Free treatment gives hope for a TB-free country
Free treatment gives hope for a TB-free country
Tantri Yuliandini, The Jakarta Post, Jakarta
One can imagine that in her youth, Nihaya was very beautiful. At 57 years of age, this petite woman looks like she is in the best of health. Her eyes twinkle, her skin glows and laugh lines are barely visible around her rosebud mouth.
Nihaya, however, is one of the hundreds of thousands of people in the country who have contracted tuberculosis (TB).
According to the World Health Organization (WHO), the rate of TB in the country in 2002 was 271 per 100,000 people, making it number three after China and India in terms of the number of patients.
The way in which Nihaya talks about her illness is down to earth. She breezes over her experiences in much the same way as one might relate their grandson's school achievements, or the pengajian (reading the Koran) gathering at a neighbor's house.
"When I have a relapse -- it usually happens in the morning you see -- I sweat profusely, my whole body gets all wet, and I cough a lot -- expectorated coughing -- and my nose runs horribly. It usually happens in the morning -- by noon it would have gone away," Nihaya explained.
She has been attending the free tuberculosis clinic on Jl. Baladewa 34, Tanah Tinggi, Central Jakarta, for five weeks now. The entire treatment program runs for six months.
"They prepare for you your whole six-month treatment package immediately after you register, did you know? And you don't have to pay anything except for the Rp 35,000 (about US$4) registration fee and first course of Roentgen (X-ray examination)," Nihaya said.
The tuberculosis clinic on Jl. Baladewa -- officially called Poliklinik Pemberantasan Penyakit Paru (Polyclinic for the eradication of lung diseases) -- was established in 1978 by the Indonesian Tuberculosis Association (PPTI).
Since then, the non-governmental organization has set up similar clinics on Jl. Sultan Iskandar Muda 66A in South Jakarta and on Jl. Dermaga I, Kompleks Nelayan in Muara Angke, North Jakarta, as well as five other clinics in North Sumatra, Jambi, South Sulawesi, Central Java, and Yogyakarta.
The clinic on Jl. Baladewa treated more than 14,000 patients between 1978 and 2003, with a cure rate of more than 90 percent, the clinic's medical supervisor Halim Danusantoso said in a journalists forum on International Tuberculosis Day last week.
The treatment strategy endorsed by the clinics is the Directly Observed Treatment Short-course, or DOTS, as recommended by WHO.
According to WHO, DOTS produces cure rates of up to 95 percent in even the poorest countries, and prevents new infections, at a cost of as little as US$10 per patient in some parts of the world.
DOTS is comprised of five key components; political commitment to sustained TB control activities, case detection by sputum smear microscopy, a standardized treatment regimen for six to eight months, the regular and uninterrupted supply of all essential anti-TB drugs, and a standardized recording and reporting system that allows for the assessment of treatment results.
Once patients with infectious TB have been identified using microscopy services, health and community workers and trained volunteers observe patients taking the full course of the correct dosage of anti-TB medicines.
In conforming with this, and to make use of the free medication, every patient admitted to the Baladewa clinic has to sign a letter of agreement. This must be acknowledged by the local administration and a third party, who commits to ensuring that the medication is taken correctly.
The letter, or contract, states that the patient has voluntarily promised to take the full course of medicine. They also agree to bring the empty plastic medicine packets with them to the clinic once a week, when they come for more medicine.
Should a patient fail to comply with the expressed procedure, he or she would be bound to repay the cost of the medicine that had been taken so far.
"This very rarely happens though. We have a compliance rate of more than 95 percent," Maria Heru Gunadi, vice president of PPTI, said.
The need for the contract stems from the fact that it is tempting for patients to stop taking their medication halfway through the course. Often they feel much better a few weeks into the treatment and mistakenly believe that they have been cured. Other times, the reason is simply that the patient is absent-minded or forgetful.
If the course is interrupted, or the dose of medicine is incorrect, the TB bacteria could become drug resistant. Treating a patient with multi-drug resistant TB (MDR-TB) is far more difficult.
"My son's mother-in-law has agreed to ensure that I take my medicine properly," Nihaya said.
Similar TB-treatment programs are available in 99 percent of the 7,240 public health clinics across Indonesia, Minister of Health Achmad Sujudi said, but this does not mean that the disease is under control, as people still have a low awareness of TB.
"DOTS only managed to reach 41.3 percent of all TB patients in 2003," he said, explaining that with the "more aggressive" dissemination of information the government expected the number to increase by 70 percent by 2005.
