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The Reggio Emilia approach is identified as a resource and inspiration in the field of early childhood education. The term 'Reggio Inspired' refers to all Reggio Emilia approach-based practices outside of Reggio Emilia, Italy. This paper presents a comprehensive study of Reggio Inspired empirical research. Results from an integrative review of the literature (51 unique studies) reveal the lack of outcome research to support the efficacy of the implementation of Reggio Inspired practices and the varied nature of this body of literature. After providing a survey of the literature on Reggio Inspired approaches from around the world, we propose an integrative framework that offers both a structure for future research and a tool for synthesizing literature rooted in the transplantation of Reggio Emilia approach to other contexts, the Reggio Inspired Research Re-framework.

The last two decades have seen institutions of higher education put increasing emphasis on both internationalizing their institutions and making them more sustainable. While laudable in their own right, there are contradictions and tensions between these goals, in particular when the carbon emissions involved in international activities like study abroad are considered. But there is also potential synergy between these goals. In this article, the authors explore two case studies of programs abroad that seriously engaged both the contradictions and opportunities inherent in the idea of sustainable international education. The first examines environmental politics and ecology in New Zealand and the Cook Islands and the second compares sustainable urban practices in Canada and the United States. Based on the lessons learned from these case studies, the authors argue that partnership between internationalization and sustainability efforts is necessary to help institutions of higher learning become both global and "green." To that effect, the authors discuss specific and concrete ways to "green" study abroad courses throughout this article, particularly within the two case studies and in their concluding discussion of strategies for international educators, faculty, and higher education administrators. (Contains 2 notes.)

Background: The World Health Organization recommends all countries consider screening for H. pylori to prevent gastric cancer. We therefore aimed to estimate the cost-effectiveness of a H. pylori serology-based screening program in New Zealand, a country that includes population groups with relatively high gastric cancer rates.Methods: A Markov model was developed using life-tables and morbidity data from a national burden of disease study. The modelled screening program reduced the incidence of non-cardia gastric cancer attributable to H. pylori, if infection was identified by serology screening, and for the population expected to be reached by the screening program. A health system perspective was taken and detailed individual-level costing data was used.Results: For adults aged 25-69 years old, nation-wide screening for H. pylori was found to have an incremental cost of US$196 million (95% uncertainty interval [95% UI]: $182-$211 million) with health gains of 14,200 QALYs (95% UI: 5,100-26,300). Cost per QALY gained was US$16,500 ($7,600-$38,400) in the total population and 17% (6%-29%) of future gastric cancer cases could be averted with lifetime follow-up. A targeted screening program for Māori only (indigenous population), was more cost-effective at US$8,000 ($3,800-$18,500) per QALY.Conclusions: This modeling study found that H. pylori screening was likely to be cost-effective in this high-income country, particularly for the indigenous population. While further research is needed to help clarify the precise benefits, costs and adverse effects of such screening programs, there seems a reasonable case for policy-makers to give pilot programs consideration, particularly for any population groups with relatively elevated rates of gastric cancer. [ABSTRACT FROM AUTHOR]

Background Current evidence suggests that fetal movements are an important indicator of fetal well-being. About a quarter of women who present with decreased fetal movements have adverse perinatal outcomes such as intrauterine growth restriction and stillbirth. There are no New Zealand studies reporting maternal knowledge about fetal movements in late pregnancy. Aims To determine what information women in the third trimester of pregnancy receive about fetal movements, both from their maternity caregivers and from other sources. Methods A convenience sample of 100 women attending two antenatal clinics in Auckland in November and December 2011 were interviewed by a medical student. Results Ninety-seven per cent of women reported that their lead maternity carer ( LMC) regularly asked about fetal movements, and 62% recalled receiving information from their LMC about what to expect regarding fetal movements in the last three months of pregnancy. Thirty-three per cent recalled receiving information from their LMC that their baby's movements should increase or stay the same and 20% that their baby's movements may decrease in late pregnancy. Forty per cent were advised to contact their LMC if they had any concerns about their baby's movements, and one-quarter were informed to seek advice if they had fewer than 10 movements in a day. Conclusions Our study suggests a proportion of pregnant women in Auckland do not have optimum information about fetal movements. Strategies to enhance maternal knowledge such as a pamphlet about fetal movements may be helpful. [ABSTRACT FROM AUTHOR]

