After it was revealed in February 2013 that San Diego’s former mayor, 67 year old Maureen O’Connor, lost more than a billion dollars at casinos, the gaming industry shed its disguise and became the gambling industry again. This was definitely not entertainment.
Maureen O’Connor reported that she was suffering from a brain tumor that might have impaired her judgment. A vulnerability that was not moderated by Las Vegas casinos sending private jets to fetch Ms O’Connor from San Diego. A trend that was also seen with Terry Watanabe who risked more than $825 million in 2007 at two casinos owned by Harrah's where it is alleged Harrah's senior management made a conscious decision to exploit his well-known addiction with alcohol and prescription drugs. No lawsuit has ever won. But what they do is expose the human tragedy fueled by the industry’s predatory use of complimentary services called “comps” against the increasing vulnerability of some older adults.
Bill Kearney—a staunch advocate for effective regulations of casinos—defines the world of comping in his excellent 2001 book “Comped”. Comping might start off with a free room, meals, free drinks and then, like Ms. O’Connor, ends up with to limos, helicopter and Lear Jet flights, interest-free loans, and lavish penthouse suites that the casinos provide as they cultivate their profits. These comps are in addition to exemptions that the gambling industry has gained, including no-limit ATM machines, sales tax exemptions, smoking exemptions, and many others. All these exemptions and comps transform the industry from one of entertainment—where you pay a predefined cost for a service—to predation.
Predation involves monitoring older adults’ gambling behavior and promoting both the frequency—through comping—or the amount—through interest-free loans, cashless gambling, free alcohol and medication pills. When you have older adults with obvious cognitive impairment then you need to question if such predatory behavior constitutes financial elder abuse under state laws.
In California, financial elder abuse has both criminal and civil definitions that apply to anyone 65 or older regardless of whether they have any diminished physical or mental capacity. Financial elder abuse occurs when any person or entity—takes, secrets, appropriates, obtains or retains real or personal property of an elder for a wrongful use or with intent to defraud—including assisting. “Wrongful use” is when a person “knew or should have known that this conduct is likely to be harmful to the elder.” Cal. Welfare & Institutions Code §15610.30.
This definition makes for a perfect storm. With increasing penetration of the gambling industry into nearly all States, increasing prevalence of older adults with cognitive and physical frailty, and an increasing awareness by families of the signs of financial elder abuse we might see our first test case of financial elder abuse laws against casinos. When Harrah’s comps $1.1 million to AARP we have to question what AARP is gambling with, and what are we likely to lose. Thom Reilly, executive director of the Harrah’s Foundation explained that “This relationship with the AARP Foundation allows us to extend our reach into that community and help them address caregiving issues.”
© USA Copyrighted 2014 Mario D. Garrett
Friday, February 14, 2014
Sunday, February 9, 2014
Cholesterol and our Aging Brains
Cholesterol is in every cell in our body and becomes concentrated
in our brain. Our brain is 60% fat, with over 25% of that being
cholesterol. Most of the cholesterol in the brain is produced in the
hypothalamus itself, establishing cholesterol as an integral part of our brain.
One of the most dramatic difference between young and old
brains is the reduced myelination—fat sheathing—around nerves, which might
explain why aging brains shrink at 1% a year. Myelin is a sheet of lipid, or
fat, with the highest cholesterol content of any brain tissue. Even neurotransmitters,
the chemical words used in the language that the brain communicates in, are
made of cholesterol. George Bartzokis, with UCLA, and his colleagues, found a correlation
between diminishing speed of performing tasks and diminishing level of
myelination. The older we get, the less myelination we have. And in older age
we can destroy this protective layer much faster through excessive alcohol intake
and some non-/prescription drugs.
Myelination seems to be important in how we learn. Although
grey matter—on the outside of the cortex made up of neurons—carry messages and
does the “thinking”—white matter—the myelinated part of the brain—controls the
strength of signals. Myelination is how we learn, strengthening some signals
above others. Myelination also occurs in at different ages. Starting from the
back of the brain as children, and finishing off at the front of the brain in
adulthood. This explains why certain tasks are easier when you are a child then
at older ages (learning to speak without an accent.)
And the role of cholesterol seems crucial to this process of
myelination. In 2008 Rebecca West and her colleagues from Mount Sinai School of
Medicine, New York, unexpectedly found that among normal—no expression of
dementia and not having the genes that predispose you to get dementia—older
adults aged 85 years and older, high total cholesterol and high LDL (bad) cholesterol
were associated with higher memory scores.
Other evidence is mounting. Elizabeth Johnson and Ernst Schaefer
with Tufts University, Boston, MA conjectured that one commercially available
fish oil capsule per week—180 mg dietary DHA/d—might reduce the risk of
dementia by half. On the negative side,
two small trials published in 2000 and 2004 by Matthew Muldoon from the
University of Pittsburgh, suggest that prescription medication we use to lower
cholesterol—statins—might bring about cognitive decline. He reported that
participants taking placebo pills improved on repeated tests of attention and
reaction while those on statins did not. This was further confirmed by anecdotal
evidence published in an article in 2003 in Reviews of Therapeutics which
reported that among 60 statin users who
had reported memory problems to MedWatch, when they stopped taking the medication
more than half reported improved memory.
Science is not truer than religion. Science is being able to
challenge the accepted reality of today. Science is a method rather than a body
of truths. The method is to question beliefs, to test expectations. The problem
with science in large U.S. institutions is that it has become a religion.
© USA Copyrighted 2014 Mario D. Garrett
Sunday, January 19, 2014
Leaving Behind the Victim of Dementia
Unfortunately, I come across many anecdotal stories of
caregivers dying. And as a result, leaving
behind the person who depended upon them. Increasingly, those left behind are
suffering from dementia.
This observation raises two questions. The obvious one,
which is an emotional question; who will look after the care recipient now? But
a second question has a more radical focus; why are these caregivers dying
earlier?
What has been described as a ‘living bereavement’, caring
for a loved one with dementia becomes increasingly difficult the further the
disease progresses. Unlike most other caregiving, where the care, in most
cases, becomes less stressful because the person improves (eg some stroke
patients) or they grow up (eg children) or they die quickly (eg some cancer
patients) , with dementia the diseases progressively incapacitates the victim. With
further incapacity comes a greater burden on the caregiver. Caregivers of loved
ones with dementia carry an extra burden that is reflected in more sever and
negative effects.
