Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study.

BACKGROUND: Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect. METHODS: An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented. RESULTS: The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed. CONCLUSIONS: This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.

What is next for the Dietary Reference Intakes for bone metabolism related nutrients beyond calcium: phosphorus, magnesium, vitamin D, and fluoride?

The science supporting the Dietary Reference Intakes (DRI) for phosphorus, magnesium, vitamin D, and fluoride was examined in this review. Along with the previous article on calcium in this series both of these reviews represent all the DRI for nutrients considered essential for bone metabolism and health, as reported in the Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (Institute of Medicine, Food and Nutrition Board (FNB), 1997). The Recomended Dietary Allowances (RDA) or adequate intake (AI), and the tolerable upper intake level (UL) were recommended for each of these essential nutrients. For adults and in the case of fluoride, for infants as well, UL were calculated since all of these nutrients have the potential for mild to detrimental side effects. Dietary intake data and controversies regarding the role these nutrients may play in other chronic diseases have also been discussed. Advances and controversies reported since the publication of the DRI for these nutrients were also addressed in this review. A recent Dietary Reference Intake Research Synthesis Workshop report identified an extensive range of suggested future research directions needed to improve our understanding of these bone-related nutrients and their contributions to human health.

Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination.

Nutrition plays an important role in health promotion and disease prevention and treatment across the lifespan. Physicians and other healthcare professionals are expected to counsel patients about nutrition, but recent surveys report minimal to no improvements in medical nutrition education in US medical schools. A workshop sponsored by the National Heart, Lung, and Blood Institute addressed this gap in knowledge by convening experts in clinical and academic health professional schools. Representatives from the National Board of Medical Examiners, the Accreditation Council for Graduate Medical Education, the Liaison Committee on Medical Education, and the American Society for Nutrition provided relevant presentations. Reported is an overview of lessons learned from nutrition education efforts in medical schools and health professional schools including interprofessional domains and competency-based nutrition education. Proposed is a framework for coordinating activities of various entities using a public-private partnership platform. Recommendations for nutrition research and accreditation are provided.

Review of the dietary reference intake for calcium: where do we go from here?

In this article the science relied on to establish the Dietary Reference Intakes (DRI) specifically for calcium was examined. The latest dietary recommendations for the essential nutrients significant with respect to their roles in bone metabolism and health were reported in the Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997) (NIM, 1997). For calcium an adequate intake was recommended because insufficient data were available at the time to determine specific Recommended Dietary Allowances. Dietary intake data and the controversies regarding the role calcium may play in other chronic diseases have also been discussed. Advances and continued dilemmas regarding these topics reported since the publication of the DRI were also addressed in this review. A recent Dietary Reference Intake Research Synthesis Workshop report identified an extensive range of suggested future research directions needed to improve our understanding of calcium and bone and health.

Relationships between the weaning period and the introduction of complementary foods in the transmission of gastrointestinal parasitic infections in children in Honduras.

PURPOSE: This study was to investigate weaning practices used by mothers when transitioning infants from breast milk to complementary foods and to determine the role these foods have in the transmission of gastrointestinal parasites. PARTICIPANTS AND METHODS: On average, of the 175 mothers extensively interviewed, 93% said they had breast-fed their infants. Approximately 20.8% of mothers had added some other liquid to their infant's diet at 3 months, while most mothers had added other liquids at 6 months (39.0%) and >6 months (32.1%). Some mothers expanded food offerings to infants before 3 months. The percentage of mothers who had added other liquids to their infants' diet was reported by age of the infant: as early as 1 day (2.5%), <1 week (1.9%), first month (3.1%), 3 months (20.8%), 6 months (39.0%), and >6 months (32.1%). These foods included fruit, vegetables, meat, and grains. The maximum age a child was found to be still breastfeeding was 13 years. RESULTS: Forty percent of mothers involved in this survey reported that their children were diagnosed and/or treated for gastrointestinal parasitic infection. Routes of infection of protozoan and helminth parasites likely resulted from contaminated complementary foods and water given to infants while still breast-feeding or from contaminated foods after breast-feeding had been completed. Contaminated water is a likely source of protozoan parasites. Contaminated water was fed to infants, mixed with formula or complementary foods, or used to wash bottles for infant feeding. There was an absence of hand-washing by children and mothers before eating or while preparing foods. CONCLUSION: The major source of soil-transmitted helminth infections was likely the result of unwashed or uncooked pureed fruit or vegetables used as complementary foods, unpasteurized animal milk, insanitary food storage, poor living conditions with exposed dirt floors, and exposure to roaming domestic animals.

