Margaret Chan, the outgoing Director General of the World Health Organization (WHO), has opened this year’s World Health Assembly (WHA) by staunchly defending the organization against critics who say it has lost its relevance.  

Chan’s tenure as head of WHO will soon end and after 10 years of service, she appears intent on handing her successor, who will be elected Tuesday, an organization that is viable and remains the essential leader in global health.  

In addressing the WHA for the last time, Chan presented 3,500 delegates from WHO’s 194 member states with, what could be seen, as a report card of her work by presenting some highlights from a report issued this month tracking the evolution of public health during her 10-year administration.

“The report sets out the facts and assesses the trends, but makes no effort to promote my administration.  The report goes some way towards dispelling criticism that WHO has lost its relevance.  The facts tell a different story,” Chan said.

Drug costs

The report covers setbacks as well as successes and some landmark events.  Among the successes, she cited WHO’s decade-long fight “to get the prices for antiretroviral treatments for HIV down.”

In contrast, she said “prices for the new drugs that cure hepatitis-C plummeted within two years.”

The results in both cases have been dramatic in making life-saving drugs affordable for millions of people.  During the past 10 years, antiretroviral treatments have fallen from $10,000 to less than $100 a year and Hepatitis C drugs, which cost a prohibitive $80,000 just two years ago can now be had for less than $200.

Chan noted for most of her tenure she has been faced with shrinking health budgets resulting from the 2008 global financial crisis.

Despite the austerity measures forced upon the organization, she said WHO has made significant progress in many areas.  These include the elimination or reduction of neglected tropical diseases, bringing mental health out of the shadows and into the spotlight, and bringing polio and guinea worm closer to eradication.

Ebola epidemic

Along with these successes, Chan accepted responsibility for mistakes and bad decisions, including the WHO failure to recognize the magnitude of the Ebola outbreak in West Africa.  

She acknowledged the devastating consequences of this lapse for the people of Liberia, Sierra Leone and Guinea, 11,315 of whom died from the deadly Ebola virus before the epidemic was declared in January 2016.

“But, WHO made quick course corrections,” said Chan, “and brought the three outbreaks under control through team work and partnerships and gave the world its first Ebola vaccine that confers substantial protection.

“This happened on my watch, and I am personally accountable,” she said.

New leader competition

The World Health Assembly, which runs through May 31, has an exceptionally heavy and important agenda, with the election of a new Director-General topping the list.

On Tuesday, delegates will choose the new head by secret ballot.  The three nominees include the first African candidate Tedros Adhanom Ghebreyesus of Ethiopia; David Nabarro of Britain, and Sanja Nishtar of Pakistan.  

This is the first time that there has been more than one candidate.  Whoever wins this fiercely contested post will take office on July 1.

During the coming nine days, delegates will approve WHO’s program budget for 2018-19, which has risen to $4.7 billion.  The Assembly also will discuss a wide-range of health-related issues, including polio eradication, antimicrobial resistance, access to medicines and vaccines, health emergencies and the health of refugees and migrants.

This forum offers an opportunity for health ministers and other officials to present their views.  

Newly appointed U.S. Health and Human Services Secretary Tom Price took the floor Monday to express the Trump Administration’s commitment to work with the new director general “on an agenda for ongoing improvements” including changes to ensure “a rapid and focused response to potential global health crises.”

Price stressed the need for reform and said Washington expected the next director-general “to prioritize threats to global health, including influenza.”

He said “we will work to enable all countries around the world to prevent, detect, respond to, mitigate, and control these outbreaks.”

Looking ahead

In closing her remarks to the WHA, Margaret Chan urged governments to maintain investments in health development, which, she said “brings dramatic results, also as a poverty reduction strategy.”

She said behind every number and every statistic is a person “who defines our common humanity and deserves our compassion, especially when suffering or premature death can be prevented.”

Judging from the thunderous applause at the end of her speech, the delegates appeared to have given Margaret Chan a good report card for her work during the past 10 years.
…

your ads here!

Children younger than one should drink breast milk or formula, and should only drink fruit juice if advised by a doctor, according to the American Academy of Pediatrics. The organization made the recommendation in the journal Pediatrics amid concerns about rising childhood obesity and tooth decay.

This is the first time since 2001 that the doctors’ group has reviewed its recommendation on fruit juice, which is a leading source of dietary sugar.

