For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Issue 5
09/07/07 12:15
Welcome
to Issue 5
Can fasting help prevent disease?
Alternate-day fasting and chronic disease prevention: a review of human and animal trials
Krista A Varady and Marc K Hellerstein
Calorie restriction (CR) and alternate-day fasting (ADF) represent 2 different forms of dietary restriction. Although the effects of CR on chronic disease prevention were reviewed previously, the effects of ADF on chronic disease risk have yet to be summarized.
Accordingly, we review here animal and human evidence concerning ADF and the risk of certain chronic diseases, such as type 2 diabetes, cardiovascular disease, and cancer. We also compare the magnitude of risk reduction resulting from ADF with that resulting from CR. In terms of diabetes risk, animal studies of ADF find lower diabetes incidence and lower fasting glucose and insulin concentrations, effects that are comparable to those of CR. Human trials to date have reported greater insulin-mediated glucose uptake but no effect on fasting glucose or insulin concentrations. In terms of cardiovascular disease risk, animal ADF data show lower total cholesterol and triacylglycerol concentrations, a lower heart rate, improved cardiac response to myocardial infarction, and lower blood pressure. The limited human evidence suggests higher HDL-cholesterol concentrations and lower triacylglycerol concentrations but no effect on blood pressure.
In terms of cancer risk, there is no human evidence to date, yet animal studies found decreases in lymphoma incidence, longer survival after tumor inoculation, and lower rates of proliferation of several cell types.
The findings in animals suggest that ADF may effectively modulate several risk factors, thereby preventing chronic disease, and that ADF may modulate disease risk to an extent similar to that of CR. More research is required to establish definitively the consequences of ADF.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 7-13, July 2007
© 2007 American Society for Nutrition
Australians live longer, says UN poll
July 9, 2007
Australia has one of the highest life expectancies in the world, according to a new United Nations report.
The State of the World Population 2007 report prepared by the United Nations Population Fund reveals Australian women live to 83.4 years on average and men to 78.4 years. This is higher than the average life expectancy of what the report terms "more developed regions",
which stands at 79.8 years for women and 72.5 years for men.
The average life expectancy across the globe is 68.6 years for women and 64.2 years for men.
Of the 153 countries listed, only two had higher life expectancies than Australia for both genders.
In Hong Kong, men can expect to live to 79.2 years and women to 85.1 years while in Japan women survive for 86.3 years and men for 79.1 years.
AAP
Copyright © 2007. The Sydney Morning Herald
There is good evidence that getting rid of that gut ("waist girth") will avoid some of the wonderful cardiac procedures out there
Abdominal obesity and coronary artery calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Chong-Do Lee, et al.
Background: Whether abdominal obesity is related to coronary artery calcification (CAC) is not known.
Objective: We investigated the relations of waist girth and waist-hip ratio (WHR) to CAC in 2951 African American and white young adults from the Coronary Artery Risk Development in Young Adults Study.
Design: The present study was a cross-sectional and observational cohort study. Using standardized protocols, we measured CAC in 2001–2002 by using computed tomography and measured waist and hip girths in 1985–1986 (baseline), 1995–1996 (year 10), and 2001–2002 (year 15, waist girth only). CAC was classified as present or absent, whereas waist girth and WHR were placed in sex-specific tertiles.
Results: After adjustment for age, sex, race, clinical center, physical activity, cigarette smoking, education, and alcohol intake, baseline waist girth and WHR were directly associated with a higher prevalence of CAC 15 y later (P for trend < 0.001 for both). The odds ratios (ORs) for CAC in the highest versus lowest tertiles of waist girth and WHR were 1.9 (95% CI: 1.36, 2.65) and 1.7 (1.23, 2.41), respectively. Waist girth and WHR at year 10 and waist girth at year 15 similarly predicted CAC. These associations persisted after additional adjustment for systolic blood pressure, fasting insulin concentrations, diabetes, and antihypertensive medication use but became nonsignificant after additional adjustment for blood lipids.
