Gold-Mining and Mercury Pollution: a complicated marriage between global environmental policy and individual livelihoods

31 October 2011 – Nairobi, Kenya: 
Roughly 500 delegates from 125 countries descended on the United Nations Environmental Program [UNEP] headquarters in Nairobi, Kenya to negotiate a legally-binding global treaty to reduce and, where possible eliminate, global mercury release in the environment. [1]

The treaty aims to hold governments, companies, and individuals accountable for mercury release into the environment. While there are many ways mercury can enter the environment – adversely affecting public health, as mercury is known to severely impact the brain and nervous system – the focus of this year’s meeting was to discuss the reduction of mercury and consider policy options to criminalize the use of mercury in small-scale gold mining [SGM] operations.

What is the connection between mercury and gold mining and why does it matter to international law?

In small-scale gold mining [SGM] operations mercury is used to purify gold as it binds tightly to the metal allowing miners to easily extract high-quality gold from the ore. Mercury is used in mining processes in over 70 countries in Africa, Asia, and South America because it is cheap, readily available, and enables miners to swiftly extract gold.

Globally, SGM releases 1000 tons of mercury into the environment. Recently, SGM operations were awarded the not-so-honorable distinction of ‘second largest global emitter of mercury’ – first place went to the coal-combustion sector!

If SGM operations contribute to the global mercury burden, who are the emitters and will they be held accountable to international law?

The typical profile of a not-so-evil SGM emitter is an individual or household living in a rural area of the developing world, where abject poverty is pervasive. These individuals lack basic provisions like clean water, a stable food source, and basic health care; their financial resources are immeasurably stretched; and miners typically lack education and access to improved technologies – approximately 10-15 million individuals, in 70 countries, practice SGM. In Tanzania alone, it is estimated that more than 400,000 individuals practice SGM and entire families are usually part of the mining operation – money generated from individual gold-mining operations is oftentimes the sole-source of household income.

And, YES, these SGM emitters will be expected to strictly abide by international law.

Understanding the complicated marriage between global policy and individual livelihoods

In a recent publication [2], Samuel Spiegel explores the complexities of the SGM industry and the factors that will cause a global mercury abatement treaty to be ineffective and irresponsible if the needs of the small-scale mining community are not taken into consideration. Spiegel’s most relevant finding was despite the rising cost of mercury, the hazardous occupational conditions, and looming regulations, small-scale gold miners continue to use mercury for their operations; this indicates that complex social and economic-based needs are actually driving mercury’s continued use.

Below are some of the barriers that may prevent miners from eliminating mercury during mining activities:

• They do not have the financial resources or the ability to access cleaner technology, which is often more expensive than mercury.
• There is a deeply embedded black-market for mercury that has enabled miners to still purchase mercury despite global prices rising 300% in the recent past.
• Strict laws regulating use of mercury in SGM will likely provide unintended support for black-market purchases of mercury.
• When creating programs or legislation, foreign experts and policy makers have shamefully overlooked the mining communities reliance on mercury –besides mercury, there are few alternative options currently available to the small-scale gold mining community.

Overall, I think the challenges above are summarized well by Spiegel who argues that mercury pollution abatement strategies will fail unless international governments and national agencies explicitly address local social and economic needs.

And while big business and big brother [government] are hammering out the details of a global ban on mercury, is there something that we, as consumers of gold products, can do to make an impact?

The answer is YES!

Do you care?

Hopefully, and if you do, there is something that the average American can do.

• First, think about the minerals you are purchasing and where they are coming from.
• If you decide to purchase gold, there is a fair-trade, environmentally friendly program in Colombia called Green Gold:
• Also, the Alliance for Responsible Mining works to educate, set standards, and support producers and miners.
• Furthermore, gold consumers, like you and I, can financially support organizations like the ones above, or NGOs like the Blacksmith Institute, which has training programs for miners to learn how to appropriately use different technologies to recapture the mercury for reuse.

1) United nations Environmental Program: Global Mercury Partnership.  http://www.unep.org/hazardoussubstances/Mercury/GlobalMercuryPartnership/tabid/1253/Default.aspx

2) Spiegel, Samuel. Socioeconomic Dimensions of Mercury Pollution Abatement: Engaging Artisanal Mining Communities in Sub-Saharan Africa. Ecological Economics. 68 (2009); 3072-3083.

3) picture source: http://ecopolproject.blogspot.com/2010/10/gold-mining-cause-considerable.html

Cassie O'Lenick is in her first-year of a PhD program at Emory University in Environmental Health Sciences. She is an outdoor enthusiast, a self-diagnosed goof-ball, and big fan of science and public health. My one unachievable goal in life is to give everyone in this great big world a hug or a high-five [whatever is more culturally acceptable at the time].

