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We give you many useful information about health

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Minggu, 04 Desember 2011

Measles outbreaks on the rise across Europe

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AppId is over the quota
LONDON (AP) — After years of decline, measles is on the rise in Europe, according to a new report released Thursday.

As of October, European health officials reported more than 26,000 measles cases this year and nine deaths. That's a threefold increase in cases from the same time period in 2007, said the World Health Organization.

France accounted for about 14,000 cases, mainly in children older than five and in young adults.

Other big outbreaks of the highly-contagious disease have been identified in Spain, Romania, Macedonia, and Uzbekistan. So far, measles has killed nine people in Europe and hospitalized thousands of others. The report was published Thursday by the U.S. Centers for Disease Control and Prevention.

"We are seeing a surge of cases much larger than we've seen in the past five or six years," said Rebecca Martin, immunization program manager for WHO's Europe office in Copenhagen. Measles cases had been dropping for years, but began to increase sharply in late 2009.

Martin said the epidemic was fueled mainly by low vaccination rates and noted about half the cases were in people older than 15.

"Over the years, people who haven't been vaccinated are now giving the virus a big opportunity to spread," Martin said.

The report said overall vaccination rates in Europe were high, but still didn't meet the 95 percent target needed to stop outbreaks. Of the people who got measles, about half weren't vaccinated and the vaccination histories of many of the others was unknown.

More cases in Europe have also meant spillover elsewhere. The U.S. has 205 cases this year — the most in a decade — and virtually all are linked to other regions, including 20 cases from Europe. Because North America has so little measles, every imported case requires a thorough investigation and response costing tens of thousands of dollars, Martin said.

The U.S. normally only has about 50 cases a year. In May, international health officials posted an alert urging travelers everywhere to get vaccinated before flying overseas.

Measles is highly contagious and up to 90 percent of people exposed to an infected person get sick, experts say. The virus spreads easily through the air, and in closed rooms, infected droplets can linger for up to two hours after the sick person leaves.

It causes a fever, runny nose, cough and a rash all over the body. The disease kills about one to two children for every 1,000 it infects, and can also cause pregnant women to have a miscarriage or premature birth.

In 2008, there were about 164,000 measles deaths worldwide. More than 95 percent of those deaths were in poor countries.

Health officials say controlling measles outbreaks in Europe is still being compromised because of ignorance of the disease's severity and skepticism about the vaccine.

The measles shot was tainted by now discredited research published by Andrew Wakefield in 1998 suggesting a possible link between autism and the vaccine for measles, mumps and rubella. Parents abandoned the vaccine in droves and suspicion about its safety still lingers, even though repeated studies have shown no connection.

Unlike in the U.S., where most states require children to be vaccinated against measles before starting school, no such regulations exist in most of Europe.

Spain and Switzerland exclude unvaccinated children from school during measles outbreaks, but don't otherwise insist on vaccination. In France and Britain, parents are advised to have their children immunized if they haven't received the measles shot, but there is no penalty for not doing so.

WHO's Martin said Europe's measles epidemic appeared to be on the decline. She said France and Switzerland were planning to offer the measles vaccine to older age groups in the future.

She warned people who skipped the shot that measles is not a mild disease.

"It's a dangerous decision not to get vaccinated," she said. "One death is too many when we have an effective vaccine."

____

AP Medical Writer Mike Stobbe contributed to this report from Atlanta.

___

Online:

CDC report:www.cdc.gov/mmwr/

(This version CORRECTS Corrects number of cases in U.S. to 205, not 250)

Associated Press

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Sabtu, 01 Oktober 2011

Rates of diabetes-related amputation vary across U.S.

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AppId is over the quota
By Amy Norton

NEW YORK | Fri Sep 30, 2011 12:19pm EDT

NEW YORK (Reuters Health) - Rates of foot and leg amputations among Americans with diabetes may vary widely according to where they live, a new study suggests.

About 26 million Americans have diabetes, and an estimated 65,000 had a lower limb amputation in 2006, the most recent year with available data.

One recent study found that the rate of amputation may be declining among Americans with diabetes. But the new findings, reported in the journal Diabetes Care, suggest that in some parts of the country that rate can be almost double the national average -- at least among older Americans.

Amputation is a complication of diabetes because the disease often causes nerve damage over time. When people lose sensation in their feet and legs, they may more easily get a cut, blister or sore -- even from ill-fitting shoes -- and be less likely to notice it until it's infected.

Those wounds can be difficult to heal because diabetes often causes poor blood circulation to the lower limbs. In severe cases, doctors may choose to amputate a foot or leg to prevent a dangerous, systemic infection.

The current study found that in 2008, certain pockets of Arkansas, Louisiana, Mississippi, Oklahoma and Texas had the highest rates of diabetes-related amputation among Medicare beneficiaries -- at about 7 to 8 per 1,000.

That compared with a national rate of 4.5 per 1,000 in the same year. And certain locations -- like portions of Arizona, Florida, Michigan and New Mexico -- had particularly low rates. There, older adults with diabetes had amputations at a rate of 2.4 to 3.5 per 1,000.

"The rate of amputation really varies greatly," said lead researcher Dr. David J. Margolis, of the University of Pennsylvania in Philadelphia. "We don't know why that is, we just know that it's there."

The researchers were able to account for some factors -- like the prevalence of diabetes in a given area, the number of people diagnosed with diabetic foot ulcers, and an area's income and racial mix. That explained some of the geographical variation, Margolis told Reuters Health, but not all of it.

He cautioned that the relatively high rates of amputation in certain regions do not necessarily mean the rates are "too high." It's possible, for example, that doctors in those areas see more people with severe diabetes complications and based on experience, have found that an earlier amputation is often better.

"We don't know that they are doing 'too many,'" Margolis said. "For all we know, they could be doing the right amount."

There are no general guidelines on when to do an amputation in someone with severe diabetic ulcers, so it's up to the doctor's judgment and what the patient wants.

"It's not a clear-cut decision," Margolis noted.

The findings are based on data from Medicare, the government insurance program for older Americans, for the years 2006 to 2008. About 5 million beneficiaries had diabetes each of those years.

It's not known whether the same geographical variations in amputation would be true of younger Americans with diabetes, the researchers say.

More research is now needed to understand the reasons for the variations among Medicare beneficiaries, Margolis said. For now, people with diabetes can take steps to protect their limbs, he noted.

Experts recommend that people with diabetes check their feet everyday to catch cuts, swelling or other injuries early. They should also have their doctor examine their feet at least once a year.

Diabetic nerve damage often causes pain at first, Margolis said. So if you have pain, tell your doctor and talk about what you should do to protect your feet and legs.

Nerve damage can also change the shape of the feet, Margolis pointed out. In some cases, your doctor might recommend special therapeutic shoes, so you are not trying to wedge your changed feet into regular shoes.

SOURCE: bit.ly/nk6Jh8 Diabetes Care, online September 20, 2011.



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