Addressing Syndemic Health Disparities Among Latin Immigrants Using Peer Support.

The purpose of this project was to develop a multidimensional understanding of synergistic connections between food-related and emotional health in the lives of Latina immigrants using a community-engaged approach with women who participate in a social isolation support group. The domains of interest included the intersection of social isolation, depression, diabetes, and food insecurity. We tested an innovative "structured dialogue" (SD) approach to integrating the domains of interest into the group dynamic. We documented key positive impacts of participation in the group on women's everyday experiences and emotional wellbeing. We demonstrated the extent to which this approach increases women's knowledge of food and food resources, and their self-efficacy for dealing with diabetes and food insecurity.

How medical schools can encourage students' interest in family medicine.

The discipline of family medicine is essential to improving quality and reducing the cost of care in an effective health care system. Yet the slow growth of this field has not kept pace with national demand. In their study, Rodríguez and colleagues report on the influence of the social environment and academic discourses on medical students' identification with family medicine in four countries-the United Kingdom, Canada, France, and Spain. They conclude that these factors-the social environment and discursive activity within the medical school-influence students' specialty choices. While the discourses in Canada, France, and Spain were mostly negative, in the United Kingdom, family medicine was considered a prestigious academic discipline, well paying, and with a wide range of practice opportunities. Medical students in the United Kingdom also were exposed early and often to positive family medicine role models.In the United States, academic discourses about family medicine are more akin to those in Canada, France, and Spain. The hidden curriculum includes negative messages about family medicine, and "badmouthing" primary care occurs at many medical schools. National education initiatives highlight the importance of social determinants in medical education and the integration of public health and medicine in practice. Other initiatives expose students to family medicine role models and practice during their undergraduate training and promote primary care practice through new graduate medical education funding models. Together, these initiatives can reduce the negative effects of the social environment and create a more positive discourse about family medicine.

Feasibility and effectiveness of supplementation with locally available foods in prevention of child malnutrition in Kenya.

OBJECTIVE: To establish the operational feasibility and effectiveness of using locally available foods to prevent malnutrition and improve child growth in Kenyan children. DESIGN: Quasi-experimental design with an intervention group of children in all villages in one region and a non-intervention group of children in all villages in an adjacent region. The intervention was the distribution of a monthly food ration for the index child, a separate family ration, and group education on appropriate complementary feeding and hygiene. SETTING: Rural villages in the arid lands of eastern Kenya with a high prevalence of child malnutrition. SUBJECTS: All children in the target villages aged 6-20 months with weight-for-length Z-score (WHZ) greater than -2 at baseline. RESULTS: Children in the intervention and non-intervention groups had similar baseline anthropometric measures. The caregivers in the intervention group confirmed that the intended amounts of food supplements were received and child nutrient intake improved. During the 7-month intervention period there were significant group differences in pre-post Z-score changes between the intervention and non-intervention groups for weight-for-age (0·82, P < 0·001) and weight-for-height (1·19, P < 0·001), but not for height-for-age (-0·20, P = 0·09), after adjusting for multiple covariates. Compared with the non-intervention group, the intervention group had a lower prevalence of wasting (0% v. 8·9%, P = 0·0002) and underweight (6·3% v. 23·0%, P < 0·0001). Infectious morbidity was similar in both groups. CONCLUSIONS: The findings suggest that the distribution of locally available foods is operationally feasible and improves child weight gain and decreases acute malnutrition in Kenyan children.