Data sharing by popular health apps is routine and far from transparent, warn experts

Externally peer-reviewed? Yes
Type of evidence: Traffic and network analysis
Subjects: Mobile apps

Developers should allow users to choose precisely what data are shared and with whom, say researchers

Health-related apps (Image source: Pixabay)
Health-related apps (Image source: Pixabay)

Sharing of user data by popular mobile health applications (apps) is routine, yet far from transparent, warn experts in a study published in The BMJ today.

They say regulators should emphasise the accountabilities of those who control and process user data, and health app developers should disclose all data sharing practices and allow users to choose precisely what data are shared and with whom.

App developers routinely, and legally, share user data. But evidence suggests that many health apps fail to provide privacy assurances around data sharing practices, and pose unprecedented risk to consumers’ privacy, given their ability to collect sensitive and personal health information.

So researchers led by Assistant Professor Quinn Grundy at the University of Toronto, set out to investigate whether and how user data are shared by popular medicines related mobile apps and to characterise privacy risks to app users, both clinicians and consumers.

They identified 24 top rated medicines related apps for the Android mobile platform in the United Kingdom, United States, Canada, and Australia.

All apps were available to the public, provided information about medicines dispensing, administration, prescribing, or use, and were interactive.

First, they downloaded each app onto a smartphone and used four dummy user profiles to simulate real world use.

They ran each app 14 times and found baseline traffic relating to 28 different types of user data. They then altered one source of user information and ran the app again to detect any privacy leaks (sensitive information sent to a remote server, outside of the app). Companies receiving sensitive user data were then identified by their IP address, and their websites and privacy policies were analysed.

Most (19 out of 24; 79%) of the sampled apps shared user data outside of the app.

A total of 55 unique entities, owned by 46 parent companies, received or processed app user data, including developers and parent companies (first parties) and service providers (third parties).

Of these, 18 (33%) provided infrastructure related services such as cloud services and 37 (67%) provided services related to the collection and analysis of user data, including analytics or advertising, suggesting heightened privacy risks.

Network analysis revealed that first and third parties received an average of three unique transmissions of user data. Both Amazon.com and Alphabet (the parent company of Google) received the highest volume of user data (24 unique transmissions), followed by Microsoft (14).

Third parties also advertised the ability to share user data with 216 “fourth parties” including multinational technology companies, digital advertising companies, telecommunications corporations, and a consumer credit reporting agency.

Only three of these fourth parties could be characterised predominantly as belonging to the health sector.

Several companies, including Alphabet, Facebook, and Oracle, occupied central positions within the network with the ability to aggregate and re-identify user data

The researchers point to some limitations that may have influenced the results. For example, it is unknown whether iOS apps share user data and whether these apps share user data more or less than other health apps, or apps in general.

Nevertheless, they say their findings suggest that health professionals “should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent.”

Privacy regulators should also consider that loss of privacy is not a fair cost for the use of digital health services, they conclude.

Notes:
Research: Data sharing practices of medicines related apps and the mobile ecosystem: traffic, content, and network analysis
Journal: The BMJ

http://www.bmj.com/content/364/bmj.l920

Author contacts:
Quinn Grundy, Assistant professor and honorary senior lecturer, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Tel: +1 647 913 7075
Email: quinn.grundy@utoronto.ca (or @quinngrundy on Twitter

Dr Ralph Holz, School of Computer Science, The University of Sydney, Sydney, NSW, Australia
Tel: +61 475 421 044
Email: ralph.holz@sydney.edu.au

Early life exposure to common pesticides linked to small increased risk of autism spectrum disorder

Externally peer-reviewed? Yes (research); No (editorial)
Type of evidence: Observational; Opinion
Subjects: Offspring
Findings support efforts to prevent exposure to pesticides during pregnancy

Autism thinking (Image source: Pixabay)
Autism thinking (Image source: Pixabay)

Exposure to common agricultural pesticides before birth and in the first year of life is associated with a small to moderately increased risk of autism spectrum disorder (ASD) compared with infants of women without such exposure, finds a study published in The BMJ today.

The researchers say their findings support efforts to prevent exposure to pesticides during pregnancy to protect a child’s developing brain.

