News in Brief

New diabetes 2 guideline

The International Diabetes Federation (IDF) and the Clinical Guidelines Task Force have released the second edition of the Global Guideline for Type 2 Diabetes. This edition features new and revised information on: Type 2 management in older people; Algorithms for people with type 2 diabetes; Glucose control therapy and lifestyle management. The guideline’s goal is to ensure that optimal type 2 diabetes management reaches people who need it most, particularly those in resource poor settings.

Global Guideline for Type 2 Diabetes

US NIH awards US$100m to autism research

The US National Institutes of Health has awarded of US$100 million over five years for the Autism Centers of Excellence (ACE) research programme, which will feature projects investigating sex differences in autism spectrum disorders, or ASD, and investigating ASD and limited speech. ASD affects about one in 88 children in the United States. The NIH created the ACE Program in 2007 to launch an intense and coordinated research programme into the causes of ASD and to find new treatments.

Coca-Cola to help with medicine distribution

The Coca-Cola Company and the Global Fund to Fight AIDS, Tuberculosis and Malaria announced they will expand a project leveraging Coca-Cola’s expansive global distribution system and core business expertise to help government and non-governmental organisations deliver critical medicines to remote parts of the world, beginning in rural Africa. As part of their participation in the Clinton Global Initiative’s (CGI) Annual Meeting, the company and the Global Fund outlined their plans to expand the reach of “Project Last Mile”, a publicprivate partnership established in 2010 to help Tanzania’s governmentrun medicine distribution network, Medical Stores Department (MSD), build a more efficient supply chain by using Coca-Cola’s proven logistics models for delivering beverages almost anywhere in the world. The newest phases of the partnership will increase the availability of critical medicines to 75% of Tanzania and expand the initiative to Ghana and Mozambique. Opportunities to expand into additional countries are being explored.

One person dies every 10 seconds from CVD in China

The Chinese Society of Cardiology (CSC) is calling for urgent action to reduce the number of CVD-related deaths in the country. Every year three million people – one every 10 seconds – die from CVD in China says the CSC. They are also calling on doctors to mend their ways and serve as an example to their patients. “Half of male physicians are smokers and one-third of Chinese male cardiologists are smokers, so it’s a real problem,” said Professor Dayi Hu, chief of the Heart Centre at the People’s Hospital, Peking University and president of the CSC.

Virtual diabetes forum for doctors

The Diabetes Education Network for Health Professionals (D-NET) is celebrating two years since its launch in 2010. Developed as a response to requests from health professionals, the 1,700 memberstrong virtual network demonstrates the International Diabetes Federation’s commitment to health professional education and collaboration. It has become a successful virtual community of practice.


Handwashing initiative gains traction

Unilever and the Earth Institute have begun a new initiative to bring handwashing with soap to the Millennium Villages, a project that works with nearly 500,000 people in rural villages, across 10 countries in sub-Saharan Africa. Over the past two years, Unilever has successfully changed the handwashing behaviour of 50 million people in Africa and South-Asia, through its leading soap brand Lifebuoy and partnerships with Population Services International and UNICEF. Paul Polman, CEO Unilever, said: “Addressing hygiene in deep rural Africa can enable us to develop more effective solutions to reduce child mortality. It is unacceptable that two million children die every year from infectious diseases when we have easy and cheap lifesaving solutions, such as handwashing with soap.”

ENCODE project gets US$30m grant

Grants totalling US$30.3 million in fiscal year 2012 will expand the ENCyclopedia Of DNA Elements (ENCODE), a comprehensive catalogue of functional elements that control the expression of genetic information in a cell, the US-based National Human Genome Research Institute (NHGRI) announced. The ENCODE project’s goal is to provide the scientific community with information they need to understand better the role that the genome plays in health and disease.


Ebola outbreak in Democratic Republic of Congo

As of 24 September 2012, 51 cases of Ebola haemorrhagic fever (EHF) had been reported in the Democratic Republic of Congo (DRC). Of these, 20 were thought to be fatal. The cases reported were from Isiro and Viadana health zones in Haut-Uélé district in Province Orientale. The Ministry of Health (MoH) continues to work with partners, under the National Task Force which includes: WHO; Médecins Sans Frontières (MSF); the International Federation of Red Cross and Red Crescent Societies (IFRC); US Agency for International Development (USAID); US CDC; and others.

Research suggests flu virus can be passed on before symptoms show

Research at Imperial College London examining influenza transmission in ferrets suggests that the virus can be passed on before the appearance of symptoms. If the finding applies to humans, it means that people pass on flu to others before they know they’re infected, making it very difficult to contain epidemics. Previous research using mathematical models estimated that most flu transmission occurs after the onset of symptoms, but some happens earlier.

