‘Test and treat’:

New strategy for eliminating malaria

As researchers work to eliminate malaria worldwide, new strategies are needed to find and treat individuals who have malaria, but show no signs of the disease.

The prevalence of asymptomatic or minimally symptomatic malaria can be as high as 35 percent in populations with malaria and these asymptomatic individuals can serve as a reservoir for spreading malaria even in areas where disease transmission has declined.

In a new study, researchers have found that a strategy of actively identifying undiagnosed malaria and then treating those with the disease resulted in significantly lower prevalence of malaria cases compared to a control group.

Their findings are published in the journal PLoS ONE “New strategies are needed, particularly in areas of declining transmission. One strategy is to screen people for malaria and treat those who are infected, even those who are not sick enough to go to the clinic,” said lead author, Catherine G. Sutcliffe, an assistant scientist with the Johns Hopkins Bloomberg School of Public Health's Department of Epidemiology. “Using artemisinin combination therapy can enhance this strategy, as treatment can reduce transmission to mosquitoes.

In regions of declining transmission, the burden of malaria could be reduced to such an extent that elimination is achievable.”

In the study conducted in southern Zambia, researchers analysed data from surveys conducted in 2007 and between 2008 and 2009.

In both surveys, households were screened for malaria using rapid diagnostic tests and treated with artemisinin combination therapy when malaria was detected.

According to the new study, a proactive test-and-treat case-detection strategy resulted in a sixfold reduction in prevalence in 2008 and 2009, with the initial parasite prevalence at 4 percent.

Test and treat showed a twofold reduction in 2007, when community prevalence was higher at 24 percent.

“Proactive case detection with treatment using artemisinin-combination therapy can reduce transmission and provide indirect protection to household members.

Worldwide, malaria afflicts more than 225 million people.

The disease kills between 800,000 and 1 million people each year, many of whom are children living in Africa.

MNT

Painful periods eased by combined oral contraceptive pill

A large Scandinavian study, that has been running for 30 years, has finally provided convincing evidence that the combined oral contraceptive pill does, indeed, alleviate the symptoms of painful menstrual periods report scientists from the University of Gothenburg, Sweden.

The research is published in Europe´s leading reproductive medicine journal Human Reproduction. Although some previous studies and anecdotal evidence have suggested that the combined oral contraceptive pill could have an impact on painful periods, a 2009 review of all the available research by the prestigious Cochrane Collaboration concluded that there was limited evidence for pain improvement.

Less severe pain

The new findings by Dr Ingela Lindh and her colleagues at the Gothenburg University, Sweden, show that women who used the combined oral contraceptive pill suffered less severe pain compared with women who did not use it. Young women often seem to suffer more from painful periods than older women, and the researchers also found that increasing age did alleviate the symptoms, but the effects of pill use and age were independent of each other, with the pill having a greater effect.

Follow-up five years later

The researchers questioned three groups of women who reached the age of 19 in 1981, 1991 and 2001. Each group included approximately 400 to 520 women, who provided information on their height, weight, reproductive history, pattern of menstruation and menstrual pain, and contraceptive use. Five years later they were assessed again at the age of 24.

Significant difference

By comparing the same women at two different ages, the researchers were able to use each woman as her own control, enabling them to establish whether any reduction in severity of symptoms was due to combined oral contraceptive (COC) use or increasing age.

Dr Lindh, who is also a registered nurse and midwife, said: “By comparing women at different ages, it was possible to demonstrate the influence of COCs on the occurrence and severity of dysmenorrhoea, at the same time taking into account possible changes due to increasing age.

We found there was a significant difference in the severity of dysmenorrhoea depending on whether or not the women used combined oral contraceptives.”

Two scales for measuring pain

Pain and other symptoms were measured by two different scales: VMS (verbal multidimensional scoring system), which grades pain as none, mild, moderate or severe, and also takes into account the effect on daily activity and whether any painkillers were required; and VAS (visual analogue scale), where a woman can grade her degree of pain on a 10 cm line that starts with “no pain at all” and ends with “unbearable pain”.

From severe pain to moderate

Dr Lindh said: “We found that combined oral contraceptive use reduced dysmenorrhoea by 0.3 units, which means that every third woman went one step down on the VMS scale, for instance from severe pain to moderate pain, and which meant that they suffered less pain, improved their working ability and there was a decrease in the need for analgesics. On the VAS scale there was a reduction in pain of nine millimetres.”

