DiversityNursing Blog

When Screening Tests Turn Healthy People Into Patients

Posted by Erica Bettencourt

Wed, Mar 04, 2015 @ 12:29 PM

Markus MacGill

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As part of its campaign against "too much medicine" The BMJ has published reviews that question the value of screening for breast cancer in women and aneurysm in men - asking whether the harm of "over-diagnosis" outweighs the benefit of detecting and treating real cases of disease.

In the case of breast cancer, the analysis of the history of screening for the disease, written by a public health expert, calls for "urgent agreement" in the debate and controversy that exists between scientists.

For abdominal aortic aneurysm, the review about screening men who do not have symptoms suggests that the ratio of harm to benefit of carrying out these programs has worsened over the years.

This, they say, is thanks to a reduction in risk factors such as smoking, which has reduced the chance that screening will succeed in finding actual cases.

And a third paper looks at the results of surveys that gauged the level of over-diagnosis people would accept from screening programs aiming to detect different cancers - finding a wide range of attitudes to the harm or benefit of screening.

In the research on abdominal aortic aneurysm (a swelling in the main artery from the heart, which can lead to death when it ruptures), the authors estimate that 176 of every 10,000 men invited to screening are over-diagnosed. 

This means smaller aneurysms being picked up - and perhaps being repaired in preventive surgery - even though they might have swelled little and presented a low risk of rupturing. 

The researchers describe the real-life consequences of the programs, which, in the UK, invite all men over the age of 65 for screening, and in the US, only those who have smoked (a risk factor that greatly increases the likelihood of an aneurysm). They explain:

"These men are unnecessarily turned into patients and may experience appreciable anxiety throughout their remaining lives."

 

"Moreover," the authors continue, "37 of these men [out of every 10,000 screened] unnecessarily have preventive surgery and 1.6 of them die as a consequence." 

The authors quote men who have had abdominal aortic aneurysms detected by screening - they "report existential thoughts about frailty and mortality after diagnosis." One man describes his diagnosis as "a ticking bomb inside your stomach."

 

In addition to such risks of psychological burden, the authors cite the surgical risks for those who undergo a preventive operation, and the public health implications over cost-effectiveness.

"When health authorities invite asymptomatic men to screening, there should be no doubt that benefits clearly outweigh harms," the authors conclude. "We cannot judge whether this is true of abdominal aortic aneurysm screening: the harms have not been adequately investigated, as is true for cancer screening."

Value of breast cancer screening 'can be improved'

On the question of how good the harm-to-benefit ratio is for breast cancer screening, Prof. Alexandra Barratt, from the School of Public Health at the University of Sydney in Australia, gives an overview of the history of screening programs, and offers a list of ways to improve their benefit.

Writing her review for The BMJ's "too much medicine" campaign, Prof. Barratt believes "agreement between experts about over-diagnosis in breast cancer screening is urgently needed so that women can be better informed." She presses for the following measures, too:

  • Do better research to quantify the true amount of over-diagnosis - by developing "internationally agreed standards" for studies that monitor the problem created by screening programs
  • Investigate less aggressive treatment options for screen-detected breast cancers
  • Be more wary of new technology - for example, digital mammography has increased cancer detection without reducing death rates, so three-dimensional mammography (tomosynthesis), which "promises a 30-50% increase in detection of breast cancers" should not be implemented without more research on "whether it alters the balance of benefit and harm"
  • Provide quality information to women. "Many women continue to be 'prescribed' or encouraged to undergo screening rather than being supported to make an informed choice," says Prof. Barratt, yet "information is an intervention that may have both positive and detrimental effects"
  • Think twice before extending screening programs - "extending screening to women in their 70s has been shown to significantly increase the incidence of early-stage breast cancer, and this could have detrimental effects for older women."

Prof. Barrett says lessons have been learned in breast cancer screening that should inform programs for other cancers. Breast cancer has "led the way in developing awareness" about the potential for screening to over-diagnose and treat people who have no symptoms, and this is also needed for "the early detection of lung and thyroid cancers, as well as breast and prostate cancers."

This neatly leads to the subject of the third paper, on cancer screening more generally, which analyzes people's risk attitudes in relation to the early detection of different cancers and varying levels of benefit.

Over-detection is acceptable to patients

Dr. Ann Van den Bruel - a senior clinical research fellow at the University of Oxford's Nuffield department of primary care health sciences in the UK - conducted a survey with colleagues "to describe the level of over-detection people would find acceptable in screening for breast, prostate and bowel cancer."

Her "striking" findings, from asking people in the UK's general population, were that more people would accept a screening program that created over-detection "in the entire population" being tested than would accept "no over-detection at all."

People aged 50 or older accepted less over-detection, however, and there was a wide overall variation in the risks of over-diagnosis that people would accept from cancer screening.

The average levels of "acceptability" ranged from 113 cases of over-detection in every 1,000 people screened, to 313 cases.

People were significantly less happy to accept the risk of being over-diagnosed with bowel cancer than they were of this happening with breast or prostate cancer - the latter, in other words, being more worthwhile screening for in terms of perceived benefit versus risk.

The following results from the study highlight the two extremes expressed for attitudes to screening:

  • 4-7% of respondents indicated they would tolerate no amount of over-detection at all from a screening program
  • 7-14% considered it would be acceptable for the entire screened population to be over-detected - that is, doing the screening would be worthwhile even if it resulted in all 1,000 people tested being unnecessarily diagnosed.

