Research Notes

Indoor mold, building dampness linked to respiratory problems

Scientific evidence links mold and other factors related to damp conditions in homes and buildings to asthma symptoms in some people with the chronic disorder, as well as to coughing, wheezing and upper respiratory tract symptoms in otherwise healthy people, says a new report from the Institute of Medicine of the National Academies.

The little evidence that is available on links between either indoor dampness or mold and the wide range of other health complaints that have been ascribed to them does not support an association. Because so little evidence is available, however, the committee could not rule out the possibility.

Given the frequent occurrence of moisture problems in buildings and their links to respiratory problems, excessive indoor dampness should be addressed through a broad range of public health initiatives and changes in how buildings are designed, constructed and maintained, says the committee that wrote the report.

"An exhaustive review of the scientific literature made it clear to us that it can be very hard to tease apart the health effects of exposure to mold from all the other factors that may be influencing health in the typical indoor environment," says committee chair Noreen Clark, dean of the School of Public Health. "That said, we were able to find sufficient evidence that certain respiratory problems, including symptoms in asthmatics who are sensitive to mold, are associated with exposure to mold and damp conditions.

"Even though the available evidence does not link mold or other factors associated with building moisture to all the serious health problems that some attribute to them, excessive indoor dampness is a widespread problem that warrants action at the local, state and national levels."

The study was sponsored by the Centers for Disease Control and Prevention. To read the full news release and the report, visit http://national-academies.org.
—National Academies

The pursuit of self-esteem has become a central preoccupation of American culture, but the need to prove ourselves often causes more harm than good, according to a U-M researcher.

Even though boosting self-esteem makes people feel good, it doesn't make them smarter or improve job performance or leadership. And few realize the psychological costs of trying to enhance self-esteem, says psychology professor Jennifer Crocker, who presented her findings to the American Psychological Society last month. She gives more details in an article in Psychological Bulletin.

Crocker contends that "the pursuit of self-esteem is a uniquely American phenomenon, born of the nation's founding ideologies," that American beliefs in self-reliance, meritocracy and the Protestant work ethic all encourage Americans to try to prove our value to others constantly. The Japanese are at the other extreme, she says, focusing instead on relationships with others and "fitting in rather than standing out."

She suggests that pursuing goals to prove one's value or worth as a person usually backfires. When people try to prove their worth by demonstrating they are competent, attractive or virtuous, they focus on themselves instead of other people, have a harder time identifying where they need to improve and feel pressure to succeed.

They prefer to work on tasks that make them feel competent instead of tasks that are difficult but important to achieve their goals, she says. Their self-esteem is boosted by success but drops when they fail, and over time, their unstable self-esteem contributes to symptoms of depression. The alternative, Crocker says, is to focus on what we need to learn and improve in ourselves and have goals that are good for other people as well as the self.

For more about Psychological Bulletin, visit http://www.apa.org/journals/bul/currentTOC.html.
—Joseph Serwach, News Service

Many women who regularly get checked for breast cancer and cervical cancer still don't go for a test that could save them from another big killer—colon cancer—according to U-M research.

Researchers suggest mammogram and Pap smear appointments could be used as "teachable moments" to help prompt women to get their colons checked.

In all, women who get the recommended screenings for breast and cervical cancer still are far more likely than others to have their colons examined through colonoscopy or other methods, the researchers report. But a large percentage of these seemingly health-conscious women fail to get screened for colon cancer, the No. 3 cause of cancer death in women, after lung cancer and breast cancer.

In presentations at the annual meeting of the Society for General Internal Medicine (SGIM) and at the American Roentgen Ray Society annual meeting, the team reported findings from national and Michigan population samples.

"Women have internalized the public health message that they should go for regular mammograms and that they should have Pap smears, because that's what normal women do for themselves," says Dr. Ruth Carlos, assistant professor of radiology who led the research. "Now, they need to add colorectal screenings to the list."

Carlos was lead author on a presentation at the SGIM meeting, given by Dr. Steven Bernstein, associate professor of internal medicine, showing the gap between breast, cervix and colon cancer screening. In all, only 46 percent had been checked for colon cancer as recommended, while nearly 70 percent were up-to-date with cervical cancer screening, and more than 82 percent had been getting their breasts checked like they should.

Dr. Mark Fendrick, professor of internal medicine, was Carlos's co-author on an American Journal of Managed Care editorial on the teachable moment issue.
—Kara Gavin, UMHS Public Relations

Some 600 vials stored in a U-M freezer for more than 30 years may hold keys to rescuing nearly extinct Tahitian land snails.

The snails, famous since the late 1800s as classic examples of species that had diversified rapidly in an isolated environment, later became victims of a "spectacularly inept attempt at biological control," says mollusk expert Diarmaid U+00C3U+0093 Foighil, associate professor of ecology and evolutionary biology and a curator at the Museum of Zoology.

J.B. Burch in Tahiti in 1970. (Photo by J.B. Burch)

The trouble started in 1975 when the predatory rosy wolf snail was introduced deliberately to many South Pacific islands to control an agricultural pest. The rosy wolf snail had a bigger appetite for native land snails than for the pests it was supposed to devour. Over the years, the native snails virtually were wiped out, and today only six of the original 61 species of land snails originally found in the Society Island archipelago survive in the wild.