Age also a factor

Independent of the effect of COC use, the researchers found that increasing age reduced the severity of dysmenorrhoea but not as much as COC did; it shifted women down 0.1 units on the VMS scale and five millimetres on the VAS scale. Childbirth also seemed to reduce the severity of symptoms, but this result was limited by the fact that very few women had given birth between the ages of 19 and 24.

Worse symptoms among young women

The researchers also found that in the youngest group (those born in 1982), more women reported suffering from painful periods, and the severity of the symptoms was worse.

“We are unsure why this is,” said Dr Lindh.

“It may be due to changes in the type of oral contraceptive used, for example, differences in oestrogen content and progestogen type, or a different appreciation of pain in the women born in later years, in that they may be more pain sensitive or are more prepared to complain about pain than women of the same age but born earlier.”

Billions of dollars in lost productivity

Dysmenorrhoea has been estimated to account for 600 million lost working hours and two billion dollars in lost productivity in the USA. Dr Lindh said: “Painful periods occurs frequently, particularly in young women where as many as 50-75% suffer from dysmenorrhoea.

It can have a detrimental effect on these women's lives, causing regular absenteeism from school and work, and interfering with their daily activities for several days each month.

Therefore, effective management of dysmenorrhoea is beneficial for both the women affected and society.

“Information about the effects of COC use on painful periods should be included in contraceptive counselling, as it has been shown that women who experience a beneficial effect of COCs other than contraception such as a reduction in dysmenorrhoea, are more likely to continue with the pill.”

Call for controlled trial

At present, the combined oral contraceptive pill is approved for contraception by regulatory authorities such as the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA), and they would require a randomised controlled trial to in order to include dysmenorrhoea treatment as another indication for COC use, although some doctors already prescribe it “off-label” to help with painful periods.

Dr Lindh said: “We are aware that drug companies have discussed with the authorities the possible design of a randomised controlled trial for the evaluation of COCs in the treatment of dysmenorrhoea but this has not yet been finalised or performed.

However, our study has clearly indicated a beneficial influence of COCs on the prevalence and severity of dysmenorrhoea and the absence of a randomised controlled trial confirming this in no way reduces the value of this information.”

- sciencenewsonline

Too much emphasis on time and money affects happiness

What does “free time” mean to you? When you're not at work, do you pass the time - or spend it? The difference may impact how happy you are.

A new study shows people who put a price on their time are more likely to feel impatient when they're not using it to earn money.

And that hurts their ability to derive happiness during leisure activities.

"Treating time as money can actually undermine your well-being,” says Sanford DeVoe, one of two researchers at the University of Toronto's Rotman School of Management who carried out the study.

Prof. DeVoe and PhD student Julian House based their conclusions on three experiments.

In each, a sub-group of participants was primed, through survey questions, to think about their time in terms of money.

This group subsequently showed greater impatience and lower satisfaction during leisure activities introduced during the experiments.

However, those put into the sub-group reported more enjoyment and less impatience when they were paid during one of those activities, which was listening to music.

The experiments’ results demonstrate that thinking about time in terms of money “changes the way you actually experience time,” says Prof. DeVoe.

“Two people may experience the same thing, over the same amount of time, yet react to it very differently.”

With growth over the last several decades in jobs paid by the hour, it's important for people to be “mindful,” of the impact this can have on their leisure enjoyment, he says, and allow themselves “to really smell the roses.”

- healthnewszone

Spinning sessions trigger the same biochemical indications as heart attacks

A short spinning session can trigger the same biochemical indications as a heart attack - a reaction that is probably both natural and harmless, but should be borne in mind when people seek emergency treatment for chest pain, reveals a study from the Sahlgrenska Academy, Sweden.

Heart attacks increase the secretion of enzymes known as cardiac biomarkers, which can be measured using a simple blood test.

This is important for rapid diagnosis and initiation of treatment. However, levels of these biomarkers also increase in situations that have nothing to do with heart disease, such as long periods of strenuous physical exertion like marathons, triathlons or long skiing races.

Important for accurate assessment

Researchers at the University of Gothenburg's Sahlgrenska Academy have now investigated whether shorter and less intensive forms of exercise have the same effect on cardiac biomarkers. This information is important for the accurate assessment of patients seeking emergency medical treatment after exercise.

Heart attack levels

The study included ten healthy people, with an average age of 30, who took part in an hour-long spinning session where researchers measured cardiac biomarkers in the blood immediately before the session as well as one hour after and again 24 hours after.

