There's new evidence that regular screening for colon cancer has long-term benefits.

Testing for blood in the stool reduced the risk of death from colorectal cancer by as much as 32 percent and it seemed to keep the death rate low even after testing stopped, according to one study.

A second found that getting a regular colonoscopy, where a tube is put in the colon to look for and - in some cases - remove abnormal growths, was linked to a 68 percent reduction in risk. It also confirmed that, if no growths are found, people can safely wait 10 years for their next test.

But the findings do not compare the relative merits of the two methods, even though that may be tempting, wrote Drs. Theodore Levin and Douglas Corley in an editorial in the New England Journal of Medicine, where the studies appear.

"Both colonoscopy and fecal occult-blood testing are effective for colorectal cancer screening, and these new studies support current screening guidelines," said the duo, who are based at Kaiser Permanente Medical Centers in California - Levin in Walnut Creek and Antioch and Corley in San Francisco.

"Both tests have been improved since they were used among the participants in either study. However, the two studies are different, which makes direct comparisons of effectiveness difficult."

"These studies don't break new ground, but they put us on more solid footing in recommending colorectal cancer screening by the current methods and, in general, at the current intervals," said Dr. Greg Enders, a gastroenterologist at Fox Chase Cancer Center in Philadelphia, who was not connected with either study.

Colorectal cancer kills over 600,000 people worldwide each year, according to the World Health Organization. The American Cancer Society estimates that the U.S. has about 50,800 deaths per year, with 142,800 new cases annually, a rate that has been declining thanks to screening.

But doctors are still trying to discern how best to screen and how often.

The government-backed U.S. Preventive Services Task Force recommends people between ages 50 and 75 get screened by colonoscopy every 10 years, with a high-sensitivity fecal occult blood test every year or with a sigmoidoscopy every five years in addition to fecal occult blood testing every three years.

The test that looks for blood in the feces has been the safest, cheapest and least complicated. But unless a tumor is releasing blood, the test can miss it. If blood is found, a colonoscopy is done to look for cancer or remove suspicious growths.

For its evaluation of the blood test, a team led by Dr. Aasma Shaukat of the University of Minnesota in Minneapolis looked at records from 46,551 participants in the Minnesota Colon Cancer Control Study who were followed for 30 years.

People were either screened for fecal blood annually, every two years or not at all. However, the formal screening program only spanned two six-year windows. The researchers had no follow-up information on which patients received subsequent screening with the blood test or a colonoscopy.

Nonetheless, the people who received annual screening during those initial periods ultimately saw a 32 percent reduction in their risk of dying from colorectal cancer. With biennial screening, the risk was cut by 22 percent. Screening did not affect the overall risk of dying during that period.

In total, 732 of 33,020 deaths over the 30 years were from colorectal cancer.

"You would expect to see a decrease in the risk of dying of colon cancer in the first eight to 10 years. The fact that the effect was sustained through 30 years is actually fairly remarkable," said Shaukat.

"It shows that the effect of colon cancer screening is profound," she said.

"The study of fecal occult blood testing provides the longest follow-up of any colorectal cancer screening study to date - an impressive 30 years - and shows that the benefits of screening by this method endure for the lifetime of the patient," Enders told Reuters Health in an email.

The researchers also found that with the fecal blood test, the greatest benefit was among men age 60 to 69. Their risk of death from colon cancer dropped by 54 percent compared to men of that age who were not screened.

The study on colonoscopies also looked at a less-thorough technique, known as a sigmoidoscopy, where a tube is only inserted into the end of the large intestine. A colonoscopy examines the full length. The information on 88,902 people, followed over 22 years, came from two databases: the Nurses' Health Study and the Health Professionals Follow-up Study.

Screening with sigmoidoscopy was tied to a 41 percent reduced risk of death from colorectal cancer. A full exploration of the colon by a colonoscopy was linked to a 68 percent lower risk.

The study "lays to rest a lingering concern that colonoscopy might not be more effective than sigmoidoscopy in preventing colorectal cancer deaths," said Enders. "National medical societies and Medicare have gone 'all in' on the common sense notion that more endoscopy - that is colonoscopy - is better, but convincing data were not in hand."

