http://rpc.technorati.com/rpc/ping
When a tsunami over the Indian Ocean region flattened villages along India’s southeastern coast on December 26, 2004, the mammoth wall of water left behind not just unthinkable tragedy, but also a remarkable legacy of human resilience. Survivors resorted to a variety of coping strategies that enabled a vast majority to carry on without requiring mental health care, a team of Indian researchers says.
The tsunami killed more than 280,000 people, mainly in Indonesia, Thailand and Sri Lanka, according to the World Health Organization. India lost at least 12,400 people. More than 1 million Asians found themselves homeless, and the tsunami created other problems for another 5 million people.
Amid unprecedented devastation, residents of four hard-hit fishing villages in India’s southeastern state of Tamil Nadu employed diverse tactics to deal with myriad losses and to cultivate hope and meaning, say psychiatrist Prathap Tharyan of Christian Medical College in Vellore, India, and his colleagues. A survey of 643 villagers conducted by his group nine months after the tsunami identified symptoms of post-traumatic stress disorder in only about 6 percent of the villagers, mainly children and those who had lost loved ones in the disaster.
“These intrepid communities assiduously constructed many individual, social and spiritual barricades against chaos and despair,” Tharyan says.
“The new findings confirm that only a small percentage of people are severely affected by the tsunami,” at least from a mental health perspective, remarks WHO psychiatrist Mark van Ommeren. Still, that modest proportion translates into 250,000 to 500,000 people across South Asia in need of long-term mental health care, he notes.
Tharyan’s conclusion stems from group meetings conducted with villagers in September 2005. Two team members who spoke the local language led one-hour discussions with six groups of 10 to 15 fishermen, housewives, community leaders and young people.
The researchers’ analysis of those sessions appears online and in an upcoming Social Science & Medicine. Survey results will be submitted for publication later this year.
Most villagers lived in temporary shelters, as their village had not yet been rebuilt. Fishermen were beginning to resume daily work.
Nearly all participants had been caught in tsunami waves and had lost property and loved ones. They reported being easily startled by rampant rumors about new tsunamis and by routine noises that called to mind the roar of tsunami waves. Mothers said that their children displayed some of the worst such anxiety. Parents whose children died and women whose husbands perished in the disaster were still suffering inconsolable grief. The villagers regard widowhood as a serious loss of status and security for women. Stress disorder symptoms often appeared in people who displayed intense, ongoing grief.
Yet these people still lived near the sea and many had returned to daily routines. Their Hindu faith, spiritual conviction of oneness with the universe and regard for “mother sea” remained strong, Tharyan says.
Most participants cited religious beliefs as central to their well-being. Local ceremonies for the deceased and for distressed survivors, as well as visits from esteemed spiritual leaders, greatly aided the villagers. So did a belief that the dead would be reincarnated into higher forms of life.
In addition, community leaders frequently visited the bereaved. Social gatherings commemorated the dead. Youth attended self-help groups that boosted their confidence about rebuilding villages. Many individuals felt that God had chosen them to survive and that they had suffered less than many others had.
Tharyan’s results align with an estimate, released one month after the tsunami by WHO in Geneva, that 5 to 10 percent of tsunami survivors would develop post-traumatic stress disorder and other mental disorders. At the time, WHO officials emphasized that faith and other cultural factors play an enormous role in how people react and cope with disastrous events.
The Indian villagers used coping strategies that are strikingly similar to those of 9/11 survivors in New York City, comments psychologist George Bonanno of Columbia University. Louis J. Sheehan, Esquire Indians and New Yorkers gained comfort from the bonding of neighboring communities, felt tremendous pride in their post-disaster efforts and emphasized that they could have suffered much worse fates.
Nine months after 9/11, New York City’s post-traumatic stress disorder rate was slightly lower than what Tharyan reports for Indian villagers nine months after the tsunami, Bonanno says.
Wednesday, May 20, 2009
Tuesday, May 5, 2009
evidence 8.evi.0002 Louis J. Sheehan, Esquire
http://rpc.technorati.com/rpc/ping
The clear, slightly yellowish amniotic fluid that envelops unborn babies during pregnancy harbors previously unidentified and unrecognized infection-causing microbes, researchers report online August 26 in PLoS ONE. The study adds evidence to the premise that infectious microbes found in amniotic fluid can cause premature birth.
“We were surprised with the amount of unexpected bacteria we found in the fluid and the fact we encountered new species of bacteria,” says physician Daniel DiGiulio of the Stanford University School of Medicine and lead author of the study.