The Climate Change Debate in the Climate Scientist Community

Image taken from http://pixdaus.com/single.php?id=250193

With hurricanes, tornadoes and other forms of extreme weather occurring more and more frequently, most people are convinced that climate change is happening all around us, still some people, include some climate scientists, remain unconvinced that the cause of all these climate changes is us.A recent paper by Anderegg, et al. published in the Proceedings of the National Academy of Sciences has analyzed publications by 1372 climate researchers and came to the conclusion that most of the prominent climate scientists agree that human activities were the causes of climate changes we experience today (anthropogenic climate change, or ACC).

In the study, Dr. Anderegg, et al. ranked the climate scientists by number of publications, then divided these scientists into two groups, those who are convinced by the evidence of ACC (CE) and those who are unconvinced by the evidence of ACC (UE). The CE group was determined by combining the list of Intergovernmental Panel on Climate Change (IPCC) contributors and signatories of 4 prominent scientific statements endorsing the IPCC. The UE researchers were signatories of statements that strongly dissents from the views of IPCC.

Dr. Anderegg, et al. found that 49 out of 50 (98%) top climate scientists belonged to the CE group. The number remains consistent for the top 100 (97 belonged to CE group, or 97%) and top 200 (195 belonged to CE group, or 97.5%). When comparing the CE group against the UE group, the differential credentials of the researchers belonging to each group is obvious. While 90% of the CE group has over 20 climate publications, only 20% of the UE group has over 20 climate publications. On average, a CE climate scientist has published 119 papers, as opposed to an average of 60 papers published by UE climate scientists.

Dr. Anderegg himself stated that “scientific confidence is earned by the winnowing process of peer review and replication of studies over time. In the meanwhile, given…the state of debate over perception of climate change, we must seek estimates while confidence builds. Based on the arguments presented here, we believe our findings capture the differential climate science credentials of the two groups.” So what? With an overwhelming majority of top climate scientists agreeing with ACC, there is little doubt that we are the cause of the ongoing climate changes and the catastrophes they bring to life on Earth. We also know that whenever a climate denier quotes a scientist, then the scientist is most likely not an authority on the subject matter.

Some people are still confused about whether there is a consensus within the scientific community, therefore, it would be helpful to have more public announcements, founded by NGO's, to inform the public that the consensus is that our day-to-day activities are indeed the cause of much of the climate changes we experience today, and we must push for more actions to be done. Getting people to sign petitions for tougher actions to reduce greenhouse gas emissions and other causes of climate change can also help inform the general public through fliers and helpful volunteers. However, this does not mean that all climate scientists who disagree with ACC in its entirety should be ignored outright. If they can back their opinions up with evidence, then they should not be denied the chance to present their findings to the community.

Citations:
Anderegg WRL, Prall JW, Harold J, Schneider SH. Expert credibility in climate change. Proc Natl Acad Sci USA. 2010;107:12107–12109.

Will Zhu is a student at Rollins School of Public Health. He hopes to visit all 58 National Parks someday.

No Soup for You?!?

Once again BPA is in the news. Or should I say, in the soup?

BPA, or bisphenol A, is an industrial chemical used to make plastics and resins that seems to have been linked to everything from developmental and reproductive effects to obesity, cardiovascular disease and diabetes.  

And over the last few years, headlines have proclaimed BPA to be found in -and on- everything from plastic water bottles, to canned foods, to receipts and even money!

This latest follows a study published in last week's edition of the Journal of the American Medical Association, a team of researchers at the Harvard School of Public Health conducted a study of 75 participants that compared people who were given canned vegetable soup for lunch for 5 straight days  with people who consumed prepared vegetable soup -made without any canned ingredients- for 5 straight days

And what did they find?

That within a few hours after eating, those participants who had eaten canned soup had levels of BPA in their urine that were approximately 12x greater than the participants who had been eating the prepared vegetable soup! Although it's important to note that even though the study utilized Progresso brand soup, this is an industry-wide practice, so these sorts of results would be expected from other companies with canned soup products.

Scary, right?

Well, maybe not...it's important to keep in mind that these levels were still in what our government considers a safe range. But there is still a lot of public concern about potential public health effects of bisphenol A, but not a lot of solid answers. This is why reports of exposures to potential health hazards should always include at least a reference to information on health effects, or potential health effects. And ideally, the same for a method to reduce exposure!

As this type of report leaves me wondering....we know we're exposed to BPA...but what are the realistic health effects? 

Not very clear! But BPA is currently being investigated, by private and public institutions, including the US Food and Drug Administration and the National Toxicology Program at the National Institutes of Health, especially as regards possible effects of BPA on the brain, behavior, and sexual development in infants and young children. Dr. Burcher, Associate Director of the National Toxicology Program, has explained that BPA is considered to be of some concern  because "scientists that have looked at this information recognize that there is something really going on here, but it's not exactly clear".  For more information about the NTP conclusions, see the NIEHS page on the topic.

So, while the jury--or in this case, the science---is out, what can/should you do?

