01 February 2017

Cancer, burnt toast and roast potatoes

Country-potatoes-712661_1280

I should think the entire western world is now afraid to eat their roast potatoes.  This comes after the international media coverage  of the UK Food Standards Agency’s new campaign “"Go for Gold” , [@CABI_Health 23rd Jan ], which hopes to encourage us (UK) to reduce acrylamide in our diet by cooking starchy foods to a pale golden colour and no further.

Speaking as someone who spent nearly 20 years in labs handling acrylamide on a daily basis (for analysing proteins), I can’t say I am too worried about the acrylamide content of my Sunday lunch roast potatoes  and burning my toast.

But what about the general public? Should they be nervous…so what is behind the UK Food Standards Agency (FSA) campaign?

It’s their recently published Total diet study of inorganic contaminants, acrylamide & mycotoxins (TDS-2014), covering years 2014 and 2015 for the UK, and how the results fit with European Food Safety Agency (EFSA) recommendations.

A total diet study differs from other food surveys in that foods are firstly prepared and cooked for consumption. The aim of TDS-2014 was to estimate dietary exposure to contaminants for population age groups: it assessed 138 food categories, and for each category pooled food items collected from 24 UK towns.

Acrylamide put in perspective

Acrylamide occurs naturally in our diets, when starchy foods like potatoes, parsnips & bread, are cooked at high temperatures for long periods (e.g. baking, frying, toasting and roasting). The darker the colour, the more acrylamide…so the advice is go for gold[en] not burnt.

Studies in animals have shown that acrylamide in their diet can damage DNA and so this means it can cause cancer. Studies in people are inconclusive.

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09 December 2016

Universal health coverage gains momentum in 2016

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WHO definition: Universal Health Coverage (UHC) means everyone can access the quality health services they need without financial hardship.

This year it seems that organisations, governments and citizens everywhere are answering the call to UHC, whose annual awareness day is December 12th.

From this year forward, UHC is seen as central to improving health systems, improving economies, and ensuring global health security. The G7 group countries, the primary source of funding for Low and Middle-Income Countries (LMIC), met in Ise-Shima Japan 2016 and made UHC their umbrella concept. Through this, they seek to improve health systems and global health security.  Of the 17 SDGs agreed by the United Nations, just one is directly health-related but it is “achieving UHC”.

Judith Rodin, (President Rockefeller Foundation, has observed that “25 of the wealthiest nations all have some form of universal coverage, as do some middle-income countries including Brazil, Mexico and Thailand and lower-income nations, such as Ghana, the Philippines, Rwanda and Viet Nam, are working towards achieving UHC.”

Rather than talk about why we need UHC, I thought I’d talk  about what is actually proposed by middle-income and lower-income countries (LMIC) to fulfil UHC and what the NGOs, donors and global health community championing UHC would like it to encompass.

What is UHC?

UHC systems vary from country to country: there is no one size fits all.  It very much depends on the minimum health outcomes a government wants to achieve and how much of its GDP it is prepared to spend. The main variables being the level of care delivered, who delivers it, who receives it and how it is funded. 

UHC of itself does not mean universal access to health services nor care for all diseases. It’s about providing a basic level of health services (“Essential Packages of Health Services”) to as much of the population as possible.

The first UHC system was the UK’s National Health Service set up in 1948.

The USA has a non-universal system of health coverage.

What do LMIC see it as?

Over time,  as far as I can see, these basics for a cost-effective UHC have emerged:

  • government regulation, legislation and taxation
  • primary health care
  • vaccination programmes for children (for LMIC this is organised through GAVI, the Vaccine Alliance)
  • maternal healthcare (pregnancy)
  • health insurance to finance (public tax, private insurance or a mix of both)
  • financial protection: pooled funds to reduce out of pocket payments amongst the poorest and vulnerable  

Much of the following information is derived from the RSTMH 2016 Chadwick memorial lecture "Neglected Tropical Diseases in the Time of Blue Marble Health and the Anthropocene Epoch", given by  Professor Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas and President of the Sabin Vaccine Institute.

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31 October 2016

One Health will improve health and well-being of us all: plant, animal, human and ecosystem

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Pastoralists, Chad. Image courtesy of Esther Schelling, Swiss TPH. 

 One of a series of blogs  written by CABI editors for One Health Day November 3rd 2016

It's always nice to meet up with a CABI author at a conference especially when they are giving a talk around a theme dear to CABI‘s heart,  namely “One Health”: the concept of working across the interface of animal, plant, human  and environment to achieve health  & development  which is sustainable and fair. CABI has been gathering, managing and generating research information across all these sectors since 1912.  We know “its all connected”.

The conference was the RSTMH biennial meeting [Cambridge, September 12-16th, 2016], and the author in question, Esther Schelling, co-editor  of CABI’s  book One Health: The Theory and Practice of Integrated Health Approaches [2015]. To read a free e-chapter, use this link.

