Predictors of Obesity in a Cohort of Children Enrolled in WIC as Infants and Retained to 3 Years of Age.

This longitudinal study of children enrolled as infants in the New York State (NYS) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) examined predictors of obesity (body mass index ≥ 95th percentile) at 3 years of age. NYS WIC administrative data which included information from parent interviews and measured heights and weights for children were used. All 50,589 children enrolled as infants in WIC between July to December 2008 and July to December 2009 and retained in WIC through age three were included. At 3 years of age, 15.1% of children were obese. Multiple logistic regression analysis showed that children of mothers who received the Full Breastfeeding Food Package when their infant was enrolled in WIC (adjusted OR = 0.52) and children with ≤2 h screen time daily at age 3 (adjusted OR = 0.88) were significantly less likely to be obese (p < 0.001) controlling for race/ethnicity, birth weight, and birthplace. In this cohort of NYS WIC participants, maternal receipt of the Full Breastfeeding Food Package (a surrogate measure of exclusive breastfeeding) is associated with lower levels of obesity in their children at age 3. The relationships between participation in WIC, exclusive breastfeeding, and obesity prevention merit further study.

Changing WIC changes what children eat.

OBJECTIVE: This study assessed the impact of revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on nutritional behavior and obesity in children 0- to 4-years-old participating in the New York State (NYS) WIC program. In January 2009, NYS was the first to implement these revisions, which added fruits, vegetables, and whole grains and replaced whole milk with low(1%)-/nonfat milk for children 2- to 4-year-old. DESIGN AND METHODS: In this cross-sectional study, >3.5 million administrative records in the NYS WIC Statewide Information System (WICSIS) were analyzed at 6-month intervals from July to December 2008 (pre-implementation) through July to December 2011. Behavioral data in WICSIS were obtained from parent interview by WIC staff at mandatory certification and recertification visits. RESULTS: Comparing July to December in 2008 and 2011, increases were observed in breastfeeding initiation (72.2-77.5%); delaying introduction of solid foods until after 4 months of age (90.1-93.8%); daily fruit (87.0-91.6%), vegetable (78.1-80.8%), and whole grain consumption (59.0-64.4%) by children aged 1-4 years; and switches from whole milk to low-/nonfat milk by children aged 2-4 years (66.4-69.4%). In 1-year-old children, the proportion ≥95th percentile weight-for-recumbent length decreased from 15.1 to 14.2%; the proportion of children 2- to 4-year-old with body mass index (BMI) ≥95th percentile decreased from 14.6 to 14.2%. CONCLUSIONS: These findings demonstrate that positive changes in dietary intake and reductions in obesity followed implementation of the USDA-mandated cost-neutral revisions to the WIC food package for the hundreds of thousands of young children participating in the NYS WIC program.

Cerebrovascular risk factors and preclinical memory decline in healthy APOE ε4 homozygotes.

OBJECTIVE: To characterize the effects of cerebrovascular (CV) risk factors on preclinical memory decline in cognitively normal individuals at 3 levels of genetic risk for Alzheimer disease (AD) based on APOE genotype. METHODS: We performed longitudinal neuropsychological testing on an APOE ε4 enriched cohort, ages 21-97. The long-term memory (LTM) score of the Auditory Verbal Learning Test (AVLT) was the primary outcome measure. Any of 4 CV risk factors (CVany), including hypercholesterolemia (CHOL), prior cigarette use (CIG), diabetes mellitus (DM), and hypertension (HTN), was treated as a dichotomized variable. We estimated the longitudinal effect of age using statistical models that simultaneously modeled the cross-sectional and longitudinal effects of age on AVLT LTM by APOE genotype, CVany, and the interaction between the two. RESULTS: A total of 74 APOE ε4 homozygotes (HMZ), 239 ε4 heterozygotes (HTZ), and 494 ε4 noncarriers were included. APOE ε4 carrier status showed a significant quadratic effect with age-related LTM decline in all models as previously reported. CVany was associated with further longitudinal AVLT LTM decline in APOE ε4 carriers (p=0.02), but had no effect in noncarriers. When ε4 HTZ and HMZ were considered separately, there was a striking effect in HMZ (p<0.001) but not in HTZ. In exploratory analyses, significant deleterious effects were found for CIG (p=0.001), DM (p=0.03), and HTN (p=0.05) in APOE ε4 carriers only that remained significant only for CIG after correction for multiple comparisons. CONCLUSION: CV risk factors influence age-related memory decline in APOE ε4 HMZ.

