Archives for the month of: February, 2013

GBD Image

Executive summary:

The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.GBD 2010 consists of seven Articles, each containing a wealth of data on different aspects of the study (including data for different countries and world regions, men and women, and different age groups), while accompanying Comments include reactions to the study’s publication from WHO Director-General Margaret Chan and World Bank President Jim Yong Kim. The study is described by Lancet Editor-in-Chief Dr Richard Horton as “a critical contribution to our understanding of present and future health priorities for countries and the global community.”

Link to the study here.

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From Living On Earth (portions of radio discussion of the “the health effects of the deepwater disaster”):

GELLERMAN: . . . . It’s been more than six months since BP finally capped its runaway oil well in the Gulf of Mexico. But now come reports of a wave of illnesses and puzzling symptoms from some residents along the Gulf Coast. Their blood contains high levels of chemicals found in oil and the dispersants that were used to clean up the mess.

Many who are suffering say firm answers and adequate treatment are hard to come by, and there’s a growing sense of frustration with government agencies and the medical community. Living on Earth’s Jeff Young has the first part of our special report: “Toxic Tide – Discovering the Health Effects of the Deepwater Disaster”.

[HEARING: OIL SPILL COMMISSIONER DON BOESCH Okay, questions and comments from the floor…]

YOUNG: When the National Oil Spill Commission presented its final report in New Orleans, commissioners expected to get an earful from rig workers and fishermen worried about their jobs. Instead they heard speaker after speaker worried about something else: their health.

SPEAKER 1: I worked 60 days on the frontline for BP out here. I’m sick today, nobody wants to take care of me.

SPEAKER 2: The issue is ongoing; people are getting sick and dying.

SPEAKER 3: I have seen small children with lesions all over their body. We are very, very ill. And there’s a very good chance now that I won’t get to see my grandbabies.

YOUNG: Some had worked cleaning up the oil, others lived in or had visited places where oil washed ashore. All complained of mysterious ailments that arose after the spill.

Robin Young was one of those who spoke out. She manages vacation rental properties in Orange Beach, Alabama, where she has lived for 10 years.

When the spill started, Young helped form a citizen group called Guardians of the Gulf. At first, the group was not focused on health issues. Then, people, including Young, started getting sick.

R YOUNG: Headaches, I would get nauseous – and these are all things that I don’t normally experience at all, I’ve always been very, very, very healthy. Then the coughing – I coughed up so much nasty looking mess.

J YOUNG: Young says symptoms started after she spent a day near the water in June and she still hasn’t fully recovered. She heard from others in her community and across the Gulf coast with similar problems.

* * *

J YOUNG: Young’s group paid for more blood sampling. The Louisiana Environmental Action network asked biochemist and MacArthur grant winner Wilma Subra to analyze the results. The blood samples came from cleanup workers, crabbers, a diver who’d been in oiled water, and at least two children who live on the coast. All had reported recent health problems. Subra compared the levels of volatile organic compounds in those samples to a national database of VOC’s in blood compiled by the National Center for Health Statistics.

SUBRA: They’re as much as 5 to 10 times what you’d find in the normal population. And again, these are chemicals that relate back to chemicals in the BP crude and the dispersants.

* * *

SUBRA: I think it’s demonstrating that the chemicals they are being exposed to are showing up in their blood. We’ve briefed the federal agencies on it, tried to get them interested – they are evaluating the results. And I think there’s a lot of frustration in the community members across the coastal areas. They are really requesting answers.

* * *

YOUNG: Solid answers will take time. There’s little in the scientific literature on long term health effects of oil spills. In March the National Institute of Environmental Health Sciences plans to start enrolling Gulf spill cleanup workers in a long-term health study. The principal investigator is Dale Sandler, chief of epidemiology at NIEHS. She hopes to track some 55,000 subjects for at least five years.

SANDLER: This will be by far the largest study of individuals exposed during an oil spill disaster that’s ever been conducted. So we have been moving heaven and earth to make this go quickly.