The survey asked questions about three different types of cancer screening: breast cancer for women, prostate cancer for men, and bowel cancer for both.

For each type, the researchers presented the absolute number of cases there were each year in the UK, plus a description of the treatment, including adverse effects. They then presented two scenarios of screening effectiveness: a 10% reduction in deaths from the specific cancer, or a 50% cut.

Dr. Van den Bruel says:

"People accepted more over-detection when they perceived a higher benefit from cancer screening, so from a 10% mortality reduction to 50% mortality reduction, median acceptability increased significantly, with a maximum of 313 cases per 1,000 people screened for breast cancer."

Source: www.medicalnewstoday.com

 

 


Topics: nurse, health, disease, doctor, cancer, breast cancer, patient, medicine, treatment, prostate cancer, diagnosed, screening

Meet the Alzheimer's Patient Who Helped Julianne Moore Win An Oscar

Posted by Erica Bettencourt

Mon, Feb 23, 2015 @ 11:41 AM

GILLIAN MOHNEY

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On her 50th birthday, Sandy Oltz sat on the film set of “Still Alice” and listened to actress Julianne Moore speak a line that Oltz, an early onset Alzheimer’s patient, had struggled to write.

“Please do not think I am suffering. I am not suffering,” Moore said as the character of Alice Howland. “I am struggling, struggling to be a part of things, to stay connected to who I once was.”

Playing a woman with early onset Alzheimer's disease, Moore was giving a speech to a fake meeting of the Alzheimer's Association. It's a position that Oltz has been in many times before.

Oltz, a self-described “type-A” person and former nurse, was diagnosed with early onset Alzheimer’s disease at age 47, when she was raising two teenage sons and juggling a high-pressure job.

“There is some family history, but I never really thought that it would be me,” said Oltz of her early diagnosis. "We tried menopause, we tried brain tumor, we thought stroke, seizure. It took about a year to come to Alzheimer’s.”

Months before the “Still Alice” film shoot in New York, Oltz partnered with the cast and crew of the film through the Alzheimer’s Association. She gave tips from her own life about how to cope with Alzheimer's, such as using a highlight to mark text she's reading. The work seems to have paid off with Moore winning a Golden Globe and an Oscar for her role.

"[Moore] would just ask questions like, ‘What does it feel like to have Alzheimer's,'" said Oltz. "I would say, 'Well, it’s like all these words [are here] and you can’t find the right one.'"

After living with the disease for three years, Oltz said she's mostly learned to accept her limitations, but she still worries that her disease will have an impact on how her sons view her.

"I worry ... they’re never going to know how smart I really was," she said. "They see their mom as kind of funny because I have to be."

Oltz said the film was important so that people can understand that it does not just affect the elderly.

“There’s a stigma that they’re grandmas and grandpas, and their life has been lived and they’re done,” she said of stereotypes about Alzheimer patients. “I pray [the film] breaks the stigma.”

Early onset Alzheimer’s disease affects 200,000 people in the U.S., according to the Alzheimer Association. The film “Still Alice” will be released in limited locations this Friday.

Source: http://abcnews.go.com

Topics: disease, patient, nurse, Alzheimer's, movie, Still Alice, Golden Globe, Oscar

New, Aggressive Strain Of HIV Discovered In Cuba

Posted by Erica Bettencourt

Wed, Feb 18, 2015 @ 11:58 AM

JESSICA FIRGER

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Scientists have discovered a highly aggressive new strain of HIV in Cuba that develops into full-blown AIDS three times faster than more common strains of the virus. This finding could have serious public health implications for efforts to contain and reduce incidences of the virus worldwide.

Researchers at the University of Leuven in Belgium say the HIV strain CRF19 can progress to full blown AIDS within two to three years of exposure to virus. Typically, HIV takes approximately 10 years to develop into AIDS. Patients with CRF19 may start getting sick before they even know they've been infected, which ultimately means there's a significantly shorter time span to stop the disease's progression. 

The scientists began studying the cases in Cuba when reports began coming in that a growing number of HIV-infected patients were developing AIDS just three years after diagnosis with the virus. The findings of their study were published in the journal EBioMedicine.

Having unprotected sex with multiple partners can expose a person to numerous strains of the HIV virus. Research has found that when this occurs, the different strains can combine and form a new variant of the virus.

When HIV first enters the human body it latches on to anchor points of a certain protein, known as CCR5 on the cell membranes, which then allows it to enter human cells. Eventually the virus then latches onto another protein of the cell membrane, known as CXCR4. This marks the point when asymptomatic HIV becomes AIDS. In CRF19, the virus makes this move much sooner. 

For the study, the researchers analyzed blood samples of 73 recently infected patients. Among the group, 52 already had full-blown AIDS, while the remaining 21 were HIV-positive but the virus had not yet progressed. The researchers compared their findings to blood samples of 22 AIDS patients who had more common strains of the virus. 

The researchers found that patients with CRF19 had higher levels of the virus in their blood compared with those who had more common strains. 

They also had higher levels of the immune response molecules known as RANTES, which bond to CCR5 proteins in early stages of the virus. The abnormally high level of RANTES in patients infected with the new strain indicates that the virus runs out of CCR5 anchor points much earlier and moves directly to CXCR4 anchor points.