Conclusions: Abdominal obesity measured by waist girth or WHR is associated with early atherosclerosis as measured by the presence of CAC in African American and white young adults. This is consistent with an involvement of visceral fat in the occurrence of coronary artery calcium in young adults.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 48-54, July 2007
© 2007 American Society for Nutrition
-=-=-=-=-=-
Hi Joe,
Ever seen a discectomy.
This would be good for the blog.
Donald
http://www.spine-health.com/dir/lumbarmicroendodiscectomy.html
=-=-=-=-=--
Joe,
All the hard work is done in these.
D
Check No 2, No 1, and 5.
Donald
http://www.chiroltd.com/FREESTUFF.htm
-=-=-=-=-=-=-=-
Measles Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
News
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June)
EXERCISE: You need far less than you think in order to stay fit
How much exercise do you really need in order to be fit?
Apparently, it's far less than we've been told by government health agencies, who reckon on 20 minutes a day.
Researchers have discovered that people who walk or cycle for just half that amount – 72 minutes a week, or just over 10 minutes every day – improve their overall fitness by 4.2 per cent.
Double the exercise time and your fitness level will improve by 6 per cent, while those who walk or cycle for 27 minutes every day can see an 8 per cent improvement.
The other good news is that everyone – in all the exercise groups – saw a 2cm average reduction in their waist measurement, and that's without changing their diet.
However, none of the group – made up of post-menopausal women who lived mainly sedentary lives – lost weight, and their cardiovascular risk factors didn't reduce, either.
So some level of fitness is attainable for pretty much all of us, just as long as we're prepared to walk 10 minutes every day.
(Source: Journal of the American Medical Association, 2007; 297: 2081-91).
-=-=-=-=-=-=-=
Marginalization.
NB:This is a good word to describe how medicine tries to contain certain professions.
Piercing the veil: The marginalization of midwives in the United States
University of Colorado at Denver and Health Sciences Center, PO Box 6511, Campus Box 8309, 80045 Aurora, CO, USA
Social Science & Medicine. Volume 65, Issue 3, August 2007, Pages 610-621
Abstract
This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US.
This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care.
Currently midwives attend only 7% of births, compared to 50–75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing.
This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions.
These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.
-=-=-=-=-=-=-=
hi joe,
Better patient care from the medical files.
Donald
Editorial
The Lancet 2007; 370:2
Evidence-based handshakes
In Kill as few patients as possible, a collection of darkly humorous essays written a generation ago, Oscar London advises colleagues to: “let no one leave your office without a handshake, a blood count, and a smile.” His aphorism is confirmed by Gregory Makoul and colleagues, whose research in the June 11 issue of Archives of Internal Medicine, shows that 78% of patients in the USA want to be greeted with a handshake. While the qualitative telephone interviews employed might not be the Everest of evidence, the findings do reflect actual practice among a small cohort of primary care physicians in the USA, and accord with a similar recent study by Romona Davis and co-workers.
Both papers consider patients' attitudes to greetings and the importance placed on introductions and respect as a mark of professionalism. 81% of the 191 patients in Davis' survey believed that doctors in training should be taught to shake hands. Even more expect that the proffered hand should be washed between patients. A handshake symbolises mutual respect and trust in many cultures. When combined with an exchange of given and family names, the greeting also communicates reciprocity and, Makoul adds, correct identification of the patient. In response to an open question, the 415 participants in his study also list other expected behaviours: smile; be friendly, attentive, and polite; make the patient feel like a priority; and make eye contact. In essence, good manners and good medicine go hand in hand.
The value of exploring patient expectations lies in their ability to stimulate reflection, to improve care, and most importantly, to serve as a reminder that all aspects of practice, research, funding, and legislation should ultimately be directed to the benefit of patients. Ever since Laënnec invented the stethoscope, technological advances risk distancing doctors from their patients, and patients from the centre of health care. Hands can shorten the distance between doctors and patients, and are a precious tool for diagnosis, treatment, and communication.
