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Ebola survivors in Liberia are symbols of hope and help

By Misha Hussain

DAKAR (Thomson Reuters Foundation) - Ebola survivors in Liberia are quickly becoming an important part of the fight against the deadly virus that has killed more than 4,500 people in West Africa since being detected in the region in March.

Once rejected by their communities, survivors are now being seen as part of the solution as scientists try to find a way to use the antibodies in their blood to help treat victims.

Sheldon Yett, Country Director for the United Nations Childrens Fund (UNICEF) in Liberia, said survivors were still stigmatised, but people were starting to see them as a real sign of hope and help.

In the capital Monrovia, Ebola survivors are helping in Liberia’s first state-run interim care centre for Ebola orphans. There are some 3,700 Ebola orphans in the region today, according to UNICEF.

“Ebola plays on the most basic of human emotions; children just want a hug, but fear has meant that even loved ones have kept them at arms' length. Ebola survivors can provide that support, knowing that they have a natural immunity to the virus,” Yett told the Thomson Reuters Foundation by telephone from Monrovia.

Meinu Kpetermani, a survivor working at the Willing Hearts centre, monitors the children's temperature and reports to the caretaker if any child has a fever or shows other symptoms of Ebola.

“Ebola survivors are doctors, nurses and social workers. We come from all walks of life. We can make a real contribution to society if people are willing to use our skills,” said Kpetermani, a nurse who contracted Ebola in September.

 

SURVIVORS’ ANTIBODIES

The World Health Organization, now largely responsible for coordinating the development of a treatment and vaccine for Ebola, said on Tuesday that a serum based on antibodies in survivors’ blood might be ready as early as December.

“The partnership that is moving the quickest will be in Liberia where we hope that in the coming weeks there will be facilities set up to collect the blood, treat the blood and be able to process it for use,” WHO assistant director general Marie Paule Kieny told a news conference in Geneva.

In the past, Ebola outbreaks occurred mainly in remote parts of Sudan and the Democratic Republic of Congo and were managed through contact tracing, isolation and rehydration therapy. There is currently no widely available vaccine or treatment.

The West Africa Ebola outbreak is the largest in history and has infected more people than the 25 previous outbreaks over 40 years combined. The WHO has reported more than 9,000 cases, mostly in Guinea, Liberia and Sierra Leone.

Kieny warned that supply of a new serum may not meet demand, and that extreme care must be taken to avoid infecting Ebola victims with other diseases such as HIV or hepatitis. Drugs and vaccines may not be ready till January 2015, she said.

EBOLA SURVIVORS TOP 1,000

The medical charity Medecins Sans Frontieres (MSF), which has been leading the fight against Ebola, said this week it had released the 1,000th Ebola survivor treated in its clinics in West Africa, Liberian James Kollie.

Kollie, like many other survivors, now faces a struggle to avoid being rejected in his home town of Hengbelahun, in Lofa County's Kolahun District, just across the border from the original source of the outbreak in Guinea.

“They are afraid of me. They say I still have Ebola and I want to kill them,” Kollie, 16, told the Thomson Reuters Foundation by skype from Foya in Liberia, where his father is an outreach worker for MSF.

Kollie’s father, Alexandre Kollie, said many people in their community didn’t believe Ebola existed, including his own wife, who died of Ebola in Monrovia while he was working in Foya.

“Ebola had come to Liberia so I tried to talk to my family about the virus and to educate them, but my wife did not believe in it. I called my wife begging her to leave Monrovia and bring the children north so we could be together here. She did not listen. She denied Ebola.”

James Kollie, who also lost his two sisters to Ebola, said he would like to work with his father, telling people how to avoid the disease. “It’s important that you wash your hands with chlorinated water and avoid body contact to keep Ebola out of your community.”

(Reporting By Misha Hussain, editing by Tim Pearce)

Changes in 'Parkinson's walk' predict dementia

Wednesday October 22 2014

People with Parkinson's disease often go on to develop dementia as well

Changes in walking style could be a result of dementia

"Subtle changes in the walking pattern of Parkinson's patients could predict their rate of cognitive decline," The Times reports after new research compared the gait of people with Parkinson's disease with those of healthy volunteers.

Parkinson's disease is a condition with three classic features: a tremor, stiff rigid muscles and slow movements, notably a slow, shuffling walk. It also has other symptoms, including Parkinson's dementia, though it can be difficult to predict who will go on to develop dementia.

