Little Earth Strong: A Community-Level, Culturally Appropriate Diabetes Prevention Pilot Targeting Urban American Indians.

PURPOSE: The purpose of this study was to develop a culturally appropriate, community-based diabetes prevention program, named Little Earth Strong, through partnership with an urban, Indigenous, American Indian community and determine its feasibility in lowering diabetes risks. METHODS: Using a community-based participatory research, community-level intervention approach, and after conducting a focus groups with key stakeholders (n = 20), a culturally appropriate health intervention was designed across six stages. This included providing nutrition and physical activity individual, family, and group counseling and conducting individual level biometric tests at a monthly Progress Powwow. Community participants (n = 69) included Indigenous individuals ages 18 to 64 years and their families residing in an urban American Indian housing organization. RESULTS: Findings included the project's feasibility, sustainability, and future needs. Lessons learned included the need the need to situate health interventions within Indigenous culture, engage multiple stakeholders, remain flexible and inclusive of all community members, address cultural concerns regarding biometric testing, and focus on specific ages and groups. The outcome variables included qualitative focus group data regarding feasibility and design and quantitative biometric data including hemoglobin A1C levels and weight in which a significant decrease in A1C values were found among womenConclusions: Little Earth Strong was both feasible and successful in decreasing A1C levels using a community-level approach, especially in high participators who attended most events. These results demonstrate the promise of diabetes prevention fitness and nutrition interventions that are collaboratively designed with the community.

Lipoteichoic acid from Staphylococcus aureus induces lung endothelial cell barrier dysfunction: role of reactive oxygen and nitrogen species.

Tunneled central venous catheters (TCVCs) are used for dialysis access in 82% of new hemodialysis patients and are rapidly colonized with Gram-positive organism (e.g. Staphylococcus aureus) biofilm, a source of recurrent infections and chronic inflammation. Lipoteichoic acid (LTA), a cell wall ribitol polymer from Gram-positive organisms, mediates inflammation through the Toll-like receptor 2 (TLR2). The effect of LTA on lung endothelial permeability is not known. We tested the hypothesis that LTA from Staphylococcus aureus induces alterations in the permeability of pulmonary microvessel endothelial monolayers (PMEM) that result from activation of TLR2 and are mediated by reactive oxygen/nitrogen species (RONS). The permeability of PMEM was assessed by the clearance rate of Evans blue-labeled albumin, the activation of the TLR2 pathway was assessed by Western blot, and the generation of RONS was measured by the fluorescence of oxidized dihydroethidium and a dichlorofluorescein derivative. Treatment with LTA or the TLR2 agonist Pam((3))CSK((4)) induced significant increases in albumin permeability, IκBα phosphorylation, IRAK1 degradation, RONS generation, and endothelial nitric oxide synthase (eNOS) activation (as measured by the p-eNOS(ser1177):p-eNOS(thr495) ratio). The effects on permeability and RONS were effectively prevented by co-administration of the superoxide scavenger Tiron, the peroxynitrite scavenger Urate, or the eNOS inhibitor L-NAME and these effects as well as eNOS activation were reduced or prevented by pretreatment with an IRAK1/4 inhibitor. The results indicate that the activation of TLR2 and the generation of ROS/RNS mediates LTA-induced barrier dysfunction in PMEM.