The World at 7 Billion

31 October 2011 | The World at 7 Billion

The arrival of the 7 billionth person on 31 October presents a rare moment to reflect on the slow but relentless demographic trends that shape our lives and our environment.

Population is growing fastest in the poorest countries, where people are least able to fulfill their basic needs. Indeed, ninety percent of the largest generation of adolescents in history live in the developing world, and they are now entering the childbearing years.

This number of adolescents entering their reproductive years means that high-quality, voluntary family planning services are more important than ever. They must meet the needs of this new generation of clients. This surge of young people requires accelerated investment in human development, particularly girls’ education. Educating girls is a powerful way to reduce birth rates. Data have shown that when women are educated they usually opt for smaller families, are more capable of overcoming obstacles to family planning use, and have more opportunity to become employed.

In their own voices, Council president Peter Donaldson, demographer John Bongaarts, community health physician Saroj Pachauri, and researcher Kelly Hallman describe the far-reaching implications of investing in family planning and young people. Read more >>

A world of 7 billion is both a challenge and an opportunity. We are focused on the opportunity to improve the lives of the world’s most vulnerable people.

Intrauterine Devices Might Prevent More Than Pregnancy.

Meta-analysis shows that IUDs provide protection against cervical cancer.
Because intrauterine devices (IUDs) pass through the cervix, concern has been raised that use of these highly effective reversible contraceptives might affect risk for cervical cancer. To explore the possible associations between IUD use, cervical cancer risk, and presence of cervical human papillomavirus (HPV) DNA, researchers pooled international data from 10 case-control studies of cervical cancer and 16 survey studies of HPV prevalence. Information on IUD use was obtained via interviews, and HPV status was determined with polymerase chain reaction–based assays. The case-control studies involved 2205 women with cervical cancer and 2214 matched controls without cervical cancer; an additional 15,272 healthy women participated in the HPV prevalence studies.
In meta-analyses adjusted for factors such as number of previous Pap smears, cervical HPV DNA status, and age at sexual debut, a protective association was found between ever use of an IUD and cervical cancer (odds ratio, 0.55; P<0.0001), whether squamous-cell carcinoma (OR, 0.56; P<0.0001) or combined adenocarcinoma and adenosquamous carcinoma (OR, 0.46; P=0.035). This benefit was not related to duration of IUD use. Among women without cervical cancer, IUD use was not associated with detection of cervical HPV DNA.
Comment: The mechanisms by which intrauterine device use might lower the rate at which human papillomavirus infection progresses to cervical cancer remain unclear. The authors hypothesize that IUDs might exert this protective effect by inducing a chronic, low-grade, sterile inflammatory response in the endocervical canal that could modify the course of HPV infection. Alternatively, preinvasive cervical lesions might be removed when the device is placed or removed. Although the authors controlled for many confounders, the possibility remains that screening bias led to residual confounding. Although types of IUDs were not specified in this analysis, in the countries where these studies were conducted, few women use hormone-releasing IUDs; thus, future work should be aimed at examining whether levonorgestrel-releasing IUDs prevent cervical cancer.
Published in Journal Watch Women's Health October 13, 2011

Malaria Vaccine: Interim Results Show Promise

Each year, malaria occurs in approximately 225 million persons worldwide,
and 781,000 persons, mostly African children,die from the disease. During the past decade,the scale-up of malaria-control interventions has resulted in considerable reductions in morbidity and mortality associated with malaria
in parts of Africa. However, malaria continues to pose a major public health threat. A malaria vaccine, deployed in combination with current malaria-control tools, could play an important role in future control and eventual elimination of malaria Worldwide.
Study of the efficacy, safety, and immunogenicity of candidate
malaria vaccine RTS,S/AS01  conducted in seven African countries showed an efficacy of 56% in interim, phase III results published in the New England Journal of Medicine. The study was partially funded by and included scientist-employees of the vaccine maker. After 12 months of follow-up among 6000 African children vaccinated at age 5 to 17 months, the incidence of malaria was 0.44 per person-year among RTS,S/AS01 recipients and 0.83 among recipients of a control vaccine. Meningitis was more frequent among RTS,S/AS01 recipients.
An editorialist praises the work, while wondering about the duration of the vaccine's protection and its cost.
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Clean Care is Safer Care .

