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Recent trends in the prevalence of overweight and obesity among Canadian children [Research]

Background:

Previous studies have shown an increase in the prevalence of overweight and obesity among Canadian children from 23.3% to 34.7% during 1978–2004. We examined the most recent trends by applying current definitions of overweight and obesity based on World Health Organization (WHO) body mass index (BMI) thresholds and recently validated norms for waist circumference and waist:height ratio.

Methods:

We examined directly measured height and weight data from the Canadian Community Health Survey (2004–2005) and the Canadian Health Measures Survey (2009–2013). We calculated z scores for BMI, height and weight based on the 2014 WHO growth charts for Canada, including the new extension of weight-for-age beyond 10 years. To calculate z scores for waist circumference and waist:height ratios, we used new charts from the reference population in the US NHANES III (National Health and Nutrition Examination Survey, 1988–1994).

Results:

Data were available for 14 014 children aged 3–19 years for the period 2004–2013. We observed a decline in the prevalence of overweight or obesity, from 30.7% (95% confidence interval [CI] 29.7% to 31.6%) to 27.0% (95% CI 25.3% to 28.7%) (p < 0.001) and stabilization in the prevalence of obesity at about 13%. These trends persisted after we adjusted for age, sex and race/ethnicity. Although they declined, the median z scores for BMI, weight and height were positive and higher than those in the WHO reference population. The z scores for waist circumference and waist:height ratio were negative, which indicated that the Canadian children had less central adiposity than American children in historic or contemporary NHANES cohorts.

Interpretation:

After a period of dramatic growth, BMI z scores and the prevalence of overweight or obesity among Canadian children decreased from 2004 to 2013, which attests to progress against this important public health challenge.

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial [Research]

Background:

The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting.

Methods:

We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting.

Results:

Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] –0.20, 95% confidence interval [CI] –0.36 to –0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD –6.72, 95% CI –10.9 to –2.57), function (Functional Status Scale score MD –0.22, 95% CI –0.38 to –0.05), dexterity (time to complete blinded pick-up test MD –6.13 seconds, 95% CI –10.6 to –1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale –0.70, 95% CI –1.34 to –0.06), and not significant for sensation (first finger monofilament test –0.08 mm, 95% CI –0.22 to 0.06).

Interpretation:

For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting.

Trial registration:

Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR-TRC-11001655).

News briefs

Ken Harvey awarded ANZAAS Medal

Dr Ken Harvey, renowned anti-pseudoscience activist and critic of regulatory agencies, has been awarded the Australian and New Zealand Association for the Advancement of Science (ANZAAS) Medal for 2016. Dr Harvey, who is adjunct associate professor in Monash University’s School of Public Health and Preventive Medicine, was presented with medal by Dr Malcolm Jenkins, the chair of ANZAAS, on 17 August. The medal is awarded each year for “services for the advancement of science or administration and organisation of scientific activities, or the teaching of science throughout Australia and New Zealand and in contributions to science that lie beyond normal professional activities”. Sir Gus Nossal and Sir Mark Oliphant are previous winners. Dr Harvey is an executive member of Friends of Science in Medicine (FSM), and has a national reputation as a strong champion of evidence-based medicine and treatment. “My interest in unethical promotion started in the 1970s when I was trying to contain hospital acquired antibiotic-resistant microorganisms,” Dr Harvey said. “I advocated the use of older, narrow-spectrum, more cost-effective antibiotics. The response of many pharmaceutical companies was, ‘You can’t afford to be wrong, use our latest, broadest-spectrum and most expensive antibiotics.’ A number of purveyors of complementary, alternative and integrative medicine also make unethical claims. So what to do? Marshal the evidence; flood the regulators with complaints, engage the media and agitate for policy change.” Congratulating Dr Harvey on his award, Professor John Dwyer, president of FSM said: “Ken Harvey is a champion for better public health in Australia. His efforts over many years have been focused on reducing the harm to consumers associated with misleading and even fraudulent promotion and use of treatments and medicines for which there is no scientific support.”