In New Zealand, there is a need for a comprehensive and accessible database with national occupational exposure information, such as a general population job-exposure matrix (GPJEM). However, few New Zealand-specific exposure data exist that could be used to construct such a GPJEM. Here, we present the methods used to develop a GPJEM for New Zealand (NZJEM), by combining GPJEMs from other countries with New Zealand-specific exposure information, using wood dust as an example to illustrate this process. The assessments of GPJEMs from other countries were made available to a New Zealand expert in occupational wood dust exposure, who then provided a preliminary NZJEM assessment (including the percentage exposed and the level of exposure for each occupation). Where possible, this assessment was based on New Zealand exposure measurements. In the next step, information from a nationwide workplace exposure survey of 3000 members of the New Zealand workforce was used to finalize the NZJEM assessments. The final NZJEM listed 104 of the 956 New Zealand occupational codes as exposed to wood dust. The percentage of workers exposed within an occupation ranged from 5% (e.g. boiler attendants) to 100% (e.g. cabinet makers). The level of exposure ranged from 0.05 mg m−3 (e.g. electricians) to 3 mg m−3 (e.g. carpenters). Of these assessments, 23% were mainly based on New Zealand exposure data, 37% on overseas GPJEMs and exposure data, and for 40% the national survey data served as the main source of information for the expert assessment. Combining the NZJEM assessments with national employment statistics indicated that 5.6% of the New Zealand workforce is occupationally exposed to wood dust, corresponding to a total of 97 000 workers (86% male and 14% female). Construction-related occupations included the largest number of exposed workers. [ABSTRACT FROM PUBLISHER]

As a consequence of the global trend towards new managerialism the New Zealand government undertook reforms of the health-care system during the 1980s and 1990s. These reforms, to a system that had functioned essentially unchanged since the 1930s, improved fiscal accountability at the expense of ensuring continuity of care. The restructuring particularly affected vulnerable populations with permanent disability and long-term health needs. This study sought to address the service deficits of the current health service delivery system and to identify strategies to ensure continuity of care for this group. The development of a clinical pathway and the appointment of a clinical care coordinator to oversee the delivery of comprehensive seamless health-care services were the major recommendations resulting from this study. [ABSTRACT FROM AUTHOR]

Abstract: A 14-meter long pelagic clay core recovered at Marlin Rise (40°00.531′S, 154°2.601′W; 4775 m water depth) in the Southwest Pacific Basin contains a record of eolian dust deposited since the early Miocene. Downcore analysis of detrital minerals reveals a dominantly eolian signature with relatively constant proportions of quartz, feldspar and illite and trace amounts of chlorite, kaolinite and smectite, consistent with a continental (loess-like) source region. Fish tooth Sr isotope stratigraphy reveals the base of the core to be 17.5 Ma, with low sedimentation rates (<0.5 mm/kyr LSR) indicated for the interval 17.5 to 10 Ma; several hiatuses in deposition appear to be present upcore, but are beyond the age resolution of the fish teeth stratigraphy. These intervals are revealed as apparent discontinuities in the Sr isotope record, accompanied by pulses of anomalously rapid sedimentation at ~10 Ma, 6.7 Ma and 4.1 Ma. Bulk mass accumulation rates (MAR) are calculated at ~10 mg/cm2/kyr over the last 4 Myr, consistent with previously estimated Quaternary eolian flux rates to this part of the Pacific. Nd, Pb and Sr radiogenic isotopic compositions of the detrital mineral extract (<38 µm) show no trends with age, while 40Ar/39Ar ages show an upcore younging trend (~180 Ma to ~150 Ma), in concert with a slight coarsening of eolian grain-size distributions. These ages likely reflect mixing of Mesozoic illite-dominated clay from at least two continental source areas: southeastern Australia (Murray–Darling Basin/Lake Eyre Basin) and New Zealand (South Island). The data indicate remarkable constancy of continental eolian sources exposed to weathering and dispersal at this latitude during the Neogene. [Copyright &y& Elsevier]

