LONDON – Treating African children at home for malaria doesn't help in cities because most fevers aren't actually caused by malaria, a new study said Tuesday.
Malaria drugs were distributed to households where parents had been told by researchers to automatically treat their children if they became feverish.
Roughly half the children were treated at home while the other half were taken to health clinics within a day of developing a fever.
To effectively treat malaria, children must be treated within a day of getting sick. The study found that children at home got twice as many medicines as those taken to clinics, but didn't do any better.
The research highlights holes in malaria treatment across the continent and raises questions about an upcoming U.N. initiative to fight the disease.
Experts monitored more than 400 children aged between 1 and 6 in Kampala, Uganda, from 2005-2007.
The research was published online Tuesday in the medical journal, Lancet. It was paid for by the Gates Malaria Partnership.
Malaria, which is spread by mosquito bites and carries symptoms such as fever, chills and vomiting, primarily affects poor people in remote areas.
Some doctors said the study showed a worrying tendency to treat fevers before they were diagnosed as malaria.
"If you just go on fever, you're over-treating so many children and you could miss other diseases by using malaria drugs," said Dr. Tido von-Schoen Angerer of Medecins Sans Frontieres, aka Doctors Without Borders. He was not linked to the study.
Malaria medicines don't work on fevers caused by other diseases like pneumonia, and children can die if they are not properly treated.
Previous studies have found home treatment works in rural areas. But malaria is also a problem in cities, and will have to be tackled differently there than in the countryside.
Von-Schoen Angerer said the Lancet study underlined that standard care for malaria in Africa is appalling.
Despite decades of work and renewed U.N. efforts to combat the disease, only 5 percent of children in Uganda are promptly treated with effective medication. Across Africa, the World Health Organization puts the figure at 3 percent.
WHO estimates malaria sickens about 247 million people and kills nearly 1 million every year.
Later this week, the United Nations and partners will announce a $200 million strategy called the Affordable Medicines Facility for Malaria to make drugs cheaper in 11 African countries.
Von-Schoen Angerer and others worry the tendency to over-treat malaria, as proven by the Lancet study, will be worsened by the strategy. They fear it will flood the market with drugs that promote resistance.
The initiative, led by WHO and the Global Fund to fight AIDS, tuberculosis and malaria, will subsidize the price of artemesinin combination therapies, the most effective malaria treatments.
But the U.N. has not insisted the drugs be combined in a single pill, which would curb the resistance risk.
Artemesinin combination therapies are also sold as several pills. Some cause side effects like nausea, and patients commonly throw those pills out, encouraging resistance.
"The risk of resistance is very scary," von-Schoen Angerer said. "We don't have a back-up medicine at this stage."
Richard Tren, director of the nonprofit Africa Fighting Malaria, called the U.N. initiative "an untested experiment," and warned the strategy could backfire.
"We need policies based on evidence," he said. "And the evidence this could work is pretty shaky."
___
On the Net:
http://www.lancet.com
http://www.theglobalfund.org
http://www.who.int
http://www.msf.org
news source of www.news.yahoo.com
..read more...
Senin, 13 April 2009
Treating kids with malaria at home doesn't work
Study gathers best science on heart-healthy foods
CHICAGO – What we know for sure about diet and what protects the heart is a relatively short list.
That's the conclusion of new research based on an analysis of nearly 200 studies involving millions of people.
Vegetables, nuts and the Mediterranean diet made the grocery list of "good" heart foods. On the "bad" list: starchy carbs like white bread and the trans fats in many cookies and french fries.
The "question mark" list includes meat, eggs and milk and many other foods where there's not yet strong evidence about whether they're good or bad for the heart.
"I do research. I also buy groceries for my family every week," said study co-author Dr. Sonia Anand of McMaster University in Hamilton, Ontario, who hopes the findings "decrease the confusion around what we should eat and what we shouldn't eat."
The study, appearing in Monday's Archives of Internal Medicine, doesn't actually read like a shopping list. It's a complicated explanation of how the researchers rated 189 prior studies on the topic.
In short, they used criteria developed by Sir Austin Bradford Hill, the late British scientist who helped establish a link between smoking and lung cancer. When multiple studies on a certain food or diet showed a strong link with better heart health, that put the food or diet at the top of the list.
Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, said the analysis underlines that there's a big gray area and a shorter list of foods with strong links to heart health.
Linda Van Horn, professor of preventive medicine at Northwestern University's Feinberg School of Medicine, said the analysis is more about the strengths and limits of previous studies than advice for consumers.
But she said the analysis reaffirms the benefits of a Mediterranean diet — rich in vegetables, nuts, whole grains, fish and olive oil — compared to a Western diet, heavy on processed meats, red meat, refined grains and high-fat dairy.
Beyond that, she found no reason to tear up your grocery list based on the findings.
"It's really about the totality of the usual eating pattern, rather than whether you ate a hot dog on opening day of baseball season," Van Horn said.
The Heart and Stroke Foundation of Canada and the Canadian Institutes of Health supported the research.
___
On the Net:
Archives: http://www.archinternmed.com
news source of www.news.yahoo.com
..read more...
America's uninsured haven't shown collective power
WASHINGTON – If the uninsured were a political lobbying group, they'd have more members than AARP. The National Mall couldn't hold them if they decided to march on Washington.
But going without health insurance is still seen as a personal issue, a misfortune for many and a choice for some. People who lose coverage often struggle alone instead of turning their frustration into political action.
Illegal immigrants rallied in Washington during past immigration debates, but the uninsured linger in the background as Congress struggles with a health care overhaul that seems to have the best odds in years of passing.
That isolation could have profound repercussions.
Lawmakers already face tough choices to come up with the hundreds of billions it would cost to guarantee coverage for all. The lack of a vocal constituency won't help. Congress might decide to cover the uninsured slowly, in stages.
The uninsured "do not provide political benefit for the aid you give them," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "That's one of the dilemmas in getting all this money. If I'm in Congress, and I help out farmers, they'll help me out politically. But if I help out the uninsured, they are not likely to help members of Congress get re-elected."
The number of uninsured has grown to an estimated 50 million people because of the recession. Even so, advocates in the halls of Congress are rarely the uninsured themselves. The most visible are groups that represent people who have insurance, usually union members and older people. In the last election, only 10 percent of registered voters said they were uninsured.
The grass-roots group Health Care for America Now plans to bring as many as 15,000 people to Washington this year to lobby Congress for guaranteed coverage. Campaign director Richard Kirsch expects most to have health insurance.
"We would never want to organize the uninsured by themselves because Americans see the problem as affordability, and that is the key thing," he said.
Besides, added Kirsch, the uninsured are too busy scrambling to make ends meet. Many are self-employed; others are holding two or three part-time jobs. "They may not have a lot of time to be activists," he said.
Vicki and Lyle White of Summerfield, Fla., know about such predicaments. They lost their health insurance because Lyle had to retire early after a heart attack left him unable to do his job as a custodian at Disney World. Vicki, 60, sells real estate. Her income has plunged due to the housing collapse.
"We didn't realize that after he had the heart attack no one would want to insure him," said Vicki. The one bright spot is that Lyle, 64, has qualified for Medicare disability benefits and expects to be getting his card in July.
But for now, the Whites have to pay out of pocket for Lyle's visits to the cardiologist and his medications. The bills came to about $5,000 last year. That put a strain on their limited budget because they are still making payments on their house and car.
"I never thought when we got to this age that we would be in such a mess," said Vicki, who has been married to Lyle for 43 years. "We didn't think we would have a heart attack and it would change our life forever."
While her own health is "pretty good," Vicki said she suffers chronic sinus infections and hasn't had a checkup since 2007. "I have just learned to live with it," she said.
The Whites' example shows how the lack of guaranteed health care access undermines middle-class families and puts them at risk, but that many of the uninsured eventually do find coverage. Lyle White has qualified for Medicare, even if the couple must still find a plan for Vicki.
Research shows that nearly half of those who lose coverage find other health insurance in four months or less. That may be another reason the uninsured have not organized an advocacy group. At least until this recession, many have been able to fix the situation themselves.
"The uninsured are a moving target," said Cathy Schoen, a vice president of the Commonwealth Fund, a research group that studies the problems of health care costs and coverage.
But even if gaps in coverage are only temporary, they can be dangerous. "Whenever you are uninsured, you are at risk," said Schoen. "People don't plan very well when they are going to get sick or injured."