Minimize your exposure to BPA by minimizing your exposure to the products we know are likely to be contaminated! That means in addition to ditching the BPA-containing plastic water bottles, you should think about trying to reduce overall consumption of canned goods. At the least, try to minimize consumption of canned food that is acidic, like canned tomatoes, or salty, because BPA is more likely to leach from the epoxy-resin linings of these cans right into these types of food!

Take the opportunity to try out a few recipes yourself....you never know, you might even enjoy cooking!

And on the bright side, we know that this approach can work...last March the journal Environmental Health Perspectives published the results of a small Silent Spring-sponsored study in which twenty participants from five families eliminated canned and packaged foods for only three days, but were able to reduce their levels of BPA exposure by approximately 60%!

Mary M. is doctoral student at Emory University's Rollins School of Public Health. If you need a little inspiration in the kitchen, she might just have a recipe for you!

It Ain't Easy Raising a Family on a Farm These Days...

If you were raised in a city or in suburbia, farm life must seem serene, bucolic, and wholesome. Sure, it means hard work, but it's honest and lets you escape to simpler times in human history...

Fields Near Greenfield, CA

In some ways, you'd be right. In most ways...


The Salinas Valley in California is known as the "Salad Bowl of the World" with its large production of lettuce, spinach, tomatoes and more. This title was not awarded simply by having small subsistence farms. Agriculture in the United States is big business, with heavy machinery, large acres of land, huge water needs, fertilizers, and pesticides. As such, farm life is complicated, scientific, and dangerous.


In 2007, organophosphate (OP) pesticides accounted for 36% of all pesticides used in the United States. This class of pesticides, whose membership includes chlorpyrifos, malathion, and phosmet, is greatly important to agriculture and the Californian economy.


Pesticides in the organophosphate class work by inhibiting the enzyme acetylcholinesterase. The targeted enzyme is important for proper neuron to neuron signalling in insect as well as human nervous systems, which makes it an excellent target for a pesticide.


However, many studies have shown associations with poorer neurobehavioral development in very young children who have been exposed to OP pesticides while in the womb or as an infant. Usually, this exposure to the pesticide is due to dietary consumption by the pregnant mother or infant. A recent study published in August of 2011 sought to examine whether these biological effects were long lasting, and at whether prenatal or postnatal exposure was a larger contributor to the observed neurobehavioral deficiencies.


The study examined data from a cohort of largely Latino pregnant mothers and children living in an agricultural community in the Salinas Valley. Their exposures to OP pesticides are, by and large, very high compared to other populations around the country, but are still within possible levels for the general population. They found, by measuring biological samples, that OP pesticide exposure to a pregnant mother is associated with lower IQ scores in her children even at the age of 7. Those children that had the highest exposure through their mothers had  an average deficit of 7 points! On the other hand, exposure during childhood was not associated with this outcome.


Now what do we do? We've been told to eat well and eat our veggies, especially when someone is pregnant. Are we simply poisoning our children with good intentions? No. Certainly not, agrees Elizabeth Marder, a University of California-trained toxicologist. "It is important to recognize that determining an exposure has occurred does not necessarily mean that a harmful exposure has occurred." But, there are clear indications for actions that can be taken for at risk people.


MINIMIZE EXPOSURE:
1) Pregnant mothers have many things to worry about during their pregnancies. If a pregnant mother is associated with or lives in a farming community, she should also be vigilant about possible ways to be exposed to these pesticides and avoiding them. For example, staying indoors on a crop dusting day, and making sure that any relatives that visit who work on the farm change into clean clothes before entering your home.


2) Always eat well--whether you're pregnant or not! This also means making sure any ingredients that are being used in a meal are cleaned thoroughly before being transformed into a healthy salad, casserole, or curry. Avoiding nutritionally healthy products based on a possible exposure is NOT the solution!


WAYS TO ACHIEVE:
1) For the population of women involved in this presented study, starting strong educational programs for avoiding or minimizing pesticide exposure while pregnant may be helpful. After all, knowledge is power. In this case, it's the power to know what other precautions a new mother can take as early as possible in pregnancy. Community outreach programs targeting agricultural populations in the languages they speak would seem to be the way to go.


2) A broader campaign may include television or radio ads encouraging the proper cleaning of fruits and vegetables before consumption. Reminders of good practices in common media can improve the chance the general population is maximally reducing their exposure to pesticides through their diets in ways they can afford.


DONE AND DUSTED (Wait, wait, not really):

Unfortunately, any opportunity to advocate good practices runs the risk of unintentionally alienating a population. The ability for persons to avoid exposures is also limited by their economic abilities. Migrant workers, for example, are a vital source of labor in California's agriculture infrastructure. They do not necessarily have the means to "avoid" pesticide exposures if a family depends upon the income generated by a working person. In this scenario, even a pregnant woman may insist on working in the fields during her pregnancy. Also, don't even bother thinking that she could use her maternity leave.