Fat mass was recently shown to be a positive determinant of bone mass and size independently of lean mass in a birth cohort of British 9-year-olds. The present study was undertaken to investigate whether similar relationships are evident in younger, preschool children. Height and weight were measured, and a total-body dual-energy X-ray absorptiometric scan was performed on 194 preschool New Zealand children (81 girls, 113 boys) participating in the Dunedin birth cohort Family, Lifestyle, Activity, Movement, and Eating (FLAME) study close to their fifth birthday. Relationships of total-body fat mass and lean mass to total-body-less-head (TBLH) bone area and TBLH bone mineral content (BMC) were evaluated using linear regression. Girls had higher mean fat mass (3.9 vs. 3.2 kg) and lower lean mass (14.5 vs. 15.2 kg) than boys ( P < 0.001), but their heights, weights, and TBLH bone area were similar. Although a given weight of lean tissue was associated with greater increases in TBLH area than a given weight of fat tissue, our results show that fat mass was an independent predictor of TBLH bone area ( R 2 = 0.79, P < 0.001) and TBLH BMC ( R 2 = 0.74, P < 0.001) in data adjusted for socioeconomic status, ethnic group, lean mass, and height. We conclude that increased fat mass is associated with outward expansion of the TBLH skeletal envelope (wider bones) independently of height and lean mass in very young children. [ABSTRACT FROM AUTHOR]

Waitkera waitakerensis occupies lowland forests of New Zealand's North Island, where temperatures decrease in a southwestward direction. The mean annual temperatures of 18 collecting sites, as extracted from GIS data, are directly related to the first femur length of adult females. Neither site elevation nor phylogeny affected spider size or other variables examined. The direct relationship between spider body size and environmental temperature followed a pattern observed in other terrestrial arthropods with a univoltine life cycle and can probably be explained by the longer growing season of warmer regions. Egg diameter was uniform across the species. Site temperature and female first femur length were each directly related to the number of eggs deposited in egg sacs. The date of egg sac collection was inversely related to egg number, suggesting that clutch size declines during the reproductive season. Females deposit eggs beneath a triangular platform and then cover them with a lower silk sheet. The area of this upper platform and the volume of the egg sac were each directly related to egg number, but not to female first femur length. The depth of the lower covering was not related to egg number or to spider first femur length. This suggests that spiders use information about the volume of eggs in their abdomens to construct an egg sac whose volume will accommodate the volume of eggs to be laid and that females do so principally by adjusting the size of the sac's upper triangular platform. [ABSTRACT FROM AUTHOR]

The article discusses a study on parental perceptions of elevated adiposity in children based on dual energy x-ray absorptiometry (DXA) measurements conducted in New Zealand. The weight, height, body mass index (BMI) and waist girths of the children were recorded. It found that parents underestimated the weight status of their children. BMI values at or above 85th percentile indicates high body fat.