Researchers and conservationists stepped in during the 1980s and began setting up captive populations in European and North American zoos, and snails from these breeding programs gradually are being reintroduced to protected areas in their former ranges. Understanding the evolutionary relationships between the captive populations, the remaining wild snails and the original species would greatly aid conservation and rehabilitation efforts, says Ó Foighil, and that's where those long-forgotten vials come in.

Specimen of the Tahitian land snail Partula otaheitana sampled by J.B. Burch in 1970. (Photo by Gene Lindsay)

In 1970, professor emeritus John (Jack) Burch traveled to Tahiti to study the native snails, which had not yet been decimated by the rosy wolf snail. Hiking deep into valleys where the snails were found, Burch collected several thousand specimens. He shipped about 600 live snails to the University to be freeze-dried. A plan to use the freeze-dried material for a detailed study of evolutionary relationships never materialized, leaving the vials of snails in three wooden trays in a freezer at the Museum of Zoology.

Thanks to a chance conversation with Burch, Ó Foighil learned about the vials. By extracting, amplifying and analyzing DNA from the samples, as well as from snails that die naturally in the zoo collections, Ó Foighil and colleagues can construct evolutionary trees. Some of the information they obtain may help conservationists determine which captive snail populations are best to reintroduce to the wild.
—Nancy Ross-Flanigan, News Service

Amid the flood of recent news about America's uninsured, a new study finds a troubling undercurrent: Millions of low-income children's health care gets interrupted because they start the year with one kind of insurance but end it with another kind—or they go without any coverage for part of the year.

More than 5.7 million low-income children may experience a transition in their health insurance sometime during each year, the study finds. They may shift to or from being uninsured, or they may join or leave private insurance policies and public programs such as Medicaid, as their family income or situation changes.

The study also finds that low-income kids who experience these changes in their coverage each year are more likely to postpone doctor visits and prescriptions, to go a year without seeing a doctor, or to be in fair or poor health.

The study is the first to show a link between health insurance transitions and child health care trends. It was published in the May issue of Ambulatory Pediatrics by a team from the Child Health Evaluation and Research (CHEAR) Unit of the Medical School's Department of Pediatrics and C.S. Mott Children's Hospital.

"The uninsured in America are not a homogenous group, but a rather mixed group, with some children and families remaining uninsured for a long time and others becoming uninsured more recently, or finding a new source of insurance after being without coverage for some period of time," says senior author and assistant professor Dr. Matthew Davis.

Other authors were Dr. Kimberly Aiken, a clinical instructor of pediatrics who led the analysis during her fellowship; and Dr. Gary Freed, chief of the Division of General Pediatrics and director of the CHEAR unit.
—Kara Gavin, UMHS Public Relations

In addition to the many cultural and language issues faced by elderly Arab Americans in the Detroit area, changes in family dynamics have resulted in increased challenges in providing health care and other social services to the group.

That was one of the findings of a survey and set of interviews conducted in 2002-03 by researchers from U-M-Dearborn. Paul Wong, former dean at U-M-Dearborn who now is at San Diego State University, conducted the study with a grant from the federal Administration on Aging, administered by Wayne County Senior Citizens' Services. The project was completed in conjunction with The Senior Alliance-Area Agency on Aging 1-C, which serves the elderly in western and southern Wayne County, and the Arab Community Center for Economic and Social Services (ACCESS).

"All of the respondents had quite a bit to say about changing roles and customs within the Arab American family of today," Wong says. "The biggest change, all agreed, was in the lesser amount of care and time devoted to the elderly due to economic and societal pressures, particularly the employment of women and other family members."

Topping the list of problems faced by Arab and Chaldean elderly in the survey was the problem of language, followed closely by issues connected to cultural differences. Language barriers can result in social isolation and contribute to depression in some cases. Some of the recent immigrants also suffer from depression or post-traumatic stress due to experiences in their countries of origin.

The elderly in the survey indicated a need for transportation more than any other item in the needs-assessment section. Prescription assistance received the second-highest rating of need.
—Terry Gallagher, U-M-Dearborn

In the years at the dangerous border between adolescence and adulthood, about three men die for every woman, according to a study of the ratio of male to female mortality rates in 20 nations, including the United States.

The study, selected as a "hot topic talk" presented May 28 at the annual meeting of the American Psychological Society, also appears in the current issue of the journal Evolutionary Psychology.

"Being male is now the single largest demographic risk factor for early mortality in developed countries," says Daniel Kruger, lead author of the study and a social psychologist at the Institute for Social Research (ISR). ISR researcher Randolph Nesse, professor of psychiatry at the Medical School, was the co-author of the study.

Funding for the analysis was provided by the National Institute of Mental Health.

In the United States, they found that in the year 2000 males had higher mortality rates than females for 11 causes of death across the lifespan. "The magnitude of the sex difference is most starkly summarized by the numbers of deaths before age 50," Kruger says. "For every 10 premature female deaths, 16 men died prematurely."

