Sunday, October 26, 2008

Critical Links: Population, Health and the Environment

The impact of the world’s 6.3 billion people on the environment is unprecedented. Humans had a negligible effect on the environment 3,000 years ago when fewer than 100 million people lived on Earth, but by the early 21st century, we have altered more than one-third of Earth’s ice-free surface, and threatened the existence of many plant and animal species.

However, the number of people is just one factor driving environmental change. Where people live, and the rate of population growth are important, as well as other forces such as public policies, technological developments, and culture. All of these can ease or worsen the pressures that demographic factors place on society and the environment.

There is a relationship among population, health, and environment, but it is a complex one. It encompasses the study of human population growth, consumption, and resource use, as well as the study of the natural world, its climatology, genetics, biochemistry, and population biology. Cooperation between natural and social scientists has been complicated by major differences in paradigms, assumptions, and definitions.

Among the many questions scientists have investigated when studying the relationship among population, health, and the environment, is the question of whether population growth is good or bad for the environment and human well-being. The answer to this question is neither straightforward nor simple.

Consider the case of urbanization. A population shift toward urban areas means that a larger share of people will have access to health care, education, and other services, and living standards are likely to improve. At the same time, dense urban populations may produce more waste than the environment can absorb, leading to significant air and water pollution and a greater incidence of infectious and parasitic diseases.

Environmental conditions affect the spread of communicable diseases, which account for about one-fifth of annual deaths worldwide. An estimated 60 percent of the global burden of disease from acute respiratory infections, 90 percent from diarrheal disease, 50 percent from chronic respiratory conditions, and 90 percent from malaria could be avoided by simple environmental interventions. More than 60% of the diseases associated with respiratory infections are linked to air pollution. Most of this pollution comes from the burning of fossil fuels.

Outdoor air pollution has stabilized or declined in Western Europe and North America since 1970, according to the World Health Organization’s (WHO) air quality standards, while it has continued to increase in the less developed countries. Overall, children are at greater risk from environmental health problems than adults. Children under age 5 breathe more air, drink more water, and eat more food per unit of body weight than adults do, so they may experience higher rates of exposure to pathogens and pollutants.

Indoor air pollution also poses serious health risks. Half of the world’s households use biomass fuels such as wood, animal dung, or crop residues that produce particulates, carbon monoxide and other pollutants. Studies in less developed countries have linked indoor air pollution to lung cancer.

In addition to air pollution, new threats have been posed by industrialization. Since 1900, modern industry has introduced almost 100,000 previously unknown chemicals into the environment. Many have found their way into the air, water, soil and food. Many of these chemicals are cancer producing, promulgate genetic damage, and brain and bone damage.

Efforts to understand and manage the relationships between population, health and the environment, and to enact appropriate public policies are underway through field studies; university programs to educate policy-makers about population, health and environment relationships; international projects to document, evaluate, and disseminate information; and international conferences and working groups. These efforts contribute to a knowledge base, test methods for appropriate field interventions, engage policy makers in concrete action, and capitalize on human ingenuity to balance human needs with environmental protection.

(Summarized from POPULATION BULLETIN, Sept. 2003 pp3-43, Article by Roger-Mark DeSouza, John S. Williams, and Frederick A.B. Meyerson. Copyright© Population Reference Bureau, Inc., September, 2003.

Saturday, October 25, 2008

Asthmatic Kids and their “Dust” Cloud

Recent research has shown that no matter how clean kids are kept, they are wreathed in invisible halos of dirt and dust that can be detected using small personal monitors. Just like the Peanuts character PIG-PEN who said, “I have affixed to me the dirt and dust of countless ages,” the dust and dirt adhering to children each day can make them sick.

According to Nathan Rabinovich of the National Jewish Medical and Research Center in Denver, “Each kid has his own individual pollution cloud. What’s in it depends on what’s in their house, their school, and what their daily experience is.”