SAVE LIVES: Clean Your Hands

The My 5 Moments for Hand Hygiene approach defines the key moments when health-care workers should perform hand hygiene.

This evidence-based, field-tested, user-centred approach is designed to be easy to learn, logical and applicable in a wide range of settings.

This approach recommends health-care workers to clean their hands

Pharmacokinetics of antimalarials in pregnancy: a systematic review

Malaria is a serious parasitic infection, which affects millions of people worldwide. As pregnancy has been shown to alter the pharmacokinetics of many medications, the efficacy and safety of antimalarial drug regimens may be compromised in pregnant women. The objective of this review is to systematically review published literature on the pharmacokinetics of antimalarial agents in pregnant women. A search of MEDLINE (1948-May 2011), EMBASE (1980-May 2011), International Pharmaceutical Abstracts (1970-May 2011), Google and Google Scholar was conducted for articles describing the pharmacokinetics of antimalarials in pregnancy (and supplemented by a bibliographic review of all relevant articles); all identified studies were summarized and evaluated according to the level of evidence, based on the classification system developed by the US Preventive Services Task Force. Identified articles were included in the review if the study had at least one group that reported at least one pharmacokinetic parameter of interest in pregnant women. Articles were excluded from the review if no pharmacokinetic information was reported or if both pregnant and non-pregnant women were analysed within the same group. For quinine and its metabolites, there were three articles (one level II-1 and two level III); for artemisinin compounds, two articles (both level III); for lumefantrine, two articles (both level III); for atovaquone, two articles (both level III); for proguanil, three articles (one level II-1 and two level III); for sulfadoxine, three articles (all level II-1); for pyrimethamine, three articles (all level II-1); for chloroquine and its metabolite, four articles (three level II-1 and one level II-3); for mefloquine, two articles (one level II-1 and one level III); and for azithromycin, two articles (one level II-1 and one level III). Although comparative trials were identified, most of these studies were descriptive and classified as level III evidence. The main findings showed that pharmacokinetic parameters are commonly altered in pregnancy for the majority of recommended agents. Importantly, first-line regimens of artemisinin-based compounds, lumefantrine, chloroquine and pyrimethamine/sulfadoxine may undergo significant changes that could decrease therapeutic efficacy. These changes are usually due to increases in the apparent oral clearance and volume of distribution that commonly occur in pregnant women, and may result in decreased exposure and increased therapeutic failure. In order to assess the clinical implications of these changes and to provide safe and effective dosage regimens, there is an immediate need for dose-optimization studies of all recommended first- and second-line agents used in pregnant women with malaria.SOURCE

Obesity

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height.
Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might tip the balance include your genetic makeup, overeating, eating high-fat foods and not being physically active.
Being obese increases your risk of diabetes, heart disease, stroke, arthritis and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Ibuprofen may ‘raise miscarriage risk’

Women who take even a small dose of painkillers such as ibuprofen early in their pregnancy more than double their risk of suffering a miscarriage,” reported The Guardian.
This news story covered a study that looked at women who had miscarried in early pregnancy and compared their use of non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, diclofenac and naproxen) with that of pregnant women who had not miscarried. The researchers found the risk of miscarriage to be 2.4 times greater in women taking any type of NSAID, compared with women not taking these drugs.
The findings of this large well-conducted study are likely to be reliable. NSAIDs are already known to carry potential risk in pregnancy, and the British National Formulary states that they should be avoided during pregnancy, unless the potential benefit is expected to outweigh the risks. Other potential risks that have been associated with NSAID use include delayed onset of labour and failed closure of the ductus arteriosus, which forms part of the foetal heart circulation.
Paracetamol is regarded as safe to take during pregnancy, when pain relief is needed. Pregnant women who are in need of regular pain relief, or who are finding paracetamol insufficient, are advised to consult their doctor, as the cause of pain and the most appropriate course of management require proper medical assessment.
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