Category: Public Health

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By Lauren Baggett
Illustration by Larry Choskey and Allen Sutton

Potato chips, frozen pizza, fast-food burgers—these staples of the American diet are saturated with sodium. No surprise, then, that 90 percent of Americans eat more than the recommended amount of sodium per day, a habit that can lead to high blood pressure and heart disease.

The need to reduce sodium consumption is clear, but research from UGA has shown that one popular approach—nutrition labeling—doesn’t work.

“We don’t know which interventions are most effective to reduce sodium intake in the U.S. population,” says Donglan “Stacy” Zhang, assistant professor of health policy and management at the College of Public Health and lead author of a paper published in the American Journal of Preventive Medicine. “The Nutrition Labeling and Education Act is the only policy in the U.S. focusing on informing consumers about sodium content on most packaged foods.”

Nutrition labels are designed to help consumers make the best food choices for their health, which is why calories, fats and other major nutrients like protein, fiber, and vitamins and minerals are prominently featured.

Zhang and her collaborators examined the link between regularly reading nutrition labels and consumption of high-sodium foods. Using two consumer behavior datasets from the National Health and Nutrition Examination Survey, the researchers compared how frequently participants used nutrition labels and their daily sodium intake.

They found only a small effect. Frequent nutrition label users consumed 92 milligrams less sodium per day than infrequent nutrition label users, a reduction of about 3 percent. Indeed, label readers were still eating around 3,300 milligrams of sodium—well over the Food and Drug Administration’s recommended upper limit of 2,300 milligrams per day.

“That’s a very small reduction,” Zhang says. “Without health promotion, without any other additional education intervention, nutrition labeling has little impact on sodium consumption.”

Better label design can help, according to Zhang. The current label can present challenges to some consumers with limited education or poor command of English. Visual or color-coded designs, like the traffic light model used on food packaging in the U.K., can overcome low literacy.

“We need more research in this area, how to better design the label and how to best get this information to consumers to guide their decision-making,” she says.

Zhang also found that the effect varied widely across age, gender and socioeconomic groups. Specifically, low-income consumers were less likely to use nutrition labels.

“We suspect that low-income people are more concerned about other variables such as food prices or convenience,” she says.

Interventions that increase nutritious food choices for these consumers, she says, may prove to be more successful than labeling in spurring them to reduce sodium intake.

This story appeared in the spring 2018 issue of Research Magazine. The original press release is available at https://news.uga.edu/nutritional-labeling-for-sodium/.

Lack of firsthand experience leads to fear and misunderstanding

Celebrity endorsement contributed to increase in BRCA testing

Celebrity endorsement contributed to increase in BRCA testing

Convincing parents that they are vulnerable to this kind of tragedy is key

Sinus infections are one of the most common reasons patients leave a doctor’s office with a prescription for antibiotics. But bacteria cause only about one-third of sinus infections—the rest are caused by viruses, which are not treatable with antibiotics.

To curb unnecessary antibiotic prescribing, physician and UGA researcher Mark Ebell developed a clinical decision rule for diagnosing sinus infections, or acute rhinosinusitis. In a study published in the Annals of Family Medicine, Dr. Ebell presented a series of clinical rules that integrate patient symptoms and a simple lab test to accurately detect acute bacterial rhinosinusitis.

“A lot of the signs and symptoms of a bacterial sinus infection can be similar to those of a viral respiratory infection,” said Ebell, professor of epidemiology at the College of Public Health. “It can be difficult to distinguish between the two.”

Primary practice guidelines recommend the use of antibiotics only for patients who have experienced prolonged or severe symptoms, but an estimated 72 percent of patients receive an antibiotic.

“Patients have been conditioned to expect an antibiotic for sinus infections,” Ebell said. “The goal of our research was to help identify patients who didn’t need an antibiotic because their infection is probably caused by a virus.”

To develop a clinical decision rule, Ebell needed to determine which combination of symptoms and tests best predicted the presence of bacteria and compare that prediction model to a reference standard used to confirm its accuracy. A positive bacterial culture of sinus fluid was the preferred reference standard in this study.

He and his colleague, Dr. Jens Hansen of Aarhaus University Hospital in Denmark, recorded the symptoms and C-reactive protein (CRP) levels for 175 patients suspected of having sinus infections. Based on these data, Ebell created a simple, six-item point score to determine whether a patient is at low, moderate or high risk for bacterial infection.

CRP tests detect inflammation in the body, which can indicate an infection. This is an important component of the point score, but CRP testing is not available in most primary care settings in the U.S., Ebell said.

