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Old August 12th, 2002, 19:07
sysadmin sysadmin is offline
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August 4 - August 10, 2002


Saturday, August 10, 2002

Music Decreases Anxiety Over Waiting for the Doctor
Soothing music has been shown to alleviate the stress of waiting for a doctor who is running late, in addition may reduce a patient's perception of pain. [ BMJ 2002;325:346 ( 10 August ) ]  


Friday, August 09, 2002

BASIC INSTINCT Writer Regrets Smoke-Laden Scripts
Hollywood screenwriter Joe Eszterhas now publicly states that he regrets intentionally portraying smoking as a hip, sexy habit in his screen characters. He was recently stricken with throat cancer. Writing in the Op-Ed page of the New York Times, he states that his intentional glamorization of smoking in his movies was wrong. Comment: finally, one Hollywood writer acknowledges that what they portray in films affects public behavior. It is unfortunate that Eszterhas needed to get throat cancer before making this change in his attitude. However, we applaud his honesty and his new efforts to change irresponsible Hollywood behavior. [ article ]  


LEADING AIDS EXPERTS CALL FOR MAJOR EXPANSION OF HIV PREVENTION

The Global HIV Prevention Working Group, composed of nearly 40 of the world’s leading HIV prevention experts, recently released a blueprint to prevent millions of new HIV infections before the end of the decade.

The blueprint calls for spending on global HIV prevention to quadruple to $4.8 billion by 2004. This increase would allow for a massive expansion of effective prevention efforts, including HIV testing, condom promotion, STD control, and behavior change programs. Today, fewer than one in five people at risk for HIV infection receives basic prevention services.

“We failed to act decisively in the early stages of the epidemic in sub-Saharan Africa, and now we are paying the price,” said David Serwadda of Makerere University in Kampala, Uganda, and co-chair of the working group. “But we still have an opportunity to save the next generation in Africa from AIDS, and to prevent runaway epidemics in India, Russia, and China.”

“There is clearly a major gap in access to prevention worldwide,” said Helene D. Gayle, M.D., M.P.H., director of the Bill & Melinda Gates Foundation’s global HIV/AIDS program and co-chair of the working group. “While we treat those infected, while we search for a vaccine, we have to embark on an unprecedented expansion of existing, proven HIV prevention programs.”

The report, Global Mobilization for HIV Prevention: A Blueprint for Action, was released in conjunction with a new study in The Lancet, which projects that there will be 45 million new HIV infections by 2010 without an expanded prevention effort. The study states, however, that 29 million of these could be prevented with the aggressive scaling up of existing prevention strategies. The study was conducted by UNAIDS, WHO, The Futures Group International, the U.S. Census Bureau and Imperial College, London.

Interventions cited in the working group’s blueprint and the Lancet study i
nclude: mass media campaigns; condom distribution, promotion and social marketing; voluntary counseling and testing (VCT) programs (including those VCT programs linked to mother-to-child transmission prevention programs); blood screening; school-based programs; programs for out-of school youth; workplace programs; treatment of sexually transmitted diseases (STDs); peer counseling for sex workers and men who have sex with men (MSM), and harm reduction programs for injecting drug users (IDUs).

“Just as combination therapy attacks HIV from different angles, prevention requires a combination of approaches,” said Gayle. “There is no single magic bullet. ‘Combination prevention,’ however, has proven very effective.”

In the U.S., prevention programs have cut annual HIV infections by two-thirds since the mid-1980s. Prevention efforts have also contained the epidemic in countries such as
Senegal, Thailand, and Uganda. More recently, Zambia, Brazil and Cambodia have seen significant results from prevention efforts. For example, as a result of a comprehensive prevention program in Cambodia, HIV among pregnant women has declined by one-third in the past three years.

The Global HIV Prevention Working Group is composed of 37 leaders in public health, clinical care, biomedical, behavioral, and social research, and people affected by HIV/AIDS from around the world. The working group was convened earlier this year by the Gates Foundation and the Kaiser Family Foundation to review scientific evidence on HIV prevention and assess the status of global prevention efforts. The working group’s blueprint strongly affirms the importance of a comprehensive approach to fighting the epidemic—one that combines both prevention and treatment.“We have a moral imperative both to prevent millions of new HIV infections and to care for those who are already infected,” said Gayle. “Treatment not only prolongs lives, but it also supports prevention efforts by encouraging knowledge of HIV status.”