Although David Roth and his colleagues, in their study of 3,503
family caregivers, reported that caregiving was not associated with increased
risk of death, they failed to identify the specific type—and intensity—of care
being provided. Not all caregiving is the same. And you learn that when you
look after a victim of dementia.
As early as 1990, Janice Kiecolt-Glaser from Ohio State
University and her colleagues measured the different impact caring for a
patient with dementia had on their caregivers. They reported that caregivers of
people with dementia had significantly more depression, reported less support
and fewer important personal relationships, and experienced more days of
illnesses from infections, when compared with caregivers of non-demented loved
ones. What was convincing in their argument is that these caregivers had physical
immunological deficiencies. They were sicker.
Richard Schulz and his colleagues from the University of
Pittsburgh in 1999 showed how even after adjusting for a variety of factors, caregivers
who are experiencing strain had mortality risks that were 63% higher than non-caregiving
controls. The beneficial spiritual and physical effects of caregiving do
not override the negative effects of caring for someone with dementia.
One indicator of sickness, which also reduces your
lifespan—is the size of your telomeres. These DNA blocks at the end of each of
our 46 chromosomes have been likened to an aglet—the plastic at the end of
shoelaces. The size of these telomeres determine how many times each cell can
replicate—the longer the telomeres, the more your cell can replicate, the longer
they live, the longer you live. There are numerous studies being published
showing how stress and trauma reduces telomeres. With varying intensities of
care there are reduction in these telomeres. Dementia caregivers not only have
vastly shortened telomeres, but this change is permanent even after their loved
one dies. Despite most caregivers of dementing illness being older and frailer
than other caregivers, most choose to look after their loved ones. The
decision, of whether providing this care accelerates your mortality faster than
the mortality of your care recipient, is not an easy one to make.
© USA Copyrighted 2014 Mario D. Garrett
Sunday, January 12, 2014
Older Adults' Fascination with Obituaries
The fascination of reading the obituaries forms a purely older adult phenomenon. And it is not a morbid fascination with death, but a testament that the reader is still alive. Longevity is related to being happy with your lot. Even if you could change events, you wouldn’t--that kind of happiness. Because the only anti-aging that nature knows is death, nature rewards those who accept aging and the losses we experience on the way.
How older adults deal with loss points to effective strategies that they have learned to use in maintaining an optimistic perspective. These are patterns of coping that start early in life. These coping strategies result in less damage to the body and result in greater longevity. One theory popular in the 1980s is now known as the Baltes’s Selective Optimization with Compensation—SOC—theory. Here Baltes describes strategies of how we address physical and mental losses as we age in order to minimize their effect.
Let's take for example that you are becoming deaf. The theory predicts three main strategies that older adults follow. First you become selective. You will increasingly choose quieter social settings without conflicting noises. You stop going to loud parties. Then you will optimize those situations that you choose to participate in. You will choose to be with people that you can hear better, sitting closer, giving them your best ear, you optimize what hearing you do have. This optimizes your remaining ability to listen. Lastly, you will start to compensate. You might start going to the cinema or theatre more where you do not have to converse with anyone. You might do more activities where you do not have to talk (running, swimming, hiking.) You might also compensate by learning to use hearing aides. These three SOC strategies allow you to participate without drastically changing your lifestyle. SOC is a strategy for accepting your losses. To focus on what you can do rather than what you cannot do. This strategy, learned earlier on, gets more useful with increasing age as we experience more deficits.
One of the uniquely frequent experiences in older age is the death of a close friend. Although death never becomes easier to accept--it is so final--there is a greater appreciation of acceptance. In 2001 Christopher Davis from St. Francis Xavier University and Susan Nolen-Hoeksema from the University of Michigan reported that older adults who have lost a loved one often try to extract some meaning of their loss. Even if meaning cannot be found the authors report that older adults search for some benefit in the loss. This is different from grief of younger adults or children. The belief that there is meaning or some benefit even in anguish of loss suggest a positive strategy. Again, the strategy of SOC is to accept the reality and to try and compensate the loss by finding some hidden meaning or benefit.
The philosophy is “it could be worse.” Which brings us back to the fascination older adults have with the obituaries. You are always better than those who are dead.
© USA Copyrighted 2014 Mario D. Garrett
How older adults deal with loss points to effective strategies that they have learned to use in maintaining an optimistic perspective. These are patterns of coping that start early in life. These coping strategies result in less damage to the body and result in greater longevity. One theory popular in the 1980s is now known as the Baltes’s Selective Optimization with Compensation—SOC—theory. Here Baltes describes strategies of how we address physical and mental losses as we age in order to minimize their effect.
Let's take for example that you are becoming deaf. The theory predicts three main strategies that older adults follow. First you become selective. You will increasingly choose quieter social settings without conflicting noises. You stop going to loud parties. Then you will optimize those situations that you choose to participate in. You will choose to be with people that you can hear better, sitting closer, giving them your best ear, you optimize what hearing you do have. This optimizes your remaining ability to listen. Lastly, you will start to compensate. You might start going to the cinema or theatre more where you do not have to converse with anyone. You might do more activities where you do not have to talk (running, swimming, hiking.) You might also compensate by learning to use hearing aides. These three SOC strategies allow you to participate without drastically changing your lifestyle. SOC is a strategy for accepting your losses. To focus on what you can do rather than what you cannot do. This strategy, learned earlier on, gets more useful with increasing age as we experience more deficits.
One of the uniquely frequent experiences in older age is the death of a close friend. Although death never becomes easier to accept--it is so final--there is a greater appreciation of acceptance. In 2001 Christopher Davis from St. Francis Xavier University and Susan Nolen-Hoeksema from the University of Michigan reported that older adults who have lost a loved one often try to extract some meaning of their loss. Even if meaning cannot be found the authors report that older adults search for some benefit in the loss. This is different from grief of younger adults or children. The belief that there is meaning or some benefit even in anguish of loss suggest a positive strategy. Again, the strategy of SOC is to accept the reality and to try and compensate the loss by finding some hidden meaning or benefit.
The philosophy is “it could be worse.” Which brings us back to the fascination older adults have with the obituaries. You are always better than those who are dead.
© USA Copyrighted 2014 Mario D. Garrett
Sunday, December 8, 2013
The Death Experience.
Older Adults do not fear death they fear dying. Specifically,
we fear a prolonged process of dying—the agonal image of death. This is not a
new observation.
