Hidden deaths of the world’s newborn babies
Improving newborn survival rates takes more than money, says Joy Lawn. But how do you get disparate partners, countries and donors working together effectively?
Q: You and your colleagues produced the Lancet neonatal series in 2005 helping to put 4 million annual newborn deaths on the global agenda. Why were these deaths previously invisible?
A: Despite the huge numbers, newborn deaths were and to some extent still are invisible at many levels. This starts in the homes of the poor where most of these deaths occur and goes right up to the corridors of power. More than two-thirds of these 4 million newborns die in sub-Saharan Africa and south Asia, often in the first days of life, without a name let alone a birth certificate. There have been initiatives such as the Safe Motherhood Initiative, which was most concerned for the mother, while the child survival campaign was primarily for the older child. The newborn has fallen between the cracks. However, if all partners worked together effectively, if roles were clear and services were integrated, this would not be the case.
Q: Neonatal mortality was a neglected issue until 2005. How has this changed and how do you respond to criticism of some of the initiatives?
HIV drives children’s pneumonia in sub-Saharan Africa
Pneumonia in HIV-positive children is proving to be a challenge across sub-Saharan Africa. Claire Keeton reports from Cape Town.
Nokhwezi Hoboyi knows about the devastation of pneumonia after losing her first two babies to the disease.
The 27-year-old mother from Cape Town saw her first child die of pneumonia at four months of age. Her second child started coughing at two months and was diagnosed with pneumonia. She was hospitalized, became ill at three months and did not respond to antibiotics.
Saving teeth by using periodontal ligament regeneration
Teeth may fall out as a result of inflammation and subsequent destruction of the tissues supporting the teeth. Dutch researcher Agnes Berendsen has investigated a possible solution to this problem. At the Academic Centre for Dentistry Amsterdam (ACTA), she has studied the regeneration of the periodontal ligament by use of tissue engineering. The 3D in vitro model she has developed appears to be promising for regenerating periodontal ligament and may also prove valuable for restoring tendons and ligaments elsewhere in the body.
The periodontal ligament forms a flexible connection between the tooth root and the surrounding jaw bone. Trauma or inflammation can cause destruction of the periodontal ligament. Berendsen chose tissue engineering to tackle this problem.
How best to treat chronic pain? The jury is still out
How best to alleviate chronic pain, a leading cause of disability and employee absenteeism, continues to perplex both patients and their doctors.
A review of recent studies on pain medicine appearing in the June 2008 issue of the Journal of General Internal Medicine reports that while various approaches and combinations of therapies to treat pain have advantages and disadvantages, researchers don’t yet know how to determine which is best for individual patients.
Among the approaches to pain management studied were those relying on the prescription of opioids (drugs such as morphine, Percocet and Vicodin), surgery, and alternative medicine (acupuncture, herbal remedies).
U of I study shows how to lose weight without losing bone
A higher-protein diet that emphasizes lean meats and low-fat dairy foods as sources of protein and calcium can mean weight loss without bone loss--and the evidence is in bone scans taken throughout a new University of Illinois study.
The research, which compared the results of a high-protein, dairy-intensive diet with a conventional weight-loss diet based on the food-guide pyramid, was published in this month’s Journal of Nutrition.
“This is an important finding because many people, especially women in mid-life, are concerned with both obesity and osteoporosis,” said Ellen Evans, a U of I associate professor of kinesiology and community health and member of the U of I Division of Nutritional Sciences.
Non-whites Receive Harsher Sentences for Inflicted Traumatic Brain Injury of Children
Non-white defendants are nearly twice as likely to receive harsher prison sentences than white defendants in North Carolina criminal cases stemming from inflicted traumatic brain injury of young children.
That’s the conclusion reached by researchers from the Injury Prevention Research Center at the University of North Carolina at Chapel Hill, who tracked down what happened in every such case prosecuted in North Carolina in 2000 and 2001. Their study appears in the June issue of the journal Pediatrics.
Inflicted traumatic brain injury is a specific form of child abuse, which includes but is not limited to shaken baby syndrome.
