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"Mitchell, Clive"
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Review: Artisanal Gold Mining in Africa—Environmental Pollution and Human Health Implications
About nine million Artisanal and Small-scale Gold Mining (ASGM) workers in Africa and people living near ASGM activities are highly exposed to geogenic and anthropogenic potentially toxic elements (PTEs). Despite the hazards and risks posed by ASGM being well characterized, coordinated multidisciplinary environmental characterization with combined public health studies are limited, with often piecemeal and snapshot studies reported, as highlighted by this review. Furthermore, studies are often not connected with efforts to minimize hazards holistically. Given this, we systematically reviewed the scientific literature on human health hazards associated with ASGM in Africa through Google Scholar, Science Direct, and Pubmed databases. One hundred and seventy-three peer-reviewed papers published between 1996 and June 2023 from 30 African countries were identified. Toxicological environmental hazards were reported in 102 peer-reviewed papers, notably As, Cd, CN, Cr, Hg, Pb, respirable SiO
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-laden dust, and radionuclides. Exposure to PTEs in human biomonitoring matrices and associated health impacts were documented in 71 papers. Hg was the most reported hazard. Gaps in research robustness, regulation and policy framework, technology, risk detection, surveillance, and management were found. Despite international and in-country mitigation efforts, ASGM-related hazards in Africa are worsening. This review paper highlights the need for coordinated action and multidisciplinary collaborative research to connect dispersed isolated studies to better characterize the associated disease burden associated with ASGM in Africa and sustainably maximize the wider benefits of ASGM whilst protecting public health and the environment.
Journal Article
A Platform for the Remote Conduct of Gene-Environment Interaction Studies
Gene-environment interaction studies offer the prospect of robust causal inference through both gene identification and instrumental variable approaches. As such they are a major and much needed development. However, conducting these studies using traditional methods, which require direct participant contact, is resource intensive. The ability to conduct gene-environment interaction studies remotely would reduce costs and increase capacity.
To develop a platform for the remote conduct of gene-environment interaction studies.
A random sample of 15,000 men and women aged 50+ years and living in Cardiff, South Wales, of whom 6,012 were estimated to have internet connectivity, were mailed inviting them to visit a web-site to join a study of successful ageing. Online consent was obtained for questionnaire completion, cognitive testing, re-contact, record linkage and genotyping. Cognitive testing was conducted using the Cardiff Cognitive Battery. Bio-sampling was randomised to blood spot, buccal cell or no request.
A heterogeneous sample of 663 (4.5% of mailed sample and 11% of internet connected sample) men and women (47% female) aged 50-87 years (median=61 yrs) from diverse backgrounds (representing the full range of deprivation scores) was recruited. Bio-samples were donated by 70% of those agreeing to do so. Self report questionnaires and cognitive tests showed comparable distributions to those collected using face-to-face methods. Record linkage was achieved for 99.9% of participants.
This study has demonstrated that remote methods are suitable for the conduct of gene-environment interaction studies. Up-scaling these methods provides the opportunity to increase capacity for large-scale gene-environment interaction studies.
Journal Article
Artisanal gold mining in Kakamega and Vihiga counties, Kenya: potential human exposure and health risk
Artisanal and small-scale gold mining (ASGM) represents 20% of gold supply and 90% of gold mining workforce globally, which operates in highly informal setups. Pollutants from mined ores and chemicals introduced during gold processing pose occupational and inadvertent health risks to the extent that has not been well elucidated in Africa. Trace and major elements were analysed using inductively coupled plasma mass spectrometry in soil, sediment and water samples from 19 ASGM villages in Kakamega and Vihiga counties. Associated health risks for residents and ASGM workers were assessed. This paper focuses on As, Cd, Cr, Hg, Ni and Pb for which 96% of soil samples from mining and ore processing sites had As concentrations up to 7937 times higher than the US EPA 12 mg kg−1 standard for residential soils. Soil Cr, Hg and Ni concentrations in 98%, 49% and 68% of the samples exceeded respective USEPA and CCME standards, with 1–72% bioaccessibility. Twenty-five percentage of community drinking water sources were higher than the WHO 10 µg L−1 drinking water guideline. Pollution indices indicated significant enrichment and pollution of soils, sediment and water in decreasing order of As > Cr > Hg > Ni > Pb > Cd. The study revealed increased risks of non-cancer health effects (98.6) and cancer in adults (4.93 × 10−2) and children (1.75 × 10−1). The findings will help environment managers and public health authorities better understand the potential health risks in ASGM and support evidence-based interventions in ASGM processes, industrial hygiene and formulation of public health policy to protect residents and ASGM workers’ health in Kenya.
