Wednesday, 3 December 2008

In sickness and in health has moved

This blog has moved to my new personal website

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See you there!

Monday, 1 December 2008

World AIDS Day roundup

Today December 1st is World AIDS Day. As many as 33 million people worldwide are living with HIV, and there are 80,000 people with HIV in the UK. The aim of World AIDS Day is to raise awareness of the challenges and consequences of the epidemic - ultimately halting the spread of the HIV virus and improving the lives of people living with infection.

The UK theme for World AIDS Day 2008 is "Respect & Protect". Many people living with HIV face discrimination - this year's campaign hopes to highlight the responsibility everyone has to transform attitudes to HIV and encourage actions that stop its spread.> You can show your support for the campaign by wearing a red ribbon, which you can get your hands on in Gap, H&M, Selfridges and Levi's stores around the UK, as well as in Red Cross charity shops.

There is a whole selection of events and promotions worldwide to mark World AIDS day. For example, this weekend a flash mob descended on Glasgow town centre, "freezing" while handing each another red ribbons and condoms in the event organized by the British Red Cross.

South Africa is poised to grind to a halt for 15 minutes to talk about AIDS. This weekend the country received £15 million worth of support from the UK to tackle the HIV epidemic. In South Africa, 20–30% of the population is HIV positive and as many as 365,000 people have died unnecessarily thanks to the AIDS denialism of former president Thabo Mbeki.

Online, has launched the “Facing AIDS for World AIDS Day” campaign. Participants are invited to take a photo of themselves wearing a red ribbon and, on World AIDS Day, put the photo on their social networking site, blog, Twitter page, or website. There is also a Flickr group and a Facebook group where supporters can upload their pictures.

Digital magazine (RED)Wire by Product (RED), the charity run by Bono to engage the private sector in AIDS programmes, launched today. For a monthly subscription fee of £4, half of which will go to the Global Fund to help people in Africa with HIV and AIDS, users can get world premieres of exclusive tracks from the likes of Elton John, Jay-Z and Coldplay.

Bloggers Unite, a movement that aims to "harness the power of the blogosphere to make the world a better place", has invited bloggers to dedicate their blog posts today to issues related to HIV/AIDS, with the aim of reminding people that HIV/AIDS is still a critical issue and to promote HIV testing. You can follow World AIDS day on Twitter with the tag #WAD08.

There is also a World AIDS day Musical Festival in Second Life, which will feature HIV/AIDS presentations and displays, tours, writing workshops, and virtual red ribbons and t-shirts.

Friday, 28 November 2008

You've got mail... or chlamydia

The young people's sexual health charity Brook has teamed up with the NHS and the laboratory testing company Preventx to offer free chlamydia testing kits through the post.

By using the website, young people between the ages of 16 and 24 can order a postal home testing kit, return their urine sample or vaginal swab by post, and receive the results by text message, email or on the website's tracking service.

According to Brook, chlamydia is the most common sexually transmitted infection, with 1 in 10 people affected. Up to 75% of women and 50% of men with chlamydia have no symptoms, but left untreated the disease can cause serious health problems such as pelvic inflammatory disease and scarring of the reproductive system, and can lead to infertility.

Chlamydia can be treated easily with antibiotics, but these drugs can stop the contraceptive pill or patch from working.

Wednesday, 26 November 2008

'Two for the price of one' tactic improves outcomes after organ transplantation

A new study of more than a million transplant recipients has found that rejection rates are lower in patients who receive two organs at once than in those who receive a single organ.

The study, published in Annals of Surgery, found that the rejection rates for organs cotransplanted with a donor-specific liver, heart or kidney were significantly lower than those for organs transplanted alone.

It has been known for some time that transplanting a liver with another organ such as a kidney or a section of intestine reduces the likelihood of rejection of the primary organ, leading to the suggestion that liver allografts protect other organs from rejection. Combined liver and kidney transplantation is used in patients with hepatorenal syndrome - in which acute kidney failure occurs as a result of liver cirrhosis or fulminant liver failure - or in patients with end-stage renal disease who also have liver damage as a result hepatitis B or C virus infection. Simultaneous intestine and liver transplantation is used in patients with intestinal failure following the removal of a large section of intestine (e.g. because of a tumor) and end-stage liver disease, which may be due to receiving their meals intravenously following intestine removal (total parenteral nutrition).

The recent study by Rana et al. has revealed that heart and kidney allografts are also immunoprotective and are themselves protected when transplanted with another organ.

The authors searched the United Network for Organ Sharing database – which contains data about every transplant that has taken place in the US since 1986 – and identified all thoracic, kidney, intestine and liver transplant recipients over 18 years old.

