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Global response to flu must change

'Evil' scientists, deadly viruses and terrorist plots are usually the preserve of Hollywood blockbusters. But when it comes to pandemic influenza, it is the stuff of real life.

As controversy about research into the H5N1 bird flu virus continues, a new find argues for a complete overhaul of current approaches to pandemic preparedness.To Pandemic or Not? Reconfiguring Global Responses to Influenza, by Dr Paul Forster, investigates the H1N1 swine flu pandemic of 2009-10 and sets out some vital lessons if we are to prepare for pandemic influenza effectively, while avoiding confusing and costly mistakes.

When the H1N1 outbreak in 2009-10 was milder than the World Health Organisation had predicted, WHO was accused of colluding with the pharmaceutical industry and national governments of squandering billions.The Council of Europe said US$18 billion was wasted, and branded WHO's actions "one of the greatest medical scandals of the century". The event revealed weaknesses in the world's current configuration of planning for and responding to pandemic influenza, according to Dr Forster. Science, public health policy makers and the worldwide public were confounded by the uncertainty, complexity and politics of pandemic influenza and the high emotions it inspires. Amid this confusion, the global and national institutions responsible for protecting public health were shown to be over-reliant on a reductive, science-led approach that prioritised a one-size-fits-all response, and failed to address the needs and priorities of the world's poorest and most vulnerable people.

Dr Forster suggests new ways to construct plural responses more suited to tackling the globalised mix of politics, people and pathogens that pandemics produce.

"Preparing for an influenza pandemic means preparing for surprises and being ready to respond rapidly and flexibly under conditions of uncertainty. If people across the globe are to be ready, plural and diverse response pathways are required," said Dr Forster, an independent development consultant and STEPS Centre researcher.

"The world would be better protected by a re-ordering of pandemic preparedness and response efforts around the needs of the world's poorest, most vulnerable, and most exposed people," he added.

A re-ordered response would allow the undue pre-eminence of pharmaceuticals to be examined, and bring focus on the pressing need for disease surveillance in animals, scrutiny of contemporary agricultural practices and a broadening of research efforts. It might also refresh the World Health Organisation's approach, which Dr Forster believes supports an inflexible and narrow set of interests by default, rather than conspiracy.

With most flu experts agreeing that it is not so much a question of if, but rather when, a new pandemic will arrive, the sooner the lessons of outbreaks such as that in 2009-10 can be learned, the better.

MNT


Mass migration exposes Indians to HIV

A view published on bmj.com exposes the true scale of HIV in India, placing the majority of blame on mass migration.

The Times of India proposes that "mass migration is the greatest threat to India's HIV control program" and asks how this can be combatted.

India's 2001 census showed that a third of the population are migrants (up from 27.4 percent in 1991). And worryingly, India's National AIDS Control Organisation (NACO) found that they have a 3.6 percent prevalence of HIV, 10 times that of the general population.

In the Indian state of Maharashtra, studies from 2009 showed that 18.6 percent of migrants had sexually transmitted infection symptoms, of which 45 percent did not seek treatment. seventy six percent did not even perceive any risk of HIV and as such, only 13 percent had been tested for the infection.

India's health ministry fear HIV prevalence will worsen due to migrants' "risky sexual behaviour", lack of social and economic security and "risk taking activities". Plus a recent study found that migrants were 1.68 times more likely to contract HIV than non-migrants.

Studies have shown that four times as many informal workers have casual sexual partners or visit sex workers, compared with those who are faithful to their spouses. Plus, only 25 percent of these workers use condoms, compared to 42 percent by others. To combat this, NACO is implementing a new migration policy covering the main railway stations in India where migrants usually board long distance trains. The primary focus is on informal labourers with a high prevalence of HIV. NACO hope this program will help to interrupt the transmission from rural migrants to high urban risk groups, but concludes that "language, cultural norms and available timings for migrants to access services" may present a challenge.

- medicalxpress


Does power lead people to greater happiness?

How does being in a position of power at work, with friends, or in a romantic relationship influence well-being? While we might like to believe the stereotype that power leads to unhappiness or loneliness, new research indicates that this stereotype is largely untrue: Being in a position of power may actually make people happier.

Drawing on personality and power research, Yona Kifer of Tel Aviv University in Israel and colleagues hypothesised that holding a position of authority might enhance subjective well-being through an increased feeling of authenticity.

The researchers predicted that because the powerful are able to "navigate their lives in congruence with their internal desires and inclinations," they feel as if they are acting more authentically - more "themselves" - and thus are more content.

In their first experiment, the researchers surveyed over 350 participants to determine if internal feelings of power are associated with subjective well-being in different contexts: at work, with friends, or in romantic relationships.

The results indicated that people who feel powerful in any context tend to be more content.

The most powerful people surveyed felt 16 percent more satisfied with their lives than the least powerful people. This effect was most pronounced in the workplace: Powerful employees were 26 percent more satisfied with their jobs than their powerless colleagues. The power-based discrepancy in happiness was smaller for friendships and romantic relationships.

The researchers posit that this may be because friendships are associated with a sense of community rather than hierarchy, and therefore having power in this kind of relationship is less important.

In the second and third experiments, Kifer and colleagues examined the causal relationship between power, feelings of authenticity, and general well-being, by manipulating each of the factors independently.

The results revealed that being in a position of power causes people to feel more authentic and "true to themselves" - that is, it allows their actions to more closely reflect their beliefs and desires. Feelings of authenticity, in turn, enhance subjective feelings of well-being and happiness.

"By leading people to be true to their desires and inclinations - to be authentic - power leads individuals to experience greater happiness," the researchers conclude.

