Diet-related determinants of childhood obesity in urban settings: a comparison between Shanghai and New York.

Over the past three decades, both Shanghai and New York City (NYC), have experienced dramatic rises in childhood obesity rates. Given the role that obesity plays in the aetiology of chronic diseases such as diabetes and heart disease, the elevated rates are a major concern. Despite differences in governance systems and cultures, Shanghai and NYC have experienced rapid industrialization, a growing population and a rise in income inequality. The prevalence of childhood obesity in Shanghai and NYC is greater than their respective national rate. However, the trajectory and development of this epidemic has differed between the cities. The distribution of obesity by race and ethnicity, socio-economic status, sex, and age differs markedly between the two cities. To reduce prevalence and inequities within this complex epidemic requires an understanding of the dynamic changes in living conditions among social groups in each city and the behaviours that are influenced by such changes. By comparing changes in the influences on dietary behaviours, such as food distribution, pricing, gender values, and media and marketing, this highlights opportunities for Shanghai, NYC, and other world cities with high or rising rates of childhood obesity to inform future program and policy initiatives. It reiterates the importance of a comprehensive and multilevel approach that includes action at the individual, family, community, municipal, national, and global levels.

Getting food policy on the Mayoral table: a comparison of two election cycles in New York and London.

Cities and Mayors are increasingly being recognized as important in shaping social policy and improving social well-being. And municipal food policies are increasingly important as a tool to reduce food insecurity and prevent diet-related chronic diseases. Thus city governments have a unique ability to improve local food environments. To realize this potential for improving urban food environments, nutrition advocates will need to find innovative approaches for influencing municipal food policy. This paper examines Mayoral elections as a vehicle to advance food policy. To explore this strategy, Mayoral elections in two cities, New York City (NYC) and London, during two recent cycles were compared. To gather evidence multiple sources were used including campaign documents, media and opinion polls as well as the authors' own observations as food policy observers and participants in the two cities. Mayoral governance differs between NYC and London, with the Mayor in NYC having greater powers of management and administration, whilst the London Mayor has a more strategic role and may need to also use 'influence'. Food policy and related issues did not feature strongly in the first election cycles in either city. However by the 2012 and 2013 elections food issues were definitely 'on the table' and featured in main candidates' campaign literature. These latter elections also saw the importance of food advocates coming together to form common alliances and place food issues higher on the municipal agenda. In this way, food policy has become part of the election dialogue in both cities and candidates are expected to consider food policy issues. This analysis leads to make observations which could guide advocates as to how to use Mayoral elections to raise policy objectives for the benefit of public health.

Institutional food as a lever for improving health in cities: the case of New York City.

OBJECTIVES: To describe and examine the factors that most facilitate and impede the provision of healthy foods in a complex institutional food system. STUDY DESIGN: Comparative case study of three institutional food settings in New York City. METHODS: Document review and interviews with relevant city government staff. RESULTS: Factors that facilitate and impede the provision of healthy food vary across institutional food settings, and particularly between centralized and decentralized settings. Generally pro-health factors include centralized purchasing and the ability to work with vendors to formulate items to improve nutritional quality, though decentralized purchasing may offer more flexibility to work with vendors offering healthier food items and to respond to consumer preferences. Factors most often working against health in more centralized systems include financing constraints that are unique to particular settings. In less centralized systems, factors working against health may include both financing constraints and factors that are site-specific, relating to preparation and equipment. CONCLUSIONS: Making changes to institutional food systems that will meaningfully influence public health requires a detailed understanding of the diverse systems supporting and shaping public food provision. Ultimately, the cases in this study demonstrate that agency staff typically would like to provide healthier foods, but often feel limited by the competing objectives of affordability and consumer preference. Their ability to address these competing objectives is shaped by a combination of both forces external to the institution, like nutritional regulations, and internal forces, like an agency's structure, and motivation on the part of staff.

The role of urban food policy in preventing diet-related non-communicable diseases in Cape Town and New York.