Lora-Jean Collett and David Lester made this distinction in 1969 and devised a scale to distinguish between the fear of death from the fear of the process of dying. Some older adults are better at confronting death than others. In an interesting study, James Griffith from Shippensburg University, Pennsylvania and his colleagues examined attitudes toward dying and death among older men who had different experiences with danger. The group of men included skydivers (high death risk), nursing home residents (high death exposure), volunteer firefighters (high death risk and high death exposure), and a control group. Their analyses identified that accepting death by risking death, reduces the fear of death. High death riskers are better at accepting death. It seems that the fear of death can be minimized, perhaps not only by risking death.
Studies with nurses have reported that working with dying patients diminished their fear of death. This acceptance of death occurred while in nurse training as well. As always, the fear is brought on more by the unknown. And this fear determines how we behave. Balfour Mount, a palliative care specialist suggested that deep-rooted existential fear of death prevents healthcare professionals from providing good and compassionate care for the dying.
Maturity involves an appreciation that dying is itself a process. A process which, at the very end, we seem to share with other people across many cultures.
Raymond Moody coined the term “Near Death Experience”—NDE. As early 1975 Moody described survivors who ‘let go’ and accepted their death, but when they survived, reported experiences of great joy. Although there are exceptions—especially with the use of medications at the end-of-life—Moody describes how after travelling through darkness they came against a bright light, accompanying “beings of light” that helped them to review their life. Such experiences have been shown to be experienced across many cultures. And the interesting outcome after these NDEs is that these individuals report having a diminished fear of death.
It was up to a chemistry professor with West Texas A&M to find some of the physiology reasons for NDEs. James E. Whinnery studied fighter pilots subjected to extreme gravitational forces in a giant centrifuge. What he found is that under extreme g-forces, fighter pilots experience gravitationally-induced loss of consciousness—G-LOC—similar to NDEs in many of its characteristics, including the tunnel experience and the bright lights. Only when Whinnery went beyond the pilots losing consciousness, to the brink of near death, did the fighter pilots have a near death experience.
We are conscious of our death and we have developed an evolutionary positive method of dealing with it. Death, as defined by our evolution, is a positive experience. Death might be detrimental to the individual, but it is imperative for the specie to survive. It is appropriate that evolution honors this. The way to reduce our fear of death is to confront it, dying itself is a positive experience.
© USA Copyrighted 2013 Mario D. Garrett
Lora-Jean Collett and David Lester made this distinction in 1969 and devised a scale to distinguish between the fear of death from the fear of the process of dying. Some older adults are better at confronting death than others. In an interesting study, James Griffith from Shippensburg University, Pennsylvania and his colleagues examined attitudes toward dying and death among older men who had different experiences with danger. The group of men included skydivers (high death risk), nursing home residents (high death exposure), volunteer firefighters (high death risk and high death exposure), and a control group. Their analyses identified that accepting death by risking death, reduces the fear of death. High death riskers are better at accepting death. It seems that the fear of death can be minimized, perhaps not only by risking death.
Studies with nurses have reported that working with dying patients diminished their fear of death. This acceptance of death occurred while in nurse training as well. As always, the fear is brought on more by the unknown. And this fear determines how we behave. Balfour Mount, a palliative care specialist suggested that deep-rooted existential fear of death prevents healthcare professionals from providing good and compassionate care for the dying.
Maturity involves an appreciation that dying is itself a process. A process which, at the very end, we seem to share with other people across many cultures.
Raymond Moody coined the term “Near Death Experience”—NDE. As early 1975 Moody described survivors who ‘let go’ and accepted their death, but when they survived, reported experiences of great joy. Although there are exceptions—especially with the use of medications at the end-of-life—Moody describes how after travelling through darkness they came against a bright light, accompanying “beings of light” that helped them to review their life. Such experiences have been shown to be experienced across many cultures. And the interesting outcome after these NDEs is that these individuals report having a diminished fear of death.
It was up to a chemistry professor with West Texas A&M to find some of the physiology reasons for NDEs. James E. Whinnery studied fighter pilots subjected to extreme gravitational forces in a giant centrifuge. What he found is that under extreme g-forces, fighter pilots experience gravitationally-induced loss of consciousness—G-LOC—similar to NDEs in many of its characteristics, including the tunnel experience and the bright lights. Only when Whinnery went beyond the pilots losing consciousness, to the brink of near death, did the fighter pilots have a near death experience.
We are conscious of our death and we have developed an evolutionary positive method of dealing with it. Death, as defined by our evolution, is a positive experience. Death might be detrimental to the individual, but it is imperative for the specie to survive. It is appropriate that evolution honors this. The way to reduce our fear of death is to confront it, dying itself is a positive experience.
© USA Copyrighted 2013 Mario D. Garrett
Saturday, November 16, 2013
Cougar Sex
David M Buss has been writing about older women’s sexual adventures for some time. He notes in “Why Women Have Sex” that women use sex as a defensive tactic against a mate’s infidelity (protection), as a ploy to boost self-confidence (status), as a barter for gifts or household chores (resource acquisition), or as a cure for a migraine headache (medication). Like most of men's evaluation of women’s sexuality, pleasure is not one of the reasons explored.
Using Craigslist to enlist three quarters of their volunteers Buss and his colleagues found that women aged 27 through 45 years of age report having more sexual fantasies, more intensely and engaging in more sexual encounters than their younger cohorts. The impact of marriage and having children was not found to be as important as age . Only age had a strong positive effect on women's reported sexual interest and behavior. Women’s sexual awakening seems to be formidable.
Women’s sexual interest was believed to peak and then fall precipitously after menopause. But this drop might be a misinterpretation by some researchers.
Susan E. Trompeter, and her colleagues from the University of California San Diego looked at women 25 years after their menopause. Half (49.8%) reported sexual activity within the past month with or without a partner. Sexual activity included arousal (64.5%), lubrication (69%), and orgasm (67.1%) at least most of the time. Only a third reported low, very low, or no sexual desire. Although frequency of sexual activity decreased with age, they all reported increased satisfaction when they did have an orgasm.
Having the brain as one of the largest sex organ—together with the skin—determines that emotional closeness is associated with more frequent arousal, lubrication, and orgasm during sex. Overall, two thirds of sexually active women were moderately or very satisfied with their sex life. With such statistics, the idea of peaking only before menopause seems a myth. For some women they keep on going.