Seasonality of childhood infectious diseases in Niono, Mali.

Common childhood diseases vary seasonally in Mali, much of the Sahel, and other parts of the world, yet patterns for multiple diseases have rarely been simultaneously described for extended periods at single locations. In this retrospective longitudinal (1996-2004) investigation, we studied the seasonality of malaria, acute respiratory infection and diarrhoea time-series in the district of Niono, Sahelian Mali. We extracted and analysed seasonal patterns from each time-series with the Multiplicative Holt-Winters and Wavelet Transform methods. Subsequently, we considered hypothetical scenarios where successful prevention and intervention measures reduced disease seasonality by 25 or 50% to assess the impact of health programmes on annual childhood morbidity. The results showed that all three disease time-series displayed remarkable seasonal stability. Malaria, acute respiratory infection and diarrhoea peaked in December, March (and September) and August, respectively. Finally, the annual childhood morbidity stemming from each disease diminished 7-26% in the considered hypothetical scenarios. We concluded that seasonality may assist with guiding the development of integrated seasonal disease calendars for programmatic child health promotion activities.

Patterns and predictors of asthma-related emergency department use in Harlem.

STUDY OBJECTIVES: To assess the roles of poor access to care, psychological risk factors, and asthma severity in frequent emergency department (ED) use. DESIGN: A cross-sectional survey. SETTING: Harlem Hospital Center ED and outpatient chest clinic. PARTICIPANTS: Three hundred seventy-five adult residents of Harlem, a predominantly African-American community in New York City. MEASUREMENTS: Asthma severity was assessed by self-reported symptoms using National Asthma Education and Prevention Program guidelines, health-care utilization, and psychometric scales. RESULTS: Respondents with more severe asthma were more likely to have a primary asthma care provider, and to have had more scheduled office visits for asthma in the year prior to the interview (mean number of visits for patients with severe asthma, 3.6 visits; moderate asthma, 2.4 visits; and mild asthma, 1.7 visits). Despite having a regular source of care, 69% of respondents identified the ED as their preferred source of care; 82% visited the ED more than once in the year prior to interview (median, four visits). Persons with moderate or severe asthma were 3.8 times more likely to be frequent ED users compared to those with mild asthma (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2 to 6.6). This was the strongest predictor of frequent ED use. Other predictors of ED use were number of comorbid disorders (OR, 1.5; 95% CI, 1.1 to 2.1) and self-reported global health in the year prior to the ED visit (OR, 1.8; 95% CI, 1.2 to 2.7). Psychological characteristics were not predictive of frequent ED use when controlling for disease severity. CONCLUSIONS: Frequent ED users present with serious medical conditions. They do not substitute physician care with ED care; they augment it to address serious health needs.

Maelstrom is required to position the MTOC in stage 2-6 Drosophila oocytes.

The factors that determine intracellular polarity are largely unknown. In Drosophila oocytes one of the earliest polar events is the positioning of the microtubule-organizing center (MTOC). Here we present data that are consistent with the hypothesis that maelstrom is required for posterior positioning of the MTOC.

Impact of appointment reminders on vaccination coverage at an urban clinic.

