Better health standards in Jaffna

By Nilma DOLE

After the dawn of peace, Jaffna's health sector looks positive with health infrastructure and development of key hospitals and clinics to help the people of the Northern Province. At the forefront of developing and supporting the health sector in Jaffna was the regional conference held by the Sri Lanka Medical Association which began on January 27 and ends today.

President of the Sri Lanka Medical Association Prof.Vajira Dissanayake said, "Our regional workshop is aimed at restoring the faith of the Jaffna medical services for the people and to say that they need not travel from all the way for good and high-quality health services and facilities." He said that there needs to be more development in health infrastructure, but money is trickling in and corporates are now becoming more attuned to helping the people of Jaffna.

This is evident from the much-publicised donation walk for Trail Sri Lanka which generated funds to build a Jaffna Cancer Hospital.

"It is true, there is a form of cancer which is spreading in Jaffna and we still can't identify it. As a genetologist, I am happy to see many young doctors who have passed out from here and abroad, have been interested in working in the Jaffna health sector," said the professor. He said the doctors are optimistic and are confident to take their knowledge to Jaffna which can be seen in the mutual exchange of ideas and knowledge between all other Universities in Sri Lanka with the University of Jaffna.

Facilities

"We hope that Jaffna will have the facilities and health expertise that can be on par with what we have in Colombo. We are also taking this regional workshop to train people in Jaffna for it doesn't only the doctors but the midwives, nurses and other medical staff," he said.

The professor said, "The objectives of the regional workshop is in a bid to boost interest in Jaffna and to sensitise policy makers and healthcare administrators on the issues faced by healthcare workers in Jaffna."

Feasible solutions

Also they hope to negotiate for feasible solutions to improve the healthcare service delivery in Jaffna. "Representatives of various categories of healthcare workers will voice on the challenges they encounter in delivering healthcare services in the Northern province," said Prof. Dissanayake.

Prof.Dissanayake said, "The chief guest for the regional conference is Prof.Lalitha Mendis, Emritus Professor of Microbiology, Faculty of Medicine (Colombo University)."

There will be concurrent workshops that will revive interest in training doctors and medical personnel in Jaffna. "Jaffna certainly has the potential in developing its infrastructure and managing with their resources because the doctors there have considerable experience in doing that. Hence, they are better knowledgeable in using limited resources the best possible manner and saving lives too," commended the professor.

Even though Jaffna's health sector is still in developing stages, there is a marked improvement in the health facilities since peace dawned.

"The Sri Lanka Medical Association is the oldest medical association in Asia and Australasia making it a pivotal body in developing medical policies and decisions which will make sure what is spoken at the conference is implement," said the professor.

According to the SLMA president, there are healthcare needs which need to be addressed and areas such as mental health and cancer research have to be urgently seen into.

"Sri Lanka has the best doctors who are not only trained locally, but most of them have gone abroad to train in the UK and other countries.

The issue is that we can't generalise the brain drain problem but there is a sparked interest by the younger generation of medical experts to come back and serve the country, especially in Jaffna," said the professor.

Demand

Moreover, the demand for doctors are great in Jaffna which goes to show that even though it is peace, there are different categories of development of medical health.

"There is a motivation factor now that the war is over and there is a significant improvement on the part of the medical experts," said the professor. He said that unlike in cities where more is not enough, in Jaffna, if you treat the patients a little, it goes a long way.

"Even if the doctors do as much as they can, residents in the cities are still not appreciative of the medical advice and resources they get but in Jaffna, a little help goes a long way because if you treat them, they are happy with the little act of kindness," said Prof.Dissanayake.

Appreciative

As a result, doctors working in the Northern Province say that working with patients from the most far-flung parts are the most appreciative and they love working with them.

"We are happy that we can take a workshop of this nature to the Northern Province to ensure that we at the SLMA have a keen interest and that we have not forgotten the medical sector there," said Prof.Dissanayake.

The keynote speakers include Dr.Rathini Jude, Northern Provincial director, Dr.Kapila Jayaratne, Dr.Mukunthan, Dr.S. Raviraj, Dr. P.Lakshman, Dr. G. Sathiyathas, Dr. A.Keetheswaran, Prof. K.Sivapalan (University of Jaffna), Dr.Malik Fernando (Ethics Committee) and the Health Minister, Maithripala Sirisena.

New malaria maps to guide battle against disease

A new suite of malaria has revealed in unprecedented detail the current global pattern of the disease, allowing researchers to see how malaria has changed over a number of years.

