MALNUTRITION: Sweden snow: Man 'survives two months trapped in car'

18 February 2012

The cold, nutrition-deprived man may have gone into a kind of hibernation, said one doctor A Swedish man has survived being trapped in his snow-covered car for two months without food, police say.

The car was found on Friday at the end of a forest track more than 1 km (0.6 miles) from a main road in northern Sweden.
Police say the temperature in the area had recently dropped to -30C (-22F).
The man, who was too weak to utter more than a few words, said he had been inside since 19 December. He may have survived by drinking melted snow.
Police say they have no reason to doubt his story.

Sleeping bag
The man, who has not been named, is recovering at Umea University Hospital - where staff say he is doing well considering the circumstances.
The 45-year-old was discovered by snowmobilers who initially assumed the car was a wreck until they dug their way to a window and saw movement inside, reported the Vasterbotten Courier newspaper.
The man was huddled in a sleeping bag on the back seat, said policeman Ebbe Nyberg.
"He was in a very poor state. Poor condition. He said he'd been there for a long time and had survived on a little snow.
"He said himself he hadn't eaten anything since December," Mr Nyberg said.
Doctors at the Umea University Hospital said they would normally expect a person to survive without food for around four weeks, said the Vasterbotten Courier.
One doctor told the newspaper that the man might have survived so long by going into a kind of hibernation.
http://www.bbc.co.uk/news/world-europe-17088173

POVERTY: Sweden 'failing' in fight against child poverty

TT/Peter Vinthagen Simpson : news@thelocal.se : 7 Jun 11


The increase in child poverty in Sweden is due in part to failed family policies and the welfare system becoming less fair, Save the Children Sweden (Rädda Barnen) has claimed in a new report on the problem which it claims affects 220,000 children.
Child poverty increases in Sweden: report (1 Feb 11)
The consequences for children who live in poverty are very serious, underlined Save the Children Sweden's secretary-general Elisabeth Dahlin.
"To grow up in social exclusion is a very bad start in life. These children are quiet and loyal and take significant responsibility for the family finances - they don't take part in school outings or leisure activities, the clothes they wear are too small and they can never go to the cinema or football," she said.
Dahlin called on the Swedish government to act to address the situation.
"Sweden has long rightly claimed to be a pioneering country in how we care for and support families with children. Let us show that we still take responsibility for reducing child poverty," she said.
Save the Children's new report entitled "Welfare state, not for all" (Välfärd, inte för alla), is a follow up on a February report on the incidence of child poverty in Sweden.
The February report showed that the proportion of children living in families unable to provide the most basic items such as food, clothing and housing, increased to 11.5 percent in 2008, from 10.9 percent in 2007 - the lowest levels since records began in 1991.
According to the charity there are three distinct groups who are the worst affected: single-parents, newly arrived immigrants and young parents who are not yet established on the labour market.
Social Democrat leader Håkan Juholt on Tuesday argued that the increase in child poverty is due to three problems: high unemployment combined with labour shortages in key sectors, a "drastic decline" in the employment of women and the expansion of charges in schools.
"It is clear that Save the Children write that the distributive policies in favour of child families have failed," he said.
Prime Minister Fredrik Reinfeldt meanwhile responded that the key to addressing child poverty lay in tackling unemployment.
"I regret that some of those commenting don't begin with the most obvious - namely to ensure that the number of jobs is increased," he said.
Reinfeldt identified a raft of government measures to aid families, including a hike in child and housing benefits.
He furthermore identified work to improve integration as key to tackling child poverty, including lowering the thresholds for employment for people from other countries.
Save the Children Sweden concluded in its report that the redistributive effects of family policy have declined in recent decades and argued that measures need to be taken to address the growing inequalities.
"The ability to reduce poverty has declined over the past ten years and the precision with which social safety nets are able to capture vulnerable families with children has disappeared," the charity argued in its report.
Save the Children Sweden suggested two immediate initiatives to begin to address the problem: to raise the guarantee level of parental insurance (currently 180 kronor ($30) per day) to a "reasonable sum", and to boost income support in line with inflation.
The charity's February report showed that while ten percent of Sweden's children lived in poverty, the problem was far greater among single-parent families and families with foreign backgrounds - 24.7 and 29.5 percent respectively.
Child poverty was defined on an index combining two factors - low levels of relative income (according to Statistics Sweden figures on normal basic consumption), or living with income support (a guaranteed minimum level established by the Riksdag in 1998).
Save the Children Sweden has produced an annual report on the incidence of child poverty in Sweden every year since 2002.