Journal Article
Use of the internet in assessing service provision for older people
Purpose – The evaluation of primary and other care services for older people remains difficult due to the challenges of cost‐effective sampling and assessment of older people's views. The internet is an increasingly attractive option for evaluation due to its low cost and flexibility of use. The purpose of this paper is to report on a pilot study into the use of a web‐platform with older people.Design/methodology/approach – A sample of 552 community dwelling men and women, aged at least 50 years, participated in an epidemiologic study conducted entirely remotely which included questions on the provision of services for older people.Findings – The sample was heterogeneous being 52 per cent male, an age range of 50‐95 years (x¯=64 years) and with 13 per cent being in the two most deprived categories of social deprivation. Awareness of the National Service Framework for older people was low (14 per cent). For areas covered by the policy satisfaction with the availability of services was generally high (>70 per cent), whilst satisfaction with level of consultation was low (≤30 per cent).Originality/value – This study shows that the internet is a viable technology for the evaluation of primary and other care services in older people.
Journal Article
The Uncommon Becoming Common: The Rise of Cardiovascular Disease Among Young Adults
Despite increasing cardiovascular disease (CVD) rates among young adults, this population remains understudied in cardiovascular health research. This qualitative study focused on cardiovascular health literacy and health information-seeking behaviors among adults ages 18–26 to identify factors contributing to rising CVD-related risk factors. With a basic qualitative approach, the study involved semi-structured interviews with 13 young adults recruited from a local community college in an area with high-risk averages for modifiable CVD risk factors. Analysis revealed significant gaps in cardiovascular health knowledge and concerning patterns in health management behaviors. Only 20% of participants accurately understood exercise guidelines for cardiovascular health, and 90% lacked detailed nutritional knowledge. Data indicated predominantly reactive rather than proactive health management approaches. The results also showed limited blood pressure monitoring behaviors. The study identified three primary catalysts for cardiovascular health information-seeking: family health history, personal health concerns, and media exposure. However, participants demonstrated limited implementation of preventive behaviors, with data showing significant disconnects between information access and practical application. Analysis revealed that although participants had abundant access to health information through digital platforms, they struggled to verify information quality and translate knowledge into sustainable health behaviors. These findings suggest critical gaps in cardiovascular health literacy among young adults and identify specific areas for intervention. The results provide detailed insights for enhancing cardiovascular health education and developing targeted interventions.
Dissertation
Sleep disturbance and daytime sleepiness predict vascular dementia
BackgroundDisturbed sleep is common throughout the community and is associated with an increase in daytime sleepiness, both of which, in turn are associated with an increased risk of ischaemic vascular disease. The hypothesis that sleep disturbances are predictive of dementia, and in particular vascular dementia was tested in a large community-based cohort of older men.MethodsA questionnaire on sleep disturbances was administered to 1986 men aged 55–69 years in the Caerphilly Cohort Study and 10 years later the men were examined clinically for evidence of dementia or cognitive impairment with no dementia (CIND).FindingsApproximately 20% of the men reported disturbed sleep and 30% reported ‘severe’ daytime sleepiness. Ten years later 1225 men (75% of the surviving men in the cohort) were tested and 268 (22%) were found to be cognitively impaired with 93 (7.6%) showing clear evidence of dementia and the remaining 175 (14.3%) showing evidence of CIND. After adjustment for possible confounding, including cognitive function and the taking of sleeping tablets at baseline, sleep disturbances appeared to be predictive of dementia and CIND of vascular origin, while there was no suggestion of prediction of non-vascular cognitive impairment by sleep. Prediction of vascular dementia appeared to be particularly strong for daytime sleepiness, with an adjusted OR of 4.44 (95% CI 2.05 to 9.61). Further adjustments for psychological distress at baseline reduced the size of the relationships, but the ORs remain large, consistent with a direct positive effect of sleep disturbance on vascular dementia.InterpretationSleep disturbances, and in particular severe daytime sleepiness, appear to be strongly predictive of vascular dementia, but have no predictive power for non vascular dementia.
Journal Article
The opportunities and challenges of developing and implementing local climate adaptation targets
Climate adaptation policies have been developed at global, national and local levels, however, significant implementation gaps persist. Adaptation targets – achieved through metrics to assess the effectiveness of an adaptation action or policy – offer a potential solution to improve implementation. If adaptation actions can be compared and tracked, it should be possible to identify which actions are most effective, where more support is needed, the extent to which vulnerabilities are addressed, and evidence what progress is made. Despite this potential, the development and delivery of adaptation targets has been challenging because: (1) adaptation is context-specific - a target in one place may not be suitable in another; and (2) there is often a lack of clarity over how metrics should be designed. We aim to stimulate debate in this area through development of guiding principles for creating climate adaptation targets. These principles aim to increase the robustness of targets through the lens of equity and vulnerability as well as highlighting some key challenges and limitations in the development and implementation of adaptation targets at the local level.
Journal Article