Category: Health

{The global death toll from Ebola has risen to 7,588 out of 19,497 confirmed cases recorded in the year-old epidemic raging in West Africa, the World Health Organization (WHO) said on Wednesday.}

The virus is still spreading intensely in Sierra Leone, especially in the north and west, with 315 new confirmed cases reported in the former British colony in the week to December 21, it said. These included 115 cases in the capital Freetown.

“The neighbouring district of Port Loko experienced a surge in new cases, reporting 92 confirmed cases compared with 56 the previous week,” the WHO said.

In Sierra Leone, information about how to prevent and treat Ebola was provided to more than 5,000 households between 10 and 17 December as part of a major awareness campaign, it said.

In Guinea, 156 confirmed cases were recorded during the same period, “the highest weekly case incidence reported by the country in this outbreak”, the WHO said.

“This largely due to a surge in cases in the south-eastern district of Kissidougou, which reported 58 confirmed cases – one-third of cases reported in the country in the past week.”

Noting the district had previously reported no more than five cases per week, it said the surge showed the need for continuing vigilance even where the virus was not widespread.

In Liberia, where case incidence has been declining for the past month, 21 cases were reported in the week to December 21.

Montserrado county, including the capital Monrovia, still has the highest rates of the disease nationwide, while along the Côte d’Ivoire border to the east, Nimba county reported 3 confirmed cases, its first in 9 weeks, the WHO said.

Five additional countries – Nigeria, Senegal, Mali, Spain and the United States – have had imported cases and are included in the global toll.

The Ebola crisis, which claimed its first victim in Guinea exactly a year ago, is likely to last until the end of 2015, according to Peter Piot, a scientist who helped to discover the virus in 1976.

Medical detective work will be the next phase in the fight against Ebola. The United Nations will deploy hundreds of health workers to identify chains of infection as the virus passes from person to person, WHO director-general Margaret Chan said in Accra, Ghana earlier on Wednesday.

World Bulletin

{Alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes a large disease, social and economic burden in societies.}

According to WHO Statistics worldwide, 3.3 million people die every year due to harmful use of alcohol, this represent 5.9 % of all deaths.

The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.

Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability- adjusted life years (DALYs).

Alcohol consumption causes death and disability relatively early in life. In the age group 20 – 39 years approximately 25 % of the total deaths are alcohol-attributable.

There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other noncommunicable conditions as well as injuries.

The latest causal relationships have been established between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS.

Beyond health consequences, the harmful use of alcohol brings significant social and economic losses to individuals and society at large.

{{Ways to reduce the burden from harmful use of alcohol}}

The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and requires actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health.

Countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Substantial scientific knowledge exists for policy-makers on the effectiveness and cost–effectiveness of the following strategies:

regulating the marketing of alcoholic beverages (in particular to younger people);
regulating and restricting availability of alcohol;
enacting appropriate drink-driving policies;
reducing demand through taxation and pricing mechanisms;
raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies;
providing accessible and affordable treatment for people with alcohol-use disorders; and
implementing screening and brief interventions programmes for hazardous and harmful drinking in health services.

{{WHO response}}

WHO aims is to reduce the health burden caused by the harmful use of alcohol and, thereby, to save lives, prevent injuries and diseases and improve the well-being of individuals, communities and society at large.

WHO emphasizes the development, implementation and evaluation of cost-effective interventions for harmful use of alcohol as well as creating, compiling and disseminating scientific information on alcohol use and dependence, and related health and social consequences.

In 2010, the World Health Assembly approved a resolution to endorse a global strategy to reduce the harmful use of alcohol. The resolution urged countries to strengthen national responses to public health problems caused by the harmful use of alcohol.

The global strategy to reduce the harmful use of alcohol represents a collective commitment by WHO Member States to reduce the global burden of disease caused by harmful use of alcohol. The strategy includes evidence-based policies and interventions that can protect health and save lives if adopted, implemented and enforced. The strategy also contains a set of principles to guide the development and implementation of policies; it sets priority areas for global action, recommends target areas for national action and gives a strong mandate to WHO to strengthen action at all levels.

