Common Diseases in Portugal

Portugal has a population of 10.5 million as of 2016, and a mortality rate of 548.6 deaths per 100,000 people. The top ten most common diseases in Portugal in 2016 were ischemic heart disease, cerebrovascular disease, Alzheimer’s disease, lower respiratory infections, COPD, colorectal cancer, lung cancer, diabetes, chronic kidney disease and stomach cancer.

The rates of ischemic heart disease, cerebrovascular disease, diabetes and stomach cancer have all gone down in recent years, though they still rank in the top ten. The top ten causes of disability in 2016 were low back and neck pain, sense organ diseases, depressive disorders, migraines, skin diseases, anxiety disorders, oral disorders, diabetes, falls and other musculoskeletal issues.

Broadly speaking, the deadliest diseases are cardiovascular diseases, cancer and neurological disorders.

Addiction: A Major Success Story

While Portugal has made strides in reducing the rates of the diseases described above, its biggest success has been in tackling addiction, particularly to heroin.

In the 1980s and 1990s, a major opioid epidemic made addiction one of the most common diseases in Portugal. By the mid-1990s, over one percent of Portugal’s population was addicted to heroin, and cocaine use was also prevalent.

To address this epidemic, Portugal took the opposite approach to other countries struggling with a similar epidemic, such as the United States. Whereas the U.S. cracked down on drug use and initiated a war on drugs, Portugal completely decriminalized all drugs, including heroin, in 2001. Dealing drugs was still illegal and punishable with jail time, but users caught with less than a 10-day supply of any drug were sent to mandatory medical treatment.

This system completely bypassed the legal system, treating addiction as a health issue instead of a crime. This approach led to a 75 percent reduction in drug cases and a 95 percent reduction in drug-related HIV infections. Deaths due to overdoses or drug-related infections in Portugal are currently five times lower than the average across the European Union.

A model for change?

While any radical change in policy must be considered in the context of each country’s current legal system and culture, aspects of Portugal’s approach to addiction constitute a model that could be successfully implemented across the world.

The basis of this model are outreach programs whose employees keep track of local drug users and encourage them to quit. If they accept, they provide them with free counseling and treatment and daily methadone to wean them off the opioids. If they refuse to quit at that time, then outreach workers hand out clean needles and condoms to reduce the spread of HIV/AIDS.

This model is also economically efficient. The U.S. currently spends approximately $10,000 per household to uphold its current drug policy, while Portugal currently spends $10 per citizen.

The most common diseases in Portugal are similar to those across the European Union. What makes Portugal stand out is its reaction to one particular disease: addiction. If Portugal brings this innovation to other realms of disease prevention, it could be poised to drastically lower its disease burden in the coming decades.

– Olivia Bradley

Photo: Flickr

 

 

Sub Saharan AfricaWith cancer claiming the lives of about 450,000 Africans per year, drug manufacturers, in a deal with the American Cancer Society (ACS) and the Clinton Health Access Initiative (CHAI), have decided to bring life-saving treatments to tens of thousands Africans in need of major healthcare improvements.

The agreement was made between two major pharmaceutical companies: Pfizer, located in the U.S. and Cipla, one of the giants in the Indian pharmaceutical world. Both will cut the prices of 16 cancer treatment drugs, including chemotherapies, for six countries in sub-Saharan Africa that are most affected by the disease.

The six countries receiving major discounts on cancer medicines are Ethiopia, Nigeria, Kenya, Uganda, Rwanda and Tanzania. A press release by the ACS reveals these are the countries in major need of health improvement, as 44 percent of all cancer cases occurring in sub-Saharan Africa each year happen in these six targeted countries.

According to the Pharmaceutical Journal, there were an estimated 626,000 new cases of cancer in sub-Saharan Africa in 2012, leading to a total of 447,000 deaths by cancer. The World Health Organization predicts this figure could double by 2030 if nothing is done, with killings reaching almost one million sub-Saharan Africans. In comparison to the U.S., with 90 percent of women surviving five years with breast cancer, Uganda and Gambia have survival rates of 46 percent and 12 percent, respectively.

