Dendritic cell-expanded, islet-specific CD4+ CD25+ CD62L+ regulatory T cells restore normoglycemia in diabetic NOD mice

Most treatments that prevent autoimmune diabetes in nonobese diabetic (NOD) mice require intervention at early pathogenic stages, when insulitis is first developing. We tested whether dendritic cell (DC)-expanded, islet antigen-specific CD4+ CD25+ suppressor T cells could treat diabetes at later stages of disease, when most of the insulin-producing islet β cells had been destroyed by infiltrating lymphocytes. CD4+ CD25+ CD62L+ regulatory T cells (T reg cells) from BDC2.5 T cell receptor transgenic mice were expanded with antigen-pulsed DCs and IL-2, and were then injected into NOD mice. A single dose of as few as 5 × 104 of these islet-specific T reg cells blocked diabetes development in prediabetic 13-wk-old NOD mice. The T reg cells also induced long-lasting reversal of hyperglycemia in 50% of mice in which overt diabetes had developed. Successfully treated diabetic mice had similar responses to glucose challenge compared with nondiabetic NOD mice. The successfully treated mice retained diabetogenic T cells, but also had substantially increased Foxp3+ cells in draining pancreatic lymph nodes. However, these Foxp3+ cells were derived from the recipient mice and not the injected T reg cells, suggesting a role for endogenous T reg cells in maintaining tolerance after treatment. Therefore, inoculation of DC-expanded, antigen-specific suppressor T cells has considerable efficacy in ameliorating ongoing diabetes in NOD mice

Examining the sociocultural, physical, and potical/economic food environments of family child care homes

Background: Nearly 23% of US-based young children aged 2-5 are overweight or obese. Since young children spend a majority of their time in child care where they consume most of the day’s meals, a better understanding of the child care food environment is warranted. Evidence shows that children placed especially in Family Child Care Homes (FCCHs) are at increased risk of becoming overweight and/or obese. Yet, there isn’t much research on examining the obesity promoting attributes of the FCCH environment. There is also limited research on how effective the United States Department of Agriculture’s program entitled the Child and Adult Care Food Program (CACFP) is in meeting its intended goal of ensuring healthy food environments in child care. Purpose: The purpose of this dissertation is to describe and examine the association between the sociocultural, physical and political/economic food environment and quality and frequency of foods offered to 2-5-year-old children in FCCHs. Design and Methods: A cross sectional design was employed. 91 licensed FCCHs (69 CACFP, 22 non-CACFP) were surveyed by phone using a proportionate random sampling technique to reflect the proportion of CACFP FCCHs in Baltimore City. Findings: CACFP participation status of FCCHs was associated with the sociocultural food environment. Additionally, the sociocultural food environment was positively associated with the frequency and quality of foods offered to children. These significant relationships persisted when adjusted for provider level characteristics. CACFP participation status of FCCHs was not associated with the quality and frequency of foods offered. Providers who reported not having had nutrition training within the past year had lower physical food environment mean scores, even when controlling for CACFP participation status. There were no significant associations between the food desert status of a FCCH and the CACFP status of FCCHs as well as the quality and frequency of foods offered. No significant associations were found between the micro physical food environment of the FCCH and the quality and frequency of foods offered to 2-5-year-old children. Conclusions: Non-CACFP FCCH providers should be targeted for enhanced training in fostering a positive mealtime environment and help to enhance what’s available in the FCCH. Advisor: Jerilyn K. Allen, Sc.D., R.N., FAAN Secondary Readers: Maureen M. Black, Ph.D., Deborah Gross, Sc.D., R.N., FAAN, Kelly Bower, Ph.D., MPH, R.N., Lawrence Cheskin, M.D

Examining the Obesogenic Attributes of the Family Child Care Home Environment: A Literature Review

Childhood obesity is a major public health concern in the US. More than a third of young children 2–5 years old are placed in nonrelative child care for the majority of the day, making the child care setting an important venue to spearhead obesity prevention. Much of the obesity research in child care has focused on center-based facilities, with emerging research on Family Child Care Homes (FCCHs)—child care operated in a home setting outside the child’s home. The purpose of this review was to assess the obesogenic attributes of the FCCH environment. A search of the PubMed, Embase, CINHAL, and PsycINFO electronic databases identified 3,281 citations; 35 eligible for full-text review, and 18 articles from 17 studies in the analysis. This review found a lack of comprehensive written nutrition and physical activity policies within FCCHs, lack of FCCH providers trained in nutrition and physical activity best practices, lack of adequate equipment and space for indoor and outdoor playtime activities in FCCHs, inaccurate nutrition-related beliefs and perceptions among FCCH providers, poor nutrition-related communication with families, and poor feeding practices. Future research focusing on interventions aimed at addressing these problem areas can contribute to obesity prevention