Pacific children living in New Zealand (NZ) are prone to excessive weight gain. In this study, we assessed the anthropometric status of 2- to 5-y-old Pacific children (n = 60) in relation to their macronutrient intakes. Measurements of height (n = 56), weight (n = 60), midarm circumference, and triceps skinfold thickness (n = 58), and 2-d weighed food records (n = 60) and demographic data were collected. Z-score results (mean +/- SD) showed that these children were tall (0.61 +/- 1.1) and heavy (1.67 +/- 1.1) for their age, and had high arm-muscle-area-for-height (geometric mean, 2.05). Over 64 and 45% of children were classified as overweight (including obesity) and obese, respectively. The percentage of energy contributed by fat in their diets met recommendations. In contrast, the percentage of energy contributed by sugar was high. The macronutrient intakes of children classified as obese (n = 32) compared with non-obese (n = 24) did not differ; however, their adjusted energy intakes were higher [5.79 (1.4) vs. 4.97 (1.4) MJ/d; P = 0.01]. Overweight and obesity were very common among very young NZ Pacific children, although the dietary etiology was not elucidated. These results emphasize the urgent need for obesity prevention for NZ Pacific children that begins early in life to avoid a future public health crisis. [ABSTRACT FROM AUTHOR]

This cross-sectional, community-based survey was designed to assess attained growth and body composition of 3- to 7-y-old Pacific children (n = 21 boys and 20 girls) living in Dunedin, New Zealand, and to examine nondietary factors associated with the percentage of body fat. Fat mass, lean tissue mass and the percentage of body fat were measured using dual energy X-ray absorptiometry. One trained anthropometrist also measured height, weight, skinfolds (triceps, subscapular) and circumferences (mid-upper arm, chest, waist, calf). Compared with the National Center for Health Statistics and National Health and Examination Surveys I and II reference data, these Pacific children were tall and heavy for their age with high arm-muscle-area-for-height. Median (quartiles) Z-scores for height and BMI-for-age and arm-muscle-area-for-height were 1.33 (0.60, 2.15), 1.20 (0.74, 4.43) and 1.09 (0.63, 1.85), respectively. Their median (quartile) percentage of body fat was 21.8% (15.0, 35.5) of which 38.5% was located in the trunk. The estimated percentage of children classified as obese ranged from 34 to 49% depending on the criterion used. Over 60% of the children had levels of trunk fat above 1 SD of reported age- and sex-specific Z-scores for New Zealand children. The nondietary factors examined (hours of television viewing and hours playing organized sports, as reported by parents) were not associated with variations in the percentage of body fat, after adjusting for age, sex and birth weight. These extremely high levels of obesity and truncal fat among very young New Zealand children will have major public health implications as these children age. [ABSTRACT FROM AUTHOR]

Studies in rats indicate that plasma total homocysteine (tHcy) is decreased in selenium deficiency and increases with selenium supplementation. The aim of this study was to determine the effect of selenium supplements on plasma tHcy concentrations in a population that has suboptimal selenium status. Subjects from Dunedin, New Zealand (n = 189) were randomly assigned to receive a supplement containing 200 micro g selenium or placebo for 20 wk. At baseline, 67% (n = 112) of the participants had plasma selenium concentrations < 1.2 micro mol/L, a concentration believed to be that necessary for full glutathione peroxidase (Gpx) activity. At 20 wk, plasma selenium concentration and Gpx activity increased in the selenium group by 1.2 micro mol/L [95% confidence interval (CI): 1.1, 1.3] and 5.1 nkat/g protein (3.7, 6.5), respectively, changes that were significantly greater than the changes in the placebo group (P < 0.001). At 20 wk, mean changes in plasma tHcy concentrations were 0.1 micro mol/L (95% CI: -0.4, 0.5) and -0.2 micro mol/L (-0.7, 0.3) in the supplemented and placebo groups, respectively, compared to baseline. There was no difference in the mean changes in plasma tHcy between the supplemented and placebo groups (P = 0.54). These results suggest that selenium supplementation does not influence plasma tHcy concentrations in healthy populations in developed countries, whose selenium status is characterized by lower plasma selenium concentrations. [ABSTRACT FROM AUTHOR]