Some of the factors explaining the start of Africa’s cancer crisis are the lack of training for providers, shortages of medications and the insufficiency of diagnostic and therapeutic equipment. Another barrier to quality care for cancer patients in Africa is linked to biology. In fact, there are differences in tumor biology between African cancer patients and patients in developed countries. As an example, African patients often have bigger tumors than patients in other regions, which demands much more care as well as adequate infrastructure to research solutions for curing the disease.

Funding is also a major problem for sub-Saharan Africa, as global funding for cancer prevention and treatment in other low-income countries represents only two percent of global health spending. This is far lower than the health spending for diseases such as HIV, malaria and tuberculosis.

Having access to high-quality and affordable cancer treatment facilities and medicine in sub-Saharan Africa has become a major goal for ACS and its partner organizations. On top of this agreement, they are preparing long term strategies that will improve the lack of care facing many African patients for years to come.

Sarah Soutoul

Photo: Flickr

Zika Virus Kills Cancer Cells

To most, “Zika virus” is synonymous with “devastation.” Here is a quick summary of Zika’s recent global impact:

  • Between January 1, 2007, and April 6, 2016, 62 nations and territories reported Zika virus transmission.
  • Zika Virus brought widespread infection to the Regions of the Americas in 2015.
  • The most recent outbreak indicated by the World Health Organization occurred in India in May 2017.
  • Based on initial research, the scientific community concedes that Zika virus is a cause of microcephaly and Guillain-Barré syndrome.
  • No vaccines or treatment exist for the mosquito-borne Zika virus.

What positive news related to this devastating threat could possibly exist?

In a startling new study, the Washington University School of Medicine—in conjunction with the University of California San Diego School of Medicine—assert that Zika virus kills cancer cells in adult human brains. The Journal of Experimental Medicine published the results in a report in early September. It posits that injecting the Zika virus into the brain at the same time as surgery could potentially remove life-threatening tumors.

The Zika virus attacks malignant brain tumors called glioblastomas. Glioblastoma is one of the most challenging cancers to treat. The conventional treatment is brain surgery followed by radiation and rounds of chemotherapy within 2 to 4 weeks after surgery. Follow-up procedures must begin as soon after surgery as possible, as new glioblastomas can generate rapidly. Frequent patient observation with magnetic resonance imaging (MRI) or computed tomography (CT) scans is another vital element of ongoing medical care.

Still, most tumors reappear within six months. A small population of cells, called glioblastoma stem cells, often survives the treatments and continues to divide, producing new tumor cells to replace the ones killed by the cancer drugs. Glioblastoma stem cells are hard to kill because they can avoid the body’s immune system and are resistant to chemotherapy and radiation. However, researchers believe that the Zika virus kills cancer cells, preventing new tumors from recurring after surgically removing the original tumor.

Despite such aggressive treatment, glioblastoma cells remain deadly: most patients die within 15 months. According to the American Association of Neurological Surgeons, nearly 52 percent of all primary brain tumors are glioblastomas. Each year in the United States, this widespread form of brain cancer affects approximately 12,000 people. U.S. Sen. John McCain announced he is battling with glioblastoma in July 2017.

The Washington University – University of California San Diego School experiment revealed that the Zika virus favored destroying glioblastoma stem cells over normal brain cells in mice. Two weeks later, the mice with Zika virus injected into their cancerous tumors exhibited smaller tumors than those without the virus. Mice with Zika virus injected into their brain tumors seemed to survive longer than those without the injections.

Despite differences in the biological systems of mice and humans, the research team believes their proposal the Zika virus kills cancer cells merits pursuing. The joint research team hopes to begin human trials in the next 18 months.

According to Michael S. Diamond, MD, Ph.D., the Herbert S. Gasser Professor of Medicine at Washington University School of Medicine, “These cells are highly resistant to conventional therapies.” Diamond continued, “While the Zika virus does harm to the brains of developing fetuses, it may prove effectual in the treatment of glioblastoma in adult brains.”

