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Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012
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Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012

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Troubles impact the future of our children in the modern world, many of which are traceable to what evolutionary thinkers call—evolutionary mismatch. I am a participant with the Evolution Institute, …

Troubles impact the future of our children in the modern world, many of which are traceable to what evolutionary thinkers call—evolutionary mismatch. I am a participant with the Evolution Institute, which says this about mismatch:


Natural selection adapts organisms to their past environments and has no ability to foresee the future. When the environment changes, adaptations to past environments can misfire in the current environment, producing a mismatch that can only be solved by subsequent evolution or by modifying the current environment. Mismatches are an inevitable consequence of evolution in changing environments.

Today, we examples of potential mismatch lurking in a whole range of mental, emotional, behavioral, and related disorders affecting maternal and child health. It this talk, I plan to explore how five simple policies might address mismatch that has created epidemics of autism, fetal alcohol effects, schizophrenia, depression, and other ills. These three policy categories emerge from robust science that challenges our conventional theories about the causes of troubling things like the rise of autism, serious mental illness, or aggressive and violent behavior.

In my experience as a prevention scientist, Manitoba is perhaps the only place in the Western Hemisphere capable of implementing policies and practices that might reverse adverse trends affecting the wellbeing of mothers and children for the future. So let us have a roundtable about three easy pieces for our futures:

1. Policy Goal 1: Reduce multiple sources of neuro-inflammation before pregnancy, during pregnancy and during childhood—using low-cost, scientifically proven evidence-based kernels [1].
2. Policy Goal 2: Recognize, reinforce and reward non-use of tobacco, alcohol & other drugs among women of childbearing age —using low-cost, scientifically proven evidence-based kernels [1].
3. Policy Goal 3: Create public-private partnerships to promote specific nurturing environments actionable strategies for children and their caregivers [2, 3]

References Utilized and Cited


1. Embry DD, Biglan A: Evidence-Based Kernels: Fundamental Units of Behavioral Influence. Clinical Child & Family Psychology Review 2008, 11(3):75-113.
2. Biglan A, Flay BR, Embry DD, Sandler IN: The critical role of nurturing environments for promoting human well-being. American Psychologist 2012, 67(4):257-271.
3. Embry DD: Behavioral Vaccines and Evidence-Based Kernels: Nonpharmaceutical Approaches for the Prevention of Mental, Emotional, and Behavioral Disorders. Psychiatric Clinics of North America 2011, 34(March):1-34.

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  • 1. Mum & egg Three Easy Pieces for Maternal and Child Health Policy: MACHS Roundtable, Winnipeg, MB CANADA • December 11, 2012 by Dennis D. Embry, PAXIS InstituteTuesday, December 11, 12
  • 2. Maternal and Child Health Conference: Leadership to Action Disclosure  of  Poten/al  for  Conflict  of  Interest • Name of Speaker: Dennis D. Embry, Ph.D. • Title of Presentation: Three Easy Pieces for Maternal and Child Health Policy • Date of Presentation: December 11, 2012 • Financial Disclosure • Grants/Research Support: Yes, Co-Investigator, Towards Flourishing, PHAC • Honoraria: I receive fees to speak at this conference and other Conference • Consulting Fees: Yes, for multiple projects in Canada and the US • Other: Training fees and royalties on multiple copyrights for publicationsTuesday, December 11, 12
  • 3. Foretelling my talk today A new concept today of evolutionary mismatch that honors wisdom and science Solving linked multi-problems or syndemics instead of one-at-a-time Using low-cost proven strategies for all as public-health policy for Maternal and Child Health (MACH)Tuesday, December 11, 12