Researchers wanted to see if comparing the differences in gait (walking pattern) and cognition (thinking) between 121 people newly diagnosed with Parkinson's disease and 184 healthy adults would provide any clues.

As may be expected, the study found measures of both gait and cognition were poorer in people with Parkinson's compared with healthy adults.

They then compared people with Parkinson's who mainly had gait problems with those who mainly had tremor problems.

Though there was no difference in cognitive abilities between the two groups, in those who mainly had gait problems there was a link between this and their cognitive function. That is, if a person had more problems with gait, they tended to have more cognitive problems.

This study will help doctors further understand how gait may be associated with cognition in people with Parkinson's. It suggests that progression in gait problems may be associated with cognitive decline.

While there is currently no cure for dementia, knowing that someone is at a higher risk could help explain often upsetting changes in mood and behaviour, and enable early access to treatment.

 

Where did the story come from?

The study was carried out by researchers from Newcastle University and was funded by the National Institute for Health Research.

It was published in the peer-reviewed open-access journal, Frontiers in Aging Neuroscience, so the article is free to access online.

The Times' reporting is accurate. But the Daily Mail's coverage is misleading and confusing, as its headline asks, "Could your walk signal dementia?"

This study is specific to Parkinson's disease and people with this condition who go on to develop dementia. It is not relevant to the population at large or to other types of dementia, such as Alzheimer's.

 

What kind of research was this?

This was a case-control study examining the differences in gait (walking pattern) and cognition (mental abilities) between people newly diagnosed with Parkinson's disease (the cases) and a comparison group of healthy older adults (the controls).

Parkinson's disease is a neurological condition with an unknown cause, where not enough of the chemical dopamine is produced in the brain. This causes characteristic symptoms of:

  • a resting tremor  shaking when the person is relaxed
  • rigidity  stiff and inflexible muscles
  • slow movements  someone with Parkinson's classically walks with slow shuffling steps, and they are generally slower in all movements

As well as these classic symptoms, there are a variety of others, and usually Parkinson's has some mental health effects, including dementia and depression.

While treatments such as Levodopa can help improve symptoms, there is no cure for Parkinson's and the condition usually progresses.

It has been observed that in people who have a predominant tremor (TD), symptoms progress more slowly than those with predominant postural instability and gait disorder (PIGD).

These people who predominantly have problems with walking and balance tend to demonstrate greater decline, not only in terms of movement, but also cognition.

This study aimed to quantitatively measure the differences in movement and cognition between cases and controls. The researchers expected to see a specific association between movement and cognition in people with the different predominant type of Parkinson's.

 

What did the research involve?

The researchers included 121 people (average age 67) who had been diagnosed with Parkinson's disease in the past four months. They were matched by age and sex to 184 healthy controls, who were able to walk independently and had no specific cognitive or mental health problem.

The Movement Disorder Society (MDS)-revised Unified Parkinson's Disease Rating Scale, which is a well-validated scale, was used to measure disease severity. It was also used to determine which features were predominant – TD (53 people) or PIGD (55 people).

Gait was measured by asking people to walk at their comfortable walking pace for two minutes around a 25m oval walkway. Researchers observed five variables: pace, rhythm, variability in step, asymmetry and posture.

Separately, a range of validated assessment scales were used to measure six domains of cognitive function: global cognition, attention, visual memory, executive function, visuospatial function and working memory.

A range of other tests were performed, including a timed chair stand to assess slow movements and muscle strength. This involved participants being asked to stand up from a seated position with their arms folded across their chest and sit down five times, as quickly as possible.

Balance was measured using the activities balance self-confidence scale, and physical fatigue and depression were also measured.

 

What were the basic results?

All gait variables were significantly different between healthy controls and people with Parkinson's.

People with Parkinson's walked more slowly, walked less symmetrically, made shorter steps, and overall had a more variable gait.

The only measures that were not different were step velocity variability, swing time and step width. As expected, gait measures were poorer for those with Parkinson's characterised as PIGD compared with TD.

When looking at cognition, cognitive outcomes were significantly poorer for people with Parkinson's compared with controls, with the exception of a measure of attention (choice reaction time).