Indeed, the Institute of Medicine, which provides scientific advice to the government, has found that a lack of health insurance increases the chances of bad outcomes for people with a range of common ailments, from diabetes and high blood pressure to cancer and stroke. Uninsured patients don't get needed follow-up care, skip taking prescription medicines and put off seeking help when they develop new symptoms.
Such evidence strengthens the case for getting everybody covered right away, Schoen said. But she acknowledges the politics may get tough. "It certainly has been a concern out of our history that unorganized voices aren't heard," she said.
___
On the Net:
White House: http://www.whitehouse.gov/agenda/health_care/
Health Care for America Now: http://www.healthcareforamericanow.org/
Commonwealth Fund: http://www.commonwealthfund.org/
Institute of Medicine: http://tinyurl.com/dm8gnn
..read more...
7th surgery shows face transplants gaining ground
Five years ago, it was the stuff of science fiction: Replace someone's face with one from a dead donor. But on Thursday, Boston doctors performed the world's seventh such transplant — less than a week after one in France — and plans are in the works for more.
"Society is allowing us to do this. I think you're going to see more and more," especially in soldiers disfigured in recent wars, said Dr. Frank Papay, a surgeon who helped perform the nation's first face transplant, in December at the Cleveland Clinic.
Some of the successes have been dazzling. People who couldn't eat, speak normally, or go out in public now can walk the streets without being recognized as someone who got a new face.
Even so, face transplants are likely to remain uncommon, used on only the most severely disfigured, because of the big risks and lifelong need to take medicines to prevent rejection.
"It's not going to be like some people imagine — routine, like people getting a facelift, or cosmetic surgery," said Stuart Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.
"We have what appears to be success," he noted, but there is always the chance that some patients may experience serious rejection problems or refuse to stay on the required lifetime of drugs.
Boston doctors stressed the care and psychological screening they required before performing the nation's second face transplant on Thursday. The operation, at Harvard-affiliated Brigham and Women's Hospital, was on a man who suffered traumatic facial injuries from a freak accident.
Face transplants go far beyond the transfer of skin and facial features, using things like bone and cartilage for reconstruction. The team led by plastic surgeon Dr. Bohdan Pomahac replaced the man's nose, palate, upper lip, and some skin, muscles and nerves with those of a dead donor.
The hospital would not identify the recipient or donor, but the donor's family members released a statement saying they hope the procedure convinces others to donate.
"The fact that we are able to give this gift was a tremendous comfort in our time of grief," the statement said.
At a news conference on Friday, Pomahac said: "There is no risk of recognizing the donor on the new patient. There's a 60 percent chance the patient will look how he used to look."
In a phone interview earlier Friday, Pomahac (pronounced POE-ma-hawk) said the man's injury occurred some years ago, and it left him with "no teeth, no palate, no nose, no lip."
"It was difficult for him to speak, to eat, to drink. It certainly caused a lot of social problems," Pomahac said.
The man had been Pomahac's patient for a long time, and doctors decided to pursue a face transplant because previous attempts to treat him left him still badly deformed. It took three months to find a suitable donor, who also provided some organs for transplant in other patients, Pomahac said.
The 17-hour operation began at 1:15 a.m. Thursday, with the recipient and the donor in operating rooms across the hall from each other. The patient was still recovering from anesthesia on Friday.
"He's still not fully awake so he has not seen himself. We have not really had a meaningful conversation so far," Pomahac said.
"He was incredibly motivated to go forward with it," and was extensively evaluated psychologically by doctors in and outside of Brigham, Pomahac said. "We really made sure that nothing was left to chance."
The seven primary surgeons and other assistants all donated their time and services, Pomahac said.
"We are essentially making a lifelong commitment to help him," the surgeon said.
Pomahac was born in Ostrava in the Czech Republic, and graduated from Palacky University School of Medicine in Olomouc, Czech Republic. He came to Brigham for a surgical research internship in 1996 and now, at 38, is associate director of its burn center, where he treats trauma and plastic surgery cases.
The Boston hospital's board approved Pomahac's plans to offer face transplants a year ago.
The world's first transplant in 2005 was led by Dr. Jean-Michel Dubernard in Amiens, France, who treated Isabelle Dinoire, a woman who had been mauled by a dog and grotesquely disfigured. Dinoire's appearance today is virtually normal.