• 441 root:shoot records were compiled for 32 locations in south temperate forests. • Root:shoot ratios were size-invariant in most tree taxa assessed. • Most dicots had similar root:shoot ratios between south and north temperate forests. • Divergences in root allocation were only noted for gymnosperms and tree ferns. • Low rainfall:temperature ratio conditions led to high root biomass allocation. Accurate quantification of total forest biomass requires sound estimates of root biomass. Because roots are challenging to measure in situ , data are sparse, and this has limited our understanding of root allocation across a range of forest types. Increased sampling in the oceanic and cool temperate forests of the southern hemisphere means we are now able to better understand biomass allocation in this biome. Here we compile and systematically review root:shoot ratios for these forests and examine the taxonomic, regional, and environmental determinants of variability in biomass allocation to roots. Specifically, we assess whether limited access to resources resulting from low temperatures or low rainfall:temperature ratios increases root allocation. A literature and database search identified 441 root:shoot records from 25 studies and 32 locations around the South Pacific. Records were weighted by excavated area as a measure of sampling effort. Root:shoot ratios for eucalypts in southeast Australia (0.277) and southern beech in South America (0.275) were 6–7% above the global mean of 0.26, while southern beech (0.233) and other dicots (0.234) in New Zealand were consistent with values reported for temperate (mostly northern hemisphere) broadleaved forests. Low root:shoot ratios (of trees ≥5 cm stem diameter) relative to the global mean were noted for South American gymnosperms (0.219), seemingly driven by low values in the Cupressaceae, and New Zealand tree ferns (0.194). Size effects were taxon dependent, with a marked decline in root:shoot ratios with increasing stem size for the southern beech in South America and modest effects for other combinations of taxa and region. A clear signal of increasing root allocation with declining rainfall:temperature ratios was detected, but no major effects of temperature were noted within the range of the data. Our findings support current approaches to biomass and carbon estimation but leave room for refinement, with specific recommendations given for the New Zealand context. [ABSTRACT FROM AUTHOR]

Abstract: The present study was undertaken to determine whether children with lower bone mass display lower muscle mass for their height than those with high bone mineral content (BMC) and whether appendicular lean mass (bone-free lean mass in arms plus legs) is associated with physical activity and/or BMC in preschool children. 158 children (59% male) from a New Zealand cohort born in 2001–2002 were studied close to their fifth birthday. Body composition was measured by dual energy X-ray absorptiometry (Lunar DPX-L). Lean mass index (LMI) was calculated as lean mass (kg) divided by height in metres squared. Physical activity was assessed objectively by accelerometry (Actical Mini-Mitter). Girls and boys had similar heights, weights and daily accelerometry counts but boys had lower fat mass, and higher lean mass and total body BMC than the girls (P <0.00l). In both sexes children with greater quantities of total and regional lean mass and higher LMI values had significantly higher bone mass. Appendicular LMI was more strongly associated with BMC than LMI. Accelerometry counts showed no associations with height but were positively associated with lean mass (r =0.23, P <0.03), appendicular LMI (r =0.25 P <0.01), total body BMC (r =0.24, P <0.02) and total body less head BMC (r =0.27 P <0.009) in the boys, but not in the girls. Greater time spent in more intense physical activity was also associated with higher appendicular lean mass and TBLH BMC only in the boys. We conclude that children with lower BMC values display not only lower lean mass but also lower total and appendicular lean mass for their height, than those with higher BMC values. The sex differences in associations of accelerometry counts to lean mass and BMC have been noted by others and require further investigation. [Copyright &y& Elsevier]