MALARIA: National Theft of Global Fund Medicines

Millions of dollars of donated antimalarial drugs have been stolen, most often by staff of recipient government medical stores; this strengthens criminal gangs and undermines donor intent. The main culprit donor is the Global Fund to Fight AIDS, TB and Malaria, which worryingly is pushing ahead with further schemes that have the same inherent weaknesses, which may worsen the theft problem. Sweden and Germany have already suspended funding to the Global Fund due to financial irregularities, but it is time for a thorough investigation of drug theft - to ensure that drugs are being used by those intended, rather than encouraging illegal parallel distribution systems, in both recipient nations and nations where products are diverted.
It is likely that the entire incentive system needs to change, so that donors only receive future taxpayer funds when they can show that the drugs they buy actually reach intended patients in developing nations, not just reach their governments’ medical stores.
http://www.fightingmalaria.org/pdfs/AFMBrief_NationalTheftofGFMedspdf

TUBERCULOSIS: How Tuberculosis Bacteria Manage to Survive Inside Body’s Macrophage Cells

ScienceDaily (Mar. 9, 2011)
Tuberculosis kills two million people each year. Researchers at Linköping University in Sweden are now presenting new findings that show how the bacterium that causes the disease manages to survive inside the body's macrophage cells in order eventually to blow them up and spread their infection.
The bacterium Mycobacterium tuberculosis is a successful organism that lives in an estimated one third of the world's population. But only about five percent of those infected develop the disease.
"We also know that many people do not become infected despite exposure to the infection. This is a question we are looking for an answer to," says Amanda Welin, who is now presenting her doctoral dissertation in medical microbiology.
The research group has studied phenomena in both the bacterium and the macrophage, whose task is to knock out infectious substances that get into the body.
One weapon is enzymes, which make the ingested bacteria feel sickly. Enzymes work best in acidic environments, with a pH level under 6. For their part, the bacteria can strike back by releasing substances that prevent the pH level from going down. Amanda Welin has shown that this warfare is directly reflected in the growth or reduction of bacteria.
These bacteria also have a capacity to kill macrophages and spread to new cells. Welin shows that this is done by having a tiny protein cause cell death, necrosis, which in turn leads to inflammation of the tissue.
To carry out these studies, Amanda Welin and her colleagues developed a new method for determining the number of bacteria inside a cell. They use a gene from sea-fire organisms, which cause strange lights in seawater at night. When this gene is added to the genes of the bacterium, the bacterium begins to produce the same luminescent substance, luciferase, as the sea-fire organism does. Thanks to this, it's possible to monitor developments inside the macrophage -- the intensity of the light radiating outward corresponds to the number of bacteria inside. If their number grows, this indicates that they have begun to multiply inside the human cell.
The method can be used to search for plausible drug candidates. In that field, the Linköping scientists are collaborating with a group of colleagues in Sudan, who are testing, among other things, various medicinal plants with substances that could possibly be used as active ingredients to combat tuberculosis.
http://www.sciencedaily.com/releases/2011/03/110309073940.htm

MALARIA: The first Finnish malariologist, Johan Haartman,

The first Finnish malariologist, Johan Haartman, and the discussion about malaria in 18th century Turku, Finland


Hulden L
After the Great Northern War in 1721, Sweden ceased to be an important military power. Instead, the kingdom concentrated on developing science. Swedish research got international fame with names as Carolus Linnaeus, Pehr Wargentin and Anders Celsius. Medical research remained limited and malaria was common especially in the coastal area and along the shores of the big lakes. Already in the beginning of the 18th century Swedish physicians recommended Peruvian bark as medication and they also emphasized that bleeding or blood-letting a malaria patient was harmful. Although malaria was a common disease in the kingdom, the situation was worst in the SW-part of Finland which consisted of the town of Turku and a large archipelago in the Baltic. The farmers had no opportunity to get modern healthcare until Johan Haartman was appointed district physician in 1754. To improve the situation he wrote a medical handbook intended for both the farmers and for persons of rank. Haartman's work was first published 1759 and he discussed all the different cures and medications. His aim was to recommend the best ones and warn against the harmful. His first choice was Peruvian bark, but he knew that the farmers could not afford it. Haartman was appointed professor in medicine at the Royal Academy of Turku in 1765. The malaria situation in Finland grew worse in the 1770's and Haartman analysed the situation. He found the connection between the warm summers and the spring epidemics next year. In a later thesis, Haartman analysed the late summer/early autumn malaria epidemics in the archipelago. Althouh Haartman did not know the connection between malaria and the vector, he gave astute advice and encouraged the farmers to build their cottages in windy places away from the shallow bays in which the Anopheles females hatched. Haartman died in 1788. After his death malaria research in Turku declined. His medical handbook would not be replaced until 1844.

