Redlining and Lead Poisoning: Causes and Consequences.

In 1934, the Federal Housing Authority precluded mortgage loans to residents of neighborhoods with non-White families or where housing was deteriorated; these were declared "hazardous" and labeled red on maps. In 1962 three redlined north Brooklyn neighborhoods had 41 children, all Black and Puerto Rican, with lead levels >60ug/dL. A review of public polices in the U.S. from 1898 to the present revealed that lead poisoning followed an income gradient with multiple disproportionate effects on non-White children in redlined neighborhoods. The poisonings diminished when federal and local regulations prevented lead exposure. While redlining had profound influences on both likelihood and severity of lead poisoning and its consequences, it was a mediator of effects. The principal causes were federal policies failing to prevent environmental contamination and local governments failing to prevent exposure.

The Death of Burghardt Du Bois, 1899; Implications for Today.

ACKNOWLEDGEMENTS: Laura Dattner, John Krai and Linda Oppenheim provided assistance in obtaining archival material and manuscript review. Edwin Rosenthal's decedents, Robert, Eleanore Jane and Edwin Rosenthal II, provided information about their distinguished grandfather's life and commitments. Linda Oppenheim, Michael Angelo, Jessica Lydon, and Sofie Serada, archivists at Princeton University, Thomas Jefferson University, Temple University, and the College of Physicians of Philadelphia provided access to material on Edwin Rosenthal and medical care in Philadelphia at the turn of the 20th century. We thanks Laura Dattner, John Krai and Linda Oppenheim for their manuscript review. BACKGROUND: The Souls of Black Folks, W. E. B. Du Bois' compelling narrative from 1903, includes a description of the death of his only son, Burghardt. His death was caused by diphtheria and occurred in Atlanta, GA in the year 1899. Mortality from diphtheria had fallen precipitously in the mid-1890s, but neither city of Atlanta nor Philadelphia, from which the family had recently moved, had made the diphtheria antitoxin available for general use. OBJECTIVES: To identify factors affecting availability diphtheria treatment in the two cities the Du Bois family lived in and to address implications for immunization policies today. METHODS: We reviewed data and observations from medical texts and articles from the turn of the 20th century, health department records, archives of newspapers and Du Bois' writings. RESULTS: Mortality from diphtheria dropped precipitously at the end of the 19th century with the introduction of laryngecostomy and a diphtheria antitoxin. However these measures required action by health departments and was dependent on the availability of physicians and medical facilities. Lack of Public Health Departments put all southerners at risk for infectious illnesses. With respect to diphtheria, there was neither an available supply of antitoxin nor physician care available. Philadelphia may have been too mired in corruption to provide antitoxin. Burghardt lived in close proximity to a facility where antitoxin was available, data suggests he would have received appropriate treatment there and was likely to have survived. Similar phenomena-disinterest and dysfunction-affect provision of immunization for children today. Currently, availability of immunization is affected by ethnicity, income levels and immigration status.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study.

INTRODUCTION: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. OBJECTIVES: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. METHODS: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. RESULTS: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. CONCLUSION: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

Relation of growth rate from birth to three months and four to six months to body mass index at ages four to six years.

Background. While rapid early weight gain are common in children who become obese later in life, so is growth faltering in the first 3 months of life. Objective. We seek to determine what relationship weight gain in the first six months of age, separated into two 3-month periods, have with the BMI of children ages 4 to 6 years in an inner-city community. Subjects. A convenience sample cohort of 154 children attending an inner-city clinic. Methods. Consecutive charts were reviewed retrospectively. Age, gender, birth weight and weight change in the first and second 3 months of life were introduced as fixed factors using mixed linear models with BMI in years 4 to 6 as the dependent variable. Results. Weight change quartile in the first 3 months of life did not predict of BMI in years 4 to 6; however, weight changes quartiles during months 4 to 6 were significant predictors for subsequent overweight. Conclusion. The data presented herein suggest that, for this specific population, weight gain can be promoted when it is most essential. It is necessary, however, to identify intermediary variables that could affect outcomes in this and other communities.

Diet and social disadvantage: the 'Medical Home' improves nutrition in childhood and diminishes likelihood of disease in adult life.

It is well appreciated that malnutrition in early life has an adverse impact on the overall health of adults. In this review, we address the impact of malnutrition, social disadvantages, and poverty on the lives of children. An integrated response to these difficulties associated in the lives of children, families and the communities in which they live - the "Medical Home" - is suggested as a means to promote health for all ages. The four types of malnutrition delineated by the World Health Organization are discussed, as are differences between "socioeconomic status" and "social gradient." The latter construct is more meaningful from a health care standpoint as differences within each of the socioeconomic groupings are greater than differences between them. Poverty affects food choices with a profound impact on nutritional status. This review suggests how providing a "Medical Home" can improve dietary habits, improve overall nutrition and prevent disease.

Outreach to immigrant communities: teaching pediatric residents about access to health care.

Twenty-seven pediatric residents were assessed for knowledge, attitudes, and behaviors regarding rights of immigrant families. A program documenting immigrant rights was reinforced in the clinic with posters and individual consultations on immigrant children's needs. This brief program was effective in instructing residents on health and nutritional services for immigrant patients.

Mauriac syndrome in a 3-year-old boy.

OBJECTIVE: To report a case of Mauriac syndrome in a young child with poorly controlled type 1 diabetes mellitus. METHODS: We describe the typical features of Mauriac syndrome and review the clinical, laboratory, and ultrasound findings and follow-up results in our current patient. RESULTS: Hepatomegaly, growth impairment, and cushingoid features characterize Mauriac syndrome. Most frequently, it is seen in adolescents and young adults with a history of poor glycemic control. In our current patient, a 3-year-old boy with type 1 diabetes mellitus of 2 years' duration, Mauriac syndrome developed in the context of a disrupted social environment. His liver enzyme derangement, hepatomegaly, and growth improved once euglycemia was achieved. CONCLUSION: Although Mauriac syndrome is currently uncommon, close monitoring of children with type 1 diabetes is important to maintain optimal glycemic control and prevent such an occurrence.

The appearance of discretionary income: influence on the prevalence of under- and over-nutrition.

Undernutrition--protein energy malnutrition or specific nutrient deficiencies--has been an inherent characteristic of impoverished populations throughout the world. Over-nutrition, obesity and nutrition imbalance is a current concern among those with rising though still insufficient incomes. We review data to suggest that the prevalence of these forms of malnutrition in populations is highly influenced by the rate of appearance of discretionary income. In developed countries, discretionary (alternatively "disposable") income refers to funds available after obligate payments (rent, heat, and the cost of getting to work) and payment for necessities (food and clothing). For families living at or below poverty, the last dollar earned is spent on these obligations. Undernutrition is common. By contrast, likelihood for obesity or imbalance increases with rising income when that last dollar is earned without certainty that it is available for discretionary spending. In the United States, neither under- nor over-nutrition is likely when new income is free and clear of debt or obligation. This occurs at approximately three times the poverty level. While income poverty and food insecurity affect risk for malnutrition rather than outcome, nutrition education programs that address issues of income and food support increase likelihood for adherence to recommendations.