Cancer Mortality Trends in Medically Underserved Counties in Virginia.

CONTEXT: Cancer mortality rates in the United States have improved during the past 40 years. The improvement in mortality rates is not equal for all types of cancer or all geographic locations, however. OBJECTIVE: To compare trends in cancer mortality rates in Virginia counties from 2005 through 2009. METHODS: Publicly available data from the National Cancer Institute, the State Cancer Profile, and the Virginia Department of Health were accessed for this analysis. For all counties in Virginia with all-cancer and lung cancer mortality data available, the authors compared counties considered medically underserved areas (VMUAs) with non-VMUAs to examine trends in cancer mortality rates that increased, remained stable, or decreased from 2005 through 2009. The significance level for all data was set at P≤.05. RESULTS: Of 136 counties in Virginia, 134 had all-cancer and 123 had lung cancer mortality data available. The VMUAs had a 48% lower decreasing all-cancer mortality rate than non-VMUAs (13 [26%] vs 37 [74%], respectively; P=.004). Non-VMUAs had a 33.3% higher stable all-cancer mortality rate than VMUAs (50 [66.6%] vs 25 [33.3%], respectively; P=.004) and a 55.2% higher lung cancer mortality rate (17 [22.4%] vs 59 [77.6%], respectively; P<.001). CONCLUSION: The all-cancer and lung cancer mortality rates were found to either remain stable or, in the case of all-cancer mortality, to increase in VMUAs.

Comparison of Mortality Disparities in Central Appalachian Coal- and Non-Coal-Mining Counties.

OBJECTIVE: Determine whether select cause of death mortality disparities in four Appalachian regions is associated with coal mining or other factors. METHODS: We calculated direct age-adjusted mortality rates and associated 95% confidence intervals by sex and study group for each cause of death over 5-year time periods from 1960 to 2009 and compared mean demographic and socioeconomic values between study groups via two-sample t tests. RESULTS: Compared with non-coal-mining areas, we found higher rates of poverty in West Virginia and Virginia (VA) coal counties. All-cause mortality rates for males and females were higher in coal counties across all time periods. Virginia coal counties had statistically significant excesses for many causes of death. CONCLUSIONS: We found elevated mortality and poverty rates in coal-mining compared with non-coal-mining areas of West Virginia and VA. Future research should examine these findings in more detail at the individual level.

Recommended dietary allowances--then and now: a review.

This is the first in a series of articles reviewing the recent revisions of the Recommended Dietary Allowances (RDA) and the resulting Dietary Reference Intakes (DRI). In the United States our nutrient guidelines have had far reaching applications to human health and agricultural practices. The broad use of the previous edition of the Recommended Dietary Allowances has necessitated a complete reevaluation of the criteria, uses and reporting of nutrient guidelines. The resulting documents, a series of reports collectively referred to as the Dietary Reference Intakes, are being released over a number of years, beginning in 1997 and expected to be completed by the year 2003.

The antioxidants--vitamin C,vitamin E, selenium, and carotenoids.

This is the second in a series of articles reviewing the recent revisions of the Recommended Dietary Allowances (RDA) and the resulting Dietary Reference Intakes (DRI). In April of 2000, the Food and Nutrition Board of the National Academy of Sciences released Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. The central premise of the report did not perpetuate the prevailing popular thought that large doses of antioxidants will prevent chronic diseases. Instead the panel concluded that at this time, insufficient scientific evidence exists to sustain claims that ingesting megadoses of dietary antioxidants can prevent certain chronic illnesses such as cardiovascular disease or cancer. In some instances recommended nutrient levels were reduced from the previous report in 1989; e.g., for the first time upper tolerable levels of ingestion (UL) were established to prevent the harmful effects of over consumption of essential nutrients, such as vitamin C, vitamin E, and selenium. Although dietary recommendations do exist for vitamin A, the panel did not set recommendations for beta-carotene or the other carotenoids due to lack of sufficient research to support recommended intakes or upper tolerable levels of intake. However, the panel advises the public to avoid intakes of provitamin A compounds, such as the numerous carotenoids, beyond the levels required to prevent vitamin A deficiency. Changes were also made with regard to estimating the amount of provitamin A carotenoids required to make a unit of retinal. The revised estimate suggests a twofold higher conversion rate than previously believed. Although this comprehensive report on the dietary reference intakes for vitamin C, vitamin E, selenium, and the carotenoids did not decisively confirm the role of antioxidants for the prevention of chronic diseases in humans, many research studies have generated new data to support this concept. Additional research is needed to define the attributes of antioxidants as studies progress from in vitro and animal studies to human nutrition.