One article warns that the absence of major investments in new technology and prevention and treatment tools could make drug-resistant strains of TB the “dominant” form of TB over the coming decades, according to the news service (5/18). The article notes “that India and China had around 50 percent of the global MDR-TB burden, followed by Russia with 9 percent,” Reuters writes. The authors write, “The future possibility of strains that are totally resistant to all anti-tuberculosis drugs is not inconceivable.”
“In other studies in the series … scientists said the combined impact of new drugs, vaccines, and diagnostic tests could cut worldwide incidence of TB by 94 percent by 2050,” the news service reports. According to experts, only about a quarter of the funding needed for drug research and development is available.
“Development of new drugs for TB is lengthy, expensive, and risky, and the expected revenues are too small to justify commercial investment,” Zhenkun Ma of the Global Alliance for TB Drug Development and co-authors write in a paper. “New financing and market incentive mechanisms are needed.”
The journal also notes that “there are 11 potential TB vaccines being tested in human trials and up to 10 experimental medicines in the TB drug 'pipeline.' Since many drugs fail in late-stage trials, this handful of possibilities is unlikely to be enough,” Reuters reports (Kelland, 5/18).
The series also focused on the broader issues that contribute to the spread of TB, the Associated Press reports. “Experts said TB isn't only a medical problem, but is intertwined with poverty, as it spreads widely among people living in overcrowded, dirty places. They said TB programs need to go beyond health and include other sectors like housing, education and transportation,” the news service writes. Philip Stevens, a health policy expert at the International Policy Network, said the disease “cannot be tackled in isolation,” noting that the focus of control efforts should be on “economic growth, which is outside the control of the U.N.” (Cheng, 5/18).
“In the eighth and final paper … a call to action is made to a wide range of sectors to assist scale-up TB service delivery, research and control. The launch of The Lancet TB Observatory, which will monitor progress on key indicators on an ongoing basis, is also announced,” according to a Lancet press release. The Observatory, which is a collaboration between the Lancet, the Stop TB Parternship, the WHO and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, “will assess and monitor” TB research, financing and other information. In a comment discussing the Observatory, Lancet Editor-in-Chief Richard Horton and Executive Editor Pamela Das observe that currently “there is no formal mechanism to assess this information critically and independently. Nor is there any means to hold the various stakeholders in tuberculosis control to account” (5/18).
The series also includes comments about how to scale-up an integrated TB and HIV response, the burden of the disease in women and children and how migration patterns within and between countries contribute to the spread of TB.
Tips for Managing Food Allergy
Get a professional diagnosis. Don't try to diagnose a food allergy yourself. If you suspect that your child has a food allergy, discuss this with your doctor. He or she can advise you accordingly and may refer you to an allergist for additional testing and treatment if needed. You should work with your doctor and/or allergist to develop an action plan for managing the allergy through indicating which foods your child should avoid, and possibly prescribing medication, such as an antihistamine or, for severe reactions, self-injectable epinephrine (EpiPen® or Twinject®).
Pass around the plan. Give your child's food allergy action plan to people who regularly see your child, including relatives, caregivers and their friends' parents.
See an Accredited Practicing Dietitian. An APD like Nastaran can help you and your child identify foods and ingredients to avoid, and develop an eating plan to ensure your child gets all the nutrients needed to grow and develop properly. For example, if your child is allergic to milk, the dietitian will recommend other calcium-containing foods and beverages.
Always read food labels. Always read food labels to see if the product contains any of the eight major allergens, or other ingredients your child is allergic to. Since food and beverage companies continually make improvements, read the label every time you purchase a product. Teach your child how to read labels, too.
Get support at school. Meet with staff at your child's school to review and distribute your child's food allergy action plan. At minimum, involve your child's primary teacher, the school nurse (if there is one), and key food service staff. Make sure all supervisory staff your child sees during the school day and during after-school activities have a copy of the plan. It is highly recommended that school administrators, teachers, and even food service staff are aware of the food allergy action plan in the absence of a school nurse.
Be cafeteria cautious. Go over the school lunch menu with your child to identify foods to avoid. Work with food service staff to plan substitutions or pack a lunch for your child to take to school. Remind your child not to share or trade food with others and make sure they know which staff can help if they have questions about a food, or if they have a reaction to a food. Be sure your school food service staff has copies of the School Foodservice and Food Allergies information sheet and review it with them when you talk to them about your child's food allergies.
Ask questions when eating out. Most life-threatening allergic reactions to foods occur when eating away from the home. Explain your child's situation and needs clearly to your host or food server—and teach your child to do the same when you're not with them. If necessary, ask to speak with the chef or manager. Some fast food restaurants provide a list of the ingredients in their menu items, as well as information on whether any of the eight major allergens are present.
Keep an allergy-safe kitchen. Rather than singling out your food-allergic child, prepare allergy-free recipes the whole family will enjoy.
Make peers “allergy allies.” Encourage your child to talk openly with friends and classmates about their allergy, what foods they must avoid, and what could happen to them if they don't. Suggest that your child enlist their friends in helping them “stay on the alert” for foods in question so they won't get sick.
Most importantly, be ready for emergencies. Teach your child the possible symptoms of a serious allergic reaction (anaphylaxis), such as difficulty breathing or swallowing, or tingling in the hands, feet, lips or scalp. If they experience symptoms after eating a food, make sure they know to immediately call 0-0-0 and, if prescribed by your allergist, use their medication to treat the reaction. If possible, have your child wear a medical alert bracelet or necklace that identifies the specific allergy. Every few months, “role play” an allergic reaction to make sure your child knows what to do.
For more information and resources on managing food allergies see Nastaran or your doctor.
Source: International Food Information Council
While most private health funds provide rebates for visits to APDs, some patients may be eligible for a Medicare rebate instead.
The Medicare Allied Health Initiative allows chronically ill people being managed by their GP under the Enhanced Primary Care (EPC) Program access to Medicare rebates for ADP services. Eligible patients are those with a chronic condition, defined as one that is likely to be present for at least 6 months. This includes, but is not limited to, asthma, cancer, cardiovascular disease and diabetes. General practitioners must be managing the patient through the GP Management Plan (GPMP) and the need must be identified as part of a Team Care Arrangement (TCA). (Please note these are not the only criteria for Medicare eligibility for a GPMP, TCA and referral.) The dietitian must provide a service that is directly related to the management of the patient’s chronic condition. General practitioners must then fill out the EPC Program Referral Form for Allied Health Services under Medicare for the rebate to be possible. The Medicare rebate is currently $48.95 per service with out-of-pocket expenses counting toward the extended Medicare safety net. Patients are given a maximum of five allied health visits per calendar year.
Medicare rebates are now also payable for group services for patients with type 2 diabetes, on referral from a GP. Contact Medicare for further information about eligibility, requirements, rebates and referral forms.