Between the ages of one and four, young children should consume no more than 118 milliliters of fruit juice, the doctors’ group says. The academy recommends that children between the ages of four and six restrict their juice intake to no more than 177 milliliters a day, while children between seven and 18 should limit their fruit juice consumption to 236 milliliters.

The new guidelines recognize that 100 percent natural and reconstituted juice can be a healthy part of a child’s diet. However, the group said juice should count for no more than one of the two to two-and-a-half recommended servings of fruit per day.

If fruit juice is given to young children, the academy discourages parents from putting it in a bottle or “sippy” cup, which may be in a child’s mouth all day, promoting cavities. Instead, it’s recommended that the juice be consumed all at once in a cup.

The group had previously recommended that parents wait until a child is six months old before introducing fruit juice to the diet. However, in light of the growing rates of obesity and other negative health effects, the American Academy of Pediatrics revisited the recommendation.

Juice is a frequent beverage of choice among U.S. teenagers and children, who experts say would rather drink it than water.

Dr. Steven A. Abrams, chairman of the Department of Pediatrics at the Dell Medical School at the University of Texas, and co-author of the policy statement, said there was nothing “magical” about the academy’s revised recommendation. 

Dell said the group simply saw no need or beneficial role for juice in very young children.
…

your ads here!

Gender confirmation surgeries jumped by 20 percent in the United States from 2015 to 2016, according to a new survey.

The American Society of Plastic Surgeons (ASPS) survey says there were more than 3,200 “transfeminine” and “transmasculine” surgeries in 2016. Included in this number is everything from body contouring to full gender reassignment.

“There is no one-size-fits-all approach to gender confirmation,” said Loren Schechter, MD, a board-certified plastic surgeon based in Chicago. “There’s a wide spectrum of surgeries that someone may choose to treat gender dysphoria, which is a disconnect between how an individual feels and what that person’s anatomic characteristics are.”

The survey is the first ever done by the ASPS and includes data from 2015 to 2016.

One driver is that insurance companies are increasingly covering some of the procedures, making them more accessible and affordable.

“In the past several years, the number of transgender patients I’ve seen has grown exponentially,” said Schechter. “Access to care has allowed more people to explore their options, and more doctors understand the needs of transgender patients.”

Changing attitude is also behind the increase.

‘It’s only in the last couple of years that we’ve seen this dramatic increase in demand for procedures, it’s certainly a subject that’s more talked about,’ Schechter told Daily Mail Online.

Schechter added that until recently, there were just six U.S. surgeons who were certified to do both male-to-female and female-to-male genital surgery.

“The numbers are increasing, but one of the barriers is that there’s been no formal training program,” he told the Daily Mail.

For those undergoing sex change procedure, surgery is usually just a part of the process.

“Surgical therapy is one component of the overall care of the individual,” said Schechter. “It takes a team of experts across different disciplines working together to provide comprehensive care. I often partner with doctors who may prescribe treatments such as hormone therapy and mental health professionals who help patients through their transitions.”
…

your ads here!

Ethiopia is battling an outbreak of acute watery diarrhea (AWD) that has affected more than 32,000 people.  At the same time, Ethiopia’s former minister of health, Tedros Adhanom Ghebreyesus, is a candidate to lead the World Health Organization.

 

The two facts are linked in that critics of Tedros say he has tried to minimize the outbreak by refusing to classify it as cholera, a label that could harm Ethiopia’s economic growth.

The WHO’s 194 member states will gather in Geneva for a 10-day assembly starting Monday. One of their first tasks is to choose the organization’s next director-general.

Tedros is one of three top contenders for the position, along with candidates from Britain and Pakistan.

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The New York Times that Ethiopia has a long history of downplaying cholera outbreaks, and the WHO could “lose its legitimacy” if Tedros, who is also a former Ethiopian minister of foreign affairs, takes over the leadership of the organization.

“Dr. Tedros is a compassionate and highly competent public health official,” he told the Times. “But he had a duty to speak truth to power and to honestly identify and report verified cholera outbreaks over an extended period.”

But others have risen to Tedros’ defense. Tom Frieden, the former director of the Centers for Disease Control and Prevention, said the controversy over naming the outbreak is overblown. “During the time that Tedros was health minister, it would have not made any difference,” Frieden told VOA.