Experimental studies have suggested that common pesticides can affect normal brain development, and environmental exposures during early brain development are suspected to increase risk for autism spectrum disorders in children.

But studies examining pesticide exposure in the real world and risk of ASD are rare.

So researchers at the University of California used registry records to identify 2,961 patients with a diagnosis of ASD – including 445 with ASD with accompanying intellectual disability – and 35,370 healthy (“control”) patients of the same birth year and sex.

Participants were born between 1998 and 2010 in California’s Central Valley, a heavily agricultural region, and 80% of cases were male.

Data from the California state-mandated Pesticide Use Registry were then integrated into a geographic information system tool to assess prenatal (before birth) and infant exposures to 11 commonly used pesticides (measured as pounds of pesticides applied per acre/month within 2 km of their mother’s residence during pregnancy and exposure during developmental periods defined as yes vs no).

These pesticides were selected because of their high use and evidence indicating toxic effects on brain development.

After adjusting for potentially influential factors, the researchers found modest increases in ASD risk among offspring exposed to several pesticides (including glyphosate, chlorpyrifos, diazinon, malathion,  permethrin, bifenthrin and methyl-bromide) before birth and during the first year of life, compared with controls.

Associations were strongest in those with ASD and intellectual disability, which represents the more severe end of the autism spectrum.

This is an observational study, and as such, can’t establish cause, and the researchers point to some limitations, such as relying on patient records for details about diagnoses, and being unable to examine clinical outcomes.

Nevertheless, they say their study is by far the largest investigating pesticides and autism spectrum disorder to date and their findings back up earlier work in this field.

“Our findings suggest that ASD risk may increase with prenatal and infant exposure to several common ambient pesticides that impacted neurodevelopment in experimental studies,” they write.

They call for further research to explore underlying mechanisms in the development of autism. However, from a public health and preventive medicine perspective, they say their findings “support the need to avoid prenatal and infant exposure to pesticides to protect the developing child’s brain.”

In a linked editorial, Amanda Bakian and James VanDerSlice at the University of Utah agree that reducing exposure to pesticides during pregnancy “is sensible public health policy” but they point out that this “might be close to impossible for some populations.”

Future research exploring underlying biological mechanisms and individual susceptibilities in other regions of the world “may help to translate these study findings into more refined public health actions for pregnant women residing in areas of high pesticide use,” they conclude.


Notes:
Research: Prenatal and infant exposure to ambient pesticides and autism spectrum disorder in children: population based case-control study
Editorial: Pesticides and autism
Journal: The BMJ

http://www.bmj.com/content/364/bmj.l962

Author contacts:

Research: Dr Ondine von Ehrenstein, Associate Professor, Departments of Community Health Science and Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
Tel: +1 213 298 70 24
Email: ovehren@ucla.edu

Editorial: Amanda Bakian, Assistant Professor, Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
Tel: +1 801 581 5413
Email: amanda.bakian@hsc.utah.edu

New Labour’s policies reduced geographical inequalities in infant mortality rates

Teddy bear

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People
The gap in infant mortality rates between English local authorities narrowed between 1999-2010, but that trend has been reversed since 2011 – perhaps as a result of austerity.

Efforts by the Labour government to reduce inequalities between the most deprived areas of England and the rest of the country had a positive impact on infant mortality rates, suggests research by the Universities of Newcastle, Leeds, York, and Liverpool published online in the Journal of Epidemiology & Community Health.

However, the authors warn that the current Conservative government’s austerity policies may have undermined these gains because the trend in decreasing inequalities has not continued perhaps due to austerity measures.

When Tony Blair’s New Labour government came to power in 1997, it attempted to use policy levers to reduce geographical health inequalities in England.

There was a focus on early years, education, supporting families, engaging communities in tackling deprivation, improving prevention, increasing access to healthcare and tackling the underlying social determinants of health (e.g. via tax credits and introducing the minimum wage).

A range of social programmes such as SureStart were funded and there were large funding increases for the NHS and other public services.

However, when the Conservative–Liberal Democrat coalition took control in 2010 this strategy was replaced with austerity measures intended to reduce the national deficit.

For this study the authors examined what impact New Labour’s policies had on health inequalities by measuring inequalities in the infant mortality rate between the most deprived local authorities and the rest of England before, during and after its health inequalities strategy was put in place.

