Air Pollution Linked To Increased Mortality, Especially In Developing Cities

MedicalResearch.com Interview with:
“air pollution, beijing” by 大杨 is licensed under CC BY 2.0Longjian Liu, M.D., Ph.D. MSc (LSHTM), FAHA

Associate Professor
Department of Epidemiology and Biostatistics
Dornsife School of Public Health, and
Adjunct Associate Professor,
College of Medicine
Drexel University
Nesbitt Hall-RM515, 3215 Market ST
Philadelphia PA, 19104 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This is an international collaborative project, supported by Drexel Office of International Programs, and Chinese Academy of Sciences.

The main findings are air pollution has posted a serious public health issue in China, specifically in urban cities.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Air pollution is an international issue, we must take action, specifically in developing counties with rapid urbanization, like China.  

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Air Pollution Related Deaths Concentrated Among Minorities and the Poor

MedicalResearch.com Interview with:

“air pollution, beijing” by 大杨 is licensed under CC BY 2.0

Air Pollution, Beijing

Philip J. Landrigan, MD, MSc, FAAP
Dean for Global Health
Professor of Preventive Medicine and Pediatrics
Arnhold Institute for Global Health
Icahn School of Medicine at Mount Sinai 

MedicalResearch.com: What is the background for this study? What are the main findings?

  1.  Pollution is the largest environmental cause of disease and premature death in the world today.  It is responsible for 9 million deaths per year – 16% of all deaths worldwide – three times more deaths than AIDS, malaria and TB combined.  These numbers are growing from year to year as pollution in many parts of the world increase.
  2. Pollution is highly unjust. 92% of all pollution-related deaths occur in low-and middle- income countries, and in the United States and other high-income countries pollution-related disease and death are concentrated among minorities and the poor.  Think Flint.
  3. Pollution is very costly.  Pollution-related diseases cause productivity losses that reduce GDP in low- and middle-income countries by up to 2% per year. Pollution-related disease also results in health-care costs that are responsible for 1.7% of annual health spending in high-income countries like the US and for up to 7% of health spending in heavily polluted and rapidly developing low- and middle-income countries.
  4. Pollution is neglected and its control is seriously underfunded.
  5. The good news is that despite its great magnitude and long-standing neglect, pollution can be controlled, and pollution prevention is highly cost-effective. Pollution is not the inevitable consequence of economic development. High-income and some middle-income countries have enacted legislation and issued regulations mandating clean air and clean water, established chemical safety policies, and curbed their most flagrant forms of pollution. As a result, our air and water are now cleaner, the blood lead concentrations of our children have decreased by more than 90%, our rivers no longer catch fire, our worst hazardous waste sites have been remediated, and many of our cities are less polluted and more livable. Health has improved and people are living longer. High-income countries have achieved this progress while increasing GDP by nearly 250%. The claim that pollution control stifles economic growth, kills jobs and drags down the economy is false and has repeatedly been proven to be untrue. Pollution control is a winnable battle, and the control of pollution will return billions of dollars to the economies of countries around the world as it has already in the United States.

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With Increasing Westernization, Inflammatory Bowel Disease Becoming a Global Health Issue

MedicalResearch.com Interview with:

Gilaad Kaplan, MD, MPH, FRCPC Associate Professor  CIHR New Investigator & AI-HS Population Health Investigator Co-Director, Environmental Health Research Group Snyder Institute for Chronic Diseases & Institute of Public Health Departments of Medicine & Community Health Sciences University of Calgary

Dr. Kaplan

Gilaad Kaplan, MD, MPH, FRCPC
Associate Professor
CIHR New Investigator & AI-HS Population Health Investigator
Co-Director, Environmental Health Research Group
Snyder Institute for Chronic Diseases & Institute of Public Health
Departments of Medicine & Community Health Sciences
University of Calgary

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The aim of the study was to provide a global perspective on the epidemiology of the inflammatory bowel diseases in the 21st century.

During the 20th century IBD was considered a disease of the Western world. At the turn of the 21st century, IBD has become a global disease with accelerating number of cases in the developing world as it transition towards a westernized society.

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The President’s Malaria Initiative Reduced All-Cause Childhood Mortality

MedicalResearch.com Interview with:

Alexsandra Jakubowski

Aleksandra Jakubowski MPH

Aleksandra Jakubowski, MPH PhD candidate
Department of Health Policy and Management
Gillings School of Global Public Health
University of North Carolina at Chapel Hill

MedicalResearch.com: What is the background for this study?

Response: The US President’s Malaria Initiative (PMI) provides approximately $600 million annually to fund implementation of key evidence-based malaria prevention and treatment interventions, including insecticide treated nets (ITNs), artemisinin-based combination therapy (ACT), and indoor residual spraying (IRS) to populations in 19 recipient countries in sub-Saharan Africa (SSA). Despite this considerable investment, no study to date has evaluated the impact of PMI on population health outcomes. Previous evaluations have noted improved health outcomes in PMI countries, but comparison groups are needed to establish whether these changes were beyond the declining trends in mortality observed in the rest of the region. Our study sought to generate objective evidence for policy makers about the role this US-funded malaria aid program may have played in curbing child mortality in SSA.

We used a quasi-experimental design known as difference-in-differences to compare trends in health outcomes in PMI-recipient vs. PMI non-recipient countries. We analyzed publicly-available data from 32 countries in SSA spanning a period that included about ten years before and after the introduction of the program.