As for Nihaya, she did not always have such confidence in doctors and used to go to a dukun (shaman) for treatment.
"It didn't always made sense of course. I mean, what does rubbing a lemon up and down your arm has to do with curing chest pain, I ask you?" Nihaya said.
But after a variety of traditional treatments failed to bring about results, Nihaya decided to give the clinic a go.
"I don't really mind, you know, whether I get better or not, that's up to God, but at least I am doing my part in trying to get better," she said cheerfully.
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Circumcision may block HIV infection
LONDON: Circumcised men are less likely to be infected with the virus that causes AIDS because of biological reasons and not less risky behavior, scientists said on Friday.
Studies have shown that men whose foreskin has been removed are six to eight times less likely to become HIV positive but there has been some debate about the reason for the lower infection rate.
Researchers at Johns Hopkins University Medical School in Baltimore, Maryland, found that circumcision had a protective effect against HIV, but not against other sexually transmitted infections (STIs) such as syphilis or gonorrhea.
"The specificity of this relation suggests a biological rather than behavioral explanation for the protective effect of male circumcision against HIV," Dr. Robert Bollinger said in a report in The Lancet medical journal.
Although male circumcision is common in the United States, the practice varies throughout the world and is influenced by cultural and religious attitudes.
Bollinger and his team studied men in India, where circumcision is not common, between 1993 and 2000. All of the 2,298 men were attending one of three sexually transmitted disease clinics and were HIV negative at the start of the study. Their HIV status and risk behavior were assessed regularly.
Because circumcision did not prevent the men from infection with other STIs, Bollinger believes the study supports the hypothesis that protection is due to the removal of the foreskin, which contains cells that have HIV receptors which scientists suspect are the primary entry point for the virus into the penis.
"Our results suggest that the foreskin has an important role in the biology of sexual transmission of HIV," he said.
Some researchers have recommended male circumcision as a means to prevent the spread of HIV. Bollinger and his team called for clinical trials, where culturally acceptable, to assess the safety and effectiveness of male circumcision as a toll against AIDS.
They also stressed the need for new compounds to block the entry of the virus into the cell. -- Reuters
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Dairy foods reduce risk of obesity
Daniel Q. Haney Associated Press San Fransisco
Youngsters who skimp on milk and other dairy food to avoid calories actually appear to substantially increase their risk of becoming overweight, a study found.
Several reports in recent years have shown health benefits of dairy products, despite their fat content. The latest research shows an unusually striking effect on weight as children go through their teens.
Pediatricians in the United States say too much weight is now the most common medical condition of childhood. The problem has doubled over the past two decades, and about 15 percent are now considered overweight or obese.
While the overall cause is too much food and too little exercise, many studies are attempting to tease apart the precise changes in habits that are driving this health hazard. Several were reported at a meeting in San Francisco of the American Heart Association.
Lynn Moore, an epidemiologist at Boston University School of Medicine, found that just two servings of dairy food a day are linked to a substantial reduction in adolescent fatness.
Childhood dairy intake has been failing for the last 20 years, in part as youngsters' preferences have switched from milk to soft drinks. During this time, soda consumption has risen by 300 percent.
Another factor, though, has been fat phobia. Youngsters "consume less and less as they get older," Moore said. "Adolescent girls in particular are concerned about eating dairy because they think it will make them fat."
However, her research, based on the Framingham Children's Study, found just the opposite is true. The analysis was financed largely by the National Health, Lung and Blood Institute with additional funding from the National Dairy Council.
Several studies -- including Moore's -- have shown that children and adults who consume adequate amounts of dairy foods have lower blood pressure. Some researchers have put adults on diets with increased dairy and found, to their surprise, that they also seem to lose weight.
In the latest study, the researchers did frequent dietary surveys on 106 families with children and followed them an average of 12 years. They judged body fat by measuring the skin thickness on four parts of their bodies.
They found that those who consumed less than two servings a day averaged about an extra inch (2.5 centimeters) of fat in a fold of skin, a surprisingly large amount. The children's average skin fold thickness was 75 millimeters, while those who ate little dairy were 25 millimeters greater.
Dr. Stephen Daniels, associate chairman of the heart center at Cincinnati Children's Hospital, noted that the benefit was seen with a relatively modest amount of dairy food, and overdoing it could mean large amounts of extra fat calories.
"You shouldn't take home from this that you need to eat as much dairy as you can, but it should be part of an overall healthy diet," he said.
He also noted that no study has yet shown that adding milk to youngsters' diet actually helps them control weight. He said those who get regular dairy foods may weight less because they eat more home-cooked meals or have breakfast each morning.
