Registration status, mercury exposure biomarkers, and neuropsychological assessment of artisanal and small-scale gold miners (ASGM) from the Western Region of Ghana.

The artisanal and small-scale gold mining (ASGM) sector is estimated to be the largest anthropogenic source of mercury pollution worldwide, and not surprisingly human exposures in this sector are amongst the highest of all population groups. While formalization of the sector has been proposed as a solution to help improve health and safety within ASGM sites, there are few empirical studies in support of this notion. The objective of this study was to assess if individuals working in ASGM sites that are registered have reduced mercury exposures and better neuropsychological scores than workers from unregistered sites. To achieve this objective, we studied biological samples (urine, hair) and survey data from a study of 404 ASGM workers (of which, 295 worked in registered ASGM sites) conducted in Tarkwa (Ghana) in 2014. Between miners working in registered and unregistered sites, there were few differences in socio-demographic characteristics. Median urinary mercury concentration (specific gravity-corrected) among those from unregistered mines was nearly 3-fold higher than those from the registered mines (18.5 versus 6.6 µg/L), and in the overall population the median concentration was 10.0 µg/L, and ranged from 0.3 to 2499 µg/L. Mercury biomarkers varied across ASGM work categories (e.g., those who burned or amalgamated had the highest) and users of personal protective equipment. Nearly 30% of the study population indicated having some challenges concerning, for example, reduced appetite, hair loss, or excess salivation. Ataxia and rigidity of gait were absent in most of the participants, and for those with slight, moderate, or marked responses, there were no differences between miners from registered and unregistered sites, across work groups, as well as in reference to mercury biomarker measures. For the pencil tapping, Frostig, matchbox, and Wechsler tests, no striking differences were found though a correlation was found between urinary mercury levels and matchbox scores among those who amalgamate and burn, and scores were similar to past studies using the same tests in ASGM sites. We believe this is the first study to compare mercury exposures and neuropsychological test results between miners from registered and unregistered ASGM sites. In doing so, the research findings provide the necessary evidence for stakeholders and parties of the Minamata Convention considering various response options to help fulfill their obligations.

Adolescent Experiences of Clinician-Patient HIV/STI Communication in Primary Care.

Effective clinician-patient communication is linked to positive patient health outcomes in adults, yet the research on adolescent populations remains limited. We describe adolescent experiences of clinician-patient HIV/STI communication through qualitative interviews with predominantly African-American adolescent women from a youth-centered primary care clinic. Participants described acknowledging clinicians are professionals, the importance of confidentiality to foster clinician-adolescent communication, and calling for clinician-initiated HIV/STI communication. Adolescents expressed the necessity for clinicians to engage youth in these challenging conversations through an open and understanding approach. Additionally, adolescents described experiences of perceived judgment and uncomfortableness from clinicians, and non-disclosure of HIV/STI risk behaviors to their clinician. Findings underscore the adolescents' desire to engage in HIV/STI communication with healthcare providers, while highlighting important strategies for clinicians. Results can inform health communication research and practice, and the development of interventions aimed at increasing clinician-adolescent HIV/STI communication.

The Usability and Acceptability of an Adolescent mHealth HIV/STI and Drug Abuse Preventive Intervention in Primary Care.

Human Immunodeficiency Virus (HIV)/sexually transmitted infection (STI) risk behaviors among adolescents remain significant public health concerns. Shifts in policy and advances in technology provide opportunities for researchers and clinicians to deliver and evaluate mobile-health (mHealth) prevention programs in primary care, however, research is limited. This study assessed the usability and acceptability of Storytelling 4 Empowerment-a mHealth HIV/STI and drug abuse preventive intervention app-among adolescents in primary care. Informed by principles of community-based participatory research, we recruited a purposive sample of 30 adolescents from a youth-centered community health care clinic in Southeast Michigan. The study sample is primarily African American and female. Adolescents who participated in the Storytelling 4 Empowerment intervention assessed its usability and acceptability, and self-reported their HIV/STI risk behaviors. We used a multiple-methods approach. Adolescents reported high acceptability of the content, process, and format of Storytelling 4 Empowerment, as evidenced by qualitative data and mean scores from the Session Evaluation Form for the HIV/STI and Alcohol/Drug content, overall Storytelling 4 Empowerment intervention, and Client Satisfaction Questionnaire-8. Findings indicate that Storytelling 4 Empowerment is acceptable among adolescents in primary care. A next step is to examine the effect of Storytelling 4 Empowerment on adolescent sexual risk and drug use behaviors and HIV/STI testing.