Thanks to advances in medical treatment and the development of highly effective antiretroviral drugs, HIV/AIDS is no longer a death sentence. But the researchers caution that patients with the new strain of the virus are more likely to be diagnosed when they already have full-blown AIDS and when damage from the disease has taken a toll.

The researchers suspect that this aggressive form of HIV occurs when fragments of other subsets of the virus cling to each other through an enzyme that makes the virus more powerful and easily replicated in the body.

There are currently 35 million people worldwide living with HIV/AIDS, according to the most recent data from the World Health Organization. Scientists have identified more than 60 different strains of the HIV 1 virus, with each type typically found predominantly in a specific region of the world.

Source: www.cbsnews.com

Topics: health, disease, health care, patients, medicine, treatment, nurses, HIV, science, AIDS, WHO, doctors, Cuba

UK Lawmakers Approve '3-parent babies' Law

Posted by Erica Bettencourt

Wed, Feb 04, 2015 @ 11:47 AM

By Laura Smith-Spark

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Lawmakers on Tuesday voted in favor of a law that sets the stage for the United Kingdom to be the first country in the world to allow a pioneering in vitro fertilization technique using DNA from three people.

The technique could prevent mitochondrial diseases but also raises significant ethical issues.

The measure was passed in the House of Commons, 382 to 128, Speaker John Bercow said.

A further vote must be held in the UK's upper house, the House of Lords, before the measure can become law.

Passage of the law is opposed by Catholic and Anglican church leaders, in part because the process involves the destruction of an embryo.

One in 6,500 babies in the United Kingdom are thought to develop a serious mitochondrial disorder, which can lead to health issues such as heart and liver disease, respiratory problems, blindness and muscular dystrophy.

Problems with mitochondria, the "powerhouse" cells of the body, are inherited from the mother, so the proposed IVF treatment would mean an affected woman could have a baby without passing on mitochondrial disease.

But the cutting-edge IVF technique, which involves transferring nuclear genetic material from a mother's egg or embryo into a donor egg or embryo that's had its nuclear DNA removed, raises ethical questions.

The new embryo will contain nuclear DNA from the intended father and mother, as well as healthy mitochondrial DNA from the donor embryo -- effectively creating a "three-parent" baby.

The amount of donor DNA in the mitochondria will, however, be much less than the parental DNA in the nucleus, which determines the baby's characteristics.

 

Called an ethical watershed

 

The Church of England's national adviser on medical issues, the Rev. Dr. Brendan McCarthy, described the step as representing an ethical watershed and said more research and wider debate were needed.

"We accept in certain circumstances that embryo research is permissible as long as it is undertaken to alleviate human suffering and embryos are treated with respect. We have great sympathy for families affected by mitochondrial disease and are not opposed in principle to mitochondrial replacement," he said.

"Our view, however, remains that we believe that the law should not be changed until there has been further scientific study and informed debate into the ethics, safety and efficacy of mitochondrial replacement therapy."

Bishop John Sherrington, in a statement posted online by the Catholic Church in England and Wales, urged lawmakers not to rush into taking such a serious step.

"It seems extraordinary that a licence should be sought for a radical new technique affecting future generations without first conducting a clinical trial," he said. "There are also serious ethical objections to this procedure which involves the destruction of human embryos as part of the process."

The California-based Center for Genetics and Society, in an open letter to UK lawmakers last month, said that although the proposed goal was noble, "the techniques will in fact put women and children at risk for severe complications, divert resources from promising alternatives and treatments, and set a policy precedent that experimentation on future generations is an acceptable biomedical/fertility development."

 

Incurable diseases

 

A team at the Wellcome Trust Centre for Mitochondrial Research, led by professor Doug Turnbull and based at Newcastle University in northern England, has been leading the research into the pioneering IVF technique.

The center points out that mitochondrial diseases cannot be cured and that in many families, several people are affected.

A Wellcome Trust fact sheet states that "nuclear DNA is not altered, and so mitochondrial donation will not affect the child's appearance, personality or any other features that make a person unique -- it will simply allow the mitochondria to function normally and the child to be free of mitochondrial DNA disease.

"The healthy mitochondria will also be passed on to any children of women born using the technique."

According to the latest estimates from the research team, published in The New England Journal of Medicine, almost 2,500 women of childbearing age in the UK are at risk of transmitting mitochondrial disease to their children, while in the United States, the number is more than 12,400.

This equates to an average of 152 births per year in the UK, and 778 births per year in the United States, the team said. 

In a Newcastle University news release, Turnbull said his team's findings had considerable implications for other countries considering the technique. Allowing it would give "women who carry these mutations greater reproductive choice," he said.

Source: www.cnn.com

Topics: health, healthcare, disease, laws, ethical, babies, parents, birth, lawmakers, 3 parent babies, DNA, embryo, health issues, IVF

TV Anchor Shares Personal News In Heartbreaking Broadcast: 'I have ALS'

Posted by Erica Bettencourt

Mon, Feb 02, 2015 @ 11:55 AM

By Chris Serico

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Larry Stogner, a retiring news anchor for an ABC affiliate in North Carolina, stunned viewers on Friday when he revealed he has ALS.

"For nearly four decades, I have met you right here, usually at 6," the WTVD anchor said during a Jan. 23 broadcast, as a slideshow of his life and career appeared on a screen behind him. "Boy, we've seen a lot of change over those years, but we have to stop meeting this way. I am sure that in recent months, you've noticed a change in my voice; my speech, slower. Many of you were kind enough to email me ideas about what it might be, or just to show concern, and I truly appreciate that. As it turns out, I have ALS, Lou Gehrig's disease."