  • 4. My Three Easy Pieces for Today • Policy Goal 1: Reduce multiple sources of neuro-inflammation before pregnancy, during pregnancy and during childhood—using low-cost, scientifically proven evidence-based kernels. • Policy Goal 2: Recognize, reinforce and reward non-use of tobacco, alcohol & other drugs among women of childbearing age —using low-cost, scientifically proven evidence-based kernels. • Policy Goal 3: Create public-private partnerships to promote specific nurturing environments actionable strategies for children and their caregivers.Tuesday, December 11, 12
  • 5. The first low-cost, proven, evidence-based kernel for maternal and child health The Epidemiological ObservationTuesday, December 11, 12
  • 6. The first low-cost, proven, evidence-based kernel for maternal and child health Chlorine Handwash The Epidemiological Observation The Experimental ObservationTuesday, December 11, 12
  • 7. The first low-cost, proven, evidence-based kernel for maternal and child health Chlorine Handwash The Epidemiological Observation The Experimental ObservationTuesday, December 11, 12
  • 8. The first low-cost, proven, evidence-based kernel for maternal and child healthTuesday, December 11, 12
  • 9. Streptococcus pyogenes The culprit of massive morbidity and mortality of mothers and children. Image credit: CDCTuesday, December 11, 12
  • 10. Streptococcus pyogenes The culprit of massive morbidity and mortality of mothers and children. But the discover caused an intellectual disease: Semmelweis reflex Image credit: CDCTuesday, December 11, 12
  • 11. A policy… A course or principle of action adopted or proposed by a government, party, business, or individual. Also, archaic, prudent or expedient conduct or action: a course of policy and wisdom. ORIGIN late Middle English: from Old French policy ‘civil administration,’ via Latin from Greek politeia ‘citizenship,’ from politēs ‘citizen,’ from polis ‘city.’ policy 2 |ˈpäləsē| noun ( pl. policies ) ORIGIN mid 16th cent.: from French police ‘bill of lading, contract of insurance,’ from Provençal poliss(i)a, probably from medieval Latin apodissa, apodixa, based on Greek apodeixis ‘evidence, proof,’ from apodeiknunai ‘demonstrate, show.’Tuesday, December 11, 12
  • 12. Let us begin with some wisdom and careful observationsTuesday, December 11, 12
  • 13. Elder wisdom about child-rearing selected Humans are everyday scientists of their by evolutionary mechanisms successesTuesday, December 11, 12
  • 14. www.thisviewoflife.com “Look up Evolutionary Mismatch” Natural selection adapts organisms to their past environments and has no ability to foresee the future. When the environment changes, adaptations to past environments can misfire in the current situation, producing a mismatch that can only be solved by evolving or by modifying the current environment. Mismatches are an inevitable consequence of evolution in changing environments.Tuesday, December 11, 12
  • 15. This creates an evolutionary mismatch in the wombTuesday, December 11, 12
  • 16. Early incubator experiences for premiesTuesday, December 11, 12
  • 17. Early incubator experiences for premies What did we learn?Tuesday, December 11, 12
  • 18. What did this nurse notice about this premie?Tuesday, December 11, 12
  • 19. What are we noticing with babies and mums more today?Tuesday, December 11, 12
  • 20. Some observable trends: • Increased postpartum depression • More addictions • More “inflammatory” diseases like asthma, diabetes and obesity • More children with disabilities such as autism spectrum disorder • Higher lifetime rates of mental, emotional, behavioral, and related physical disordersTuesday, December 11, 12
  • 21. Increases in Child Problems In Manitoba Indicator Time Period Rates/Prevalence Change ADHD 2000/01 to 2009/10 2.4% to 3.9% 66% increase SP Educ 18.7/1,000 to 2000/01 to 2009/10 106% increase Funding 38.4/1,000 Children in 2000/01-2002/03 to 3.7% to 4.0% 6% increase Care 2006/07-2008/09Tuesday, December 11, 12
  • 22. 2006 Statistics Canada report on the Participation and Activity Limitation Survey (PALS) • According to Statistics Canada, more children in this country have a learning disability than all other types of disabilities combined. • According to Statistics Canada, of all the children with disabilities in this country, more than half (59.8%) have a learning disability. • According to Statistics Canada, more than half a million adults in this country live with a learning disability, making it more challenging for them to learn in universities and colleges, and on the job. • According to Statistics Canada, learning disabilities increased considerably between 2001 and 2006 among Canadians aged 15 and over by almost 40 per cent to 631,000 people, making it one of the fastest growing types of disabilities in Canada that isn’t related to aging.Tuesday, December 11, 12
