#which should be standard everywhere but also particularly health centres

[humandisastersquad]

fjfkdg just went to my physio and she said she looks forward to my visits bc I always talk about the latest covid research and it makes her feel validated against all the covid denial and minimisation

[kathleenseiber]

COVID-19 news and trends

The numbers

Rising COVID-19 numbers in the US and Europe are alarming national leaders (in most cases) and leading to new lockdowns and predictions of winter case peaks.

In the US, cases are reported increasing in 41 states – the biggest surge since August – and insufficient testing may be contributing to under-reporting of new infections.

Across Europe, an average of more than 100,000 cases per day was reported in the past week. Yesterday France’s president Emmanuel Macron declared a state of emergency, including a 9pm–6am curfew starting on Saturday in nine cities.

The New York Times reported Macron as saying: “The virus is everywhere in France.”

On Monday, WHO director-general Tedros Adhanom Ghebreyesus told a media briefing: “Around the world, we’re now seeing an increase in the number of reported cases of COVID-19, especially in Europe and the Americas.

“Each of the last four days has been the highest number of cases reported so far. Many cities and countries are also reporting an increase in hospitalisations and intensive-care bed occupancy. At the same time, we must remember that this is an uneven pandemic. 

“Countries have responded differently, and countries have been affected differently. 

Almost 70% of all cases reported globally last week were from 10 countries, and almost half of all cases were from just three countries.”

Global

As at 16:14 CEST on Wednesday 14 October, cases confirmed worldwide by national authorities stood at 38,002,699 (287,031 of them reported in the preceding 24 hours). 1,083,234 deaths have been recorded (4108). (Source: WHO Coronavirus Disease Dashboard)

Johns Hopkins University’s Centre of Systems Science and Engineering (CSSE) reported (at 15:00 AEST on Thursday 15 October) 38,441,934 confirmed cases and 1,091,439 deaths. 

Australia

The Department of Heath reported on 7 October that national confirmed cases stood at 27,341, a rise of 25 in 24 hours. 904 deaths have been recorded.

State by state: ACT 113 total cases (first case reported 12 March); NSW 4310 (25 January); NT 33 (20 March); Qld 1161 (29 January); SA 479 (2 February); Tas 230 (2 March); Vic 20,311 (25 January); WA 704 (21 February).

Research 

Pause for safety – and definitions

Earlier this week US pharmaceutical giant Johnson & Johnson confirmed it was temporarily pausing its COVID-19 vaccine clinical trials due to an unexplained illness in a study participant. J&J did not elaborate on the illness, citing respect for the participant’s privacy.

Credit: Paul Biris

In a statement, J&J stressed the priority it gives to “the safety and well being of the people we serve every day around the world”, and the difference between the terms “study pause” and a “regulatory hold”.

It says the former, “in which recruitment or dosing is paused by the study sponsor, is a standard component of a clinical trial protocol”. The latter “is a requirement by a regulatory health authority, such as the U.S. Food and Drug Administration (FDA). 

The study pause follows a similar study pause in September by British-Swedish pharmaceutical company AstraZeneca. Their trials have since resumed. 

Australian vaccine experts backed the company’s action and emphasised that such a pause isn’t unusual.

“It is not unusual to suspend a clinical trial if there is an adverse-reaction reported during testing,” wrote Murdoch University’s Jeremy Nicholson. “This is all part of checking that the vaccine (or drug) is safe. 

“People can fall ill in clinical trials by chance and it may have nothing to do with the vaccine itself, this is especially likely in a large trial. Each case has to be investigated thoroughly to evaluate the cause and likelihood of it being trial related.”

“It does not mean the trial will not continue, and is required under ethical standards governing clinical trials,” wrote Australian Catholic University’s Roger Lord.

More safety = less carbon

The COVID pandemic has profoundly affected human activities – a state of affairs that ought to be reflected in energy use and carbon dioxide (CO2) emissions. 

Now, an international team has presented daily estimates of country-level CO2 emissions for different sectors – for instance residential, transport and aviation – based on near-real-time activity data. The results have been published in Nature Communications.

The key result is an abrupt 8.8% decrease in global CO2 emissions in the first half of 2020 compared to the same period in 2019. This decrease is of a magnitude larger than during previous economic downturns or World War II. The timing of emissions decreases corresponds to lockdown measures in each country.

The research reveals that by 1 July, as lockdown restrictions relaxed and some economic activities restarted, especially in China and several European countries, the pandemic’s effects on global emissions diminished. But substantial differences persist between countries. In the US, for instance, where coronavirus cases are still increasing, emission declines have continued.

The study’s author’s write that the “absolute decreases in CO2 emissions are larger than any in history, including those that occurred during the recent 2008–2009 global financial crisis” and emphasise the message their results sends.

“At face value, an 8.8% relative reduction of emissions seems to be small when compared to the magnitude and extent of the disturbance of human activities that the COVID produced. This means that the long-term emissions decreases needed in this century to achieve [carbon reduction] targets must be based on structural and transformational changes in energy production systems, de-carbonisation of transportation and improved building energy use efficiency, that is an improvement of the carbon intensity of economies rather than decreases of human activities.”

Is SARS-CoV-2 here to stay?

Worldwide, only a few repeat SARS-CoV-2 infections have been verified since the pandemic began. But in a Perspective article in Science, Jeffrey Shaman and Marta Galanti suggest that it’s likely the virus will become endemic – that it will be able to re-infect humans who’ve had it before.

Shaman and Galanti write that in many respiratory viruses (such the flu and the common cold) a number of processes – including particularly insufficient adaptive immune response, waning immunity and immune escape – can allow subsequent reinfection. While many questions remain about the nature of these immune responses and trajectories in the case of SARS-CoV-2, insight from other respiratory viruses points to the possibility of reinfection with it.