YOUNG: Sandler’s study has funding, thanks in part to BP. The study is a few months behind its original schedule. But researchers face another hurdle that may prove more difficult. Signing up tens of thousands of participants and getting people to accept results depends on credibility and trust. After the BP spill and Hurricane Katrina, trust is in low supply on the Gulf Coast. Here’s how Orange Beach Mayor Tony Kinnon sums up the attitude.

KINNON: The bottom line is very few people trust governmental agencies. They think there’s this incestuous relationship between BP and the government, and I tend to agree with them.

J YOUNG: And even as Robin Young asks the government to help her community, the plea comes with a note of deep suspicion.

RYOUNG: I hate to sound like a conspiracy theorist – that’s what I’m starting to feel like. Because it’s hard to believe that something like this is going on in the United States and no one’s helping.

More . . .

Link to Living on Earth podcast.

Wilma Subra’s analysis of blood samples from sick Gulf Coast residents.

The NIEHS plan for a large-scale, long-term study of cleanup workers.

Upstream Microphone

Deborah Cory-Slechta Podcast

Exposure to certain chemicals or stressors in utero can cause immediate health effects for fetuses and babies including lowered birth weight, birth defects, and impaired neurodevelopment. New lines of research are now showing that prenatal exposures may also contribute to health problems that typically arise later in life—such as obesity, diabetes, cardiovascular disease, cancer, and Parkinson disease—via changes to DNA transcription and the hypothalamic–pituitary–adrenal axis. In this podcast, Deborah Cory-Slechta discusses the phenomenon known as the fetal basis of adult disease. Cory-Slechta is a professor of environmental medicine at the University of Rochester School of Medicine and Dentistry.

Listen to the podcast here.

Podcast Transcript

AHEARN: It’s The Researcher’s Perspective. I’m Ashley Ahearn.

When we are exposed to certain chemicals or stressors in the womb, research has shown there are certain immediate health problems that may arise—lowered birth weight, birth defects, or impaired neurodevelopment, to name a few.

But what about health problems that typically arise later in life—obesity, cardiovascular disease, cancer, Parkinson’s disease? Could these also be the result of exposure to certain substances early in our development?

More and more research is being done to explore what’s called the “fetal basis of adult disease hypothesis.”

Joining me to talk about it is Dr. Deborah Cory-Slechta. She’s a professor of environmental medicine at the University of Rochester School of Medicine and Dentistry.

Dr. Cory-Slechta, thanks for being here.

CORY-SLECHTA: Glad to be with you.

AHEARN: Let’s start by laying out this hypothesis, the fetal basis of adult disease. What is it?

CORY-SLECHTA: Well, it actually started with some work done by Dr. Barker1 back many years ago looking at victims of a Dutch famine. And what he saw in those individuals was that those who suffered under-nutrition in the womb later in life had a much higher incidence of a variety of different diseases and disorders, particularly cardiovascular disease, hypertension. There were also cognitive kinds of problems, a real assortment of different diseases, and that’s what really got this whole area of the fetal basis of adult disease off and running, so to speak—that you could have something going on early in life, this under-nutrition, and even if those children ultimately caught up nutrition-wise with children who didn’t have early under-nutrition, they still ended up having this higher episode incidence of diseases and disorders later in life.

AHEARN: But this hypothesis now stretches beyond just under-nutrition in terms of stressors. We’re looking at exposures as well, right?

CORY-SLECHTA: We’re looking at, actually, a variety of different things. Yes, it does expand beyond that. So one of the things that’s become clear is that early under-nutrition itself can cause a variety of diseases and disorders later in life, and there are multiple ways in which that seems to happen. One is through something called epigenetics where you have an influence on what’s called the transcription of DNA—not a change in the DNA itself, the structure of the DNA, but in how it gets transcribed or activated. You can have what appear to be permanent changes in something called the HPA axis, the hypothalamic–pituitary–adrenal axis. That’s the body’s system that controls responses to stress, and when you have early or maternal prenatal stress you can cause increases in stress hormones in the fetus that basically result in permanent changes in the HPA axis. That HPA axis change can lead, itself, to many different diseases and disorders because it controls a lot of those organ systems.

