Evaluation of a Fall Prevention Program to Reduce Fall Risk and Fear of Falling Among Community-Dwelling Older Adults and Adults with Disabilities.

Purpose: The overarching goal of the program evaluation was to determine the reach and impact of the District-funded Safe At Home (SAH) modification program in reducing falls, fall injuries, and fear of falls among community-dwelling older adults and adults with disabilities. The SAH program has served over 6000 adults since 2016, the majority of whom are women (79%) and over age 60 (92%). Materials and Methods: Letters were mailed in September 2022 to clients (n=492) who had home modifications completed between October 2021-March 2022 inviting them to participate in a brief phone survey about program satisfaction, falls, fall location, and severity. The validated Fall Efficacy Scale (FES) was administered pre (at first visit), post (at last visit), and during the phone survey (within 6 months to 1 year of program completion) to assess fear of falling. The response rate was 55% (n=241). Results: Older adults (n=219) and adults with disabilities (n=22) reported high program satisfaction. Most clients, 79%, did not report a fall since the completion of the home modifications. The majority of falls reported, 76%, occurred inside the home. The average evaluation FES score was 32.5 (SD=22.6, range 10-100), indicating relatively low fear of falling. Higher FES scores were associated with a greater likelihood of reporting a fall (r=0.44, p < 0.001, n=51) and older age (r = 0.17, p < 0.01). FES scores were not related to gender. Evaluation FES scores were significantly lower than the pre-FES scores, indicating a reduction in fear of falling and positive impact of the home modifications (T(107) = 5.14, p < 0.001). Conclusion: The client-centered SAH program demonstrates significant reductions in falls, fear of falling, and high satisfaction among clients. Recommendations include program expansion to offer other evidence-based components to reduce falls and support safe aging in place.

Corrigendum: Social mobility and perinatal depression in Black women.

[This corrects the article DOI: 10.3389/frhs.2023.1227874.].

Epigenetic changes to gene pathways linked to male fertility in ex situ black-footed ferrets.

Environmental variation can influence the reproductive success of species managed under human care and in the wild, yet the mechanisms underlying this phenomenon remain largely mysterious. Molecular mechanisms such as epigenetic modifiers are important in mediating the timing and progression of reproduction in humans and model organisms, but few studies have linked epigenetic variation to reproductive fitness in wildlife. Here, we investigated epigenetic variation in black-footed ferrets (Mustela nigripes), an endangered North American mammal reliant on ex situ management for survival and persistence in the wild. Despite similar levels of genetic diversity in human-managed and wild-born populations, individuals in ex situ facilities exhibit reproductive problems, such as poor sperm quality. Differences across these settings suggest that an environmentally driven decline in reproductive capacity may be occurring in this species. We examined the role of DNA methylation, one well-studied epigenetic modifier, in this emergent condition. We leveraged blood, testes, and semen samples from male black-footed ferrets bred in ex situ facilities and found tissue-type specificity in DNA methylation across the genome, although 1360 Gene Ontology terms associated with male average litter size shared functions across tissues. We then constructed gene networks of differentially methylated genomic sites associated with three different reproductive phenotypes to explore the putative biological impact of variation in DNA methylation. Sperm gene networks associated with average litter size and sperm count were functionally enriched for candidate genes involved in reproduction, development, and its regulation through transcriptional repression. We propose that DNA methylation plays an important role in regulating these reproductive phenotypes, thereby impacting the fertility of male ex situ individuals. Our results provide information into how DNA methylation may function in the alteration of reproductive pathways and phenotypes in artificial environments. These findings provide early insights to conservation hurdles faced in the protection of this rare species.

The history of Coast Salish "woolly dogs" revealed by ancient genomics and Indigenous Knowledge.

Ancestral Coast Salish societies in the Pacific Northwest kept long-haired "woolly dogs" that were bred and cared for over millennia. However, the dog wool-weaving tradition declined during the 19th century, and the population was lost. In this study, we analyzed genomic and isotopic data from a preserved woolly dog pelt from "Mutton," collected in 1859. Mutton is the only known example of an Indigenous North American dog with dominant precolonial ancestry postdating the onset of settler colonialism. We identified candidate genetic variants potentially linked with their distinct woolly phenotype. We integrated these data with interviews from Coast Salish Elders, Knowledge Keepers, and weavers about shared traditional knowledge and memories surrounding woolly dogs, their importance within Coast Salish societies, and how colonial policies led directly to their disappearance.