It is, indeed, difficult to raise a family, let alone raising one in an area where certain vulnerabilities are compounded by our environments. However, steps can be made to reduce our exposures to OP pesticides while still providing ourselves with food and an economy.


Citations:
Bouchard, MF, Chevrier, J, et al. Prenatal Exposure to Organophosphate Pesticides and IQ in 7-Year-Old Children. Environmental Health Perspectives, Vol 119, No 8, Aug 2011. 
Photos sourced through the Creative Commons Licenses.


Chandresh Ladva filled his lungs with pesticides and oil refinery fumes for 18 years while living in the San Joaquin Valley before he moved eastward to study philosophy and epidemiology at the University of Pennsylvania and Yale, respectively. He longs to return to California someday, but not before finding solutions to problems associated with development and environmental toxins. He is currently a pre-doctoral candidate in environmental health sciences at Emory University.


chandresh.ladva@emory.edu

More than just noisy: Living near airports may increase blood lead levels in young children

Largely as a result of banning lead from our gasoline and paint, blood lead levels in children have declined significantly over the past 40 years. We’ve seen a drop from about 88% of preschool children having levels high enough to affect their health to less than 2%.

That still leaves 250,000 children aged 1 to 5 years with blood lead levels greater than 10 micrograms per deciliter of blood. This is the level at which CDC recommends public health actions, like evaluating the home for sources of lead, be initiated.

But, there is no safe level for blood lead in children.



Lead poisoning can affect nearly every system in the body and often the symptoms are unrecognized. Lead especially targets the brain. Even low levels can cause learning disabilities and behavioral disorders.

Lead poisoning, however, is preventable. We must continue to identify children at risk and potential sources of lead exposure.

Small aircraft continue to use leaded aviation gasoline. Lead from aviation gasoline is emitted into the air and can deposit on the ground.

According to a study by the Children’s Environmental Health Initiative, aviation gasoline is a small but significant source of lead exposure among children living near airports. The study’s authors compared the blood lead levels of children living near airports in six counties in North Carolina with children living farther away from the airports but in the same counties.

They found that children living within 500, 1000, and 1500 meters of an airport had average blood lead levels that were 4.4, 3.8, and 2.1% higher than other children. Their findings remained true after they accounted for other potential sources of lead exposure.

Unfortunately, they did not have information about where the children attended school or day care. Children attending school or day care near an airport but living farther away may have high blood lead levels but would have been counted among children not living near an airport. The reverse of this is also true. Children living near an airport but attending school or day care farther away may have low levels but would have been counted among children living near an airport. Knowing how much time children spent near an airport could strengthen the results of the study and make the impact of leaded aviation gasoline more clear.

But the results do indicate that leaded aviation gasoline may be an important source of childhood lead exposure.  According to the EPA, 16 million people live within 1 km of an airport and 3 million children attend school within 1 km of an airport. That's 16 million people and 3 million children with a greater risk of lead poisoning. These findings could help us further reduce the percent of children with blood lead levels of concern if we are able to eliminate lead from aviation gasoline or at least prevent children’s exposure to it.

As a country, we should consider removing lead from aviation gasoline. According to the article, in response to a petition from an environmental group, the EPA has proposed a rule for requiring aircraft to use unleaded fuel.

As a community, we should evaluate how close our schools and day care centers are to airports. While it would be difficult and maybe not necessary to relocate existing school and centers, we should consider location of airports when building new ones. Children attending school and day care centers already located near airports should be screened for blood lead poisoning.

As parents and guardians, we should take extra precautions to prevent lead poisoning of our children if they live or spend time near an airport.  Captain Gary Noonan of the National Center for Environmental Health at the Centers for Disease Control and Prevention offered advice to parents concerned about their child’s exposure to lead from aviation gasoline. He said to avoid contact with lead in soil, parents should:

·         Regularly wash children’s hands and toys.

·         Regularly wet-mop floors and wet-wipe window components to remove household dust.

      ·         Prevent children from playing in bare soil.

Avoiding exposure to lead in the air is more difficult for an individual. “But as always,” CAPT Noonan said, “if you are concerned about your child’s exposure to lead, talk to your doctor. He or she can test your child’s blood lead levels”.  

 Heather Strosnider

Heather is a doctoral candiate in environmental health science at Emory University. She is too witty and charming for words so no attempt will be made.

Article: Miranda ML, Anthopolos R, Hastings D. A geospatial analysis of the effects of aviation gasoline on childhood blood lead levels. Environ Health Perspect 119:1513-1516 (2011). Available at: http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1003231

assessing tradeoffs: needle exchange

Tetlock et al's work on taboo tradeoffs has strong relevance to public health policy research. Most efficiency goals, and thus almost every aspect of health reform, involve weighing health benefits against economic costs, leading to issues of incommensurability between these competing objectives. Drug policy often invokes similar tradeoffs,

Needle exchange, a famous example of harm reduction in drug policy, trades off prevalence of heroin/opiate use against prevalence of communicable diseases that are transmitted through dirty needles (most prominently, HIV). Tina Rosenberg has an excellent post on the surprisingly progressive drug policy in Iran of all places. Is it fear of dirty needles that is keeping you from shooting heroin? First, there is far stronger evidence that needle exchange reduces disease rates than there is for a resulting increase in heroin prevalence. Even if we admit that a non-negligible fraction of readers may answer "yes, but for dirty needles I'd be shooting up right now," is the deterrent value of maintaining the danger of heroin use really worth that added danger? Remember to factor in the high risk of exponential population-wide mortality increases.