  • 23. With various early childhood disabilities increasing, how does that parents and families?Tuesday, December 11, 12
  • 24. With various early Impact of childs condition on parental employment for parents of children with childhood disabilities aged 0 to 14, Canada, 2006 disabilities increasing, how does that parents and families?Tuesday, December 11, 12
  • 25. Multi-Inflammatory Brain & Body Response Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersTuesday, December 11, 12
  • 26. Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- Motor Healing Skills Multi-Inflammatory Brain & Body Response Dysfunction Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersTuesday, December 11, 12
  • 27. Substance Work Obesity, Early Mental Illness Violence Cancer School Abuse Problems etc Sex Failure Mood Lo Reward Lo Executive Lo Behavioral Inattention Function Instability Delay Competencies Poor Immune- STD’s Motor Healing Special Skills Multi-Inflammatory Brain & Body Response Dysfunction Ed Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses Reinforcement Antecedents Physiological Verbal Relations more for anti-social cue anti-social influences trigger occasion perceived than prosocial acts and threats adverse biological threats and related behaviors mechanisms reactions The Same Mismatches Predict Multiple MACH DisordersTuesday, December 11, 12
  • 28. Multi Anti-Inflammatory Brain & Body Response Multiple Behavioral Vaccines Protect the Futures of ALL Children, Youth and Adults Reinforcement Antecedents Physiological Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological safety and mechanisms affiliation Changing Conditions Protect and Prevent MACHTuesday, December 11, 12
  • 29. Mood Hi Reward Hi Executive Hi Behavioral Attention Delay Stability Function Competencies Good Immune- Motor Healing Skills Multi Anti-Inflammatory Brain & Body Response Efficiency Multiple Behavioral Vaccines Protect the Futures of ALL Children, Youth and Adults Reinforcement Antecedents Physiological Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological safety and mechanisms affiliation Changing Conditions Protect and Prevent MACHTuesday, December 11, 12
  • 30. Heart Low Work Low Delayed Mental health Prosociality Success Health Hi Sch. Addictions etc Cancer Sex Grad Mood Hi Reward Hi Executive Hi Behavioral Attention Delay Stability Function Competencies Good Immune- Low Motor Healing Higher Injuries Skills Multi Anti-Inflammatory Brain & Body Response Efficiency Ed Multiple Behavioral Vaccines Protect the Futures of ALL Children, Youth and Adults Reinforcement Antecedents Physiological Verbal Relations more for prosocial cue prosocial influences trigger occasion perceived behaviors behaviors protective biological safety and mechanisms affiliation Changing Conditions Protect and Prevent MACHTuesday, December 11, 12
  • 31. Solving some current mismatches affecting MACHTuesday, December 11, 12
  • 32. Richly Reinforce Pro-social Behaviors Reduce Toxic Influences Limit Problematic Behaviors Increase Psychological Flexibility Biglan, A., B. R. Flay, et al. (2012). "The critical role of nurturing environments for promoting human well-being." American Psychologist.Tuesday, December 11, 12
  • 33. Mothers and children in Canada do not get sufficient Vitamin D via sunlight Mothers and children in Canada do not eat foods sufficient in Vitamin D This evolutionary mismatch harms MACHTuesday, December 11, 12
  • 34. D. K. Kinney et al. Mismatch, Latitude & Schizophrenia Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality. Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For theTuesday, December 11, 12 Introduction Previous surveys found a large (>10-fold) America,in regressionlinesinNorth variation those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having
  • 35. D. K. Kinney et al. Mismatch, Latitude & Schizophrenia Semmelweis Reflex Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality. Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For theTuesday, December 11, 12 Introduction Previous surveys found a large (>10-fold) America,in regressionlinesinNorth variation those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having
  • 36. D. K. Kinney et al. Mismatch, Fish Intake & Schizophrenia Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake. Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites with Previous surveys found a largeintake, and 0.17 forin moderate fish (>10-fold) variation sitesIntroduction intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 forTuesday, December 11, 12 with low fish