Novel genomic resources contribute to the systematics of threatened arboreal deer mice of the genus Habromys Hooper & Musser, 1964 (Cricetidae, Neotominae) within a neotomine-peromyscine phylogeny.

The Crested-tailed deer mouse, Habromyslophurus, is one of seven arboreal species within the genus Habromys. Species of this genus are monotypic, relatively rare, and occur in low densities. Their geographical distribution is highly fragmented due to being restricted to montane cloud forest in Mesoamerica and they are of conservation concern. All Habromys species are endemic to Mexico, except H.lophurus, which is also distributed in Guatemala and El Salvador. In this study, we obtained and characterized the first mitogenome and several thousand nuclear ultraconserved elements (UCEs) of H.lophurus to determine its phylogenetic position within neotomine-peromyscine mice. Its mitogenome sequence (16,509 bp) is only the second complete mitogenome obtained for this poorly known genus. We also obtained the first nuclear genomic data for H.lophurus, including 3,654 UCE loci, as well as a partial mitogenome of H.simulatus (6,349 bp), and 2,186 UCE for the outgroup Holochilussciureus. Phylogenetic analyses that included our newly generated genomic data coupled with previously published data from other neotomine-peromyscine mice confirm the placement of H.lophurus, H.simulatus, and H.ixtlani within a highly supported clade. The Habromys clade was nested within a clade that also contains members of the genus Peromyscus and provides further support for the hypothesis of the paraphyly of Peromyscus. These genomic resources will contribute to future phylogenomic studies that aim to further elucidate the evolutionary history of this rare and critically endangered genus of rodents.

The Role of Teachers in Addressing Childhood Obesity: A School-Based Approach.

Childhood obesity is one of the most prevalent public health challenges in the United States, and although rates are declining overall, rates among children living in underserved neighborhoods are increasing. This five-year intervention project seeks to empower teachers (n = 92) to invest in their own health and then integrate nutrition concepts into core subjects' lessons in elementary schools. The professional development sessions reflect the concepts in the Whole Child, Whole School, Whole Community model. Results indicate that teachers who attended professional development sessions were more likely to implement nutrition lessons in the classroom (r = 0.54, p < 0.01), and students demonstrated a significant increase in nutrition knowledge (p < 0.001, df = 2, F = 9.66). Investing in school-based programs that ensure teacher well-being and professional development can yield positive benefits for both teachers and students.

Social mobility and perinatal depression in Black women.

Background: Higher socioeconomic position is associated with better birth outcomes and maternal mental health, although this relationship is less consistent for Black women. The literature is limited on the impact of social mobility across the life course on mental health of pregnant women. This study examines the impact of perceived financial status across the life-course on depressive symptoms during pregnancy among Black women. Methods: Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among pregnant Black women in metropolitan Detroit, Michigan. Depressive symptoms in the two weeks prior to birth were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Social mobility was determined at three intervals over the life course using self-report of financial status during childhood, adolescence, and current age in pregnancy. Results: 1,410 pregnant women participated, ranging in age from 18 to 45 years old. CES-D scores ranged from 0 to 53 (mean = 15.3) and 26% of the sample reported high depressive symptoms. In each age interval, higher financial status was associated with significant protective effect on depressive symptoms, and the magnitude of the effect increased across the life course. Trajectory analysis demonstrated that both the upward (4.51; 95% CI, 2.43-6.6) and downward (4.04; 95% CI, 2.62-5.46 and 3.09; 95% CI, 1.57-4.62) life-course social mobility groups had increased mean CES-D scores compared to the static social mobility group. Conclusion: This study describes the importance of previous childhood and current financial status effects on mental health in Black pregnant women.

Healthy Schoolhouse 2.0 Strides toward Equity in Obesity Prevention.