OBJECTIVES: Cities are important settings for production and prevention of non-communicable diseases. This article proposes a conceptual framework for identification of opportunities to prevent diet-related non-communicable diseases in cities. It compares two cities, Cape Town in South Africa and New York City in the United States, to illustrate municipal, regional, national and global influences in three policy domains that influence NCDs: product formulation, shaping retail environments and institutional food practices, domains in which each city has taken action. STUDY DESIGN: Comparative case study. METHODS: Critical analysis of selected published studies and government and non-governmental reports on food policies and systems in Cape Town and New York City. RESULTS: While Cape Town and New York City differ in governance, history and culture, both have food systems that make unhealthy food more available in low-income than higher income neighborhoods; cope with food environments in which unhealthy food is increasingly ubiquitous; and have political economies dominated by business and financial sectors. New York City has more authority and resources to take on local influences on food environments but neither city has made progress in addressing deeper social determinants of diet-related NCDs including income inequality, child poverty and the disproportionate political influence of wealthy elites. CONCLUSIONS: Through their intimate connections with the daily lives of their residents, municipal governments have the potential to shape environments that promote health. Identifying the specific opportunities to prevent diet-related NCDs in a particular city requires intersectoral and multilevel analyses of the full range of influences on food environments.

[Pseudo-mesotheliomatous adenocarcinoma of the lung]. / Pseudomesotheliomatöses Adenokarzinom der Lunge.

Both pathologists and clinicians are challenged by the diagnosis of a particular variant of the peripheral adenocarcinoma with involvement of the pleura parietalis, the so-called pseudo-mesotheliomatous adenocarcinoma of the lung (PMAC), which is hard to differentiate from epithelioid mesothelioma on imaging and cytology, macroscopically as well as histologically. However, the exact diagnosis is not only crucial for the patient's therapy but also for insurance matters. Immunohistochemical evaluation represents a quick and a relatively cheap tool for which a few antibody panels have been proposed in recent years as being suitable to distinguish between these two entities. One of the positive markers for epithelioid mesothelioma most often suggested seems to be calretinin. We would like to report on a case of PMAC with the special feature of positive calretinin immunohistochemical staining. Using histochemistry and a few additional antibodies we were able to reliably characterize the tumor and provide the patient with appropriate therapy. This article gives a short overview of the possibilities available for distinguishing between these two entities in the context of a case report.

Infection of C57BL/10ScCr and C57BL/10ScNCr mice with Leishmania major reveals a role for Toll-like receptor 4 in the control of parasite replication.

The innate immune system is essential for host defense; it senses the presence of potentially pathogenic-invading microorganisms, and the contribution of Toll-like receptors (TLRs) to this response is increasingly recognized. In the present study, we investigated the contribution of TLR4 to the course of cutaneous leishmaniasis in vivo. We used C57BL/10ScNCr (TLR4(0/0)) and C57BL/10ScCr [TLR4/interleukin-12 (IL-12)Rbeta2(0/0)] mice and compared the course of Leishmania major infection, parasite load, cell recruitment, and cytokine profile with those of wild-type C57BL/10ScSn mice. Our results confirm the importance of IL-12 receptor-mediated signaling in resistance to L. major infections. Importantly, we show that the lack of TLR4 results in an increased permissiveness for parasite growth during the innate and adaptive phase of the immune response and in delayed healing of the cutaneous lesions. The use of the tlr4 transgenic mouse strain TCr5 demonstrated unequivocally that TLR4 contributes to the efficient control of Leishmania growth in vivo.

Needle exchange programs and experience of violence in an inner city neighborhood.

OBJECTIVE: To assess the association between proximity to a needle exchange program (NEP) and experience of violence in an inner city neighborhood. METHODS: A cross-sectional survey of residents of Harlem, New York City provided data for this study. We used geocoding to obtain the distance between respondents and the nearest NEP. Respondents reported violence they were aware of or had personally experienced in their neighborhood. Multiple logistic regression analyses assessed the relation between violence and distance from the nearest NEP. RESULTS: Among 220 respondents, 50.1% were African American, 39.0% were Latino, 44.7% were male, and the mean age was 44.5 years. In separate age-, race-, sex-, and income-adjusted logistic regression models, there was no significant association between (1) reporting a fight and distance from the nearest NEP (odds ratio [OR] = 1.05, p =.89); (2) robbery in the neighborhood in the previous 6 months and distance from the nearest NEP (OR = 1.13, p =.71); (3) ever having experienced violence and distance from the nearest NEP (OR = 0.72, p =.52); or (4) ever having been robbed by drug users and distance from the nearest NEP (OR = 1.05, p =.91). CONCLUSIONS: There was no consistent association between living close to NEPs and violence reported by residents of Harlem in this study. This study suggests that NEPs do not adversely affect rates of violence in their vicinity.

Case history of the Center for Urban Epidemiologic Studies in New York City.

