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Wellcome Image of the Month: Malaria

19 Apr, 2013

B0006056 Mosquito, Anopheles stephensi in flight

World Malaria Day recognises global efforts being made in the fight against malaria. First established in 2007 by the World Health Assembly, it falls on 25 April every year.

Malaria is an infectious disease caused by parasites (Plasmodium species) which enter the body when infected mosquitoes feed on human blood. The World Health Organization estimates that in 2010, there were approximately 219 million cases of malaria and 660,000 deaths. In addition to malaria, mosquitoes can carry the infectious agent for a number of other diseases including yellow fever, West Nile virus, and Dengue fever.

Our image of the month is this photograph of a mosquito in flight. This particular species, Anopheles stephensi, is one of the major vectors responsible for transmitting human malaria in India and some parts of Asia. The photograph was taken by Hugh Sturrock in 2005 when he was an undergraduate student in Professor Andrew Read’s laboratory at the University of Edinburgh. Blood is clearly visible in the mosquito’s swollen abdomen. When asked how he captured the shot, Hugh said “I fed several mosquitoes, put them in the refrigerator for a few minutes to subdue them, and then caught one in a pair of tweezers. I took the shot just as she was warming up and flapping her wings.” Hugh’s image won a Wellcome Image Award in 2006.

Hugh now works as an epidemiologist in the Malaria Elimination Initiative, part of the Global Health Group at the University of California, San Francisco. His work focuses on understanding how and where clusters of malaria develop (transmission hotspots). In doing so, strategies to eliminate malaria in these remaining regions can hopefully be applied more cost effectively.

Image credit: Hugh Sturrock, Wellcome Images (Mosquito, Anopheles stephensi in flight)

Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. All our images are available in digital form so please click the link above if you would like to use the picture that features in this post, or to quickly find related ones. Many are free to use non-commercially under the terms of a Creative Commons licence and full details of the specific licence for each image are provided.

Life at the end: historical reflections on palliative medicine

16 Apr, 2013
Illustration by Marianne Dear

Illustration by Marianne Dear

What does end-of-life care really mean and how has it changed in recent history? Tilli Tansey reflects.

‘Is it really history?’ is a question I’m used to being asked. I’m now a medical historian working on the history of recent biomedicine, but for many years I was a neuroscientist. When I decided to change my career, none of my lab colleagues understood why the recent past could be of any interest, although when I asked the more senior ones to tell me of their early training and careers I would be met with ‘Oh, it was all very different then!’, which  illustrated my point exactly.  Changes and continuities are the stuff of history, and learning of, and from, the recent past is important. This thought informed and inspired the Wellcome Witnesses to Twentieth Century Medicine volumes, a series of seminars between a range of experts, and their published transcripts.

The phrase “you’ll be history” – a sort of verbal memento mori is one that could have subtitled our current volume, looking at Palliative Medicine in the UK c.1970–2010 (freely available to download). End-of-life care has been in the news a great deal recently, largely as a result of the controversy over the Liverpool Care Pathway for the Dying Patient, a strategy developed between the Royal Liverpool Hospital and the Marie Curie Hospice. With a recent online survey by the BMJ and Channel 4’s Dispatches finding that nine out of 10 palliative care experts would choose the Liverpool Care Pathway for themselves, the issue of how best to care for those beyond the scope of medicine to cure has never seemed more pressing. As Dr Robert Twycross pointed out during our recent Wellcome Witness seminar: “palliative medicine is a form of emergency medicine, because terminally ill patients typically haven’t got a lot of time left; we’ve got to get in there and get on with it. Tomorrow is second rate, and may be too late.”

Palliative medicine has a short history, but an important one in which Britain plays a hugely significant role. According to Dr Twycross, “Hospice palliative care was initially a protest movement against medical neglect in the post-war years when medicine began to evolve into the sort of specialty it is now.  As doctors had more they could do to cure, then the dying presumably got more and more neglected”. It now seems remarkable that the formal discipline did not exist before the late 1980s and it was only as recently as 2006 that the US recognised “hospital palliative medicine” as a subspeciality. Previous to this, the phrase “continuing care” was used – chosen, according to Professor Geoffrey Hanks, “because it is meaningless”. Read more…

Wellcome Film of the Month: Your children’s sleep

5 Apr, 2013

This film is from a government-sponsored series aimed at parents and looking at different aspects of parenting in the 1940s. It was made by Realist Film Unit and comes to us courtesy of the BFI Archive. The film tapped into the emerging field of child psychiatry, fuelled by governmental concern for the emerging generation post-war, this whole generation had grown up without two parents being at home.

In terms of narrative structure, the film explores common childhood sleep problems covering many of the typical disturbances encountered by parents. This subject is also being looked at in a television series currently airing on Channel 4 dedicated to sleep-entitled Bedtime Live, presented by Dr Tanya Byron who is government adviser on children as well as a psychologist. ‘Your childrens’ sleep’ delivers sensible, practical advice, although the problems may seem rather tame to modern day parents! Read more…

Paradoxic pandemic: The inexorable spread of hand, foot and mouth disease

28 Mar, 2013

Structure_of_EV71_(3)

As researchers describe a new way to make vaccines to fight diseases like foot and mouth disease in animals and polio in humans, we look at a related human viral infection called hand, foot and mouth disease. Recent outbreaks in Cambodia and Vietnam raise the prospect of what is often considered to be an innocuous childhood infection spreading further, causing increasingly severe illness, even deaths, and straining health systems around the world.

