Record AIDS spending still falls short

HIV/AIDS funding to low- and middle-income countries reached a record level in 2007, according to a new report by UNAIDS.

IRIN reports that AIDS spending by the G8 group of wealthy nations, the European Commission and other donors hit US$ 6.6 billion last year, up from US$ 5.6 billion in 2006. However, despite the largesse, UNAIDS said a US$8.1 billion gap in funding for essential HIV/AIDS programmes remained.

The United States was the largest grant-giver, providing 20% of resources in 2007, followed by the United Kingdom. Some non-G8 nations also provided significant assistance, including the Netherlands, Sweden, Australia and Ireland.

The report comes as the G8 – made up of Britain, Canada, France, Germany, Italy, Japan, Russia and the United States – reiterated a commitment they made at the 2005 summit in Gleneagles, Scotland, to spend US$60 billion to fight disease in Africa; the repeated commitment added a five-year timeline to the initiative.

Cancer survival rates vary widely country to country

Cancer survival varies widely between countries according to a worldwide study published online in July in Lancet Oncology. More than 100 investigators contributed to the study. And while the USA has the highest 5-year survival rate for prostate cancer than any of the 31 countries studied, cancer survival in black men and women is systematically and substantially lower than in white men and women.

Until now, direct comparisons of cancer patient survival between rich and poor countries have not generally been available. The CONCORD study is, to the authors’ knowledge, the first worldwide analysis of cancer survival, with standard quality-control procedures and identical analytic methods for all datasets. It provides directly comparable data on 1.9 million adult cancer patients (aged between 15 and 99) from 101 cancer registries in 31 countries on 5 continents. The study covers cancers of the breast (women), colon, rectum and prostate, which comprise a majority of all newly diagnosed cancers in adults. The study includes analyses of cancer survival in 16 states and 6 metropolitan areas in the USA, covering 42% of the population – four times as many as in previous studies.

Five-year relative survival for breast cancer (women) ranged from 80% or higher in North America, Sweden, Japan, Finland and Australia to less than 60% in Brazil and Slovakia, and below 40% in Algeria. Survival for white women in the USA (84.7%) was 14% higher than for black women (70.9%).

For colorectal cancer, five year survival was higher in North America, Japan, Australia and some western European countries and lower in Algeria, Brazil and in eastern European countries. Survival for white patients in the USA was 10% higher than for black patients (60% compared with 50%).

For prostate cancer, 5-year survival was higher in the USA (92%) than in all 30 of the other participating countries. However, there was a 7% difference in survival between black and white men (92% compared with 85.8%).

Michel P Coleman, Professor of Epidemiology and Vital Statistics at the London School of Hygiene & Tropical Medicine, and lead author of the study, comments: “The differences in cancer survival between countries and between black and white men and women in the USA are large and consistent across geographic areas. Most of the wide variation in survival is likely to be due to differences in access to diagnostic and treatment services, and factors such as tumour biology, state at diagnosis or compliance with treatment may also be significant.

“Population-based cancer registries are increasingly important in monitoring cancer control efforts, and in evaluating cancer survival. We hope that the information provided here will facilitate better comparison between rich and poor countries, and eventually enable joint evaluation of international trends in cancer incidence, survival and mortality.”

Danger of diet drinks’ aspartame highlighted

Learning and memory may be affected if young people have diet drinks containing the artificial sweetener aspartame, according to a US paediatrician who presented evidence recently to a New Zealand Health Committee concerned about the sale of these diet drinks in schools.

“The manifestations of aspartame disease in young children are myriad,” reported Dr Kenneth Stoller, MD. “These may range from severe headaches, unexplained visual loss, to depression, antisocial behaviour and seizures. Aspartame is not just a food additive. The components in it are isolated in a way that does not occur in nature. It is a neurotoxic drug, causing the deterioration of brain cells.”

Aspartame is being used in an increasing number of products, an estimated 6,000 products worldwide, not just those labelled ‘diet’ and ‘sugar free’ but also in chewing gum, sports drinks, dietary supplements and medications. Sometimes the only warning is ‘contains phenylalanine’. An estimated one in 15 people consume aspartame around the world.

Tiny implantable sensor to track heart disease

An implantable sensor providing 24-hour monitoring for patients with chronic heart problems will be developed thanks to a new grant for researchers at Imperial College London.

They have received a £760,000 (about US$1.4 million) grant from the Wellcome Trust to develop a miniature sensor – about 10mm across – to monitor the hearts of people who have undergone heart operations or who have conditions that could lead to heart failure.

