Archive for June, 2011

Ancient Disease a New Problem in Hong Kong

Tuesday, June 28th, 2011 by

Hong Kong’s recent reporting of the deaths of two children from scarlet fever is a serious reminder that infectious diseases still pose a great risk in many parts of the world, even in places that have evolved from third world status.   

The death of a seven year old in May and was the first casualty of scarlet fever in ten years. When the second death (a five year old) occurred on June 21st, officials grew increasingly concerned.  Both children deteriorated very quickly from two different antibiotic-resistant strains of scarlet fever, according to Kwok-yung Yuen, head of Hong Kong University’s microbiology department, who sequenced samples taken from the current outbreak. One of the two strains appears to be more dominant, and has undergone a genetic mutation that increases its ability to spread. 

Scarlet fever, also known as scarlatina, is rarely seen by physicians in the developed world.  Most medical students in the United States would likely miss the diagnosis despite its classic presentation- fever, sore throat, a sandpaper rash and bright tongue. The widespread use of penicillin during the 20th century virtually wiped out the infection, but overuse of both penicillin and other antibiotics such as erythromycin and clindamycin have allowed bacteria such as the streptococcus strains responsible for scarlet fever to develop resistance. Fortunately, penicillin has thus far weathered the storm and is still effective against the bug, a fact that is very surprising to Mark Walker, a microbiologist and strep expert who heads the Australian Infectious Disease Research Center. “We’re very lucky. We still have a treatment we can use.”  

 “Germs outsmarting antibiotics is a cause of lots of nightmares,” said Dr. Edward Kaplan, who heads a World Health Organization research center at the University of Minnesota that focuses on the streptococcus germ. “The fact that we still have penicillin is something we all get down on our knees and say prayers about each night.” 

Along with the nearly 550 cases of scarlet fever reported this year, which is already double Hong Kong’s annual number, there are over 9,000 cases in mainland China.  Although resistance to alternative antibiotics used by those allergic to penicillin is not new, the severe toxicity and ease of spread of the new strains seen this year is what concerns health officials the most. As the development of vaccines is years away, controlling the spread of the illness and the judicious use of antibiotics is now the top priority. 

Those traveling with children are advised to research their destination for any reported outbreaks of infectious disease.

Photo from choa.org.

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DVT and the Traveling Athlete

Monday, June 27th, 2011 by

Sitting for long periods of time while traveling, whether by airplane, train or car, can increase a traveler’s risk for developing a blood clot.  Research shows that this low-activity situation and the environmental conditions of a plane increase a person’s risk of deep vein thrombosis (DVT). DVT is the formation of blood clots in your veins, usually in the legs or pelvic region. These clots can break loose and travel upwards to get stuck in your lungs and block off blood flow and oxygen transport — a condition known as pulmonary embolism (PE). Simply by being an endurance athlete, your chances for DVT and PE are increased. Assuming no other known causes, one study shows that almost ¾ of all DVT and PE in air travelers occurs in endurance athletes.

Let’s take a closer look as to why this is. Endurance athletes have above average blood volume and slow resting heart rates. This is part of the physiological adaptation that allows the massive increase in oxygen delivery to your muscles that is necessary during training and racing. Endurance athletes can increase their cardiac output to levels much higher than what an untrained individual could sustain. However, when they get on a plane and sit in their seats, endurance athletes then have slower blood flow velocities in their veins and an increased risk of clot formation due to this by-product of their good health.  After racing, especially, the risk of clotting is increased even more by the blood vessel and muscle damage and the enhanced tendency of the blood to clot caused by the stress of racing. Research suggests employing the following strategies while traveling to help minimize one’s risk of DVT and PE:

  • Avoid Dehydration – Drink plenty of water or electrolyte replacement drinks like Gatorade.
  • Move around often – Walk around your train or plane every so often. If you are driving, pull over and stretch your legs for a couple of minutes every hour or so. It is also recommended to exercise your legs at least once every hour while seated.
  • Wear low leg compression socks – These are used often by professional sports teams and are an especially good idea if you’re traveling for more than 2 or 3 hours.
  • Consider blood thinners – Aspirin, niacin, and tea are examples of good non-prescription blood thinners. If recommended by a physician, medical blood thinners such as Heparin are effective as well.