Shaman and Galanti note that cyclic persistence of COVID in human populations may be affected by ongoing opportunities for interaction with other respiratory pathogens – it’s possible infection with a different virus could provide some short-lived protection to SARS-CoV-2. But there will need to be greater monitoring of the clinical and population-scale interactions of it with other respiratory viruses, particularly influenza, before we’ll know.

At the population scale, a possible overlap between influenza and COVID outbreaks poses a serious threat to public health systems. But the authord note that non-pharmaceutical interventions adopted to mitigate COVID transmission – such personal protective equipment, social distancing and increased hygiene – may reduce the magnitude of seasonal influenza outbreaks.

Credit: Sebastian Condrea

Based on modelling of post-pandemic scenarios for SARS-CoV-2 to date, a duration of immunity similar to that of the other betacoronaviruses (about 40 weeks) could lead to yearly COVID outbreaks, whereas a longer immunity profile, coupled with a small degree of protective cross-immunity from other betacoronaviruses, could lead to apparent elimination of the virus followed by resurgence after a few years.

“Other scenarios are, of course, possible, because there are many processes at play and much that remains unresolved,” write Shaman and Galanti.

Research bites

A new study published in JAMA Pediatrics reports that mothers with SARS-CoV-2 infection rarely transmit the virus to their newborns when basic infection-control practices are followed. The findings – the most detailed data available on the risk of SARS-CoV-2 transmission between mothers and their newborns – suggest that more extensive measures like separating COVID-19-positive mothers from their babies and avoiding direct breastfeeding may not be warranted. “Our findings should reassure expectant mothers with COVID-19 that basic infection-control measures during and after childbirth – such as wearing a mask and engaging in breast and hand hygiene when holding or breastfeeding a baby – protected newborns from infection in this series,” says study senior author Cynthia Gyamfi-Bannerman, of NewYork-Presbyterian / Columbia University Irving Medical Center. 

A new study of beliefs and attitudes toward COVID-19 in five different countries – the UK, US, Ireland, Mexico and Spain – has identified how much traction some prominent conspiracy theories can gain. Published in the journal Royal Society Open Science, the research reveals “key predictors” for susceptibility to fake pandemic news, and critically finds that a small increase in the perceived reliability of conspiracies equates to a larger drop in the intention to get vaccinated. The Cambridge University-led study asked participants to rate the reliability of several statements, including six popular myths about COVID-19. While a large majority of people in all five nations judged the misinformation to be unreliable, researchers found that certain conspiracy theories have taken root in significant portions of the population. The conspiracy deemed most valid across the board was the claim that COVID-19 was engineered in a Wuhan laboratory. “Certain misinformation claims are consistently seen as reliable by substantial sections of the public. We find a clear link between believing coronavirus conspiracies and hesitancy around any future vaccine,” says study co-author Sander van der Linden, of Cambridge.

Sudden permanent hearing loss seems to be linked to COVID-19 infection in some people, warn doctors, reporting the first UK case in the journal BMJ Case Reports. While the side-effect is uncommon, awareness of it is important because a prompt course of steroid treatment can reverse this disabling condition. “Despite the considerable literature on COVID-19 and the various symptoms associated with the virus, there is a lack of discussion on the relationship between COVID-19 and hearing,” say the report authors. “Given the widespread presence of the virus in the population and the significant morbidity of hearing loss, it is important to investigate this further.”

A new study led by researchers at Virginia Commonwealth University, US, suggests that for every two deaths attributed to COVID-19 in the US, a third American dies as a result of the pandemic. The results are published in the Journal of the American Medical Association. The study shows that deaths between 1 March and 1 August increased 20% compared to previous years, but deaths attributed to COVID-19 accounted for only  67% of those deaths. “Contrary to sceptics who claim that COVID-19 deaths are fake or that the numbers are much smaller than we hear on the news, our research and many other studies on the same subject show quite the opposite,” said lead author Steven Woolf. The study also contains suggestive evidence that state policies on reopening early in April and May may have fueled the surges experienced in June and July.

COVID-19 news and trends published first on https://triviaqaweb.weebly.com/

[demolish-the-ivory-tower-do-it]

The#SDGandME: An Occupational Therapy Students’ Roadmap Towards Making a Real Impact

2020 isn’t over, yet we’ve been struck with record-breaking pandemic all over the world, and causing a humanitarian crisis. It is a scary time for billions of people around the world and if you look at what’s happening in our communities, the word “scary” doesn’t even come anywhere close to describing the magnitude of the challenges facing the people in the communities.

I find myself as an Occupational therapist working in the community asking questions such as:

How can I help? Where should I give?

What programs can we implement that can make life better?

What can I do to make a difference is someone’s life?

As with life, there is no crystal ball that will give us answers to these questions, but thanks to the unifying work of the United Nations and its Sustainable Development Goals, there is now a framework to point us in the right direction- even though they’re a little daunting. But if you keep reading, I will show you how I as an occupational therapy student aim to achieve some of the SDGs.

But First, Some Background .On September 25th2015 the United Nations announced a comprehensive list of goals to create a sustainable planet free form injustices and inequalities by 2030.This proposal is called the Sustainable Development Goals (SGDs). There are 17 SDGs ranging from Women’s empowerment to fixing the Environment Crisis.

Across the world, dreamers, problem solvers, and change makers are aligning behind these goals , working quickly and diligently to change the direction of our earth’s future. As occupational therapist in the making, we are also working tirelessly to meet some of the goals.