Multi-dimensional knowledge of malaria among Nigerian caregivers: implications for insecticide-treated net use by children.

BACKGROUND: Poor malaria knowledge can negatively impact malaria control programmes. This study evaluates knowledge distribution in the domains of causation, transmission, vulnerability, symptoms, and treatment of malaria. It assesses the association between a caregiver's knowledge about malaria and ownership and use of insecticide-treated nets (ITNs) by children. METHODS: Some 1939 caregivers of young children were recruited through a school-based survey in two Nigerian states. A 20-item, multi-dimensional survey instrument was developed and used to rank each caregiver's knowledge in five dimensions (cause, transmission, vulnerability, symptoms, treatment of malaria). Scores for each domain were used to create an aggregate knowledge score for each caregiver. The outcome measures were ITN ownership, and ITN use the night and week before the study. Regression models were used to evaluate the relationship between caregiver's knowledge (individual domains and aggregate score) and ownership and use of ITN after controlling for likely confounders. RESULTS: The main predictor of ITN use was ITN ownership (r = 0.653; p < 0.001); however, ownership only explains 43 % of variance in net use. Total knowledge index for the study population was significantly associated with both ITN ownership (r = 0.122; p = 0.001) and use (r = 0.095; p = 0.014). The spectrum of caregiver's knowledge of malaria and its causes captured in the various domains was, however, found to be poor. Fifty percent of the respondents knew that malaria is transmitted by female mosquitoes and 65 % still believe that too much exposure to the sun is a risk factor for malaria. Knowledge of populations most vulnerable to malaria (83 %) and knowledge of malaria transmission (32 %) were the domains with the highest and lowest average correct answers. CONCLUSIONS: There is a need to improve ITN coverage in Nigeria as ITN ownership was associated with ITN use. Additionally, treating knowledge as a multi-dimensional phenomenon revealed that a lot of misperceptions about malaria still exist. Distribution of ITNs through the public/private sector may need to be augmented with tailored behavioural change communication to dispel myths and improve the multi-dimensional knowledge of malaria in the local population.

Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: Systematic Review.

BACKGROUND: HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth. OBJECTIVE: The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth. METHODS: We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included. RESULTS: Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts. CONCLUSIONS: Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed.

Injury Profiles Associated with Artisanal and Small-Scale Gold Mining in Tarkwa, Ghana.

Artisanal and small-scale gold mining (ASGM) is inherently risky, but little is known about mining-associated hazards and injuries despite the tremendous growth worldwide of ASGM and the benefits it offers. The current study aimed to characterize the physical injuries associated with ASGM in Ghana to guide policy formulation. A cross-sectional survey was carried out in the Tarkwa mining district of the Western Region of Ghana in 2014. A total of 404 small-scale miners were recruited and interviewed regarding their occupational injury experiences over the preceding 10 years using a paper-based structured questionnaire. Nearly one-quarter (23.5%) of the miners interviewed reported getting injured over the previous 10 years, and the overall injury rate was calculated to be 5.39 per 100 person years. The rate was significantly higher for women (11.93 per 100 person years) and those with little mining experience (e.g., 25.31 per 100 person years for those with less than one year of work experience). The most injury-prone mining activities were excavation (58.7%) and crushing (23.1%), and over 70% of the injuries were reported to be due to miners being hit by an object. The majority of the injuries (57%) were lacerations, and nearly 70% of the injuries were to the upper or lower limbs. Approximately one-third (34.7%) of the injuries resulted in miners missing more than two weeks of work. One-quarter of the injured workers believed that abnormal work pressure played a role in their injuries, and nearly two-fifths believed that their injuries could have been prevented, with many citing personal protective equipment as a solution. About one-quarter of the employees reported that their employers never seemed to be interested in the welfare or safety of their employees. These findings greatly advance our understanding of occupational hazards and injuries amongst ASGM workers and help identify several intervention points.

Integrated assessment of artisanal and small-scale gold mining in Ghana--part 1: human health review.

This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors' recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.