The policy options and interventions available for national action can be grouped into 10 recommended target areas, which are mutually supportive and complementary. The 10 areas are:

leadership, awareness and commitment
health services’ response
community action
drink–driving policies and countermeasures
availability of alcohol
marketing of alcoholic beverages
pricing policies
reducing the negative consequences of drinking and alcohol intoxication
reducing the public health impact of illicit alcohol and informally produced alcohol
monitoring and surveillance.

The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcohol-attributable health and social consequences and policy responses at all levels.

Successful implementation of the strategy will require action by countries, effective global governance and appropriate engagement of all relevant stakeholders. By effectively working together, the negative health and social consequences of alcohol can be reduced.

{{Date}}: December 22, 2014

{{Source}}: American Academy of Sleep Medicine

{{Summary}}:
{Insomnia symptoms mediate the relationship between alcohol use and suicide risk, and that this mediation is moderated by gender, a new study demonstrates for the first time. The study suggests that the targeted assessment and treatment of specific sleep problems may reduce the risk of suicide among those who use alcohol.}

A new study is the first to show that insomnia symptoms mediate the relationship between alcohol use and suicide risk, and that this mediation is moderated by gender. The study suggests that the targeted assessment and treatment of specific sleep problems may reduce the risk of suicide among those who use alcohol.

The study found that alcohol use was significantly associated with suicide risk among women. However, further analysis revealed that insomnia symptoms explained a significant proportion of the relationship between alcohol and suicide risk. For men, there was no direct effect of alcohol use on suicide risk, but there was a significant indirect effect of alcohol use increasing suicide risk through insomnia symptoms.

“These results are important as they help demonstrate that alcohol use is associated with an increase in suicide risk, and that this increase may be partially due to insomnia symptoms,” said principal investigator Michael Nadorff, PhD, assistant professor at Mississippi State University in Starkville, Miss. “By better understanding this relationship, and the mechanisms associated with increased risk, we can better design interventions to reduce suicide risk.”

Although the design of this study did not allow for an examination of causality, the present study lays the groundwork for future longitudinal investigations that further elucidate the relationship among alcohol use, insomnia symptoms and suicide risk.

Study results are published in the December issue of the Journal of Clinical Sleep Medicine.

According to the American Academy of Sleep Medicine, about 10 percent of people have chronic insomnia disorder, which involves a sleep disturbance and associated daytime symptoms that have been present for at least three months. About 15 to 20 percent of adults have short-term insomnia disorder. Both types of insomnia are more common in women than in men.

The study involved 375 undergraduate students at a large, public university in the southeastern U.S. They completed an online questionnaire that examined insomnia symptoms, nightmares, alcohol use and suicide risk.

The Centers for Disease Control and Prevention reports that excessive alcohol use leads to about 88,000 deaths in the U.S. each year and shortens the life of those who die by almost 30 years. Accounting for more than 38,000 deaths each year, suicide is the 10th leading cause of death in the U.S. according to the CDC.

{A patient who had suffered a traumatic brain injury unexpectedly recovered full consciousness after the administration of midazolam, a mild depressant drug of the GABA A agonists family. This resulted in the first recorded case of an “awakening” from a minimally-conscious state (MCS) using this therapy. Although similar awakenings have been reported using other drugs, this dramatic result was unanticipated. It is reported in Restorative Neurology and Neuroscience.}

Traumatic brain injuries occur at high rates all over the world, estimated at 150-250 cases per 100,000 population per year. These injuries can result in several outcomes, ranging from vegetative state, minimally conscious state, severe disability to full recovery. In most cases, the outcome will cause catastrophic changes for his/her family and a significant drain on both human and financial resources.