  • 37. D. K. Kinney et al. Mismatch, Fish Intake & Schizophrenia Semmelweis Reflex Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009 doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant Mortality, and Skin Color: A Role for Prenatal Vitamin D Deficiency and Infections? Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2 2 Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/ partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor 4 Wellesley College, Wellesley, MA Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake. Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites with Previous surveys found a largeintake, and 0.17 forin moderate fish (>10-fold) variation sitesIntroduction intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 forTuesday, December 11, 12 with low fish
  • 38. e increased markedly economic status and healthcare, as indexed in our anal- ysis by the infant mortality rate, appears to be a muchrenia prevalence with weaker predictor of risk for schizophrenia than are lati- d is not due simply to Mismatch, Skin Color & Schizophrenia tude and winter temperature. A high infant mortality ratetic and ascertainmentalysis of data collected particularly informa-t controlled for possi- ences in prevalence at investigative person- were used to obtain ent sites within the Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009studied schizophrenia doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 ites in the same timeiagnostic criteria and Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant data showedSkin very A Role for Prenatal Vitamin D Deficiency and Infections? Mortality, and a Color: with both latitude w temperature (r = Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2cially wide variation in 2 Key words: epidemiology/etiology/immune function/ 3 Genetics Laboratory, McLean Hospital, Belmont, MA; De-he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor partment of Psychiatry, Harvard Medical 4 Wellesley College, Wellesley, MA Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the Tuesday, December 11, 12 Introduction Previous surveys found a large (>10-fold) variation in
  • 39. e increased markedly economic status and healthcare, as indexed in our anal- ysis by the infant mortality rate, appears to be a muchrenia prevalence with weaker predictor of risk for schizophrenia than are lati- d is not due simply to Mismatch, Skin Color & Schizophrenia tude and winter temperature. A high infant mortality ratetic and ascertainmentalysis of data collected Semmelweis particularly informa- Reflext controlled for possi- ences in prevalence at investigative person- were used to obtain ent sites within the Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009studied schizophrenia doi:10.1093/schbul/sbp023 Advance Access publication on April 8, 2009 ites in the same timeiagnostic criteria and Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant data showedSkin very A Role for Prenatal Vitamin D Deficiency and Infections? Mortality, and a Color: with both latitude w temperature (r = Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority. William Hyman2, and Emerald Huang2cially wide variation in 2 Key words: epidemiology/etiology/immune function/ 3 Genetics Laboratory, McLean Hospital, Belmont, MA; De-he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor partment of Psychiatry, Harvard Medical 4 Wellesley College, Wellesley, MA Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the Tuesday, December 11, 12 Introduction Previous surveys found a large (>10-fold) variation in
  • 40. Latitude and Infantile Autism Grant, W. B. and C. M. Soles (2009). "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.Tuesday, December 11, 12
  • 41. Latitude and Infantile Autism Semmelweis Grant, W. B. and C. M. Soles (2009). Reflex "Epidemiologic evidence supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism." Dermatoendocrinol 1(4): 223-228.Tuesday, December 11, 12
  • 42. Estimated deaths per year would fall by 37,000 people, or about 16%-22% of annual mortality in Canada. And, $14 billionTuesday, December 11, 12
  • 43. Estimated deaths Semmelweis per year would fall by 37,000 people, Reflex or about 16%-22% of annual mortality in Canada. And, $14 billionTuesday, December 11, 12