“The SDG are an acknowledgement of what ALL young people already know , which is that the current global economic structure is enormously destructive and unstainable”

-Corporate Citizenship Initiative

I will be highlighting 5 SDG’s that as an occupational therapy student I could work towards within the community I am currently working in:

Goal 1: End poverty in all its forms everywhere

According to the United Nations, globally the number of people living in extreme poverty declined from 36 per cent in 1990 to 10 per cent in 2015 (Home, 2020). However, the pace of change is decelerating and the COVID-19 crises risks vulnerable groups to extreme poverty. As part of basic food security and nutrition, gardening project was established at the clinic that we are working at.The harvest from the garden, will be offered to low income families so that they can have food on the table.The garden project is  also open to the communities for persons that want vocational rehabilitation , as members of the community can learn the skills of gardening and entrepreneurship training. Therefore, meeting goal #1 as it aims to end poverty in all its forms everywhere. By 2030, to ensure that all men and women, especially the poor and vulnerable, have equal rights to economic resources.

Goal: 3 Good health and well-being

At a primary healthcare level, one of the many roles as occupational therapist is to promote healthy lives and promote well-being. As the world is facing a global health crisis COVID-19 , as health workers , we saw the gap that we must educate people coming to the clinic on how they can protect themselves and others from contracting the virus , such as wearing their mask appropriately. The targets for this goal also point at preventing deaths of newborns, children under 5 years , communicable diseases and non-communicable diseases. Working at the clinic, screening babies that come to the clinic , health promotional talks on epidemics of AIDS , as well as health promotional talks on integration of reproductive and general health for women were part of working toward the goal#3.

Goal 4: Quality Education

Education is key to success, it may not seem so with all the high unemployment rates of graduates in South Africa , but .. I repeat but education is a key to escaping poverty. Weybright et al., (2020), emphasised from Department of Basic Education, Republic of South Africa, (2015) ,found that in South Africa , dropout in 2015 alone , approximately 60% of first graders will ultimately drop out rather than complete Grade 12 and likewise by grade 12 only 52% of the age appropriate population remain enrolled. To ensure the well-being of children and that they have continued learning, as an occupational therapist in the community , I took the opportunity to tackle the and facilitate inclusive learning opportunity during this period of sudden and unprecedented educational disruption. An opportunity to develop a programme which will facilitate the return of students to school when they reopen to avoid an upsurge of dropout rates. 

At the age of 30, Graca became one of the youngest Members of Parliament in her country. She was singled out by the UN Women as a “ Women of Achievement ”You can read a full interview here http:beijing20.unwomen.org/en/news-and-events/stories/2014/10/woa-cabo-verde-graca-sanches. This is an example of how Goal #5 aims to achieve equality and empower all women and girls. By 2030, the goal is to ensure that women’s full and effective participation for leadership at all levels of decision-making in political, economic and public life is reach (The Global Goals,2020). In the community I’m working in, one of the aims to try and empower woman to become entrepreneurs and for them to become more than just nurtures of the households. Putting women and girls at the centre as emerging evidence shows that , since the outbreak of the pandemic , violence against women and girls –and particularly domestic violence –has intensified. There it is essential that ay community level , women empowerment is encouraged and motivated.

Goal 8: Decent work and economic growth

The sustainability and inclusivity of economic growth can drive progress, create decent jobs for all and improve living standards. One of the aims by 2030 is to achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of value. Working towards this goal within the community, would mean having income-generating programmes that the community members could take part in. As on OT being creative and innovative, by encouraging the formalisation and growth of micro-, small- and medium-sized enterprises.

As you can see as a young OT still training I am making the change where I can. Now is the time to act so that we can build an equitable, sustainable planet by 2030. I hope that you will also explore what the SDGs mean, and how you can make a small change in your life starting today to help us achieve them.

Reference

1. The Global Goals.2020. The Global Goals.[ online] Available at: https://www.globalgoals.org/[ Accessed 21 August 2020]

2. Weybright,E., Caldwell,L.,LXie,H.,Wegner,L. and Smith,E.,2020. Predicting Secondary School Dropout Among South African Adolescents: A survival Analysis Approach.

3. United Nations Sustainable Development.2020.Home.[online]Available at: <http//www.un.org/sustainabledevelopment/> [ Accessed 21 August 2020]

[qubemagazine]

New Post has been published on Qube Magazine

New Post has been published on https://www.qubeonline.co.uk/cities-lead-fight-against-climate-change-and-renewable-energy-report-reveals/

Cities lead fight against climate change and renewable energy - report reveals

NEWS FEATURES FIRE & SECURITY SUBMISSIONS RESOURCES

“It might come as a surprise to some, but it is a pattern that we now find everywhere in the world: Cities are driving the transition towards renewable energy. They understand that renewables mean less lung and heart diseases, more local jobs and relief for the municipal budget,” says Rana Adib, REN21’s Executive Secretary. “If cities alone were to decide, today’s climate and energy politics would look totally different.”

“Fossil fuel centered economies made it difficult for national governments to put climate concerns front and centre, with the result that globally we are not on track to meet the Paris Agreement. This truth is hard to face. The Emissions Gap Report 2019 that our partner UNEP releases today shows the harsh reality: countries collectively fail to stop growth in global greenhouse gas emissions. The gap between targets and reality is only growing. Deeper and faster cuts are required now, and cities can take climate action into their own hands,” says Rana Adib.

By November 2019, almost 1,200 jurisdictions and local governments in 23 countries had declared a state of climate emergency. Almost 10,000 have already adopted carbon emission reduction targets, many of which linked to renewable energy, notes the newly released report.