The new study, published in the open access journal PLOS ONE, is the first to investigate this question experimentally in an animal model. Ferrets are commonly used in flu research because they are susceptible to the same virus strains and show similar symptoms to humans. Ferrets with flu were put in contact with uninfected ferrets for short periods at different stages after infection. Transmission occurred before the first symptom, which is fever, appeared. This was true both when the ferrets were in the same cage and when they were in adjacent cages.

Professor Wendy Barclay, the study’s lead author, said: “This result has important implications for pandemic planning strategies. It means that the spread of flu is very difficult to control, even with self-diagnosis and measures such as temperature screens at airports. It also means that doctors and nurses who don’t get the flu jab are putting their patients at risk because they might pass on an infection when they don’t know they’re infected.”

The flu strain used in the study was from the 2009 swine flu pandemic, which killed almost 300,000 people worldwide. The researchers found that ferrets were able to pass on flu to others just 24 hours after becoming infected themselves. The animals did not suffer from fever until 45 hours after infection and began sneezing after 48 hours. The results are consistent with earlier studies which found that sneezing is not necessary to transmit flu – droplets of virus are expelled into the air during normal breathing.

In the late stages of infection, after five or six days, flu was transmitted much less frequently, suggesting that people can return to work or school soon after symptoms subside with little risk of passing flu on to others.

More children now survive beyond their 5th birthday than ever before

According to a report recently released by UNICEF, more children now survive their fifth birthday than ever before. The global number of under-five deaths has fallen from around 12 million in 1990 to an estimated 6.9 million in 2011.

“All regions have shown steady reductions in under-five mortality over the past two decades. In the last decade alone, progress on reducing child deaths has accelerated, with the annual rate of decline in the global under-five mortality rate rising from 1.8% in 1990-2000 to 3.2% in 2000-2011,” says Anthony Lake, executive director, UNICEF.

He said the gains have been broad, with marked falls in diverse countries. Between 1990 and 2011, nine low-income countries – Bangladesh, Cambodia, Ethiopia, Liberia, Madagascar, Malawi, Nepal, Niger and Rwanda – reduced their under-five mortality rate by 60% or more.

Nineteen middle-income countries, among them Brazil, China, Mexico and Turkey, and 10 high-income countries, including Estonia, Oman, Portugal and Saudi Arabia, are also making great progress, reducing under-five mortality by two-thirds or more over the same period.

“Our advances to date stem directly from the collective commitment, energy and efforts of governments, donors, nongovernmental organisations, UN agencies, scientists, practitioners, communities, families and individuals,” said Lake.

“Measles deaths have plummeted. Polio, though stubbornly resistant thus far to elimination, has fallen to historically low levels. Routine immunization has increased almost everywhere. Among the most striking advances has been the progress in combatting AIDS. Thanks to the application of new treatments, better prevention and sustained funding, rates of new HIV infections and HIV-associated deaths among children have fallen substantially.”

However, Lake warned that any satisfaction should be tempered by the unfinished business that remains.

“On average, around 19,000 children still die every day from largely preventable causes. With necessary vaccines, adequate nutrition and basic medical and maternal care, most of these young lives could be saved,” he pointed out in the APR Progress Report 2012. Great divides and economic disparities persist among regions and within countries and it is the economically poorest regions, least developed countries, most fragile nations, and most disadvantaged and marginalised populations that continue to bear the heaviest burden of child deaths.

More than 80% of all under-five deaths in 2011 occurred in sub-Saharan Africa and South Asia.

In June this year, in an effort to reduce these child mortality figures, the governments of Ethiopia, India and the United States, as well as UNICEF and some 700 partners from the public, private and civil society sectors, came together for a child survival Call to Action. What emerged from the Call to Action was a rejuvenated global movement for child survival, with partners pledging to work together.

Since the Call to Action, more than 110 governments have signed a pledge vowing to redouble efforts to accelerate declines in child mortality; 174 civil society organizations, 91 faith-based organisations, and 290 faith leaders from 52 countries have signed their own pledges of support, Lake noted.

He explained that this global movement, led by governments, is mobilising to scale up action on three fronts:

- sharpening evidence-based country plans and setting measurable benchmarks;

- strengthening accountability for maternal, newborn and child survival;

- and mobilising broad-based social support for the principle that no child should die from preventable causes.

“Countries can achieve rapid declines in child mortality, with determined action by governments and supportive partners. Our progress over the last two decades has taught us that sound strategies, adequate resources and, above all, political will, can make a critical difference to the lives of millions of young children,” Lake said.