Heather Hopkins

Photo: Flickr

Top 3 Diseases in Israel
While Israel has been able to lower the number of deaths caused by diseases, many conditions in Israel are still prevalent. The death rates from certain diseases in Israel have declined by 80 percent since the 1970s, but there is always room for improvement. Here are the top three diseases in Israel.

Top Three Diseases in Israel

  1. Cancer: Cancer, the major killer in Israel, caused almost one-quarter of total deaths in Israel in 2011. Even though the cancer rate is relatively low compared to other countries, cancer is still a primary cause of death. The most common cancer among Israeli men is lung cancer, which is primarily caused by tobacco smoking. The most common cancer among Israeli women is breast cancer. About 4,500 Israeli women are diagnosed with breast cancer each year, and 900 dying from it. However, according to the Israel Cancer Association, the number of women surviving breast cancer is steadily on the rise thanks to research and technology able to detect early signs. It has also been reported that the lung cancer rate among men is lower than most countries.
  2. Coronary Heart Disease: Coronary Heart Disease is the second most prevalent cause of death in Israel. Together, cancers and heart disease account for 40 percent of deaths. However, like cancer, heart disease in Israel is being contained. The death rate from heart disease in Israel has dropped by 50 percent since 1998, partly due to declines in smoking and national campaigns against obesity, diabetes and hypertension. The people of Israel have been willing to change their lifestyles to prevent heart disease. There are also reliable ambulance services in Israel to respond to any emergency.
  3. Diabetes: Diabetes is the next leading cause of death after cancer and heart disease. Compared to other countries, deaths from diabetes are high in Israel. But the country has tried a number of ways to defeat diabetes including using an artificial pancreas, medical smartphones and glucose-sensing enzymes. Researchers have also been looking for a cure with the help of the Juvenile Diabetes Research Foundation and the Israel Science Foundation. Scientists are also working on an antibody to block killer cells that destroy helpful cells in the pancreas.- Emma MajewskiPhoto: Flickr


Cancer affects the lives of children all over the world, but it is estimated that up to 90% of children with cancer live in developing countries. In low-income countries where access to healthcare is limited, childhood cancer survival rates are as low as 10 to 20%. Although HIV/AIDS infections amongst children remain a critical health priority in sub-Saharan Africa, cancer is emerging as one of the major causes of childhood death on the African continent. Treatment of childhood cancer in Africa is of growing concern.

The most common forms of childhood cancer in Africa are leukemia, lymphomas and tumors of the central nervous system. In African countries with high instances of childhood HIV/AIDS, AIDS-related cancers like Kaposi’s sarcoma (a cancer of the blood vessels) are common. In countries with high rates of malaria infections, Burkitt’s lymphoma is the most common childhood cancer.

Lack of Treatment Options

Cancer in Africa is problematic to treat because it remains a largely unknown disease within communities and most patients reach out to doctors when it is too late. Advocacy and creating public awareness are thus key points to tackling childhood cancers.

Furthermore, specialist treatment facilities on the African continent are particularly lacking. Currently, there are more than 450 million children living in African countries, but there are only four specialist children’s hospitals, the majority of which are in South Africa. Most children with cancer never reach a specialist treatment center.

Due to the lack of equipped healthcare facilities, the diagnosis of cancer often takes place too late or healthcare facilities lack the equipment and training to even treat it. In 2016, more than 20 African countries did not have any facilities with a working radiotherapy machine — the most common form of cancer treatment. A survey by the Atomic Energy Agency found that there are only a few hundred radiotherapy machines on the continent of more than a billion people. The majority of these machines are in just a few countries: South Africa, Egypt, Morocco, Tunisia, Nigeria and Algeria. In most African countries, cancer is a death sentence.

New Funding Provides Hope

The Baylor College of Medicine and Texas Children’s Hospital, with additional funding from the Bristol-Myers Squibb Foundation, recently unveiled an initiative to address these issues called Global HOPE (Hematology-Oncology Pediatric Excellence). The plan includes the creation of a network of pediatric cancer care facilities in southern and east Africa in partnership with local governments. The first center will be built in Botswana. They will also train health care providers in Botswana, Malawi, Uganda and other African countries to detect and treat childhood cancers. They expect that this will create a blueprint for childhood cancer care that other countries can follow.