Having a colonoscopy every three years or less - even though no suspicious growths were seen - was tied to a 65 percent reduced risk of colorectal cancer. The reduction was 60 percent if done every three to five years and 48 percent if done every five to 10 years.

Co-author Dr. Shuji Ogino of the Dana-Farber Cancer Institute in Boston said the findings suggest that when no growths are found, a colonoscopy doesn't need to be repeated for a decade.

Up to now, "there has not been good solid evidence to support a 10-year interval," he told Reuters Health. "But now we know that with low risk individuals, 10 years won't make a difference."

People with polyps or a family history of colorectal cancer will need more frequent examinations, he said.

source: www.reuters.com

Money doesn't buy happiness, they say, but the clear evidence is that it does buy you extra years of life. The flip side of this, of course, is that the poor experience the worst health outcomes and the shortest life expectancies.

Tackling this massive health inequality should be a main priority of governments because of the ethical issues involved, says world-renowned epidemiologist Sir Michael Marmot, who has devoted his working life to the issue.

"There's an intimate relationship between where you are on the social hierarchy and your health.

"The people at the top have the longest life, those in the middle are shorter, and as you get lower and lower, the life expectancy gets shorter and shorter," he told The Irish Times on a visit to Dublin earlier this month.

'Social gradient'

Marmot's research has detailed the "social gradient" affecting the length of all our lives according to where we are on the economic pecking order.

In a 2010 report for the last Labour government in the UK, he found that people living in the poorest neighbourhoods died seven years earlier on average than those in the wealthiest neighbourhoods.

A number of Irish reports, including the 2008 all-island study by the Institute of Public Health and the more recent work by the Tasc think-tank, have pointed to similar trends here, yet it isn't clear that the Government has got the message.

Marmot believes all government policies should be proofed for their impact on health inequality. "We should have a health equity lens trained on all social and economic policy, asking what's the likely impact on health equity of trends in health equality.

"Let's not look just at debt and deficits but at the impact on people's lives of government decisions and on health equity. And if the Minister for Finance says, 'You're being unrealistic,' I say, 'Sorry, mate, we don't have the luxury of not doing that,'" says Marmot (68), lapsing just briefly into the Australian-accented patois of his youth.

Born in England, he moved to Australia in childhood and qualified as a medical doctor in Sydney. In the 1980s, he led ground- breaking research which identified a correlation between life expectancy and social status among British civil servants.

Social determinants

A former president of the British Medical Association, he chaired a World Health Organisation commission on social determinants of health from 2005-2008 and has won numerous awards for his work in public health.

In the UK review, he set out the six areas he believes governments need to develop policies to improve health equity – early child development; education; employment; minimum incomes for healthy living; health neighbourhoods; and a social determinants approach to prevention on issues such as smoking and obesity.

source: www.irishtimes.com

The number of annual Alzheimer's cases in Indonesia will go up by 19.7 million, according to the Ministry of Health, which has launched new efforts to educate the public about the illness.

"We often see 'pikun' [forgetfulness] as a problem for the elderly," Ali Ghufron Mukti, the Deputy Minister of Health, said at the "Memory Walk" Alzheimer awareness event in Jakarta on Sunday.

"This is wrong, because these are the symptoms of a serious illness," he said, referring to the widespread belief in Indonesia that Alzheimer's symptoms are part of the ordinary forgetfulness that comes with aging.

"We are working to prepare Indonesia's Alzheimer's-Dementia National Plan in the near future to demonstrate the country's commitment to this important issue," Ali said.

In addition to direct costs, Ali said that Alzheimer's tended to take a heavy toll on patients' families, who often devote tremendous time and effort in caring for their loved one's suffering from the disease.

Some 80 countries participate annually in the Memory Walk, which marks World Alzheimer's Month every September.

DY Suharya, the executive director for Alzheimer Indonesia, a nonprofit that works to raise the quality of life for dementia and Alzheimer patients, organized this year's walk along the Sudirman-Thamrin main artery in Jakarta, which marked Indonesia's first participation in the event.