Cholera vs. acute watery diarrhea

Ethiopia has been accused of covering up three cholera outbreaks during Tedros’ tenure as health minister.

Declaring cholera would not have changed Ethiopia’s response to past AWD outbreaks, according to Frieden.  In fact, he says, avoiding the cholera label has not been irresponsible but rather a necessary compromise.

“It allowed public health to respond rapidly,” Frieden said.

The literature on AWD and cholera shows that treatment is the same. It calls for hydrating the patient, chlorinating water and improving sanitation. In fact, the WHO uses the terms interchangeably in their teaching materials on how to deal with an outbreak.

Lately, the development of cholera vaccines has brought the value of identifying the bacterial disease to the fore, said Frieden. “At this time, all African countries that report acute watery diarrhea should be rapidly doing lab confirmation and, if it’s cholera, considering the use of cholera vaccine in the response,” he said.

 

In the current outbreak, Ethiopia’s Somali region has been hit the hardest, with 768 deaths since January, according to a WHO report published May 12.  Almost 99 percent of the deaths and 91 percent of cases are in the same region.

The WHO representative to Ethiopia, Dr. Akpaka Kalu, says the government is right to call it AWD because regional health centers do not have the capacity to test every case.

If all cases are treated as cholera, the disease has the potential to spread more quickly when children who do not have it are brought into cholera treatment centers, Kalu said.

“We know, biologically, malnutrition causes diarrhea. Now, if you admit that child into a cholera treatment center, you’ve actually turned that center into a cholera transmission center,” he said, speaking by phone from Addis Ababa.

Current response

Over the past six weeks, the response to AWD in Ethiopia appears to have been effective.

Kalu said his team, along with regional leadership and government officials, have focused on prevention and intervention. They have instituted community-based surveillance to monitor the regional drought in general and AWD in particular, and there has been a drop in reported cases.

“We have evidence the average number of cases [dropped] from over 600 a day to about 54 a day,” he said.

Kalu argues that early interventions are getting results and doesn’t think that vaccinating 6 million people in the Somali region is feasible.

He says Ethiopia is now preparing to prevent outbreaks from spreading to other parts of the country such as the Afar and Amhara regions as the rainy season approaches.

“We need to enhance preparedness because, as the rains come, usually what happens is the rains wash and enter the water bodies including where there is open defecation,” he said. “That’s how water bodies get contaminated and people use the water and become sick. So there is a need, our focus is to build capacity to be able to detect and contain so that it doesn’t spread.”
…

your ads here!

Minutes matter when it comes to treating sepsis, the killer condition that most Americans probably have never heard of, and new research shows it’s time they learn.

 

Sepsis is the body’s out-of-control reaction to an infection. By the time patients realize they’re in trouble, their organs could be shutting down.

 

New York became the first state to require that hospitals follow aggressive steps when they suspect sepsis is brewing. Researchers examined patients treated there in the past two years and reported Sunday that faster care really is better.

 

Every additional hour it takes to give antibiotics and perform other key steps increases the odds of death by 4 percent, according to the study reported at an American Thoracic Society meeting and in the New England Journal of Medicine.

 

That’s not just news for doctors or for other states considering similar rules. Patients also have to reach the hospital in time.

 

“Know when to ask for help,” said Dr. Christopher Seymour, a critical care specialist at the University of Pittsburgh School of Medicine who led the study. “If they’re not aware of sepsis or know they need help, we can’t save lives.”

 

The U.S. Centers for Disease Control and Prevention last year began a major campaign to teach people that while sepsis starts with vague symptoms, it’s a medical emergency.

 

To make sure the doctor doesn’t overlook the possibility, “Ask, ‘Could this be sepsis?'” advised the CDC’s Dr. Lauren Epstein.

 

Sepsis is more than an infection

 

Once misleadingly called blood poisoning or a bloodstream infection, sepsis occurs when the body goes into overdrive while fighting an infection, injuring its own tissue. The cascade of inflammation and other damage can lead to shock, amputations, organ failure or death.

 

It strikes more than 1.5 million people in the United States a year and kills more than 250,000.

 

Even a minor infection can be the trigger. A recent CDC study found nearly 80 percent of sepsis cases began outside of the hospital, not in patients already hospitalized because they were super-sick or recovering from surgery.