Background: Over the past two decades, childhood obesity has been recognized as an increasing health problem with stark disparities by race, ethnicity, and zip code. A single-level intervention that focuses on individual choices has limited success especially in under-resourced communities. Methods: The "Getting to Equity" model provides a framework for building interventions that incorporate multilevel strategies. We applied this model to an elementary school-based obesity prevention program. Results: By applying the "Getting to Equity" framework, we demonstrate how a school-based program aligns with the quadrants within the framework to holistically address childhood obesity. Conclusion: By applying this model to an elementary school-based obesity prevention program, we demonstrate how program leaders can address childhood obesity while advancing health equity.

Food Security Challenges and Resilience during the COVID-19 Pandemic: Corner Store Communities in Washington, D.C.

The COVID-19 pandemic exacerbates the complexities of food inequity. As one of the social determinants of health, food insecurity significantly impacts overall health across the life course. Guided by the Getting to Equity Framework, this qualitative community-engaged participatory project examines the impact of the pandemic on food security among adults in Washington, DC. Semi-structured interviews (n = 79) were conducted by trained community health workers between November 2020 and December 2021 at corner stores. Data analysis was performed using thematic network analysis in NVivo. Results are grouped into four key themes: (1) impact of the pandemic on food access, including expanded services and innovative solutions to meet needs; (2) coping and asset-based strategies at the individual and community level; (3) sources of information and support, and (4) impact of the pandemic on health and well-being. The importance of lived experience research in public health is increasingly recognized as an innovative approach that offers benefits through community engagement and empowerment.

Nuclear and Mitochondrial Phylogenomics of the Sifakas Reveal Cryptic Variation in the Diademed Sifaka.

The most comprehensive phylogenomic reconstruction to date was generated on all nominal taxa within the lemur genus Propithecus. Over 200 wild-caught individuals were included in this study to evaluate the intra and interspecific relationships across this genus. Ultraconserved Elements (UCEs) resulted in well-supported phylogenomic trees. Complete mitochondrial genomes (CMGs) largely agreed with the UCEs, except where a mitochondrial introgression was detected between one clade of the diademed sifaka (Propithecus diadema) and the Milne-Edwards sifaka (P. edwardsi). Additionally, the crowned (P. coronatus) and Von der Decken's (P. deckeni) sifakas belonged to a single admixed lineage from UCEs. Further sampling across these two species is warranted to determine if our sampling represents a hybrid zone. P. diadema recovered two well-supported clades, which were dated and estimated as being ancient as the split between the Perrier's (P. perrierii) and silky (P. candidus) sifakas. The reconstructed demographic history of the two clades also varied over time. We then modeled the modern ecological niches of the two cryptic P. diadema clades and found that they were significantly diverged (p < 0.01). These ecological differences result in a very limited zone of geographic overlap for the P. diadema clades (<60 km2). Niche models also revealed that the Onive River acts as a potential barrier to dispersal between P. diadema and P. edwardsi. Further taxonomic work is required on P. diadema to determine if its taxonomic status should be revised. This first genomic evaluation of the genus resolved the relationships between the taxa and the recovered cryptic diversity within one species.

Challenging ecogeographical rules: Phenotypic variation in the Mountain Treeshrew (Tupaia montana) along tropical elevational gradients.