Committing to Child Survival – a Promise Renewed
Levels and Trends in Child Mortality

Free neuropathic pain resource from EPG

The launch of a new interactive online ‘Knowledge Centre’ on Neuropathic Pain has been announced by EPG Health Media. The resource is designed to support healthcare professionals involved in the management of patients with neuropathic pain and they are invited to access the information for free at
EPG Online:

The Neuropathic Pain Knowledge Centre includes a comprehensive review of diagnostic and assessment approaches to neuropathic pain, as well as the wide range of management and treatment options currently available. With over 320,000 members and more than 110,000 pages of clinical content, EPG Online represents the largest disease, medicines and free educational platform for European doctors.

Chance to eradicate polio edges closer

World leaders and experts gathering at the United Nations to celebrate efforts that have already reduced the incidence of polio by 99% around the globe, claimed we have a “once-in-a-generation” opportunity to eradicate the disease.

UN secretary-general Ban Ki-Moon said: “Globally, we have the lowest number of cases reported this year. But everything hinges on stopping polio in a few districts in Nigeria, Pakistan and Afghanistan.

“Where there is fighting and insecurity, we need warring parties to allow aid workers to operate. I appeal to all parties to provide safe passage for health workers to access and vaccinate children,” Ban said

The vaccine-preventable infectious disease raged in 125 countries when the global fight against it began in 1988 under the banner of the Global Polio Eradication Initiative (GPEI). While India had long been regarded as the nation facing the greatest challenges to eradication, it has been polio free for more than 18 months. Polio is among five major afflictions Ban pledged to tackle aggressively during this, his second term as secretary-general. He is also committed to tackling malaria, new paediatric HIV infections, maternal and neonatal tetanus, and measles.

A major GPEI donor is the Bill & Melinda Gates Foundation. Another is Rotary International, which had already contributed US$1.2 billion to polio eradication and has now announced additional funding of US$75 million over the next three years for GPEI. The Islamic Development Bank, a new donor to the polio eradication effort, announced a three-year $227 million financing package to Pakistan, and a US$3 million grant for Afghanistan.

Artificial finger developed with sense of touch

European researchers of the projects NanoBioTact and NanoBioTouch delving deep into the mysteries of touch have developed the first sensitive artificial finger. It works with an array of pressure sensors that mimic the spatial resolution, sensitivity and dynamics of human neural tactile sensors and can be directly connected to the central nervous system. Combined with an artificial skin that mimics a human fingerprint, the device´s sensitivity to vibrations is improved. Depending on the quality of a textured surface, the biomimetic finger vibrates in different ways, when it slides across the surface. Thereby it produces different signals and once it will get used by patients, they could recognise if the surface is smooth or scratchy.

Putting the biomimetic finger on artificial limbs would take prostheses to the next level. Dr Lucia Beccai from the Centre for Micro-Robotics at the Italian Institute for Technology, said: “Compared to the hand prostheses which are currently on the market, an integrated sense of touch would be a major improvement. It would be a truly modern and biometric device, which would give the patient the feeling that it belonged to his own body.” US

FDA approves first subcutaneous heart defibrillator

The US Food and Drug Administration has approved a heart defibrillator that helps to restore regular heart rhythms with leads that can be implanted just under the skin (subcutaneously) instead of connected directly into the heart.

Other implantable defibrillators on the market require a physician to insert one or more electrical conductor wires into a vein in the upper chest and guide them into the patient’s heart. X-ray fluoroscopy, a realtime imaging method, helps the physician to visualize the heart and blood vessels to guide the leads to the correct position.

The Subcutaneous Implantable Defibrillator (S-ICD) System uses a lead that is implanted just under the skin along the bottom of the rib cage and breast bone. Because the lead is placed under the skin rather than through a vein into the heart, a physician can implant the device without accessing a patient’s blood vessels or heart and without the need for fluoroscopy.

Christy Foreman, director of the Office of Device Evaluation at FDA’s Centre for Devices and Radiological Health, said: “Some patients with anatomy that makes it challenging to place one of the implantable defibrillators currently on the market may especially benefit from this device.”

FDA has reviewed data from a 321- patient study in which 304 patients were successfully implanted with the S-ICD System. At the time of implantation, the investigator tested the effectiveness of the device by inducing heart arrhythmias. The S-ICD System was successful at converting all abnormal heart rhythms that it detected back to normal rhythms. Investigators followed these patients for six months following implantation, during which time the device detected and recorded 78 spontaneous arrhythmias in 21 patients; all arrhythmias were either successfully converted back to normal by the defibrillator, or resolved on their own. Because the S-ICD System memory stores data from only the 22 most recent arrhythmia episodes, there may have been other detected episodes that could not be analyzed by investigators.

Dementia stigma keeps sufferers in denial

The latest World Alzheimer Report entitled Overcoming the Stigma of Dementia, released by Alzheimer’s Disease International (ADI) has revealed that nearly one in four people with dementia (24%) hide, or conceal, their diagnosis citing stigma as the main reason. Furthermore, 40% of people with dementia report not being included in everyday life. What is startling is that nearly two out of three people with dementia, and their carers, believe there is a lack of understanding of dementia in their countries.