Also, now we’re beginning to look at a lot of environmental exposures that probably through these different mechanisms, like epigenetics or changing the HPA axis, among others, thereby lead to these diseases and disorders by permanently changing these mechanisms.

AHEARN: What other diseases that manifest later in life do you think could be tied to early developmental exposures?

CORY-SLECHTA: Well, let me use lead exposure as an example of that, something we know a lot about. We know that lead exposure early in life is one of the kinds of exposures that can permanently change this HPA axis function. Lead exposure early in life has been tied to later hypertension, cardiovascular disease, diabetes, schizophrenia, neurodegenerative changes, all of which may occur through these changes in the HPA axis function. That’s just one example. We haven’t studied a lot of these other chemicals, but I think we’re going to be seeing some similar kinds of things. Other examples are endocrine disruptors, things like bisphenol A or phthalates, which affect sex steroid hormones. Those two are producing permanent changes early in development, in this case in hormonal systems that basically target lots of different organs in the body. So it’s really going to be a variety of different diseases and disorders that are ultimately, I think, going to get tied back to some of these kinds of exposures.

AHEARN: Why does it take so long? When you’re looking at a disease that can crop up 65 years later, 70 years later, what’s going on in the interim?

CORY-SLECHTA: Things like epigenetics really can explain that because you’re producing changes in essentially the transcription or activation of a gene that can be lifelong kinds of changes. If they occur in the sperm or the egg, they can actually then be transmitted to the next generation so now we have the possibility not only of you having these epigenetic changes that can manifest themselves in diseases and disorders later in life, but that you could transmit to your offspring. When you change things like the HPA axis early in life it can be thought of like a thermostat that you’ve now reset and you can’t change it back again. So it never operates correctly later in life either. The brain development has to unfold; a sequence of steps has to unfold perfectly in time. If you change that early in life, then it’s broken. It never can refix itself because the time at which it goes through development has long since passed. So there’s really no way to repair some of these changes. They’re basically now set in stone for life.

And I think partly the other really important thing about this whole field of fetal basis is that those effects are extremely gender-specific.

AHEARN: Could you talk a little bit more about those gender differences? I mean, am I more vulnerable as a baby boy than a baby girl?

CORY-SLECHTA: Well, it depends on the disease that we’re talking about. So if you think about something like Parkinson’s disease we know that it has a higher prevalence in males; that is, females are protected against this disease. One of the thoughts about that is that it relates to estrogen somehow, and estrogen, of course, is something that if you modify that early in life during the differentiation of the brain, you can have permanent kinds of consequences. Or if you modify testosterone early in life, you can have permanent consequences.

If we’re talking about schizophrenia, there’s not so much of a different incidence or prevalence in males and females, but the schizophrenic syndrome manifests very differently by gender. If you think about things like attention deficit/hyperactivity disorder, again, something that we really don’t understand in terms of its etiology, it has a higher prevalence in boys than girls, whereas Alzheimer’s disease has a higher prevalence in women than in men; at least, most studies would say that. So you see these very, very clear gender differences, and these are things that are very likely to translate back into epigenetic changes that differ [between males and females], changes in HPA axis programming, which are different in males versus females, or hormonal changes that occur very early in life.

AHEARN: Dr. Cory-Slechta, what’s to be done with this growing body of research we have on the fetal basis of adult disease?