Zika virus tentacles reach further

As of 10 August, 69 countries and territories have reported evidence of mosquito-borne Zika virus transmission – 66 of them since 2015 – reports the World Health Organization. The latest to join the list include the United States, the Cayman Islands, and the Netherlands. Since February 2016, 11 countries have reported evidence of person-to-person transmission of Zika virus, probably via a sexual route. As of 10 August, 15 countries or territories have reported microcephaly and other central nervous system malformations potentially associated with Zika virus infection or suggestive of congenital infection. Canada is the latest country to report a case of congenital malformation associated with a travel-related case of Zika virus infection. The US Centers for Disease Control and Prevention has reported 15 live-born infants with birth defects and six pregnancy losses with birth defects with laboratory evidence of Zika virus infection. Since 10 August, 16 countries and territories have reported an increased incidence of Guillain-Barré syndrome (GBS) and/or laboratory confirmation of a Zika virus infection among GBS cases. Grenada is the latest country to report a case of GBS associated with a confirmed Zika virus infection.

Aleppo’s dying children and shattered health system: is there light at the end of the tunnel?

Being a doctor can be risky business, some times more than others.

During my dozen medical missions to Syria, I had to crawl under a border fence, jump over walls, walk in the mountains at night for hours without any light, pass through the sniper alley in Aleppo, negotiate with smugglers and work in bombed, underground hospitals.

The Syrian crisis is now in its fifth year. The country’s health services are under unprecedented strain due to the protracted war, deliberate targeting of health staff and infrastructure by the Syrian regime and Russian forces, the exodus of physicians and nurses, shortages of medical supplies and medications and the disruption of medical education and training.

Syria’s largest city, Aleppo, has 85,000 children, including around 20,000 below the age of two. Dozens are injured every week, just like five-year-old Omran Daqneesh whose pictures have shocked the world. Many have far worse injuries and will not survive.

I took care of some of these unlucky children, such as Ahmad Hijazi, also five years old. He was hit by one of Assad’s barrel bombs. These are containers the size of barrels, stuffed with TNT and metal shrapnel, which the Syrian regime throws from helicopters onto urban areas such as hospitals, civilian neighbourhoods, fruit markets and schools.

Hijazi had shrapnel lodged in his spinal cord and was paralysed from his neck down. When I saw him, he was breathing with great difficulty, so we put a breathing tube in his mouth and put him on life support. The day after I left, he had a cardiac arrest and died.

Around half-a-million people have been killed in the conflict. Half of the population has been displaced. There seems to be no light at the end of the tunnel.

Medical neutrality is a principle under international humanitarian law that ensures protection of medical personnel, patients, facilities and transport from attack or interference. It also underpins unhindered access to medical care and treatment; humane treatment of all civilians; and non-discriminatory treatment of the injured and sick.

Systematic attacks on health care, mostly by the Syrian government and recently Russia, are violations of medical neutrality and therefore war crimes under the Geneva Conventions.

A health system in ruins

Before the onset of fighting, Syria’s health care system was comparable with that of other middle-income countries, such as Iran. By 2015, all sectors of the country’s health infrastructure had disintegrated.

Within only a few years, the life expectancy of resident Syrians has declined by 20 years; from 76 in 2010 to 56 by the end of 2014. This isn’t all due to the direct effects of war.

Many more Syrians have died prematurely from infections and chronic disease than from the fighting – this includes diseases such as pneumonia, hepatitis, tuberculosis and diarrhoeal infections, as well as heart disease, kidney disease, diabetes, cancer and chronic obstructive pulmonary disease.

Hospitals and clinics have been destroyed. Eight out of the ten hospitals in Eastern Aleppo are partially functional or out of service as a result of targeted attacks. From March 2011 to the end of May 2016, at least 738 Syrian doctors, nurses and medical aides died in 373 attacks on medical facilities.

Aleppo's dying children and shattered health system: is there light at the end of the tunnel? - Featured Image

Pictures of Omran Daqneesh have shocked the world, but doctors in Aleppo see dozens of desperate children like him every week.
ALEPPO MEDIA CENTER, @AleppoAMC / HANDOUT

The working conditions of Aleppo’s remaining doctors are unsustainable. An estimated 35 doctors are left in Eastern Aleppo which, with a population of approximately 300,000, means there is one doctor for every 8,570 people. There is not a single critical-care doctor – my own speciality – despite the abundance of critically ill patients.