This case history describes the history of the Center for Urban Epidemiological Studies (CUES), an urban research center based in New York City. Between 1996 and 1999, CUES was transformed from an institution that worked with the medical schools of the region to a center seeking to define a new practice of community-based participatory research (CBPR). The report summarizes how and why CUES has changed, identifies its main accomplishments and challenges, and discusses some of the lessons learned to date. It illustrates how the principles of CBPR have influenced the development of CUES. The case history suggests that it is possible for an organization to transform itself from a researcher-driven orientation toward a more participatory model. The early history also demonstrates that it is possible to engage community organizations and activists in an ongoing effort to study and address complex urban health problems such as asthma, substance abuse, and infectious diseases. Finally, the report illustrates that CBPR is a process that evolves in response to specific situational factors.

Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health.

This review examined the interactions between the correctional system and the health of urban populations. Cities have more poor people, more people of color, and higher crime rates than suburban and rural areas; thus, urban populations are overrepresented in the nation's jails and prisons. As a result, US incarceration policies and programs have a disproportionate impact on urban communities, especially black and Latino ones. Health conditions that are overrepresented in incarcerated populations include substance abuse, human immunodeficiency virus (HIV) and other infectious diseases, perpetration and victimization by violence, mental illness, chronic disease, and reproductive health problems. Correctional systems have direct and indirect effects on health. Indirectly, they influence family structure, economic opportunities, political participation, and normative community values on sex, drugs, and violence. Current correctional policies also divert resources from other social needs. Correctional systems can have a direct effect on the health of urban populations by offering health care and health promotion in jails and prisons, by linking inmates to community services after release, and by assisting in the process of community reintegration. Specific recommendations for action and research to reduce the adverse health and social consequences of current incarceration policies are offered.

Reintegrating women leaving jail into urban communities: a description of a model program.

Women are the fastest-growing population in the criminal justice system, and jails reach more people than any other component of the correctional system. About 1 million women pass through US jails each year. Most return to their communities within a few weeks of arrest, and few receive help for the substance abuse, health, psychological or social problems that contribute to incarceration. We describe a model program, Health Link, designed to assist drug-using jailed women in New York City to return to their communities, reduce drug use and HIV risk behavior, and avoid rearrest. The program operates on four levels: direct services, including case management for individual women in the jail and for 1 year after release; technical assistance, training, and financial support for community service providers that serve ex-offenders; staff support for a network of local service providers that coordinate services and advocate for resources; and policy analysis and advocacy to identify and reduce barriers to successful community reintegration of women released from jail. We describe the characteristics of 386 women enrolled in Health Link in 1997 and 1998; define the elements of this intervention; and assess the lessons we have learned from 10 years of experience working with jailed women.

Developing comprehensive approaches to prevention and control of obesity among low-income, urban, African-American women.

Obesity presents a major threat to the health and well-being of low-income, urban, African-American women. African-American women have among the highest rates of obesity in the United States and suffer from a corresponding excess burden of obesity-related diseases. Distinct physiological, societal, cultural, and environmental factors form a mosaic of forces that promote weight gain and prevent weight loss in these women. To develop specific strategies to improve their health, researchers need to better understand the unique nutritional problems facing low-income African-American women residing in inner cities. Individual and community interventions to promote weight reduction have been insufficient to reverse the epidemic. A problem of this magnitude requires concerted and comprehensive policy interventions. This paper uses an ecological approach to suggest multilevel public health strategies to reduce obesity among urban African-American women.

Antitumoral effect of recombinant mistletoe lectin on chemically induced urinary bladder carcinogenesis in a rat model.

BACKGROUND: The objective of this study was to determine the effect of intravesically applied, recombinant, galactoside specific mistletoe lectin (rML) on chemically induced tumor development in the urinary bladder of rats. METHODS: For tumor induction, rats were treated with four biweekly 1.5 mg doses of N-methyl-N-nitrosourea (NMU) intravesically (Weeks 0, 2, 4, and 6). The control group (n = 39 + 17 rats) received no other treatment. The four therapy groups also received rML twice weekly according to one of the following instillation regimens: 1) 30 ng rML per instillation from Week 8 to Week 13 (Group a: n = 14 rats), 2) 150 ng rML per instillation from Week 8 to Week 13 (Group b: n = 23 + 15 rats), 3) 30 ng rML per instillation from Week 14 to Week 19 (Group c: n = 22 rats), and 4) 150 ng rML per instillation from Week 14 to Week 19 (Group d: n = 19 rats). After the rats were asphyxiated at Week 21, the urinary bladders were excised in toto and examined histopathologically. To study the immunomodulatory effects of intravesically applied rML, 17 animals from the control group and 15 animals from Group b were asphyxiated at Week 13, and urinary bladder tissue was analyzed by semiquantitative reverse transcriptase-polymerase chain reaction analysis for mRNA expression of interferon-gamma, interleukin-10, and Fas ligand. RESULTS: By Week 21, atypical hyperplasia and neoplastic transformation were found in 82% of the animals in the control group. In contrast, in all four cohorts that were treated with rML, significantly lower rates of atypical hyperplasia and neoplastic transformation were found (Group a, 50%; Group b, 52%; Group c, 45%; and Group d, 42%). By Week 13, in the bladder tissue of 15 rML-treated animals from Group b, lower expression of interleukin-10 mRNA was measured, whereas the expression levels of interferon-gamma mRNA and Fas ligand mRNA were comparable to those of 17 animals from the control group. CONCLUSIONS: The current data provide evidence for an inhibitory effect of rML on experimental urothelial carcinogenesis that does not seem to be due to interferon-gamma and/or interleukin-10 dependent mechanisms.