It’s strange to think that being in excellent physical condition can put you at higher risk for a condition that, if not caught right away, can very easily kill you. However, this should not be a factor that hinders athletes from competing. Just follow the simple suggestions above and remain conscious of how often you move around – keep your legs loose and active.

Traveling to compete in regional or global events is a wonderful opportunity for an athlete. In order for an athlete to make the most of these situations, it’s important to recognize that travel itself can be a formidable opponent and to take the steps necessary to keep healthy during the journey.

Author: Derek Giannetti
Derek Giannetti, a guest contributor to the Healthy Travel blog, is an upcoming junior at Ursinus College where he plays football and studies Exercise and Sports Science. Upon graduation, Derek hopes to pursue a career in Health and Physical Education.

Photo by Konabish.

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Jet Lag and the Traveling Athlete

Monday, June 27th, 2011 by

Traveling often goes hand-in-hand with being a competitive athlete. Whether it’s a professional football player or an endurance runner, traveling before competition and, in some cases, traveling in general can decrease athletic performance and expose the athlete to health risks. In this two part series I’ll address these specific threats: Jet lag and Deep Vein Thrombosis (DVT).

We all know about, or at least have heard of, jet lag. It is a condition characterized by sleep loss, headaches, dizziness, fatigue, decreased energy, alertness, and cognition. This occurs due to air travel through multiple time zones, which causes a disruption in circadian rhythm and sleep-wake cycles. Circadian rhythm is like the body’s internal clock, running on a 24 hour cycle. It promotes, under normal circumstances, a normal sleep-wake cycle. The rhythm can be modified by bright light, darkness, melatonin (a hormone) and exercise. The strongest influence of the cycle seems to be the environment’s light-dark cycle. When the light-dark cycle is different from what the body is used to, the body’s sleep-wake cycle can be altered.

There is no clear-cut evidence that jet lag decreases athletic performance, but it is pretty widely accepted. Jet lag can negatively alter an athlete’s physiological and emotional well-being. Feeling fatigued and physically drained is clearly not the ideal mindset for competing at one’s best. There are, however, ways that athletes “reset” their circadian cycles to match their destination’s time zone. To deal with the changes in time zone and best prevent the prospect of jet lag, athletes are advised to do a number of things before, during and after traveling:

Before a Flight:

  • Plan for travel well in advance to avoid stressful situations
  • Get plenty of sleep – avoid sleep deprivation
  • Gradually shift your sleep schedule a few days before leaving (30 minutes to 1 hour per day) to match up with your destination’s time zone

During a Flight:

  • Drink plenty of water and/or fruit juice and limit caffeine and alcohol intake to avoid dehydration
  • Stretch and walk around at least once every hour to minimize muscle stiffness
  • Use earplugs to minimize noise exposure and improve sleep
  • Avoid sleeping pills unless recommended by your physician

After a Flight:

  • Avoid heavy or exotic/spicy meals
  • Exercise at low intensity to reduce muscle stiffness
  • Avoid heavy training for a few days after a long flight

Jet lag is just one of the disruptions caused by long trips; we’ll discuss the threat of deep vein thrombosis (DVT) in a future post.

Author: Derek Giannetti
Derek Giannetti, a guest contributor to the Healthy Travel Blog, is an upcoming junior at Ursinus College where he plays football and studies Exercise and Sports Science. Upon graduation, Derek hopes to pursue a career in Health and Physical Education.

Photo by See-ming Lee.

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Will Going Mobile Finally Speed Adoption of Personal Health Records?

Monday, June 20th, 2011 by

In a (somewhat) recent post on Sean Nolan’s blog, Family Health Guy, we learn that Microsoft’s HealthVault is going mobile.  I think this is big news for the adoption of personal health records, or PHRs.

Privacy concerns, the difficulties associated with integrating information from the myriad of players in the health care industry and lack of better or complete standards for PHR has hampered the adoption of their use.