They found that before New Labour’s health inequalities strategy (1983–1998), the gap in the infant mortality between the most deprived local authorities and the rest of England increased at a rate of 3 infant deaths per 100,000 births per year.

During the strategy period (1999–2010), the gap narrowed by 12 infant deaths per 100,000 births per year and after the strategy period ended (2011–2017) the gap began increasing again at a rate of 4 deaths per 100,000 births per year.

There was also a marginal decrease in relative inequalities* during the strategy period.

This is an observational study, and as such, can’t establish causality. The authors also highlight that their results may have differed if they had used infant survival rather than infant mortality as an outcome measure, or occupational class rather than geographical area as a measure of deprivation.

The observed decrease in inequalities in the infant mortality rate may also have been impacted by broader government strategies rather than the health inequalities strategy alone, they add.

Nevertheless, they say: “The multifaceted English health inequalities strategy, implemented between 1999 and 2010, was associated with a decrease in geographical inequalities in the infant mortality rate between the most and less deprived English local authorities.”

“These results imply that government policies specifically introduced to decrease inequalities in health may be beneficial, and that their discontinuation as a result of austerity may see inequalities increasing again.”

They add that the findings have important implications for current and future health policy. “Our analysis suggests that it is increases in public spending on healthcare and welfare that are associated with decreases in inequalities in the infant mortality rate, and this is something that should be learnt from by current and future governments.

“Current government policies are arguably going in the wrong direction and may squander some of the gains made in the health inequalities strategy period,” they conclude.

Notes
*Relative inequality is the difference between the rate in the most deprived areas and the rate in the rest of England expressed as a proportion of the rate in the rest of England

Research: The impact of New Labour’s English health inequalities strategy on geographical inequalities in infant mortality: a time-trend analysis doi:10.1136/jech-2018-211679
Journal: Journal of Epidemiology & Community Health
http://jech.bmj.com/lookup/doi/10.1136/jech-2018-211679

Author contact:
Professor Clare Bambra, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
Tel: +44 (0)191 208 8289
Email: clare.bambra@ncl.ac.uk

Even low levels of leisure time physical activity lowers risk of death

Physical activity (Image source: Pixabay)
Physical activity (Image source: Pixabay)

Externally peer reviewed? Yes
Evidence type: Observational; survey data
Subjects: People

And being active for longer or participating in vigorous sports has additional health benefits

Even low-level physical activities, such as walking or gardening, are associated with a lower risk of death from cardiovascular disease, cancer or any cause finds a large observational study published online in the British Journal of Sports Medicine.

Higher amounts of activity or more vigorous activities, such as running, cycling and competitive sports, are associated with additional health benefits that are not outweighed by the risks of participating in these activities, the authors say.

Every year, a representative sample of the US population is asked about their health and lifestyle behaviours for the National Health Interview Surveys. The authors used data collected through the surveys between 1997 and 2008 to estimate the activity levels of 88,140 people aged 40–85 years, and linked that data with registered deaths up until 31 December 2011.

They calculated the total leisure time physical activity of participants using definitions in 2008 US guidelines, which roughly equate one minute of vigorous activity such as running, fast cycling or competitive sports as equivalent to two minutes of moderate-intensity activity, such as brisk walking, gardening or dancing. Only activities lasting at least 10 continuous minutes were taken into account.

Compared with individuals who were inactive, those who participated in just 10–59 min/week of moderate physical activities during their leisure time had an 18% lower risk of death from any cause over the study period, and the health benefits continued to mount as activity levels went up.

US 2008 guidelines recommend at least 150 minutes per week of moderate activity done in at least 10 minute bouts, and individuals who participated in 150–299 min/week reduced their overall risk of death by 31%. Those who clocked up ten times this amount – 1500 min or more per week – almost halved their risk (46% lower).

Reductions in risk of death from cancer also corresponded with increasing activity levels.

In terms of risk of death from cardiovascular events such as strokes and heart attacks, individuals who were active for 10-59 min/week during their leisure time saw their risk fall by 12%, and those who did 120-299 min/week by 37%, compared with people who were inactive.

However, much greater levels of physical activity were not associated with any greater benefits; individuals who were active for 1500 min or more per week had a reduced risk of death from cardiovascular disease of 33% – so their risk of death was slightly higher than those who met recommended activity levels but undertaking more moderate amounts.