OBJECTIVE: To test if appointment reminders blinded to immunization status improve kept-appointment and vaccination coverage rates. Design. Controlled trial. SETTING: Pediatric clinic serving a low-income community in New York City. INTERVENTION: Children ages 4 through 18 months (n = 1273) scheduled sequentially for clinic appointments were systematically assigned to 1 of 4 study groups: control (n = 346); postcard (n = 314); telephone call (n = 307); and postcard and telephone call (n = 306). OUTCOME MEASURES: Kept-appointment and vaccination coverage rates. RESULTS: Children assigned to the postcard and telephone group were 1.75 times more likely to keep their appointments than controls (95% confidence interval [CI] = 1.2, 2.5). Children who actually received the postcard and telephone reminders were 2.3 times more likely to keep an appointment than controls (95% CI = 1.4, 3.7). Children who kept appointments were 2.3 times more likely to be up-to-date with their immunizations (95% CI = 1.7, 3.2). The reminders selectively increased vaccination coverage for the subgroup of children who were not up-to-date before the appointment (chi(2) = 11.2). The cost of the reminders was $.67 for the postcard and $1.58 for the postcard and telephone. Assuming 5000 visits per year and $100 reimbursement per visit, the return on each dollar invested was $10 for the postcard and $7.28 for the postcard and telephone reminder. CONCLUSIONS: Appointment reminders blind to immunization status are a practical and cost-effective strategy to increase kept-appointment rates for all children, and, through this mechanism, reach and vaccinate children who are not up-to-date.appointment reminder, vaccination coverage.

Medication use among children with asthma in East Harlem.

PURPOSE: To examine daily use of antiinflammatory medication among children with asthma in East Harlem, where hospitalization rates for asthma are among the highest in the United States. METHODS: We analyzed parent/guardian reports of medications used by children with current asthma (defined as physician diagnosis and wheezing during the previous 12 months) identified from a cross-sectional survey conducted in 2 elementary schools. RESULTS: From an overall sample of 1319 children, 298 with current asthma were included in this analysis. Most of those with asthma were Puerto Rican (136 [46%]) or black (98 [33%]), 168 (57%) were boys, and the median age was 8 years old. Overall, 65 (22%) were using antiinflammatory medication on a daily basis. A subgroup of 107 children with asthma had been hospitalized during the previous 12 months or had used beta(2)-agonist on a daily basis, suggesting persistent or severe asthma. Of these 107 children, 42 (39%) were taking antiinflammatory medication on a daily basis. Multivariate analysis of these 107 children revealed that daily use of antiinflammatory medication was associated with using a spacer tube (adjusted odds ratio [AOR]: 3. 08; 95% confidence interval [CI]: 1.27,7.47) and having seen a physician in the past 6 months (AOR: 3.46; CI: 1.01,11.9). Compared with Puerto Ricans, blacks (AOR:.32; CI:.12,.89) or children of other races/ethnicities (AOR:.27; CI:.09,.85) were less likely to use antiinflammatory medication on a daily basis. CONCLUSION: Daily use of antiinflammatory medication for children with persistent or severe asthma in East Harlem was underused. Differences in access to care may explain some findings; however, reasons for ethnic differences in use remain unclear. Both community interventions and additional provider education are needed.

Children on the move and vaccination coverage in a low-income, urban Latino population.

OBJECTIVES: The purpose of this study was to determine the impact of childhood moves and foreign birth on vaccination coverage among Latino children in New York City. METHODS: Vaccination coverage was assessed in a survey of 314 children younger than 5 years at 2 immunization clinics. RESULTS: Forty-seven percent of the study children had moved abroad. After adjustment for health insurance, regular source of care, and country of birth, child moves had no independent effect on vaccination coverage. Foreign-born children had diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella vaccination coverage rates similar to those of US-born children, but they were underimmunized in regard to Haemophilus influenzae type b and hepatitis B. CONCLUSIONS: Foreign birth, but not childhood moves, is a barrier to vaccinations among low-income, urban Latino children.

Molecular evolution at the decapentaplegic locus in Drosophila.