Heart Patients Fare Better in 3-Year Program
People recovering from acute heart problems such as heart attack and heart surgery are more likely to develop habits to control heart attack risk factors when they meet regularly with cardiac “disease managers,” according to researchers at Mayo Clinic in Rochester. These managers are nonphysician cardiac rehabilitation specialists who lead long-term follow-up programs that last three years. With these risk factors under control, heart patients are likely to live longer and have fewer heart problems, the Mayo researchers conclude.
The Mayo Clinic researchers studied the effects of a long-term cardiac disease manager model on 503 patients involved in cardiac rehabilitation. Their findings appear in The Journal of Cardiopulmonary Rehabilitation and Prevention. The disease manager’s role was to monitor the patient’s status, and to coach the patients in adopting heart attack prevention behaviors. At each meeting, the following factors were assessed and management strategies were discussed: blood lipid levels, blood pressure and body weight, tobacco use, cardiac medication compliance, exercise regimen and physical activity, nutrition and cardiopulmonary symptoms. After initial rehabilitation training about risk factor management, each patient met with a trained disease manager every three to six months for three years.
Extended Infant Antiretroviral Prophylaxis Reduces HIV Risk During Breastfeeding
In many resource-poor countries, infants born to mothers with HIV receive a single dose of nevirapine (NVP) and a one-week dose of zidovudine (ZDV) to prevent transmission of HIV from the mother to her newborn. The results of a randomized trial led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of Malawi College of Medicine found that extending the routine antiretroviral regimen can significantly reduce the risk of mother-to-child HIV transmission. The study is available in the June 4 online edition of New England Journal of Medicine and will appear in the June 10 print edition.
The Malawi trial, known as PEPI (post-exposure prophylaxis of infants), followed 3,016 infants born to HIV-positive mothers. The infants and mothers were followed for 2 years. All infants received the standard care of a single dose of NVP and a one-week dose of ZDV to prevent HIV infection. One group received an additional 14-week prophylaxis with NVP, while another received 14-week regimens of both NVP and ZDV.
Throughout the trial, the children who received the extended prophylactic regimens had consistently lower rates of HIV infection compared to children who received the standard care. At 9 months, 5.2 percent of infants receiving extended NVP, and 6.4 percent of infants receiving extended NVP and ZDV contracted HIV, compared to 10.6 percent of infants receiving the standard of care regimen. The frequency at which the mothers breastfed their children was similar between all three treatment groups.
Genetically low HDL not tied to heart disease
Lower levels of heart-healthy HDL cholesterol resulting from a gene mutation is not associated with an increased risk of heart disease involving ischemia—restriction of blood flow through the coronary arteries, according to a study.
This suggests that low HDL, in and of itself, is not a heart disease risk factor.
A number of studies have tied low blood levels of HDL (the “good” cholesterol) to an increased risk of ischemic heart disease. However, whether HDL cholesterol is a primary factor in the development of heart disease is unclear, in part because of other factors related to low HDL cholesterol levels, such as harmful triglycerides, which may contribute independently to increases in heart and vascular events.
Insuring your smile… the options in the UK
As more and more dentists go private and the cost of treatment soars, a growing number of consumers are insuring their pearly whites.
A standard filling can cost anything into three figures in many British surgeries and even a routine check-up on the NHS can dent your bank balance.
The mounting costs are leading to a growing number of people to neglect their oral care: almost a third of 1,000 adults surveyed earlier this year say they have not visited the dentist in the past two years.
Telltale toenail nicotine predicts heart problems
Analyzing the nicotine content of toenail clippings can help gauge a woman’s heart disease risk, a new analysis of findings from the Nurses’ Health Study shows.
Toenail analysis “could become a useful test to identify high-risk individuals in the future, especially in circumstances when smoking history is not available or is subject to bias,” Dr. Wael K. Al-Delaimy of the University of California in San Diego and colleagues say in the American Journal of Epidemiology.
Biomarkers of cigarette smoke exposure now used, such as the amount of cotinine (a nicotine breakdown product) in urine or saliva, only reflect exposure within the past few days, the researchers note. Because toenails grow slowly, they add, they may offer a longer-term, more stable estimate of a person’s total level of exposure to tobacco smoke.