Malaria Journal 2011, 10:43 (15 February 2011)

POVERTY: Putting fraud in global health spending in context

By Michael Gerson michaelgerson@washpost.com

February 4, 2011

Digging in the garden of a health official in Mali, investigators discover more than 30 counterfeit "stamps" used to validate fraudulent invoices to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The inspector general of the fund reports serious corruption in the programs of four countries - Mali, Mauritania, Zambia and Djibouti. A breathless Associated Press story concludes that "as much as two-thirds" of some Global Fund expenditures are being misspent. Germany and Sweden suspend their support. Some conservatives run with the story, which reinforces their preconceptions about foreign aid and fits the need for budget cuts. After all, in this view, two-thirds of Global Fund money is thrown down a rathole of corruption.
When scandals fit preexisting ideological narratives, they assume a life of their own. This particular narrative - the story of useless, wasted aid - is durable. It is also misleading and might be deadly.
The Global Fund controversy illustrates the point. The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical. One might as well judge every member of Congress by the cases currently before the ethics committee.
The irony here is thick. These cases of corruption were not exposed by an enterprising journalist. They were revealed by the fund itself. The inspector general's office reviewed 59,000 documents in the case of Mali alone, then provided the findings to prosecutors in that country. Fifteen officials in Mali have been arrested and imprisoned. The outrage at corruption in foreign aid is justified. But this is what accountability and transparency in foreign aid look like. The true scandal is decades of assistance in which such corruption was assumed instead of investigated and exposed.
The Global Fund has a difficult challenge. It gathers resources from governments, foundations and individuals but relies on local partners to implement programs. When providing relatively expensive commodities - anti-retroviral treatments or combination drugs for malaria - through relatively unsophisticated structures, there are opportunities for corruption. So the fund audits every grant it makes, requires measured outcomes, cuts off ineffective programs and encourages whistleblowers. It was the United States - the fund's largest supporter - that pushed in 2005 for the appointment of a strong inspector general to fight fraud. He is now doing his job. It would be difficult to make similar claims of accountability for most domestic programs in America.
The response of the fund to these cases of corruption has been, so far, serious. With fraud concentrated in training programs, all training activity has been suspended. Tighter expensing procedures are being implemented. The fund is double-checking expenditures in high-risk countries. It is also proposing an independent review of its financial-control mechanisms. The corruption in places such as Mali is not representative, but it is also not unique. There will, no doubt, be more cases exposed and more reforms needed.
But American policymakers should keep two things in mind. First, the fund is not expendable. It supports about two-thirds of the global effort against malaria and tuberculosis, and about a quarter of the fight against HIV/AIDS. Since 2002, it has helped detect and treat 7.7 million cases of TB, distribute 160 million insecticide-treated nets and put millions of people on AIDS treatment. These are not the results of a fundamentally dysfunctional program.
Second, the fund is the primary method by which America spreads the burden of encouraging global health to other nations. About a third of its funding comes from the United States. The rest is raised elsewhere. If the fund was diminished or discontinued, American health commitments around the world would need to dramatically increase - at least if we want to avoid complicity in a global tragedy.
In a scandal, the first response is anger. In global health, corruption kills. The most important response, however, is to make sure the right people get punished - not an African child who needs a bed net, or the victim of a cruel and wasting disease. They had no part in the controversies surrounding the Global Fund, but depend, unknowingly, on their outcome. An overreaction to corruption can also cost lives.

http://www.washingtonpost.com/wp-dyn/content/article/2011/02/03/AR2011020305176.html