"Alzheimer's can set in 20 years before most symptoms become apparent," Suharya said. His organization has undertaken efforts to educate the public about symptoms and detection and to promote healthy living, which can reduce the risk of getting Alzheimer's in old age.

Data from Alzheimer's Disease International showed that Southeast Asians spent $4 billion in 2010 on Alzheimer's and dementia treatment, including medicine and facilities.

source: www.thejakartaglobe.com

Dr. Mahmoud Daher, interim head of the World Health Organization's Palestinian office, spoke on campus this Thursday at the University of Tennessee's Howard H. Baker Center. His presentation informed listeners of the World Health Organization's mission both globally and in Palestine specifically.

As Dr. Daher pointed out, millions are affected annually by conflict around the world. An estimated thirty million people have been driven out of their homes and into other regions of their countries in the past year. The World Health Organization also estimates that twenty-three million people are refugees, forced to leave their own countries. Dr. Daher listed Turkey, Pakistan, Palestine, Jordan, and Latin America as several major areas of conflict.

Along with this displacement of people come health issues, including higher infant and maternal mortality rates, lack of food and clean water, and power shortages in hospitals.

Dr. Daher is a native of the Gaza Strip in Palestine, an area of heated militarized conflict that is under siege by Egypt and Israel. Because of the siege there are less jobs, resources, and healthcare services in Palestine. As an example, Dr. Daher pointed out that Gazan fishermen are permitted to sail only three miles offshore. This restricts the amount of fish that Gazans can add to an already low food supply. He works on the front lines there to provide humanitarian support to those affected by the war.

As Dr. Daher stated, the World Health Organization's concerns in areas like Palestine include loss of life, physical injury, access to safe water and food, reproductive health, mental health, and communicable disease. Internationally, the organization is viewed as a leader for the health community and sets the research agenda for health services.

When asked about where the World Health Organization acquires funding, Dr. Daher verified that they are a donation-based operation. He estimated that eighty percent of their funding comes from nations that donate to specific causes. Dr. Daher named the United States as the major donator in the World Health Organization's project to treat and stop the spread of HIV/AIDS in Egypt.

source: www.tnjn.com

Indonesia is seeking ways to reduce health risk caused by transportation-generated air pollution, and one of the most cost-effective options is by taking gas fuel rather than fossil-based fuel, a senior official at the environment ministry said here on Thursday.

The option to use gas fuel was considered as the most likely and cost-efficient among nine options discussed at a forum that involves government officials, experts and representatives from the Indonesian Automotive Industry Association, or Gaikindo.

"Results from cost-effectiveness from nine options discussed at the forum showed fuel conversion from fossil-based fuel to gas fuel is the most inexpensive one if compared to aspects offered by the other 8 options, "Deputy Environment Pollution Control Minister Sulistyowati said on the sidelines of the discussion entitled "Multi-Stakeholders Forum" held here.

"Meanwhile, adopting hybrid technology and providing comprehensive mass transport system were the second and third of most inexpensive solutions," he said.

Experts attending the discussion were the senior adviser of United States Environmental Protection Agency (US-EPA) for Asia Pacific region Mark Kasman, and Anup Brandivandekar from International Council for Clean Transportation (ICCT).

The other six options were fuel efficiency drive by 10 percent since 2009, gas fuel conversion up to 5 percent by 2021, dumping half of the cars with more than 10 years' service period, conversion of fossil fuel to bio fuels to 5 percent by 2021, acceleration of Euro 2 emission standard on motored vehicles by 2005 and Euro 4 by 2016 and adoption of catalytic converter technology to 25 percent of cars, bus and trucks, Sulistyowati said here.

According to an analysis jointly conducted by the Indonesian environment ministry, the United Nations Environment Program (UNEP) and US-EPA in 2012 entitled Cost Benefit Analysis on Fuel Economy Initiative, air pollution generated by transportation vehicles had cost greatly people who suffered from pollution-related diseases.