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Heart Failure Deadly At Earlier Age in Poorer Countries

MedicalResearch.com Interview with:

Hisham Dokainish, M.D., FRCPC, FASE, FACC Associate Professor of Medicine, McMaster University Principal Investigator, Population Health Research Insitute Director of Heart Failure Services, Director of Medical Diagnostic Units & Echocardiography, Hamilton Health Sciences Hamilton, ON, Canada

Dr. Dokainish

Hisham Dokainish, M.D., FRCPC, FASE, FACC
Associate Professor of Medicine, McMaster University
Principal Investigator, Population Health Research Insitute
Director of Heart Failure Services,
Director of Medical Diagnostic Units & Echocardiography, Hamilton Health Sciences
Hamilton, ON, Canada

MedicalResearch.com: What is the background for this study?

Response: Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions of the world, particularly from low and middle income countries.

MedicalResearch.com: What are the main findings?

Response: We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). These large regional differences in mortality persisted after multivariable adjustment for demographic, clinical, medication and socioeconomic variables. About half of the mortality risk was explained by multivariable modeling with these variables; however, the remainder was unexplained.

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Most Newly Arrived Refugees Have Overseas Vaccination Documentation

MedicalResearch.com Interview with:
Deborah Lee, MPH

Division of Global Migration and Quarantine
Centers for Disease Control and Prevention, Atlanta, GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to assess whether documentation for vaccines provided to refugees overseas was received by clinicians in the US and if doses of measles-mumps-rubella (MMR) vaccine were integrated into the vaccine schedule as recommended for adults and children by the US Advisory Committee on Immunization Practices.

CDC recommends that US-bound refugees receive vaccinations prior to arrival in the United States. Vaccinations are documented on the Vaccination Documentation Worksheet (DS-3025), which refugees bring with them to the United States, and made available to state and local refugee health programs through CDC’s Electronic Disease Notification (EDN) system. Thirty to 90 days after arrival, most refugees have a post-arrival health assessment performed by clinicians affiliated with the state and local refugee health programs.

Our assessment indicated that most refugees had overseas vaccination documentation available at the post-arrival health assessments (87%), and that MMR vaccine was given when needed (83%). Furthermore, many refugees (90%) in our assessment did not require an additional MMR dose because they had received vaccination before entering the United States.

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Pediatric Death Fall Worldwide, But Still Disproportionately Affect Poorer Countries

MedicalResearch.com Interview with:
Dr. Nicholas Kassebaum, MD Assistant Professor

Institute for Health Metrics and Evaluation
University of Washington

MedicalResearch.com: What is the background for this study?

Response: Reducing deaths of young children has been an international priority over the past few decades, and much progress has been made in this regard. Comprehensive and timely measurement of death and disease burden among children and adolescents is essential for improving the health of young people. Analyzing the latest estimates from the Global Burden of Disease (GBD), the current study quantifies and describes levels and trends of mortality and disease burden among children and adolescents under the age of 19 from 1990 to 2015.

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Promising New Drug Can Stop Malaria After Mosquito Bite

MedicalResearch.com Interview with:

Dr Mihály Sulyok MD Eberhard Karls University Institute of Tropical Medicine, Tübingen, Germany

Dr Mihály Sulyok

Dr Mihály Sulyok MD
Eberhard Karls University
Institute of Tropical Medicine,
Tübingen, Germany

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: New antimalarials are desperately needed, not just for treatment, but also for prophylaxis. DSM265, a novel antimalarial compound that selectively inhibits the plasmodial dihydroorotate dehydrogenase has a promising pharmacokinetic profile characterized by a long elimination half-life.

We performed a study at the Institute of Tropical Medicine, Eberhard Karls University (Tübingen, Germany) to investigate safety, tolerability and efficacy of DSM265 using controlled human malaria infection. In the first cohort, 400mg of DSM265 was administered orally to five healthy, malaria naive individuals one day before direct venous inoculation of an established infective dose of P. falciparum sporozoites (PfSPZ Challenge). Placebo was administered to two volunteers. The study was randomized and double blinded. In this cohort all placebo participants developed malaria, whereas all DSM265 participants were protected.

In a second cohort, 400mg DSM265 was administered 7 days before the sporozoite inoculation for six participants, two participants recieved placebo. In this cohort, the two placebo and three of six DSM265 volunteers developed thick blood smear positive malaria. The remaining three DSM265 volunteers developed transient submicroscopic parasitemia without symptoms or thick blood smear positivity. The only possible DSM265-related adverse event was a slight transient elevation in serum bilirubin in one volunteer.

The study was funded by the Global Health Innovative Technology Fund, Wellcome Trust, Bill & Melinda Gates Foundation through Medicines for Malaria Venture, and the German Center for Infection Research.

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No Increased Health Consequences After Chinese Famine Except Schizophrenia

MedicalResearch.com Interview with:

L. H. Lumey, MD, PhD Professor of Epidemiology Mailman School of Public Health Columbia University

Dr. Lumey

L. H. Lumey, MD, PhD
Professor of Epidemiology
Mailman School of Public Health
Columbia University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Chinese Great Leap Forward Famine in 1959-1961 is the largest famine in human history. Earlier studies have reported that overweight, type 2 diabetes, hyperglycemia, the metabolic syndrome and schizophrenia were more common among adults who were exposed to the famine. Our re-analysis of all previous studies shows no increases in diabetes, high blood pressure and other chronic conditions among famine births except for schizophrenia.

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Skin Diseases A Major Cause of Disability Worldwide

MedicalResearch.com Interview with:

Chante Karimkhani, MD University Hospitals Case Western Medical Center, Cleveland, Ohio now with Department of Dermatology University of Colorado, Denver

Dr. Karimkhani

Chante Karimkhani, MD
University Hospitals Case Western Medical Center, Cleveland, Ohio
now with Department of Dermatology
University of Colorado, Denver

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Ranging from benign inflammatory to infectious, autoimmune, and malignant conditions, skin diseases cause significant disfigurement, pain, and psychological morbidity. The Global Burden of Disease (GBD) Study 2013 is a large-scale epidemiological assessment of burden from 306 diseases in 195 countries, both sexes, and 14 age groups. Disease burden is measured by combining morbidity and mortality into a single metric of disability-adjusted life years (DALYs), where one DALY is equivalent to one year of healthy life lost. Skin diseases contributed 1.79% of the total global burden from all diseases.