The first U.S. face transplant, and the most extensive operation so far, was done in December by doctors at Cleveland Clinic. They replaced 80 percent of a woman's face with that of a female cadaver. The woman's identity has not been revealed, nor the circumstances that led to the transplant.
The woman left the hospital in February, and is doing "phenomenally well," Papay said. "Her speech is improved so everyone can understand her now, and she has a great outlook on life. She's very comfortable with the way she looks now and she's very happy."
The early successes are encouraging, but should not lead to over-exuberance, and extending the operation too fast, said Finder, the Los Angeles ethicist.
"This is still very new and hence requires a hyper-vigilance about helping patients understand what they're getting into," he said.
People who have received other transplants — organs, hands — have sometimes discovered they traded one set of problems for another, and get sick of taking the medicines needed to maintain the transplant. At least one hand transplant recipient later had the hand amputated for this reason.
Pomahac originally was considering only people who had already received a kidney or other organ transplant, because they already would be on immune-suppressing medicines and would therefore have a low risk of rejecting a new face.
"I still think that's the best group of patients but we have enlarged the protocol" to include others with severe facial deformities, he said.
"It's really in its infancy in terms of knowing what will happen," he added. "Each of the cases is its own unique story."
Eventually, surgeons hope to form waiting lists of face transplant candidates "just like for any other organ," Pomahac said.
___
Associated Press writer Russell Contreras in Boston contributed to this story.
..read more...
Report: Ethanol raises cost of nutrition programs
WASHINGTON – Food stamps and child nutrition programs are expected to cost up to $900 million more this year because of increased ethanol use.
Higher use of the corn-based fuel additive accounted for about 10 percent to 15 percent of the rise in food prices between April 2007 and April 2008, according to the nonpartisan Congressional Budget Office. That could mean the government will have to spend more on food programs for the needy during the current budget year, which ends Sept. 30. It estimated the additional cost at up to $900 million.
The CBO said other factors, such as skyrocketing energy costs, have had an even greater effect than ethanol on food prices. CBO economists estimate that increased costs for food programs overall due to higher food prices will be about $5.3 billion this budget year.
Ethanol's impact on future food prices is uncertain, the report says, because an increased supply of corn has the potential to eventually lower food prices.
Roughly one-quarter of corn grown in the United States is now used to produce ethanol and overall consumption of ethanol in the country hit a record high last year, exceeding 9 billion gallons, according to the CBO. It took nearly 3 billion bushels of corn to produce ethanol in the United States last year — an increase of almost a billion bushels over 2007.
The demand for ethanol was one factor that increased corn prices, leading to higher animal feed and ingredient costs for farmers, ranchers and food manufacturers. Some of that cost is eventually passed on to consumers, since corn is used in so many food products.
Several of those affected groups have banded together to oppose tax breaks and federal mandates for the fuel. They said Thursday that the report shows the unintended consequences of ethanol.
"As startling as these figures are, they do not even tell the story of the toll higher food prices have taken on working families, nor the impact higher feed prices have had on farmers in animal agriculture who have seen staggering losses and job cuts and liquidation of livestock herds," the Grocery Manufacturers Association, American Meat Institute, National Turkey Federation and National Council of Chain Restaurants said in a statement.
Supporters of ethanol disagreed, saying the report was good news.
"The report released by the Congressional Budget Office confirms what we've known for some time: The impact of ethanol production on food prices is minimal and that energy was the main driver in the rise of food prices," said Tom Buis, CEO of Growth Energy, an ethanol industry group.
Ethanol producers asked the Environmental Protection Agency last month to increase the amount of ethanol that refiners can blend with gasoline from a maximum of 10 percent to 15 percent, which could boost the demand for ethanol by as much as 6 billion gallons a year. They said raising that cap would create thousands of new jobs.
Agriculture Secretary Tom Vilsack has said he believes the administration could move quickly to raise the cap to at least 12 percent or 13 percent, but the EPA has not yet decided.
The report also looked at ethanol's effects on greenhouse gas emissions, concluding that over time ethanol's benefits over gasoline could diminish. The report says the use of ethanol reduced gasoline consumption by about 4 percent last year and reduced the gases blamed for global warming from the burning of gasoline by less than 1 percent. But the clearing of cropland and forests to produce more ethanol could more than offset those reductions.
..read more...