Air pollution also exacerbates productivity and affects life quality, which eventually undermined the country's efforts to attain higher growth, according to the analysis.

The ministry learned that in 2010, 57.8 percent of Jakarta's residents suffered from various diseases, among others asthma, bronkopneumonia and lung obstructive generated from air pollution.

They had to spend a total of 38 trillion rupiah (about 3.4 billion U.S. dollars) on medical treatment, according to the ministry.

Should there be no concrete efforts to address this problem, pollution of particulate matters (PM) 10, sulfur dioxide and carbon oxide in the capital city may rise up to 4 times and Ozone and nitric oxide up to 7 times by 2030.

The green house effect emission formed in carbon dioxide may also rise up 3 times from 2010 level.

source: news.xinhuanet.com

America is facing a "perfect storm of vulnerability" for exposure to infectious diseases, making public health efforts more important than ever, the head of the Centers for Disease Control and Prevention warned Tuesday.

"There is in some quarters a sense that public health is less and less relevant," CDC Director Dr. Tom Frieden said during a luncheon at the National Press Club. "Public health is more needed than ever and has more potential than ever."

The successful fight against many infectious diseases can lead to a sense of complacency, Dr. Frieden warned. But the increasing interconnectedness of the world means America is always at risk of being affected by outbreaks in other nations. A lot of food and medication in the U.S. comes from outside its borders, he said, and it only takes one missed diagnosis to unleash an epidemic.

"A blind spot anywhere in the world is a risk to us," Dr. Frieden said. "A virus anywhere is just a plane ride away."

He pointed to the H7N9 strain of the bird flu virus that was diagnosed this year in China. It can be lethal, but the only thing preventing a widespread outbreak is that it doesn't yet spread from person to person.

The virus could develop that capability tomorrow — or never, Dr. Frieden said.

"There's nothing that can kill as many people as influenza," he said, noting that, on average, about 10,000 Americans die each year from the disease.

Dr. Frieden said that his agency is working to develop a vaccine for the latest bird flu strain, and that it launches on average one new investigation into infectious diseases every day. But faced with growing debt and shrinking funds, many cuts are being made to the nation's health infrastructure, he added.

"Over the past four years, about 46,000 jobs have been eliminated by local and state governments in public health care professions," he said.

The CDC has also seen its budget dwindle, and Congress authorized the lowest amount in decades — about $5.4 billion — to fund the agency, Dr. Frieden said.

The cuts have stopped investments in the latest technologies, such as advanced molecular detection that can help identify pathogens more quickly than traditional means. The CDC is asking Congress for $40 million in the 2014 fiscal year beginning Oct. 1 to try to get the newest diagnostic technology brought online.

"Every time someone is not there to identify an outbreak we're putting people at risk," Dr. Frieden said. "Infectious diseases continue to be and will always be part of our lives."

And it's not just natural threats the CDC is concerned about either. The agency remains on the lookout for bioterrorism threats, such as the letters laced with the poison ricin that were sent to Washington earlier this year.

Dr. Frieden was named director of the CDC in 2009. He has worked for the agency since 1990, apart from a seven-year break when he led New York City's Health Department.

source: www.washingtontimes.com

The WHO (World Health Organization) published on 2008 a very important report on "Primary Heath Care" which in our view should be an essential reading and reference for every primary heath care decision-makers. This is why we will review some of its essential parts. It was also published on the year which marked both the 60th birthday of the WHO and the 30th anniversary of the Declaration of Alma-Ata on Primary Health Care in 1978.

Responding to Challenges

On the whole, people are healthier, wealthier and live longer today than 30 years ago. If children were still dying at 1978 rates, there would have been 16.2 million deaths globally in 2006. In fact, there were only 9.5 million such deaths9. This difference of 6.7 million is equivalent to 18 329 children's lives being saved every day. The once

revolutionary notion of essential drugs has become commonplace. There have been significant improvements in access to water, sanitation and antenatal care.