Doctors, local administrators and NGOs are struggling in substandard conditions and often use unorthodox methods to do their work. They work in underground makeshift hospitals, hospitals dug into mountains or in natural caves for protection. They perform surgeries without light, proper anaesthesia or sterilisation, transfuse blood without proper matching and have medical students or dentists perform life-saving procedures due to the shortage of specialists.

Much-needed medical supplies are channelled through dangerous routes across the borders of Lebanon, Jordan and Turkey. As physicians, we can’t wait for politicians to fix the crisis.

What needs to be done

Fifteen Aleppo doctors recently penned an open letter to US President Obama, in which they wrote that “there is an attack on a medical facility every 17 hours” by the Russian-backed Syrian air force.

Meanwhile, the charity Syrian American Medical Society reported that July has been the worst month for attacks on health care since the beginning of the conflict. There were 43 attacks on health facilities in the month – more than one a day. By comparison, this number of attacks occurred over six months in 2015, with 47 attacks from January to May.

Charities and other organisations, such as the Syrian American Medical Society, have pioneered solutions to some of the resource gaps. These include portable ultrasounds and other point-of-care diagnostic tools, as well as virtual wards connecting nurses and doctors in besieged areas with specialists in the United States.

Doctors in the US and other Western nations have helped Syrian counterparts make the best of the situation by providing training and helping with technology and treatment. But more needs to be done to support remaining health workers.

International medical organisations should advocate on behalf of their Syrian colleagues and champion an end to violations of international humanitarian law.

Educational opportunities to support Syrian health professionals, including scholarships for medical students, would help with ensuring there are enough staff to rebuild the Syrian health system. More resources should be directed to research the impact of conflicts on health care and the use of technology and other innovative solutions to mitigate harms.

Consensus should be achieved and acted on by the international community on the urgent need to protect civilians from airstrikes and chemical attacks. This is needed to apply pressure on the Syrian government to stop targeting the remaining health care staff and hospitals.

We should share knowledge, skills and technology with all patients, across the world. Although our local patients are a priority, we can also benefit the global community.

The Conversation

Zaher Sahloul, Associate Clinical Professor, University of Illinois at Chicago This article was originally published on The Conversation. Read the original article.

Main photo: kafeinkolik / Shutterstock.com

Other doctorportal blogs

[Comment] Sitting on the FENSA: WHO engagement with industry

When decisions are made that will impact on people’s health, who should be represented at the policy-making table? Is it sufficient to rely upon representatives from national governments, or should other stakeholders participate—and if so, to what purpose? To advise? Make decisions? Or as funders? These questions lie at the heart of a governance debate1 that has been rancorously discussed in relation to WHO for some years. In May, 2016, the World Health Assembly (WHA) reached consensus in a resolution known as FENSA (Framework of engagement with non-State actors): “WHO engages with non-State actors….to encourage [them] to…protect and promote public health”, in which non-State actors are “non-governmental organizations [NGOs], private sector entities, philanthropic foundations and academic institutions”.

News briefs

Fungus v Aedes aegypti: battle on

Scientists looking to combat the Zika virus are trying to “weaponise” a fungus called Metarhizium brunneum which has the happy knack of being able to eat mosquito larvae from the inside out, Wired reports. Research published in PLOS Pathogens has shown that the fungus spore sticks to the mosquito larva, then “eats its way through the exoskeleton and starts to grow, fast”. The larva itself helps the process by eating more spores, which work their way through its gut and into its body cavity. The fungus grows, destroying the larva from the inside. “The fungus actually attacks mosquitoes in two ways. One variety of the fungus spore, the conidium, is airborne — it attacks adult mosquitoes. The blastospore, though, does better underwater — that’s the one that attacks the larvae … [and] is so much more virulent than the conidium. Mosquitoes are now developing resistance to pesticides, but it’s harder to resist predators and parasites that are evolving right along with them. Metarhizium brunneum could be a crucial part of the arsenal [against Zika] — as long as it doesn’t spread so widely that it starts killing more than mosquitoes.”