Using an elaborate set of cis-regulatory sequences, the decapentaplegic (dpp) gene displays a dynamic pattern of gene expression during development. The C-terminal portion of the DPP protein is processed to generate a secreted signaling molecule belonging to the transforming growth factor-beta (TGF-beta) family. This signal, the DPP ligand, is able to influence the developmental fates of responsive cells in a concentration-dependent fashion. Here we examine the sequence level organization of a significant portion of the dpp locus in Drosophila melanogaster and use interspecific comparisons with D. simulans, D. pseudoobscura and D.virilis to explore the molecular evolution of the gene. Our interspecific analysis identified significant selective constraint on both the nucleotide and amino acid sequences. As expected, interspecific comparison of protein coding sequences shows that the C-terminal ligand region is highly conserved. However, the central portion of the protein is also conserved, while the N-terminal third is quite variable. Comparison of noncoding regions reveals significant stretches of nucleotide identity in the 3' untranslated portion of exon 3 and in the intron between exons 2 and 3. An examination of cDNA sequences representing five classes of dpp transcripts indicates that these transcripts encode the same polypeptide.

ZnT-3, a putative transporter of zinc into synaptic vesicles.

The murine ZnT3 gene was cloned by virtue of its homology to the ZnT2 gene, which encodes a membrane protein that facilitates sequestration of zinc in endosomal vesicles. ZnT-3 protein is predicted to have six transmembrane domains and shares 52% amino acid identity with ZnT-2, with the homology extending throughout the two sequences. Human ZnT-3 cDNAs were also cloned; the amino acid sequence is 86% identical to murine ZnT-3. The mouse ZnT3 gene has 8 exons and maps to chromosome 5. Northern blot and reverse transcriptase-PCR analyses demonstrate that murine ZnT-3 expression is restricted to the brain and testis. In situ hybridization reveals that within the brain, ZnT-3 mRNA is most abundant in the hippocampus and cerebral cortex. Antibodies raised against the C-terminal tail of mouse ZnT-3 react with the projections from these neurons and produce a pattern similar to that obtained with Timm's reaction, which reveals histochemically reactive zinc within synaptic vesicles. We propose that ZnT-3 facilitates the accumulation of zinc in synaptic vesicles.

ZnT-2, a mammalian protein that confers resistance to zinc by facilitating vesicular sequestration.

A cDNA encoding a second zinc transporter (ZnT-2) was isolated from a rat kidney cDNA expression library by complementation of a zinc-sensitive BHK cell line. The protein predicted from the open reading frame of ZnT-2 cDNA has 359 amino acids and initiates with a CTG codon. It resembles ZnT-1 (a plasma membrane protein that stimulates zinc efflux) in overall topology in that it has six membrane-spanning domains, a histidine-rich intracellular loop and a long C-terminal tail; however, the overall amino acid identity is only 26%. Unlike ZnT-1, which is in the plasma membrane and lowers cellular zinc by stimulating zinc efflux, ZnT-2 is localized on vesicles and allows the zinc-sensitive BHK cells to accumulate zinc to levels that are much higher than non-transformed cells can tolerate. Zinc was visualized within these vesicles with zinquin, a zinc-specific fluorescent probe. The intracellular compartment that accumulates zinc is acidic as revealed by staining with acridine orange or LysoTracker. Prolonged exposure of cells expressing ZnT-2 to zinc causes an accretion of intracellular vesicles. We suggest that ZnT-2 protects these cells from zinc toxicity by facilitating zinc transport into an endosomal/lysosomal compartment.

Molecular lesions associated with alleles of decapentaplegic identify residues necessary for TGF-beta/BMP cell signaling in Drosophila melanogaster.

We have identified the molecular lesions associated with six point mutations in the Drosophila TGF-beta homologue decapentaplegic (dpp). The sites of these mutations define residues within both the pro and ligand regions that are essential for dpp function in vivo. While all of these mutations affect residues that are highly conserved among TGF-beta superfamily members, the phenotypic consequences of the different alleles are quite distinct. Through an analysis of these mutant phenotypes, both in cuticle preparations and with molecular probes, we have assessed the functional significance of specific residues that are conserved among the different members of the superfamily. In addition, we have tested for conditional genetic interactions between the different alleles. We show that two of the alleles are temperature sensitive for the embryonic functions of dpp, such that these alleles are not only embryonic viable as homozygotes but also partially complement other dpp hypomorphs at low temperatures. Our results are discussed with regard to in vitro mutagenesis data on other TGF-beta-like molecules, as well as with regard to the regulation of dpp cell signaling in Drosophila.