The Lancet
Measles
Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Every year about 20 million people worldwide, mainly children, contract measles. In 2005 there were 345 000 measles related deaths, but in developed countries that have taken eradication measures the disease is now rare. In 2004 the World Health Organization received reports of only 37 cases of measles in the United States.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June), doi:10.1136/bmj.39248.481701.DB
-=-=-=-
Pain Guidelines, if you did not get them
Hi Joe,
Here is a link to the NHMRC Acute pain guidelines.
http://www.nhmrc.gov.au/publications/synopses/_files/cp94.pdf
It may be useful to have as a reference on the blog.
Donald
Can fasting help prevent disease?
Alternate-day fasting and chronic disease prevention: a review of human and animal trials
Krista A Varady and Marc K Hellerstein
Calorie restriction (CR) and alternate-day fasting (ADF) represent 2 different forms of dietary restriction. Although the effects of CR on chronic disease prevention were reviewed previously, the effects of ADF on chronic disease risk have yet to be summarized.
Accordingly, we review here animal and human evidence concerning ADF and the risk of certain chronic diseases, such as type 2 diabetes, cardiovascular disease, and cancer. We also compare the magnitude of risk reduction resulting from ADF with that resulting from CR. In terms of diabetes risk, animal studies of ADF find lower diabetes incidence and lower fasting glucose and insulin concentrations, effects that are comparable to those of CR. Human trials to date have reported greater insulin-mediated glucose uptake but no effect on fasting glucose or insulin concentrations. In terms of cardiovascular disease risk, animal ADF data show lower total cholesterol and triacylglycerol concentrations, a lower heart rate, improved cardiac response to myocardial infarction, and lower blood pressure. The limited human evidence suggests higher HDL-cholesterol concentrations and lower triacylglycerol concentrations but no effect on blood pressure.
In terms of cancer risk, there is no human evidence to date, yet animal studies found decreases in lymphoma incidence, longer survival after tumor inoculation, and lower rates of proliferation of several cell types.
The findings in animals suggest that ADF may effectively modulate several risk factors, thereby preventing chronic disease, and that ADF may modulate disease risk to an extent similar to that of CR. More research is required to establish definitively the consequences of ADF.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 7-13, July 2007
© 2007 American Society for Nutrition
Australians live longer, says UN poll
July 9, 2007
Australia has one of the highest life expectancies in the world, according to a new United Nations report.
The State of the World Population 2007 report prepared by the United Nations Population Fund reveals Australian women live to 83.4 years on average and men to 78.4 years. This is higher than the average life expectancy of what the report terms "more developed regions",
which stands at 79.8 years for women and 72.5 years for men.
The average life expectancy across the globe is 68.6 years for women and 64.2 years for men.
Of the 153 countries listed, only two had higher life expectancies than Australia for both genders.
In Hong Kong, men can expect to live to 79.2 years and women to 85.1 years while in Japan women survive for 86.3 years and men for 79.1 years.
AAP
Copyright © 2007. The Sydney Morning Herald
There is good evidence that getting rid of that gut ("waist girth") will avoid some of the wonderful cardiac procedures out there
Abdominal obesity and coronary artery calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Chong-Do Lee, et al.
Background: Whether abdominal obesity is related to coronary artery calcification (CAC) is not known.
Objective: We investigated the relations of waist girth and waist-hip ratio (WHR) to CAC in 2951 African American and white young adults from the Coronary Artery Risk Development in Young Adults Study.
Design: The present study was a cross-sectional and observational cohort study. Using standardized protocols, we measured CAC in 2001–2002 by using computed tomography and measured waist and hip girths in 1985–1986 (baseline), 1995–1996 (year 10), and 2001–2002 (year 15, waist girth only). CAC was classified as present or absent, whereas waist girth and WHR were placed in sex-specific tertiles.