Little is written about late life sexual activity except for educational purpose. What has been written is about marriage from public records. In a recent article in an unlikely journal of Review of Economics and Statistics, Hani Mansour and Terra McKinnish from the University of Colorado reported that couples with big age differences are typically less attractive, less educated and make less money than couples of similar ages. The more pronounced the age difference the less positive attributes they had.
Interestingly, they make a class issue (using education as a proxy for class.) More educated people tend to interact more with people their own age while those with lower formal education and who work in low-skill jobs are more likely to socialize with people of a wide range of ages. Poorer people have networks that are more age diverse. But this might be about marriage, a social contract.
Pleasure comes in many forms and sexual gratification is one of them. Marriage is not an indication of pleasure, but age is. Maurice Chevalier’s "never date anyone under half your age plus seven" might be appropriate for most people but it might not apply to some older women. Sexual arousal for older women matches those of younger men.
© USA Copyrighted 2013 Mario D. Garrett
Using Craigslist to enlist three quarters of their volunteers Buss and his colleagues found that women aged 27 through 45 years of age report having more sexual fantasies, more intensely and engaging in more sexual encounters than their younger cohorts. The impact of marriage and having children was not found to be as important as age . Only age had a strong positive effect on women's reported sexual interest and behavior. Women’s sexual awakening seems to be formidable.
Women’s sexual interest was believed to peak and then fall precipitously after menopause. But this drop might be a misinterpretation by some researchers.
Susan E. Trompeter, and her colleagues from the University of California San Diego looked at women 25 years after their menopause. Half (49.8%) reported sexual activity within the past month with or without a partner. Sexual activity included arousal (64.5%), lubrication (69%), and orgasm (67.1%) at least most of the time. Only a third reported low, very low, or no sexual desire. Although frequency of sexual activity decreased with age, they all reported increased satisfaction when they did have an orgasm.
Having the brain as one of the largest sex organ—together with the skin—determines that emotional closeness is associated with more frequent arousal, lubrication, and orgasm during sex. Overall, two thirds of sexually active women were moderately or very satisfied with their sex life. With such statistics, the idea of peaking only before menopause seems a myth. For some women they keep on going.
Little is written about late life sexual activity except for educational purpose. What has been written is about marriage from public records. In a recent article in an unlikely journal of Review of Economics and Statistics, Hani Mansour and Terra McKinnish from the University of Colorado reported that couples with big age differences are typically less attractive, less educated and make less money than couples of similar ages. The more pronounced the age difference the less positive attributes they had.
Interestingly, they make a class issue (using education as a proxy for class.) More educated people tend to interact more with people their own age while those with lower formal education and who work in low-skill jobs are more likely to socialize with people of a wide range of ages. Poorer people have networks that are more age diverse. But this might be about marriage, a social contract.
Pleasure comes in many forms and sexual gratification is one of them. Marriage is not an indication of pleasure, but age is. Maurice Chevalier’s "never date anyone under half your age plus seven" might be appropriate for most people but it might not apply to some older women. Sexual arousal for older women matches those of younger men.
© USA Copyrighted 2013 Mario D. Garrett
Children Killing Their Parents
As upsetting as it is, there are numerous blogs on how to kill your parents. Unlike elder abuse, killing younger parents seems to be voyeuristic entertainment. This surprising revelation is worrisome
The animosity children feel towards their parents provides a necessary feeling of detachment, augurs for a healthy separation process from their parents. It is how they differentiate themselves from their primary influences in life in order for them to become whole persons. Such feelings are nothing new. The surprise being websites devoted to killing one’s parents, with instructions. Then the second surprise was the statistics.
For more than two decades, Kathleen Heide from the University of South Florida has been conducting analysis of homicides where children kill their parents. In the USA about five parents a week are killed by their biological children. Matricide—where the mother is murdered--and patricide—where the father is murdered—are both very rare events and constitute about 1 percent of all homicides in the United States—but we have a lot of homicides in the US.
In a 2011 report from the Department of Justice, Alexia Cooper and Erica L. Smith reported a change in trend of family homicide. The most common were homicide by a spouse or ex-spouse, which is declining from 52% of all family homicides in 1980 to 37% in 2008. Children killed by their parents were the second most frequent type of family homicide. This is seeing an increase, from 15% in 1980 to 25% in 2008. But the fastest growing homicide is the last category where parents are killed by one of their children. This type of homicide has been increasing steadily from 9.7% of all family homicides in 1980 to 13% in 2008. Children killing their parents is the fastest growing type of family homicide. In the latest federal statistics both matricide and patricide is committed primarily by sons between 16-19 years and then declines rapidly at older ages.
In 1993 Clifford J. Linedecker wrote a book on “Killer Kids” where he reports that there were over a million assaults in the USA by children on their parents, some were fatal. He documents some of the most horrific cases. Most use their parents’ guns, others use knives, axes and any available weapon. The younger killers are more likely to use their parents’ gun.
Since patricide is most frequent (nearly twice as likely as matricide) and increasing, there might be a number of reasons for this. With increasing breakdown of family structure in the USA--with one in two marriages ending up in divorce--there is a risk of one parent alienating their children against the second parent. Parental alienation is on the increase as are children killing their fathers. Very often the father (rather than the mother) becomes portrayed as the reason for all the negative emotions. Parental alienation does not start or end with divorce. But there are reasons for this behavior. We just need to find that reasoning, however repugnant and irrational.
© USA Copyrighted 2013 Mario D. Garrett
The animosity children feel towards their parents provides a necessary feeling of detachment, augurs for a healthy separation process from their parents. It is how they differentiate themselves from their primary influences in life in order for them to become whole persons. Such feelings are nothing new. The surprise being websites devoted to killing one’s parents, with instructions. Then the second surprise was the statistics.
For more than two decades, Kathleen Heide from the University of South Florida has been conducting analysis of homicides where children kill their parents. In the USA about five parents a week are killed by their biological children. Matricide—where the mother is murdered--and patricide—where the father is murdered—are both very rare events and constitute about 1 percent of all homicides in the United States—but we have a lot of homicides in the US.
In a 2011 report from the Department of Justice, Alexia Cooper and Erica L. Smith reported a change in trend of family homicide. The most common were homicide by a spouse or ex-spouse, which is declining from 52% of all family homicides in 1980 to 37% in 2008. Children killed by their parents were the second most frequent type of family homicide. This is seeing an increase, from 15% in 1980 to 25% in 2008. But the fastest growing homicide is the last category where parents are killed by one of their children. This type of homicide has been increasing steadily from 9.7% of all family homicides in 1980 to 13% in 2008. Children killing their parents is the fastest growing type of family homicide. In the latest federal statistics both matricide and patricide is committed primarily by sons between 16-19 years and then declines rapidly at older ages.