Community-based strategies for immunizing the "hard-to-reach" child: the New York State immunization and primary health care initiative.

The 1989-1991 measles epidemic in New York City drew attention to the low immunization coverage rates found in urban neighborhoods. This article describes a joint initiative of the New York State Department of Health and the Columbia University School of Public Health to mobilize parents to fully immunize their children. Eleven community-based organizations (CBOs) used a variety of outreach strategies to identify and enroll underimmunized children in primary care. They enrolled 4,555 children, of whom 75% needed at least one basic vaccine dose to be up-to-date for their age. Enrolled children were followed by CBOs to ensure compliance with appointments. After nine months of program operation, 73% of children in an evaluation sample were up-to-date for age for their immunizations. Immunization coverage increases were greatest for the youngest children, for whom coverage rates more than doubled in the first nine months of program operation. Ninety-one percent of these "hard to reach" children were tracked successfully by CBOs. This article compares the strategies used by the community organizations and concludes with suggestions for improvements of future community-based mobilization programs.

Cloning and functional characterization of a mammalian zinc transporter that confers resistance to zinc.

A cDNA encoding a zinc transporter (ZnT-1) was isolated from a rat kidney cDNA expression library by complementation of a mutated, zinc-sensitive BHK cell line. This cDNA was used to isolate the homologous mouse ZnT-1 gene. The proteins predicted for these transporters contain six membrane-spanning domains, a large intracellular loop and a C-terminal tail. ZnT-1 is homologous to zinc and cobalt resistance genes of yeast. Immunocytochemistry with an antibody to a myc epitope added to the C-terminus of ZnT-1 revealed localization to the plasma membrane. Transformation of normal cells with a mutant ZnT-1 lacking the first membrane-spanning domain conferred zinc sensitivity on wild-type cells, suggesting that ZnT-1 functions as a multimer. Deletion of the first two membrane-spanning domains resulted in a non-functional molecule, whereas deletion of the C-terminal tail produced a toxic phenotype. Mutant cells have a slightly higher steady-state level of intracellular zinc and high basal expression of a zinc-dependent reporter gene compared with normal cells. Mutant cells have a lower turnover of 65Zn compared with normal cells or mutant cells transformed with ZnT-1. We propose that ZnT-1 transports zinc out of cells and that its absence accounts for the increased sensitivity of mutant cells to zinc toxicity.

Emigration from the Sahel.

PIP: This report on international migration from the Sahel (the band of countries which lies just south of the Sahara and extends to the Atlantic) opens with a historical overview of the region which includes a description of the response of its people to periodic droughts (including gradual migration to the south), a look at commercial expansion which led to the growth of urban centers, and the destabilizing effects of Atlantic trade and subsequent colonization. The report continues by examining 1) the ethnic and political factors which influenced migration, 2) emigration trends from the region, 3) economic factors, and 4) the effect of the agricultural system on male migration. It is noted that the agricultural sector is unlikely to meet the region's needs for food or cash and that the mining sector can generate cash but not food or sufficient jobs. Industrial growth has been limited, and only the public sector has shown consistent growth. After examining the macro-economic context formed by foreign aid and foreign debt, the current international migration situation is described. The recent phenomenon of female migrants is analyzed as a response to economic crisis. A case study is then presented of emigration from Mali with an emphasis on emigration from the Senegal River Valley which has been plagued by drought. Finally, it is projected that migration trends will continue as long as the propelling economic, environmental, and political crises continue. A need exists for programs to help migrants channel their funds for their return. In addition, collaborative development projects should incorporate the emigration process by 1) strengthening the financial contribution of emigrants, 2) incorporating return migrants, and 3) strengthening the underlying economic insecurity which exacerbates migration.^ieng