Cognition was no different between the TD and PIGD types of Parkinson's, with the exception of one measure of executive function (semantic fluency), which was poorer in people with PIGD.

The researchers found some association between gait and cognition in both people with Parkinson's and controls. In the group with Parkinson's, four measures of gait (pace, rhythm, variability and postural control) were correlated with measures of cognition, such as poorer measure of gait and poorer cognition.

Two of these measures (pace and postural control) were also associated with cognition in controls. In both people with Parkinson's and the controls, the strongest association was between pace and attention.

Looking at the different types of Parkinson's, associations between measures of gait and cognition were evident in people with PIGD, but not TD.

 

How did the researchers interpret the results?

The researchers say their observations provide a basis for understanding the complex role of cognition in Parkinson's gait.

 

Conclusion

Parkinson's is a neurological disease with characteristic features of tremor, rigidity and slow movements, as well as a variety of other classic symptoms, including Parkinson's dementia.

This case-control study demonstrates how measures of both gait (walking) and cognition are, as would be expected, poorer in people newly diagnosed with Parkinson's disease compared with healthy controls.

The study also demonstrates that in Parkinson's disease, people with a predominant postural instability and gait disorder (PIGD) unsurprisingly have poorer measures of gait than people with predominant tremor disorder (TD).

Though there was little difference in cognitive measures between people with PIGD and TD, in those with PIGD there was a correlation between measures of their gait and cognitive function.

This suggests that progressive gait problems may be associated with progressive cognitive decline in people with Parkinson's disease, though the specific biological mechanisms behind this link were not investigated by this study. The researchers now plan to investigate this link further.

The researchers also acknowledge several limitations with their study, including the relatively small sample size – involving only around 50 people with each subtype of Parkinson's. This means these are small numbers on which to base firm conclusions about the differences between the two subtypes.

There are also other measures the study may not have been able to take into account, including the influence of medication (some had started Levodopa, some not) and depression.

Overall, this study helps doctors to further understand how gait may be associated with cognition in people with Parkinson's, and that predominant gait problems may also be an indicator of more cognitive problems.

While there are no current preventative or treatment implications of these findings in terms of Parkinson's, early recognition of people who may be at risk of dementia is likely to be beneficial.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

U.S. tightens Ebola monitoring for West African visitors

By Bill Berkrot

NEW YORK (Reuters) - U.S. health officials unveiled new measures on Wednesday to carry out Ebola monitoring on anyone entering the country from the three nations at the centre of a West African epidemic, increasing precautions to stop the spread of the virus.

The U.S. Centers for Disease Control and Prevention (CDC) said that beginning Monday, travellers from Liberia, Sierra Leone and Guinea will be directed to check in with health officials every day and report their temperatures and any Ebola symptoms for 21 days, the period of incubation for the virus.

The travellers will be required to provide emails, phone numbers and addresses for 21 days, and the information will be shared with local health authorities.

Six states account for nearly 70 percent of all travellers entering the United States from the affected countries: New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia.

The travellers will be required to coordinate with local public health officials if they intend to travel within the United States. If a traveller does not report in, local health officials will take immediate steps to find the person.

CDC Director Dr. Tom Frieden told reporters the active monitoring programme will remain in place until the outbreak in West Africa is over. The U.N. World Health Organization's latest figures on Wednesday showed at least 4,877 people out of 9,936 cases have died in the outbreak, the worst on record.

"These new measures I'm announcing today will give additional levels of safety so that people who develop symptoms of Ebola are isolated early in the course of their illness," Frieden said. "That will reduce the chance that Ebola will spread from an ill person through close contact and to healthcare workers."

The move builds upon enhanced screening of passengers from the three countries at major U.S. airports for international travel, but stops short of an outright travel ban advocated by some U.S. lawmakers.

The Department of Homeland Security has said that beginning Wednesday travellers from Liberia, Sierra Leone and Guinea would be funneled to one of five major U.S. airports conducting enhanced screening for the virus.

The CDC said the active monitoring programme affects anyone coming back from the region including CDC employees and journalists. The agency said all affected travellers when they enter one of the five airports will receive a care kit that contains tracking log, a pictorial description of symptoms, a thermometer, instructions on how to monitor their temperature and information on what to do if they experience symptoms.