In 1993 Clifford J. Linedecker wrote a book on “Killer Kids” where he reports that there were over a million assaults in the USA by children on their parents, some were fatal. He documents some of the most horrific cases. Most use their parents’ guns, others use knives, axes and any available weapon. The younger killers are more likely to use their parents’ gun.
Since patricide is most frequent (nearly twice as likely as matricide) and increasing, there might be a number of reasons for this. With increasing breakdown of family structure in the USA--with one in two marriages ending up in divorce--there is a risk of one parent alienating their children against the second parent. Parental alienation is on the increase as are children killing their fathers. Very often the father (rather than the mother) becomes portrayed as the reason for all the negative emotions. Parental alienation does not start or end with divorce. But there are reasons for this behavior. We just need to find that reasoning, however repugnant and irrational.
© USA Copyrighted 2013 Mario D. Garrett
Dying to Be Born
Mekayla Storer, and her colleagues in Barcelona, and Daniel Muñoz-EspÃn, and his colleagues in Madrid, just published interesting findings about death. When a cell dies, it was always assumed that it is in response to age, stress or trauma. In fact, the anti-aging industry is built upon the foundation of stopping cell death with the hope of making us immortal. But these Spanish researchers have shown that cell death is a necessary process for development. That in order for other cells to grow they need some of the cells to die first and create a pattern. What is unique in these studies is that the information comes not from older adults but from studies on the embryo.
For the first time, there is evidence showing that cell death is programmed in order for specific organs to be able to develop. Cell death is not only a part of development but is a required part it. They are like the advance party that charts out a territory and then die, sending out directions for the main party. In the embryo, when a cell dies, its death instructs new tissue growth. The necessity of cell death has been shown to help control normal limb formation, nervous system development, development of kidneys and ear formation.
These studies are showing that cell death is a necessary part of development of normal organs. This is new. Such studies are a death knoll to the anti-aging industry, since such knowledge destroys the concept of eradicating cell death in order to gain immortality. Cell death is a necessary process in order to pave the way for other cells to grow and to enable the growth of different parts of our bodies.
The process is determined by how the dead cells are cleaned by specialized cells that leave behind them a pattern that is followed by the new cells. When cells do not die, then there are problems with development. It is no wonder that birth defects are in parts of the embryos where these dead cells occur. The death of cells and how they are cleaned up is instrumental for the normal growth of cells.
This is important for older adults because dying cells and how they are cleaned up have complementary functions in cancer. We do not know the exact relationship (whether one encourages the other or not) but we know that they are related because we can listen to them communicating. Cells communicate in short distances—known as paracrine—and long distances—through hormones and endocrine system. This language could be what differentiates good dying cells from bad dying cells—cancer. Good dying cells have a different short distance message from cancer cells. Good dying cells might call out to the cleaner cells while cancer cells give short messages that keep the cleaner cells away. How these two different types of dying cells work in aging is still unknown, but we now know that cell death communicate with those living cells. Can you hear me now?
© USA Copyrighted 2013 Mario D. Garrett
Saturday, November 9, 2013
Aging Plastic Surgery: How does invasive cosmetic surgery stand the test of time.
Despite a lengthy economic recession, cosmetic surgery is still
on the increase throughout developed countries. What Roberta Honigman and David
J Castle call the “looks industry” is alive and well. It seems everyone is
doing it. It is a quick fix to a perceived embellishment.
But the fix might be more in the head than on the face. Joshua Zimm, from the University of Toronto
and his colleagues published a study in 2013 showing that facial cosmetic
surgery does not significantly enhance attractiveness and only reduces
perceived age by 3.1 years. So objective improvement is, at best, minimal.
The growth of cosmetic surgery is not a reflection of the
increasing ugliness of people but a reflection of our increasing negative
self-perception. The fact that cosmetic surgery is still increasing in
popularity despite showing little positive outcome—objective measure of
attractiveness or youth—points again to our desire to become perfect.
Body image is closely aligned to self-image and self-esteem.
The sad part of this “looks industry” is that the problem is not how people look,
but how they think they look. Because of this, surgery is often ineffective in
changing this psychology.
The Norwegian researcher Tilmann M Von Soest, from the
University of Oslo, followed 1,500 teenage girls for 13 years where 78 girls had
cosmetic surgery. Those that had cosmetic surgery tended to have a history of
poorer mental health for which cosmetic surgery showed no improvement. If the
issue about our body image is a psychological one, and even when successful—and
most people report that they are happy with the surgery two years on—the
intervention will not change your negative self image. In severe cases of such
negative self-image—body dysmorphic disorder—there is no surgical solution but
psychological.
If you undergo any surgery when you are younger, the effect
might look more unnatural since aging will include loss of skin elasticity and
collagen, along with loss of skin fat across your body. You might have a newly
formed nose but the rest of your face (and body) will be sagging.
In one such example of balance, Teri L. Hernandez and Robert
H. Eckel of the University of Colorado, found that liposuction may slim one
problem area but after a year it will create another problem area. Women who had
fat suctioned from their thighs and lower abdomen ultimately put weight back on
in often less flattering areas like the upper abdomen, back and arms. What we
are learning is that the body controls the number of its fat cells as carefully
as it controls the amount of fat. We need to work with the body to maintain healthy
good looks rather than cutting it up.
There is no data on the number of repeated surgical
procedures. Because the problem is psychological,
it is likely that most people will continue chasing their ideal image through
surgery, until either their money or body gives up. At some point you will have
to address the problem in your head.
© USA Copyrighted 2013 Mario D. Garrett
Wednesday, November 6, 2013
Intergenerational Conflict and the Addiction to Money
There is a social contract between generations that we learn to accept.
The contract simply states that we look after you until you grow up and then when you start working, you look after those who helped you. Sounds decent. Except that this social contract, when managed by politicians, translates into conflict for the obvious reason that administrators and politicians are addicted to spending money.
Back to the social intergenerational contract.
If the social generational contract was working why do we have such negative outcomes for children and older adults? In 2010 the 112th Congress Senate introduced bill 294 highlighting that Congress finds the following:
(1) The United States ranks 17th in reading, 31st in mathematics, 23rd in science, and 18th in overall secondary education out of 36 developed nations, according to the Organization for Economic Co-operation and Development (OECD).