Bergmann's and Allen's rules were defined to describe macroecological patterns across latitudinal gradients. Bergmann observed a positive association between body size and latitude for endothermic species while Allen described shorter appendages as latitude increases. Almost two centuries later, there is still ongoing discussion about these patterns. Temperature, the common variable in these two rules, varies predictably across both latitude and elevation. Although these rules have been assessed extensively in mammals across latitude, particularly in regions with strong seasonality, studies on tropical montane mammals are scarce. We here test for these patterns and assess the variation of several other locomotory, diet-associated, body condition, and thermoregulatory traits across elevation in the Mountain Treeshrew (Tupaia montana) on tropical mountains in Borneo. Based on morphological measurements from both the field and scientific collections, we found a complex pattern: Bergmann's rule was not supported in our tropical mountain system, since skull length, body size, and weight decreased from the lowest elevations (<1000 m) to middle elevations (2000-2500 m), and then increased from middle elevations to highest elevations. Allen's rule was supported for relative tail length, which decreased with elevation, but not for ear and hindfoot length, with the former remaining constant and the latter increasing with elevation. This evidence together with changes in presumed diet-related traits (rostrum length, zygomatic breadth and upper tooth row length) along elevation suggest that selective pressures other than temperature, are playing a more important role shaping the morphological variation across the distribution of the Mountain Treeshrew. Diet, food acquisition, predation pressure, and/or intra- and inter-specific competition, are some of the potential factors driving the phenotypic variation of this study system. The lack of variation in body condition might suggest local adaptation of this species across its elevational range, perhaps due to generalist foraging strategies. Finally, a highly significant temporal effect was detected in several traits but not in others, representing the first phenotypic variation temporal trends described on treeshrews.

Healthy Schoolhouse 2.0 Health Promotion Intervention to Reduce Childhood Obesity in Washington, DC: A Feasibility Study.

Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline-post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers' self-efficacy and students' nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p < 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p < 0.010, n = 659) and knowledge score changes (W = 17064, p < 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p < 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.

Interest in Receiving Nutrition Information Through Social Media Among Food-Security Program Participants in Washington, DC.

INTRODUCTION: Effective communication approaches are necessary to reach food-security program participants. Accessing food-security programs has been especially challenging during the COVID-19 pandemic. Social media can play an important role in reducing some communication barriers. We examined interest in receiving nutrition information via social media among adults participating in food-security programs in Washington, DC. METHODS: We developed and administered a 22-item survey to adults participating in food-security programs (N = 375). Participants were recruited at Martha's Table, in Washington, DC, from January through March 2020. We performed bivariate analyses and multinomial logistic regressions to examine predictors of interest in receiving nutrition information via social media. RESULTS: Sixty-nine percent of participants reported using social media, and 49% expressed interest in receiving nutrition information via social media. Higher levels of self-efficacy and belief in the value of digital technology were associated with greater likelihood of interest in receiving nutrition information via social media (χ2 6 = 139.0; Nagelkerke R2 = 0.35; P < .001). We found no differences by sex or digital technology access in interest in receiving nutrition information via social media. CONCLUSION: Social media is a widely used and a feasible method to reach food-security program participants. Understanding program participants' interest in receiving health information via social media may help food-security programs plan effective communication strategies to improve food security, especially when in-person participation is limited, such as during the COVID-19 pandemic.

Family involvement in pregnancy and psychological health among pregnant Black women.

Social determinants of health influence psychological health in pregnancy and contribute to health inequities in birth outcomes. This study examines the association between family involvement during pregnancy and psychological health among Black women. Pregnant women in Detroit, MI and Columbus, OH were recruited between 8 and 29 weeks' gestation (n = 203). Higher family involvement was associated with lower depressive symptoms (CES-D; ß = -1.3, p < 0.001), perceived stress (ß = -0.8, p < 0.001), and anxiety (ß = -0.39, p < 0.01), and higher levels of psychological well-being (ß = 2.2, p < 0.001). Family involvement may be a protective factor for pregnant Black women.

Folding Stability of Pax9 Intronic G-Quadruplex Correlates with Relative Molar Size in Eutherians.

Eutherian dentition has been the focus of a great deal of studies in the areas of evolution, development, and genomics. The development of molar teeth is regulated by an antero-to-posterior cascade mechanism of activators and inhibitors molecules, where the relative sizes of the second (M2) and third (M3) molars are dependent of the inhibitory influence of the first molar (M1). Higher activator/inhibitor ratios will result in higher M2/M1 or M3/M1. Pax9 has been shown to play a key role in tooth development. We have previously shown that a G-quadruplex in the first intron of Pax9 can modulate the splicing efficiency. Using a sliding window approach with we analyzed the association of the folding energy (Mfe) of the Pax9 first intron with the relative molar sizes in 42 mammalian species, representing 9 orders. The Mfe of two regions located in the first intron of Pax9 were shown to be significantly associated with the M2/M1 and M3/M1 areas and mesiodistal lengths. The first region is located at the intron beginning and can fold into a stable G4 structure, whereas the second is downstream the G4 and 265 bp from intron start. Across species, the first intron of Pax9 varied in G-quadruplex structural stability. The correlations were further increased when the Mfe of the two sequences were added. Our results indicate that this region has a role in the evolution of the mammalian dental pattern by influencing the relative size of the molars.