In other developments, Ron Klain, the lawyer appointed by the White House to coordinate to coordinate the country's response to the outbreak got to work on Wednesday. President Barack Obama was due to meet with Klain later in the day.

Leading drugmakers also gave details of a plan to accelerate development of an Ebola vaccine and produce millions of doses.

Only three Ebola cases have been diagnosed in the United States: Thomas Eric Duncan, a Liberian who fell ill after flying to the United States in September, and two nurses who treated him at Texas Health Presbyterian Hospital in Dallas. Duncan died on Oct. 8, while the two nurses are being treated at other hospitals.

VACCINE DRIVE

The World Health Organization said it hopes tens of thousand of people in Africa, including front-line healthcare workers, can start receiving vaccines beginning in January.

U.S. drugmaker Johnson & Johnson announced that it aims to produce 1 million doses of its two-step vaccine next year, and said it has discussed collaboration with Britain's GlaxoSmithKline, which is working on a rival vaccine.

Human testing of a second "investigational" Ebola vaccine is under way at the U.S. National Institutes of Health's Clinical Center in Maryland, the NIH said on Wednesday. Testing on a first possible vaccine began last month and initial data was expected by the end of the year.

"The need for a vaccine to protect against Ebola infection is urgent," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. He said the vaccine, called VSV-ZEBOV, was "promising."

It was developed by researchers at the Public Health Agency of Canada's National Microbiology Laboratory and has been licensed to NewLink Genetics Corp through its wholly owned subsidiary BioProtection Systems, both based in Ames, Iowa, the NIH said.

NBC freelance cameraman Ashoka Mukpo, an American who contracted Ebola while working in West Africa, is free of the virus and will leave the Nebraska Medical Center on Wednesday, the hospital said.

"After enduring weeks where it was unclear whether I would survive, I’m walking out of the hospital on my own power, free from Ebola," Mukpo said in a statement.

"I feel profoundly blessed to be alive, and in the same breath aware of the global inequalities that allowed me to be flown to an American hospital when so many Liberians die alone with minimal care," Mukpo added.

(Additional reporting by Ben Hirschler in London, Will Dunham and Susan Heavey in Washington, Barbara Goldberg in New York and Julie Steenhuysen in Chicago and David Bailey; Writing by Will Dunham; Editing by Michele Gershberg and Grant McCool)

NICE wants tooth brushing to be taught in schools

Wednesday October 22 2014

Shockingly some children start school without knowing how to brush their teeth

NICE recommend that nurseries teach children about oral health

“Children should get their teeth brushed at school, says NHS watchdog,” The Daily Telegraph reports. The new guidelines have been welcomed by some, but others have accused the watchdog of acting like a “supernanny state”.

The headlines follow the publication of guidance by the National Institute for Health and Care Excellence (NICE) on ways for local authorities to improve the oral health of their communities.

The guidance follows a recent Public Health England survey that demonstrated the wide disparity in oral health across the country, particularly among younger children and vulnerable socioeconomic groups.

Overall, across the country, 12% of young children were found to have tooth decay, but this varied  from more than a third of children in Leicester, to just 2% in other parts of the country.

As NICE says, dental problems such as tooth decay and gum disease can have a wide range of effects, not only causing pain and the need to remove decayed teeth, but affecting a person’s ability to speak, eat, smile and socialise.

The recommendations aim to help authorities commission health, social care and educational services that promote and protect oral health. This includes advice on ways to improve oral hygiene, such as reducing the consumption of sugary food and drinks, alcohol and tobacco, increasing the availability of fluoride, and encouraging people to get regular dental check-ups.

Among these recommendations are those focused towards improving oral health among young and school-age children, including considerations for nurseries and primary schools to supervise tooth brushing in children at high risk of tooth decay.

 

Bazian Ltd produced two evidence reviews to support the development of this NICE guidance.

 

This Behind the Headlines analysis was produced under the standard process.

What do NICE recommend?

Essentially, the recommendations centre aims to promote and protect oral health by:

  • improving diet and reducing consumption of sugary food and drinks, alcohol and tobacco
  • improve oral hygiene
  • increase the availability of fluoride
  • encourage people to go to the dentist regularly
  • increase access to dental services

Public services

Among the recommendations targeted towards public action, they advise that:

  • Public services (including leisure centres, community or drop-in centres, nurseries and schools) make plain drinking water freely available and provide a choice of sugar-free food and drinks, including vending machines on site.
  • All health and wellbeing policies and services for adults, children and young people should include advice and information on nutrition and wellbeing, and how tooth decay and gum disease are preventable; this includes educating people on the importance of regular tooth brushing and tooth brushing techniques, the importance of fluoride toothpaste and regular dental check-ups, and the links between high-sugar diets, alcohol and tobacco, and poor oral health.