(Source: http://whyy.org/cms/radiotimes/2010/01/22/needle-exchange/)

And yet, dirty needles endure. The issue is not the public health merits of such programs, for which there is sufficient evidence of benefit to convince most health policy scholars. Rather, as Rosenberg writes:


"The problem is the politics. It seems wrong for the government to be muddying a 'don’t-do-drugs' message by supplying the equipment for an illegal and dangerous activity. But to oppose harm reduction only provides the illusion of morality. Surely it is more moral to choose a strategy that does not increase drug use, but does save lives."


BIO:
Zachary Cahn  has been in various places doing various things and now does public health policy at the Emory Rollins School of Public Health with a focus on substance control policy.

Any Differences in Diabetes Care between Blacks and Whites ?

In the U.S., diabetes-related mortality is found to be much higher among blacks than that among whites. Why this can happen? Because of different insurance coverage among these two groups? Or because of different access to health care, or any other reasons exist? No matter what factors can cause the disparities in diabetes, if they are indeed the dominant basis for the disparities, then we have reasons to believe that such disparities should not be present when access to care is relatively uniform.

Is that true?

So as to test this hypothesis, a recent study approved by the Emory University Institutional Review Board is conducted by comparing glucose and A1C (i.e. a common blood test used to diagnose diabetes) levels in veterans, who receive consistent follow-up care at medical centers in the southeastern U.S. In this study, 1456 blacks and 2624 white veterans who met certain criteria are analyzed. Researchers have found that differences in A1C between blacks and whites were generally small and within the range associated with race, no difference in underlying glucose levels. However, even in the Veteran Administrations, blacks had higher A1C levels than whites when the diagnosis was made and when drug treatment was initiated, and at these times, the differences in A1C reflected underlying differences in glucose levels as well.  In other words,

glucose levels are generally comparable in blacks and whites except at the times of diagnosis and initiation of drug treatment, when glucose levels are higher in blacks.

What we get?

This study includes a large number of patients and the information is collected from multiple medical centers across states in the southeastern US, hence its results to a large extent is reliable. That is to say, if other patients are found to have consistent follow-up care similar to those in the present study, the results can be applied!

However, people must be very careful in applying the results because Limitations also exist! In this study, sample patients were largely males and the sample is not a national sample. So if different results are got by studying patients from others states, don’t be surprised! Also the measurement of A1C and glucose levels is not uniform, which indicates the results may be biased.  We should also recognize that care in the Veteran Administrations is not necessarily “free”, since some categories of eligibility require a copayment for pharmaceuticals or services received. Although such requirements are stratified according to service connection, income, and insurance coverage, the impact of differences in financial status is not fully eliminated. Therefore, understanding the basis for such remaining disparities may be important to improve the health of blacks in the U.S., a health care system with structure and organization similar to that in the Veteran Administrations may also contribute importantly to relieving disparities in health.

Jing Yang is a  first year PhD student in Biostatistics and Bioinformatics at Emory University. She loves travelling, skiing and is a huge fan of Alan Rickman (Prof Snape! Huhu~~~~)

Reference: Twombly, J.G., Long,Q., Zhu, M., Wilson, P.W.F., Narayan, V.K.M., Fraser, L-A., Brian C. Webber, B.C., and Phillips, L.S. Diabetes care in black and white veterans in the southeastern United States.

Diabetes Care

, 33(5): 958-63, 2010.

Mobile telephone food journal-Just take pictures!

 Image from seek4media.com

Have you ever used a food diary to make healthy eating choices or to lose weight? We know that keeping a food diary helps us stay more accountable to our health plan, but we would surely be happier if we could make do without having to use cumbersome traditional paper-based food diaries.

Mobile apps that act as food journals could very well be your knight-in-shining-armor. These days there are numerous available apps once downloaded to your mobile that can serve as online food diaries. Some that even allow pictures of foods to be taken and sent to a dietitian partnered with the mobile app. But, how reliable are these apps?

According to a recently published study in the Journal of the American Dietetic Association, a new mobile telephone food record has been successfully tested. The study set out to test how much easier would it be for adolescents to capture a useful image of their food and what is their ease of using a mobile telephone food record, in general and after training. The adolescents in this study, aged 11-18 years, used their cell phones to capture an image of their meals (including snacks) before and after eating.