This is an observational study, and as such, can’t establish cause, and also relied on participants self-reporting activity levels. However, the authors point out that the study also has many strengths, including its large sample size representative of the US population, and that their findings support US recommendations on activity levels.

The study also showed that individuals who participated in vigorous physical activities had significantly lower risk of death than those who only did light/moderate physical activity, so the authors recommend, like the US guidelines, that people short of time should consider more vigorous activities.

Attaining the highest levels of physical activity assessed – 1500 min or more/week “is difficult to achieve for a working adult”, they admit. “Participation in vigorous-intensity activity is more time-efficient than moderate-intensity activity,” the authors say.

“Vigorous-intensity physical activity may be an attractive option for able-bodied individuals with limited time.”

Research: Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults doi:10.1136/bjsports-2018-099254
Journal: British Journal of Sports Medicine

http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2018-099254

Author contact:
Dr Bo Xi, Department of Epidemiology, School of Public Health, Shandong University, China
Email (preferred – author will respond promptly): xibo2007@126.com

The rise & fall of Ziggy star formation & the rich dust from ancient stars

Researchers have detected a radio signal from abundant interstellar dust in MACS0416_Y1, a galaxy 13.2 billion light-years away in the constellation Eridanus. Standard models can’t explain this much dust in a galaxy this young, forcing us to rethink the history of star formation. Researchers now think MACS0416_Y1 experienced staggered star formation with two intense starburst periods 300 million and 600 million years after the Big Bang with a quiet phase in between.

Stars are the main players in the universe, but they are supported by the unseen backstage stagehands: star dust and gas. Cosmic clouds of dust and gas are the sites of star formation and masterful storytellers of the cosmic history.

“Dust and relatively heavy elements such as oxygen are disseminated by the deaths of stars,” said Yoichi Tamura, an associate professor at Nagoya University and the lead author of the research paper. “Therefore, a detection of dust at some point in time indicates that a number of stars have already formed and died well before that point.”

Using ALMA (Atacama Large Millimeter/submillimeter Array), Tamura and his team observed the distant galaxy MACS0416_Y1. Because of the finite speed of light, the radio waves we observe from this galaxy today had to travel for 13.2 billion years to reach us. In other words they provide an image of what the galaxy looked like 13.2 billion years ago, which is only 600 million years after the Big Bang.

The astronomers detected a weak but telltale signal of radio emissions from dust particles in MACS0416_Y1 [1]. The Hubble Space Telescope, the Spitzer Space Telescope, and the European Southern Observatory’s Very Large Telescope have observed the light from stars in the galaxy; and from its color they estimate the stellar age to be 4 million years.

ALMA and Hubble Space Telescope (HST) image of the distant galaxy MACS0416_Y1. Distribution of dust and oxygen gas traced by ALMA are shown in red and green, respectively, while the distribution of stars captured by HST is shown in blue.Credit: ALMA (ESO/NAOJ/NRAO), NASA/ESA Hubble Space Telescope, Tamura et al.

ALMA and Hubble Space Telescope (HST) image of the distant galaxy MACS0416_Y1. Distribution of dust and oxygen gas traced by ALMA are shown in red and green, respectively, while the distribution of stars captured by HST is shown in blue.

Credit: ALMA (ESO/NAOJ/NRAO), NASA/ESA Hubble Space Telescope, Tamura et al.
Artist’s impression of the distant galaxy MACS0416_Y1. Based on the observations with ALMA and HST, researchers assume that this galaxy contains stellar clusters with a mix of old and young stars. The clouds of gas and dust are illuminated by stellar light.
Credit: National Astronomical Observatory of Japan

Artist’s impression of the distant galaxy MACS0416_Y1. Based on the observations with ALMA and HST, researchers assume that this galaxy contains stellar clusters with a mix of old and young stars. The clouds of gas and dust are illuminated by stellar light.
Credit: National Astronomical Observatory of Japan

“It ain’t easy,” said Tamura, half-lost in a moonage daydream. “The dust is too abundant to have been formed in 4 million years. It is surprising, but we need to hang onto ourselves. Older stars might be hiding in the galaxy, or they may have died out and disappeared already.”