The skin diseases arranged in order of decreasing global DALYs are: dermatitis (atopic, contact, seborrheic), acne vulgaris, urticaria, psoriasis, viral skin diseases, fungal skin diseases, fungal skin diseases, scabies, melanoma, pyoderma, cellulitis, keratinocyte carcinoma (basal and squamous cell carcinomas), decubitus ulcer, and alopecia areata. Younger populations had the greatest burden from infectious skin conditions, while acne caused the greatest burden in the second and third decades of life. Elderly populations had the greatest DALY rates from melanoma and keratinocyte carcinoma. Skin conditions also exhibit distinct geographical patterns of disease burden.

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Western US Smog Increasingly Due To Asian Emissions

MedicalResearch.com Interview with:

Dr. Meiyun Lin PhD Research Scholar NOAA and Princeton University’s Cooperative Institute for Climate Science

Dr. Meiyun Lin

Dr. Meiyun Lin PhD
Research  Scholar
NOAA and Princeton University’s Cooperative Institute for Climate Science

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Ground-level ozone, also known as smog, has climbed in the rural West over the past 25 years, even in such seemingly pristine places as Yellowstone National Park. We have found out why – and why cutting our own output of smog-forming chemicals such as nitrogen oxides by 50% hasn’t helped. This study found that increased pollution from Asia, which has tripled its nitrogen oxide emissions since 1990, contribute to the persistence of smog in the West.

While ozone in the eastern U.S. has decreased overall, the levels can spike during heat waves, characterized by large-scale air stagnation, warm temperatures, and plentiful radiation needed for ozone formation locally. As heat waves appears to be on the rise due to global climate change, progress in reducing smog in the eastern US is likely to be slower in the coming decades.

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Educating Religious Leaders Improves Uptake of Male Circumcision in Tanzania

MedicalResearch.com Interview with:

Jennifer A. Downs, M.D., Ph.D. Assistant Professor of Medicine and Microbiology & Immunology Department of Medicine Weill Cornell Medicine Center for Global Health New York, NY 10065

Dr. Jennifer Downs

Jennifer A. Downs, M.D., Ph.D.
Assistant Professor of Medicine and Microbiology & Immunology
Department of Medicine
Weill Cornell Medicine
Center for Global Health
New York, NY 10065

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Between 2002 and 2006, three large randomized controlled trials in sub-Saharan Africa demonstrated that male circumcision reduces new HIV infections in men by approximately 60%. Based on these findings, the World Health Organization recommended male circumcision as an HIV prevention strategy in countries with high levels of HIV and a low prevalence of male circumcision. This led to prioritization of 14 countries in Eastern and Southern Africa for massive scale-up of male circumcision beginning in 2011.

In many of these countries, the uptake of male circumcision was lower than expected. In northwest Tanzania, where we work, there are a number of barriers to male circumcision. Some of these barriers are cultural, tribal, economic, and religious. We conducted focus group interviews in 2012 that showed that many Christian church leaders and church attenders in our region in Tanzania had major concerns about whether male circumcision was compatible with their religious beliefs. This led us to hypothesize that the uptake of male circumcision could be increased when religious leaders were taught about male circumcision, with the goal that they would then be equipped to discuss this issue with their congregations.
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Air Pollution Linked To Millions of Preterm Births

MedicalResearch.com Interview with:

Chris Malley PhD The Stockholm Environment Institute University of York

Dr. Chris Malley

Chris Malley PhD
The Stockholm Environment Institute
University of York

MedicalResearch.com: What is the background for this study?

Response: When a baby is born preterm (at less than 37 weeks of gestation, an indicator of premature birth), there is an increased risk of infant death, or long-term physical and neurological disabilities. For example, 965,000 infant deaths in 2013 (35% of all neonatal deaths) have been estimated to be due to preterm birth complications. In 2010, an estimated 14.9 million births were preterm – about 4–5% of the total in some European countries, but up to 15–18% in some African and South Asian countries. The human and economic costs are enormous.

There are many risk factors for preterm birth – from the mother’s age, to illness, to poverty and other social factors. Recent research has suggested that exposure to air pollution could also be a risk factor. Our study quantifies for the first time the global impact of pregnant women’s exposure to outdoor fine particulate matter (PM2.5) by combining data about air pollution in different countries with knowledge about how exposure to different levels of air pollution is associated with preterm birth rates.

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Physical Activity Not Enough To Ward Off Weight Gain

MedicalResearch.com Interview with:

Lara Dugas, PhD, MPH, FTOS Public Health Sciences Loyola University Chica

Dr. Lara Dugas

Lara Dugas, PhD, MPH, FTOS
Public Health Sciences
Loyola University Chicago

MedicalResearch.com: What is the background for this study?

Response: Our NIH-funded study is led by Dr. Amy Luke, Public Health Sciences, Loyola University Chicago, and is titled “Modeling the Epidemiologic Transition study” or METS. It was initiated in 2010, and 2,500 young African-origin adults were recruited from 5 countries, spanning the Human Development Index (HDI), a WHO index used to rank countries according to 4 tiers of development. The 5 countries include the US, Seychelles, Jamaica, South Africa, and Ghana. Within each country 500 young adults, 25-45 yrs., and 50% male, were recruited and followed prospectively for 3 years. Each year, contactable participants completed a health screening, body composition, wore an activity monitor for 7 days, and told researchers everything they had eaten in the preceding 24hrs. Our main research questions we were trying to answer were to understand the impact of diet and physical activity on the development of obesity, and cardiovascular disease in young adults. It was important to have countries spanning the HDI, with differences in both country-level dietary intake and physical activity levels.