(2) According to data compiled by the OECD, in 2008 the United States had a child poverty rate of 20.6 percent, which is the 4th highest child poverty rate of the 30 OECD countries that are ranked in this category...
In 2011 we now have a child poverty rate of over 22% with single parents with children having the third highest rate among all OECD countries.We are losing ground.
This is not a successful intergenerational contract. But the litany of woes continues.
Once our children mature and start going to college, there are other pitfalls that do not exist for children in other developed countries. Of the 20 million students that attend college every year in the US, close to 12 million borrow to help cover costs. The August 2013 Federal Reserve Statistics student loans amounted to $1,178 Trillion. Student loans are hovering around $100 Billion a year in new loans per year. Students in the US owe more than the total GDP of over 180 countries and territories (out of 194).
It surprises Europeans to learn that this cost is in addition to state funds that contribute more than $1,060 per student per 3-unit class. An enviable sum for any Country offering free education. All this cost ensures that from infants, to children, to adolescents to adulthood young Americans are enslaved in an economic stranglehold.
From the very young to young adults, between 25%-50% of Americans are destined to remaining in poverty, becoming debt ridden or electing to be uneducated and join the daily cycle of minimum work at $8:50 an hour.
So the social intergenerational contract is not working so well for our children. But at least, for older adults in the USA, there is some benefit to the social intergenerational contract.
Back to the social intergenerational contract.
We need to examine the federal figures more closely for this one.
The most successful social programs in the US has been the introduction of Social Security in 1935. Social Security has been instrumental in lowering poverty levels among older adults. But if we look at the metrics—without denying the comparative improvement of welfare of millions of older adults—the improvement does not translate to economic security in older age.
The 2010 Current Population Survey reported 43.6 million people living in poverty—the largest number in the 51 years for which poverty estimates have been published. Surprisingly, the same report shows that between 2008 and 2009, poverty increased for children under age 18 (from 19.0 to 20.7 percent) and people aged 18 to 64 (from 11.7 to 12.9 percent), but decreased for older adults (from 9.7 to 8.9 percent).
The federal poverty level was defined by Mollie Orshansky between 1963-1964 while she was working for the Social Security Administration. Ms Orshansky used the U.S. Department of Agriculture’s economy food plan for families of three or more persons and multiplied the costs by a factor of three. A sensible enough metrics in 1960s.
How can this happen when the US planned for the aging of the baby boomers? Ronald Reagan established the 1982 Commission to study and make recommendations to Congress on how to solve the Social Security obligations when the baby boomers mature. The venerable Alan Greenspan chaired the Commission. The recommendations, which become law in 1984, was for a major payroll tax hike to generate Social Security surpluses for the next 30 years, in order to build up a large reserve in the trust fund that could be drawn when the boomers become retirees—which is now. This created a massive surplus of $2.7 trillion.
Unlike other countries in the world, the United States is alone in that the surplus is spent, every cent, every year. There is even a law to stop Congress from doing this. The Budget Enforcement Act—Section 13301—made it illegal for Congress to use Social Security funds by excluding Social Security from all budgets including the congressional budget. However the intent of the law is ignored.
The 2013 Social Security Trustees Report states that "Redemption of trust fund bonds, interest paid on those bonds, and transfers from the General Fund provide no new net income to the Treasury, which must finance these payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public." This means that these are no bonds that could be sold. In order to pay this money back the government will have to raise, borrow, or print additional monies to honor them.
The "special issue Treasury Bonds" are not bonds, because they cannot be bought, sold or bartered, but simply IOUs that Congress is NOT obligated to pay back. There are Supreme Court decisions, especially the 1960 Flemming v. Nestor. where the Court denied Nestor's benefits even though he had contributed to the program for 19 years and was already receiving benefits. The decision states that there is no obligation for the federal government to honor its commitment to provide social security regardless of your contribution. It is an entitlement as long as we say it is.
The contract simply states that we look after you until you grow up and then when you start working, you look after those who helped you. Sounds decent. Except that this social contract, when managed by politicians, translates into conflict for the obvious reason that administrators and politicians are addicted to spending money.
Back to the social intergenerational contract.
If the social generational contract was working why do we have such negative outcomes for children and older adults? In 2010 the 112th Congress Senate introduced bill 294 highlighting that Congress finds the following:
(1) The United States ranks 17th in reading, 31st in mathematics, 23rd in science, and 18th in overall secondary education out of 36 developed nations, according to the Organization for Economic Co-operation and Development (OECD).
(2) According to data compiled by the OECD, in 2008 the United States had a child poverty rate of 20.6 percent, which is the 4th highest child poverty rate of the 30 OECD countries that are ranked in this category...
In 2011 we now have a child poverty rate of over 22% with single parents with children having the third highest rate among all OECD countries.We are losing ground.
This is not a successful intergenerational contract. But the litany of woes continues.
Once our children mature and start going to college, there are other pitfalls that do not exist for children in other developed countries. Of the 20 million students that attend college every year in the US, close to 12 million borrow to help cover costs. The August 2013 Federal Reserve Statistics student loans amounted to $1,178 Trillion. Student loans are hovering around $100 Billion a year in new loans per year. Students in the US owe more than the total GDP of over 180 countries and territories (out of 194).
It surprises Europeans to learn that this cost is in addition to state funds that contribute more than $1,060 per student per 3-unit class. An enviable sum for any Country offering free education. All this cost ensures that from infants, to children, to adolescents to adulthood young Americans are enslaved in an economic stranglehold.
From the very young to young adults, between 25%-50% of Americans are destined to remaining in poverty, becoming debt ridden or electing to be uneducated and join the daily cycle of minimum work at $8:50 an hour.
So the social intergenerational contract is not working so well for our children. But at least, for older adults in the USA, there is some benefit to the social intergenerational contract.
Back to the social intergenerational contract.
We need to examine the federal figures more closely for this one.
The most successful social programs in the US has been the introduction of Social Security in 1935. Social Security has been instrumental in lowering poverty levels among older adults. But if we look at the metrics—without denying the comparative improvement of welfare of millions of older adults—the improvement does not translate to economic security in older age.
The 2010 Current Population Survey reported 43.6 million people living in poverty—the largest number in the 51 years for which poverty estimates have been published. Surprisingly, the same report shows that between 2008 and 2009, poverty increased for children under age 18 (from 19.0 to 20.7 percent) and people aged 18 to 64 (from 11.7 to 12.9 percent), but decreased for older adults (from 9.7 to 8.9 percent).