Aussie heads WHO’s Health Emergencies program

Dr Peter Salama, a medical epidemiologist and a University of Melbourne and Harvard University alumnus, has been appointed as the Executive Director of the World Health Organization’s (WHO) new Health Emergencies Program. Dr Salama, 47, has spent the last 18 months as the United Nations Children’s Emergency Fund (UNICEF) Regional Director for Middle East and North Africa and Global Emergency Coordinator for the crises in Syria, Iraq and Yemen. Before that was UNICEF’s Country Representative in Ethiopia and Zimbabwe, as Global Coordinator for Ebola, and as Chief of Global Health. He previously worked at the Centers for Disease Control in the US and with Medecins Sans Frontieres. According to a statement from the WHO: “WHO’s new Health Emergencies Program is designed to deliver rapid, predictable and comprehensive support to countries and communities as they prepare for, face or recover from emergencies caused by any type of hazard to human health, whether disease outbreaks, natural or man-made disasters or conflicts. The development of the new Program is the result of a reform effort, based on recommendations from a range of independent and expert external reports, involving all levels of WHO — country offices, regional offices and headquarters.

[Comment] Human resources for health: time to move out of crisis mode

For the past decade, attention on the global health workforce has been characterised by crisis. Advocacy efforts persistently frame this issue as a global emergency, with more than 50 countries identified to be facing “critical shortages” of health workers with “immediate action” required to “overcome the crisis”.1,2 In light of the new global strategy on human resources for health presented at the 2016 World Health Assembly,3 we call for an end to this cataclysmic framing of the health workforce agenda.

Baggoley steps down

The former Deputy Chair of Health Workforce Australia has been appointed to replace Professor Chris Baggoley, who has retired as the nation’s Chief Medical Officer.

Professor Brendan Murphy, who served on the now-defunct HWA and has been Chief Executive Officer of Austin Health in Victoria since 2005, has been selected by Health Department Secretary Martin Bowles to succeed Professor Baggoley in the frontline role.

Mr Bowles announced Professor Baggoley’s departure last week, and praised the leadership he had shown in the CMO role in the past five years, particularly in advancing the nation’s response to mounting global antibiotic resistance, the threat of communicable diseases, and improved detection of non-communicable illnesses such as cancer.

The Health Department head singled out Professor Baggoley’s significant contribution to the international response to epidemics including Ebola, Middle East Respiratory Syndrome (MERS) and, most recently, the Zika virus.

In addition to his work on the World Health Organisation’s International Health Regulations Emergency Committee – which played a central advisory role during the Ebola, MERS and Zika outbreaks – Mr Bowles said Professor Baggoley had also been instrumental in work to improve the nation’s defences against, and response to, international health emergencies.

Professor Murphy will take up the CMO position on 4 October. In the interim, the position will be filled by Dr Tony Hobbs, who has been appointed Deputy CMO.

Adrian Rollins

Gene discovery sparks hope for type 2 diabetes

By Andrew Spece, The Lead South Australia
Researchers have identified the gene they believe is responsible for the onset of type 2 diabetes,
sparking hope for treatments to prevent and possibly reverse the progressive condition.
The researchers from Flinders University in South Australia collaborated with international research teams from the
United States, Sweden and the United Kingdom to narrow down the possible field of 5000 candidate genes to one,
known as RCAN1.
Study leader and Flinders University cell physiologist Professor Damien Keating said a cross-referencing approach
using genes from individuals with Down syndrome was crucial to the result.
Professor Keating said people with Down syndrome were prone to a range of health disorders, including diabetes,
resulting from the overexpression of particular genes because Down syndrome occurred when people had an extra
copy of chromosome 21.
“Many individuals with Down syndrome experience lower insulin secretion, mitochondrial dysfunction and increased
oxidative stress in the insulin-producing beta cells of the pancreas, which are all conditions that also appear in
people with type 2 diabetes,” Professor Keating said.
To identify genes duplicated in Down syndrome that contribute to problems with insulin secretion, scientists
screened the genes of four mouse models of the disorder – two had high blood sugar and two did not, with the
variation enabling a short-list of 38 implicated genes to be identified.
The scientists then narrowed down the list by comparing it to genes overexpressed in beta cells from humans with
type 2 diabetes.
“The comparison identified a single gene, RCAN1, which, when we overexpress it in mice, causes them to have
abnormal mitochondria in their beta cells, produce less cellular energy and secrete less insulin in the presence of
high glucose,” Professor Keating says.
According to the World Health Organisation, the number of people with diabetes in 2014 was 422 million, up from
108 million in 1980. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2
million deaths were attributable to high blood glucose.
Type 2 diabetes, which accounts for the majority of diabetes cases, is a progressive condition in which the body
becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in
the pancreas. The cause of type 2 diabetes is unknown.
“Given that we’ve identified this gene as important for reducing insulin secretion in type 2 diabetes, we are now at a
stage where we have a series of drugs that target RCAN1 and we are now going to test to find whether these drugs
can improve insulation secretion in type 2 diabetes,” Prof Keating said.
“We don’t understand what changes in our pancreas or in our insulin secreting beta cells to cause that transition
from just being insulin resistant and having metabolic syndrome to transitioning to full-blown type 2 diabetes.
“RCAN1, this gene we identified, is certainly a candidate now for that.”
Prof Keating said none of the available treatments for type 2 diabetes targeted the primary cause of the condition.
“All the drugs out there simply alleviate the symptoms,” he said.
“So we have to test these drugs that we have because we feel like that may be able to go straight to the cause of the
reduced insulin secretion that causes Type 2 diabetes … prevent it and possibly reverse it.”
The results of the study led by Prof Keating have been published in the international journal PLOS Genetics.