Stogner added that, last summer, he'd participated in an Ice Bucket Challenge video to help raise awareness and money for the cause. "Little did I know, it was about to change my life," he said. "There is no cure. My career in broadcast journalism is coming to an end."

Married with six children, Stogner joined WTVD in 1976. In addition to conducting one-on-one interviews with Barack Obama, John McCain and other prominent political figures, the Air Force veteran reported live from Raleigh-Durham and beyond — including a 2002 assignment in Afghanistan, according to his ABC11 bio.

In the final minute of the broadcast, Stogner called his WTVD position "the best job in the world," and shared plans to take two weeks of vacation with his wife before returning in early February to share "a few final thoughts and a more personal goodbye."

Flanked by four of his WTVD colleagues, he concluded, "And now more than ever, I say to you, for all those 39 years: Thanks for the company. Have a good night."

Source: www.today.com

Topics: health, healthcare, disease, cure, medicine, treatment, Awareness, TV, news, ALS, cause, ice bucket challenge

A Nurse Decides to Get Hands-On in the Ebola Zone

Posted by Erica Bettencourt

Mon, Jan 19, 2015 @ 11:03 AM

By ANEMONA HARTOCOLLIS

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Lindsey Hallen is in the bug spray aisle at REI, the outdoor equipment emporium in SoHo, looking for exactly the right mosquito repellent to take to West Africa’s Ebola zone, when her phone rings. Three ascending tones, the personal anthem of an emergency room nurse, captured in a ringtone called “Summit.”

“Hello?” she says, pulling the phone out of her jacket pocket. Then in an aside, “I think this is them.”

Ms. Hallen listens, pacing back and forth along the aisle, as her gaunt face takes on the same wide-eyed look of concentration it assumes as when she works in the emergency room at Lenox Hill Hospital in Manhattan. Total Focus. Matter of Life and Death.

Since the latest Ebola outbreak entered public consciousness, most accounts of United States health workers have focused on the ones returning; the missionaries who were airlifted out and brought back from the brink of death, or Craig Spencer, the young doctor cured of the virus at New York City’s premier public hospital, Bellevue Hospital Center in Manhattan, while much of the city held its breath.

Now Ms. Hallen, a 31-year-old nurse with two years’ experience working with critically ill patients in this country, is going the other way, heading to West Africa to fight an epidemic that has sickened 21,000 people and killed more than 8,000.

“Why?” her friends and colleagues invariably ask when they find out what she is doing. Why would a relatively young, untested nurse want to risk putting her life in jeopardy to help save people living thousands of miles away, people sick and dying of a brutal, bleeding, contagious fever?

The question annoys her. Her reasons are instinctive, from the gut. You feel driven to do this or you don’t. The thinking only comes later.

“Why not?” she replies. “Why not me?” So the phone call shakes her. The woman on the other end of the line is a recruiter for Partners in Health, the Boston organization that is sending her to West Africa. Instead of Sierra Leone, as had been planned, the group now wants her to go to Liberia, the woman says. Ebola cases there have fallen, but they need people who can rebuild the shattered medical system, teach about controlling infection. She won’t have direct contact with patients. Yes, she can still go to Sierra Leone if she wants to, and take care of patients there. The final decision is up to her.

So the choice is this: Be an instructor, safe, teaching other people how to wear a protective suit, or be the one wearing the suit. She is given a day to decide.

Ebola officially reached American shores on Sept. 30, when Thomas Eric Duncan, a Liberian visiting family in Dallas, tested positive for the virus. Preparing for a possible onslaught, Lenox Hill Hospital set up a room within the emergency department where Ebola patients would be isolated. The staff had to be trained in wearing protective gear, the stifling, fluid-proof layers that include bootees, gloves, gowns, goggles and face shields. The more Ms. Hallen learned, the more she wanted to know. She volunteered for advanced training. She started lingering on the website of the Centers for Disease Control and Prevention. “I was looking at the case numbers and I started to become a little obsessed with everything that was going on over there, and how it was impacting us here,” she said.

She spoke of her newfound interest to her older sister, Kimberly, a real estate photographer, who sensed that this was more than a casual attraction. “She texted me saying she had volunteered to train how to handle Ebola if it came to New York City,” Kimberly recalled. “In the back of my head, I was like, ‘Oh, God, I feel like this is going to expand into her wanting to do a little bit more.’ But I kind of put it away. Maybe not.”

“She’s always been like this ever since she was little,” Kimberly Hallen said. “She was always the one who was trying to find the next fun thing to do. She was bored so easily.”

Lindsey Hallen, a slight blonde with eyes that shift from green to blue depending on the weather and her mood, grew up in suburban Cheshire, Conn., and was a communications major in college, but not a very serious one. “I was very social and that was what I cared about,” she said. After graduation, she moved to Hawaii, without knowing anyone or even having visited. “I was amazed how well everything fell into place,” she said.

She worked at an animal clinic and went to South Africa on an unpaid internship in wildlife conservation. After two years, she moved to Boston, where her sister lives, and began working at Global Vision International, the organization that had sponsored her internship. Her job sent her to South Africa, Guatemala and Costa Rica, to make sure projects were running smoothly. As a memento, she wears three bracelets on her right arm made of twisted copper and brass that she bought at street markets in South Africa. She never took them off, but she had to leave them with her sister before departing for Africa.

