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Posts tagged ‘New England Journal of Medicine’

Second HIV Baby in Study Free of Virus.

Two children with HIV who were treated immediately after birth have no signs of the virus 9 and 23 months later, scientists said in a report that suggests a potential approach to curing HIV-infected babies.

The findings from the two children are spurring doctors in Canada, South Africa and the U.S. to try to replicate the results, and spawned a study in 54 babies, the researchers said yesterday.

The research suggests that deploying drugs early in life may help keep the virus from gaining a foothold. The importance of such a result is clear: More than 260,000 children were infected globally with HIV in 2012, either at birth or through breastfeeding.

While the early findings are promising, a final step is needed before determining that a cure is at hand, said Deborah Persaud, an associate professor of infectious diseases at the Johns Hopkins University School of Medicine in Baltimore.

“The only way we can prove that we’ve accomplished remission in these kids is taking them off treatment, and that’s not without risks,” Persaud, who was involved in the research on both babies, said in an interview yesterday at a medical meeting on infectious disease held in Boston.

While the latest HIV drugs can keep the virus in check, they don’t eliminate it from hidden reservoirs deep within the body. The drugs are taken for a lifetime and patients often have to cycle among different medicines to offset the disease’s ability to become resistant.

Los Angeles Baby

Persaud presented results yesterday from a child born last year in Los Angeles County. The baby began treatment with anti- HIV drugs four hours after being born and still has no trace of the virus in its blood, Persaud said. The baby remains on treatment, and there’s no immediate plan to stop the medicine to see whether the virus rebounds, she said.

The previous child, born in Mississippi, was cleared of the virus with a similar approach a year ago, and remains HIV-free 23 months after ceasing treatment, according to Persaud, who presented her report yesterday at the annual Conference on Retroviruses and Opportunistic Infections.

Inspired by the Mississippi baby, doctors in Canada are now seeking to repeat the result in five newborns, and three babies in South Africa are also receiving medicines in an effort to cure them. Within the next few months, researchers also plan to start a trial in 54 children to test whether the approach can be repeated on a larger scale, Persaud said.

That larger study will start infected infants on treatment within 48 hours of birth, then take them off drugs two years later to see whether the virus rebounds.

Drug Combination

The babies will receive a three-drug combination of zidovudine and lamivudine, two now-generic medicines developed by GlaxoSmithKline Plc, and nevirapine, a treatment from Boehringer Ingelheim GmbH that has also lost patent protection.

The cases involving the two infants build on increasing evidence about approaches to curing a disease doctors once thought an insurmountable challenge.

To date, the only adult to have been cured of the virus is Timothy Ray Brown, the so-called Berlin patient. Brown has been clear of the virus since having a bone marrow transplant for leukemia in 2007 from a donor with a rare mutation to a gene called CCR5 that keeps HIV at bay without the aid of antiretroviral drugs.

While the case proves that HIV can be cured, bone marrow transplants are too expensive and dangerous to make them practical on a mass scale.

Sangamo Biosciences Inc. is trying to mimic the CCR5 mutation with a gene-altering technology. In a study published yesterday in the New England Journal of Medicine, researchers led by Carl June at the University of Pennsylvania infused 12 patients with Richmond, California-based Sangamo’s SB-728-T, an experimental treatment that changes CCR5.

While the trial was designed to assess the product’s safety, not its efficacy, it found that the treatment was associated with a drop in the amount of virus in some patients who were taken off their regular anti-AIDS drugs.


© Copyright 2014 Bloomberg News. All rights reserved.

Obamacare Seen Straining Clinics With Medicaid Expansion.

They start showing up at the St. John’s Well Child and Family Center in Los Angeles at 5 a.m. By the time the doors open at 8 a.m., as many as 60 patients are queued up in a line that stretches down the street.

In South L.A., where St. John’s is one of the few organizations that makes doctors available to the poor, the lines may soon get much longer. More than 5 million additional Americans are expected to enroll over the next two years in Medicaid, the taxpayer-funded insurance for the poor that’s expanding Jan. 1 under the Affordable Care Act. Yet 43 percent of doctors in California and a third nationwide won’t take new Medicaid patients. Low pay is one of the reasons.

A shortage of Medicaid doctors will leave many newly insured seeking care in a two-tiered system in which they will have access to less experienced medical staff, longer travel times to find a doctor who accepts Medicaid, and be subject to appointment waiting times sometimes weeks longer than those with private coverage. The advent of the law, rather than help, could make a bad situation even worse as overwhelmed clinics, like St. John’s, struggle to meet greater demand, according to doctors and policy analysts.

“It has been very difficult for Medicaid beneficiaries to get primary care and find physicians who will accept Medicaid,” said Catherine Sreckovich, a managing director at Navigant Consulting Inc., who has worked with state Medicaid agencies for more than 25 years. “That challenge will continue to grow as more people have insurance and are competing for the same limited set of physicians.”