Currently, patients who have had heart operations or suffer from chronic heart conditions need to be regularly monitored in hospital to detect changes in their condition. This is time consuming and inconvenient for patients and costly for hospitals. Scientists believe that their implantable sensor could improve heart monitoring by remotely providing a constant flow of information, enabling doctors to more accurately predict serious illnesses, improve the timing of operations to maximise their effectiveness and free the patient from regular visits to the hospital.

The sensor is constructed from silicon and vibrates at a rate which varies according to the pressure inside the heart. Once at home, patients would wear a reader, a miniature device that detects these vibrations through radio pulses, and translates them into precise measurements.

Patients would be able view their own readings at home via the reader, while doctors could take measurements by dialing up the reader via a mobile phone or by logging onto a secure internet site. The reader could also be set to automatically send alarms to the doctor if a patient’s heart reading reaches critical levels.

Lead researcher, Professor Christofer Toumazou, from Imperial College London’s Institute of Biomedical Engineering, says: “The heart pressure sensor could transform the lives of people living with chronic heart problems and has the potential to revolutionise heart monitoring. At the touch of a few buttons a family doctor could dial up their patient’s heart history and plot pressure trends to better manage their condition and prevent the progression of heart failure.”

Sir Magdi Yacoub, Professor of Cardiothoracic Surgery at Imperial College London, has trialed the pressure sensor successfully on animal laboratory models. Sir Madgi added: “This device is one of the most exciting developments during the last 20 years. Heart failure is currently reaching epidemic proportions in the UK and I think this sensor will have a major impact on the management of patients and will help to guide doctors when timing operations to maximise their benefits for patients.”

New corneal transplant offers hope for children

For infants and children with blinding diseases of the cornea, a sophisticated new corneal transplantation technique offers the hope of improving vision while overcoming the technical difficulty and low success rate of traditional penetrating keratoplasty (PK) in children, according to reports in the current issue of the Journal of AAPOS (American Association for Pediatric Ophthalmology and Strabismus), Volume 12, #3, 2008.

The issue includes two case reports on the successful use of “Descemet stripping automated endothelial keratoplasty” (DSAEK) in children with corneal disease. If the promising results are borne out by further research, DSAEK could provide an alternative to traditional corneal transplantation – a notoriously difficult procedure in children, failing more often than it succeeds.

Dr Bennie H. Jeng and colleagues of The Cleveland Clinic Cole Eye Institute performed DSAEK in a 21- month-old boy, while Dr Mark M. Fernandez and colleagues of Duke University Eye Center report the results of DSAEK in a 9-year-old boy. Both children had irreversible damage to the corneal endothelium – a specialised, single-cell layer at the rear (posterior) of the cornea – after complications of cataract surgery.

In DSAEK, the diseased endothelium is removed and replaced by a “button” of healthy endothelium from a cornea donor. After careful handling and meticulous placement, the button is held in place for the first 24 hours by nothing more than a bubble of air – during this time, the patient must lie flat to keep the air bubble and transplant in place.

In adults, DSAEK is currently “in vogue” as an alternative to traditional penetrating keratoplasty, according to a commentary by Dr Kathryn Colby of Massachusetts Eye and Ear Infirmary, Harvard Medical School. DSAEK offers several advantages over PK. One key advantage is much more rapid recovery of vision – within 6 to 12 weeks after DSAEK, compared to 6 to 12 months with traditional PK surgery.

Shorter recovery time is especially important in young children with developing vision, who are at risk of further, potentially severe vision loss (amblyopia). Both children in the case reports had good results, showing improved vision within a few months after DSAEK. Because it is less invasive, DSAEK also has a lower risk of certain complications compared to PK. Postoperative management is simplified because no sutures are placed in the cornea. Many questions remain regarding the use of DSAEK in children.

Since most children who need corneal transplants have other abnormalities as well, DSAEK would be an option in only about 20% of cases. The need to have the patient lie flat for 24 hours after surgery poses challenges in young children, and concerns about potential complications and long-term results have to be addressed. Other treatment options are emerging as well, including the use of an artificial cornea or “keratoprosthesis”.

UK Research Reserve to protect journals

The Higher Education Funding Council for England (HEFCE) has announced £9.84 million of funding for a groundbreaking collaboration between higher education libraries led by Imperial College London and the British Library following a successful 18-month pilot. The funding will enable the creation of the UK Research Reserve (UKRR).

UKRR is an agreement between higher education and the British Library whereby the British Library will store low-use journals for the HE community and make them accessible to researchers and others using state-of-the-art ordering and delivery systems.