Objectives: This study examines national patterns of functional impairment, and how they vary by the presence of non-communicable disease (NCD), type of health condition, comorbidity, age, sex, ethnicity, deprivation and living situation., Design: A cross-sectional examination using a national research database of linked administrative and survey data sets including census, tax and health data., Setting: Aotearoa New Zealand PARTICIPANTS: All individuals living in NZ on 30 June 2018, identified by the Statistics NZ Integrated Data Infrastructure estimated residential population (4.79 million individuals). Nine NCDs among these individuals were identified from national health data sets using existing and adapted algorithms., Primary and Secondary Outcome Measures: Functional impairment was assessed via hospitalisations, comorbidities (Elixhauser index), activity limitations (census) and income support., Results: Three-tenths (29%) of the population had at least one NCD. Functional impairment was strongly patterned by NCD prevalence (3% activity limitation in people without any NCDs, 13% if one or more NCDs and 25% if two or more NCDs). Activity limitation was most common in individuals with dementia (68% activity limitation), stroke (42%) and coronary heart disease (26%). After age stratification, there was also a high level of activity limitation and income support in people with mental health conditions. Māori and Pacific peoples and people living in deprived areas or alone were more likely to have functional impairment., Conclusions: Functional impairment was strongly patterned by NCD type. NCD prevention efforts and disability supports are needed to reduce the burden of disability experienced., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Cancer is increasingly responsible for the mortality gap between high and low socioeconomic position groups in high-income countries. This study investigates which cancers are contributing more to socioeconomic gaps in mortality and how this changes over time.New Zealand census data from 1981, 1986, 1991, 1996, 2001 and 2006, were linked to three to five years of subsequent mortality and cancer registrations, resulting in 54 and 42 million years of follow-up cancer incidence and mortality, respectively. Age- and ethnicity-standardised cancer mortality rates and the slope index of inequality (SII) by income were calculated.The contribution of cancer to absolute inequalities (SII) in mortality increased from 16 to 27% for men and from 12 to 31% for women from 1981-84 to 2006-11, peaking in 1991-94 for men and in 1996-99 for women and then levelling off, parallel to peaks in lung cancer inequalities. Lung cancer was the largest driver of cancer inequality trends (49% of the cancer mortality gap in 1981-84 to 33% in 2006-11 for men and 32 to 33% for women) followed by colorectal cancer in men (2 to 11%) and breast cancer in women (declining from 44 to 13%). Women in the lowest income quintile experienced no decline in cancer mortality.The contribution of cancer to income inequalities in all-cause mortality has expanded in this high-income country. Action to address socioeconomic inequalities should prioritise equitable tobacco control, obesity control and improved access to cancer screening, early diagnosis and high quality treatment for those with the lowest incomes., (© 2016 UICC.)

Background: Merino and Merino-derived sheep breeds have been widely distributed across the world, both as purebred and admixed populations. They represent an economically and historically important genetic resource which over time has been used as the basis for the development of new breeds. In order to examine the genetic influence of Merino in the context of a global collection of domestic sheep breeds, we analyzed genotype data that were obtained with the OvineSNP50 BeadChip (Illumina) for 671 individuals from 37 populations, including a subset of breeds from the Sheep HapMap dataset., Results: Based on a multi-dimensional scaling analysis, we highlighted four main clusters in this dataset, which corresponded to wild sheep, mouflon, primitive North European breeds and modern sheep (including Merino), respectively. The neighbor-network analysis further differentiated North-European and Mediterranean domestic breeds, with subclusters of Merino and Merino-derived breeds, other Spanish breeds and other Italian breeds. Model-based clustering, migration analysis and haplotype sharing indicated that genetic exchange occurred between archaic populations and also that a more recent Merino-mediated gene flow to several Merino-derived populations around the world took place. The close relationship between Spanish Merino and other Spanish breeds was consistent with an Iberian origin for the Merino breed, with possible earlier contributions from other Mediterranean stocks. The Merino populations from Australia, New Zealand and China were clearly separated from their European ancestors. We observed a genetic substructuring in the Spanish Merino population, which reflects recent herd management practices., Conclusions: Our data suggest that intensive gene flow, founder effects and geographic isolation are the main factors that determined the genetic makeup of current Merino and Merino-derived breeds. To explain how the current Merino and Merino-derived breeds were obtained, we propose a scenario that includes several consecutive migrations of sheep populations that may serve as working hypotheses for subsequent studies.