Scientists have known for a long time that dust and dirt make allergies worse, especially in inner-city urban areas. Studies have focused on measuring the efforts of counseling families on cleaning their houses and buying supplies, such as impermeable mattress and pillow covers. Yet, these studies have focused on allergens in the home, and not on what children carry with them.

Rabinovitch chose to focus his study of what he and other scientists have coined the “Pigpen Effect” on an allergenic protein called endotoxin. Endotoxin, a component of the pollution cloud, comes from bacteria that are everywhere in the environment.

What the researchers hoped to answer was why children’s asthma gets better or worse from day to day. In addition, they wanted to answer how pets may complicate a child’s asthma, even when the child is involved in activities away from home. Although the “hygiene hypothesis,” in which children exposed to endotoxin from animals and insect dust from an early age may be protected from allergies, has found favor with many researchers, it doesn’t explain why some children are allergic from an early age with such early exposure.

The research Rabinovitch conducted with children at the National Jewish Kunsbeg School found that personal exposures to endotoxin, as measured by monitors worn by the children, were significantly higher than the levels kids were exposed to in the environment. Therefore, they were definitely surrounded by a personal cloud, akin to the Pigpen illustration.

This may explain why a child who is exposed to a pet in the home can still can have an asthma attack from that pet while outside the home. As the researchers have reported in the Journal of Allergy and Clinical Immunology, the more endotoxin that surrounds a child, the more airway obstruction he or she will have to endure.

(Summarized from USA Today: Article by Steve Sternberg)

Tuesday, October 21, 2008

New studies point to the environment as having a larger role in the epidemic growth of allergies

Ft. Lauderdale veterinarian Al Brunz faced losing the occupation he loved as wheezing episodes filled his days. A visit with an allergist showed him what he suspected. “Animals are my No. 1 allergy—I’m allergic to cats,” he said.

The incidence of allergies is rising quickly, and scientists use words like “epidemic” to describe the growth. Eight percent of children age 6 or younger have some type of food allergy, while only 1 to 2% of adults are affected, the National Institutes of Health reports.

Other allergic conditions are on the rise: Eczema --itchy allergic skin rash- is the most common skin condition in children younger than 11. Incidence has increased from 3% in the 1960’s to 10% in the 1990’s, according to the NIHs.

The allergic response remains full of paradox. Filth can cause disease and asthma attacks. Yet, new studies suggest clean living probably unleashes allergies. The thinking is that clean homes, food, and water have deprived us of the constant exposure to germs and parasites that our ancestors survived. Dr. Marc Rothenberg, chief of Allergy and Clinical Immunology for the Cincinnati Children’s Hospital refers to it as the immune system’s “delinquency problem.” He states that “The immune system has too much free time, and it is getting into things that it shouldn’t.”

Other theories abound including: the rise of allergy, asthma and autoimmune diseases, as whooping cough and measles diminished; childhood vaccines; antibiotic use in babies; environmental pollutants; and, finally, Western diets that include trans-fats. For Al Brunz, who loves jogging almost as much as animals, running through downtown Ft. Lauderdale, with all of its traffic and trucks, set off his wheezing. He suspects truck and car exhaust makes his animal allergy worse.

There is mounting evidence that immunotherapy -- allergy shots -- work well for treating inhaled allergies and insect-venom allergies, and these shots can prevent new allergies and asthma, especially in children. For Al Brunz, allergy shots have freed him to return to the things he loves – jogging, yard work, and most of all, animals. Immunotherapy – allergy shots – works by exposing an allergic person to progressively greater doses of the substance they are allergic to over a period of years. That is basically a cure for many people, said Ft. Lauderdale allergist Dr. Linda Cox. “Medications work, but when you stop the meds, the allergies come back, she said. “Immunotherapy is the only intervention that can modify the allergic disease.” (Summarized from SUN-SENTINEL, Ft. Lauderdale, Florida, Feb. 2003, by Health Correspondent, Stacey Singer)

Saturday, October 18, 2008

WHY HAS ALLERGY BECOME EPIDEMIC

Heredity plays a role, but genes cannot explain the sharp increase over the past 30 years, particularly in developed countries.