As one of the three top players in the PHR field, along with Google Health and Dossia, Microsoft may be in the best position to take the lead.  While Dossia operates under a different model (it is a non-profit working for the benefit of its founder companies and additional employers), HealthVault and Google Health are focused mainly on the “P” in PHR – the patient or person.  Microsoft’s leadership in taking the PHR mobile may be just what is needed to break through and convince people that it is worth it to have a PHR, keep it up to date and use it when seeking health care.

Microsoft has also been smart, as Nolan points out, by making sure that HealthVault works well with all of the main mobile platforms.  They will soon release SDKs for Apple’s iOS and Google’s Android operating systems; the SDK for Windows Phone 7 is out.

I am excited to see how quickly Microsoft’s move ushers in a new generation of innovative and deeply capable mobile health applications that take advantage of integration with one’s PHR.  What’s available so far in the app stores does not address many of the shortcomings that seem to be holding back adoption of PHRs.

What do you think?  Do you have a PHR?  Are you still concerned about privacy issues?  Will making them mobile make a difference in your thinking?

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FDA Regulations Call for Broad Spectrum Sun Protection

Thursday, June 16th, 2011 by

After decades of debate, the FDA has finally released guidelines for sunscreen products that will help protect consumers against both sunburn — caused by ultraviolet B rays, and skin cancer and aging — caused by more dangerous ultraviolet A rays.  The guidelines also set limits on acceptable sun protection factor (SPF) levels.

New regulations will require manufacturers to specifically address whether or not their products block both UVA and UVB rays.  The new buzzword from the FDA is “broad spectrum” to describe sunscreen that blocks both.  They also require manufacturers to market sunscreens with a SPF rating of at least 15, but less than 50, unless they have data to substantiate a higher number.   ”These changes to sunscreen labels are an important part of helping consumers have the information they need so they can choose the right sun protection for themselves and their families,” said Dr. Janet Woodcock, director of FDA’s drug division. The majority of consumers are not aware that most sunscreens on the market today are designed to only prevent sunburn by blocking out UVB rays, while affording little to no protection against UVA rays.  The FDA is hoping that this will soon change.

Malignant melanoma, the most deadly form of skin cancer, is diagnosed each year in over 65,000 Americans, resulting in almost 9,000 deaths.  Dermatologists recommend that in order to prevent melanoma and the other ravaging effects of exposure, sunbathing enthusiasts should apply a sunscreen that is “broad spectrum” and with a SPF of 30 or greater every two hours.  The FDA is also banning sunscreen claims such as “sweatproof” and/or “waterproof”, which the agency says are “exaggerations of performance.”

Starting in 2012, if a sunscreen product does not protect against both UVA and UVB rays, or if the sun protection factor is below 15, then it must have a disclaimer which reads “This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”  In order to be compliant, some manufacturers, such as Coppertone and Neutrogena, already have labels that read “broad spectrum UVA and UVB protection.”

Whether you’re spending the day at the beach or taking a ten minute walk in the sun, take the necessary precautions to protect your skin.

Photo by sgt fun.

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World Blood Donor Day – More Blood More Life

Tuesday, June 14th, 2011 by

A safe blood supply is something many in the U.S. take for granted.  All countries don’t employ the same precautions to ensure their blood bank is safe or have an adequate supply available – for example in some areas in Europe, patients are required to find donors to replace the blood they use.

June 14, 2011 marks the annual recognition of World Blood Donors Day. As described by the World Health Organization (WHO) this worldwide event is meant to “raise awareness of the need for safe blood and blood products and to thank voluntary unpaid blood donors for their live-saving gifts of blood.”

In the U.S. every two seconds someone needs blood. If you’re looking to help provide a solution to this problem, visit the American Red Cross website to find a blood drive.

If you’re abroad and want to join in on the festivities, view the list of world events here.

Thanks to all who give!

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Volcanic Ash Cloud Continues to Imperil Travelers in South America, Australia and New Zealand

Monday, June 13th, 2011 by

Ten days of intermittent erupting by Chile’s Puyehue volcano has created an ash cloud stretching 6,000 miles through the atmosphere to Australia and New Zealand. The latest news reports carry accounts of cancelled flights throughout the southern hemisphere. On the ground, volcanic ash closed roads in southern Patagonia (Argentina).  Air traffic is reportedly often able to skirt the ash particles by flying at lower altitudes, but airports in Buenos Aires, Argentina and Montevideo, Uruguay halted flights today.