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Effects of Delayed Vs Early Umbilical Cord Clamping on Infant Anemia

Ola Andersson, MD, PhD Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden

MedicalResearch.com Interview with:
Dr. Ola Andersson MD, PhD
Uppsala University,
Uppsala, Sweden

MedicalResearch.com: What is the background for this study?

Response: Anemia affects over 40% of all children under 5 years of age in the world. Anemia can impinge mental and physical performance, and is associated with long-term deterioration in growth and development. Iron deficiency is the reason for anemia in approximately 50% of the children.is. When clamping of the umbilical cord is delayed, ie after 3 minutes, iron deficiency up to 6 months of age can be prevented, but it has not been shown to prevent iron deficiency or anemia in older infants.

At birth, approximately 1/3 of the child’s blood is in the placenta. If clamping of the umbilical cord is done immediately (early cord clamping), the blood will remain in the placenta and go to waste (or can be stored in stem cell banks). If instead clamping is postponed for 3 minutes, most of the blood can flow back to the child as an extra blood transfusion, consisting of about one deciliter (1/2 cup) of blood, equivalent to about 2 liters (half a US gallon) of an adult. A blood donor leaves 0.4-0.5 liters of blood.

Blood contains red blood cells that contain hemoglobin. Hemoglobin carries oxygen to the tissues of the body. Hemoglobin contains a lot of iron, and the extra deciliter of blood may contain iron that corresponds to 3-4 months of the need for an infant.

The World Health Organization (WHO) recommends umbilical cord clamping at 1 minute or later, American College of Obstetricians and Gynecologists (ACOG) recommends umbilical cord clamping at 30-60 seconds or later.

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Hypertension Is Global Risk For Disability and Premature Death

MedicalResearch.com Interview with:

Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington

Dr. Gregory Roth

Dr. Gregory Roth MD
Assistant Professor of Medicine
Institute for Health Metrics and Evaluation and
Division of Cardiology at the University of Washington

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time.

In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased.

Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).

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C-Section Rate Varies Across China from 4% to 64%

MedicalResearch.com Interview with:
Jianmeng Liu, PhD, MD
Professor in Epidemiology and Biostatistics
Director, Institute of Reproductive and Child Health/key Laboratory of Reproductive Health Ministry of Health
Director, Office for National Maternal and Child Health Statistics of China
Peking University Health Science Center
Beijing, China

MedicalResearch.com: What is the background for this study?

Response: Cesarean overuse can jeopardize maternal and child health. It has been widely concerned that cesarean rate in China is at an extremely high level. Concerns about “alarming” rates increased after a World Health Organization (WHO) report that 46.2% of births were delivered by cesarean in 2007-2008, based on analysis of deliveries in 21 hospitals of 3 provinces of China.

Since 2002, reducing the cesarean rate has been a national priority, and a variety of policies, programs and activities have emerged at both the central and local governments. Previous national estimates of cesarean rates have been based on surveys with limited geographical coverage. Given the marked diversity of geography, economy, and life circumstances throughout China, survey estimates are likely to be sensitive to the area sampled.

By analyzing county-level national data on cesarean rates that have been collected since 2008, this study aimed to determine the overall rate and change in rate of cesarean deliveries, examine geographic variation, and, in areas where declines occurred, assess changes in maternal and perinatal mortality.

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Cancer Rises Globally As World Population Ages

MedicalResearch.com Interview with:

Christina Fitzmaurice, MD, MPH Assistant Professor Department of Medicine, Division of Hematology Institute for Health Metrics and Evaluation University of Washington Seattle, WA

Dr. Christina Fitzmaurice

Christina Fitzmaurice, MD, MPH
Assistant Professor
Department of Medicine, Division of Hematology
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cancer is the second leading cause of death worldwide behind cardiovascular diseases. We found that cancer cases increased by 33% from 13.1 million cases in 2005 to 17.5 million in 2015. The largest driver behind this increase was an aging population, followed by a growing population worldwide. The smallest factor contributing to this increase was a rise in cancer incidence rates. Because of increasing life expectancy and better control of communicable diseases cancer will remain a major burden in the foreseeable future. Adjusting and building health systems that can appropriately deal with this challenge is only possible with good data on the burden of cancer. In our study we estimate the number of cancer cases, and cancer deaths over time for 32 cancers in 195 countries and territories from 1990 to 2015. We also estimate how many years of life were lost due to cancer as well as disability adjusted life years and a summary measure that combines these two into disability adjusted life years.

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Cures of Multidrug Resistant Tuberculosis Probably Underestimated Under Current WHO Guidelines

MedicalResearch.com Interview with:
Dr. Heinke Kunst, M.D.
Queen Mary University Hospital, London, United Kingdom

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Multidrug resistant tuberculosis (MDR-TB) has been on the increase worldwide over the past decade. Many patients who have been identified with MDR-TB live in the European region. Despite treatment with expensive second-line drug regimens, curing MDR TB remains a challenge and cure rates were thought to be very low. As part of the EU Commission funded TB-PANNET project 380 patients with MDR-TB were observed at 23 TB centers in countries of high, intermediate and low TB burden in Europe over a period of 5 years. Observation started from the time of diagnosis and lasted until one year after the end of the treatment.