Food Desert Status of Family Child Care Homes: Relationship to Young Children’s Food Quality

Family child care homes (FCCHs) are a favored child care choice for parents of young children in the U.S. Most FCCH providers purchase and prepare foods for the children in their care. Although FCCH providers can receive monetary support from the Child and Adult Care Food Program (CACFP), a federal subsidy program, to purchase nutritious foods, little is known about FCCH providers’ access to nutritious foods, especially among FCCH providers serving children from communities that have been historically disinvested and predominantly Black. This study aims to describe the food desert status of FCCHs in Baltimore City, Maryland, and examine the relationship between food desert status and the quality of foods and beverages purchased and provided to children. A proportionate stratified random sample of 91 FCCH providers by CACFP participation status consented. Geographic information system mapping (GIS) was used to determine the food desert status of each participating FCCH. Participants reported on their access to food and beverages through telephone-based surveys. Nearly three-quarters (66/91) of FCCHs were located in a food desert. FCCH providers working and living in a food desert had lower mean sum scores M (SD) for the quality of beverages provided than FCCH providers outside a food desert (2.53 ± 0.81 vs. 2.92 ± 0.70, p = 0.036, respectively). Although the significant difference in scores for beverages provided is small, FCCH providers working in food deserts may need support in providing healthy beverages to the children in their care. More research is needed to understand food purchases among FCCH providers working in neighborhoods situated in food deserts

Heterogeneity in Cardiovascular Disease Risk Factor Prevalence Among White, African American, African Immigrant, and Afro‐Caribbean Adults: Insights From the 2010–2018 National Health Interview Survey

Background In the United States, Black adults have higher rates of cardiovascular disease (CVD) risk factors than White adults. However, it is unclear how CVD risk factors compare between Black ethnic subgroups, including African Americans (AAs), African immigrants (AIs), and Afro‐Caribbeans, and White people. Our objective was to examine trends in CVD risk factors among 3 Black ethnic subgroups and White adults between 2010 and 2018. Methods and Results A comparative analysis of the National Health Interview Survey was conducted among 452 997 participants, examining sociodemographic characteristics and trends in 4 self‐reported CVD risk factors (hypertension, diabetes, overweight/obesity, and smoking). Generalized linear models with Poisson distribution were used to obtain predictive probabilities of the CVD risk factors. The sample included 82 635 Black (89% AAs, 5% AIs, and 6% Afro‐Caribbeans) and 370 362 White adults. AIs were the youngest, most educated, and least insured group. AIs had the lowest age‐ and sex‐adjusted prevalence of all 4 CVD risk factors. AAs had the highest prevalence of hypertension (2018: 41.9%) compared with the other groups. Overweight/obesity and diabetes prevalence increased in AAs and White adults from 2010 to 2018 (P values for trend <0.001). Smoking prevalence was highest among AAs and White adults, but decreased significantly in these groups between 2010 and 2018 (P values for trend <0.001), as compared with AIs and Afro‐Caribbeans. Conclusions We observed significant heterogeneity in CVD risk factors among 3 Black ethnic subgroups compared with White adults. There were disparities (among AAs) and advantages (among AIs and Afro‐Caribbeans) in CVD risk factors, suggesting that race alone does not account for disparities in CVD risk factors

Addressing hypertension among Haitian adults with insufficient access to quality healthcare: A discursive review

AimThe purpose of this article is to summarize research targeting hypertension and healthcare access among adults living in rural Haiti. BackgroundHypertension is a significant public health problem that impacts one in five persons globally. It is the leading cause of cardiovascular-related conditions such as stroke and myocardial infarction and accounts for most global non-communicable disease-related deaths. Limited healthcare access and social determinants of health are known contributors to poor health outcomes among persons with hypertension. Among Haitians, there are stark health disparities between those who live in urban versus rural areas. DesignA discursive review. ResultsSeveral issues are identified as barriers to proper hypertension prevention and management. However, after examining the effective interventions, we found that social determinants of health such as transportation costs, lack of field care facilities close to patients, roadway conditions, political disturbance, and ineffective leadership and policies are major barriers to controlling hypertension in Haiti. Although Haiti has received help from international organizations, strengthening its internal infrastructure is paramount in improving healthcare access. DiscussionThe review concludes that Haitians living in rural parts of Haiti are less likely to receive healthcare to manage non-communicable diseases such as hypertension. Similar to other developing countries, a heightened awareness is needed to address the lack of healthcare access for those living in rural communities. Impact to Nursing PracticeNurses and other healthcare professionals working with populations in Haiti should become aware of the barriers and facilitators that promote sufficient healthcare access. To achieve this goal, nurses must understand the social determinants and other factors that serve as barriers for achieving access to quality care for this vulnerable population. No Patient or Public ContributionThere was no patient or public involvement in the design or drafting of this discursive paper