ResearchBlogging.org

Much concern is rightly focused on influenza and the risk of pandemics, but there are other emerging and re-emerging infections that demand our attention. In this post, I look at hand, foot and mouth disease from various perspectives, taking in epidemiology, clinical medicine, structural biology, virology and public health, to try and understand what threat it presents, what we are doing to counter it, and what difference an effective vaccine would make.

It starts with a high temperature, though that’s no surprise – children under five are always getting fevers. But then the spots appear: a rash on her hands and feet and around her mouth. And then you notice her finger twitching.

That trivial twitch means she already has grade 2 hand, foot and mouth disease, a viral infection that is no problem for most children to ride out but which in a few cases leads to severe neurological illness and, rarely, death. The difficulty is that there is no way to know how the infection is going to progress in any individual.

Faced with this uncertainty, countries where severe hand, foot and mouth disease is endemic end up admitting hundreds of thousands of children to hospital each year, just in case, putting their health systems under great stress.

As the number of endemic countries rises, as the virus spreads slowly but surely through populations and across borders, is this often harmless childhood illness becoming a serious international problem? What action are we taking to defend ourselves against the possibility of a ‘creeping pandemic’?

Read more…

Wellcome Image of the Month: Dandelion

22 Mar, 2013

B0004566 TS dandelion flower bud, light micrograph

For many, March represents the end of winter and the start of spring, though some controversy still exists over the exact date when the seasons change. In meteorology, spring begins on 1 March, whilst historically it did not begin until the spring equinox on 20 March.

Throughout time flowers have been used in a variety of ways from sources of food or medicine, to national emblems or tokens of affection.

The dandelion (Taraxacum), is considered a weed by some and a versatile, nutritious food source by others. The flower is made up of lots of small florets clustered together into a composite flower head. This month’s image is a transverse section through a dandelion flower bud taken by microscopist Spike Walker. He explained “several florets are visible each consisting of five petals fused into a tube. Inside these are the anthers (pollen boxes) of five stamens (also fused). The anthers are ripe and their walls are splitting to release the pollen. At the centre are the two halves of the stigma (which is forked like a snake’s tongue). The space between the florets is packed with hairs which will eventually form the ‘parachute’ of the dandelion fruit (achene)”. Originally acquired with a light microscope, this image has subsequently undergone solarisation, a technique which alters the tones in the image. In 2010, Spike Walker was awarded the Royal Photographic Society’s Combined Royal Colleges Medal for his ‘outstanding contribution to photography and its application in the service of medicine’. He has also won a total of 24 Wellcome Image Awards to date.

Dandelion flowers mature into a spherical seed head sometimes termed a dandelion ‘clock’. These were used by children to ‘tell the time’ by the number of breaths required to blow away the fruits. This year British summer time begins on 31 March so don’t forget to turn your clocks forward at the end of the month!

Image credit: Spike Walker, Wellcome Images (TS dandelion flower bud, light micrograph)

Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. All our images are available in digital form so please click the link above if you would like to use the picture that features in this post, or to quickly find related ones. Many are free to use non-commercially under the terms of a Creative Commons licence and full details of the specific licence for each image are provided.

SNOWS on World Water Day

22 Mar, 2013
A woman collecting water from a river in the Masai village of Rosalin, Hai District of Tanzania.

A woman collecting water from a river in the Masai village of Rosalin, Hai District of Tanzania.

Water and sanitation are two of the most fundamental factors in health yet we still don’t know how best to tackle these in Africa due to the lack of evidence-based research. Today on World Water Day, Samira Abd Elrahman introduces a collaboration aiming to put this right. 

The African SNOWS (Scientists Networked for Outcomes from Water and Sanitation) Consortium takes its inspiration from Dr John Snow, who not only founded the science of epidemiology but was also the father of evidence-based interventions for environmental health. He famously halted an outbreak of cholera in 19th century in London, by removing a water pump’s handle to prevent its use, as he lacked the funds to provide something like a better water supply.

Ever since then, environmental health has lacked its fair share of resources, and environmental health practitioners have had to use all their creativity and innovation to achieve challenging goals, such as behaviour change, as cheaply as possible. Environmental health research has also suffered, particularly in Africa where resources are scarce. At the start of 2008, the International Year of Sanitation, nearly two-thirds of the population of sub-Saharan Africa are still without a toilet.

Diarrhoeal disease kills as many children globally as AIDS, malaria and TB combined. One third of these children are in Africa. For those who survive, repeated episodes of diarrhoea contribute to malnutrition, which in turn causes impaired cognitive performance, late entry to schooling and ultimately to the work force, which according to a recent study (World Bank 2008) robs a typical African country of some 8 per cent of its potential GDP. This loss of life, productivity and wellbeing is preventable, chiefly by improved water supply, sanitation and domestic hygiene.

Indeed, hygiene promotion is the most cost-effective of all interventions against the high-burden diseases of the developing world, yet, little research is conducted to determine how to implement such interventions to the best effect.  Read more…

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