The TBNET proposed new definitions for “cure” and “failure” of MDR-TB treatment based on the sputum culture status at 6 month after the initiation of therapy and whether patients were free from disease recurrence one year after the end of therapy. The researchers found that the WHO criterion for “cure” could not be applied in the majority of patients, simply because most patients who were being treated successfully were not able to produce sputum after 8 months of therapy. The TB-PANNET study showed much higher cure rates using a new definition of cure and failure of treatment for MDR TB in the European region. (61% cure rates compared to only 31% when using WHO criteria.)

The study also demonstrates that the results for “cure” from MDR-TB correlate very well with the level of drug resistance and the time to culture conversion that means the time when TB bacilli are no longer detectable in sputum. The new definitions are also independent of the total duration of treatment and can be applied to the standard 20 months MDR-TB regimen as well as to the 9-12 months shorter course MDR-TB treatment that was recently proposed by the WHO.

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Many Congolese Refugees Applying for Resettlement to the US Have Marked Splenomegaly

MedicalResearch.com Interview with:
Dr. Matt Goers

Internal Medicine Resident at UMN

MedicalResearch.com: What is the background for this report? What are the main findings of the evaluations of refugee populations in western Uganda?

Response: In 2014, International Organization of Migration (IOM) reported an unusually high number of Congolese refugees in western Uganda had palpable, enlarged spleens detected during their routine refugee pre-departure medical examinations. Due to this trend, the IOM, with the assistance of the Centers for Disease Control and Prevention (CDC), implemented a diagnostic and treatment protocol to further evaluate and assist with management of refugees with splenomegaly during their pre-departure medical examinations.

In March and June 2015, a total of 987 U.S.-bound refugees underwent medical examinations performed as part of their routine resettlement process. Of those evaluated, 145 (14.7%) had a detectable spleen on physical examination. In fact, 84.7% (122 people) were found to have marked or massive splenomegaly during their evaluation (classified based on a prior World Health Organization ultrasonography protocol). During the work-up for this condition, less than 33% were found to have an infectious cause of their condition including 26.9% (39 people) who had malaria.

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Pandemic of Global Physical Inactivity Costs Lives and Money

MedicalResearch.com Interview with:

Ding Ding (Melody), Ph.D., MPH NHMRC Early Career Senior Research Fellow/Sydney University Postdoctoral Research Fellow Prevention Research Collaboration Sydney School of Public Health The University of Sydney

Dr. Melody Ding

Ding Ding (Melody), Ph.D., MPH
NHMRC Early Career Senior Research Fellow
Sydney University Postdoctoral Research Fellow
Prevention Research Collaboration
Sydney School of Public Health
The University of Sydney

MedicalResearch.com: What is the background for this study?

Response: Understanding the true burden of a pandemic is indispensable for informed decision making. After decades of research, we now have established knowledge about how physical inactivity contributes to pre-mature deaths and chronic diseases, but the economic burden of physical inactivity remains unquantified at the global level. Through estimating the economic burden of physical inactivity for the first time, we hope to create a business case for investing in cost-effective actions to promote physical activity at the global levels.

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Almost A Million Cases of Maternal Syphilis Globally Per year

MedicalResearch.com Interview with:

N. Saman Wijesooriya Public Health Advisor/Technical Advisor Centers for Disease Control and Prevention

N. Saman Wijesooriya

N. Saman Wijesooriya
Public Health Advisor/Technical Advisor
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The article Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modeling study by Wijesooriya, et al published in the August 2016 issue of The Lancet Global Health (Open source – http://dx.doi.org/10.1016/S2214-109X(16)30135-8) estimates the incidence and prevalence of maternal and congenital syphilis for both time periods and identifies gaps antenatal care access and syphilis testing and treatment services to assess progress in the global elimination of congenital syphilis, or mother-to-child transmission of syphilis, as a public health problem.

Untreated maternal syphilis is understood to be transmitted from mother-to-child in utero in 50% of cases resulting in tragic adverse pregnancy outcomes, or congenital syphilis infections, including early fetal death, stillbirth, preterm birth, low birthweight, neonatal death, and congenital infections in infants. Since most maternal syphilis infections are asymptomatic, it is recommended that screening for syphilis use a combination of serological tests for pregnant women and treatment of syphilis seropositive women with at least 2.4 million units of benzathine penicillin intramuscularly early in pregnancy to prevent most congenital syphilis infections.

In 2007, the World Health Organization responded to estimates indicating 2 million maternal and 1.5 congenital syphilis infections would occur annually without treatment and launched the global initiative for the Elimination of Congenital Syphilis (ECS). The strategy includes reducing the prevalence of syphilis in pregnant women and mother-to-child transmission of syphilis. The objective is for countries to achieve high performing antenatal care systems providing access to antenatal care to more than 95% of pregnant women, syphilis testing for more than 95% of pregnant women, and treatment for more than 95% of seropositive women to attain a congenital syphilis rate of 50 or fewer cases per 100,000 live births.

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Medical Tourism Market Booming As Patients Seek Cheaper Prices or More Sophisticated Care

Yan Alicia Hong, Ph.D. Associate Professor Dept of Health Promotion & Community Health Sciences School of Public Health Texas A&M Health Science Center College Station, TX, 77843

Dr. Yan Alicia Hong

MedicalResearch.com Interview with:
Yan Alicia Hong, Ph.D.
Associate Professor
Dept of Health Promotion & Community Health Sciences
School of Public Health
Texas A&M Health Science Center
College Station, TX, 77843

MedicalResearch.com: What is the background for this study and discussion? What are the main findings?

Dr. Hong: Medical tourism has grown rapidly in the past decade, as Internet has greatly facilitated information sharing. A 2013 online survey from US reported that 27% of patients had engaged in some form of medical tourism. The global market of medical tourism is estimated at $439 billion. Traditionally, medical tourists travel from high-income countries to middle- and low-income countries to seek comparable or identical care at a lower price. But in recent years, more and more patients from middle- and low-income countries travel to the high-income countries for better diagnostic capabilities, state-of-the-art medical technologies, and advanced treatment options that may not be available in their home countries. I wrote up this article in response to the opening of a Chinese-American Physicians E-Hospital, a new online service to facilitate Chinese patients seeking medical care in U.S..