Collaboration among community members, local health service providers, and researchers in an urban research center in Harlem, New York.

The Urban Research Center at the Center for Urban Epidemiologic Studies brings together community members and researchers working in Harlem, New York. A Community Advisory Board (CAB) composed of community members, service providers, public health professionals, and researchers was formed to assist the Center's research and interventions and to guide community partnerships. Through a collaborative process, the CAB identified three public health problems-substance use, infectious diseases, and asthma-as action priorities. To deal with substance use, the Center created a Web-based resource guide for service providers and a "survival guide" for substance users, designed to improve access to community services. To deal with infectious diseases, the Center is collaborating with local community-based organizations on an intervention that trains injection drug users to serve as peer mentors to motivate behavior change among other injection drug users. To deal with asthma, the Center is collaborating with community child care providers on an educational intervention to increase asthma awareness among day care teaching staff, enhance communication between staff and families, and improve the self-management skills of children with asthma. The Center's experience has demonstrated that active communities and responsive researchers can establish partnerships that improve community health.

Coxsackievirus B3 infection induces anti-flavoprotein antibodies in mice.

Enteroviruses, the most common cause of acute myocarditis, are also supposed aetiological agents of dilated cardiomyopathy. Autoantibodies (anti-M7; Klein & Berg, Clin Exp Immunol 1990; 58:283-92) directed against flavoproteins with covalently bound flavin (alphaFp-Ab; Otto et al., Clin Exp Immunol 1998; 111:541-2) are detected in up to 30% of sera of patients with myocarditis and idiopathic dilated cardiomyopathy (IDCM). Mice inoculated with a myocarditic variant of coxsackievirus B3 (CVB3) were employed to study the occurrence of serum alphaFp-Ab following viral infection. The presence of alphaFp-Ab was analysed by Western blotting with the flavoprotein antigens 6-hydroxy-D-nicotine oxidase (6HDNO) and sarcosine oxidase (SaO). Of 10 sera from CVB3-infected mice, five showed a strong reaction with both antigens. The sera were reactive also to the mitochondrial covalently flavinylated proteins dimethylglycine dehydrogenase and sarcosine dehydrogenase. Sera of non-infected mice did not react with these antigens. A 6HDNO mutant protein with non-covalently bound FAD no longer reacted on Western blots with sera of CVB3-infected mice. Preincubation with FAD abolished or reduced the reaction of the sera with the 6HDNO antigen. At 2 weeks p.i. the alphaFp-Ab were of the IgM and IgG isotypes, at 7 and 9 weeks p.i. of the IgG isotype. The sera of CVB3-infected mice reproduced closely the antigenic specificity of the anti-M7 sera of patients, lending further support to the role of coxsackieviruses in the pathogenesis of IDCM.

Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, 1980-1995.

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

Health promotion in the city: a review of current practice and future prospects in the United States.

To achieve its health goals, the United States must reduce the disproportionate burden of illness and poor health borne by urban populations. In the 20th century, patterns of immigration and migration, changes in the global economy, increases in income inequality, and more federal support for suburbanization have made it increasingly difficult for cities to protect the health of all residents. In the last 25 years, epidemics of human immunodeficiency virus infections and substance abuse and increases in homelessness, lack of health insurance, rates of violence, and concentrations of certain pollutants have also damaged the health of urban residents. Several common strategies for health promotion are described, and their relevance to the unique characteristics of urban populations is assessed. To identify ways to strengthen health promotion practices in U.S. cities, lessons have been taken from five related fields of endeavor: human rights, church- and faith-based social action, community economic development, youth development, and the new social movements. By integrating lessons from these areas into their practice, public health professionals can help to revitalize the historic mission of public health, contribute to creating healthier cities, and better achieve national health objectives.