Current problems with food recall especially among youngsters include estimating how much one ate and drank and being able to compare it to the suggested portion sizes. Catherine McCarroll, Registered Dietitian and Coordinated Program Director, Division of Nutrition at Georgia State University says, “from my experience working with both healthy weight adolescents and above average weight adolescents, it is difficult to obtain accurate food records with this age group.  Parents are not a reliable source of information since adolescents typically are not with their parents for one or more meal and snacks per day.”

According to the study, a majority of the adolescents (79%) found the mobile telephone food record easy to use and the longer they used it, the more likely they were to continue using it. Training the adolescents to use the food record on their cell phones made them more agreeable to take images of the food before snacking.

The authors of the study suggest that successfully testing the mobile telephone dietary food record is valuable not only to adolescents and to others, but also benefits health care professionals such as Registered Dietitians. The study lends valuable information to the further development of the mobile telephone food record. Dr. Mildred Cody, PhD, RD, Professor Emeritus, Division of Nutrition, Georgia State University says, “use of a familiar mobile, multi-purpose technology that can take pictures of the food and record other notes, such as information on where the food is consumed and other information relevant to the individual's situation, has potential to improve both record-keeping compliance and diet recall detail.”

While the mobile telephone food record is further being developed, such studies lend support to a user-friendly food record soon within our reach. At the end of the day, adolescents are more likely to accept tools that fit into their lifestyles. When it comes to staying in shape, technology is helpful and interactive products more acceptable.  As Evelyn Leo, Diabetes Educator and Registered Dietitian summarizes, “using a phone camera to take pictures of foods may improve accuracy of food recalls for a population accustomed to using technology in their everyday lives.” 

What’s in it for you?

Not only youngsters, but as a consumer you stand to gain from using a mobile telephone food record because:

• It is easy to use. You need not be tech-savvy
• It will literally be available at your finger tips
• It is reliable having undergone successful testing
• A pictorial food diary would most likely be preferred over using a paper-based food diary
• Frequently using it after undergoing training will make you more efficient in recording your food intake 
• You will be able to send valuable dietary information and receive feedback from your dietitian
• You will be a true eco-friendly citizen saving paper otherwise used for paper-based food diaries!

Mobile telephone food records seem promising. We might soon joyfully bid adieu to keeping old-fashioned food diaries.

About the author: Nida Shaikh, MS, RD, LD

A self-confessed chocoholic, outdoor enthusiast, half-marathon distance runner and an ambidextrous Registered Dietitian currently pursuing a doctoral degree in nutrition at Emory University.

Reference: Six BL, Schap TE, Zhu FM, Mariappam A, Bosch M, Delp EJ, Ebert DS, Kerr DA, Boushey CJ. Evidence-based development of a mobile telephone food record. J Am Diet Assoc. 2010 Jan;110(1):74-9.

Do sleep problems during pregnancy affect your unborn child? (Cassie Gibbs)

The importance of a good night's sleep

Most of us know that a good night's sleep is essential for our overall health. According to Dr. Dana Wyner at the Emory Student Counseling Center, "Sleep allows us to repair and maintain good physiological functioning in a variety of systems in our bodies...if we do not get sufficient sleep, our bodies are susceptible to break down in those domains, perhaps leading to illness, mood swings, inability to attend to daily tasks, and an overall lower tolerance to stressors."

Getting a good night's sleep during pregnancy can be even more difficult, due to the many hormonal and physiological changes in the body (1). But does sleep deprivation during the third trimester of pregnancy affect the unborn infant? This was a question addressed by a recent study conducted in Greece (1). The authors looked at how sleep deprivation (defined as ≤5 hours sleep per night) or snoring during the third trimester of pregnancy are associated with several infant outcomes. Snoring may seem like a strange exposure to examine, but snoring and sleep apnea result in less oxygen being delivered to the body, and this could affect fetal growth. 

Infant outcomes: The authors looked at low birth weight (a birth weight less than 5 pounds, 8 ounces), preterm birth (when an infant is born before 37 weeks of gestation), and fetal growth restriction (when an infant's birth weight is small compared to others of the same sex and gestational age). 

Findings: The authors found that women who were "severe snorers" during pregnancy were over 2.5 times as likely to deliver a low birth weight infant and twice as likely to deliver an infant that was "growth restricted." Women with ≤5 hours sleep per night were over 1.5 times as likely to deliver a preterm infant; they were almost 2.5 times as likely to have a preterm infant that was delivered through a planned C-section or induced delivery.

Why do these findings matter?

An infant born low birth weight, preterm, or growth restricted is at risk of many poor outcomes. Low birth weight infants are more likely to have serious health problems as a newborn (and to require treatment in the newborn ICU), more likely to die as a newborn, and are at higher risk of other lasting disabilities. As adults, they may be more likely to develop diabetes, heart disease, and high blood pressure (2). Sleep problems also affect the mother. Lack of sleep places a pregnant woman at higher risk of becoming ill or depressed (6). Researchers have found that sleep deprivation may place a pregnant woman at higher risk of diabetes and high blood pressure during pregnancy (1).