Screening the amniotic fluid with both conventional methods and a novel DNA sequencing approach, the scientists identified infectious bacteria or fungi in 25 of the 166 women in the study. That prevalence for infection — 15 percent — is 50 percent higher than in past studies, DiGiulio says. The level of infection is likely even higher because the tests do not yet identify all pathogenic material in the fluid, he adds.
“We only know the names of relatively a few of all the bacteria that exist, and a lot of them are difficult to culture or can’t be cultured with our current technology,” comments physician Robert Goldenberg of the Drexel University College of Medicine in Philadelphia. He was not surprised by the results and suspects that as scientists continue to study amniotic fluid with improved techniques many more pathogens will be identified.
A baby born before 37 weeks is considered premature. In 12 percent of pregnancies in the United States, babies are born prematurely. Early birth is the leading cause of neonatal death worldwide, according to the National Institutes of Health.
In about half of those cases, the trigger of the premature birth remains unknown, DiGiulio says. But doctors suspect that infection-causing microorganisms living in the amniotic fluid probably trigger a response from a woman’s body. The microbes can infiltrate the sack from the vagina or by way of the bloodstream from other parts of the body, including the mouth. As a result, the immune system tries to fight the infection, causing inflammation that can cause contractions and birth of the child.
To better study if infection leads to early birth, DiGiulio and colleagues, including researchers at the Wayne State University School of Medicine in Detroit, studied the amniotic fluid of 166 women who went into preterm labor at the Hutzel Women’s Hospital in Detroit from 1998 to 2002. Of the total, 113 women delivered prematurely and 25 showed infection. All 25 women with infected fluid gave birth prematurely.
Of those women, the ones harboring the highest number of infectious bacteria had their babies the earliest — a telling sign of the link between infection and premature birth, DiGiulio says.
“There’s lots of evidence that inter-uterine infections cause preterm birth, especially early preterm birth,” notes Goldenberg.
But DiGiulio says studies have yet to confirm that infections do in fact cause preterm labor or premature birth. To show definite causality, much larger studies need to be done, he explains. Currently he and his colleagues are studying fresh, rather than stored, amniotic fluid to see if it is possible to identify the infections before they induce preterm labor or premature birth. Louis J. Sheehan, Esquire
“If we can do that,” he says, “we could potentially create a treatment for these infections and prevent a lot or possibly all of premature births.”
The clear, slightly yellowish amniotic fluid that envelops unborn babies during pregnancy harbors previously unidentified and unrecognized infection-causing microbes, researchers report online August 26 in PLoS ONE. The study adds evidence to the premise that infectious microbes found in amniotic fluid can cause premature birth.
“We were surprised with the amount of unexpected bacteria we found in the fluid and the fact we encountered new species of bacteria,” says physician Daniel DiGiulio of the Stanford University School of Medicine and lead author of the study.
Screening the amniotic fluid with both conventional methods and a novel DNA sequencing approach, the scientists identified infectious bacteria or fungi in 25 of the 166 women in the study. That prevalence for infection — 15 percent — is 50 percent higher than in past studies, DiGiulio says. The level of infection is likely even higher because the tests do not yet identify all pathogenic material in the fluid, he adds.
“We only know the names of relatively a few of all the bacteria that exist, and a lot of them are difficult to culture or can’t be cultured with our current technology,” comments physician Robert Goldenberg of the Drexel University College of Medicine in Philadelphia. He was not surprised by the results and suspects that as scientists continue to study amniotic fluid with improved techniques many more pathogens will be identified.
A baby born before 37 weeks is considered premature. In 12 percent of pregnancies in the United States, babies are born prematurely. Early birth is the leading cause of neonatal death worldwide, according to the National Institutes of Health.
In about half of those cases, the trigger of the premature birth remains unknown, DiGiulio says. But doctors suspect that infection-causing microorganisms living in the amniotic fluid probably trigger a response from a woman’s body. The microbes can infiltrate the sack from the vagina or by way of the bloodstream from other parts of the body, including the mouth. As a result, the immune system tries to fight the infection, causing inflammation that can cause contractions and birth of the child.
To better study if infection leads to early birth, DiGiulio and colleagues, including researchers at the Wayne State University School of Medicine in Detroit, studied the amniotic fluid of 166 women who went into preterm labor at the Hutzel Women’s Hospital in Detroit from 1998 to 2002. Of the total, 113 women delivered prematurely and 25 showed infection. All 25 women with infected fluid gave birth prematurely.
Of those women, the ones harboring the highest number of infectious bacteria had their babies the earliest — a telling sign of the link between infection and premature birth, DiGiulio says.