Global Fund: Sweden sits on health aid cash over graft fears

(AFP)
STOCKHOLM — Sweden has told the head of the global fund to fight AIDS that it will not pay its 167 million euro contribution unless more is done to ensure the cash is not siphoned off, a report said Saturday.
Michel Kazatchkine, the executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria, said that Sweden's refusal to meet its commitments would have a major impact on his organisation's plans.
But after talks with Kazatchkine in Stockholm on Friday, Development Minister Gunilla Carlsson said that Sweden felt more had to be done to prevent its cash falling victim to corruption among recipient countries.
"We are paying greater heed to the danger of corruption so before we commit ourselves to aid, we want to see practical measures put in place to combat this problem," the minister was quoted as saying by the Svenska Dagbladet daily.
According to the paper, Sweden has refused to stump up its 1.5 billion krona (167 million euro, $226m) contribution for the period covering 2011-2013 since a report by the United Nations last year showed how donors' cash had been diverted by corrupt officials in at least four countries.
Sweden is the biggest per capita contributor to the fund which was created by the G8 group of industrialised nations in 2002.
The Swedish contribution "is a significant amount of money for us," Kazatchkine was quoted as saying by newspaper.
"The fact that Sweden is stalling on its commitment is not a good sign. We need to know quickly whether we can pour our energies into our aid projects," he added.
"We also believe that we have demonstrated a much greater degree of transparency and that we are doing everything that we can to fight corruption."
The fund, which has an overall budget of 21.7 billion dollars drawn from 150 countries, is the largest single source of funding for three of the world's biggest killer diseases.
http://www.google.com/hostednews/afp/article/ALeqM5jINVzkuPoN2T0snlC0LVe9-GG1kA

TUBERCULOSIS: Extensive transmission of an isoniazid-resistant strain of Mycobacterium tuberculosis in Sweden (2003-5).

Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden. boris.kan@karolinska.se
SETTING: City of Stockholm, Sweden.
BACKGROUND: The incidence of tuberculosis (TB) in Sweden increased by 40% between 2003 and 2005. The spread of a unique TB strain resistant to isoniazid (INH) contributed to this increase.
OBJECTIVE: To describe outbreaks of TB caused by this single strain, elucidate possible causes for its extensive spread and identify shortcomings of the TB control programme in Sweden.
RESULTS: We identified a cluster consisting of 102 culture-confirmed TB cases with identical DNA fingerprints and 26 epidemiologically related cases, not confirmed by culture, all diagnosed between 1996 and 2005. Five partly separate outbreaks of this strain were discovered. Epidemiological links were established for 56% of the culture-confirmed cases and for all cases not confirmed by culture. Three patients died while receiving treatment, four became failures and eight defaulted or were lost to follow-up. Only eight patients received directly observed treatment (DOT) up to a period of 3 months, although 40% had poor adherence.
CONCLUSIONS: Shortcomings of the national TB programme were revealed. Improved contact tracing and case holding, including DOT, is crucial to reduce TB transmission in Sweden.
http://www.ncbi.nlm.nih.gov/pubmed/18230254

TUBERCULOSIS: Molecular epidemiology of drug-resistant tuberculosis in Sweden

Drug-resistant tuberculosis (TB), including the more severe forms of multidrug- and extensively drug-resistant forms, is an increasing public health concern globally. In Sweden the majority of patients with TB are immigrants from countries with a high incidence of TB including the drug-resistant forms. In this study, the spread of resistant TB in Sweden was investigated by molecular fingerprinting. Isolates resistant to at least one of the drugs, isoniazid, rifampicin, ethambutol or streptomycin, from 400 patients collected between 1994 and 2005, were studied by restriction fragment length polymorphism (RFLP) and by spoligotyping. Thirty-five clusters of patients infected with strains with identical RFLP and spoligotyping patterns (2–96 patients per cluster), comprising a total of 203 patients, were found. One large outbreak of isoniazid resistant tuberculosis was identified, involving 96 patients, mainly from the Horn of Africa. To identify chains of transmission, molecular epidemiological characterization of TB isolates should, if possible, be performed on isolates from all new TB patients.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VPN-4S5FJJT-3&_user=10&_coverDate=05%2F31%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1583107264&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ca52446010330645997a02e31030ab10&searchtype=a