“That’s one of the issues we wanted to call attention to,” he said. “This is a test that’s widely used by doctors in Europe, the U.K. and Australia and has been shown to decrease inappropriate antibiotic use for other respiratory infections as well.”

About half of patients in the study had a low score, meaning they were low risk for bacterial infection and most likely had a viral infection. Withholding antibiotics from this group could cut the proportion of patients receiving antibiotics in half.

Physicians can easily incorporate this point score into clinical practice, Ebell said. During an initial interview, a nurse or medical assistant can identify whether patients are experiencing any of five symptoms—previous upper respiratory or sinus infections, discolored mucus, pain in the area under the eyes, or a toothache. Then, the physician can decide whether to order a CRP test and determine a final score for sinus infection.

Ebell plans to perform a randomized clinical trial to test the effectiveness of the point score system, including the use of a CRP test, in clinical practice.

“We need to give physicians better tools to support their decision-making, and that can include clinical decision rules and point-of-care tests like CRP,” he said. “Using these kinds of tools, we can hopefully reduce unnecessary antibiotic use.

This story appeared in the fall 2017 issue of Research Magazine. The original press release is available at http://news.uga.edu/releases/article/ebell-sinus-infections-antibiotic-use/.

Tool could help track and predict Lyme disease in people

In fall 2016, nine people died when strong storms moved across southeastern Australia. They didn’t die from tornadoes, damaged power lines, flash flooding or fallen trees. Instead, they died from thunderstorm asthma, after high grass pollen concentrations dispersed by strong, gusty winds caused severe respiratory problems for thousands.

Now, UGA researchers are exploring new ways to predict thunderstorm asthma outbreaks that may one day provide early warnings for health professionals, emergency management officials and residents in affected areas.

The study, published in the Journal of Applied Meteorology and Climatology, is one of the first to specifically include well-known aspects of thunderstorm diagnostics often used by meteorologists to assess storm severity.

“Thunderstorm asthma is a very complex phenomenon and involves interactions of allergens like grass pollens, thunderstorms and susceptible groups of people,” said lead author Andrew J. Grundstein, professor of geography in the Franklin College of Arts and Sciences. “Our study may help anticipate significant thunderstorms by employing a technique that helps identify wind magnitudes commonly associated with thunderstorm asthma outbreaks.”

According to the study, the combination of rainfall, winds and lightning from thunderstorms in conjunction with bioaerosols—airborne particles like pollen or mold spores—can worsen asthma symptoms. Rainfall and high humidity rupture bioaerosols, breaking them into smaller fragments more easily inhaled into the lungs. Thunderstorm electrical activity contributes further to fragmentation, and gusting winds can spread the particles ahead of a storm. Several of these factors combined may result in an event reaching epidemic proportions.

In Melbourne, strong winds swept ryegrass pollen from surrounding pastures into the city while a thunderstorm also moved across the area between 5 and 6 p.m., when many residents were likely to be outside after leaving work or school. Downdraft winds pushed the fragmented pollen to ground level, causing respiratory distress for thousands. Emergency services were overwhelmed. More than 8,000 people went to hospitals, and there were more than 2,300 calls for ambulances.

Grundstein’s research team cross-referenced several forecast modeling tools, concluding that strong downdraft winds were a distinct characteristic of this event, a factor that may be useful in developing advance warning systems.

“While this study does not yet provide the capability of predicting thunderstorm asthma outbreaks, our methodology may provide a key piece to the puzzle for alerting public health officials about which storms may trigger an episode and which ones may not,” said co-author Marshall Shepherd, Georgia Athletic Association Distinguished Professor of Geography and Atmospheric Sciences.

That’s particularly good news for Melbourne. Thunderstorm asthma epidemics have occurred there more frequently than anywhere else in the world, Grundstein said.

This story appeared in the fall 2017 issue of Research Magazine. The original press release is available at http://news.uga.edu/releases/article/thunderstorm-asthma/.

A UGA study finds that large portions of the Southeast don’t have enough opioid treatment programs to match their high rates of opioid use disorder.

Training service coordinators in low-income public housing to better assist aging residents could improve community members’ health outcomes and save the government money.

Almost one out of every two students in abusive relationships reported threatening someone with a weapon, the study says.

Americans are split on getting an annual flu shot, with four out of 10 having done so in the past year.

Increased enrollment in the Supplemental Nutrition Assistance Program in Georgia contributed to the growth of grocery retailers at all levels from 2007 to 2014.

Dental surface restorations composed of dental amalgam, a mixture of mercury, silver, tin and other metals, significantly contribute to prolonged mercury levels in the body, according to new research from UGA’s College of Public Health.

Studies examine why people refuse vaccines