After three years, she wanted to grow. She thought about veterinary school, but she also wanted to travel. “Nursing came to mind as a perfect middle ground,” she said. Now, after two years in the E.R., the dread that she has done something wrong no longer wakes her at night. She can rattle off the medical script for an alcoholic with the shakes, a child with the flu or an elderly woman with a broken hip like someone reciting a Social Security number.

There has to be more to life than the three-block dash from her Upper East Side brownstone studio to the 8-a.m.-to-8-p.m. shift at Lenox Hill, and back.

The Ebola patient in Dallas died on Oct. 8, having set off a rapid chain of events. Two nurses who treated him fell ill, shaking confidence in the United States health care system. In mid-October, several New York hospitals volunteered to be Ebola treatment centers, including a sister hospital to Lenox Hill. On Oct. 23, Dr. Spencer, recently returned from Guinea, was rushed to Bellevue and tested positive. The next day, Kaci Hickox, a nurse returning from Sierra Leone through Newark Liberty International Airport, was forced into quarantine because of public officials’ fears.

Rather than being frightened, Ms. Hallen was swept away. Ebola was her 9/11, the disaster that nourished her sense of purpose.

Scrolling through the C.D.C. website, she came across a link to an application form for medical volunteers willing to go to West Africa, kind of like a universal college application online.

She recalls sending it in a few days after Ms. Hickox returned. Her first response, from Partners in Health, arrived on Halloween night. She sent back an email as she dressed for a Halloween party. She was not a sexy witch, or even a nurse. She wore a $12 zombie suit with a zipper splitting her face.

Still, she didn’t really think it would happen. And she assumed that even if she were selected, she would not be paid, and she could not afford that. But Partners in Health agreed to pay for her travel, expenses and medical insurance, as well as provide a stipend that would cover most of her lost salary for nine weeks; six weeks in West Africa and three weeks upon her return, during the disease’s incubation period. As a single person, she didn’t have to worry about disrupting anyone else’s life.

The agency also agreed to pay for her evacuation if she contracted Ebola — a further reminder of the dangers.

Her mother, Laura, cried when she heard the news. Her father, Dan, “had a million questions” but was proud of her.

“I think that she’s got the right mentality to perform in this type of environment,” Mr. Hallen said. “I guess what I would liken it to is firefighters that rush into a burning building when everyone else is running out. All I can say to that is, thank God for them. Where would we be without them?”

That mentality is not widely shared, the numbers suggest.

Since November, about 1,300 people have applied to travel to West Africa through Partners in Health, and about 360 have been hired, Sheila Davis, chief of the agency’s Ebola response, said. She said she was still looking for people with the right “humility,” but the number of applicants has declined as Ebola has moved off the front pages.

North Shore-LIJ Health System, the hospital network that includes Lenox Hill, has 54,000 employees. Ms. Hallen is only the second one to go to West Africa to treat Ebola, Joseph Moscola, the system’s chief of human resources, said. An informal survey of other New York City hospitals found few if any volunteers at most of them.

At some hospitals an internal debate rages over whether highly trained specialists should be volunteering to do menial work in African field hospitals or can make a better contribution at home, perhaps by doing Ebola research.

“Major academic institutions, you would think, would be those who would be pushing it,” Ms. Davis said. “But it’s the opposite. It’s definitely been Middle America, and California, but not the numbers you would think in Boston and New York.”

In preparation for Ms. Hallen’s trip, Partners in Health sent her a packing list. Mostly it is similar to a list for summer sleep-away camp: shampoo, toothbrush, underwear. But not entirely. She will need a headlamp, in case the electricity goes down, and some fancier clothes to wear for Embassy events. Also, styptic pencils to stanch cuts, and tampons, for nosebleeds, ominous inclusions in an environment where bodily fluids may be deadly. Ms. Hallen has scratched out the word “condoms.” She has enough contagion to worry about, she said. She trades email with other volunteers. Bring washable shoes, they say. Dried fruit, nuts and granola bars, to break the monotony of rice and beans.

She picks up her mosquito net at REI and jokes that she might use it to keep away the cockroaches in her apartment. Last night she slept with a hat on, haunted by a woman who had arrived at the emergency room with ear pain. The diagnosis: a cockroach stuck in her ear canal.

At the checkout counter, the brooding, longhaired salesman examines her basket and asks where she is going. “Sierra Leone or Liberia,” she replies.

“You should read this book,” he says, and on a scrap of paper writes the name Peter Piot, author of a memoir about the discovery of Ebola and AIDS.

The next night, she writes an email to the recruiter from Partners in Health. Deletes it. Writes it again. Presses “send” at 11:42 p.m.

At 10 a.m. Saturday, she was scheduled to fly to Sierra Leone, to care for people who are sick and dying of Ebola.

Source: www.nytimes.com

Topics: hospital, disease, patients, sick, treatment, nurse, nursing, illness, medical, epidemic, Ebola, outbreak, West Africa

Paralympic Champion Makes The Case For Meningitis Vaccine

Posted by Erica Bettencourt

Mon, Jan 05, 2015 @ 11:07 AM

By ALISON BRUZEK

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The last thing on your mind while you're home from school for the holidays is avoiding a deadly disease.

But imagine catching a disease as a teenager — a disease so terrible that it takes not just months to recover, but requires sacrificing both your legs.