Recommendations: The working group’s blueprint identifies the major obstacles to scaling up HIV prevention, and makes specific recommendations for overcoming them:

  1. Increase funding. Annual investment in HIV prevention for low-and middleincome countries should quadruple by 2004 – increasing from approximately $1.2 billion today to $4.8 billion, as called for by UNAIDS. Annual funding must be sustained at this level through 2010 and well into the next decade.
  2. Scale up proven prevention strategies, including voluntary counseling and testing, condom promotion, mass media campaigns, blood screening, STD treatment, peer outreach, workplace programs, school-based programs and programs for out-of-school youth.
  3. Train local personnel to develop prevention expertise that can be sustained over the long-term.
  4. Encourage political leaders to be vocal proponents of science-based HIV prevention policies a
    nd programs.
  5. Use prevention resources more strategically. Today 1 in 4 developing countries lacks a strategic HIV/AIDS plan. In order to most effectively fight AIDS, all countries should have a strategic plan in place, tracking of HIV/AIDS should be improved, and prevention funding and programs should be coordinated.
  6. Expand access to prevention tools, such as condoms and HIV test kits, while dramatically expanding access to HIV/AIDS therapies.
  7. Accelerate research into new prevention technologies by increasing funding by $1 billion for vaccines, and $1 billion for microbicides by 2007, and expand research into female-controlled barrier methods.
  8. Confront the social factors that facilitate HIV, such as AIDS stigma, poverty and women’s disempowerment.

Global HIV Prevention Working Group: Helene Gayle, J.V.R. Prasada Rao, David Serwadda, Drew Altman, Judith D. Auerbach, Mary Bassett, Seth Berkley, Jordi Casabona, Tom Coates, Awa Marie Coll-Seck, J. Peter Figueroa, Geeta Rao Gupta, Catherine Hankins, Shen Jie, Salim Karim, Milly Katana, Susan Kippax, Peter Lamptey, Kgapa Mabusela, Marina Mahathir, William Makgoba, Rafael Mazin, Michael Merson, Jeffrey O'Malley, Peter Piot, Vadim Pokrovsky, Tim Rhodes, Zeda Rosenberg, Bernhard Schwartlander, Moses Sichone, Mark Stirling, Donald Sutherland, Paolo Teixeira, Ronald O. Valdiserri, Mechai Viravaidya, Catherine Wilfert, Debrework Zewdie [ article ]

  


First Canadian Dies of Human 'Mad Cow' Disease
A Saskatchewan man has just died from variant Creutzfeldt-Jakob disease ('Mad Cow' disease). Officials state that "all evidence points to the patient having acquired the disease in the United Kingdom." Comment: Mad Cow disease is incurable except through prevention. A variation of the disease is also becoming widespread throughout wild deer and elk in the US. The situation with this virus needs to be taken seriously. [ article ]  


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Thursday, August 08, 2002

HIV Resistance to Medications Growing
This analysis found that over the five year period from 1995 to 2000 there has been an alarming increase in resistance by the human immunodeficiency virus found in North America to antiretroviral medications. High-level resistance to one or more drugs increased from 3.4% to 12.4% and multidrug resistance increased from 1.1% to 6.2% Comment: this rapid increase in drug resistance means that the human immunodeficiency virus is undergoing rapid mutations allowing it to become resistant, i.e. stronger than all known antiretroviral treatments. Obviously, for HIV and many other diseases, prevention is the best cure. If this trend continues, there is going to be an alarming increase in AIDS in America. Worldwide, there already is a disturbing trend of rapid increases in HIV incidence. This problem needs to be aggressively attacked, immediately, on a global scale. [ NEJM 2002;347(6):385-394 ]  


Botulinum Toxin Useful in Stroke
This study of 126 stroke patients with increased flexor tone in the wrist and fingers found that intramuscular injection of botulinum toxin type A reduced their disability at all followup visits through 12 weeks. Comment: this treatment makes sense, given its success in treating muscle contractions in the face (as a cosmetic treatment) [ NEJM 2002;347(6):395-400 ]  


Wednesday, August 07, 2002

Bush Signs Born-Alive Infants Protection Act Into Law
Jeff Johnson, CNSNews.com, Tuesday, Aug. 6, 2002 -

President Bush Monday signed legislation protecting infants "accidentally" born during abortion procedures from being killed or left to die.
Bush signed the "Born-Alive Infants Protection Act" (H.R. 2175) during a trip to Pennsylvania, to mirror laws already on the books in more than 30 states.
"This important legislation assures that every infant born alive, including an infant who survives an abortion procedure, is considered a person under federal law," he said. Attending the ceremony were Gianna Jessen, a young woman who survived an attempted saline abortion in 1977 and Jill Stanek, a nurse who alerted Congress about infants who were born alive but then allowed to die following botched abortions. "Today, through sonograms and other technology, we can clearly see that unborn children are members of the human family as well. They reflect our image, and they are created in God's own image," Bush said. "The Born-Alive Infants Protection Act is a step toward the day when every child is welcomed in life and protected in law.

