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Widespread testing begins on malaria vaccine

Mothers wait for their children to be vaccinated against malaria at the start of a pilot program at Mitundu Community Hospital, in Lilongwe, Malawi, on April 23, 2019.

    With malaria deaths rebounding worldwide, a pilot program testing a new and fiercely debated malaria vaccine began on Tuesday in Malawi. Dr. Katherine O’Brien, the World Health Organization’s director of immunization, called the rollout “a historic moment in the fight against malaria,” and said the testing will soon expand to malarious regions of Ghana and Kenya. But the vaccine, known as RTS,S, or Mosquirix, has been in development for more than 30 years, and it has serious drawbacks that have led some experts to argue that it does not work well enough to spend millions of dollars pursuing.

    Malaria kills about 450,000 people a year, most of them young African children. Over the last 15 years, the death rate has been reduced by more than half through extensive, donor-funded efforts to hand out free mosquito nets, spray homes with insecticide and treat people with a new generation of medicines. Nevertheless, deaths have increased again as money has run short, populations have grown, resistance to some new drugs has emerged and mosquitoes have expanded their ranges. Finding new weapons is crucial, experts agree, but making a malaria vaccine has proved challenging in the extreme.

    The new vaccine has many weaknesses. It is inconvenient: a child must receive four injections before age 2, sometimes at intervals that do not match the routine vaccine schedules for most other diseases. And it is only partly effective. Testing in more than 10,000 African children from 2009 to 2014 showed that, even after four doses, the vaccine prevented only about 40 percent of detectable malaria infections. The vaccine reduced the occurrence of severe malaria by about 30 percent. It did not protect well against parasite strains that were poor genetic matches, raising a concern that, over time, parasites could evolve resistance to the vaccine as they have to drugs.

(Donald G. McNeil Jr. www.nytimes.com, 24.04.2019. Adaptado.)

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In place of submitting a traditional application for admission, prospective students may choose to apply for admission under the Test Score Application System. Under this system, the University accepts as applications the official score reports from either the American College Test (ACT) or the Scholastic Aptitude Test (SAT). High School juniors and seniors who take the ACT or the SAT should indicate this university as a score recipient of their ACT or SAT registration form. Upon receipt of the ACT Student Profile report or the SAT report, the Admissions Office will notify students of their eligibility for admission. Under this system, itis unnecessary to submit a high school transcript until after graduation unless the student wishes to apply for a scholarship.

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Reducing preventable harm in hospitals

Each year, in the United States, millions of patients are harmed while receiving care in hospitals.
They get infections, experience adverse reactions to drugs, develop dangerous bedsores or come
down with pneumonia from the very ventilators meant to help them breathe.
The estimates of the number of people who die each year as a result of hospital errors have ranged
[5] from as many as 98,000 in a landmark Institute of Medicine report from 1999 to as many as 440,000
in a 2013 study.
It’s believed that most of these deaths could be prevented if health care providers always adhered
to evidence-informed practices. In recent years, the Centers for Medicare and Medicaid Services,
have sought to drive improvements by linking payments to hospital performance, including patient
[10] safety.
Amid the complexity, the chaotic pace and the increasing need for coordination, how can hospitals
do better to improve patient safety? How can they ensure, for example, that every single time a
patient receives a medication, precautions are taken to reduce the risks of an adverse drug reaction?
The big challenge is not just designing systems with better defenses; it is gaining acceptance for
[15] them, and properly implementing them. Over the past decade, for example, many hospitals have
adopted a key feature of aviation safety − checklists − to improve safety in areas where standard
protocols can save many lives, such as inserting central line catheters, using ventilators and while
performing surgery and assisting childbirth.
When the checklists are well implemented, the results of their use have been stunning. However,
[20] as checklists have proliferated, the results have been inconsistent, often because front-line
practitioners rejected them or adopted them halfheartedly. The devotion to protocol that pilots
see as integral to their professionalism is derided by some doctors as “cookbook medicine”. Atul
Gawande, a surgeon and contributor to The New Yorker, has said that the high value that physicians
place on autonomy and independence makes them reluctant to submit to checklists.
[25] So the big question is: how can health systems be made safer when success means changing the
attitudes and habits of health care professionals at a time when many are overwhelmed and deeply
frustrated by all of the demands being made on them? What does it take to get them to embrace,
with urgency, new ways of working?

opinionator.blogs.nytimes.com

Controlling the global obesity epidemic
The challenge

    At the other end of the malnutrition scale, obesity is one of today’s most blatantly visible – yet most neglected – public health problems. Paradoxically coexisting with undernutrition, an escalating global epidemic of overweight and obesity – “globesity” – is taking over many parts of the world. If immediate action is not taken, millions will suffer from an array of serious health disorders.

    Obesity is a complex condition, one with serious social and psychological dimensions, that affects virtually all age and socioeconomic groups and threatens to overwhelm both developed and developing countries. In 1995, there were an estimated 200 million obese adults worldwide and another 18 million under-five children classified as overweight. As of 2000, the number of obese adults has increased to over 300 million. Contrary to conventional wisdom, the obesity epidemic is not restricted to industrialized societies; in developing countries, it is estimated that over 115 million people suffer from obesity-related problems.

    Generally, although men may have higher rates of overweight, women have higher rates of obesity. For both, obesity poses a major risk for serious diet-related noncommunicable diseases, including diabetes mellitus, cardiovascular disease, hypertension and stroke, and certain forms of cancer. Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life.

The response: making healthy choices easy choices

    World Health Organization began sounding the alarm in the 1990s, spearheading a series of expert and technical consultations. Public awareness campaigns were also initiated to sensitize policymakers, private sector partners, medical professionals and the public at large. Aware that obesity is predominantly a “social and environmental disease”, WHO is helping to develop strategies that will make healthy choices easier to make.

In collaboration with the University of Sydney (Australia), WHO is calculating the worldwide economic impact of overweight and obesity. It is also working with the University of Auckland (New Zealand) to analyse the impact that globalization and rapid socioeconomic transition have on nutrition and to identify the main political, socioeconomic, cultural and physical factors which promote obesogenic environments.