First ever Global Stock-taking of Cities’ Efforts to Transition to Renewable Energy

Many countries still expect that the implementation of 100% renewable energy systems will take several decades. Yet, there are plenty of cities in the world that already today source 100% of their electricity from renewables. Now, they are taking steps to expand their ambitions to get rid of fossil fuels in heating, cooling, transport and industry.

The report shows that more and more cities in Europe take the energy supply back into their own hands by re-municipalising energy companies or forming new ones. Barcelona Energía, recently formed to supply locally produced renewable energy to the city’s inhabitants and municipal facilities, is just one example. In 2000, Barcelona was also one of the first European cities to require all new and renovated buildings to use solar energy to supply a minimum of 60% of a building’s running hot water needs. The next project in line is a solar cooling network which is expected to start operating by the end of 2019.

Renewables could Save Millions from Premature Death

“An important message from the report is that many cities understand that they are directly suffering from the burning of fossil fuels. Shifting to efficient and renewable energy systems is the only way out,” notes Adib.

One of the most powerful motivations is air pollution. Particles and other air pollutants from fossil fuels literally asphyxiate cities. They barely measure a fraction of the diameter of a human hair, but according to studies by the World Health Organisation, their presence above urban skies is responsible for millions of premature deaths and costs billions. Health damages by road traffic alone cost the European Union around 62 billion euros a year.

Mr. Ban Ki-Moon, former UN Secretary General and Chair of Korea’s National Council on Climate and Air Quality underlines the link between burning of fossil fuel and citizens’ health.  “Unsustainable and reckless consumption of energy has led to concerning levels of air pollution, making it the fourth-largest threat to human health and the single biggest environmental health risk that we face today. Against this background, transition to a cleaner and more sustainable energy model is no longer a choice but a must.  Cities can spearhead progress in combating air pollution, by implementing creative policies and incubating innovative ideas, like what the Seoul Metropolitan Government is doing. We have the necessary means to pursue energy transition. All we need is the political and institutional will to make the transition into reality.”

Like Seoul, Barcelona, Berlin, Copenhagen, Heidelberg, Lisbon, London, Madrid, Paris, Rotterdam, Stockholm and Warsaw have all pledged to set new air quality standards that meet or exceed existing national targets within two years. When signing the declaration in October, Copenhagen’s Mayor Frank Jensen commented: “Air pollution is a global problem, but it has a local solution. Copenhagen wants to be the world’s first climate-neutral capital by 2025. This year, we have put 400 electric buses on the streets and by next year ferries should go electric, too. We want that our citizens can take a deep breath at any time of the year without fearing for their health.”

Many Cities in Developing Countries are Leaders in Renewable Expansion

“We can say that many benefits from renewables are the same all over the world,” explains Adib. “But there are also differences. For cities in the developing world, renewable energy is the only way to expand energy access to all inhabitants, particularly those living in urban slums and informal settlements and in suburban and peri-urban areas.”

Cape Town has the highest electrification rate in South Africa but thousands of households are in areas which are un-electrifiable because the land is illegally occupied or situated in a flood prone or restricted area. Poverty often causes households to not use electricity for part of the month. “While efforts to deliver housing are ongoing there is significant informality. Open flame technologies like candles and paraffin stoves are used. Devastating shack fires occur periodically causing deaths, injuries and displacement. Solar home systems are a safe and affordable alternative”, explains Dan Plato, Mayor of Cape Town.

Executive Director of the United Nations Environment Programme, Inger Andersen, believes that “by avoiding resource depletion and pollution, and creating jobs, renewable energy is a common-sense engine of social and economic development. As our cities expand, those built on a strong renewable energy base will thrive.”

Renewables make Cities Resilient

Data in the report reveals that increased prosperity and living standards in cities cause a sheer insatiable hunger for energy. REN21´s report shows that 70% of all cities are already affected by the impact of climate change today. Says Adib: “If cities don’t do something about the way they produce and use energy, they are going to wreak their own destruction. It’s that simple and they know it. And with more than one billion people worldwide living in urban slums and informal settlements, the poorest will be the hardest hit. Even in Europe, tropical storms will become more frequent. We got a taste of it when storm Leslie hit northern and central Portugal with wind speeds of over 100 km/h and brought heavy rainfall in Spain and France last year.”

Keeping the energy infrastructure working, once the flood or storm arrives, is essential to secure continued operation of rescue services, hospitals and information systems. Businesses and industry invest in renewable energy to avoid disruptions. Cities adopt energy systems based on distributed renewable generation because they are more flexible and resilient to those central shocks which are becoming more frequent with climate change, underlines the report.

Participation at the Local Level Makes the Difference

“An advantage of renewable energy is that it gives citizens a role in shaping the infrastructure,” says Adib. “Our report shows that in recent years, the number of community energy projects using renewable sources has surged, confirming that democracy is just as important as a driver for the energy transition as climate change.” Denmark, Germany and the UK are at the forefront of this development. Yet, such projects begin to emerge also in other parts of the world including Thailand, Japan, and Canada, the report notes.

“Cities can actively drive the fight against climate change at national and global level. They are able to tap into opportunities that other levels of government do not have, including a more direct relationship with local citizens and businesses,” notes Germany’s Minister for Environment, Nature Conservation and Nuclear Safety, Svenja Schulze. “Citizen engagement and public pressure have raised cities’ level of ambition on renewables in many places around the world, reaping economic, social and environmental benefits.”

“Yet, it is important to emphasise that even the world’s largest cities with the most decision-making structure cannot replace national governments and their responsibility in fulfilling their commitments under the Paris Agreement. As the climate crisis unfolds, no one can hide,” Adib, concludes.