The study showed that levels of a commonly used cardiac biomarker, the heart enzyme troponin T, doubled an hour after the session. In two of the individuals the enzyme rose to levels that are routinely used as the threshold for heart attacks.

Normal in 24 hours

“Levels returned to normal in everyone in the study 24 hours after the spinning session,” says Smita Duttaroy, researcher at the Sahlgrenska Academy. “This is an important difference to patients who've had a heart attack, where levels of the markers can remain raised for several days afterwards.”

More awarness needed

The exercise-induced increase in cardiac biomarkers in healthy people is probably not dangerous but is, instead, a normal bodily reaction to exercise. However, Duttaroy feels that the similarities with heart attacks mean that emergency treatment teams must be more aware.

“When somebody with chest pains comes for emergency treatment, and a blood test shows that the cardiac biomarkers are rising, it's important to recognise that this kind of increase can also occur in healthy people after a normal exercise session.”

- MNT

Headaches... when to take them seriously

by Dr. R. A. R. Perera

Although headaches are painful and annoying, the vast majority of headaches do not indicate a serious disorder. Tension headaches and migraine account for 90% of all headaches.

One approach in categorising headaches is to distinguish ‘urgent headaches (those that may be life threatening) from others that may be ‘less urgent.’

Urgent headaches may be immediately life threatening, and should be treated promptly.

Patients typically describe a headache related to a brain haemorrhage as a sudden, “thunderclap” headache, often the ‘worst headache’ of life.

After this sudden onset, the pain may persist at a high or low intensity for days. Abnormal neurological symptoms may occur, including brief loss of consciousness at the onset of the headache, a stiff neck, or eye movements’ abnormalities.

Such a headache mandates prompt evaluation by a physician, since a missed brain haemorrhage can result in a stroke or death. A scan of the brain and a spinal tap will show abnormalities and sometimes brain surgery is essential part of the treatment.

Inflammation

Headaches could be due to some inflammation of the medium size arteries in people over 50 years or over. Chewing aggravates this headache and there are aches and pains all over the body.

This could cause weakening and sometimes loss of vision. Medical treatment with drugs can reduce this type of headache.

Meningitis can cause headache with fever and a stiff neck. Medical management includes hospitalisation and treatment with antibiotics.

Though a fear for many headache sufferers, brain tumours are uncommon. The most frequent presentation of a brain tumour is a seizure (a fit) and neurological abnormalities.

Waking with a headache is said to be an important sign of a tumour-related headache, although this occurs frequently in chronic headaches. This can be diagnosed with a brain scan.

Another type of headaches is called cluster headache. It is characterised by pain that is often situated behind one eye and usually the same eye with redness, tearing and nasal stuffiness on the inner side. These headaches come on very suddenly and without any warning and disappears in about one hour. It is often triggered by alcohol and this will awaken a person from sleep.

Sinus headaches typically occur with a cold and they are usually dull. It is worse in the morning and is localised to one specific area of the face or head.

Allergies

The headache is made worse by coughing, sneezing, sudden movement of the head, cold weather and alcohol. A person with sinus headaches may have hay fever or allergies.

Eye strain headache is associated with prolonged reading or staring at a computer screen.

Hormonal headaches are related to menstrual cycle, menopause or due to the use of contraceptive tablets. This headache tends to diminish cyclically, or after menopause is completed or after hormone discontinuation.

Coital headaches occur around the time of intercourse, and lasts from minutes to hours, and may be indistinguishable from a brain haemorrhage. Post concussion headaches include confusion, dizziness, irritability, memory disturbances, headache and impaired concentration. Mild analgesics and reassurance is generally effective.

Another common type of headache is the migraine headache.

A typical migraine headache is preceded by an aura (blinking lights) followed in 30-60 minutes by a throbbing, unilateral headache which lasts for 6-8 hours.

Generally, this is associated with nausea, vomiting and difficulty to see light. Certain foods, strong smells or the menstrual cycle can precipitate a migraine headache.

Stress, alcohol, or certain food (cheese, chocolate) can aggravate the pain in the headache. Identification and avoidance of precipitants may prevent attack. Migraine headache is due to dilation of arteries in the head, and cranial vasoconstrictor drugs given as an injection or orally is the general treatment.

Tension

Another common type of headaches is the tension headache.

This headache is located in both sides of the head and in the neck and is precipitated by stress and usually occurs later in the day.

Tension headaches can last for weeks or months and the pain may fluctuate in severity.

Cognitive therapy with simple painkillers generally cures this. But for some tension headaches, it may be necessary to treat as for a migraine headache.