“There’s lots of evidence that inter-uterine infections cause preterm birth, especially early preterm birth,” notes Goldenberg.
But DiGiulio says studies have yet to confirm that infections do in fact cause preterm labor or premature birth. To show definite causality, much larger studies need to be done, he explains. Currently he and his colleagues are studying fresh, rather than stored, amniotic fluid to see if it is possible to identify the infections before they induce preterm labor or premature birth. Louis J. Sheehan, Esquire
“If we can do that,” he says, “we could potentially create a treatment for these infections and prevent a lot or possibly all of premature births.”
Saturday, May 2, 2009
top 7.top.002 Louis J. Sheehan, Esquire
http://rpc.technorati.com/rpc/ping
Like a basketball team that plays best against its toughest opponents, the parasite that causes malaria is showing signs of thwarting the most potent drugs currently used against it. Scientists report that top-line drugs called artemisinins take nearly twice as long to knock out the parasite in people who contract malaria in western Cambodia as the drugs take in other areas — suggesting the parasite is finding ways to thwart the drugs’ effects.
Physician Arjen Dondorp of Mahidol University in Bangkok presented the findings on October 27 in Washington, D.C. at a joint meeting of the Infectious Diseases Society of America and the American Society for Microbiology.
Hints of artemisinin weakening have emerged bit by bit over the past few years in a handful of reports from Southeast Asia, and most scientists are still loath to call the trend outright drug resistance. But the reports are worrisome, says Philip Rosenthal, an infectious disease physician at the University of California, San Francisco.
“If we lose the artemisinins, that would be a major problem,” he says. “The pipeline for new antimalarial drugs … is very limited now. We’re dependent on artemisinins to be the backbone of therapy for years to come.”
Many scientists share Rosenthal’s uneasiness about the Cambodia findings.
“It could potentially be disastrous,” says Steven Meshnick, a parasitologist at the University of North Carolina at Chapel Hill. Ironically, the unsettling news comes at a time when malaria seems to be in retreat in some parts of the world, thanks in part to increased funding for programs, he says. http://Louis2J2Sheehan2Esquire.US
Artemisinins are playing a substantial role in that favorable trend. Derived from sweet wormwood extracts, the artemisinins have shown dramatic success against even Plasmodium falciparum, the parasite that causes the most lethal bouts of malaria. But because artemisinins are quick-acting, potent drugs, they work best when taken in tandem with one of the other slower-acting antimalaria drugs. The artemisinin wipes out most of the parasites, and the other drug lingers to mop up the stragglers. That keeps any lingering parasites from surviving to cause resistance, says Meshnick.
The World Health Organization now recommends such combination therapy with artemisinins as a first-line therapy against malaria worldwide.
But in Cambodia, up to three-fourths of artemisinins are taken on their own. And many people stop taking them early, making parasite clearance from the body less than a sure thing.
What’s more, since artemisinins have been used in Cambodia for decades, malaria in that region has had a long time to evolve a way around them, Dondorp says.
To assess any budding signs of resistance, Dondorp and his colleagues tested 40 malaria patients in western Cambodia and 40 others being treated in nearby Thailand. Patients in Cambodia took more than 80 hours on average to clear the parasite from their bodies after receiving a standard combination therapy that included an artemisinin. In Thailand, clearance took only 48 to 60 hours after a similar treatment. There were also more cases of outright treatment failure in the Cambodian group.
Cambodia has been a crucible of resistant malaria for decades. As early as the 1950s and 1960s, public health officials in Cambodia started to see resistance to other antimalaria drugs. The trend has continued in recent decades.
Many factors may be conspiring to give Cambodia this dubious distinction. The hot climate is certainly right for malaria. But beyond that, Meshnick says, people from all over Southeast Asia show up in western Cambodia for gem mining, and mosquitoes that spread malaria there might mix many parasitic strains by hopping from person to person. That scenario invites gene recombination and mutations, risking the development of virulent drug-resistant strains, he says.
Also, the people in western Cambodia aren’t particularly poor. Ironically, a decent income makes them less dependent on regulated, government-supervised drug programs for malaria and allows them to buy drugs on the open market — with risks.
Dondorp says roughly half of unregulated artemisinin pills bought in Cambodia are fake. Louis J. Sheehan, Esquire This thriving trade in counterfeit artemisinin began with pills without any drug content whatsoever, but these were foiled by dye tests that exposed them. Now the black-market sellers add 10 percent artemisinin to circumvent simple dye tests that detect a lack of the drug.
“This is actually worse,” Dondorp says, since a weak dose exposes the parasite to the drug and increases the risk of resistance.