Allergy is becoming epidemic in the United States. Up to 30% of adults and 40% of children now suffer from allergic rhinitis. Yet, despite their ubiquity, allergies remain mysterious. Genes are a factor, but they alone cannot account for the significant rise in allergies in the last 30 years, especially in the developed countries.

Many culprits have been proposed, including pollution and changes in lifestyle. The most startling possibility: Allergy may be caused by the success of civilization. As modern life has become more hygienic, with indoor plumbing, immunizations, and antibiotics, the human immune system is not kept running at its fullest capacity. Thus, the immune system attacks allergens to keep itself busy.

Fortunately, for the first time in decades, completely new allergy treatments are in the works. Using tools from molecular biology and genetics, researches are devising once-a-month allergy shots and vaccines that could make life virtually allergy free for millions.

The problem is not just pollen, but a host of triggers, including nuts and latex. With people spending 90 % of their time indoors, allergies to cats, molds and dust mites have become a serious health concern. Most adults work in climate controlled offices, and children play indoors after school instead of riding bikes around the neighborhood. As a result, indoor allergens have become a larger problem.

Finding out what sets off a person’s allergies isn’t too hard. An allergist can perform a skin-prick test, and blood tests are sometimes used to detect antibodies to allergens. It’s figuring out what to do next that’s difficult.

The primary weapon remains antihistamines. Although allergy shots are effective, they can cause reactions that are dangerous. There are new medications in the pipeline, such as an “anti-IgE” drugs, monoclonal antibody and anti-leukotriene drugs - such as Accolate and Singular that have proved useful for treating asthma and allergies since 1996. Scientists are working hard to create more medications. But the ultimate goal in allergy treatment may be to convince the body right from the outset that allergens are not worthy of an immune response at all.



Among the many allergies, food allergies are rare, but they are also the most dangerous, affecting mostly children. For now, the only way to evade the risk is to avoid the food.

Throughout the house, frequent cleaning with a HEPA vacuum is recommended. A HEPA or electrostatic filter on your heating and air-conditioning system will also help capture some of the dust.

There are plenty of other ways to rid one’s house of allergy triggers. As Jayne Ruppenkamp, author of 101 WAYS TO REDUCE ALLERGENS IN YOUR HOME, puts it, “Do as much or as little as it takes to make you feel better.”

(Summarized from U.S. News & World Report, May 8, 2000 pp46-53. Article by Nancy Shite)

Tuesday, October 14, 2008

The Asthma Epidemic: Unraveling a Mystery

New Jersey, the most densely populated state in the nation, is an interesting study of epidemic asthma rates across the United States. Asthma rates have climbed 75% in the United States since 1980 and almost doubled among children. Officially, 20 million Americans suffer from asthma, one third of them under age 18. In the city of Passaic, New Jersey, 22% of the children are suffering from Asthma, nearly three times the national average. Yet, fifty miles west of Passaic, in a bucolic town named Belvidere, asthma rates have soared. It has been a mystery to scientists.

Most asthma attacks are allergic reactions. The body protects itself from what it sees as a foreign invader. Something like stray particles of smoke from a nuclear plant, or a bit of rat droppings, finds its way into the air passages. An overeager immune system counterattacks, flooding the lungs with antibodies. The immune response swells the lungs, narrowing tunnels through which oxygen reaches blood vessels. Mucus clogs the remaining air spaces, the respiratory system seizes.

While scientists know what triggers asthma, such as pollution, dust and mold, the reason why people develop asthma remains unclear. Still, there is evidence that youngsters growing up in smoggy cities are three times as likely to develop asthma as other children. This was the conclusion of an 11 year old University of Southern California study tracking thousands of youngsters in nearby cities. Later, USC also reported that the lungs of children in more polluted areas grow more slowly and move air less efficiently.