The federal poverty level was defined by Mollie Orshansky between 1963-1964 while she was working for the Social Security Administration. Ms Orshansky used the U.S. Department of Agriculture’s economy food plan for families of three or more persons and multiplied the costs by a factor of three. A sensible enough metrics in 1960s.
Fast forward to 2013. The US is very different from the US of 1960s. The poverty metrics does not take into account housing costs, differences in living expenses across the country, child care, health care costs, medications and transportation. National Academy of Science developed a new formula to account for these changes. And in January 2011, the federal government officially but reticently acknowledged the need to improve the outdated federal poverty level by releasing a ‘Supplemental Poverty Measure.’
The new index, now known as the Elder Index, was calculated by the UCLA Center for Health Policy Research on behalf of the Insight Center for Community Economic Development, and Wider Opportunities for Women. The Elder Index shows that the cost of living for most US older adults far outpaces the Federal Poverty Level. The Elder Index estimates that 18.6 percent of Americans over 65 live below the poverty line, which translates to 6.8 million older adults. This index is more accurate than either the antiquated Federal Poverty Level or the Supplemental Poverty Measure because it takes into account the costs of child care, health care and transportation.
Unlike other countries in the world, the United States is alone in that the surplus is spent, every cent, every year. There is even a law to stop Congress from doing this. The Budget Enforcement Act—Section 13301—made it illegal for Congress to use Social Security funds by excluding Social Security from all budgets including the congressional budget. However the intent of the law is ignored.
The 2013 Social Security Trustees Report states that "Redemption of trust fund bonds, interest paid on those bonds, and transfers from the General Fund provide no new net income to the Treasury, which must finance these payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public." This means that these are no bonds that could be sold. In order to pay this money back the government will have to raise, borrow, or print additional monies to honor them.
The "special issue Treasury Bonds" are not bonds, because they cannot be bought, sold or bartered, but simply IOUs that Congress is NOT obligated to pay back. There are Supreme Court decisions, especially the 1960 Flemming v. Nestor. where the Court denied Nestor's benefits even though he had contributed to the program for 19 years and was already receiving benefits. The decision states that there is no obligation for the federal government to honor its commitment to provide social security regardless of your contribution. It is an entitlement as long as we say it is.
Back to the social intergenerational contract.
On the younger generational side there is Infant mortality, child poverty, educational debt encumbered, while on the older adult side we have an increasing number experiencing poverty--despite Social Security--and a Congress that has expropriate--illegally under Section 13301--all of our Social Security Trust Funds. Older adults insurance no longer exists.
Lets look at the social intergenerational contract again.
Intergenerational "conflict" is a product of abuse of funds. It is a creation of politicians and administrators who abuse the implicit agreement we have across generations. When we allow for this to happen--for administrators to expropriate our investment--then we allow for our society, our community, to fend for itself. There are no safety nets. How did we get to this place and what are some of the solutions?
We got to this place because we keep being distracted by peripheral issues that have no significance to our well being. Whenever there is an issue that hits at the core of our being, our civic society, we are distracted by jingoism and national pride or petty politics. The solution is education. Not a radical idea, but one that sounds simpler than it is. Education, not in a formal sense of going to college (which we should if we can afford it or have that inclination) but in terms of being open to discussing everything. To fight for an truly open society. To invest time to understand the issues and not to settle for sound bites. This is hard. Attend a council meeting. Participate. You do not have to say anything, just listen and be aware.
© USA Copyrighted 2013 Mario D. Garrett
We got to this place because we keep being distracted by peripheral issues that have no significance to our well being. Whenever there is an issue that hits at the core of our being, our civic society, we are distracted by jingoism and national pride or petty politics. The solution is education. Not a radical idea, but one that sounds simpler than it is. Education, not in a formal sense of going to college (which we should if we can afford it or have that inclination) but in terms of being open to discussing everything. To fight for an truly open society. To invest time to understand the issues and not to settle for sound bites. This is hard. Attend a council meeting. Participate. You do not have to say anything, just listen and be aware.
© USA Copyrighted 2013 Mario D. Garrett
Epigenetic and Dementia
Epigenetic is a process where so-called "dormant" genes are switched on or off in response to specific chemical triggers. The best example we have in aging is the increasing differentiation of identical twins—twins that developed from a single egg. In the 2005 proceedings at the National Academy of Science where a group of Spanish, Swedish, Danish, English, and American investigators report their study conclusions, it was reported that whereas young identical twin pairs are essentially indistinguishable in their epigenetic markings, older identical twin pairs show substantial variations. Resulting in increasing differences between the pair. This has been termed as “epigenetic drift” which is associated with aging.
Differences in gene expression among older twin pairs were some four times greater than those observed in young twin pairs. And the environment plays a significant role in this differentiation. The more different the twins' upbringing, the greater the difference in their epigenetic makeup and observable differences between the two twins. In some cases there is enough of a difference so that one twin gets dementia and the other does not. Although some genes have been identified for some early-onset forms of Alzheimer's disease, genes only explain 10-5% of diagnosed Alzheimer's disease, the rest remain unexplained and epigenetics might hold the answer.
Paul Coleman, from Sun Health Research Institute, in Arizona, looked at one set of identical twins—one who died of Alzheimer's disease, while the other twin died without Alzheimer’s disease. Coleman and his colleagues found that the twin that died from Alzheimer's disease not only had the characteristic disease in the brain but he also had less epigenetic activity (DNA methylation) indicating that this might be the reason for getting the disease in the first place. The twins attended the same schools and both worked as chemical engineers. However in their adult life, the one that died from Alzheimer's disease at the age of 76 was exposed to extensive pesticides at work, while the healthier twin worked in a different environment and died of prostate cancer at age 79.
Because there are so many factors involved in daily living, there is an issue in saying that the environment switches on/off specific genes that causes changes in the brain. However, emerging new results in dementia, are exposing examples where people with the disease—plaques and tangles throughout the brain—are escaping the expression of dementia. The only feasible answer is the possibility of epigenetic influences.
Epigenetic process has also been shown why certain diseases promote the expression of dementia A study by Jun Wang and her colleagues from New York Mount Sinai Hospital demonstrated that diabetes may bring about epigenetic changes. Having diabetes switches on a disease mechanism in the brain that makes the diabetic patient more prone to dementia. For the first time there is a study that shows why diabetic patients are at an increased risk of developing dementia. This new evidence, that diabetes might be the trigger to dementia, is a more likely cause given that approximately 60 percent of Alzheimer's disease patients have at least one serious medical condition associated with diabetes.