The World Alzheimer Report 2012 provides 10 recommendations to enable governments and societies to overcome stigma:

1) Educate the public
2) Reduce isolation of people with dementia
3) Give people with dementia a voice
4) Recognise the rights of people with dementia and their carers
5) Involve people with dementia in their local communities
6) Support and educate informal and paid carers
7) Improve the quality of care at home and in care homes
8) Improve dementia training of primary healthcare physicians
9) Call on governments to create national Alzheimer’s disease plans
10) Increase research into how to address stigma

The World Alzheimer Report 2012

Cholera in Sierra Leone

More than 18,500 cases (including 271 deaths) have been reported in the cholera outbreak in Sierra Leone since the beginning of the year. The highest numbers of cases are reported from the western area of the country where the capital city of Freetown is located.

The Ministry of Health and Sanitation (MOHS) is working closely with partners at national and international levels to step up response to the cholera outbreak. Activities at the field level include case management; communication and social mobilisation; water, sanitation and hygiene promotion; surveillance and data management.

Emphasis is being placed on early detection of cases and timely provision of treatment at the district levels in order to reduce deaths. Cholera cases are managed in cholera treatment units (CTUs) and where there are no established CTUs, emphasis is placed on designating specific areas within the health facilities for isolation purposes.

Experts call for cloud computing data

The exponential growth in the power of computing has affected the amount of scientific data produced, managed and analysed over the past decade, turning biology into a data-intensive science, states a new report by healthcare experts GBI Research. The report states that the advent of genomics will change our understanding of biology and human diseases, but cloud computing must step up, to store and share this enormous amount of data.

Research in the pharmaceutical industry has moved towards next-generation sequencing, and research centres all over the globe are generating thousands of gigabytes of DNA sequences. Over 10,000 human genomes were completely sequenced by the end of 2011, but it is estimated that over a million could be sequenced by 2015. In addition to genome sequencing, understanding of the whole genome expression data also reveals information on the normal and diseased states of the human body. Although large amounts of genomic data, coupled with other clinical and biological texts, are easily available for downloading, there is currently a lack of a conceptual framework to integrate all the data.

A biomedical cloud with large amounts of publicly available data on biology, medicine, technology and healthcare, could be accessed by individuals on personal devices and by companies through large data centres, through a secure platform. The cloud could also enable the use of software programs, such as CrossBow, which is capable of analysing the entire human genome in a single day.

Yemen food crisis

The United Nations World Food Programme is scaling up operations in Yemen, where more than 10 million people – almost half the country’s population – are estimated to need food assistance, and the humanitarian situation continues to deteriorate.

In an update, the agency attributed the situation to high food and fuel prices, rising poverty, a breakdown of social services, diminishing resources, internal conflict and political instability.

The country is particularly vulnerable to rises in food prices since it imports up to 90% of its main staple foods, including wheat and sugar. According to WFP, child malnutrition rates in the country are among the highest in the world with close to half of its children under five years – two million children – stunted and one million acutely malnourished.

In response, the agency is scaling up its operations and is aiming to assist a total of 5.5 million people by the end of 2012. Among those receiving assistance are severely food-insecure households, internally displaced people, refugees, pregnant women, nursing mothers, malnourished children under five years, as well as schoolgirls and their families.

UN agencies and their partners have requested US$584 million for the Yemen Humanitarian Response Plan, of which 48% has been provided to date.

Developing countries need their own technology

A study from Imperial College London examined how medical technology should best be used to improve health in low- and middle-income countries and found that, in many cases, medical technology, which is almost exclusively developed in rich countries, is inappropriate for use in poorer nations.

Co-author Peter Howitt, of the Institute of Gobal Innovation at Imperial College London, said: “Most health technology is produced by companies from highincome countries for high-income markets. Health technology is therefore mostly designed for an environment with high spending on health, a reliable energy supply and large numbers of trained healthcare professionals.”

According to hospital inventories, an estimated 40% of healthcare equipment in developing countries is out of service, compared with less than 1% in highincome countries. The inappropriate deployment of medical technologies from wealthy countries plays a major part in this high failure rate, the report suggests.

Instead of relying on hand-me-down technologies from wealthier countries, which can be costly, inappropriate for local conditions and even dangerous, the authors urge a renewed effort towards developing what they call “frugal technologies”. These are cost-effective technologies that are developed specifically to cope in local conditions, such as the eRanger (a durable rural ambulance, based around a motorbike and stretcher sidecar); the Uniject injection system (developed by NGO PATH, which allows once-only use of needles for contraceptive injections); and the Jaipur foot (a rubber prosthetic designed in the late sixties in India for people who have lost their leg below the knee, which has a flexible design allowing users to walk on uneven surfaces without a shoe).


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