  • 44. Among pregnant women, lower Vitamin D is associated with: • Adverse fertility • Primary cesarean section parameters (n = 2), (n = 1), • Preeclampsia (n = 5), • Few days (n = 2) shorter gestation, • Gestational diabetes or higher blood glucose • And, postpartum (n = 6), depression (n = 1) • Bacterial vaginosis (n = 4), Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/ aogs.12000. Epub 2012 Oct 17. The impact of vitamin D on pregnancy: a systematic review. Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.Tuesday, December 11, 12
  • 45. Among pregnant women, lower Vitamin D is associated with: Semmelweis • Adverse fertility • Primary cesarean section Reflex parameters (n = 2), (n = 1), • Preeclampsia (n = 5), • Few days (n = 2) shorter gestation, • Gestational diabetes or higher blood glucose • And, postpartum (n = 6), depression (n = 1) • Bacterial vaginosis (n = 4), Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/ aogs.12000. Epub 2012 Oct 17. The impact of vitamin D on pregnancy: a systematic review. Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.Tuesday, December 11, 12
  • 46. • Reduced postpartum depression • Reduced lifetime depression, including bipolar disorder • Increased child IQ • Better academic success • Reduced childhood Vitamin D with mental, emotional, and Omega-3 (fish) behavioural disorders Hibbeln, J., J. M. Davis, et al. (2007). "Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study." The Lancet 369(9561): 578-585. Hibbeln, J. R., L. R. Nieminen, et al. (2006). "Healthy intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity." American Journal of Clinical Nutrition 83(6 Suppl): 1483S-1493S.Tuesday, December 11, 12
  • 47. • Reduced postpartum depression • Reduced lifetime Semmelweis depression, including Reflex bipolar disorder • Increased child IQ • Better academic success • Reduced childhood Vitamin D with mental, emotional, and Omega-3 (fish) behavioural disorders Hibbeln, J., J. M. Davis, et al. (2007). "Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study." The Lancet 369(9561): 578-585. Hibbeln, J. R., L. R. Nieminen, et al. (2006). "Healthy intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity." American Journal of Clinical Nutrition 83(6 Suppl): 1483S-1493S.Tuesday, December 11, 12
  • 48. Tuesday, December 11, 12
  • 49. Semmelweis ReflexTuesday, December 11, 12
  • 50. Semmelweis ReflexTuesday, December 11, 12
  • 51. Semmelweis ReflexTuesday, December 11, 12
  • 52. Semmelweis ReflexTuesday, December 11, 12
  • 53. Semmelweis ReflexTuesday, December 11, 12
  • 54. Tuesday, December 11, 12
  • 55. Semmelweis ReflexTuesday, December 11, 12
  • 56. Richly Reinforce Pro-social Behaviors Reduce Toxic Influences Limit Problematic Behaviors Increase Psychological Flexibility Biglan, A., B. R. Flay, et al. (2012). "The critical role of nurturing environments for promoting human well-being." American Psychologist.Tuesday, December 11, 12
  • 57. How might we reduce alcohol, tobacco, and other drugs among women of child bearing ageTuesday, December 11, 12
  • 58. Which warning labels might work?Tuesday, December 11, 12
  • 59. Trendline for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous WarningsTuesday, December 11, 12
  • 60. Trendline for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Tuesday, December 11, 12
  • 61. Trendline for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Tuesday, December 11, 12
  • 62. Trendline for humorous warnings on binge drinking by women of child-rearing No Warnings Humorous Warnings 20 16 Percentage 12 8 4 0 1995 1997 1999 2001 2002 2003 2004 2005 2006 2007Tuesday, December 11, 12
  • 63. Rewarding Clerks & Stores for Not Welling to Minors Youth Who Smoked During the Last 30 Days Baseline Reward and Reminder Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming 40.0% Youth Who Smoked During the Last 30 Days 16.0% Youth Who Smoked Every Day the Last 30 Days 35.0% Baseline Reward and Reminder 14.0% Baseline Reward and Reminder 45.0% 30.0% 18.0% 12.0% Source: Youth Risk 25.0% 40.0% Wyoming 16.0% 10.0% Wyoming Behavior Survey 20.0% 35.0% 8.0% 14.0% (YRBS), Centers for 15.0% 30.0% 10.0% 6.0% 12.0% 4.0% Disease Control 5.0% 25.0% 2.0% 10.0% 0.0% 20.0% 8.0% 18.0% Wisconsin Wisconsin 40.0% 16.0% 15.0% 6.0% 35.0% 14.0% 10.0% 4.0% 30.0% 12.0% 5.0% 25.0% 2.0% 10.0% 20.0% 8.0% 0.0% 15.0% 6.0% 18.0% 10.0% Wisconsin 4.0% Wisconsin 40.0% 16.0% 5.0% 2.0% 35.0% 0.0% 14.0% 18.0% 30.0% United States 12.0% United States 40.0% 16.0% 25.0% 35.0% 10.0% 14.0% 30.0% 12.0% 20.0% 8.0% 25.0% 10.0% 15.0% 6.0% 20.0% 8.0% 10.0% 15.0% 4.0% 6.0% 10.0% 4.0% 5.0% 2.0% 5.0% 2.0% 0.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 1995 1997 1999 2001 2003 2005 2007 18.0% 1995 1997 1999 2001 2003 2005 2007 United States United States 40.0% = Trend = Wyoming 16.0% = Wisconsin =United States 35.0% 14.0%Tuesday, December 11, 12 30.0% 12.0%