  Cities lead fight against climate change and renewable energy – report reveals

NEWS FEATURES FIRE & SECURITY SUBMISSIONS RESOURCES

[biofunmy]

`Safer opioid’ has sparked a crisis in vulnerable countries

KAPURTHALA, India — Reports rolled in with escalating urgency — pills seized by the truckload, pills swallowed by schoolchildren, pills in the pockets of dead terrorists.

These pills, the world has been told, are safer than the OxyContins, the Vicodins, the fentanyls that have wreaked so much devastation. But now they are the root of what the United Nations named “the other opioid crisis” — an epidemic featured in fewer headlines than the American one, as it rages through the planet’s most vulnerable countries.

Mass abuse of the opioid tramadol spans continents, from India to Africa to the Middle East, creating international havoc some experts blame on a loophole in narcotics regulation and a miscalculation of the drug’s danger. The man-made opioid was touted as a way to relieve pain with little risk of abuse. Unlike other opioids, tramadol flowed freely around the world, unburdened by international controls that track most dangerous drugs.

But abuse is now so rampant that some countries are asking international authorities to intervene.

———

This story was produced with support from the Pulitzer Center on Crisis Reporting.

———

Grunenthal, the German company that originally made the drug, is campaigning for the status quo, arguing that it’s largely illicit counterfeit pills causing problems. International regulations make narcotics difficult to get in countries with disorganized health systems, the company says, and adding tramadol to the list would deprive suffering patients access to any opioid at all.

“This is a huge public health dilemma,” said Dr. Gilles Forte, the secretary of the World Health Organization’s committee that recommends how drugs should be regulated. Tramadol is available in war zones and impoverished nations because it is unregulated. But it is widely abused for the same exact reason. “It’s a really very complicated balance to strike.”

Tramadol has not been as deadly as other opioids, and the crisis isn’t killing with the ferocity of America’s struggle with the drugs. Still, individual governments from the U.S. to Egypt to Ukraine have realized the drug’s dangers are greater than was believed and have worked to rein in the tramadol trade. The north Indian state of Punjab, the center of India’s opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, but also illicit counterfeits hawked by street vendors.

This year, authorities seized hundreds of thousands of tablets, banned most pharmacy sales and shut down pill factories, pushing the price from 35 cents for a 10-pack to $14. The government opened a network of treatment centers, fearing those who had become opioid addicted would resort to heroin out of desperation. Hordes of people rushed in, seeking help in managing excruciating withdrawal.

For some, tramadol had become as essential as food.

“Like if you don’t eat, you start to feel hungry. Similar is the case with not taking it,” said auto shop welder Deepak Arora, a gaunt 30-year-old who took 15 tablets day, so much he had to steal from his family to pay for pills. “You are like a dead person.”

———

Jeffery Bawa, an officer with the United Nations Office on Drugs and Crime, realized what was happening in 2016, when he traveled to Mali in western Africa, one of the world’s poorest countries, gripped by civil war and terrorism. They asked people for their most pressing concerns. Most did not say hunger or violence. They said tramadol.

One woman said children stumble down the streets, high on the opioid; parents add it to tea to dull the ache of hunger. Nigerian officials said at a United Nations meeting on tramadol trafficking that the number of people there living with addiction is now far higher than the number with AIDS or HIV.

Tramadol is so pervasive in Cameroon scientists a few years ago believed they’d discovered a natural version in tree roots. But it was not natural at all: Farmers bought pills and fed them to their cattle to ward off the effects of debilitating heat. Their waste contaminated the soil, and the chemical seeped into the trees.

Police began finding pills on terrorists, who traffic it to fund their networks and take it to bolster their capacity for violence, Bawa said.

Most of it was coming from India. The country’s sprawling pharmaceutical industry is fueled by cheap generics. Pill factories produce knock-offs and ship them in bulk around the world, in doses far exceeding medical limits.

In 2017, law enforcement reported that $75 million worth of tramadol from India was confiscated en route to the Islamic State terror group. Authorities intercepted 600,000 tablets headed for Boko Haram. Another 3 million were found in a pickup truck in Niger, in boxes disguised with U.N. logos. The agency warned that tramadol was playing “a direct role in the destabilization of the region.”

“We cannot let the situation get any further out of control,” that alert read.

Grunenthal maintains that tramadol has a low risk of abuse; most of the pills causing trouble are knock-offs, not legitimate pharmaceuticals, and American surveys have shown lower levels of abuse than other prescription painkillers. The company submitted a report to the WHO in 2014, saying that the abuse evident in “a limited number of countries,” should be viewed “in the context of the political and social instabilities in the region.”

But some wealthy countries worried about increasing abuse also have acted to contain the drug.

The United Kingdom and United States both regulated it in 2014. Tramadol was uncontrolled in Denmark until 2017, when journalists asked doctors to review studies submitted to regulators to support the claim that it has a low risk for addiction, said Dr. Karsten Juhl Jorgensen, acting director of the Nordic Cochrane Centre and one of the physicians who analyzed the materials. They all agreed that the documents did not prove it’s safer.

“We know that opioids are some of the most addictive drugs on the face of the planet, so the claim that you’ve developed one that’s not addictive, that’s an extraordinary claim, and extraordinary claims require evidence. And it just wasn’t there,” said Jorgensen. “We’ve all been cheated, and people are angry about that.”

Jorgensen compares claims that tramadol is low risk to those made by American companies now facing thousands of lawsuits alleging misleading campaigns touting the safety of opioids unleashed the U.S. addiction epidemic.

Stefano Berterame, a chief at the International Narcotics Control Board, said there is a critical difference: The crisis is not as deadly as the American one, which began with prescription opioids and transitioned to heroin and fentanyl. Tramadol does not as routinely cause the respiratory depression that leads to overdose death.