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Global Economic Downturn Linked To Increase in Cancer Deaths

MedicalResearch.com Interview with:
Dr Mahiben Maruthappu MD
Senior Fellow to the CEO,NHS England
Imperial College
London, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Maruthappu: There are over 8 million deaths due to cancer every year.
At the same time, there are around 40 million unemployed people across the OECD, 7
million more than before the recent economic crisis. As a result,
understanding how economic changes affect cancer survival, given the
economic climate, is crucial.

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Infanticides in South Africa Number More Than One Per Day

MedicalResearch.com Interview with:

Prof Naeemah Abrahams South African Medical Research Council Chief Specialist Scientist: Gender & Health Research Unit Cape Town | Western Cape

Prof. Naeema Abrams

Prof Naeemah Abrahams
South African Medical Research Council
Chief  Specialist Scientist:  Gender & Health Research Unit
Cape Town | Western Cape

MedicalResearch.com: What is the background for this study? What are the main findings?

Prof Abrahams: Violence is a common feature of the South African social landscape and the murder of children is the most severe form of violence against children.  A national child homicide study reflecting 2009 murdered was done. Information was collected from mortuaries and police detectives. We identified the demographic detail of the child, the perpetrator information (if available) and the motive of the killings. In this manuscript we look in greater detail at children under the age of 5 years as this group represent the 2nd largest group of children killed. We also have a focus on neonaticides.

We estimated that 454 children under the age of 5 years were killed in South Africa in 2009. This means more than 1 young child killed per day. The study showed the first 6 days of life are the time point of highest risk for being killed among children under 5 years with more than half (53.2%) of the children killed within the 1st month of their lives and nearly two thirds of the children (74.4%)  killed as infants.  This is amongst the highest reported rates for neonaticide and infanticide.

Parents, in particular mothers, were the most common perpetrator of the younger children – this is most likely due to them being responsible for the care of young children.

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Strong Decrease in Mortality Among Young People Bodes Well For Future

MedicalResearch.com Interview with:

Janet Currie Henry Putnam Professor of Economics and Policy Affairs Chair, Department of Economics Director, Center for Health and Wellbeing Princeton University Princeton NJ 08544

Janet Currie

Janet Currie
Henry Putnam Professor of Economics and Policy Affairs
Chair, Department of Economics
Director, Center for Health and Wellbeing
Princeton University
Princeton NJ 08544

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many recent studies point to increasing inequality in mortality in the United States over the past 20 years. These studies often use mortality rates in middle and old age. This is the first study to examine mortality trends for younger ages.  We find that for infants, children and young adults below age 20, however, there have been strong mortality improvements that were most pronounced in poorer counties, implying a strong decrease in mortality inequality. There is a great deal of evidence from past studies that healthier children grow up to be healthier adults.  These current young people will form the future adult U.S. population, so this research suggests that inequality in middle and old-age mortality may have peaked and is likely to decline as these cohorts become older.

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Unusual Microorganisms and Antimicrobial Resistances in a Group of Syrian Migrants

MedicalResearch.com Interview with:
Prof. Ciccozzi Massimo Clinical Pathology and Microbiology Laboratory University Hospital Campus Bio-Medico of Rome, Italy; Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy.
Prof. Ciccozzi Massimo
Clinical Pathology and Microbiology Laboratory
University Hospital Campus Bio-Medico of Rome, Italy; Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy.  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Prof. Massimo: In the spring 2011 civil war becoming in Syria providing condition for diseases outbreaks In the Syrian Arab Republic before the crisis, the access to health services increased since the 1980s, with better equity between the rural populations and the middle class. the capacity of the health system, so as the quality of care, were not sufficient to improve the decrease the inequity. As normally happens the onset of civil war can led to the complete deterioration of the health infrastructure through the destruction of facilities.

We describe a group of 48 Syrian migrants arrived in the second week of October 2015 in the asylum seekers centre (ASC) in Rome (Italy) where they receive social, legal and health assistance. An internal healthcare facility (IHF) is operative where specialized personnel (e.g. infectivologist, nurses and psychologist) was prompt to receive the Syrian people making them all the tests for microbial agents presence (bacterial and virus agents).

This group is of importance not only because refugee from the tremendous civil war but also because stopped in this Centre for only twenty days. Our aim was the knowledge of their health status, this is important for people that have to travel in north Europe facing many kilometers again.

Rectal, nasal and pharyngeal swabs were collected from all refugees, whereas serum samples were available from 30/48 subjects. Eighteen refugees refused phlebotomy for blood collection for religious reasons.

All refugees resulted negative for HBV, HBC and HIV infections. Bacterial microorganism and fungi isolated from surveillance swabs were found with Gram-negative bacteria representing by a larger number of species than Gram-positive and fungi microorganisms.

These reports enforce the hypothesis that circulation of new emerging pathogens found, can be source of infection in susceptible patients or nosocomial settings.

Interestingly, in some subjects, polymicrobial colonization was found and in some cases until to six different microorganisms, potentially pathogens, were isolated in the same individual. The microbiological surveillance performed in this group of Syrian migrants upon their arrival in Italy evidenced the carriage of unusual microorganism, potentially pathogens and carriers of antimicrobial resistance in some cases, that could be introduced in the country giving asylum. These migrants moving from a country to another could promote the diffusion of these microorganisms within different settings during their traveling around the world.