CORY-SLECHTA: Well, let me take it a couple directions. One, I think it will tell us a lot about what we need to do better maternal health, maternal screening, in terms of preventing these kinds of effects that might lead to later diseases and disorders in children. With respect to experimental exposures, we really haven’t had the data to be able to incorporate this kind of information into risk assessment paradigms. Once it comes there will really be policy issues about how we’re going to deal with this kind of information. What would it mean with respect to exposure levels that are safe? How much would it cost to decrease those kinds of exposures? So it can have a lot of those sorts of implications above and beyond the scientific data that comes out of these studies.

AHEARN: What makes you want to study the fetal basis of adult disease?

CORY-SLECHTA: Well, it’s a really interesting area because it’s this connection between something that happens early on and something later in life. I hope it’s, as I said before, going to really allow us to understand how environmental chemicals influence health or lead to diseases and disorders. I think without that understanding we may be underestimating the risks that are actually posed by environmental chemicals, because we don’t understand or we aren’t aware at this point of whether they are having these kinds of influences. I think it’s a really exciting area of research. It may hold a lot of answers to things that have eluded us for a long time.

AHEARN: So you’re in this for the long haul.

CORY-SLECHTA: Oh yeah, I think it’s a great area of research. It just has a lot of promise for better understanding of human diseases and disorders, and that’s why you’re in this field to begin with.

AHEARN: Dr. Cory-Slechta, thanks so much for joining me.

CORY-SLECHTA: Thank you, Ashley. Nice to be here.

AHEARN: Dr. Deborah Cory-Slechta is a professor of environmental medicine at the University of Rochester School of Medicine and Dentistry.

And that’s The Researcher’s Perspective. I’m Ashley Ahearn. Thanks for downloading!

Note

  1. David J.P. Barker first reported an association between impaired fetal growth and chronic disease later in life in the seminal article “Infant Mortality, Childhood Nutrition, and Ischaemic Heart Disease in England and Wales” [Lancet 327(8489):1077–1081 (1986)]. Barker’s hypothesis is sometimes called the thrifty phenotype hypothesis.

dirty water

From UC Berkeley Press:

When it comes to climate change, deforestation and toxic waste, the assumption has been that conservative views on these topics are intractable. But new research from the University of California, Berkeley, suggests that such viewpoints can be changed after all, when the messages about the need to be better stewards of the land are couched in terms of fending off threats to the “purity” and “sanctity” of Earth and our bodies.

A UC Berkeley study has found that while people who identified themselves as conservatives tend to be less concerned about the environment than their liberal counterparts, their motivation increased significantly when they read articles that stressed the need to “protect the purity of the environment” and were shown such repellant images as a person drinking dirty water, a forest filled with garbage, and a city under a cloud of smog.

Published today (Dec. 10) in the online issue of the journal Psychological Science, the findings indicate that reframing pro-environmental rhetoric according to values that resonate strongly with conservatives can reduce partisan polarization on ecological matters.

“These findings offer the prospect of pro-environmental persuasion across party lines,” said Robb Willer, a UC Berkeley social psychologist and coauthor of the study. “Reaching out to conservatives in a respectful and persuasive way is critical, because large numbers of Americans will need to support significant environment reforms if we are going to deal effectively with climate change, in particular.”

Researchers conducted a content analysis of more than 200 op-eds published in such newspapers as The New York Times, USA Today and The Wall Street Journal, and found the pro-environmental arguments were most often pitched in terms of moral obligations to care about the natural environment and protect it from harm, a theme that resonates more powerfully with liberals, they added, than with conservatives.

They hypothesized that conservatives would be more responsive to environmental arguments focused on such principles as purity, patriotism and reverence for a higher authority. In their study, the authors specifically tested the effectiveness of arguments for protecting the purity of the environment. They said the results suggest they were on the right track:

“When individuals view protecting the environment as a moral issue, they are more likely to recycle and support government legislation to curb carbon emissions,” said Matthew Feinberg, a postdoctoral fellow in psychology at Stanford University and lead author of the study which he conducted while at UC Berkeley.