Childhood cancer in Africa, like most noncommunicable diseases on the continent, is of growing concern. These diseases are however increasingly garnering the attention needed to address them in the coming years.

Helena Kamper

Photo: Flickr

Cancer in Resource-Poor Countries
In 2012, 3.5 million women died from cancer. Women are diagnosed with cervical and breast cancer at a rate of about 2 million per year, and the diseases’ outcome can largely be predicted by geography. According to The Lancet, 62 percent of deaths resulting from breast cancer occurred in low- and middle-income countries. Similarly, 87 percent of deaths due to cervical cancer occurred in resource-poor countries. Clearly, fighting cancer in resource-poor countries can be difficult.

These trends are even more concerning given that the number of cancer-related deaths among women is expected to increase to 5.5 million by 2030. Over this same time period, the number of women diagnosed with breast cancer is expected to nearly double, and the number of women diagnosed with cervical cancer is expected to increase by 25 percent.

Most global health efforts targeted toward women focus on sexual and reproductive health. However, non-communicable diseases like cancer, cardiovascular disease, respiratory disease, diabetes, dementia, depression and musculoskeletal disorders constitute the greatest threats to women’s health. Indeed, breast cancer and cervical cancer result in three times as many deaths as childbirth and pregnancy complications do.

Further, the global economic burden of cancer is sizable ($286 billion in 2009), primarily because it keeps people out of the workforce and can lead to premature death. Addressing the burden of cancer on women’s health could lead to increased female participation in activities that benefit countries’ economies.

Even in more developed countries, cancer screenings and appropriate treatments are not equally available to all groups. Women belonging to ethnic and cultural minorities, in particular, may not have access to essential health care.

However, cancer screening and treatment is not as costly as is often assumed. As little as $1.72 per person could provide essential medical interventions to diagnose and treat cancer effectively. This amount is about 3 percent of current health care spending in resource-poor countries.

Mammograms for breast cancer screening and radiography for cancer treatment are not often available in low- and middle-income countries. A series of articles from The Lancet recommended increasing the availability of the HPV vaccine for girls and providing cost-effective screening procedures like clinical breast examinations and cervical cancer screenings through visual inspection with acetic acid.

The articles also called for mastectomy and tamoxifen treatments to be made available to people fighting cancer in resource-poor countries by 2030. The Lancet cited Mexico and Thailand as examples of countries where universal health care coverage has improved the diagnosis, treatment and outcome of cancer in women.

Madeline Reding

Photo: Flickr

Poverty and Lung Cancer
Poverty predisposes individuals to a spectrum of conditions that result from an amalgamation of lifestyle factors, health, hygiene and living conditions. Mortality from lung cancer is a more significant factor in impoverished communities compared to developed economies.

One of the major predisposing factors for high lung cancer mortality rates in developing countries is smoking. Cigarette smoke contains toxic particles which can inflict damage to cells present in the airways. Over time, these affected cells can become abnormal and lose their normal function.

The World Bank has established that smoking is more prevalent among poor groups compared to the rich, not only as a consequence of poverty but also in part due to the education individuals receive. Due to incognizance of the health risks associated with smoking, poor individuals may engage in this habit as a result of stress or poor family relationships.

Strategies to reduce lung cancer mortality in developing countries should focus on increasing access to education. Increased education can be achieved by building schooling facilities, implementing laws where education is compulsory until a certain age and subsidizing education for families who are unable to afford school fees.

A composition of diet also plays a crucial role in the development of lung cancer in impoverished countries. Some households are likely to be contingent with foods that are often processed, cheap and have poor nutritional value. As a result of low intake of fruit and vegetables, individuals are likely to be deficient in essential vitamins, minerals and antioxidants that play an important role in the body’s defense mechanisms against cancer development.