"It is a step toward the day when the promises of the Declaration of Independence will apply to everyone, not just those with the voice and power to defend their rights," he added. The bill was introduced in the 107th Congress by Rep. Steve Chabot, R-Ohio, chairman of the House Judiciary Subcommittee on the Constitution, in response to reports of infants being allowed to die after incomplete abortions. "According to eyewitness accounts, live-birth abortions are being performed on healthy infants as late as the 23rd week of pregnancy, and beyond, that suffer from nonfatal deformities resulting in live-born premature infants who are simply allowed to die, sometimes without the provision of warmth or nutrition," Chabot argued on the House floor. "Our subcommittee was told of a living infant who was found in a soiled utility closet; another who was found naked on the edge of a sink; and another infant who, horribly, was wrapped in a disposable towel and thrown in the trash, only to be later found after falling out of the towel and onto the floor."

Pro-abortion Rep. Jerrold Nadler, D-N.Y., discounted the eyewitness accounts of abortionists allowing babies to die, but supported the bill, nonetheless.
"I support the bill simply to put at rest the fevered apprehensions about nonexistent threats. But let us not overstate those nonexistent threats," Nadler said during debate on the bill. "It is a harmless bill. It is a bill that does nothing, but is harmless. And why not put people's fears at rest? So I still urge people to support the bill. But we should not get carried away and imagine that under the guise or name of 'abortions' any of this nonsense is going on."

When the bill was originally introduced in 2000 by now-retired Rep. Charles Canady, R-Fla., the National Abortion Rights Action League (NARAL) opposed the proposal, calling it "another anti-choice assault" on the "basic tenets of Roe v. Wade."

"In proposing this bill, anti-choice lawmakers are seeking to ascribe rights to fetuses 'at any stage of development,' thereby directly contradicting one of Roe's basic tenets," NARAL wrote in a July 20, 2000 press release. However a June 13, 2001 release states that, "Consistent with our position last year, NARAL does not oppose passage of the Born Alive Infants Protection Act."

The law provides that "In determining the meaning of any Act of Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of the United States, the words 'person', 'human being', 'child', and 'individual', shall include every infant member of the species homo sapiens who is born alive at any stage of development." It defines the term "born alive" as "the complete expulsion or extraction from his or her mother of [a human being], at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion." President Bush was in Pennsylvania to meet with nine coal miners who were rescued last week after being trapped underground for 77 hours. The bill was signed there in honor of its Senate sponsor, Sen. Rick Santorum, R-Pa. Copyright CNSNews.com Reprinted with permission from newsmax.com



article ]  


First Baby Breech Doesn't Require Repeat C-Section
These researchers from Ireland found that 44% of women who had c-sections due to a breech pregnancy required a repeat c-section with a subsequent baby. Comment: at this time, this research is pretty confusing, since the trend is away from vaginal births after cesarean. This is because the risk of uterine rupture is significant for women who have attempt a vaginal delivery after a previous cesarean. article ]  


Tuesday, August 06, 2002

Superbug Found: the First Case of Vancomycin-Resistant Staph Aureus
US doctors have reported the first ever case of staphulococcus aureus that is resistent to vancomycin. Comment: antibiotics won't work on this bug. Vancomycin is known as the last resort for staph aureus infections. This finding makes controlling antibiotic usage and developing new antibiotics increasingly important. [ article ]  


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Monday, August 05, 2002

Three Day Course of Amoxicillin as Effective as Five Days
This study of 200 children, aged 2 to 59 months, with non-severe pneumonia found that 3 days of treatment with amoxicillin was as effective as 5 days. This treatment failed in 21% of patients in the 3 day group, and 20% of patients in the 5 day group. Comment: the clinical usefulness of this article in terms of pediatric pneumonia is questionable, since amoxicillin isn't a common treatment for pneumonia in many if not most countries. Still, it does suggest that short courses of amoxicillin are as effective as longer courses. [ http://image.thelancet.com/extras/01art7461web.pdf ]  


Sunday, August 04, 2002

Buproprion Helps African Americans Quit Smoking
This study of 600 African American cigarett smoking adults found that the use of 150 mg of sustained-release bupropion taken twice daily increased the quit rate by approximately 50% at 26 weeks (from 13.7% in the placebo group to 21% in the bupropion group). Comment: the placebo group fared pretty well also with a quit rate of almost 15% at 6 months. Unfortunately, "expert" medical ethicists have made prescribing placebos illegal. Too bad. [ article ]  
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