Scientific consensus on the existence of warming global land and ocean temperatures – attributed in large part to human activities that produce greenhouse gas emissions – continues to grow and influence public opinion, especially with such extreme weather events as Hurricane Sandy. A recent Rasmussen poll reported that 68 percent of Americans view climate change as a “serious problem,” compared to a 2010 Gallup poll in which 48 percent of Americans said they thought global warming was exaggerated.

In the first experiment, 187 men and women recruited via several U.S. Craigslist websites rated their political ideology on a scale of “extremely liberal” to “extremely conservative.” They then rated the morality of such activities as recycling a water bottle versus throwing it in the garbage. The results of that experiment, and a similar one conducted on 476 college undergraduates, showed that liberals are more prone to viewing sustainability as a moral issue than are conservatives.

Next, researchers conducted a content analysis of pro-environmental videos on YouTube and more than 200 op-eds in national newspapers, sorting them under the themes of “harm/care,” which they expected to resonate more with liberals, and “purity/sanctity,” which they predicted would appeal more to conservatives. They found that most pro-environmental messages leaned strongly toward liberal moral concerns.

In the last experiment, 308 men and women, again recruited via Craigslist, were randomly assigned to read one of three articles. The harm/care-themed article described the destruction wreaked on the environment by humans and pitched protection of the environment as a moral obligation. Images accompanying the text were of a forest with tree stumps, a barren coral reef and drought-cracked land, which are more typical of the visuals promoted by pro-environmental groups.

The purity/sanctity-themed article stressed how pollution has contaminated Earth and people’s bodies, and argued for cleaning up and purifying the environment. To enhance those themes and elicit disgust, the accompanying images showed a person drinking filthy water, a city under a cloud of pollution and a forest full of garbage. The neutral article talked about the history of neckties.

Participants were then asked to rate how strongly they felt certain emotions, including disgust, in response to what they’d read. Next, they reported how strongly they agreed or disagreed with such statements as “It is important to protect the environment,” “I would support government legislation aimed at protecting the environment” and ‘I believe humans are causing global warming.”

Overall, the study found that the purity-themed message inspired conservatives to feel higher levels of disgust, which in turn increased their support for protecting the environment.

Miller-McCune: America’s hidden diseases.

Millions of poor Americans living in distressed regions of the country are chronically sick, afflicted by a host of hidden diseases that are not being monitored, diagnosed or treated, researchers say. From Appalachia to the Mississippi Delta to the segregated inner cities of the Great Lakes and Northeast, they say, and from Navajo reservations to Latino communities along the U.S.-Mexico border, more than 20 chronic diseases are promoting the cycle of poverty in conditions of inadequate sanitation, unsafe water supplies and rundown housing. “These are forgotten diseases among forgotten people,” said Peter Hotez, a microbiologist at George Washington University, president of the Washington, D.C.-based Sabin Vaccine Institute and co-founder of the institute’s Global Network for Neglected Tropical Disease Control. “If these were diseases among middle-class whites in the suburbs, we would not tolerate them. They are among America’s greatest health disparities, and they are largely unknown to the U.S. medical and health communities.”  More . . .

The Pittsburgh Post-Gazette recently completed an amazing series of reports on the cancer clusters in Western Pennsylvania. Here is a sample from Day 3 of their 8-day series.

A more accurate and thorough air-monitoring network is necessary to assess human health risks and support enforcement of environmental regulations. And that’s especially true in rural areas where few monitors now exist.

“We do not have the kind of robust monitoring network we need nationally,” said S. William Becker, executive director of the National Association of Clean Air Agencies. “And we never have enough monitors in environmental justice areas, poorer areas, and rural areas that cannot protect themselves as well.”

State Department of Environmental Protection documents show that only seven of the 18 ambient air-quality monitors in 13 western counties measure levels of nearly invisible particulates — known as PM2.5 because they are smaller than 2.5 micrometers — that can be inhaled deeply into human lungs and cause or aggravate a variety of health problems, including asthma and cardiac and respiratory disease.

More . . .

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