The UKRR will safeguard the long term future of printed research journals. Low-use journals will be stored and maintained at the British Library, enabling quick and easy access to research materials. Building on the strengths of the British Library's document supply service, researchers can choose to access journal articles in printed or electronic format.

● The British Library

WHO issues safe surgery checklist

With major surgery now occurring at a rate of 234 million procedures per year – one for every 25 people – and studies indicating that a significant percentage result in preventable complications and deaths, WHO has published a new safety checklist for surgical teams to use in operating theatres, as part of a major drive to make surgery safer around the world.

“Preventable surgical injuries and deaths are a growing concern,” said Dr Margaret Chan, Director-General of WHO. “Using the checklist is the best way to reduce surgical errors and improve patient safety.”

The checklist is not a regulatory device; it is intended as a practical easy-to-use tool for clinicians interested in improving the safety of their operations and reducing unnecessary surgical deaths and complications.

The manual provides suggestions for implementing the checklist, understanding that different practice settings will adapt it to their own circumstances.

Several studies have shown that in industrial countries major complications occur in 3% to 16% of inpatient surgical procedures, and permanent disability or death rates are about 0.4% to 0.8%. In developing countries, studies suggest death rates of 5% to 10% during major operations. Mortality from general anaesthesia alone is reported to be as high as one in 150 in parts of sub-Saharan Africa. Infections and other postoperative complications are also a serious concern around the world. These studies suggest that about half of these complications may be preventable.

“Surgical care has been an essential component of health systems worldwide for more than a century,” said Dr Atul Gawande, a surgeon and professor at the Harvard School of Public Health. “Although there have been major improvements over the last few decades, the quality and safety of surgical care has been dismayingly variable in every part of the world.

The Safe Surgery Saves Lives initiative aims to change this by raising the standards that patients anywhere can expect.” The Safe Surgery Saves Lives initiative is a collaborative effort led by the Harvard School of Public Health. More than 200 national and international medical societies and ministries of health are working together to reduce avoidable deaths and complications in surgical care. The WHO surgical safety checklist, developed under the leadership of Dr Gawande, identifies a set of surgical safety standards that can be applied in all countries and health settings.

Preliminary results from 1,000 patients in eight pilot sites worldwide indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care. Use of the checklist in pilot sites has increased the rate of adherence to these standards from 36% to 68% and in some hospitals to almost 100%. This has resulted in substantial reductions in complications and deaths in the 1,000 patients. Final results on the impact of the checklist are expected in the next few months.

The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: before the induction of anaesthesia (“sign in”), before the incision of the skin (“time out”) and before the patient leaves the operating room (“sign out”). In each phase, a checklist coordinator must confirm that the surgery team has completed the listed tasks before it proceeds with the operation.

● The checklist can be downloaded from the WHO website:

Lose weight in Second Life

The University of Houston department of health and human performance is launching an international effort to recruit 500 participants for a study promoting healthy dietary habits and physical activity. The study will take place entirely in the virtual world of Second Life (SL).

The project is part of the UH Texas Obesity Research Center’s (TORC) International Health Challenge, and offers an enjoyable way for participants to learn about preventing and treating obesity through education, skills training and outreach.

“This is an excellent opportunity to learn and practice these new behaviours in a virtual environment and in real life,” said Rebecca Lee, associate professor and director of TORC. “It’s also a great place to meet other avatars and share information and experiences.”

The TORC International Health Challenge in Second Life will provide opportunities for avatars to earn Lindens – the currency of Second Life – for walking on treadmills, riding bikes and trying new fruits and vegetables in Second Life. Participants compete to earn “Challenge Points” for their healthy behaviours. The country team that earns the most Challenge Points will win the International Health Challenge. Materials will be available in English, French and Spanish.

Participants must be members of Second Life and can visit < secondlife/HHP at UH/128/128/0>. For more information, participants can instant message Sirina Felisimo or Samu Sirnah in Second Life or call TORC in the United States at 713-743-9310.

TORC was an awardee of the University of Southern California-Annenberg School for Communication's Network Culture Project: Second Life and the Public Good Community Challenge. TORC will develop space in Second Life, create games and interactive learning opportunities and reward avatars when they join the International Health Challenge and participate in health behaviours in Second Life.

“We hope to develop multinational collaborations in SL to increase awareness, knowledge, skills and support for healthy living,” Lee said. “Reducing obesity is an international priority, and SL provides a portal to an international community.”

Lee has conducted extensive research on the subject of obesity, in particular the neighbourhood factors that may lead to obesity, such as availability and quality of fresh produce, and the quality and quantity of physical activity resources available in neighborhoods.

● For more information about TORC at the University of Houston, visit:


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