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Childhood Rheumatic Heart Disease Remains Silent Epidemic In Underdeveloped Countries

MedicalResearch.com Interview with:

Thomas Pilgrim, Prof. Dr. med. Oberarzt, Invasive Kardiologie Universitätsspital Bern Bern Switzerland

Dr. Thomas Pilgrim

Thomas Pilgrim, Prof. Dr. med.
Oberarzt, Invasive Kardiologie
Universitätsspital Bern
Bern Switzerland

MedicalResearch.com: What is the background for this study?

Dr. Pilgrim: Three quarters of all children worldwide grow up in regions endemic for rheumatic heart disease. Clinically manifest rheumatic heart disease represents only the tip of the iceberg: only one in in 5 to 8 children with valvular lesions consistent with rheumatic heart disease have a heart murmur or clinical symptoms; the remaining children have clinically silent disease that goes undetected unless echocardiography is performed. An understanding of incidence, prevalence, and progression of disease is an important prerequisite to guide active surveillance and secondary prevention. We therefore performed a school-based cross-sectional study among more than 5000 children from 26 schools in Nepal. The objective of the study was to assess prevalence of clinically silent and manifest rheumatic heart disease as a function of age, gender and socioeconomic status and to estimate the age-specific incidence from available prevalence data.

MedicalResearch.com: What are the main findings?

Dr. Pilgrim: In our population-based observational cross-sectional study, the prevalence of borderline or definite rheumatic heart disease among schoolchildren in Eastern Nepal amounted to 10.2 (95% CI 7.5-13.0) per 1000 children between the ages of 5 and 15 years, and was more common in girls as compared to boys. The prevalence increased across age categories in a nearly linear fashion from 5.5 (95% CI 3.5-7.5) per 1000 in children 5 years of age to 16.0 (95% CI 14.9-17.0) in children 15 years of age, while the average incidence remained stable at 1.1 per 1000 children per year. The prevalence of clinically silent rheumatic heart disease was 5 times higher compared to manifest disease and the ratio of manifest to subclinical disease increased with increasing age.

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Antiretroviral Vaginal Ring May Become HIV Prevention Tool For Women

MedicalResearch.com Interview with:

Jared Baeten, MD PhD Vice Chair, Department of Global Health Professor, Departments of Global Health, Medicine, and Epidemiology Co-Director, International Clinical Research Center University of Washington

Dr. Jaret Baeten

Jared Baeten, MD PhD
Vice Chair, Department of Global Health
Professor, Departments of Global Health, Medicine, and Epidemiology
Co-Director, International Clinical Research Center
University of Washington

MedicalResearch.com: What is the background for this studies?

Dr. Baeten: Women account for nearly 60 percent of adults with HIV in sub-Saharan Africa, where unprotected heterosexual sex is the primary driver of the epidemic. While several studies have shown that antiretroviral medications (ARVs) are highly effective in preventing HIV, other studies – such as VOICE and FACTS 001 – suggest that for young, at-risk women in Africa, ARVs delivered as a vaginal gel or as a tablet may not be acceptable. Products must be used to be effective, and that was not the case for most of the participants in previous studies.

Medical Research: What was the aim of ASPIRE and The Ring Study?

Dr. Baeten: As Phase III clinical trials, ASPIRE and The Ring Study were designed to determine whether a vaginal ring containing an antiretroviral (ARV) drug called dapivirine is safe and effective in protecting women against HIV when used for a month at a time. These trials also sought to determine whether women find the vaginal ring practical and easy to use. As sister studies, ASPIRE and The Ring Study were designed as the centerpiece of a broader licensure program to provide the strength of evidence to support potential licensure of the dapivirine vaginal ring for preventing HIV in women. Because at least two Phase III efficacy trials are usually needed for a product to be considered for regulatory approval, ASPIRE and The Ring Study were conducted in parallel to accelerate the timeline to the ring’s potential approval.

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Colon Cancer Rising In Transitional Economies

MedicalResearch.com Interview with:

Dr. Melina Arnold Section of Cancer Surveillance International Agency for Research on CancerLyon, France

Dr. Melina Arnold

Dr. Melina Arnold
Section of Cancer Surveillance
International Agency for Research on Cancer
Lyon, France

MedicalResearch.com: What is the background for this study? What are the main findings? 

Dr. Arnold: In this study, we looked at patterns and time trends in the incidence in and mortality from colorectal cancer on the global scale. In the analyses, we used data from the Globocan database, Cancer Incidence in Five Continents, both hosted by the International Agency for Research on Cancer (IARC), and the World Health Organisation mortality database. We documented a ten-fold variation in colorectal cancer incidence and mortality rates worldwide. We also found distinct gradients across human development levels, meaning that changes in patterns and trends of this cancer could be linked to economic development and that the adoption of a Western lifestyle may have a role. While incidence and mortality rates are on the increase in many countries in socioeconomic transition, stabilizing or decreasing trends are seen in highly-developed countries where rates remain among the highest in the world. These observations point to widening disparities and an increasing burden in transitioning countries.
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UK Primary Care Reforms Resulted In More Unplanned Hospital Admissions For Children

MedicalResearch.com Interview with:
Elizabeth Cecil, MSc
Department of Primary Care and Public,
Health, Imperial College London
London, United Kingdom

Medical Research: What is the background for this study? What are the main findings?

Response: Unplanned hospital admissions in children have been rising for more than a decade placing strain on health care resources in the UK. Unnecessary hospital admission exposes children to hospital acquired infections and an over invasive approach, and is inconvenient for their families as well as adding to pressures on staff dealing with sicker children.

Our team from Imperial College London were interested in assessing the impact of primary care policy reforms on short stay admissions, in England. The reforms were nationally implemented in April 2004 and reduced the availability of primary care physicians for children. Our study, found that reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions and with fewer children’s admissions being referred by a primary care physician.