Advice for parents

Specific to younger children, NICE recommends that all early years services (including midwives and health visitors, children’s centres, nurseries and childminding services) should have a requirement to train staff in giving oral health advice.

This advice should include:

  • promoting breastfeeding and healthy weaning
  • promoting food, snacks (such as fresh fruit) and drinks (water and milk) that are part of a healthier diet
  • explaining that tooth decay is a preventable disease and how fluoride can help prevent it
  • promoting the use of fluoride toothpaste as soon as teeth come through
  • encouraging people to regularly visit the dentist from when a child gets their first tooth
  • giving a practical demonstration of how to achieve and maintain good oral hygiene and encouraging tooth brushing from an early age
  • advising on alternatives to sugary foods, drinks and snacks as pacifiers and treats
  • using sugar-free medicine
  • giving details of how to access routine and emergency dental services
  • explaining who is entitled to free dental treatment
  • encouraging and supporting families to register with a dentist

Schools and nurseries

A recommendation that has stimulated the most comment and debate in the newspapers is that nurseries and primary schools in areas where children are at risk of poor oral health should consider supervising children in tooth brushing.

Such schemes would include having a requirement to get consent from parents or carers, and provide free toothbrushes and fluoride toothpaste – one set for the premises and one to take home.

In high-risk nurseries and primary schools, where supervised tooth brushing is not possible, a fluoride varnish programme should be considered. This involves coating the teeth with a film of the chemical fluoride, which has a protective effect against decay. At least two applications of fluoride varnish a year would be needed.

NICE also includes recommendations to raise awareness of the importance of oral health during a child’s school years. This includes similar policies to above, of having healthy food and drink choices available, ensuring that opportunities are found in the curriculum to teach the importance of maintaining good oral health and highlighting how it links with appearance and self-esteem.

 

What has been the response to the recommendations?

Some newspapers have accused NICE of promoting a nanny state agenda, such as the Mail Online stating that: “Now nanny state wants lessons in brushing teeth! Schools told they must help halt decay caused by children's sugary diets.”

Just a few weeks before, the same newspaper was reporting that: “One in 8 three-year-olds has rotting teeth… and [sugary] fruit juice is to blame.”

Early intervention at a young age, through education on effective dental care both at home, and reinforced at school, could make a lifetime’s worth of difference.

As Elizabeth Kay, foundation Dean for the Peninsula Dental School, Plymouth, says: “Around 25,000 young children every year are admitted to hospital to have teeth taken out. Given that we know how to prevent dental disease, this really should not be happening.

“If there were a preventable medical condition which caused thousands of young children (mostly around five years old) to end up in hospital to have body parts removed, there would be an outcry.

“These guidelines offer local authorities an opportunity and evidence as to how they can stop the most vulnerable children and adults in their areas from suffering from the pain, trauma and lifetime negative effects of tooth decay.”

The director of the centre for public health at NICE, Professor Mike Kelly, further explains: “Children as young as three are being condemned to a life with rotten teeth, gum disease and poor health going into adulthood. Many children have poor diets and poor mouth hygiene because there is misunderstanding about the importance of looking after children’s early milk teeth and gums. They eat too much sugar and don’t clean their teeth with fluoride toothpaste. As a society, we should help parents and carers give their children the best start in life and act now to stop the rot, before it starts.”


Analysis by
Bazian. Edited by NHS Choices. Follow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Ebola deaths at 4,877 as cases near 10,000 - WHO

GENEVA (Reuters) - At least 4,877 people have died in the world's worst recorded outbreak of Ebola, and at least 9,936 cases of the disease had been recorded as of Oct 19, the World Health Organization said on Wednesday.

The worst-hit countries - Liberia, Sierra Leone and Guinea - still have far too few Ebola bedspaces - 25 percent of the number needed - and too few firm commitments of help from foreign medical teams, the WHO said.

(Reporting by Tom Miles, editing by Robert Evans)

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