Background: The aim of this paper is to estimate the seroprevalence of Helicobacter pylori infection in the New Zealand population by ethnicity and year of birth., Methods: A systematic search identified seven studies in New Zealand that reported prevalence of H. pylori infection among 4463 participants. Prevalence data were pooled to estimate the Māori, Pacific, and European seroprevalence of H. pylori in four birth cohorts (1926-40, 1941-55, 1956-70, and 1971-85), by assuming that infection is acquired in childhood and seroprevalence is stable with aging. The best estimates of national seroprevalence were obtained by geographic regional weighting and corrections for selection and measurement bias., Results: Infection rates among all ethnic groups declined in more recent birth cohorts. Prevalence was highest among Pacific peoples (ranging from 39-83%) followed by Māori (18-57%) and then European (7-35%). The absolute ethnic differences in seroprevalence decreased in subsequent cohorts, but the relative ethnic differences increased., Conclusions: There is scope to much further reduce Māori and especially Pacific people's risk of H. pylori infection. Solutions to reduce H. pylori prevalence and its sequelae should focus on people at greatest risk of the infection. Further evaluation of strategies to address H. pylori infection is warranted. Interventions to be evaluated could include household crowding reduction and eradication therapy for asymptomatic infected persons to reduce their risk of noncardia stomach cancer., (© 2014 John Wiley & Sons Ltd.)

Rationale: Both obesity and asthma are common conditions, and both are characterized by the presence of inflammation. Animal studies suggest that the development of airway hyperresponsiveness with antigen challenge is exaggerated with obesity. However, clear evidence for either an additive or a synergistic pathologic interaction between obesity and asthma is lacking in humans., Objectives: To identify whether an interaction between systemic and local inflammation occurs in obese subjects with asthma in a controlled observational study., Methods: We studied 79 women: obese patients with asthma (n = 20), normal-weight patients with asthma (n = 19), obese patients without asthma (n = 20), and normal-weight patients without asthma (n = 20). After corticosteroid withdrawal, between-group differences in spirometric values, lung volumes, exhaled nitric oxide, induced sputum cell counts, and biomarkers of inflammation in sputum supernatant and blood were measured, and interactions explored., Measurements and Main Results: Markers of systemic inflammation were increased with obesity, and Th2 cytokines were increased with asthma, but no important interactions were identified. Obesity adversely affected lung function with increases in functional residual capacity and residual volume in obese but not normal-weight patients with asthma, with a significant obesity by asthma interaction., Conclusions: The link between obesity and asthma is unlikely to be explained by enhancement of the "classical" forms of airway inflammation resulting from the systemic inflammatory effects of obesity itself. Other mechanisms, possibly related to innate immunity, may explain the relationship between obesity and asthma.

Introduction: The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated that implantable cardioverter defibrillator (ICD) therapy reduced overall mortality in patients with class II or III heart failure and left ventricular ejection fraction (LVEF)

Objective: The increasing prevalence of obesity in young children emphasises the need for accurate measures of total and regional fat at this age. Thus the aim of this study was to evaluate the ability of waist circumference, waist-to-height ratio (WHtR) and the conicity index (CI) to discriminate between children with low and high levels of trunk fat mass., Methods: Trunk fat mass was measured by dual-energy x-ray absorptiometry (DXA) in 301 predominantly Caucasian children (150 girls) aged 3-5 years. High trunk fat was defined as an internal z-score of > or =+1. Receiver-operating characteristic (ROC) curves and the areas under each curve (AUC) were constructed to compare the relative ability of waist circumference, WHtR and CI to identify children with low and high trunk fat mass., Results: Girls had more truncal fat than boys (P<0.001). AUCs indicated that waist circumference correctly discriminated between children with low and high trunk fat mass 87% (for girls) to 90% (for boys) of the time. Waist circumference performed better than WHtR (AUCs: 0.79 in girls and 0.81 in boys; P=0.164 and P=0.011, respectively) and the CI (AUCs: 0.53 in girls and 0.65 in boys, P<0.0001). A z-score of 0.55 correctly identified 79% of girls and 81% of boys with high trunk fat mass, and 82% of girls and 84% of boys with low trunk fat mass. Suggested waist circumference cut-offs for each half-year of age in both sexes are reported., Conclusion: Waist circumference performs reasonably well as an indicator of high trunk fat mass in preschool-aged children.