On the other hand, as Beijing, China continues to industrialize, only 8% of school children have asthma, according to Noreen Clark, dean of the University of Michigan’s School of Public Health. By contrast, the air is cleaner and people smoke less in Detroit, yet 20% of the city’s students have asthma.

The answer may lie in the fact that while suburbs may not have the belching factories and smoggy interstates common to urban areas, urban pollution eventually drifts outside city limits. This may explain why Belvidere, New Jersey, located on the Delaware River, is experiencing so much asthma. A large power plant across the river is belching sulfur dioxide on the prevailing westerly winds. There are other, huge plants in Pennsylvania whose emissions can reach Belvidere.

Whatever the specific causes of asthma, people need to know whether they have it, or other respiratory conditions. Shortness of breath, wheezing, chest pain or tightness; coughing, especially at night; sputum production; excessively rapid breathing or gasping; exhaustion; insomnia due to shortness of breath; or intolerance to the smell of chemicals may all be signs of asthma. You need to see your doctor with any of these symptoms and get a formal diagnosis.

(Summarized from THE RECORD, Hackensack, NJ; copyright Knight-Ridder Newspapers: Distributed by Knight-Ridder / Tribune Information Services.)

Saturday, October 11, 2008

What Needs to be Done to Make Asthma Manageable

While asthma has grown in epidemic proportions across the United States, the disease has also become a manageable one for those that seek medical care and receive the proper education about their condition.

The problem is that still too many asthma patients lurch from asthma crisis to asthma crisis. An on-going Harvard University study of asthma patients at more than 100 emergency rooms found that one in five ended up in the ER at least six times a year, and as many as one in three suffered a relapse within three weeks of their visit.

Regular, daily use of prescription medicine is needed to prevent crises and poor breathing for people with moderate to severe asthma, but many people lack health insurance, or the coverage for drugs. Insurance is no guarantee, however, that asthma patients will get the right medications from their doctors. Some physicians, who are not allergy specialists or pulmonologists, may not prescribe the needed medications.

In addition, patients must be motivated to follow an action plan that includes lifestyle changes: quitting smoking, ridding the home of carpeting and pet dander, and dust. Some HMOs bolster the physician's educational efforts with regular phone calls from a national bank of trained nurses. Others mail reminder cards and asthma information to patients.

A combination of prescribing proper medication, motivating patients to modify their lifestyle – such as including HEPA air filters in their homes – and educating disadvantaged populations readily available ways to make asthma a manageable disease.

Summarized from THE RECORD, Bergen County, NJ; Article by Lindy Washburn and Alex Nussbaum)

Tuesday, October 7, 2008

Unusual and Promising Approaches to Allergy Prevention and Treatment

As strange as it may seem, a child's exposure to peanuts, pets, and intestinal worms might actually be good for the immune system. Doctors are trying to make use of novel approaches to retrain the immune system once it's too late and allergies set in.

Allergy shots work, but they're costly and often must be continued for years. Then the protection fades over time. There are two new strategies being developed that may improve treatment.

One strategy, pioneered by researchers in Berkeley California, involves disguising a key ragweed protein with DNA from a bacterium. The goal is to create a short course of allergy shots that tricks the immune system into permanently thinking that ragweed is a bacterium, so it will attack it like a germ and not mount an allergic response.

A second strategy being developed at UCLA involves fusing a cat allergen with a snippet of a powerful antibody call IgG. Researchers hope the combo will turn off histamine-producing cells, eventually retraining the immune system to accept that cats are harmless. Other researchers believe a low-grade infection with intestinal worms - pig whipworms because they cannot reproduce in humans - can restore the immune system.

Whether it is endotoxin or worms, scientists continue to investigate all of the factors that can confer protection against allergy and other immune diseases. For less extreme measures, or at least ones that are proven, choosing a HEPA air filter can reduce the allergens in your home, thus lowering triggers of allergic reactions.

(Summarized from: USA TODAY, March 19, 2006, article by: Steve Sternberg; Copyright© 2006 USA TODAY. Distributed by Knight-Ridder/Tribune Information Services. March 19, 2006.)