“There have been several ideas proposed to overcome this ‘dust budget crisis,’” said Ken Mawatari, a researcher at the University of Tokyo. “However, no one is conclusive. We made a new model which doesn’t need any extreme assumptions diverging far from our knowledge of the life of stars in today’s universe. The model well explains both the color of the galaxy and the amount of dust.” In this model, the first burst of star formation started at 300 million years and lasted 100 million years. After that, the star formation activity went quiet for a time, and then restarted at 600 million years. The researchers think ALMA observed this galaxy at the beginning of its second generation of star formation.

“Dust is a crucial material for planets like Earth,” explains Tamura. “Our result is an important step forward for understanding the early history of the universe and the origin of dust.”

Note:
[1] ALMA detected dust emissions in galaxy A2744_YD1 with an age similar to MACS0416_Y1 [https://alma-telescope.jp/en/news/mt-ancient_stardust_sheds_light_on_the_first_starsmost_distant_object_ever_observed_by_alma], though the detection was marginal. The detection of dust in the present research has a better signal-to-noise ratio.

Media Contact:
Dr. Masaaki Hiramatsu
Assistant Professor/Education & Public Outreach Officer
ALMA Project, NAOJ
hiramatsu.masaaki@nao.ac.jp
+81 422-34-3600

Science Contact:
Dr. Yoichi Tamura
Associate Professor
Nagoya University
ytamura@nagoya-u.jp

Reference:
“Detection of the Far-infrared [O III] and Dust Emission in a Galaxy at Redshift 8.312: Early Metal Enrichment in the Heart of the Reionization Era,” Y. Tamura et al., 2019 Mar. 20, Astrophysical Journal [http://apj.aas.org, preprint: https://arxiv.org/abs/1806.04132].

The research team members are Yoichi Tamura (Nagoya University), Ken Mawatari (Osaka Sangyo University/The University of Tokyo), Takuya Hashimoto (Osaka Sangyo University/National Astronomical Observatory of Japan), Akio K. Inoue (Osaka Sangyo University), Erik Zackrisson (Uppsala University), Lise Christensen (University of Copenhagen), Christian Binggeli (University of Copenhagen), Yuichi Matsuda (National Astronomical Observatory of Japan/SOKENDAI), Hiroshi Matsuo (National Astronomical Observatory of Japan/SOKENDAI),Tsutomu T. Takeuchi (Nagoya University), Ryosuke S. Asano (Nagoya University), Kaho Sunaga (Nagoya University), Ikkoh Shimizu (Osaka University), Takashi Okamoto (Hokkaido University), Naoki Yoshida (The University of Tokyo), Minju Lee (Nagoya University/National Astronomical Observatory of Japan), Takatoshi Shibuya (Kitami Institute of Technology), Yoshiaki Taniguchi (The Open University of Japan), Hideki Umehata (The Open University of Japan/RIKEN/The University of Tokyo), Bunyo Hatsukade (The University of Tokyo), Kotaro Kohno (The University of Tokyo), and Kazuaki Ota (University of Cambridge/Kyoto University).

This research was supported by JSPS/MEXT KAKENHI (Nos. 17H06130, 17H04831, 17KK0098, 17H01110, 18H04333, and 17K14252) and the Swedish National Space Board.

The Atacama Large Millimeter/submillimeter Array (ALMA), an international astronomy facility, is a partnership of the European Organisation for Astronomical Research in the Southern Hemisphere (ESO), the U.S. National Science Foundation (NSF) and the National Institutes of Natural Sciences (NINS) of Japan in cooperation with the Republic of Chile. ALMA is funded by ESO on behalf of its Member States, by NSF in cooperation with the National Research Council of Canada (NRC) and the Ministry of Science and Technology (MOST) and by NINS in cooperation with the Academia Sinica (AS) in Taiwan and the Korea Astronomy and Space Science Institute (KASI). ALMA construction and operations are led by ESO on behalf of its Member States; by the National Radio Astronomy Observatory (NRAO), managed by Associated Universities, Inc. (AUI), on behalf of North America; and by the National Astronomical Observatory of Japan (NAOJ) on behalf of East Asia. The Joint ALMA Observatory (JAO) provides the unified leadership and management of the construction, commissioning and operation of ALMA.