Results: After adjustment for age, sex, race, clinical center, physical activity, cigarette smoking, education, and alcohol intake, baseline waist girth and WHR were directly associated with a higher prevalence of CAC 15 y later (P for trend < 0.001 for both). The odds ratios (ORs) for CAC in the highest versus lowest tertiles of waist girth and WHR were 1.9 (95% CI: 1.36, 2.65) and 1.7 (1.23, 2.41), respectively. Waist girth and WHR at year 10 and waist girth at year 15 similarly predicted CAC. These associations persisted after additional adjustment for systolic blood pressure, fasting insulin concentrations, diabetes, and antihypertensive medication use but became nonsignificant after additional adjustment for blood lipids.
Conclusions: Abdominal obesity measured by waist girth or WHR is associated with early atherosclerosis as measured by the presence of CAC in African American and white young adults. This is consistent with an involvement of visceral fat in the occurrence of coronary artery calcium in young adults.
American Journal of Clinical Nutrition, Vol. 86, No. 1, 48-54, July 2007
© 2007 American Society for Nutrition
-=-=-=-=-=-
Hi Joe,
Ever seen a discectomy.
This would be good for the blog.
Donald
http://www.spine-health.com/dir/lumbarmicroendodiscectomy.html
=-=-=-=-=--
Joe,
All the hard work is done in these.
D
Check No 2, No 1, and 5.
Donald
http://www.chiroltd.com/FREESTUFF.htm
-=-=-=-=-=-=-=-
Measles Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
News
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June)
EXERCISE: You need far less than you think in order to stay fit
How much exercise do you really need in order to be fit?
Apparently, it's far less than we've been told by government health agencies, who reckon on 20 minutes a day.
Researchers have discovered that people who walk or cycle for just half that amount – 72 minutes a week, or just over 10 minutes every day – improve their overall fitness by 4.2 per cent.
Double the exercise time and your fitness level will improve by 6 per cent, while those who walk or cycle for 27 minutes every day can see an 8 per cent improvement.
The other good news is that everyone – in all the exercise groups – saw a 2cm average reduction in their waist measurement, and that's without changing their diet.
However, none of the group – made up of post-menopausal women who lived mainly sedentary lives – lost weight, and their cardiovascular risk factors didn't reduce, either.
So some level of fitness is attainable for pretty much all of us, just as long as we're prepared to walk 10 minutes every day.
(Source: Journal of the American Medical Association, 2007; 297: 2081-91).
-=-=-=-=-=-=-=
Marginalization.
NB:This is a good word to describe how medicine tries to contain certain professions.
Piercing the veil: The marginalization of midwives in the United States
University of Colorado at Denver and Health Sciences Center, PO Box 6511, Campus Box 8309, 80045 Aurora, CO, USA
Social Science & Medicine. Volume 65, Issue 3, August 2007, Pages 610-621
Abstract
This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US.
This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care.
Currently midwives attend only 7% of births, compared to 50–75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing.
This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions.
These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.
-=-=-=-=-=-=-=
hi joe,
Better patient care from the medical files.
Donald
Editorial
The Lancet 2007; 370:2
Evidence-based handshakes
In Kill as few patients as possible, a collection of darkly humorous essays written a generation ago, Oscar London advises colleagues to: “let no one leave your office without a handshake, a blood count, and a smile.” His aphorism is confirmed by Gregory Makoul and colleagues, whose research in the June 11 issue of Archives of Internal Medicine, shows that 78% of patients in the USA want to be greeted with a handshake. While the qualitative telephone interviews employed might not be the Everest of evidence, the findings do reflect actual practice among a small cohort of primary care physicians in the USA, and accord with a similar recent study by Romona Davis and co-workers.