Measures to overcome poor dietary habits can include campaigns educating individuals about healthy eating. Subsidies can be offered to local supermarkets to ensure that fresh, affordable produce is readily available to individuals.

Rural communities often have poor access to health care services which can impede their ability to seek professional help at early stages. This prevents cases of lung cancer from being diagnosed and treated in the inchoate stages. Cancer can eventually progress to a serious stage where it is completely incurable and has a risk of significant mortality. Higher mortality in poor communities can also stem from a reluctance to utilize health care resources, possibly as a result of personal prejudice or concerns about a financial expense.

A recent study published by the Centers for Disease Control and Prevention states that 40 percent of identified cancer cases are associated with tobacco usage. This represents a significant proportion of cases that can be attributed to smoking, which is a preventable risk factor.

Widespread smoking cessation campaigns in both developing and developed countries can be implemented to encourage individuals to reduce smoking gradually. This can be done through advertising, counseling with health care professionals or even offering alternatives to smoking such as nicotine replacement therapy.

With greater than 36 million smokers in the United States alone, urgent action must be taken to ensure both poverty and lung cancer are reduced through a combination of corrective measures such as education, health care advice, and smoking cessation campaigns.

Tanvi Ambulkar

Photo: Flickr

cancer_testing
Cancer. The dreaded disease kills millions around the world. It sometimes seems like everyone knows someone that it has cursed with its cruel touch. But even in the developing world, it is having a huge impact on thousands of people.

According to the World Health Organization (WHO), around 7.9 million people around the world die from cancer each year. While many think of this as more of a developed world problem, 5.5 million of those cancer-related deaths take place in the developing world. That is 70 percent of cancer deaths across the globe. Once a disease associated with the affluent, it is now an affliction of the poor.

Worse, cancer deaths are to increase to 6.7 million by the end of this year and further to 8.9 million by 2030 in the developing world. During the same time frame, cancer deaths are expected to remain at current levels in the developed world.

A few factors will contribute to this expected rise within the next 15 years of cancer-related deaths. First is the globally aging population. To go along with this is a increase in rapid, unplanned urbanization as well as the globalization of unhealthy lifestyles.

Most health infrastructures in developing countries are designed to respond to infectious diseases. Cancer requires more resources financially, as well as treatment technology, equipment, staff or training than most countries have access to.

There is not only an issue here of deaths but also needless suffering. Sadly, there is very large lack of response capacity in the developing world. There is a lack of preventatives, treatment, public education and diagnosis. Early diagnosis in particular is a problem, and once diagnosed it is usually the rich that have access to treatment, whether surgery, chemotherapy or radiotherapy out of country. This is especially the case in Africa.

After all that, it might appear that everyone is doomed. However, recent good news about new technology to diagnose cancer early in the developing world has things looking up.

Early diagnosis is key in cancer. If the disease is not recognized early through cancer testing, then treatment is usually not effective. Seventy percent of those that even get diagnosed in the developing world do at this late stage when treatment is essentially useless.

Important to detecting cancer are biomarkers – cells or molecules along with “any other measurable biological characteristic that can be used as an objective way to detect disease.” Glycoproteins are especially useful biomarkers. They are found throughout the body, in blood, mucus and sperm.

New technology is using glycoproteins to detect cancer early. The lock and key method takes a disease biomarker, like a glycoprotein of prostate cancer, and makes a cast of it. “The prostate cancer glycoprotein is tethered to a surface and detection molecules are assembled around it. When the glycoprotein is removed, it leaves behind a perfect chemical ‘cast’.”

Essentially, the lock and key technique means that only another cancer glycoprotein will fit the mold – others might be the same size, but they will not have the specific molecules needed to bind to the lock created by the original one.

As this method of diagnosis does not rely on antibodies, it does not require special storage. The lock and key cancer testing method is a simple and effective way to detect cancer early, and can even be molded to specific cancers and other diseases. The advantages are obvious, but time will tell if the method of testing becomes wide-spread in the developing world.