That's what happened to Amy Purdy at age 19, when she was diagnosed with bacterial meningitis. It affects only about 4,000 people a year in the United States, according to the Centers for Disease Control and Prevention, but more than 10 percent of those people die. Others, like Purdy, suffer devastating consequences, including hearing loss, brain damage, or the loss of limbs from bloodstream infection.

College students are especially vulnerable, because meningitis is spread by living in close quarters and sharing drinking and eating utensils, or kissing. (An outbreak at Princeton University in 2013 sped up approval a new vaccine for the meningitis B strain.)

That's why the CDC recommends meningitis vaccine for all teenagers, especially if they weren't vaccinated as preteens.

Purdy, now 35, went on to become a Paralympic snowboarding champion and contestant in Dancing with the Stars. She's got a new book, On My Own Two Feet: From Losing My Legs to Learning the Dance of Life, coming out Dec. 30. Shots spoke to her about her battle with the disease and people's misconceptions about meningitis. This is an edited version of the conversation.

Had you heard about meningitis before you became sick?

Of course I heard the name meningitis before. I recognized what it was, but I had no idea that I was at risk. And I have to say, my mom actually told me just about a year before I got sick about one of her friends' son's who battled this horrific disease that came out of nowhere. He ended up losing his legs and his kidneys. It was the exact same thing that I got a year later.

Do you know how you got meningitis?

We have no idea how I got it. I was at an age that's more at risk — I was 19 years old. However, I wasn't a college student. I didn't live in a college dorm. I really wasn't even around that environment. They do say that those who are in college dorms are slightly more at risk than the rest of the world. I don't know how I got it, I was incredibly healthy at the time, I was a massage therapist, I worked out every day, I really took care of myself. It's just this invisible killer that kind of comes out of nowhere.

How did you cope with this loss at such a young age?

For me, it was life-changing. I nearly died multiple times in the hospital. I lost my legs, I lost my spleen, I lost my kidney function. I lost the life that I knew. And going through so much in such a small amount of time and so quickly, for me it put my life into perspective. There were certain things I focused on — I focused on how grateful I was for the things I had versus things I lost. I got a second chance at life and I wanted to use it. I didn't want to waste it by dwelling on what happened or why it happened.

One of the ironies is that those losses actually led to a lot of great things, like Dancing With the Stars and the Paralympics.

Definitely. The way I look at it is, we all have disabilities. We all have things that limit us and that challenge us. But really, our real limitations are the ones we believe. And I, from the beginning, believed that I could accomplish my goals and accomplish my dreams and I set out to do that. I'm very grateful that I've had the opportunities I've had.

A new vaccine for meningitis B was approved this fall, and you're now working with the manufacturer, Pfizer, to promote it. How did that happen?

Pfizer's actually teamed up with my nonprofit organization, which is called Adaptive Action Sports. I cofounded this organization in 2005 to help people with physical disabilities get involved in action sports, go snowboarding, skateboarding. Obviously, they want to get the word out there that there's protection against this bacteria.

I'm really proud to be a part of this campaign, though. You hear about rare diseases and weird things happening to people on Oprah and Dateline and you just never think it's going to happen to you. And then come to find out you actually could've protected yourself against it. To me it seems like a no-brainer.

What do you want parents to ask their teen's doctor about meningitis?

The number one question is, "Do you carry the meningococcal meningitis vaccination?" I feel like if parents could vaccinate their kids against car accidents, they would. This is one of those things where there are ways to help protect your kid against this.

Source: www.npr.org

Topics: health, nurses, healthcare, hospital, disease, doctors, CDC, vaccine, medicine, treatment, medical, teens, Meningitis, Paralympic Champion, preteens

The debilitating outbreak sweeping the Americas

Posted by Erica Bettencourt

Wed, Dec 17, 2014 @ 11:04 AM

By Meera Senthilingam

141212185044 chikungunya mosquito vector horizontal gallery

Its name means "bending over in pain." It has no treatment or vaccine. Its symptoms resemble Dengue fever. And it has infected more than 1 million people -- 155 of them fatally -- since spreading to the Americas one year ago.

The mosquito-borne Chikungunya virus has long been diagnosed in travelers returning from countries in Asia and Africa, where the disease is widespread. But in December 2013, the first people infected by mosquitoes local to the region were reported on the Caribbean island of Saint Martin.

This was the first outbreak of the debilitating disease in the Western hemisphere, health officials said.

All countries in Central America have now reported local transmission of Chikungunya [pronounced chik-un-GOON-ya], and the United States had 11 confirmed cases of local infection this year as of December 12, all in the state of Florida. There also have been 1,900 imported cases across the U.S. in returning travelers.

"It wasn't until 2013 that unfortunately a traveler resulted in local transmission of Chikungunya," said Erin Staples of the U.S. Centers for Disease Control (CDC), referring to the people infected in Saint Martin.

Those infected carry the virus in their bloodstream; it can then be picked up by mosquitoes as they bite, making them carriers. The virus has since spread rapidly and shows no signs of leaving, as ecological conditions are perfect for the disease to flourish.

"We knew it would spread," said Staples, a medical epidemiologist.

The big question perplexing officials: Why now?

Two mosquito species primed to the temperatures of Central and South America carry Chikungunya. The species -- Aedes aegypti and Aedes albopictus -- also carry the virus behind Dengue fever.

