‘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. |