Photo by sacabezas.

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E. coli Detective Work Produces No Answers

Tuesday, June 7th, 2011 by

Although it has been over a month since the first case of enterohemorrhagic E. coli was reported in Germany, officials in that country have yet to identify the source of the outbreak.  Although both Spanish cucumbers and sprouts grown by German farmers have been implicated, further tests have failed to substantiate initial claims.  The inability to positively identify the source of the bacteria is rapidly becoming a source of embarrassment for the country.

German officials acknowledge that time is not on their side, as the number of new cases appears to be on the decline, and testing produce several weeks after the initial outbreak may no longer be helpful.  Dr. Guenael Rodier, an epidemiologist at the World Health Organization, told the Associated Press on Tuesday that the contaminated vegetables have likely disappeared from the market and it will be difficult to link patients to produce so long after they first became infected. He added, “If we don’t know the likely culprit in a week’s time, we may never know the cause.”

Despite the fact that the source remains elusive, there is little question that vegetables are the culprit and that washing and peeling all fruits and vegetables is the only sure way to prevent food-borne illness.

Photo by shawnleishman.

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E. coli: Search for the Source Continues

Monday, June 6th, 2011 by

Scientists continue to work to identify the source of the new deadly strain of E. coli bacteria that has infected over 2,200 people in 12 European countries. “This is a unique strain that has never been isolated from patients before,” Hilde Kruse, a food safety expert at WHO, told The Associated Press.  The new strain has “various characteristics that make it more virulent and toxin-producing” than the many E. coli strains people naturally carry in their intestines.

Despite speculation over the weekend that the outbreak could be traced to a German bean sprout farm, the search for the source continues.  German authorities on Sunday issued a warning against eating any sprouts and repeated earlier warnings against eating tomatoes, cucumbers and lettuce.  The WHO is recommending the usual precautions to avoid illnesses that are transmitted by raw food — wash hands before eating or cooking and wash and peel all fruits and vegetables, especially if eaten raw.

HTB will continue to monitor what is turning out to be the worst outbreak of E. coli-related illness in eleven years, and already the third-largest involving E. coli in recent world history.

Photo by agrilifetoday.

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Rare Bacterial Infection Hits Europe

Wednesday, June 1st, 2011 by

An unusually toxic version of the “Montezuma’s revenge” bacteria known as enterohemorrhagic E. coli, or EHEC,  is sweeping Europe this week and is now thought to be responsible for at least 17 deaths and over 1,500 cases of severe illness known as “hemolytic uremic syndrome.”  The World Health Organization (WHO) said cases of the E. coli illness have been reported in nine European countries: Austria, Denmark, Germany, the Netherlands, Norway, Spain, Sweden, Switzerland and the U.K. All but two cases are either people in Germany, or people who had recently traveled to northern Germany, the organization said.  The source of the food borne bacteria, generally found on vegetables, has thus far evaded health officials. Scientists are working hard to find the source of the contaminated vegetables.

Benign strains of the E. coli inhabit the human intestinal tract, while other strains are responsible for much of the diarrhea experienced by travelers to underdeveloped countries with poor water sanitation.  But EHEC, causes more severe symptoms, ranging from bloody diarrhea to the rare hemolytic uremic syndrome (HUS), in which E. coli infection attacks the kidneys, sometimes causing seizures, strokes, comas and death.

“The idea of an outbreak of over 300 hemolytic uremic syndrome cases is absolutely extraordinary,” said Dr. Robert Tauxe, deputy director of foodborne, waterborne and environmental diseases at the U.S. Centers for Disease Control.  “There has not been such an outbreak before that we know of in the history of public health,” Tauxe said, adding that the German strain of E. coli has not been seen in the United States.

Anyone traveling to Europe should be aware of the situation and avoid the consumption of raw vegetables until the situation is resolved.

If you want to track the situation, The Guardian has created an interactive map to track the E. coli spread across Europe.

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