"Given the level of Dengue in the region, we knew there could be the same levels of Chikungunya," Staples said. Both diseases can cause joint pain and inflammation, headaches, rashes and fever, and can lead to death in rare cases.

But this tropical disease with an exotic name (which originates from the African Makonde dialect) causes more intense joint pain and inflammation. For some people the pain can last for months or years, resulting in additional psychological strain.

The lack of immunity among people living in the Americas provided a blank canvas for Chikungunya to spread throughout the population this year. As of December 12, more than 1.03 million people have been infected, in addition to the 155 who died, according to the Pan-American Health Organisation (PAHO). Almost all of the fatalities occurred in the Caribbean island countries of Guadaloupe and Martinique.

"Where we saw the biggest jump was after it reached the Spanish-speaking countries in the region," said Staples, referring to the weakened infrastructures and health systems of countries such as the Dominican Republic, which has reported more than 520,000 cases -- more than half of the overall outbreak and 5% of the island country's population.

As South American countries approach their summer, numbers are expected to rise there as the mosquitoes flourish in the heat.

"Brazil, Peru, Paraguay are coming into their summer months and reporting their first local transmission," Staples said. Already, more than 2,000 people have been infected in Brazil.

Is there cause for concern?

Because infection with Chikungunya is rarely fatal, the issue of most concern to officials is the burden on health services and the impact of the debilitating symptoms on the economy.

"The high number of cases can overload health services," says Dr. Pilar Ramon-Pardo, regional adviser for PAHO, the regional office of the World Health Organization. Until recently, monitoring for Chikungunya was not part of routine surveillance in the region.

"Clinicians have to be ready to diagnose," she said

About 20% to 30% of cases are expected to become chronic, with symptoms such as arthritis and other rheumatic manifestations leading to physical disabilities, Ramon-Pardo said. Further long-term effects are psychological as people become more depressed and tired.

All of this can result in missed work and lower school attendance, she said, hurting local economies.

Is it here to stay?

The warm climate of the region offers potential for Chikungunya levels to be maintained for years to come, just like Dengue fever. But areas of most concern are the tropics.

"The areas which have year-round favorable climate for the mosquito are at the greatest risk," says Dr. Laith Yakob of the London School of Hygiene and Tropical Medicine, which is monitoring the spread of the outbreak.

While the climate and mosquitos have long been present, Ramon-Pardo said, "we don't know why this is happening now." She said globalization is likely to blame, with increased population movement from one country to another. This offers more opportunities for local mosquitos to bite infected humans.

The CDC's Staples said she is temporarily at ease regarding numbers in the U.S. "We're moving into fall and winter periods, which should see activity decrease," she said. Cold temperatures reduce mosquito survival rates.

The rapid spread of Chikungunya this year also could help minimize future infections. "Chikungunya will go through a region quite rapidly and create a level of population immunity which helps mitigate large outbreaks of the disease," Staples said. Unlike Dengue, infection with Chikungunya results in lifelong immunity.

Like many other infections, Chikungunya could, however, remain in the background through animals capable of carrying the virus in their bloodstream and acting as so-called reservoirs of the disease.

"In Asia and Africa there is a transmission cycle in small mammals and monkeys," Ramon-Pardo said, meaning these animals keep the virus present within the population. "In the Americas ... we don't know yet."

Those words -- "we don't know" -- resonate throughout the community of scientists and government officials trying to control the outbreak.

The future risk of spread, levels of future immunity, risk from animal reservoirs, why this is only happening now, and the total economic impact are all unknown.

"Mathematical models are under construction by numerous research groups around the world to improve confidence over projections of future spread," said Yakob, whose team is modeling the disease. As they work, control efforts continue.

Getting it under control

When it comes to controlling Chikungunya, there are two main strategies -- reduce the likelihood of bites and remove the ever-biting mosquito. Prevention is the priority.

Unlike the mosquitoes behind malaria, which bite at night, the species behind Chikungunya bite any time, day or night. Those living in affected areas are asked to use repellent, sleep under bed nets and wear long clothing to avoid getting bitten. The air conditioned and indoor environments of people living in the U.S. mean numbers are likely to stay low there.

But mosquito control is at the heart of it all. Mass spraying of insecticides and removal of any sources of shallow water in which mosquitoes can breed are taking place across the continents. According to the CDC's Staples, Florida has been highly aggressive with its approach to control. "We're only at 11 (cases) due to such proactive measures," Staples said. For now, prevention is all they have as officials wait and see how the outbreak pans out.

"There is no vaccine currently and no good antivirals, so we are trying to control the spread of the disease," Staples said. "There are a lot of questions and only time will tell what we'll see for Chikungunya in the future."

Source: www.cnn.com

Topics: health, nurses, healthcare, disease, vaccine, hospitals, medicine, treatment, physicians, medical, infection, Chikungunya, symptoms, DCD, mosquitos, WHO

'Movember': Mustaches for Men's Health!

Posted by Erica Bettencourt

Wed, Nov 05, 2014 @ 12:18 PM

By Denise Whitaker

141103 movember lg resized 600

'Movember' is men's health awareness month.  It's a global initiative that's now gaining steam and raising millions to help find cures for men's cancers and other health issues. 

Originally started by two mates in Australia more than 10 years ago, it's grown from 30 growing mustaches that first year, to more than 4 million in almost two dozen countries.

The original rules still exist, right along with the concept, spelled out by the announcer in a Movember YouTube video:  "It's a reality check on your health and a responsibility to take action."