TUBERCULOSIS: Sweden, screening of immigrants is optional

Migrants from countries with a high-burden of tuberculosis (TB) are at a particular risk of contracting and developing the disease. In Sweden, new immigrants are routinely offered screening for the disease, yet very little is known about their beliefs about the disease which may affect healthcare-seeking behaviours.In this study we assessed recent immigrant students'knowledge of, and attitudes towards TB, and their relationship with the screening process.Methods: Data were collected over a one-year period through a survey questionnaire completed by 268 immigrants consecutively registered at two Swedish-language schools in Umea, Sweden. Participants originated from 133 different countries and their ages varied between 16-63 years.Descriptive and multivariate logistic regression analyses were then performed.Results: Though most of them (72%) were screened, knowledge was in general poor with several misconceptions. The average knowledge score was 2.7+/-1.3 (SD), (maximum=8).Only 40 (15 %) of the 268 respondents answered at least half of the 51 knowledge items correctly. The average attitude score was 5.1 +/- 3.3 (SD) (maximum=12) which meant that most respondents held negative attitudes towards TB and diseased persons.Up to 67% lacked knowledge about sources of information while 71% requested information in their vernacular. Knowledge level was positively associated with having more than 12 years of education and being informed about TB before moving to Sweden.Attitude was positively associated with years of education and having heard about the Swedish Communicable Disease Act, but was negatively associated with being from the Middle East. Neither knowledge nor attitude were affected by health screening or exposure to TB information after immigration to Sweden.Conclusions: Though the majority had contact with Swedish health professionals through the screening process, knowledge about tuberculosis among these immigrants was low with several misconceptions and negative attitudes.Information may currently be inaccessible to most of these immigrants due to the language barrier and unfamiliarity with the Swedish healthcare system. If TB education was included as a component of screening programmes, ensuring that it was tailored to educational background, addressed misconceptions and access problems, it could well help improve TB control in these communities.
http://7thspace.com/headlines/348043/screening_migrants_for_tuberculosis___a_missed_opportunity_for_improving_knowledge_andattitudes_in_high_risk_groups_a_cross_sectional_study_of_swedish_language_students_in_umea_sweden.html

TUBERCULOSIS: Beijing genotype

Background
Drug resistant (DR) and multi-drug resistant (MDR) tuberculosis (TB) is increasing worldwide. In some parts of the world 10% or more of new TB cases are MDR. The Beijing genotype is a distinct genetic lineage of Mycobacterium tuberculosis, which is distributed worldwide, and has caused large outbreaks of MDR-TB. It has been proposed that certain lineages of M. tuberculosis, such as the Beijing lineage, may have specific adaptive advantages. We have investigated the presence and transmission of DR Beijing strains in the Swedish population.
Methodology/Principal Findings
All DR M. tuberculosis complex isolates between 1994 and 2008 were studied. Isolates that were of Beijing genotype were investigated for specific resistance mutations and phylogenetic markers. Seventy (13%) of 536 DR strains were of Beijing genotype. The majority of the patients with Beijing strains were foreign born, and their country of origin reflects the countries where the Beijing genotype is most prevalent. Multidrug-resistance was significantly more common in Beijing strains than in non-Beijing strains. There was a correlation between the Beijing genotype and specific resistance mutations in the katG gene, the mabA-inhA-promotor and the rpoB gene. By a combined use of RD deletions, spoligotyping, IS1547, mutT gene polymorphism and Rv3135 gene analysis the Beijing strains could be divided into 11 genomic sublineages. Of the patients with Beijing strains 28 (41%) were found in altogether 10 clusters (2–5 per cluster), as defined by RFLP IS6110, while 52% of the patients with non-Beijing strains were in clusters. By 24 loci MIRU-VNTR 31 (45%) of the patients with Beijing strains were found in altogether 7 clusters (2–11 per cluster). Contact tracing established possible epidemiological linkage between only two patients with Beijing strains.
Conclusions/Significance
Although extensive outbreaks with non-Beijing TB strains have occurred in Sweden, Beijing strains have not taken hold, in spite of the proximity to high prevalence countries such as Russia and the Baltic countries. The Beijing sublineages so far introduced in Sweden may not be adapted to spread in the Scandinavian population.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0010893?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+%28PLoS+ONE+Alerts%3A+New+Articles%29