In a study published in the Malaria Journal, a multinational team of researchers from the Malaria Atlas Project (MAP), funded mainly by the

Wellcome Trust, present the results of a two-year effort to assemble all available data worldwide on the risk of Plasmodium falciparum malaria, the most deadly form of the disease. Using computer modelling and data on climate and human populations, they have revealed the complex landscape of malaria across the globe. The maps build on the first ever Atlas of Malaria-Eliminating Countries published earlier this year.

Malaria continues to exert an huge burden of illness and death worldwide but, after decades of neglect, the war against the disease has entered an unprecedented era: it is high on the policy agenda, international funding is beginning to translate into real increases in populations protected by bed nets and other key interventions, and a growing body of evidence points towards important reductions in illness and death.

The maps have been made freely available, along with a wide range of other malaria resources via the launch of a new online portal at www.map.ox.ac.uk.

The research was led by Dr Pete Gething from the Department of Zoology at

the University of Oxford. He says: "These new maps and our online portal are really aimed at everyone involved in the battle against the disease: from the major international organisations and funders, to other scientists, to those actually doing the disease control work on the ground."However, in order to allocate funding where it is most needed, accurate maps detailing where the disease is most intense and where the largest concentrations of people at risk are found.

The new maps reveal for the first time the startling variations in malaria risk, even over short distances.

Dr Simon Hay, who leads the MAP group in Oxford, explains: "It's increasingly clear that malaria transmission is extremely heterogeneous. This means a one-size-fits all approach to controlling is not appropriate.

What works in one place might not work elsewhere. These maps are designed to help unravel that complexity and provide a practical guide to help target resources."

Sir Richard Feachem, Director of the Global Health Group at the University of California, San Francisco, and Chair of the Malaria Elimination Group has welcomed the role the new maps can play in pursuing malaria elimination. He says: "From the perspective of elimination, the key message is that malaria transmission is actually very low across large swathes of the endemic world - including the 36 countries currently engaged in elimination programs.

Mapping transmission levels in detail helps to guide these initiatives and highlights how, with concerted effort and sustained financing, we can continue to shrink the malaria map."

- MNT

Cervical cancer screening via self-collection

Human papillomavirus (HPV) testing of self-collected specimens may be a more effective way to screen for cervical cancer in low-resource settings compared to visual inspection with acetic acid (VIA) and liquid-based cytology (LBC), according to a study published in the *Journal of the National Cancer Institute.*

Cervical cancer is the third most common cancer found in women with approximately 530,000 new cases each year resulting in an estimated 275,000 deaths. In developed countries, cervical cancer incidences have declined, mostly due to cervical cytology screening campaigns, which requires significant medical resources and laboratory infrastructure.

Cervical cancer is on the rise in the developing world, with one-seventh of the world's cervical cancer cases in China, where there is no nationwide screening program for the disease yet.

There, researchers have proposed that HPV testing of self-collected Pap specimens might serve as an alternative or complementary method of primary cervical cancer screening method.

To determine the effectiveness of HPV testing of self-collected Pap specimens (termed "Self-HPV testing" in the report), Professor You-Lin Qiao, M.D., Ph.D., of the Cancer Institute/Hospital at the Chinese Academy of Medical Sciences/Peking Union Medical College and colleagues, assembled individual patient data from five population-based cervical cancer-screening studies in China from 1999-2007, in which participants received HPV testing of self-collected Pap specimens, HPV testing of physician-collected Pap specimens, LBC, and VIA. The researchers then analysed the pooled data to detect biopsy-confirmed cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) or CIN3+. Of the 13,140 rural Chinese women screened for cervical cancer, 507 were diagnosed with CIN2+, 273 with CIN3+, and 37 with cervical cancer.

The researchers found that HPV testing of self-collected Pap specimens was more sensitive and less specific than VIA and LBC but less sensitive and similarly specific compared to physician-collected Pap specimens.

They conclude that self-collection with HPV testing could help expand China's current screening outreach. "Although it is not specific enough to be a stand-alone test, self-HPV testing provides sensitive results without pelvic exams, medical professionals, or health-care facilities and thus has the potential to serve as a primary cervical cancer screening method for women, regardless of their geographic location or access to health care," the researchers write.

Self-sampling procedures were instructed by medical professionals, and it is unclear whether unsupervised self-examinations would give out similar outcomes. Still, the researchers write, "The incorporation of Self-HPV testing in the Chinese government's planning of a national cervical cancer screening program would complement the current program by increasing its coverage of unscreened populations."

