Over twenty groups from around the world, including the international Zero Mercury Working Group (2) released the study, which maintains that the problem demands an effective response from governments and the United Nations.
"Mercury contamination of fish and mammals is a global public health concern," said Michael Bender, co-coordinator of the Zero Mercury Working Group. "Our study of fish tested in different locations around the world shows that internationally accepted exposure levels for methylmercury are exceeded, often by wide margins, in each country and area covered."
According to the report, "Mercury in Fish: An Urgent Global Health Concern," the risk is greatest for populations whose per capita fish consumption is high, and in areas where pollution has elevated the average mercury content of fish. In cultures where fish-eating marine mammals are part of the traditional diet, mercury in these animals can add substantially to total dietary exposure. In addition, the study shows that methylmercury hazards still exist where these dietary and local pollutant levels are less prevalent.
The report indicates that mercury is a persistent, bioaccumulative transboundary pollutant that contaminates our air, soil, water and fish. Because of this potential for global contamination, mercury pollution requires a coordinated international response.
"The report outlines that all governments face similar threats from mercury since it is a global pollutant that contaminates fish around the world," said Elena Lymberidi-Settimo, Project Coordinator Zero Mercury Campaign, European Environmental Bureau. "In response, governments should agree to start work immediately on a global mercury treaty at the United Nations meeting in Nairobi next week."
Mercury is a dangerous neurotoxin that can make its way up the food chain into humans, and poses an increased exposure risk to developing fetuses and young children and to adults exposed to mercury.
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The authors add that a comparison of the two programs with the most positive results with the other programs indicates there were a number of noteworthy differences, including higher rates of in-person contact per month per patient; treatment group members were significantly more likely than control group members to report being taught how to take their medications; care coordinators for both HQP and Mercy worked closely with local hospitals, which provided the programs with timely information on patient hospitalizations and improved their potential to manage transitions and reduce short-term readmissions; and care coordinators in both programs had frequent opportunities to interact informally with physicians.
"Despite these underwhelming results for care coordination interventions in general, the favorable findings for Mercy and HQP suggest that the potential exists for care coordination interventions to be cost-neutral and to improve patients' well-being," the researchers write.
Editorial: The Elusive Quest for Quality and Cost Savings in the Medicare Program
John Z. Ayanian, M.D., M.P.P., of Brigham and Women's Hospital and Harvard Medical School, Boston, writes in an accompanying editorial that despite these findings, this study offers two important insights to guide Medicare policy on coordination of chronic disease care going forward.
"First, care coordinators must interact in person with patients and not simply educate or assist them by telephone. Only 4 of the 15 programs emphasized in-person contact between coordinators and participants, including both of the programs that CMS allowed to continue."
"A second crucial lesson is that care coordinators must collaborate closely with patients' physicians to have a reasonable prospect of influencing care. Only 4 of the 15 programs had coordinators who were based in physicians' offices or who attended patients' medical appointments, including both of the programs that were authorized by CMS to continue."
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