Two years after the injury caused by a motor vehicle accident, the patient was mildly sedated, in order to undergo a CT scan, using midazolam instead of the more commonly used propofol. As the authors described in the article, the patient began to interact with the anesthetist and soon after with his parents. He talked by cellphone with his aunt and congratulated his brother when he was informed of his graduation; he recognized the road leading to his home. When he was asked about his car accident, he did not remember anything and apparently he was not aware of his condition. This clinical status lasted about two hours after drug administration and disappeared quickly thereafter, taking the patient back to the previous condition.

To further investigate this phenomenon, the researchers collected extensive EEG scans before, during, and after administration of midazolam. Using sophisticated data analysis, they were able to show the locations within the brain where the drug induced changes and followed the onset and the decline of the effects.

They noted that the patient could have also been diagnosed with the classic symptoms of catatonia, based on the similarity of the EEG sometimes observed in that pathology. Catatonia can be a manifestation of a non-convulsive status epilepticus (NCSE). The authors were thus faced with a two-fold mystery: Is this a case of catatonia mimicking a case of MCS or does the MCS, as a syndrome in itself, also include elements of a catatonic nature? Do the relative contributions of MCS versus catatonia in the individual patient determine whether or not he/she will respond to GABA A agonist drugs?

Maria Chiara Carboncini, MD, Medical Director of the Brain Injury Unit, Department of Neuroscience, University Hospital of Pisa and Adjunct Professor, University of Pisa, Italy, states, “Considering the MCS from this point of view could pave the way to new perspectives for both therapy and clinical management: at least a part of MCS patients could in fact benefit from treatment with non-selective GABA A agonists….” She also notes that as a practical consequence, “such patients should be tested not only with GABA A selective drugs like zolpidem, but also with GABA A non-selective drugs like benzodiazepines.”

Science Daily

{Richard Mazimpaka, committed suicide last week in what family members say was a result of depression. According to friends and workmates, the former employee of GT Bank Rwanda, was hard working and exemplary but during the days leading to his death, he exhibited tendencies that were uncommon about him.}

According to accounts of workmates and friends, he had issues with his Nigerian boss and had resigned on Monday last week before being convinced to resume his duties. On the fateful day, he took his wife to work and headed straight back home where he found his children in the living room and asked them not to disturb him because he wanted to sleep.

On reaching the bedroom, the maid over heard him in the ceiling but since they had set poison traps for rats, she thought he was getting out a dead rat. However, it turned out that he went for the ceiling woodwork, tied a wire around it and hang himself. All the while, no one bothered him since they all thought he was sleeping until his wife came back home and found her husband hanging in the bathroom.

With all the above, anyone would want to know why such a young man, with a good job and a young family, would do such a thing. Well, according to friends, it turns out that Mazimpaka has had depression break downs since childhood but no one thought it would finally get to suicide.

Richard’s case might be among the few but psychiatrists worn that if depression is not treated it can lead to suicide?

According to Marie Josie Kayitesi, a senior counselor and clinical psychologist at National Association of Trauma Counselors (ARCT RUHUKA) depression is a medical illness that causes constant feeling of sadness and lack of interest. It affects how a person feels, behaves and thinks.

Kayitesi says that causes of depression range from someone’s background, standards of living and their life in general.

“These are strong elements that can cause depression and depending on how it is treated, depression can grow and lead an individual into committing suicide.”

She points out that while the symptoms of depression are easy to identify, whether or not that depression can lead someone to commit suicide, is difficult to assess.

“Indications of depression usually involve less communication and isolation of an individual. A person who is depressed is more likely to ignore basic details, like how they dress up, hygiene habits, etc. The person tends to complain about severe headache, loss of appetite, and will be very negative and pessimistic in conversations. A depressed person will most likely suffer from insomnia and it will show in their appearance. However, when depression takes a serious turn and the person is unable to handle it, it drives them to suicide,” explains psychiatrist Kayitesi.