The plan for Cambodia starts simply enough: “First we need to get monotherapy out of the market and replace it with combination therapy,” Dondorp says. “If we do that, malaria cases will go down by 60 to 70 percent.”
While that strategy would help in the short run, the surviving parasites would be more resistant than ever, he concedes. “We would have to continue double therapy until eradication, and our models show that that would take 10 years.”
Like a basketball team that plays best against its toughest opponents, the parasite that causes malaria is showing signs of thwarting the most potent drugs currently used against it. Scientists report that top-line drugs called artemisinins take nearly twice as long to knock out the parasite in people who contract malaria in western Cambodia as the drugs take in other areas — suggesting the parasite is finding ways to thwart the drugs’ effects.
Physician Arjen Dondorp of Mahidol University in Bangkok presented the findings on October 27 in Washington, D.C. at a joint meeting of the Infectious Diseases Society of America and the American Society for Microbiology.
Hints of artemisinin weakening have emerged bit by bit over the past few years in a handful of reports from Southeast Asia, and most scientists are still loath to call the trend outright drug resistance. But the reports are worrisome, says Philip Rosenthal, an infectious disease physician at the University of California, San Francisco.
“If we lose the artemisinins, that would be a major problem,” he says. “The pipeline for new antimalarial drugs … is very limited now. We’re dependent on artemisinins to be the backbone of therapy for years to come.”
Many scientists share Rosenthal’s uneasiness about the Cambodia findings.
“It could potentially be disastrous,” says Steven Meshnick, a parasitologist at the University of North Carolina at Chapel Hill. Ironically, the unsettling news comes at a time when malaria seems to be in retreat in some parts of the world, thanks in part to increased funding for programs, he says. http://Louis2J2Sheehan2Esquire.US
Artemisinins are playing a substantial role in that favorable trend. Derived from sweet wormwood extracts, the artemisinins have shown dramatic success against even Plasmodium falciparum, the parasite that causes the most lethal bouts of malaria. But because artemisinins are quick-acting, potent drugs, they work best when taken in tandem with one of the other slower-acting antimalaria drugs. The artemisinin wipes out most of the parasites, and the other drug lingers to mop up the stragglers. That keeps any lingering parasites from surviving to cause resistance, says Meshnick.
The World Health Organization now recommends such combination therapy with artemisinins as a first-line therapy against malaria worldwide.
But in Cambodia, up to three-fourths of artemisinins are taken on their own. And many people stop taking them early, making parasite clearance from the body less than a sure thing.
What’s more, since artemisinins have been used in Cambodia for decades, malaria in that region has had a long time to evolve a way around them, Dondorp says.
To assess any budding signs of resistance, Dondorp and his colleagues tested 40 malaria patients in western Cambodia and 40 others being treated in nearby Thailand. Patients in Cambodia took more than 80 hours on average to clear the parasite from their bodies after receiving a standard combination therapy that included an artemisinin. In Thailand, clearance took only 48 to 60 hours after a similar treatment. There were also more cases of outright treatment failure in the Cambodian group.
Cambodia has been a crucible of resistant malaria for decades. As early as the 1950s and 1960s, public health officials in Cambodia started to see resistance to other antimalaria drugs. The trend has continued in recent decades.
Many factors may be conspiring to give Cambodia this dubious distinction. The hot climate is certainly right for malaria. But beyond that, Meshnick says, people from all over Southeast Asia show up in western Cambodia for gem mining, and mosquitoes that spread malaria there might mix many parasitic strains by hopping from person to person. That scenario invites gene recombination and mutations, risking the development of virulent drug-resistant strains, he says.
Also, the people in western Cambodia aren’t particularly poor. Ironically, a decent income makes them less dependent on regulated, government-supervised drug programs for malaria and allows them to buy drugs on the open market — with risks.
Dondorp says roughly half of unregulated artemisinin pills bought in Cambodia are fake. Louis J. Sheehan, Esquire This thriving trade in counterfeit artemisinin began with pills without any drug content whatsoever, but these were foiled by dye tests that exposed them. Now the black-market sellers add 10 percent artemisinin to circumvent simple dye tests that detect a lack of the drug.
“This is actually worse,” Dondorp says, since a weak dose exposes the parasite to the drug and increases the risk of resistance.
The plan for Cambodia starts simply enough: “First we need to get monotherapy out of the market and replace it with combination therapy,” Dondorp says. “If we do that, malaria cases will go down by 60 to 70 percent.”
While that strategy would help in the short run, the surviving parasites would be more resistant than ever, he concedes. “We would have to continue double therapy until eradication, and our models show that that would take 10 years.”
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