Gregory Baker

Sources: The Conversation, WHO
Photo: The Conversation

cancer_seeing_glasses

Dr. Samuel Achilefu, a Nigerian born scientist, has developed glasses that can see cancer cells. For this new technology, Dr. Achilefu was awarded the 2014 St. Louis Award.

This award is given to a recipient who has made outstanding contributions to the profession of chemistry and has demonstrated potential to further the profession.

Dr. Achilefu, a professor of radiology and biomedical engineering, and his team developed glasses that contain imaging technology. The glasses are intended to help surgeons view cancer cells while operating, instead of operating “in the dark.”

The project began in 2012 when Dr. Achilefu and his team received a $2.8 million grant from the National Institutes of Health. Before the grant, the team received limited funding from the Department of Defense’s Breast Cancer Research Program.

The glasses were in the development stage for years, testing the technology on mice, rats and rabbits to confirm the effectiveness of the glasses.

In order to see the infected cells, two steps must be followed.

First, the surgeons must inject a small quantity of an infrared fluorescent marker into the patient’s bloodstream. The marker, also known as a tracer, contains peptides that are able to locate the cancer cells, and buries itself inside.

The tracer lasts about four hours. As it moves through the patient’s body, it will clear away from non-cancerous tissue.

By wearing the glasses, the surgeon can inspect the tumors under an infrared light that reacts with the dye. The combination of the tracer and infrared light causes the tumor to glow from within and allows the surgeon to see the infected cells.

This technology was first tested on humans at the Washington University School of Medicine in June 2015. Four patients with breast cancer and over two-dozen patients with melanoma or liver cancer have been operated on using the goggles.

Ryan Fields, a surgical oncologist who is collaborating with Dr. Achilefu says, “[the glasses] allow us to see the cells in real time, which is critical. Because the marker has not been FDA approved, doctors are currently using a different, somewhat inferior marker that also reacts with infrared light.”

Julie Margenthaler, a breast cancer surgeon, explains that many breast cancer patients must go back for second operations because the human eye cannot see the extent of the infected cells alone.

“Imagine what it would mean if these glasses eliminated the need for follow-up surgery and the associated pain, inconvenience, and anxiety”.

The Food and Drug Administration are still reviewing the cancer seeing glasses and the tracer developed by Dr. Achilefu and his co-researchers. But, if the glasses are approved, the removal of cancerous cells has been changed forever. And most importantly, patients will receive the care in order to treat their cancer.

Kerri Szulak

Sources: IT News Africa, Premium Times, St. Louis Section of American Chemical Society
Photo: Pax Nigerian

Cancer cases
According to the World Health Organization, Cancer cases are soaring each year. Data indicates an upward trend from 12.7 million cases in 2008 to 14 million in 2012. Cancer related deaths have also increased from 7.6 million to 8.3 million since 2008. With these growing rates, there is a desperate need for advances in diagnosis and detection of cancer.

An IARC report has shown a connection between increased smoking, obesity and cancer rates. This report also predicts a rise in cancer cases to 19.3 million by 2025. Several types of cancer kill every year but the most common cancer affecting thousands of women worldwide and is a leading cause of deaths in developing countries is attributed to breast cancer.

Developed countries do not have the clinical advances required to stop the disease at an early stage. Several people living below the poverty level don’t even know they have breast cancer since clinics are scarce. The Word Health Organization has also claimed this urgency for treatment of breast cancer in developing countries as thousands die from late detection. In 2012, around 522,000 women from around the globe died of this disease. Lung cancer is also among the top most common cancers worldwide, about 13% of total cancer cases. The large amount of lung cancer rates has been linked to both increased smoking from adults and young adults alike. Longer lifespans also contributes to these spiking rates according to the BBC.

Several health leaders from IARC believe that these growing cancer rates can be changed through preemptive action seen before with cervical cancer and access to the HPV vaccination. They hope that national programs for screening can produce similar excellent results and by giving easy access to treatment or detection centers, several will be able to beat other forms of cancer.

Maybelline Martez

Sources: BBC, NY Daily News, Global Post
Photo: Giphy.com