In One Health beyond early detection and control of zoonoses Esther talked about her long-time project with nomadic pastoralists in Chad and a Rift Valley Fever (RVF) control project in Kenya.  She drew attention to the need for:

  • more interdisciplinary studies to include an evaluation of One Health working
  • involvement of social scientists
  • engagement of key stakeholders

And tellingly she provided a cost-benefit analysis to society of controlling zoonoses when the disease is in its animal host before it infects human beings. 

Those cost-benefit analyses made a deep impression on the delegates, many of whom were involved in zoonotic neglected tropical diseases. Perhaps for the first time they were appreciating the added benefits and synergies that a transdisciplinary approach between science, society, humanities and medicine could bring.

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10 October 2016

Different explanations of mental illness in Jamaica: can we combine the traditional and biomedical to heal body and spirit?

  Gordon Town Health Centre
Gordon Town Health Centre, Kingston, Jamaica. Image: H. Schwartz

Today is World Mental Health Day [October 10th 2016], whose theme is "psychological first aid and the support people can provide to those in distress". An apt moment to publish the insights into Jamaican community mental health of our summer intern, Harpur Schwartz. In her opinion piece below, Harpur addresses the role of traditional health beliefs in expressing mental distress, and identifies a role for traditional medicine in supporting recovery.

Have you been hearing any voices by Harpur Schwartz, edited by Wendie Norris

I could barely make out his answer to the question, “Have you been hearing any voices”, as he was speaking an English based creole language commonly known as Patwa. From what I could understand, spirits come to him during the night and tell him the ‘truth’ of the world around him. He said that his madness was caused by a spirit or Obeah. It was clear that this man had a mental illness that he strongly believed was caused by supernatural factors. The psychiatrist in the room asked patient number 23, “But you understand these voices are not real, right?” His response was “Yes”. Satisfied with his answer, the psychiatrist administered his medicine and handed him his appointment card without a second thought.

While working with the mental health services unit at the Gordon Town Health Centre in Kingston, I noticed a pattern to each patient’s appointment: the patient would be called in by number, he or she would be asked a series of questions about mood and symptoms, an injection of medicine was always administered, and the patient would leave with an appointment card stating the date for when he or she should return the following month. There was a rhythm to this process, one with emphasis placed on drug administration.  One of the recent success stories for Jamaican public health is access to psychotropic drugs for its community mental health services - WHO reported that about 81-100% of physician and non-physician based primary health care clinics had at least one psychotropic medicine from each category.

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27 September 2016

Why Latin America is nearer elimination of rabies than Africa

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 Copyright: CC, Global Alliance for Rabies Control 

Rabies: a contagious and fatal viral disease of dogs and other mammals, transmissible through the saliva to humans and causing madness and convulsions.                                            

Latin America is doing far better at managing, controlling and ultimately eliminating rabies from the region. Africa is failing to make the same gains and a rethink is required: can the lessons learned in Latin America be  applied or adapted to Africa?

At RSTMH meeting “Challenges in Disease Elimination” held in Cambridge [September 12-16th, 2016], Dr Katie Hampson described the Pan American Health Organisation (PAHO)'s surveillance & management framework operating in Mexico and Brazil, devised to support the elimination of rabies in 25 PAHO countries, which could be adapted.  Tanzanian researchers have developed a targeted surveillance system to improve case detection for the African setting where resources are constrained.

Current situation of rabies control in Latin America vs Africa

The short answer is that in Latin America, PAHO, which exists to “strengthen national and local health systems and improve the health of the peoples of the Americas”, has concentrated on vaccinating the dog population against rabies and interrupting transmission. African countries have no similar regional support structure for their health ministries and rely on post-exposure prophylaxis (PEP)  of humans bitten by dogs, to achieve a form of control of rabies. PEP vaccination only saves lives if the bitten person has timely access to a well-stocked clinic, and the money to pay for the shots. In remote and rural areas, this can lead to grim choices: which child do you treat if you only have money for one? We heard at the RSTMH of an African mother with several children bitten by the “family dog”, who having travelled a great distance to reach the vaccine, was then faced with that very choice.

World Rabies Day is September 28th and  so this month's Global Health Knowledge Base e-newsletter will focus on  Rabies.

Read more on  Handpicked and Carefully Sorted

 

11 July 2016

Mycetoma finally joins the official list of neglected tropical diseases

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Woman with fungal mycetoma, West Indies CDC/ Dr. Lucille K. Georg

From Harpur Schwartz, an economics/global health student interning with Cabi’s Global Health team

The Sixty-ninth World Health Assembly at the World Health Organization, Geneva, May 2016, officially recognised mycetoma (Madura foot) as one of the neglected tropical diseases, and I listened into the discussion online.  By categorizing mycetoma as a neglected tropical disease,  wider recognition of the disease will lead to a boost in the development of control strategies and tools to be implemented in the areas where this disease is prevalent.