This shows that progress is possible. It can also be accelerated. There have never been more resources available for health than now. The global health economy is growing faster than gross domestic product (GDP), having increased its share from 8% to 8.6% of the world's GDP between 2000 and 2005. In absolute terms, adjusted for inflation, this represents a 35% growth in the world's expenditure on health over a five-year period. Knowledge and understanding of health are growing rapidly. The accelerated technological revolution is multiplying the potential for improving health and transforming health literacy in a better-educated and modernizing global society. A global stewardship is emerging: from intensified exchanges between countries, often in recognition of shared threats, challenges or opportunities; from growing solidarity; and from the global commitment to eliminate poverty exemplified in the Millennium Development Goals (MDGs).

However, there are other trends that must not be ignored. First, the substantial progress in health over recent decades has been deeply unequal, with convergence towards improved health in a large part of the world, but at the same time, with a considerable number of countries increasingly lagging behind or losing ground.

Furthermore, there is now ample documentation– not available 30 years ago – of considerable and often growing health inequalities within countries.

Second, the nature of health problems is changing in ways that were only partially anticipated, and at a rate that was wholly unexpected. Ageing and the effects of ill-managed urbanization and globalization accelerate worldwide transmission of communicable diseases, and increase the burden of chronic and non-communicable disorders. The growing reality that many individuals present with complex symptoms and multiple illnesses challenges service delivery to develop more integrated and comprehensive case management. A complex web of interrelated factors is at work, involving gradual but long-term increases in income and population, climate change, challenges to food security, and social tensions, all with definite, but largely unpredictable, implications for health in the years ahead.

Third, health systems are not insulated from the rapid pace of change and transformation that is an essential part of today's globalization. Economic and political crises challenge state and institutional roles to ensure access, delivery and financing. Unregulated commercialization is accompanied by a blurring of the boundaries between public and private actors, while the negotiation of entitlement and rights is increasingly politicized. The information age has transformed the relations between citizens, professionals and politicians.

In many regards, the responses of the health sector to the changing world have been inadequate and naïve. Inadequate, insofar as they not only fail to anticipate, but also to respond appropriately: too often with too little, too late or too much in the wrong place. Naïve insofar as a system's failure requires a system's solution – not a temporary remedy. Problems with human resources for public health and health care, finance, infrastructure or information systems invariably extend beyond the narrowly defined health sector, beyond a single level of policy purview and, increasingly, across borders: this raises the benchmark in terms of working effectively across government and stakeholders.

While the health sector remains massively under-resourced in far too many countries, the resource base for health has been growing consistently over the last decade. The opportunities this growth offers for inducing structural changes and making health systems more effective and equitable are often missed. Global and, increasingly, national policy formulation processes have focused on single issues, with various constituencies competing for scarce resources, while scant attention is given to the underlying constraints that hold up health systems development in national contexts. Rather than improving their response capacity and anticipating new challenges, health systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a clear sense of direction.

Today, it is clear that left to their own devices, health systems do not gravitate naturally towards the goals of health for all through primary health care as articulated in the Declaration of Alma- Ata. Health systems are developing in directions that contribute little to equity and social justice and fail to get the best health outcomes for their money. Three particularly worrisome trends can be characterized as follows:

health systems that focus disproportionately on a narrow offer of specialized curative care; health systems where a command-and-control approach to disease control, focused on short term results, is fragmenting service delivery; health systems where a hands-off or laissez-faire approach to governance has allowed unregulated commercialization of health to flourish.

These trends fly in the face of a comprehensive and balanced response to health needs. In a number of countries, the resulting inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability.

source: news.sudanvisiondaily.com

Could rice help prevent blindness and even death in children?

The International Rice Research Institute believes so. IRRI is pushing field trials so that farmers could their sow fields by 2015 with a new rice variety — called golden rice – that could help address Vitamin A deficiency. A lack of the vitamin is a leading cause of preventable blindness and is linked to death due to infections in many poor countries.

The World Health Organization estimates that 250 million young children don't get enough Vitamin A. Up to 500,000 of these young children go blind every year. Half die within a year of losing their sight.

The golden rice program has received the backing of such groups as the Bill and Melinda Gates Foundation, Helen Keller International, the Rockefeller Foundation and the U.S. Agency for International Development. USAID provided $10.3 million in 2010 that is paying for research on golden rice's safety and field trials in the Philippines and Bangladesh.