And it’s the strong signs of depression that mostly go unnoticed, says Kayitesi. “If you notice a person behaving very strangely or talking a lot about dead people or how there is no hope in life, it should immediately give you a hint that the person could be suicidal. In fact, it’s an indirect way of asking for help and that help has to be immediate. Most of us make the mistake of ignoring this urgency,” Kayitesi adds.

Depression, like other health related issues, has types and they all vary according to how they are treated. “Low depression is usually short term and whatever a person does is a reaction of the moment. People who suffer from low depression need therapy, exercise, change of environment, but medication is not really necessary at this point,” explains Kayitesi.

The other type of depression is mild depression. “Mildly depressed people exhibit symptoms for a long time. Mild depression symptoms do not disable a person. However, people affected may find it hard to function normally and feel well. Such people can get medication as well as counseling and they need close monitoring,” adds Kayitesi.

The last type is major depression which is most likely to lead a person to suicide. Kayitesi explains that when the above are not treated well, this is the point where a person crosses over and starts getting suicidal thoughts.

“Suicidal symptoms can sometime be difficult to understand. One needs to be observant when dealing with a person going through depression. Some symptoms are indirect, if a person starts saying words such as; “I just can’t deal with everything – life’s too hard”, “I’m better off dead,” “give this to my parents for me”. Or they start giving away things they treasured saying “I want you to keep this”, etc. If you also notice a person obtaining a weapon or writing a suicide note, that is a clue,” she adds.

However, Kayitesi says that the rate of depression in Rwanda is not alarming although the majority of cases they have encountered include mostly the youth.

“Majority of our cases are the youth because of their age bracket and what they experience at their age. Most of them indulge in drugs or other habits that influence how they live their day to day life. The other cases can be found in prisons. We conducted a case study in 2011 at Nyarugenge Prison (1930) and found depressed prisoners,” she says.

Kayitesi says that by asking people who experience signs of depression to immediately seek assistance by undergoing counseling sessions, therapy and seeking medication attention, it doesn’t always have to end tragically. She urges people to desist from indulging in alcoholic drinks and drugs as an escape from depression since they worsen the situation.

{{The New Times}}

{In order to assist people who want to be healthy, WAKA Fitness has slashed its off-peak membership from RWF 51,000 to as low as RWF 30,000 for a group of 5 people.}

The slash in the cost of off-peak usage comes as a result of WAKA trying to improve client service.

“We expanded our off peak hours to include mornings and all day weekends, which mean the only time an off-peak member cannot use the facility is Mon-Friday from 5 pm – 8 pm.” WAKA Fitness says in a communiqué released earlier this month.

More Flexible Options

After several requests from clients asking for more flexibility in the pricing options to accommodate a group of friends, company or spouse, the gym now has individual, group and couple rates, as well as a weekly and quarterly membership, which it did not have before.

“We are also in the process of developing a class punch card, starting in January 2015, to accommodate those members who just want access to classes.”

Full Fitness Package

Waka Fitness now has memberships that include personal training 3 times a week and has adjusted personal trainers schedule to ensure “we have more coverage for more members than ever.”

For membership Prices click [here->http://igihe.com/IMG/pdf/waka_membership_information_01.11.2014_3_.pdf]

{{Honorable Ministers,}}
{{ • Representatives of international organizations,
• Keynote speakers,
• Dear children,
• Distinguished delegates,
• People living with HIV and AIDS,}}

Good afternoon,

It is clear, from the recommendations presented by Dr. Sabin and Aline, that the last 72 hours were well spent. By exchanging experiences and evidence, we are better able to continue the collective struggle against the scourge of HIV and AIDS.

We are delighted to have hosted this year’s international HIV research and pediatric conference, and it is an honor for me to share a few reflections with you today.