Among other findings of Moore's study: * Youngsters who ate moderate amounts of fat -- between 30 percent and 35 percent of total calories -- weighed less than those who ate either more or less. * Increased consumption of fruits and vegetables was also associated with lower weight. * Contrary to one popular theory, the glycemic index of children's diet -- the amount of fast-burning carbohydrates -- had no bearing on their eventual weight gain.
Just how dairy food might moderate weight gain is a mystery. Moore speculated that calcium or some other nutrient in milk might help influence the way the body stores energy in fat cells. Or perhaps dairy foods simply make children feel less hungry.
Moore noted some parents who cannot eat dairy foods also withhold milk from their children, although lactose intolerance is usually not a problem among the young.
Another study at the conference, presented by Dr. Nicolas Stettler of Children's Hospital of Philadelphia, suggests the important of early infancy weight gain. He followed 1,850 pairs of full-term siblings to help sort out the effects of household and genetic factors.
Six percent of those who gained between 3.6 and 4.5 kilograms during their first four months of life were obese by the time they reached age six, compared with 3 percent of those who put on between 2.7 and 3.6 kilograms during this critical early period.
He said the work suggests that breast-feeding, which leads to less quick weight gain than formula feeding, may help prevent later obesity.
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U.S. FDA finds cancer-risk acrylamides in more food
Maggie Fox Reuters Washington, D.C.
Acrylamide, a cancer-causing substance that caused scares when it was found in fried potatoes and other popular foods, is also found in olives, prune juice and teething biscuits, U.S. regulators said on Thursday.
The U.S. Food and Drug Administration released figures on a new batch of food it tested and confirmed earlier findings that suggest cooked and especially fried snacks contain the highest levels -- potato chips (crisps), pretzels and popcorn.
To their relief, officials found no acrylamides in infant formula but said they would continue looking as it is a sole source of food for so many babies.
Scientists stress that they have no idea what any of this means, yet, for human health.
Acrylamide is naturally formed in some starchy foods when they are fried, baked, or roasted at high temperatures. No one suspected it was so pervasive in food until Swedish scientists announced they had found it in 2002.
"To date, acrylamide is known to cause cancer and reproductive problems in animals at high doses and is a neurotoxin in humans at high doses," the FDA said in a statement.
"Although initial reports of acrylamide's presence in some foods raised concerns because of possible links with increased risk of cancer in some laboratory animals, it was largely unknown how pervasive it was in the food supply, and its true public health significance for humans," the FDA added.
"Based on the current understanding of the science, FDA continues to advise consumers to eat a balanced diet, choosing a variety of foods that are low in trans-and saturated fat and rich in high fiber grains, fruits and vegetables."
Trans-fats are created when fat is processed and clog the arteries like cholesterol does.
To find out how much acrylamide people might be eating, the FDA has been testing popular food products. For its latest sample the FDA bought 750 different foods from bread to pancake syrup.
It found no acrylamide in the processed cheeses, milk and ice cream tested. Relatively high levels were found in arrowroot cookies -- commonly given to small children -- teething biscuits, sweet potatoes and lower levels in some prepared meals such as turkey and vegetable dinners.
Other childhood favorites such as peanut butter and chocolate chip cookies were also sources.
Home-cooked meats seemed acrylamide-free but fried chicken and fast-food chicken nuggets contained the compounds.
Fresh fruits and vegetables seemed clear but bottled prune juice and black olives had relatively high levels of acrylamides. The FDA says it plans more studies on just how toxic acrylamides may be.
In June a team at the City of Hope National Medical Center in Duarte, California, found that acrylamides can mutate DNA. Experts say the best way to find out if acrylamide causes cancer in people is to do epidemiological studies -- studies of populations to see if people who eat more foods containing acrylamides have higher rates of cancer.
One such study, published by U.S. and Swedish researchers in January 2003, found no link between acrylamide consumption and the risk of bladder or kidney cancer.
But a consumer group, the Center for Science in the Public Interest, is lobbying for limits on acrylamide in food. Rhona Applebaum, Executive Vice President of the National Food Processors Association, argued this would not be necessary.
"FDA's research on acrylamide levels in various foods is neither a warning to consumers nor a finding of risk associated with any particular foods or individual brands," she said in a statement.
More FDA data can be found on the Internet at http://www.cfsan.fda.gov/~lrd/pestadd.html#acrylamide.
REUTERS
GetRTR 3.00 -- MAR 26, 2004 02:44:58