The concept is easy: Men, especially those who don't normally grow facial hair, let their mustaches grow all month long.  The more peach fuzz, the better!

"Honestly, it looks terrible for the first several weeks and for some individuals it always looks terrible," says Seattle's Dr. Peter Nelson. "But the point that we get across is that you want people to ask you 'why are you doing this?' "

It's a conversation starter, to get men talking about their health, specifically prostate and testicular cancer plus mental health.

Men who join the movement are called Mo Bros and work to raise money to combat these issues.

"In general, men don't discuss their health issues," Dr. Nelson said.

Dr. Nelson is part of a locally growing team of Mo Bros called MoDawgs, plus he's a prostate cancer researcher at the Fred Hutchinson Cancer Research Center.

Last year, the Movember foundation awarded his team a $1.4 million grant to develop strategies to treat advanced prostate cancer. 

"Advanced prostate cancer unfortunately is really a deadly disease in which we have no cure," Nelson said. "Once prostate cancer spread out of the prostate an into bones another sites, we can often temporize it for years by cutting off the fuel supply which is testosterone but eventually these cancers all resist."

And so he explained that his team developed several interesting targets and that they're now developing drugs to block to improve treatment.  

The project is moving into the second of its 3 years of funding. 

And there are many such studies being funded in the United States through the Movember movement. Each country keeps all of the money it's raised.  To date, the United States has raised $559 million, since 2003, and some 770 men's health projects have been funded. 

So back to that Movember YouTube video, it ends with words on the screen:  "Makers, Thinkers, Growers, Doers; changing the face of men's health."

Are you willing to join the fight?

Source: www.komonews.com

 

Topics: health, disease, cancer, medical, mens health, no shave november, prostate cancer, testicular cancer, cancer research

Google[x] Reveals Nano Pill To Seek Out Cancerous Cells

Posted by Erica Bettencourt

Wed, Oct 29, 2014 @ 03:11 PM

By Sarah Buhr

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Detecting cancer could be as easy as popping a pill in the near future. Google’s head of life sciences, Andrew Conrad, took to the stage at the Wall Street Journal Digital conference to reveal that the tech giant’s secretive Google[x] lab has been working on a wearable device that couples with nanotechnology to detect disease within the body.

“We’re passionate about switching from reactive to proactive and we’re trying to provide the tools that make that feasible,” explained Conrad. This is a third project in a series of health initiatives for Google[x]. The team has already developed a smart contact lens that detects glucose levels for diabetics and utensils that help manage hand tremors in Parkinson’s patients.

The plan is to test whether tiny particles coated “magnetized” with antibodies can catch disease in its nascent stages. The tiny particles are essentially programmed to spread throughout the body via pill and then latch on to the abnormal cells. The wearable device then “calls” the nanoparticles back to ask them what’s going on with the body and to find out if the person who swallowed the pill has cancer or other diseases.

“Think of it as sort of like a mini self-driving car,” Conrad simplified with a clear reference to Google[x]‘s vehicular project. “We can make it park where we want it to.” Conrad went on with the car theme, saying the body is more important than a car and comparing our present healthcare system as something that basically only tries to change our oil after we’ve broken down. “We wouldn’t do that with a car,” he added.

Bikanta’s tiny diamonds luminesce cells in the body.

Similar to Y Combinator-backed Bikanta, the cells can also fluoresce with certain materials within the nanoparticles, helping cancer cells to show up on an MRI scan much earlier than has been possible before.

This has all sorts of implications in medicine. According to a separately released statement from Google today, “Maybe there could be a test for the enzymes given off by arterial plaques that are about to rupture and cause a heart attack or stroke. Perhaps someone could develop a diagnostic for post-surgery or post-chemo cancer patients – that’s a lot of anxious people right there (note: we’d leave this ‘product development’ work to companies we’d license the tech to; they’d develop specific diagnostics and test them for efficacy and safety in clinical trials.”

We essentially wouldn’t need to go into the doctor and give urine and blood samples anymore. According to Conrad, we’d simply swallow a pill and monitor for disease on a daily basis. We’d also be able to upload that data into the cloud and send it to our doctor. “So your doctor could say well for 312 days of this year everything looks good but these past couple of months we’re detecting disease,” Conrad said.

Privacy and security, particularly in health care is essential. Google came under fire in the last couple of years for handing over information to the U.S. government. Conrad was quick to mention that a partner, not Google would be handling individual data. “It’d be like saying GE is in control of your x-ray. We are the creators of the tech and they are the disseminators,” Conrad clarified.

The U.S. government has an active interest in this space, as well. It’s invested over $20 billion in nanotechnology research since 2013.

This project is in the exploratory phases but Conrad was hopeful that we’d be seeing this technology in the hands of every doctor within the next decade. He also mentioned that his team has explored ways of not just detecting abnormal cells but also delivering medicine at the same time. “That’s certainly been discussed,” he said, but cautioned that this was something that needed to be carefully developed so that the nanoparticles had a chance to show what was happening in the body before destroying the cells.

So far 100 Google employees with expertise in astrophysics, chemistry and electrical engineering have taken part in the nanoparticle project. “We’re trying to stave off death by preventing disease. Our foe is unnecessary death,” Conrad added.

Source: www.msn.com

Topics: health, healthcare, technology, disease, cancer, research, medical, Google, nano pill, cancerous cells

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