Epigenetics might hold the key in consolidating research findings that we could not explain before, while at the same time provide a theoretical explanation of how environmental and external factors contribute to the expression of dementia.
Differences in gene expression among older twin pairs were some four times greater than those observed in young twin pairs. And the environment plays a significant role in this differentiation. The more different the twins' upbringing, the greater the difference in their epigenetic makeup and observable differences between the two twins. In some cases there is enough of a difference so that one twin gets dementia and the other does not. Although some genes have been identified for some early-onset forms of Alzheimer's disease, genes only explain 10-5% of diagnosed Alzheimer's disease, the rest remain unexplained and epigenetics might hold the answer.
Paul Coleman, from Sun Health Research Institute, in Arizona, looked at one set of identical twins—one who died of Alzheimer's disease, while the other twin died without Alzheimer’s disease. Coleman and his colleagues found that the twin that died from Alzheimer's disease not only had the characteristic disease in the brain but he also had less epigenetic activity (DNA methylation) indicating that this might be the reason for getting the disease in the first place. The twins attended the same schools and both worked as chemical engineers. However in their adult life, the one that died from Alzheimer's disease at the age of 76 was exposed to extensive pesticides at work, while the healthier twin worked in a different environment and died of prostate cancer at age 79.
Because there are so many factors involved in daily living, there is an issue in saying that the environment switches on/off specific genes that causes changes in the brain. However, emerging new results in dementia, are exposing examples where people with the disease—plaques and tangles throughout the brain—are escaping the expression of dementia. The only feasible answer is the possibility of epigenetic influences.
Epigenetic process has also been shown why certain diseases promote the expression of dementia A study by Jun Wang and her colleagues from New York Mount Sinai Hospital demonstrated that diabetes may bring about epigenetic changes. Having diabetes switches on a disease mechanism in the brain that makes the diabetic patient more prone to dementia. For the first time there is a study that shows why diabetic patients are at an increased risk of developing dementia. This new evidence, that diabetes might be the trigger to dementia, is a more likely cause given that approximately 60 percent of Alzheimer's disease patients have at least one serious medical condition associated with diabetes.
Epigenetics might hold the key in consolidating research findings that we could not explain before, while at the same time provide a theoretical explanation of how environmental and external factors contribute to the expression of dementia.
© USA Copyrighted 2013 Mario D. Garrett
Friday, October 18, 2013
Childhood disability and Aging
Elo and Preston (1992) completed a review of the literature examining the effects of early life conditions on adult mortality. Their review begins with a discussion of the epidemiologic evidence for some of the major mechanisms whereby exposures and morbidity in childhood may have health consequences for adults. Initially, they examine a number of specific infectious diseases of childhood with well-documented, long-term health effects among adults (tuberculosis, hepatitis B, rheumatic heart disease) and then look at the growing literature suggesting that a number of chronic cardiovascular and pulmonary diseases may be related to a range of risk factors beginning in the intrauterine environment (e.g., intrauterine growth retardation) and extending through disease exposures and behavior patterns acquired in childhood (e.g., acute respiratory infections, dietary consumption of fat and salt). They examine other associations including a number of studies postulating that viral infections acquired in childhood may be linked to a wide variety of chronic diseases ranging from cancer to multiple sclerosis, juvenile diabetes, rheumatoid arthritis, and presenile dementia, as well as the extensive literature linking short stature and adult mortality.
Childhood Precursors of Adult Morbidity and Mortality in Developing Countries: Implications for Health Programs
W.Henry Mosley and Ronald GrayPerinatal conditions
Low birthweight
Growth stunting, chronic obstructive pulmonary disease
Birth trauma, asphyxia, metabolic disorders
Brain damage, cerebral palsy, mental retardation
Congenital and perinatal infections
Hepatitis B
Liver cancer, chronic liver diseases
Syphilis
Blindness, deafness, paralysis, bone disease
Gonorrhea
Blindness
Infectious diseases of childhood
Tuberculosis
Tuberculosis
Rheumatic fever
Chronic rheumatic heart disease
Poliomyelitis
Residual paralysis
Trachoma
Blindness
Chagas’ disease
Heart failure
Schistosomiasis
Liver cirrhosis, general debility
Helicobacter pylori
Stomach cancer
Epstein-Barr virus
Nasopharyngeal cancer, Burkitt’s lymphoma
Nutritional deficiencies in infancy and childhood
Protein-energy malnutrition
Growth stunting, obstetrical complications, cardiovascular disease, chronic pulmonary diseases, intellectual impairment
Micronutrient deficiency
Iodine
Cretinism, intellectual impairment
Iron
Learning disabilities, intellectual impairment
Vitamin A
Blindness
Environmental hazards
Indoor air pollution
Chronic obstructive pulmonary disease, lung cancer
Lead exposure
Intellectual impairment
Childhood Precursors of Adult Morbidity and Mortality in Developing Countries: Implications for Health Programs
W.Henry Mosley and Ronald GrayPerinatal conditions
Low birthweight
Growth stunting, chronic obstructive pulmonary disease
Birth trauma, asphyxia, metabolic disorders
Brain damage, cerebral palsy, mental retardation
Congenital and perinatal infections
Hepatitis B
Liver cancer, chronic liver diseases
Syphilis
Blindness, deafness, paralysis, bone disease
Gonorrhea
Blindness
Infectious diseases of childhood
Tuberculosis
Tuberculosis
Rheumatic fever
Chronic rheumatic heart disease
Poliomyelitis
Residual paralysis
Trachoma
Blindness
Chagas’ disease
Heart failure
Schistosomiasis
Liver cirrhosis, general debility
Helicobacter pylori
Stomach cancer
Epstein-Barr virus
Nasopharyngeal cancer, Burkitt’s lymphoma
Nutritional deficiencies in infancy and childhood
Protein-energy malnutrition
Growth stunting, obstetrical complications, cardiovascular disease, chronic pulmonary diseases, intellectual impairment
Micronutrient deficiency
Iodine
Cretinism, intellectual impairment
Iron
Learning disabilities, intellectual impairment
Vitamin A
Blindness
Environmental hazards
Indoor air pollution
Chronic obstructive pulmonary disease, lung cancer
Lead exposure
Intellectual impairment
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