Kifer and colleagues propose that future research into power dynamics, happiness, and authenticity should focus on specific kinds of power, both positive (such as charisma) and negative (such as punishment).

Together, these findings suggest that even the perception of having power can lead people to live more authentic lives, thereby increasing their happiness and well-being.

- MNT


Modifying cells in the eye may restore vision

Doctors may one day treat some forms of blindness by altering the genetic program of the light-sensing cells of the eye, according to scientists at Washington University School of Medicine in St. Louis.

Working in mice with retinitis pigmentosa, a disease that causes gradual blindness, the researchers reprogrammed the cells in the eye that enable night vision.

The change made the cells more similar to other cells that provide sight during daylight hours and prevented degeneration of the retina, the light-sensing structure in the back of the eye. Scientists are now conducting additional tests to confirm that the mice can still see.

"We think it may be significantly easier to preserve vision by modifying existing cells in the eye than it would be to introduce new stem cells," said senior author Joseph Corbo. "A diseased retina is not a hospitable environment for transplanting stem cells."

The study is available in the early online edition of Proceedings of the National Academy of Sciences.

Mutations in more than 200 genes have been linked to various forms of blindness.

Efforts are under-way to develop gene therapies for some of these conditions.Rather than seek treatment tailored to individual mutations, Corbo hopes to develop therapies that can alleviate many forms of visual impairment. To make that possible, he studies the genetic factors that allow cells in the developing eye to take on the specialised roles necessary for vision.

The retina has two types of light-sensing cells or photoreceptors. The rods provide night vision, and the cones sense light in the daytime and detect fine visual details.In retinitis pigmentosa, the rods die first, leaving patients unable to see at night. Daytime vision often remains intact for some time until the cones also die.

Corbo and others have identified several genes that are active in rods or in cones but not in both types of photoreceptors.

He wondered whether turning off a key gene that is activated only in rods could protect the cells from the loss of vision characteristic of retinitis pigmentosa.

'The question was, when retinitis pigmentosa is caused by a mutation in a protein only active in rods, can we reduce or stop vision loss by making the cells less rod-like?" he explains.

The new study focuses on a protein known as Nrl, which influences development of photoreceptors.

Cells that make Nrl become rods, while cells that lack the protein become cones.

Turning off the Nrl gene in developing mice leads to a retina packed with cone cells.

To see if this rod-to-cone change was possible in adult mice, Corbo created a mouse model of retinitis pigmentosa with an Nrl gene that could be switched on and off by scientists.

"In adult mice, switching off Nrl partially converts the rod cells into cone cells," he says.

"Several months later, when the mutant mice normally had very little vision left, we tested the function of their retina."The test showed a healthier level of electrical activity in the retinas of mice that lacked Nrl, suggesting that the mice could still see.

Corbo now is looking for other critical development factors that can help scientists more fully transform adult rods into cones.

He notes that if complete conversion of rods to cones were possible, this therapy could also be helpful for conditions where cone cells die first, such as macular degeneration.

- MNT


Small changes may equal a trip to the gym

New research suggests the health benefits of small amounts of activity - even as small as one and two-minute increments that add up to 30 minutes per day - can be just as beneficial as longer bouts of physical exercise achieved by a trip to the gym.

The nationally representative study of more than 6,000 American adults shows that an active lifestyle approach, as opposed to structured exercise, may be just as beneficial in improving health outcomes, including preventing metabolic syndrome, high blood pressure, and high cholesterol.

"Our results suggest that engaging in an active lifestyle approach, compared to a structured exercise approach, may be just as beneficial in improving various health outcomes," said Paul Loprinzi, lead author of the study.

"We encourage people to seek out opportunities to be active when the choice is available. For example, rather than sitting while talking on the phone, use this opportunity to get in some activity by pacing around while talking."

Perhaps just as importantly, the researchers found that 43 percent of those who participated in the "short bouts" of exercise met physical activity guidelines of 30 minutes day.

In comparison, less than 10 percent of those in the longer exercise bouts met those federal guidelines for exercise.

Cardinal, who has studied the "lifestyle exercise" model for more than 20 years, said one of the most common barriers people cite to getting enough exercise is lack of time.

He said the results of this study are promising, and show that simply building movement into everyday activities can have meaningful health benefits.

"This is a more natural way to exercise, just to walk more and move around a bit more," Cardinal said. "We are designed by nature as beings who are supposed to move.

People get it in their minds, if I don't get that 30 minutes, I might as well not exercise at all.

Our results really challenge that perception and give people meaningful, realistic options for meeting the physical activity guidelines."

For example, Cardinal said instead of driving half a mile, try biking or walking the same distance; instead of using a riding lawn mower, use a push lawn mower.

Instead of sitting through TV commercials, try doing some sit-ups, push-ups, or jumping jacks during the commercial breaks; and instead of sitting and being a spectator at a child's sporting event, try walking around during the halftime break.

The researchers said the participants in this study wore accelerometers, which is an objective tool to measure physical activity. Those who participated in the short bouts of activity could be moving as few as one or two minutes at a time. The people in the "short bouts" group had positive results in areas such as blood pressure, cholesterol, metabolic syndrome, and waist circumference.

For instance, the study showed those in the shorter exercise group who met physical activity guidelines had an 89 percent chance of not having metabolic syndrome, compared to 87 percent for those meeting guidelines using the structured exercise approach. Loprinzi said the one area where small bursts of activity did not seem to equal the benefits of longer, sustained exercise was in Body Mass Index, or BMI.

However, the researchers cautioned that these findings do not necessarily mean that short bouts of activity do not help with weight loss, especially since they did find a benefit on weight circumference.

- NYTS

 

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