A nationwide representative survey of New Zealand schoolchildren showed a 2.7% incidence of extreme obesity (versus 4% in the United States) but revealed worrying ethnic differences in prevalence. Prevalence percentages (95% CI) were 0.8 (0.4 to 1.9), 5.1 (3.6 to 7.1), and 10.9 (8.9 to 13.3) in New Zealand European, Māori, and Pacific Island groups, respectively. These findings warrant remedial action.

Unlabelled: DXA measurements in 90 children and adolescents with repeated forearm fractures showed reduced ultradistal radius BMC and BMD values and elevated adiposity, suggesting site-specific bone weakness and high body weight increase fracture risk. Symptoms to cow milk, low calcium intakes, early age of first fracture, and overweight were over-represented in the sample., Introduction: Although many apparently healthy children fracture their forearms repeatedly during growth, no previous studies of their bone health and body composition have been undertaken. Nor has the prevalence of established risk factors for fracture in such a population been assessed., Materials and Methods: Ninety children and adolescents (47 girls and 43 boys) 5-19 years of age, who had experienced at least two fractures of the forearm, were studied. Bone size and mineralization were assessed using DXA at the ultradistal radius, one-third radius, neck of femur, hip trochanter, lumbar spine, and total body. Total body lean mass and fat mass were also determined. The prevalence of six risk factors for fracture were also examined, and their influence on ultradistal BMC Z scores was assessed., Results: Participants experienced 295 fractures (74.9% forearm). Children with an early age of first fracture had higher rates of fracture per l00 years of exposure than those fracturing later. Four risk factors for fracture were over-represented in observed versus expected percentages: early age of first fracture (27.7% versus 11.3%), adverse symptoms to cow milk (22.2% versus 6.7%), low dietary calcium intake (20% versus 4.5%), and overweight (33.3% versus 15.5%). However, physical activity levels were similar to the reference population. Z scores for BMC and BMD were reduced, particularly at the ultradistal radius, whereas Z scores for weight, body mass index, fat mass, and body fat percentage were increased. Mean (SD) BMC Z scores were lowest at the ultradistal radius, -0.66 (1.22), where symptoms to milk were associated with reduced values (p < 0.009) and overweight with increased values (p < 0.003)., Conclusions: Our results suggest site-specific weakness and high body weight contribute to fracture risk in children and adolescents who fracture their forearms repeatedly. These findings are consonant with work showing adult Colles fractures increase as ultradistal radius BMD falls and with evidence that overweight children and adolescents are fracture prone.

The full fracture histories of 50 children (30 girls and 20 boys, age range 3 to 13 years) who had avoided drinking cow's milk for prolonged periods were compared with those in a birth cohort of more than 1,000 children from the same city. Children who avoided milk did not use calcium-rich food substitutes appropriately and had low dietary calcium intakes and low bone mineral density values. Many were overweight (22 of 50). Significantly more of the children who avoided milk reported fractures (16 observed vs 6 expected, chi(2)=31.0, P<.001, df=5). They also experienced more total fractures than the birth cohort population (22 observed vs 8 expected, chi(2)=33.6, P<.001, df=5). All of the fractures occurred before puberty, the majority (18 of 22) being associated with only slight trauma. Forearm fractures were especially common (12 fractures). We conclude that young children avoiding milk are prone to fracture.