But opponents, such as Greenpeace International, say oppose the rice, warning that genetically modified organisms could unleash serious, long-lasting problems in the environment. Greenpeace successfully petitioned the Philippine Supreme Court to stop the government's field trials of genetically modified egglant. It has yet to decided whether it will go to court to block golden rice.

"There are already working solutions to address fortification of everyday food, not just with Vitamin A but other micronutrients," said Danny Ocampo of Greenpeace.

A small clinical test on people of the bio-fortified rice was conducted in the U.S. in 2009. IRRI plans to do testing on animals through their feed as early as next year, followed by tests on humans. It is unclear whether golden rice will taste as good as other rice and whether consumers will want to buy it. An iron-fortified rice now being sold by the Philippine government is cheap, but some consumers who can afford more expensive rice avoid it because they say it doesn't taste as good.

Golden rice gets its name from its yellow color. The variety was engineered by introducing a few genes–initially from daffodils, then from yellow corn–so that the grains' edible part produces beta carotene, a pigment that gives fruits and leafy vegetables their color and that the human body converts into Vitamin A. Rice can produce beta carotene in its leaves.

The first scientific details of golden rice were made public in 2000. At that time, it was an eight-year-old project of Professor Ingo Potrykus of the Swiss Federal Institute of Technology and Dr. Peter Beyer of the University of Freiburg in Germany addressing malnutrition.

Swiss agribusiness company Syngenta AGSYNN.VX 0.00% in 2005 produced new golden rice materials that produced 23 times more beta carotene than the original breed. But instead of producing it commercially, Syngenta decided a year later to donate it to IRRRI to make the bio-fortification of rice a humanitarian project.

"Our hope is that farmers everywhere will be planting their fields with golden rice in two years," Dr. Bruce Tolentino, a deputy director general at IRRI, told The Wall Street Journal. He said after field trials this year, IRRI hopes to feed golden rice to animals and then to humans by next year.

He said scientists decided to bio-fortify rice because other food products are more expensive and aren't part of most people's diet.

"Half of the world eats rice and 70% of the poor eats rice. So why not make it more healthy," Dr. Tolentino added.

IRRI estimates that per-capita consumption of rice is around 65 kilograms a year worldwide. And in developing Asia, the consumption doubles to 135 kilos in Indonesia and triples to 200 kilos in Myanmar. Per-capita consumption of rice in the Philippines is around 120 kilos a year.

But golden rice is sparking opposition in the Philippines. In early August, an experimental farm in the Philippine town of Pili, which is testing whether golden rice could grow and be produced in various climatic conditions in this archipelago of more than 7,000 islands, was vandalized.

But Dr. Evangeline dela Trinidad, a plant pathologist designated by Philippines' Department of Agriculture to lead the golden rice trials in Pili town, said of opponents, "It's fear of the unknown."

IRRI is collaborating with the Philippine Rice Research Institute and the agriculture department for Philippine trials. Golden rice trials are also being conducted in Indonesia and Bangladesh.

Dr. dela Trinidad pointed to special corn and cotton called bt corn and bt cotton, with the bt referring to bacillus thuringiensis, a naturally occurring soil bacteria that produces proteins to stop target insects, such as the corn borer that reduces corn production.

Bt corn and Bt cotton are already being cultivated and produced in the Philippines, without the negative problems critics warned about.

"Bt corn is already being commercially produced in Isbela," said Dr. dela Trinidad, referring to the northern Philippine province that is a major producer of the grain. "We also have Bt cotton," she added.

IRRI points to a small trial on golden rice by The American Journal of Clinical Nutrition in 2009 that had five volunteers from Boston that showed 100 grams of the new variety could provide up to 70% of the recommended dietary allowance of Vitamin A for both men and women. Because that study only involved adult Americans, IRRI had to "speculate" that 50 grams of golden rice would provide children aged four to eight greater than 60% of the recommended dietary allowance.

source: blogs.wsj.com