I want to appreciate the daunting task researchers have. Occasional sudden breakthroughs cannot mask the fact that your work is, by nature, painstaking and slow. Yet perseverance is the only sure way forward. Even though we have not mastered the virus and its mutations, we have indeed made important progress in treating it and preventing its transmission. Working together, scientists and public health institutions have saved millions of lives, and given new hope to millions more.

I will spare you too many statistics, as I am sure you probably know the numbers better than me. Allow me to share a little bit about the journey we have taken to respond to HIV and the important points it has brought into focus:

• Our continent has been the most affected by HIV, representing more than 90% of the worldwide HIV burden,
• The high HIV rates are aggravated by conflict, socio-economic inequality, as well as gender vulnerability, sexual violence, and forced migration,
• We in Africa need to get the science right, which means a clear focus on research and development, but also to integrate scientific results into our national health systems,
• Funding levels for treatment programs have decreased, which calls for more innovative ways to sustain the gains we have made.

The good news is that we have learned valuable lessons about the nature of HIV infection. Even more important, is that we put these discoveries to use, to save lives.

But let’s also take a moment to recall that our work speaks to a larger context. The challenge of HIV, forces all of us to stretch the boundaries of our abilities and our imaginations, beyond what we even thought possible. This is a good thing by any measure, and it is a spirit that we can also bring to bear on the many other urgent problems that confront us as a global community.

One of the important things we have seen, is that HIV cannot be managed effectively with a broken health system. Therefore, the pandemic has shown us the broader importance of making our health systems work. Healthcare deals directly with human life in its most fragile moments, and it simply has to function. Investments in HIV/AIDS treatment and prevention, have afforded us the opportunity to improve our health system more generally, compounding the return on the investments that have been made.

One of the approaches that we found essential here in Rwanda is community engagement and empowerment.
We have 45,000 Community Health Workers nation-wide, who work on a volunteer basis to educate the community about HIV prevention and general health issues. A familiar and trusted presence at the local level, they help manage cases and help improve access to services and information for underserved populations.

Ladies and Gentlemen:
As you may know, Rwanda emerged from genocide 20 years ago. This left the nation in total collapse. There were thousands of injuries to treat, and rape and HIV had been used as weapons of war. Yet our health system, like other public institutions, had ceased to exist. This left us with no clear template for charting a way forward.

Much like a scientist or a researcher in a lab, our leadership explored a number of possibilities to try and stitch together the torn national fabric. Through hard work, a common vision, and a commitment to national unity and reconciliation, our nation has moved from an emergency phase to a period of stabilization. Now, we are working to consolidate our gains, and further expand our horizons and ambitions for the well-being of our people.

We started out using unconventional ways; truly experimenting with what we thought might deliver results for Rwandans. We set a bold vision, with measurable development targets, which leaders at all levels of government are responsible for meeting these targets.

Every year performance is evaluated against those targets. There are consequences if the targets are not met. This keeps leaders on toes (we like that); they are kept accountable and improves outcomes for citizens.

In other words, our policies and implementation are informed by evidence.

While we can be proud of the gains that have been made, challenges still remain. Otherwise, you would not have needed to spend the last three days here.

These challenges, in the fight against HIV and AIDS, should not be our stop-over but should rather our step-over.

Gatherings like these demonstrate the kind of international solidarity required to make progress in fighting this pandemic. I believe HIV and AIDS have brought the world together, to solve a problem, as no other global health issue has ever done. This shows how, even in terrible tragedy, the seeds of renewal and progress are always there to be found, if we choose to look for them.

Distinguished delegates, as I end my remarks,

I wish to urge those responsible for implementation, to take the knowledge from these brilliant minds and use it to make a difference.

Every step, every breakthrough represents a renewal of hope for people living with HIV, and a chance for them to live with the dignity they deserve. I salute their bravery and strength.

Our children both challenge and inspire us to work even harder towards the next discovery. Little ones — we have heard your voices, and we will give our all, to make sure yours is an HIV free generation.

I now declare the 2014 International HIV research conference closed.

Thank you.