Little genetic structure in a Bornean endemic small mammal across a steep ecological gradient.

Janzen's influential "mountain passes are higher in the tropics" hypothesis predicts restricted gene flow and genetic isolation among populations spanning elevational gradients in the tropics. Few studies have tested this prediction, and studies that focus on population genetic structure in Southeast Asia are particularly underrepresented in the literature. Here, we test the hypothesis that mountain treeshrews (Tupaia montana) exhibit limited dispersal across their broad elevational range which spans ~2,300 m on two peaks in Kinabalu National Park (KNP) in Borneo: Mt Tambuyukon (MT) and Mt Kinabalu (MK). We sampled 83 individuals across elevations on both peaks and performed population genomics analyses on mitogenomes and single nucleotide polymorphisms from 4,106 ultraconserved element loci. We detected weak genetic structure and infer gene flow both across elevations and between peaks. We found higher genetic differentiation on MT than MK despite its lower elevation and associated environmental variation. This implies that, contrary to our hypothesis, genetic structure in this system is not primarily shaped by elevation. We propose that this pattern may instead be the result of historical processes and limited upslope gene flow on MT. Importantly, our results serve as a foundational estimate of genetic diversity and population structure from which to track potential future effects of climate change on mountain treeshrews in KNP, an important conservation stronghold for the mountain treeshrew and other montane species.

The Evolving Role of Public Health in Medical Education.

Medical education in the twentieth century was largely influenced by the Flexner Report, with significant proportions of instruction dedicated to the molecular underpinnings of the pathologic pathways and minimal mention of the socio-ecological determinants of health. When examining the predominant diseases of the twenty first century landscape, widening health disparities, and significant changes in the United States healthcare system, it is imperative to view wellness and sickness in a broader public health context rather than a singular focus of the biomedical model. While undergraduate opportunities to study public health are on the rise in the United States, there is a parallel urgency for medical curricula to recognize the importance of the complex interrelated socio-ecological root causes of health, well-being, and illness. In order to reduce the risk of non-communicable diseases and increase health equity, it is necessary for medical education to integrate core public health knowledge and competencies. Contemporary health challenges require a public health approach, in addition to clinical skills, for physicians to provide equitable care. The COVID-19 pandemic further underscores the necessity to mitigate the effects of socio-ecological determinants of health. Seven key recommendations are presented from a training to practice timeline emphasizing the important linkages between medical education, socio-ecological influences on health, and public health. As the health challenges in society and communities shift, so too must training of future physicians. There is a need and an opportunity for medicine and public health to address the shared health challenges of our global society.

Design and Implementation of a 5-Year School-Based Nutrition Education Intervention.

OBJECTIVE: To describe the research methods of a multicomponent nutrition education program empowering teachers to improve nutrition literacy and prevent obesity among elementary school students. DESIGN: Prospective 5-year study following a pre-post intervention design. SETTING: Four elementary schools in a high-needs area in Washington, DC: 2 intervention and 2 comparison schools. PARTICIPANTS: Approximately 100 teachers (25/school) and 800 students (200/school) enrolled over the study period. INTERVENTION: Healthy Schoolhouse 2.0 will engage teachers as agents of change by designing, implementing, and evaluating a structured professional development program to support the integration of nutrition concepts in the classroom. MAIN OUTCOME MEASURES: Change in pre-post survey assessment of students' nutrition literacy, attitudes, and intent; change in teachers' self-efficacy toward teaching nutrition; fruit and vegetable consumption data collected 6 times/y in the cafeteria. ANALYSIS: Process evaluation throughout the study to document implementation and challenges. Multilevel mixed modeling will be used to determine the impact of the intervention.