By addressing sleep problems during pregnancy, we may be able to improve the health of both the infant and the mother. Doctors should screen pregnant women for sleep disorders so that they can refer the woman to the appropriate resources. Pregnant women should also seek out their doctor's advice and educate themselves about ways to improve sleep quality.

How can we improve sleep quality during pregnancy?

• Figure out if you have a sleep disorder. Keep a sleep diary, and record how many hours of sleep you get per night. If you wake up feeling exhausted every day, it may be time to seek help. If you snore during the night and wake up tired, you could suffer from sleep apnea.                                 

• If you have a sleep disorder (whether you are pregnant or not), it would be helpful to see your primary care physician and discuss this issue. Your physician can refer you to the appropriate resources or specialists.

• Look for nonmedical interventions to help with sleep disorders (see the following bullet points for more detail). For pregnant women, it is especially important to combat sleep disorders without medication or supplements, since these may harm the developing fetus. If you snore, there are mouthguards (such as the Snore Guard [3]) you can wear that help promote deeper breathing during sleep.

• Manage stress: Practice yoga, meditation, or other activities that help you relax and de-stress at night. The more relaxed you are, the easier it should be for you to fall asleep.

• Establish good sleep habits: Establishing a consistent routine helps your body know when it is time to go to sleep and can help you fall asleep naturally. Good sleep hygiene refers to habits that will help you fall asleep, such as turning off computers/ cell phones at least an hour before sleep (since the glow from these devices keeps you awake) and avoiding caffeine before bed. Additional resources on general sleep hygiene are available here (4) and here (5).

• Also educate yourself about sleeping tips for pregnant women, such as how to sleep comfortably. For instance, you should sleep on your left side during pregnancy. This and other tips can be found here (6).

Is it ethical to recommend that women address sleep disorders during pregnancy?  
I believe so, although some minor issues could arise. Women could choose to take medications/herbal supplements (against doctors' recommendations), which could harm the fetus. Furthermore, some women might spend considerable amounts of time and money trying to address their sleep disorder without finding a (non-drug) solution. Still, many good sleep habits can be adopted easily and without spending money, and there are large potential benefits to both mother and child from improved sleep.

References:

1.  Micheli K, Komninos I, Bagkeris E, Roumeliotaki T, Koutis A, Kogevinas M, Chatzia L. Sleep Patterns in Late Pregnancy and Risk of Preterm Birth and Fetal Growth Restriction. Epidemiology 2011; 22: 738–744.

2. March of Dimes: Low birthweight

3. Snore Guard anti-snoring device
4. University of Maryland Medical Center: Sleep Hygiene
5. Harvard Med: How to get better sleep 
6. Sleep tips for pregnant women 
Images are taken from Wikimedia Commons (a media file repository making available public domain and freely-licensed educational media content).
 

Cassie Gibbs, MPH is a PhD student who is studying maternal and child health. She is a nerd at heart who enjoys using statistics to study patterns of disease in different populations. In her free time, she enjoys watching movies, riding horses, and attending graduate school events that provide free food.

Genes Tell

People always say “my son is a big boy, because I am tall”. Parents taken credited for this before any scientific evident were discovered. Have you ever thought about why your kids are tall, why they look like you and why they think and behave like you? A recently published paper (Yang et al. 2010) proved that parents indeed responsible for their children’s height. The paper showed that the large part of height is determined by the genes, which are the “life code” given by our parents and will also pass to our children. So, now you can confidently and soundly to say that your children are tall because of you. Although some “outside” conditions like what the children eat, whether they exercise enough, whether they sleep enough also decide their heights, the effects of these “outside” conditions are not as large enough as gene. As showed in the paper, 45% of the height can be explained by genetic factors alone based on current findings. This means that, other factors together will contribute to the remaining 55% at best. Actually, this paper is not the first one to uncover the genes’ function on people’s height. Another paper published in 2009 showed that 21% of the height can be explained by genes. So is height the only thing genes can decide? Well, genes are much more powerful than this. Another example: double-fold eyelids. Scientists found that double-fold eyelids are also determined by the genes. If both parents are double-fold eyelids, the chance that their children are also double-fold eyelids are more than 75%. And if both parents are single-fold eyelids, their children will almost surely be single-fold eyelids. Genes are magic, right?  