But it is mostly afflicting poor nations, where overdose statistics are erratic, he said, so the true toll of tramadol is unknown.

———

The United Nations established the International Narcotics Control Board in 1961 to spare the world the “serious evil” of addiction. It has since tracked most opioids.

Tramadol’s exemption means authorization isn’t required as the drug moves across borders. Its easy availability also leads to confusion about what tramadol even is, experts say. In many countries, it is thought to be a mood enhancer or treatment for depression and post-traumatic stress. Some take it to improve sexual stamina or endure grueling labor.

Grunenthal synthesized tramadol in the 1960s, as the company was embroiled in scandal over its marketing of the sedative thalidomide, which caused extreme birth defects in thousands of babies whose mothers took it. Tramadol was initially believed to have a low risk of abuse because initial trials studied injected tramadol, the most potent route for most opioids. But researchers later found that tramadol releases a far more powerful dose taken orally because of how it is metabolized by the liver.

Tramadol’s worldwide market quickly expanded in the 1990s. In 2000, the WHO, which assesses medications and recommends scheduling, noted reports of dependence. A committee has reviewed the drug numerous times since, recommended it remain under surveillance but declined to add international regulation.

There is no alternative to tramadol, said Forte, the committee’s secretary. It is the only opioid available in some of the world’s most desperate places; relief organizations rely on it in war zones and natural disasters. It is used extensively not because it is a particularly good medication, he said. The most effective opioid is morphine, but morphine is strictly controlled and countries in crisis fear abuse. Tramadol became the default precisely because it’s uncontrolled.

The WHO is analyzing whether any other drug could take its place but have so far found none. Meanwhile, Forte said, the agency is working with battered nations to ferret out counterfeits.

Legitimate tramadol remains a lucrative business: market research estimates the global market amounts to around $1.4 billion, according to Grunenthal. The medication long ago lost its patent protection. It is now manufactured by many companies and sold under some 500 brand names. Grunenthal markets it as Tramal as well as Zaldiar, tramadol combined with paracetamol. In 2018, those products brought in 174 million euros ($191 million), according to the company’s annual report.

“Our purpose at Grunenthal is to develop and deliver medicines and solutions which address the unmet needs of patients with the goal of improving their quality of life,” the company wrote in a statement that said it acknowledges opioids pose a risk of abuse and addiction. “”We do so with the highest ethical standards.”

Grunenthal also sells other opioids and is expanding around the world. The Associated Press this year revealed executives were swept up in an Italian corruption case alleging they illegally paid a doctor to promote the use of opioids.

The company has campaigned to keep tramadol unregulated. It funded surveys that found regulation would impede pain treatment and paid consultants to travel to the WHO to make their case that it’s safer that other opioids.

Spokesman Stepan Kracala said regulation would not necessarily curtail illicit trade and could backfire: Some desperate pain patients turn to the black market if no legal options exist. Egypt’s long struggle with tramadol abuse is an example, he said. The country enacted strict regulation in 2012 and a later survey found some suffering from cancer using counterfeit tramadol for relief.

Kracala also pointed to regulatory decisions as proof of tramadol’s comparable safety: The U.S. in 2014 added tramadol to its list of controlled substances but included it in a lesser category than opioids like oxycodone or morphine, signaling it is less risky.

There are growing calls to change that.

The Mayo Clinic hospital in Minnesota worked to reduce opioids prescribed post-surgery as the American epidemic escalated, said surgeon Cornelius Thiels. Doctors there started shifting patients to tramadol because it was billed as safer. But Thiels and his colleagues analyzed prescription data and were surprised to find patients prescribed tramadol were just as likely to move on to long-term use.

They published their findings this year to alert authorities, he said: “There is no safe opioid. Tramadol is not a safe alternative. It’s a mistake that we didn’t figure it out sooner. It’s unfortunate that it took us this long. There’s a lot more that we need to learn about it, but I think we know enough that we also can’t wait around to act on this.”

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Indian regulators knew the massive quantities manufactured in the country were spilling over domestically and countless Indians were addicted. But S.K. Jha, responsible for the northern region of India’s Narcotics Control Bureau, said he was shocked to learn in 2018 that tramadol from India was ravaging African nations. They realized then they needed to act, he said.

India regulated tramadol in April 2018. Regulators say exports overseas and abuse at home came down. But they acknowledge that the vastness of the pharmaceutical industry and the ingenuity of traffickers makes curtailing abuse and illegal exports all but impossible. Tramadol is still easy to find.

Jyoti Rani stood on her front steps and pointed to house after house where she said tramadol is still sold in her neighborhood of narrow roads and open drains, where school-aged boys sit hunched over the street in the middle of a weekday.

Rani’s addiction began with heroin. When her 14-year-old son died, she fell into depression.

“I wanted to kill myself, but I ended up becoming an addict,” she cried. A doctor prescribed tramadol to help kick the habit — instead, she formed a new one. She locked herself in her room, not eating or taking care of her two children. Rani used tramadol until she ran out of money and entered treatment. Now her family tells her she’s her old self again.

The crackdown on tramadol coincided with the opening of dozens of addiction clinics that administer medicine and counseling to more than 30,000 each day.

“We are trying our level best,” Jha said, “but it’s a challenge for all of us.”

Countries’ efforts to control tramadol on their own often fail, particularly in places where addiction has taken hold, according to the Center for Strategic and International Studies.

India has twice the global average of illicit opiate consumption. Researchers estimate 4 million Indians use heroin or other opioids, and a quarter of them live in the Punjab, India’s agricultural heartland bordering Pakistan, where some of the most vulnerable are driven to drugs out of desperation.