The highest male-female mortality ratio for a specific cause was 9.03 for suicide from ages 75 to 79, meaning that nine men in this age range killed themselves for every woman who took her own life. The next highest male-female mortality ratios were for homicide (5.72) and non-automobile accidents (4.91) from ages 20 to 24.
—Diane Swanbrow, News Service

Researchers have developed a new technique for drawing maps that could provide a valuable tool for showing human data such as census findings, election results and disease incidence.

The new technique produces cartograms—maps in which sizes of areas on the map are in proportion to the population or some other variable, says Mark Newman, assistant professor of physics in LSA. Newman wrote a paper on the technique, which appeared in the May 19 issue of the Proceedings of the National Academy of Sciences, with graduate student and research assistant Michael Gastner.

Making maps of this kind is not a new idea, but until now the methods that existed for drawing cartograms often yielded maps that were difficult to read or that had badly distorted shapes.

Newman and Gastner applied a fundamental physics formula, usually used to solve problems like those associated with gases, to "diffuse" the populations of people in the mapped area. Typically populations are non-uniform, with more people in cities and fewer in outlying areas. Using the formula, they diffused the populations in the mapped area from densely populated areas to less populated areas—similar to the way a gas naturally diffuses in air—until the population was spread out uniformly. Then they redrew the map with the resulting boundaries. The process is done on a computer, Newman says.

The computer program and the maps it produces provide a useful visualization tool with important scientific applications, such as studies of the geographic distribution of cancer cases.
—Laura Bailey, News Service

Pancreatic cancer kills swiftly and surely, and it often goes undiagnosed until it's too late for doctors to provide the only cure: surgery. But new research may give patients a better chance at early detection, firm diagnosis and, someday, better treatment options for the fourth-leading cause of cancer death.

Researchers from the Comprehensive Cancer Center (CCC) last month announced they have found a protein that allows them to tell pancreatic cancer from normal tissue better than the protein used in the current "gold standard" blood test utilized nationwide. They believe this protein, called CEACAM 1, could be used to detect early signs of cancer, especially in those patients at highest risk for the disease.

The same team also reported new findings about the basic cellular processes that allow pancreatic cancer to develop. The discovery of "crosstalk" between two cell signaling pathways involved in the disease may yield clues about why pancreatic tumors develop, and perhaps one day lead to innovative ways to stop them.

Additionally, the researchers reported initial results from gene-based efforts to tell pancreatic cancer from its more common imposter: chronic inflammation of the pancreas, or pancreatitis. By looking at expression levels for three genes in tiny tissue samples removed from patients through a slender needle, they were able to distinguish the two conditions. More research is needed, but the technique could lead to new ways of telling pancreatitis from cancer without the need for surgery.

All three announcements were made at the Digestive Diseases Week meeting in New Orleans. Dr. Diane Simeone's laboratory team made the cell signaling discovery; she co-leads the effort to translate basic genetic research into clinically useful tests, is an associate professor of surgery and runs the CCC's multidisciplinary pancreatic cancer clinic. Researchers also included Craig Logsdon, professor of physiology; postdoctoral fellow Gangyong Li; gastroenterologist Michelle Anderson; Baoan Ji, who presented the CEACAM 1 data; Beth Weinman, James Scheiman, Lizhi Zhang, Vijaya Ramachandran, David Hu, Michael Uhler, Thiruvengadam Arumugam, Samir Hanash, Thomas Giordano, Joel Greenson and Jeremy Taylor.

The research team receives funding from the Michigan Life Sciences Corridor, the Lustgarten Foundation for Pancreatic Cancer Research, CCC and the National Cancer Institute.
—Kara Gavin, UMHS Public Relations

Lois Verbrugge takes her research personally. When Verbrugge, an avid swimmer, built a home with her husband on a northern Michigan lake, her scientist's curiosity was piqued by the irritation her skin developed every time she indulged her hobby.

"I started to swim and itched intensely afterward," says Verbrugge, research professor and senior distinguished research scientist at the Institute of Gerontology. "I'm a curious person and started asking questions about what was in the lake."

Out of that was born an article in the May issue of the American Journal of Public Health. Verbrugge examined the incidence and risk factors of swimmer's itch—the lay term for cercarial dermatitis—caused by parasites in the water.

Verbrugge conducted her research at the U-M Biological Station on the shores of Douglas Lake near Pellston. She found that the more days people spent in the water, the more likely they were to develop the painful skin irritation.

Also, time spent in water waist deep or shallower increased likelihood of irritation, as didtime spent in areas of the lake with onshore, or receiving winds—winds that blow in toward shore. Onshore winds keep locally produced cercariae in place, and also bring in cercariae produced in other areas, so they become more concentrated.

Verbrugge says it probably is up to individual swimmers to take precautions. She hopes additional epidemiological studies will learn what preventive actions are successful. Verbrugge wears a full Lycra wetsuit to keep the cercariae out of her skin. She never walks through the shallow water near shore, instead walking out to the end of a long dock to get into the lake.
—Colleen Newvine, News Service