In patients who simultaneously received heart and kidney transplants from a single deceased donor, the incidences of renal allograft rejection and cardiac allograft rejection at one year were lower than in patients who received either a heart or a kidney allograft alone. In addition, the rate of rejection-free survival at one year was higher in the combined organ recipients. Likewise, compared with patients who received a single organ, rejection of either organ and rejection-free survival were lower and higher, respectively, in individuals who received combined liver and kidney transplants.

On the other hand, cotransplantation of intestine or pancreas in patients undergoing kidney or liver transplantation did not lower the risk of rejection or improve rejection-free survival.

The authors suggest that combined simultaneous organ transplantation could be used more widely to reduce rejection rates and lower the need for immunosuppression in transplant recipients.
Rana A et al. (2008) The Combined Organ Effect: Protection Against Rejection? Annals of Surgery 248 (5): 871-879 DOI: 10.1097/SLA.0b013e31817fc2b8

Sunday, 23 November 2008

British Heart Foundation petition against cigarette machines

The British Heart Foundation has launched a petition to ban the sale of cigarettes from vending machines in the UK. The charity hopes that banishing cigarette vending machines will reduce the number of under 18s who take up smoking.

In the UK you need to be at least 18 years old to buy cigarettes from a shop and, technically, this old to get cigarettes from a vending machine. Vending machines aren't manned, however, making it easier for under 18s to circumvent this rule and get their hands on cigarettes. 66% of adult smokers started when they were under age, so stopping people from taking up smoking as teenagers is crucial to prevent a livelong addition to cigarettes.

According to the BHF, 6% of children aged 11-15 are regular smokers and as many as one in six of these teenagers buy their cigarettes from cigarette vending machines. A 2007 study reporting on test purchases by young people found that teenagers were able to buy cigarettes from vending machines on more than four in ten occasions, with a number of councils reporting a 100% successful purchase rate. Using vending machines was the most successful way for young people to get hold of cigarettes - almost twice as successful as other ways tested such as purchasing cigarettes from a newsagent, off licence or petrol station kiosk.

Smoking is a leading risk factor for heart disease - of the 114,000 smokers who die as a result of smoking each year in the UK, one in four die from cardiovascular disease. Measures to help people quit smoking, or stop them from smoking in the first place, are thus a key part of the BHF's strategy.
  • You can help put cigarette vending machines out of order for good by signing the BHF petition here.

Thursday, 20 November 2008

Chronic kidney disease patients claim to know nothing about their condition

A study by Finkelstein and colleagues published recently in Kidney International has found that as many of a third of patients with chronic kidney disease (CKD) claim to know nothing about their disease or about their treatment options when their kidneys ultimately fail.

CKD encompasses many types of kidney damage and is characterized by the gradual loss of renal function, often with few symptoms bar raised blood pressure and nonspecific signs such as fatigue and reduced appetite. CKD is graded on a 5-point scale, with stage 1 being slightly diminished kidney function and stage 5 being established kidney failure. Despite treatment many cases progress, in some instances to the point of kidney failure, otherwise known as end-stage renal disease. Once a patient reaches end-stage renal disease, they have to regularly undergo life-saving treatment that mimics the roles performed by their now defunct kidneys. Some such treatments include dialysis and kidney transplantation.

In the study by Finkelstein et al., 676 patients with stage 3–5 CKD who had been receiving nephrology care for about 5 years completed a questionnaire to assess their knowledge of CKD and of renal replacement therapies. Only 23% of patients reported having a great deal or extensive knowledge about their CKD and 35% reported having very limited or no knowledge. When questioned about their knowledge of renal replacement therapy, 35% of patients reported knowing nothing about any end-stage renal disease treatment modality.

Various studies have shown that decent education about CKD can delay the onset renal failure, increase the likelihood of the patient choosing a less costly home-based therapy rather than elaborate hospital-based dialysis, and improve outcomes of patients after the start of dialysis.

The findings of the Finkelstein et al. study indicate that despite receiving specialized kidney care for several years, many patients with CKD feel they have little knowledge of their disease and are, therefore, ill equipped to make treatment decisions. In an editorial accompanying the research, Chester Fox and Linda Kohn of University at Buffalo, New York, suggest that, "A multidisciplinary team - including dieticians, social workers, nurse educators, and pharmacists - and access to transplant surgeons are necessary to improve patient knowledge and understanding about progression of CKD and treatment options."

Finkelstein FO et al. (2008). Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies Kidney International 74 (9): 1178-1184 DOI: 10.1038/ki.2008.376

Another recent study, this time published in Archives of Internal Medicine, measured whether the introduction of early detection guidelines had improved the number of patients with CKD who were aware that they had the disease. The authors specifically asked 2,992 patients with stage 1-4 CKD whether or not they had been told that they had weak or failing kidneys. Between 1999 and 2004, awareness improved only in patients with stage 3 CKD. Patients with risk factors for CKD such as diabetes or hypertension were most likely to be aware of their disease.