Amandeep Kaur was pregnant when her husband died of a heart attack. She turned to the sex trade to make ends meet. She wanted not to feel, and a fellow sex worker suggested tramadol. She had no idea she’d get addicted, but eventually needed three pills to get through the day.

“If I didn’t have it I felt lifeless, my body ached as if I was going to die,” she said, and joined the line stretching from the addiction clinic’s doors.

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The Global Opioids project can be seen here. http://bit.ly/2zWNwSk

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Associated Press journalist Rishi Lekhi contributed to this report.

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Kaiser Permanente Discusses Their Diabetes Care

Since we love to gripe about healthcare providers, but seldom get an opportunity to talk together frankly, I was excited to finally run into a few executives from Kaiser Permanente (KP) at a healthcare blogging occasion.   Enjoy ’em or hate ’em, Kaiser is America’s leading integrated health care company with a distinctive nonprofit business model (and also those cool “your-couch-is-a-carb” / / Thrive advertisements).

They are extremely interested in Social Media, therefore it didn’t take too much coercion to make them agree to a DiabetesMine.com interview with one of their most articulate (and pragmatic) leaders. Dr. Michael Mustille serves as “Associate Executive Director, External Relations.” An extremely major PR title. However, Dr. Mustille is likewise an occupational medicine doctor with 33 years’ expertise and former manager of the South San Francisco KP health centre. He now sits at the executive director of the Permanente Federation, the organization’s medical arm, and can be personally involved in rather a range of health quality initiatives.

Oh, the irony!  Of course I conducted this interview before last week allegations of mismanagement and medical misconduct hit the fan.

Anyhoo, here is what Dr. Mustille needed to say about what he believes makes Kaiser powerful and how this impacts individuals with diabetes.

*     *     *

DM) Kaiser has been pioneering in best practices for chronic disease control, even launching the subsidiary KP Healthy Solutions to let their expertise. What exactly does KP actually do so well here for diabetes patients particularly?

MM) Why is Kaiser is such a leader in healthcare? I’d say it is all about Quality of Care. We’ve shown this consistently, and within the previous decades two things stand out: our treatment for chronic conditions and also our “health & wellness” push to find the greatest possible prevention and screening.

This is in fact substantiated using standardized quality performance measures, such as those from the NCQA, that monitors quality health and certifies health plans/HMOs throughout the country. They use a standardized data set, and also a publicly available rating methodology. (You can look up report cards on almost any HMO in america.) Kaiser is at or near the top round the Nation.

These standards include, by way of instance, a bundle of diabetes-related steps for individuals: Can you get your A1c tested? Your lipids tested? Your microalbumin measured?   We do occasionally examine patients, but we track the quality of care received from our recordings, including claims data and chart reviews.

Obviously, quantifying in these ways is not the same as making people healthy inside their daily lives. For this, we are in need of a coordinated application of actions/treatments which help get patients where they have to be health-wise — in this instance, if they have pre-diabetes, full diabetes, or complications of diabetes have established in.

DM) How simple is it for diabetes patients with Kaiser to get their own “diabetes care team” — endocrinologist, CDE, nutritionist, podiatrist, etc. — to actually communicate and work together?

MM) One big benefit is shared medical documents. At Kaiser, all those people today work in the same organization, usually at the same location. In a less coordinated system, your providers are across town and each has their own medical documents — that are incomplete, because they only demonstrate the care you received at that office. KP providers work shoulder-to-shoulder with the same records, measuring real outcomes.

We cure 277,000 patients throughout the country with diabetes (out of 8.5 million KP members complete). We all know that their A1c, whether have observed the doctor or where in the hospital recently, and if they’ve filled their diabetes prescriptions. We can tell who they are, where they are, and what degree of control they have, therefore we really know what works concerning team care.

We’re making a real effort now to further advance health information technologies with a brand new suite of software programs called KP HealthConnect(Editor’s note: that has also come under scrutiny). Everything significant for each member is recorded digitally, including visits, lab results, prescriptions, etc.,– no more paper records. The information could be shared with any KP provider anywhere.

We’d also like to see interoperability outside of the KP system, therefore emergency teams along with other critical providers possess some way to retrieve and transmit vital patient information. We’re engaging in a national effort to nurture the Interoperability of Medical Records.

DM) Isn’t Kaiser helping establish standards for transfer of data from many different kinds of health tracking systems (that the Continua Health Alliance)? What are a few of the roadblocks or hot buttons there?

MM) Yes, this is a different problem, which is how to create medical devices “speak to one another. “Kaiser is a charter member of their Continua standards committee. The focus is on Home Monitoring Devices — scales, sugar monitoring, blood pressure apparatus etc — would link mechanically with each other to some degree and also to a database at your supplier’s site.

We’re proficient at designing systems which seem strong, but are siloed, meaning they work great only in the range of their wants, but don’t contribute to your overall medical care. A lot of new apparatus beg the question: Is this really beneficial? Or simply confusing, and possibly even dangerous?

These systems are very fresh, and people tend to lump numerous different monitoring technologies together.   What is their value, and for whom?   These questions will need to be answered by doing a few studies.

DM) What about going into continuous glucose monitoring (CGM) because the quality of diabetes treatment? Where does Kaiser stand on this particular issue?

MM) One of the nice things about practicing medicine in KP is the fact that if you’ve got a excellent idea on how best to help individuals, you can go ahead and try it out. A few of our endocrinologists in Southern California recognized CGM engineering early on and decided to try it. They experimented with patients utilizing Minimed’s model and found it quite useful for hypoglycemic unawareness. However, many Type 2 diabetics may do quite well with this system.

DM) Are individuals encouraged and/or encouraged to try the latest cutting-edge treatments?

