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HIV Prevention Efforts In Five African Countries Not Reaching At-Risk Groups, Report Says
National HIV prevention strategies in at least five African countries are not reaching the groups most at risk of infection, according to a report from UNAIDS and the World Bank conducted in conjunction with the national HIV/AIDS authorities of Kenya, Lesotho, Mozambique, Swaziland and Uganda, IRIN/PlusNews reports. The study was conducted between 2007 and 2008 to determine how and where most HIV cases were occurring in each country. It also aimed to examine whether prevention programs and spending aligned with those findings. According to the report, most prevention initiatives are not based on evidence of the behaviors that spread HIV in the five surveyed countries. For example, most new infections in Lesotho occur because of concurrent sexual partnerships, both before and after marriage. However, the country does not have any prevention strategies aimed at concurrent partnerships, or couples who are married or in long-term relationships. In addition, the report found that in Mozambique, an estimated 19% of new HIV infections were spread through commercial sex work, 3% from injection drug use and 5% among men who have sex with men. According to the report, few programs in the country target sex workers, while none are tailored to IDUs or MSM. According to the report, spending on HIV prevention often is low in the surveyed countries. Lesotho spends 13% of its national HIV/AIDS budget on prevention, while Uganda spends 34%. Director of the World Bank"s Global HIV/AIDS Unit Debrework Zewdie said that the economic downturn makes it important to maximize the impact of HIV prevention investments. "These syntheses use the growing amounts of data and information available to better understand each country"s epidemic and response and identify how prevention might be more effective," she said. The report includes recommendations on how the surveyed countries can better implement evidence-based prevention efforts. It said that Lesotho should revise its prevention messages to address multiple concurrent partnerships and integrate the subject into future initiatives. In addition, Mozambique should focus condom promotion on groups such as sex workers, the report said. According to IRIN/PlusNews, the five-country program aims to enhance capacity to ensure that the countries can conduct similar studies in the future (IRIN/PlusNews, 5/27).
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New Study Finds Social And Economic Factors Play Major Role In Determining Who Gets Bariatric Surgery
Less than one-half of one percent (0.4%) of the 22 million people in the U.S. who are medically eligible for bariatric surgery actually get the surgery, and those who do are most likely to be white females with higher incomes and covered by private health insurance, according to a new study presented here at the 26th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).
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Universal Access To Malaria Drugs, Prevention By 2013 Will Lead To Eradication, Nigerian Government Says
The Nigerian government believes that by 2013 malaria will cease to be a major public health problem in the country because families will have universal access to prevention and treatment, which will ultimately lead to malaria eradication in Nigeria, according to a document prepared by the National Malaria Control Program of the Federal Ministry of Health in Abuja, Nigeria, Xinhua reports.
Oncology

Life-Saving Cardiac Rehabilitation

Coronary heart disease (CHD) is the leading cause of death worldwide and a major driver of medical and economic costs, especially among older adults. It has long been established that cardiac rehabilitation improves survival, at least in middle-aged, low- and moderate-risk white men. Now a large Brandeis University-led study published in the Journal of the American College of Cardiology reports that older cardiac patients benefit as much from cardiac rehab as their younger counterparts. Worldwide, in 2004, 7.2 million people died from CHD, while in the United States alone, more than 13 million people suffered from CHD, and almost half a million died from heart disease in 2003. Moreover, Americans aged 65 and older account for more than 55 percent of heart attacks and 86 percent of CHD deaths. "The good news is that patients who use cardiac rehab live longer than those who do not use it, regardless of their clinical diagnosis, gender, race, or socioeconomic background" said Dr. Jose Suaya, lead author and visiting scholar at the Heller School for Social Policy and Management at Brandeis University. The study showed that "patients with different clinical backgrounds - heart attacks, coronary bypass operations, and even congestive heart failure - all had lower mortality when using cardiac rehab," Dr. Suaya asserted. The study examined mortality in 601,099 Medicare beneficiaries who were hospitalized in 1997 for heart disease or bypass surgery and followed up through 2002. The study used three different statistical techniques to compare mortality between patients who used cardiac rehab and those who didn"t. Overall, within a span of five years, mortality rates were 21 percent to 34 percent lower in older adult patients who used cardiac rehab. Cardiac rehab is a covered benefit under Medicare. "Despite the significant benefits of cardiac rehab, only 12 percent of these patients actually took advantage of it," said Professor Donald Shepard, a health economist at the Heller School for Social Policy and Management at Brandeis. The regimen typically includes aerobic exercise and lifestyle counseling to reduce cholesterol, weight, and stress. The study found that patients who engaged in more than 24 sessions were an additional 19 percent less likely to die over five years than patients who used 24 sessions or fewer. The findings are magnified among the extreme elderly and patients with other diseases, such as diabetes, on top of their heart disease. These types of patients were even less likely than others to participate, but those who did attend obtained especially large gains from cardiac rehab. "This study should be a wake-up call to cardiac patients, their families, and their physicians that cardiac rehab can extend life and improve the quality of life, even in older people," said Dr. William Stason, senior scientist at the Heller School. "The evidence is clear. Cardiac rehab saves lives but it is severely underused," noted Dr. Philip Ades, Professor of Cardiology at the University of Vermont and a coauthor of the study. "The consistency of findings among the study"s methodologies increases the reliability of the findings," observed Prof. Sharon-Lise Normand of Harvard Medical School and Harvard School of Public Health, another co-author of the study. "More coronary patients should use cardiac rehab. Perhaps one way to achieve this would be to require hospitals and physicians to report rates of referrals and use of this service as quality indicators of their performance," Dr. Suaya and coauthors concluded. The study was funded by the Centers for Medicare & Medicaid Services. Laura Gardner Brandeis University


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