 

There’s no single symptom

 

In addition to symptoms of infection, worrisome signs can include shivering, a fever or feeling very cold; clammy or sweaty skin; confusion or disorientation; a rapid heartbeat or pulse; confusion or disorientation; shortness of breath; or simply extreme pain or discomfort.

 

If you think you have an infection that’s getting worse, seek care immediately, Epstein said.

 

What’s the recommended care?

 

Doctors have long known that rapidly treating sepsis is important. But there’s been debate over how fast. New York mandated in 2013 that hospitals follow “protocols,” or checklists, of certain steps within three hours, including performing a blood test for infection, checking blood levels of a sepsis marker called lactate, and beginning antibiotics.

 

Do the steps make a difference? Seymour’s team examined records of nearly 50,000 patients treated at New York hospitals over two years. About 8 in 10 hospitals met the three-hour deadline; some got them done in about an hour. Having those three main steps performed faster was better — a finding that families could use in asking what care a loved one is receiving for suspected sepsis.

Who’s at risk?

 

Sepsis is most common among people 65 and older, babies, and people with chronic health problems.

 

But even healthy people can get sepsis, even from minor infections. New York’s rules, known as “Rory’s Regulations,” were enacted after the death of a healthy 12-year-old, Rory Staunton, whose sepsis stemmed from an infected scrape and was initially dismissed by one hospital as a virus.

 

What’s next?

 

Illinois last year enacted a similar sepsis mandate. Hospitals in other states, including Ohio and Wisconsin, have formed sepsis care collaborations. Nationally, hospitals are supposed to report to Medicare certain sepsis care steps. In New York, Rory’s parents set up a foundation to push for standard sepsis care in all states.

 

“Every family or loved one who goes into a hospital, no matter what state, needs to know it’s not the luck of the draw” whether they’ll receive evidence-based care, said Rory’s father, Ciaran Staunton.

 
…

your ads here!

The World Health Organization’s regional chief for Africa reports prospects for rapidly controlling the spread of the deadly Ebola virus in the Democratic Republic of Congo are good.

While not underestimating the difficulties that lie ahead in bringing this latest outbreak of Ebola to an end, Matshidiso Moeti told VOA she is “very encouraged” by the speed with which the government and its national and international partners have responded to this crisis.

“I am quite optimistic because this is a government that is experienced at this, and which has got off to a very quick start and we are already on the ground with the partners.  

“We are getting logistic support from WFP (World Food Program) and from the U.N. mission.  So, I am quite optimistic,” Moeti said.

WHO has reported 29 suspected cases, including three deaths since Ebola was discovered in a remote region of DRC on April 22.   This deadly virus causes fever, bleeding, vomiting and diarrhea.  It spreads easily through bodily fluids and can kill more than 50 percent of its victims.

This is the eighth recorded outbreak of Ebola in DRC since 1976.  The outbreak was first detected in Bas-Uele Province, a densely-forested area in northeastern Congo near the border with the Central African Republic.

Outbreak isolated

Moeti calls the remoteness of the area “a mixed blessing.”

She said that there was little likelihood of a “rapid expansion of the outbreak to other localities due to population movement as happened in West Africa.  Although, we are keeping a close eye on the Central African Republic … where we are concerned that there is insecurity there.”

She said it was difficult to operate and carry out surveillance or investigations in this area because the road network leading there was not very well developed and “we have to drive long distances, not in a car, but have to use a motorbike.”

To remedy this, she said the government had fixed up a landing strip to enable helicopters to fly in the experts and material needed to deal with this crisis.

Moeti, a South African physician, replaced Luis Gomez Sambo of Angola as WHO regional head for Africa in January 2015 after he was criticized for his lackluster leadership in handling the 2014 Ebola outbreak in West Africa.  

The World Health Organization has come under scathing criticism by the international community for its slow and inept response to that unprecedented epidemic.  By the time WHO declared the Ebola epidemic at an end in January 2016, the deadly virus had killed 11,315 people in Liberia, Sierra Leone, and Guinea.

Experience put to use

During a recent visit to Kinshasa, Matshidiso Moeti said she saw how the hard lessons that have been learned from this tragic experience were being applied in DRC.

“What I observed was that the government itself was very quick in getting out to this remote area from the central level.  