Over the study period from April 2000 to March 2012, we found that more than half of the 7.8 million unplanned hospital admissions for children younger than 15 years were short-stay admissions for potentially avoidable infections and chronic conditions. The primary care policy reforms implemented in April 2004 were associated with an 8 percent increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3 percent annual increasing trend. Notably, the policy reforms were not associated with an increase in short-stay admission rates for infectious illness.
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Physical Activity Critical To Global World Health

MedicalResearch.com Interview with:
Philipe de Souto Barreto (PhD)

Toulouse University Hospital (CHU Toulouse)
Gérontopole of Toulouse – Head of Department: Prof Bruno Vellas

Medical Research: What is the background for this study? What are the main findings?

Dr. Barreto: This study discusses about the importance of physical activity for health promotion globally. The main argument is that, since physical activity is associated to health benefits in a dose-response manner, even less than the currently recommended amounts of physical activity, i.e., 150 minutes of moderate-to-vigorous physical activity per week or equivalent, will be associated to health promotion. Therefore, from a global health perspective, it would be interesting to promote small increments in physical activity among those who are fully sedentary.

Medical Research: What should clinicians and patients take away from your report?

Dr. Barreto: The “take home message” of this article is that, regarding the associations between physical activity and health, “every little bit counts, and more is often better”.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Barreto: In my opinion, future research on the topic of physical activity and health promotion should focus on two main aspects: revisiting current public health guidelines on physical activity in order to confirm, refine or modify current public health messages, and increasing public awareness on sedentary behaviours, which constitutes a different concept from physical activity.

Citation:

Global health agenda on non-communicable diseases: has WHO set a smart goal for physical activity?

Philipe de Souto Barreto, researcher

 MJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h23 (Published 21 January 2015) Cite this as: BMJ 2015;350:h23

 

 

Regular Use of Some NSAIDs May Increase Adverse Cardiovascular Events.

Anthony Bavry, MD MPH Interventional Cardiology, North Florida/South Georgia Veterans Health System Associate Professor of Medicine, University of Florida Gainesville, FL 32610MedicalResearch.com Interview with:
Anthony Bavry, MD MPH
Interventional Cardiology, North Florida/South Georgia Veterans Health System
Associate Professor of Medicine, University of Florida
Gainesville, FL 32610

Medical Research: What are the main findings of the study?
Dr. Bavry:
1) Among post-menopausal women, the regular use of NSAIDs was associated with an increased risk of cardiovascular death, myocardial infarction, or stroke.
2) Cardiovascular risk was observed among users of celecoxib, naproxen, but not ibuprofen.
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Accidents and Violence Account For Most Deaths Among US Young People

MedicalResearch.com Interview with: Tamara Haegerich, PhD Deputy Associate Director for Science Division of Unintentional Injury Prevention CDC - National Center for Injury Prevention and ControlMedicalResearch.com Interview with:
Tamara Haegerich, PhD
Deputy Associate Director for Science
Division of Unintentional Injury Prevention
CDC – National Center for Injury Prevention and Control


MedicalResearch: What are the main findings of the study?

Dr. Haegerich: In the first three decades of life, more people in the US die from injuries and violence than from any other cause. Approximately 60% of fatal injuries are unintentional (for example, from motor vehicle crashes, drug overdose, and falls), 20% are due to suicide, and 20% are due to homicide. Injuries and violence have been linked to a wide range of physical, mental health, and reproductive health problems, and chronic diseases. They take an enormous economic toll, including the cost of medical care and lost productivity. Importantly, injuries and violence are preventable through education, behavior change, policy, engineering, and environmental supports. For example, laws that promote the use of seat belts and child safety seats, and prevent drunk driving, can reduce motor-vehicle-related injuries. Early childhood home visitation, school-based programs, and therapeutic foster care are examples of evidence-based approaches to preventing violence. Improving proper prescribing of painkillers and access to treatment for substance misuse could prevent prescription drug overdoses. Improvements are possible by framing injuries and violence as preventable, identifying interventions that are cost-effective and based on research, providing information to decision makers, and strengthening the capacity of the health care system.

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Slowdown In US Health Care Costs Largely Due to Flat Physician Reimbursement, Use of Generic Drugs

MedicalResearch.com Interview with: 
M Luca Lorenzoni
OECD Organisation for Economic Co-operation and Development
Health Accounts, Asian Health and Social Policy Outreach
ELS/Health Division

MedicalResearch: What are the main findings of the study?
Answer: 

  • The United States is an outlier in the scenery of OECD as it ranks first for health care expenditure, but last for coverage.
  • The slowdown in US health care spending during the past decade brought the growth rate closer to that of other high-spending countries -Canada, France, Germany, the Netherlands and Switzerland- at around 1%. Previously in 2002, the US’s health expenditure growth was around 7%, much higher than the approximate 3% which was the average for the other countries examined in the study
  • Higher health-sector prices (e.g., hospital care and prescription drugs) are thought to be the main driver of expenditure differences between the US and other high-spending countries, and recent price dynamics largely explain declines in health expenditure growth.
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Hand Hygiene: Global WHO Strategy

Prof Didier Pittet, MD, MS Director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, SwitzerlandMedicalResearch.com Interview with :
Prof Didier Pittet, MD, MS
Director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland

 

MedicalResearch.com : What are the main findings of the study?

Prof. Pittet: The main finding is that the WHO hand hygiene promotion strategy is feasible and sustainable across healthcare settings worldwide. For the first time, we have evidence of its feasibility and successful effects to improve hand hygiene in a variety of different geographical and income settings, with an even greater impact in low-/middle-income countries than in high-income countries.

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