHODS: We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77). RESULTS: INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables. CONCLUSION: Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis.

An active school model to promote physical activity in elementary schools: action schools! BC.

OBJECTIVE: To assess the impact of an active school model on children's physical activity (PA). DESIGN: 16-month cluster randomised controlled trial. SETTING: 10 elementary schools in Greater Vancouver, BC. PARTICIPANTS: 515 children aged 9-11 years. INTERVENTION: Action Schools! BC (AS! BC) is an active school model that provided schools with training and resources to increase children's PA. Schools implemented AS! BC with support from either external liaisons (liaison schools, LS; four schools) or internal champions (champion schools, CS; three schools). Outcomes were compared with usual practice (UP) schools (three schools). MAIN OUTCOME MEASUREMENTS: PA was measured four times during the study using pedometers (step count, steps/day). RESULTS: Boys in the LS group took 1175 more steps per day, on average, than boys in the UP group (95% CI: 97 to 2253). Boys in the CS group also tended to have a higher step count than boys in the UP group (+804 steps/day; 95% CI: -341 to 1949). There was no difference in girls' step counts across groups. CONCLUSIONS: The positive effect of the AS! BC model on boys' PA is important in light of the current global trend of decreased PA.

An examination of the stages of change construct for health promotion within organizations.

PURPOSE: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change. DESIGN/METHODOLOGY/APPROACH: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods. FINDINGS: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating. PRACTICAL IMPLICATIONS: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness. ORIGINALITY/VALUE: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.

SARS wars: an examination of the quantity and construction of health information in the news media.

The media have the power to sway public perception of health issues by choosing what to publish and the context in which to present information. The media may influence an individual's tendency to overestimate the risk of some health issues while underestimating the risk of others, ultimately influencing health choices. Although some research has been conducted to examine the number of articles on selected health topics, little research has examined how the messages are constructed. The purpose of this article is to describe an examination of the construction of news reports on health topics using aspects of the social amplification of risk model and the elaboration likelihood model of persuasion for theoretical direction. One hundred news media reports (print, radio, television, and Internet) were analyzed in terms of message repetition, context, source, and grammar. Results showed that health topics were more often discussed in terms of risk, by credible sources using strong language. This content analysis provides an empirical starting point for future research into how such health news may influence consumer's perceptions of health topics.

Advancing Health Promotion Priorities: Stories of Capacity Building from the Canadian Heart Health Initiative (CHHI).

The purpose of this paper is to explore how public health professionals built capacity to carry out health promotion despite a low level of investment and competition for financial resources with acute-oriented healthcare services. Three data sources are used in this analysis: key-informant interviews with project participants, final reports from three provincial Heart Health projects in Canada (Prince Edward Island, Ontario and Manitoba) and major provincial health policy documents prior to and during each project. We use a narrative policy analysis to identify contextual factors influencing health promotion priority and progress through capacity building. Common capacity building themes emerged from the data despite the different contexts within which the projects were situated: building community trust and support, developing a linking system that promotes provincial partnerships and assisting in sustainability efforts by coordinating resources and efforts towards a common chronic disease prevention strategy. Each of these provincial projects overcame instances of resistance to advancing a health promotion agenda by concentrating on building relationships, by making better use of existing structures and organizations and by developing new productive unions that shared a primary prevention agenda.