Study finds 5:2 diet is useful weapon in fight against diabetes

A popular diet is proving to be effective for improving the health of people with type 2 diabetes.
In a pilot trial conducted by the University of South Australia, use of the 5:2 diet resulted in a significant reduction of
blood glucose level and weight loss.
In the three-month trial involving 35 people, participants reduced their haemoglobin A1C (HbA1c) by an average of
0.6 per cent and also reduced their bodyweight by 6-7kg.
The results have prompted a larger year-long study to begin in the coming months, which aims to involve 100
participants.
University of South Australia PhD candidate Sharayah Carter said there had been a lot of research to support the
new diet, but none that looked into its potential benefit for people with type 2 diabetes mellitus (T2DM).
“One of the major struggles with weight loss is people’s ability to stick to a daily-restricted calorie diet,” she said.
“On top of that, people with T2DM have medication to consider. A person with diabetes is not going to be able to take
the same amount of medication on those two days because they’re not eating enough food to support that
medication.
“What we found was that two days of severe energy restriction basically achieves similar results to a daily restriction
diet.”
The UniSA trial was the first of its kind and tested the effects of a two-day intermittent energy restriction (IER) diet
with 5-days of habitual eating for people with T2DM. This was compared to a daily restricted diet.
The results showed that while the IER diet has less of an impact on lifestyle and medication, both diets achieved
similar reductions on weight and in haemoglobin A1C levels.
The standard calorie restriction diet consisted of 1200 calories a day for women and 1500 calories for men. All
participants were asked to walk an extra 2000 steps per day to increase their level of exercise.
People who are obese are up to 80 times more likely to develop type 2 diabetes than those with a Body Mass Index
(BMI) of 22. Weight loss can help control and possibly halt the disease.
According to the World Health Organisation, the number of people with diabetes in 2014 was 422 million, up from
108 million in 1980. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2
million deaths were attributable to high blood glucose.
Type 2 diabetes, which accounts for the majority of diabetes cases, is a progressive condition in which the body
becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in
the pancreas. The cause of type 2 diabetes is unknown.
“IER uses short periods of severe energy restriction – 500 calories for women and 600 calories for men – followed by
periods of habitual eating to achieve similar health improvements as daily dieting but unlike some IER diets, does
not require non-fasting days to involve restricted dieting,” Carter said.
“We achieved a 0.6 per cent drop in HbA1c in both groups which was a significant drop in that time frame and
importantly all our participants who were on medication reduced their dosages which is important for both the
individual and the health budget.
“Essentially you are achieving the same total energy restriction after seven days by following the two-day restriction
and getting the same results.”
The study was conducted in collaboration with the Sansom Institute for Health Research. It is a consortium of
leading researchers with the aim of intervening early to prevent illness, improve health systems and services,
creating more effective therapies and advancing health equality.