What is even more magic is that genes do not only tell us about our appearances, but can also tell us our health conditions. When you visit a physician for a disease, let’s say type 2 diabetes, you might be asked about whether you have family history of type 2 diabetes. So, why are your grandparents or your great grandparents’ health condition related to you? This is also because of gene. Huntington disease, normally onset at the middle age with syndromes such as lower IQ and psychology disorders, is another genetic disease. If either parent has Huntington disease, the children will have 50% chances to get the disease. If both parents have Huntington disease, their children will have 100% chances to get the disease. According to the Center for Disease and Control, genes are related with nine of ten leading cause of death in the US. Imagine, if we can find which genes cause which disease and we can change that gene, we will be a group of healthier and merrier people. And trust me, this is not a fiction. There are already 1212 genes found to be associated with 120 traits according to National Institute of Health. Don’t regard these researches as time-consuming, expensive and unrealistic ones. Battelle Technology Partnership Practice did a study and shows that “for every 1 dollar invested by the U.S. government, the Human Genome Project’s impact has resulted in the return of $141 to the U.S.”. In the following decades, we will witness the power of genes. As what is predicted by Eric Green, the director of National Human Genome Research Institute “There is little doubt that the predicted benefits of the Human Genome Project, originally envisioned more than 25 years ago, are beginning to arrive — both economically and clinically. “    

Yang et al., Common SNPs explain a large proportion of the heritability for human height, Nature Genetics, 42, 565-569, 2010

http://www.genome.gov/27527308

About Yunxuan Jiang: Yunxuan is a first year PhD student at Emory University. Biostatistics is her major and interest. Her old favorite thing was lying on the couch, doing nothing and pretending she was dead. Started from this year, she decided to say goodbye to her couch and enjoy the fantastic world. She is learning badminton and yoga now. And she is going to visit California for the first time in her life this winter!

Dying 20 years too early

The lives of individuals with serious mental disorders are 15 to 20 years shorter compared with the general population.^ These are the findings of a newly published report that analyzed data from three Nordic countries. What is also troubling is that there has been little improvement in the physical health outcomes of individuals with mental disorders over the past 20 years.^ Similar findings about life expectancy and mental health conditions have been reported in the United States as well.^

The main author of the current study, Professor Wahlbeck, suggested a number of possibilities for the decreased life expectancy within this population:^

“These include an unhealthy lifestyle, inadequate access to good-quality physical healthcare, and a culture of not taking physical disease into consideration when treating psychiatric patients. In addition, people with mental illness are more often poor, unemployed, single and marginalized - all known risk factors for poor health and premature mortality.”

Addressing health disparities, such as differences in mortality by population group, is an important goal for public health.^  Individuals with mental health conditions are a particular group affected by health disparities. Another expert in the field, Professor Graham Thornicroft, commented, “If such a disparity in mortality rates affected a less stigmatized section of the population, then we would witness an outcry.”^

Image from ArtTherapy

While interventions are available to improve outcomes for individuals with mental health conditions, many individuals do not receive needed care. In part, receiving appropriate health care may be clouded by the relationship between mental and physical health. These conditions are intertwined. Individuals with mental health conditions are more likely to have physical health conditions, and individuals with physical health conditions are more likely to have mental health conditions. However, as the current study shows, the physical health of individuals with mental health conditions is frequently overlooked. For individuals who have been treated for mental health conditions, symptoms related to physical health conditions may be ‘masked’ by their ‘primary’ condition.

An unbelievable example of such a case involved a 56-year-old Californian man who had been hospitalized a number of times for serious mental health conditions.^ A friend came by to check on him, because he said he was not feeling well. His friend found him unresponsive and called for help. He was pronounced dead by emergency responders. A number of people thought the death was caused by an accidental drug overdose or suicide due to his past history. However, an examination found that he died of complications from emphysema - a preventable lung condition. Possible heart complications, associated with the emphysema, may explain the sudden death. He had been a heavy smoker for over 25 years. Although he had frequently been admitted to the hospital and had contact with health professionals, he died 20 years early as a result of tobacco use. Hospital records indicate that he tried quitting at least 10 times, but he never received any assistance.^ In this case, his physical condition was overlooked and left untreated. If it had been recognized, he could have received treatment that may have prevented his premature death.

Preventing similar instances from occurring will require considerable effort. In order to garner the support needed, increased attention to the physical health of individuals with mental health conditions is a first step. However, this only addresses part of the problem, because many people with serious mental health conditions do not have regular contact with health professionals. As the lead author above suggests, other determinants, such as employment and stigma are additional avenues for intervention. Interventions that go beyond health care delivery are needed. Otherwise, we may not reach some of the most marginalized individuals - reducing our ability to address the persistent health disparities affecting this group. 

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Robin McGee is a first year doctoral student in the Behavioral Sciences and Health Education department at the Rollins School of Public Health. She has been interested in mental health promotion ever since a summer internship experience with Mind, a mental health charity in the UK.

Wahlbeck, K., Westman, J., Nordentoft, M.,Gissler, M., & Laursen, T.M. (2011). Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journalof Psychiatry, 199, 453-458. doi: 10.1192/bjp.bp.110.085100

Prochaska, J.L., Schane, R., Leek, D., Hall, S.E., & Hall, S.M. (2008). Investigation into the causes of death of a56-year-old man with serious mental illness. American Journal of Psychiatry, doi: 10.1176/appi.ajp.2007.07091455