  • 64. Rewarding Clerks & Stores for Not Welling to Minors Youth Who Smoked During the Last 30 Days Baseline Reward and Reminder Youth Who Smoked Every Day the Last 30 Days Baseline Reward and Reminder 45.0% 18.0% Wyoming Wyoming 40.0% Youth Who Smoked During the Last 30 Days 16.0% Youth Who Smoked Every Day the Last 30 Days 35.0% Baseline Reward and Reminder 14.0% Baseline Reward and Reminder 45.0% 30.0% 18.0% 12.0% Source: Youth Risk 25.0% 40.0% Wyoming 16.0% 10.0% Wyoming Behavior Survey 20.0% 35.0% 8.0% 14.0% (YRBS), Centers for 15.0% 30.0% 10.0% 6.0% 12.0% 4.0% Disease Control 5.0% 25.0% 2.0% 10.0% 0.0% 20.0% 8.0% 18.0% Wisconsin Wisconsin 40.0% 16.0% 15.0% 6.0% 35.0% 14.0% 10.0% 4.0% 30.0% 12.0% 5.0% 25.0% 2.0% 10.0% 20.0% 8.0% 0.0% 15.0% 6.0% 18.0% 10.0% Wisconsin 4.0% Wisconsin 40.0% 16.0% 5.0% 2.0% 35.0% 0.0% 14.0% 18.0% 30.0% United States 12.0% United States 40.0% 16.0% 25.0% 35.0% 10.0% 14.0% 30.0% 12.0% 20.0% 8.0% 25.0% 10.0% 15.0% 6.0% 20.0% 8.0% 10.0% 15.0% 4.0% 6.0% 10.0% 4.0% 5.0% 2.0% 5.0% 2.0% 0.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control 0.0% 0.0% 1995 1997 1999 2001 2003 2005 2007 18.0% 1995 1997 1999 2001 2003 2005 2007 United States United States 40.0% = Trend = Wyoming 16.0% = Wisconsin =United States 35.0% 14.0%Tuesday, December 11, 12 30.0% 12.0%
  • 65. Wait for the Timer for tobacco addictions with SMI/CMI Antecedent Kernel Happens BEFORE the behaviorTuesday, December 11, 12
  • 66. Teaching Psychological flexibility by cognitive defusion the thought d put it on s and a f an fee ling le the s “s tre on am g ” lin ee af nd a ht ug tho a Write I am h avin g a se nsa tio no f… I am ha ving at… a fe elin th g of ht … ug tho the in g hav I am Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.comTuesday, December 11, 12
  • 67. Teaching Psychological flexibility by cognitive defusion the thought d put it on s and a f an fee ling le the s “s tre on am g ” lin ee af nd a ht ug tho a Write I am h avin g a se nsa tio no f… I am ha ving at… a fe elin th g of ht … ug tho the in g hav I am Copyright © 2007-2012, PAXIS Institute. All rights reserved. May be reproduced but not sold. www.paxtalk.comTuesday, December 11, 12
  • 68. Lifespan example of one kernel for prevention, intervention and treatment Reinforcement KernelHappens AFTER the behavior Available from Amazon.com for $45Tuesday, December 11, 12
  • 69. Mobilizing for MACHTuesday, December 11, 12
  • 70. Implementation & Logic Models See: Multi-problem analyses Predict Create Plan Population- Identify Benefits: Level Change: Nurturing Environments Logic Model for population-level benefits Cultivate Create Community Prevention Identify Score/Dashboard Update Research Databases for Proven Prevention Solutions Document Launch Social Marketing: Advocacy & Media Population-Level Targeting Products Performance B Developmen Birth Childhood ta l stages Low Report Adolescence Adulthood Intensity Hi Multiple reach Fa Sc Place Price els m ho ilie Settings o lev Or s ga ls A Co ni mm atio ach un ns itie /re s C Promotion sity en Recognize & Reward Int successes in/by High Intensity Low reach Note: Workforce development efficiency achieved by broad use of similar/same evidence-based Create Monitor & Coach strategies or evidence-based kernels. & Developed by PAXIS Institute © 2010-2012, all rights reserved. May be freely reporduced in total with attribution and noticeTuesday, December 11, 12
  • 71. Epigenesis Social Biological Environmental Inputs These Genesis Epigenetics are Nurturing or Toxic polygenes Environments, heritable Disease, or can be changes in Threats “added”, gene expression “subtracted”, caused by “divided”, or mechanisms “multiplied.” M g or lin Phosphorlyation other than ph na og Acetylation changes in the Sig en Methylation underlying DNA sis Histone Remodeling sequence. Chromatin Stucture Changes Development Immunity Stem Cell Changes Imprinting These changes Parent, can pass 1st Generation Three through multiple Generation Baby, generations. Effects 2nd Generation Reproductive Cells, 3rd GenerationTuesday, December 11, 12
  • 72. Thank you Dennis D. Embry dde@paxis.orgTuesday, December 11, 12

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