In an accompanying editorial, Patrick Petignat, M.D., of the University Hospitals of Geneva, writes that while HPV Self-Sampling for primary cervical cancer screening may help increase the number of women being screened, introducing a new screening method should be met with caution. He feels that determining both the cost effectiveness of the procedure as well as women's personal willingness to undergo self-screening is essential; furthermore, patients need to be properly educated about self-screening."Efforts are still needed to increase awareness about HPV and cervical cancer, and more information is needed about the reliability of the method," Petignat writes.

"Health-care professionals should provide sufficient support to participants to properly interpret their test results, thus avoiding any delay to follow-up and treatment." - MNT

The genome and timing of menopause

An international team of researchers has discovered 13 new regions of the genome associated with the timing of menopause.

These genes shed light on the biological pathways involved in reproductive lifespan and will provide insights into conditions connected to menopause, such as breast cancer and heart disease. Menopause is a major hormonal change that affects most women when they are in their early 50s.

The timing of menopause can have a huge impact on fertility, as well as influencing the risk of a range of common diseases such as breast cancer.

It has been known for some time that genetic factors influenced the onset of menopause, however until recently very few genes had been identified.

In the new study, published in the journal Nature Genetics, Dr Anna Murray, University of Exeter, Peninsula College of Medicine and Dentistry (PCMD) Dr John Perry, PCMD and WTCHG, University of Oxford, and dozens of international collaborators, examined the genomes of over 50,000 women.

They identified 13 novel gene regions associated with menopause onset, and confirmed four previously identified. Most of the 17 regions include genes related to DNA damage/repair or the immune system, whilst others are linked to hormonal regulation.

Dr Perry said: "The new findings highlight biological pathways not previously associated with reproductive lifespan, and may provide insightsinto the other conditions connected with menopause age, such as cardiovascular disease and breast cancer."

The association with breast cancer is related to the length of time a woman menstruates in total and is thought to be related to oestrogen exposureover a lifetime - in fact earlier menopause is protective for breast cancer. Cardiovascular risk is increased in post-menopausal women compared to pre-menopausal and reduced oestrogen is thought to be a key component of this increased risk. Genetic studies will be beneficial in working out exactly what the relationships are between these conditions.

Dr. Murray added: "Menopause is a process most women go through, yet we know very little about what governs the timing of this key event in a woman's life.

By finding out which genes control the timing of menopause we hope to be able understand why this happens very early to some women, reducing their chances of having children naturally."

The authors said they expected further research will identify additional genes, and also assess the impact of these genetic regions on related reproductive disorders.

The research team are currently investigating women who had very early menopause, before 45 years, to determine whether the new menopause genes play a role in this clinically important condition which affects over five per cent of women.

whyhotflashes.com

Childhood obesity should be tackled through family focus

Parents should be involved in treatment programs for their obese children, according to a new scientific statement published in Circulation: Journal of the American Heart Association.

"In many cases, the adults in a family may be the most effective change agents to help obese children attain and maintain a healthier weight," said Myles S. Faith, Ph.D., chair of the American Heart Association's statement writing group "To do so, the adults may need to modify their own behaviour and try some research-based strategies."

The authors evaluated research on the outcomes of behavioural change strategies that included high involvement by parents and other adult caregivers of obese children in the context of treatment programs.

The treatment programs were typically multi-disciplinary - implemented by a team of psychologists, medical staff and dieticians in a university or hospital clinic setting.

Access to such intensive treatment programs is limited for many families across the country.

"While these strategies were implemented by healthcare professionals in a treatment program, the psychological principles on which they are based provide sound guidance for families of obese children as well," Faith said. Strategies that have been linked to better outcomes include:

- As a family, identify specific behaviours that should be changed.

- Set goals and monitor progress. The goals should be clearly defined, such as reducing or limiting television screen time to no more than two hours per day.

- Provide a home environment that encourages healthier choices.

For example, limit temptations at home, such as higher calorie desserts, while providing access to a variety of fruits from which children can choose.

- Parents should praise their children's progress and, instead of criticising, use "slips" as an opportunity to help children identify ways to make different choices if the same situation arises again.

- Food shouldn't be a reward or withheld as punishment.

- Keep track of progress toward goals, using a written or online tracker.

Previous research has yielded mixed results on the effectiveness of parental involvement in family-based treatment for childhood obesity how-much-should-i-weigh.

- antofredchem.com