Both papers consider patients' attitudes to greetings and the importance placed on introductions and respect as a mark of professionalism. 81% of the 191 patients in Davis' survey believed that doctors in training should be taught to shake hands. Even more expect that the proffered hand should be washed between patients. A handshake symbolises mutual respect and trust in many cultures. When combined with an exchange of given and family names, the greeting also communicates reciprocity and, Makoul adds, correct identification of the patient. In response to an open question, the 415 participants in his study also list other expected behaviours: smile; be friendly, attentive, and polite; make the patient feel like a priority; and make eye contact. In essence, good manners and good medicine go hand in hand.
The value of exploring patient expectations lies in their ability to stimulate reflection, to improve care, and most importantly, to serve as a reminder that all aspects of practice, research, funding, and legislation should ultimately be directed to the benefit of patients. Ever since Laënnec invented the stethoscope, technological advances risk distancing doctors from their patients, and patients from the centre of health care. Hands can shorten the distance between doctors and patients, and are a precious tool for diagnosis, treatment, and communication.
The Lancet
Measles
Outbreaks with 90% coverage?
Wow. No guarantees of protection here?
Donald
Teenage measles outbreak shows shortcomings in Japan's immunisation programme
Peter Moszynski
London
An outbreak of measles in Japan has led to the closure of more than a hundred schools and universities in the past month and to calls for a new push to eradicate the virus completely. Japan is one of the few industrialised countries yet to eliminate the disease.
In 1978 Japan introduced a mandatory measles vaccination programme for preschool children. But mandatory vaccination stopped when the law was revised in 1994. Although vaccination rates remained at about 90%, according to the National Institute of Infectious Diseases, this was short of the 95% coverage needed to eradicate the disease from the general population.
Nobuhiko Okabe, director of the institute's infectious disease surveillance centre, warned last week that the gaps in immunisation coverage had led to the virus affecting older age groups than usual, causing greater risk of this extremely infectious disease spreading in the general population.
"The outbreak is not as widespread as in 2001, when between 200 000 and 300 000 patients, most of whom children, were estimated [to have been infected. But] an epidemic among teenagers and young adults, who can wander across a much wider range than infants, could extend infections to large numbers of people of all ages," he warned.
Although there is no comprehensive count of patients with measles, a nationwide survey by the institute of about 450 medical institutions found 286 people aged 15 years and older had contracted the disease by 20 May, and there had been about 907 cases in children.
Every year about 20 million people worldwide, mainly children, contract measles. In 2005 there were 345 000 measles related deaths, but in developed countries that have taken eradication measures the disease is now rare. In 2004 the World Health Organization received reports of only 37 cases of measles in the United States.
Peter Strebel, of WHO's expanded programme on immunisation, told the BMJ, "In general, outbreaks of measles that affect teenagers and young adults are usually the result of the accumulation of susceptible persons who either have never been vaccinated—for example, as a result of earlier years in which routine vaccination coverage was less than 95%—or who were vaccinated but did not respond—so called vaccine failures because the vaccine is approximately 85-95% effective depending on the age at which it is given.
"In Japan, I believe the main challenge has been getting on-time vaccination coverage with the first dose above 95%, and, until recently, the lack of a second dose of measles vaccine in their routine childhood immunisation schedule."
Dr Okabe pointed out, "Japan did not revise the preventive vaccination law to make the second vaccination a requirement until . . . 2006." He says that the problem has been compounded because "only children of certain ages are eligible to receive routine vaccinations free or partially free of charge. All other ages must pay the full expenses of vaccination."
He recommends that when outbreaks occur "the government should find ways to inject public funds as a temporary measure to prevent further spread of the disease."
Dr Strebel cautioned that measles is one of the most infectious agents known, and "thus it behoves all countries to maintain a high level of immunisation to prevent its spread."
BMJ 2007;334:1292 (23 June), doi:10.1136/bmj.39248.481701.DB
-=-=-=-
Pain Guidelines, if you did not get them
Hi Joe,
Here is a link to the NHMRC Acute pain guidelines.
http://www.nhmrc.gov.au/publications/synopses/_files/cp94.pdf
It may be useful to have as a reference on the blog.
Donald