As a student studying global health, I was a little disappointed with myself; I had heard of the other neglected tropical diseases (NTDs),  but not of mycetoma,  a destructive fungal or bacterial infection  of the foot (or limb) that results in disfigurement and social stigma, and as with other NTDs, is linked to poverty. I did not know there was a mycetoma belt with most cases reported from India, Mexico, Sudan, Chad, Mali, Mauritania, Somalia and Yemen.  If mycetoma was unfamiliar to me, how many other people had never heard of this disease?  I have provided answers to some basic questions I had about mycetoma in case you too are unfamiliar with this disease.

Read more on  Handpicked and Carefully Sorted

 

 

10 June 2016

World Blood Donor Day: blood donation in post-Ebola West Africa

47798-4_contestCopyright: James Meiring. Winner HIFA Photography award 2016

What do wellington boots drying in the African sun have to do with blood donation in the post-ebola era? Tell you later.

But first, as its World Blood Donor Day on June 14th, lets consider the differences between the blood transfusion services in a high income country like the UK with those in Nigeria or Sierra Leone? How has the ebola epidemic impacted on these services? 

Blood transfusion services in the UK

I think we in the UK, or any other high-income country, probably take our well-established national blood services somewhat for granted and only really give it a second thought when either we need to call on its use or something drastic goes wrong.

Established in 1946,  the Blood Transfusion Service (BTS) in England and Wales employs over 6000 people to collect & process the blood alone. All sorts of rules and practices surround the preparation and distribution and use of that blood. We are very fortunate that over 3% of people in the UK donate that blood (1% being the figure recommended as a min. by WHO to meet a populations needs) but even then we get regular appeals for more blood and we still suffer shortages for particular blood groups and platelets.

But, have you ever asked yourself why we need continuing fresh donations of blood and who are the usual recipients of that blood?

Read more on  Handpicked and Carefully Sorted

01 June 2016

World Blood Donor Day: balancing fairness with safety when selecting blood donors

Blood-732297_1280 image: Give Blood.
creative commons CCO

Our guest blogger this month is Harpur Schwartz, an economics/global health student from Connecticut College, USA.  Harpur is interning with Cabi’s Global Health team, learning how information resources can support public health education programmes.

World Blood Donor Day 2016 [June 14th] is quickly approaching, and this year’s theme will be “Blood connects us all”. The goal is to motivate regular blood donors to continue to give blood while motivating new blood donors to start by showing how patients and donors are connected. With the current blood donation crisis, the worry is people do not understand that they qualify to donate. To clear up any blood donation confusion, many countries like the UK have provided specific guidelines [blood donation rules] for who can give blood. Donors have to wait only four months after getting a tattoo or piercing to give blood and a mother only must wait six months after giving birth. Gay and bisexual men who used to face a lifetime ban in the UK, can donate blood if they have not had sex with another man for at least 12 months. This 12 month rule came into force in 2011 in the UK but has only recently done so in the USA (December 21st 2015, FDA updates blood donor deferral policy). It is the reason why many people in Orlando USA, anxious to donate blood to help their injured friends, are not able to do so (Gay Blood Donation Ban Under Fire in Wake of Orlando Shooting).

I have always been interested in how society is responsible for defining disease, and how once a person is labeled as having a certain disease, it frames their very being. In one of my university classes, we discussed how ‘Disease as framed’ is the way in which a person’s image changes as a result of disease. The example we discussed was AIDS and gay men. With the current blood donation policy, my question is if gay men are still being discriminated against because of their association with HIV and AIDS, or if the policy is based on sound evidence?

There has always been a stigma attached to the gay population in regards to HIV and AIDS, mainly because this was where the disease was first identified. [The story of the discovery of the AIDS epidemic is chronicled in the 1993 film “And the Band Played On”. Attitudes began to change in the USA when Mary Fisher delivered her speech, “A Whisper of AIDS”, at the Republican National Convention that took place in Houston in 1992. As a white female, and mother of two, Mary became a new face for HIV and AIDS. She was not a haemophiliac, she was not gay, she did not inject drugs, and yet she still tested HIV positive. Fisher explained to the world how “…HIV asks only one thing of those it attacks. Are you human?”

The gay and bisexual community are still unhappy with being treated differently.

Read more on Handpicked and Carefully Sorted

27 April 2016

Malaria incidence and invasive plants – is there a link?

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Contributed by Arne Witt, Coordinator, Invasive Species, CABI

25 April is World Malaria Day – a time to reflect on the steps we can take to tackle this terrible disease. Much progress has been made in the fight against malaria over the past 15 years, like the use of bed nets impregnated with pesticides, but 3.2 billion people are still at risk. If we are to achieve a 90% reduction in global malaria incidence and mortality by 2030 we must do more.

Read more at CABI's blog: "Handpicked...and carefully sorted"

Malaria control, disasters and conflict


Malaria_CDC_PHIL
WHO European Region announced last week that Europe is now malaria free. This is great news to coincide with World Malaria Day this year. The challenge is to make sure Europe remains free of malaria into the future.

Europe has been declared malaria free before, back in 1975. What happened to allow it to return?

Read more at CABI's blog "Hand picked... and carefully sorted"

Photo credit:CDC

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