MM) In Kaiser, a CGM apparatus would be covered if the patient can’t achieve good glucose control even after exhausting all of the other attempts. This is, we have a step-wise (or evidence-based) way of employing new remedies. We’ve got quidelines for what therapies are appropriate to begin with, and what is the next step and the next step then.

We don’t look at these items insurance choices. These are medical decisions at KP.

It actually is an issue of the person and their doctor making the decision; should they think that current therapy is not working well, they could decide to proceed to the next step.

DM) How can your approach particularly progressive or distinct from what other healthcare organizations do?

MM) We actually have evidence that diabetes patients at KP do better than everywhere. For one thing, we have an innovative way of assessing actual costs. We’ve developed an analytical motor utilizing clinical and financial information to gauge the costs of covering certain inhabitants. By way of instance, we can take all the available information for folks who work in a rubber plant at Des Moines, Iowa, and estimate costs for this population.

With this predictive model we could compute outcomes 10 years from now when we alter the peoples’ therapy, i.e. when we implement a nutrition program or put them on certain medicines, what is the likely impact on their health issues? This is actually significant information, because we could save thousands of dollars and stop countless heart attacks!

In terms of diabetes care, we could understand that there’s generally a return on investment (ROI) of 2 or 3 dollars on each dollar set in. That is strong financial evidence that proactive diabetes therapy is a enormous cost savings for providers in the long term. For employers, in addition, it implies less absenteeism, no extra money wasted in simple treatments, and so forth.

DM) How does all this play from the individual’s perspective?

MM) We provide our expertise via web-based and telephone training, in which patients have direct contact with caregivers who help them develop plans for their individual needs. This isn’t only for chronic conditions, but also for nourishment, exercise, stress reduction, end-of-life care, plus even more. Here is the support which KP Healthy Solutions helps provide to organizations outside of Kaiser.

We’ve had the largest impact (cost savings and outcomes) with chronic conditions like asthma, diabetes, coronary heart disease, heart failure, and depression.

Depression is amazingly important. We’ve discovered that, by way of instance, a diabetic manhood generally spends 4x as many days at the hospital compared to an average member. With depression and diabetes, the member spends 8x as many days at the hospital. So among the first things we do is monitor patients for depression. In addition, we train our care teams on how best to determine motivational factors, and we’re making counseling part of the therapy program.

DM) What about early intervention and pre-diabetes care?

MM) We have guidelines for this, 220 pages of these! Seriously, if a man has a family history of diabetes or other markers, then we are doing Favorable screening. In addition, we understand you can’t use this sort of care for a cookie cutter approach; it needs to be tailored to the person.

Additionally, we have a fresh A-L-L initiative to incorporate cardiovascular hazard management to diabetes care. This states BG management is essential, but lipid management can also be crucial.   Cardiovasulcar complications associated with lipid abnormalities are among the greatest killers of diabetics. A combo of medications can really aid: Aspirin, Lovastatin, Lisinopril.

We’re targeting each diabetic over 55 and those with different complications, such as hypertension or coronary artery disease, and putting them on those three meds, that are shown to reduce cardiovascular disease by 20-30%. We see enormous impact already, because the complications of large BG show up much later, however, the cardiovascular disease (heart attack, stroke) generally show up within a few years.

Beyond this, we also possess an excellent proactive system of patient reminders for your next pap smear, next mammogram, etc.

DM) Kaiser got pretty beat up recently in the kidney transplant scandal. How is it working to restore patients’ religion in its care?

MM) I have to admit that we didn’t deal with this well. There is some irony in the sense that the true transplant care was good, but we snapped it with all the administrative section. We failed to get patients moved on the new waiting list in order of their current seniority. So individuals ended up in limbo on the receiver list.

What are we doing about it? Phasing out the transplant program. We brought the app in-house because we thought we could do much better job. But we’re admitting defeat within this field.

What we’re understanding is that individuals can’t deal with this sort of program without a significant administrative overhaul. So we’re shutting down that program till we’re sure can we get it done correctly. We’re not giving up on kidney care, but going back to utilizing outside contracted surgeons to run the transplant, at UC Davis and UCSF (that is how we did it previously).

DM) Finally, Kaiser’s unique capitation system (members pay a predetermined amount per covered “mind” per month) makes some people today think they’re barred from utilizing Kaiser unless their employer is contracted with the company. What’s the chance for individuals already diagnosed with diabetes to join Kaiser should they prefer?

MM) Many of the individuals who enter KP do come as a member of an employee group — especially if they have a pre-existing chronic condition, as as part of a team, they don’t need medical screening to join.

Should you apply as an individual, you do need to go through screening. And you may be denied or have limitations placed on your coverage, meaning you might need to pay for some remedies out of your pocket. And to be honest, some people likely do get rejected out of hand. That is a fantastic reason why the majority of folks look to work for a business offering fantastic medical insurance benefits.

DM) Dr. Mustille, what is your message into the diabetes community?

MM) I just feel that Kaiser is a very good location for those who have diabetes. A coordinated, organized system is the perfect method to look after a complex condition like this. So I’d say, if you’ve got access to Kaiser, then you should make the most of it.

You won’t hear that from many other health plans — asking possibly expensive members to join… but I’d say we do quite a good job with diabetes and people should make the most of it whenever they could!

Thanks, Dr. M, for giving us the provider perspective; we will all be curious to observe how Kaiser recovers by the latest scandals along with resignations. Ugh.

Disclaimer: Content Made by the Diabetes Mine team. For additional information click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health site centered on the diabetes community. The content isn’t medically reviewed and does not stick to Healthline’s editorial instructions. To learn more about Healthline’s partnership with Diabetes Mine, please click here.

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