“So, they sent a team from Kinshasa within a day or two of getting this alert to go and investigate and from the provincial level very rapidly, the government got down into this local area,” she said.

Moeti is leading a reform process to transform the WHO in the African Region into what she called a “more responsive, accountable, effective and transparent organization.”

She told VOA that this process was a component of WHO’s global reform effort and she would be rolling out the plan during a side-event on May 22, the opening day of this year’s World Health Assembly.

She said the reform program focused largely on how to improve measures for more quickly and efficiently tackling emergencies and communicable diseases.

“Clearly, as we saw very starkly with the Ebola outbreak, an outbreak can quickly transform into a big humanitarian crisis with all sorts of impacts.”

While the job of health reform is far from complete, Moeti said, “I am really pleased to say that we are starting to see how those changes that we have made are making a difference in how we operate.”

 

 
…

your ads here!

A giant rhinoceros the size of three African elephants once grazed on treetops in Tibet, but succumbed to climate change more than 20 million years ago.

The high treetops disappeared, along with its food source, says Xiaoming Wang of the Natural History Museum of Los Angeles County. Wang has done field research on the long-legged rhino, more formally called the Indricotherium, one of the stars of a new exhibit that shows how radical adaptations that aid survival in one setting can spell disaster in another.

Through fossils and reconstructions, the exhibit tells the story of Mother Nature’s radical gambits to keep organisms alive in changing conditions. The show was built around an earlier exhibit from the American Museum of Natural History in New York, which also included ice age remains from the La Brea Tar Pits in Los Angeles.

Mammals that have adapted in the extreme include an ancient whale that walked on land and more recent pygmy mammoths on California’s Channel Islands, whose small size is illustrated with side-by-side jaw bones of a Columbian mammoth and its pygmy relative, which shrunk to cope with limited food resources on the islands.

Many species challenged

Climatic variations over the ages and the more recent incursion of humans have challenged many species, said Emily Lindsey of the La Brea Tar Pits, a site rich with fossils from the mammoths and giant cats that once roamed California, but died out more than 10,000 years ago.

Seen in the exhibit are the extinct American lion, “which along with the cave lion in Europe was the biggest cat that ever lived,” Lindsey said.

There are fossils from a scimitar cat, also extinct, and a long-gone subspecies of jaguar.

“And then we have the mountain lion, which is the only one of those five big cats that’s still alive today,” she notes.

Also known as the cougar, panther or puma, the species is represented with a photo of a celebrated cat that continues to roam through the hills above Los Angeles.

“People thought he would just spend a couple of days there, then continue to move on or attempt to move on,” said Miguel Ordenana, who coordinates the amateur citizens scientists who make wildlife observations to help scientists better understand the region. Mountain lions, he said, typically do not survive crossing busy freeways, but this intrepid mountain lion is a survivor, as is his species.

Arctic island was once like Florida

Other mammals in the exhibit include the Batodonoides, a long-extinct shrewlike mammal from 50 million years ago so tiny that it could have perched on a pencil. The South American Macrauchenia, with a camellike body and giraffelike neck, had a flexible trunk, like an elephant. It went extinct a mere 10,000 years ago, but is represented here in a reconstruction.

Earth’s extreme changes can be seen in a diorama of Ellesmere Island in the Arctic.

Just 1,000 kilometers from the North Pole, it was home to warm swamps 50 million years ago and a host of animals adapted to a Floridalike climate.

Those intense changes served many species well, but presented extreme problems. Especially as environmental conditions caused the Arctic freeze over, leaving Ellesmere Island one of the coldest and driest locations on Earth.

An earlier version of this report had Xiaoming Wang’s name misspelled. VOA regrets the error.
…

your ads here!

The challenges of adaptation and survival are the themes of a new exhibit at the Natural History Museum of Los Angeles. Mike O’Sullivan reports that the the exhibit, Extreme Mammals, shows the radical changes in animal species over millions of years and the extinctions of species that failed to adapt.
…

your ads here!

Recent studies suggest that as many as 400 million people around the world do not have access to basic health care. In some cases it’s because of conflict, but in some cases it’s just geography: humans live in some very far away places, Siberia for instance. That’s where the medical ship comes in handy. VOA’s Kevin Enochs reports.
…

your ads here!