Bridging the Gap Between Transformative Practices and Traditional Public Health Approaches.

CONTEXT: The release of the 24/7 Wall Street publication in November 2018 labeling the Waterloo-Cedar Falls, Iowa, community as the worst city for Black Americans to live in the United States sparked conversations and calls to action across the community-from the kitchen table to the boardroom. It became clear that this was a critical moment for innovative leadership from public health. PROGRAM: To bring together these individual efforts, and diverse perspectives, toward deeper understanding and system transformation, Black Hawk County Public Health, with support from Engaging Inquiry, adopted a participatory action approach of dynamic system mapping and systemic strategy design. IMPLEMENTATION: Using participatory methodologies and tools for systems analysis, stakeholders developed a system map visualizing the patterns driving inequitable outcomes, but also the bright spots and resiliencies, identified and experienced across the community. This map, populated with local stories and data, represents a "theory of context," and offered a foundation of understanding and connectivity upon which high-impact opportunities for engagement could be identified and developed. By working across sectors and building on existing energy and resources present within the community, systemic strategies were designed to foster critical shifts toward a healthier community. EVALUATION: A developmental evaluation approach is applied throughout the mapping process to maximize rapid learning and adaption of a complex challenge when stakeholder engagement and trust building is essential. DISCUSSION: Participatory systems mapping shows promise as an adaptive approach to allow public health departments to go beyond the traditional roles of public health practice, to collaborate with nontraditional partners, and implement strategies, initiatives, and/or policies that explicitly address inequity and the social determinants of health. Adaptive strategies provide opportunities for the local public health system to identify community health improvement strategies that align with Public Health 3.0.

Evaluation of an extract of North American ginseng (Panax quinquefolius L.) in Candida albicans-infected complement-deficient mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Ginseng is a widely consumed aromatic herb that is purported to have health benefits. Several studies report a beneficial impact of ginseng or its derivatives on Candida albicans infection in mice and suggest that its immune-modulatory properties contribute to this effect. However, these studies generally administered ginseng to experimental animals by injection, whereas people typically ingest ginseng. Furthermore, although disseminated candiasis is typically a disease of immune-impaired hosts, previous studies have generally used immune competent host species in the assessments. MATERIALS AND METHODS: We evaluated the efficacy of an ingested extract of ginseng against Candida albicans infection in DBA/2J mice, which are highly susceptible to Candida albicans infection. A ginseng extract was added to the drinking water for two days before and for the remainder of the study after intravenous inoculation of mice with Candida albicans. Mice were evaluated for morbidity, mortality, Candida albicans titers, and concentrations of inflammatory cytokines and chemokines. RESULTS: Ingestion of the ginseng extract did not significantly affect overall morbidity or mortality. However, ingestion of the extract was associated with significantly lower renal titers of Candida albicans and with significantly lower concentrations of some inflammatory cytokines in kidney and/or serum. CONCLUSIONS: Assessment of morbidity, mortality, inflammatory markers, and renal titers after spontaneous ingestion of ginseng by susceptible hosts represents a comprehensive approach to characterizations of therapeutic efficacy against infectious agents. Our findings extend previous reports of the efficacy of ginseng against Candida albicans by demonstrating significant reductions in infectious load and some markers of inflammation in susceptible mice. Our data therefore support further assessment of the immune-modulatory properties of this widely consumed herb and its components.