State Option

Much of the attention on Obamacare has centered on the law’s insurance exchanges, which opened Oct. 1 and allow people to shop online for health plans. Millions have flooded the marketplaces since then, causing them to close down or work slowly. This weekend, the federal government partially closed its site during the early morning hours to add capacity and fix bottlenecks, after announcing it had recorded 8.6 million visitors over the first three days.

Less noticed has been the law’s provision to provide states funding to expand their Medicaid programs to individuals making as much as 133 percent of the federal poverty level, far more generous than eligibility requirements in most states prior to the law. So far, 25 states have said they plan to expand Medicaid, according to the Kaiser Family Foundation.

While the law greatly improves access to coverage for the poor, it’s unclear how much that will translate to improved care. Medicaid pays an average of 34 percent less for all services than Medicare, the U.S. program for the elderly and disabled, according to data from the Menlo Park, California- based foundation.

Per-Visit Costs

In some states, the payments are as low as $29 for a 30- minute visit with a patient, $277 for delivering a baby and $357 for a cataract surgery. In California, Medicaid pays $25 for a pelvic exam and a pap smear compared with as much as $200 from private insurance.

In New Jersey, where Medicaid payments are about half of what Medicare pays, 60 percent of doctors said they won’t take new Medicaid patients, according to study in the journal Health Affairs. Many Medicaid enrollees in the state go to the ER now because they have trouble getting to a doctor’s appointment, said Katherine Grant-Davis, chief executive of the New Jersey Primary Care Association, which represents federally funded health centers that focus on the poor.

“Doctors can make more money treating rich people and they don’t really want to deal with the poor because they are tough to follow and they have more complex health problems,” said Arthur Caplan, director of the division of medical ethics at New York University in Manhattan who has studied the disparities in Medicaid coverage. “The more you make medicine into a business, the more you put it in the hands of people with an MBA, the poor become less interesting.”

Longer Wait

In a 2011 study, two-thirds of callers trying to make an appointment with a specialist for a child on Medicaid were denied care compared with 11 percent of kids with private insurance. The Medicaid children who were able to get an appointment had to wait an average of 22 days longer than the privately insured ones, according to the study published in the New England Journal of Medicine.

Medicaid patients can find it difficult to see a fully certified doctor even at nonprofit hospitals. At New York City’s major teaching hospitals, including New York Presbyterian and Mount Sinai, those with Medicaid seeking an appointment with a specialist are more likely to be seen by a doctor still in training because many of the board-certified staff doctors won’t take Medicaid, said Ronda Kotelchuck, chief executive officer of the Primary Care Development Corp., a New York-based nonprofit group focused on expanding primary care to under-served areas.

Less Coordinated

While the medical residents and fellows are overseen by a fully-trained attending physician, the care is less coordinated than at a doctor’s private practice. Some patients see a different resident each visit and there is no on-call service for after-hours problems, Kotelchuck said.

Some hospitals limit the number of Medicaid plans they accept or the services provided to those with Medicaid. Memorial Sloan-Kettering Cancer Center in New York takes just three of the more than a dozen Medicaid plans in the state. The only Medicaid patients that the Mayo Clinic’s facilities in Arizona will accept are those for transplants and adult congenital heart patients, as well as children needing a bone marrow or liver transplant.

Doctors say they often can’t afford to take too many Medicaid patients because of the low reimbursements, especially if they are in private practice rather than being paid a salary by a hospital, said Dale Blasier, chairman of the American Academy of Orthopedic Surgeons’ coding, coverage and reimbursement committee. About 40 percent of orthopedic surgeons nationwide aren’t taking new Medicaid patients, according to the study in Health Affairs.

More Costs

“As I talk to people in private practice, it often costs more to see a Medicaid patient for a visit than what the reimbursement pays,” said Blasier, an orthopedist at Arkansas Children’s Hospital in Little Rock. “It is the bottom of the barrel. No one pays worse than Medicaid.”

There can also be added costs because of additional paperwork, delays in getting paid, and services the patient needs that aren’t covered, Blasier said.

Obama’s health law tries to entice some doctors to treat Medicaid patients by raising the payments to family physicians, internists and pediatricians for primary care services to the same level as Medicare until 2014. Many doctors are skeptical those payments will remain at the higher levels for more than two years, making them hesitant to start taking new Medicaid patients, said Sreckovich of Chicago-based Navigant.

Greater Share

That leaves federally subsidized community health centers, like St. John’s in Los Angeles, to take the brunt of the new patients. More than 1 million uninsured people in California are expected to join Medicaid starting next year. While those people are now getting some care at emergency rooms and free clinics, they are expected to start seeking even more services once they have insurance, said Jim Mangia, St. John’s chief executive officer.

At St. John’s, Mangia estimates a 40 percent increase in the number of patient visits to his centers next year. That is on top of the more than 30 percent jump they’ve seen this year after California started expanding insurance to the poor and his centers increased capacity, he said.

St. John’s has received federal funding to help open two new specialty care centers, built four new school-based clinics, and expanded its headquarters and facilities in Compton, California. It has hired a consultant to suggest ways to improve work flow so more patients can be seen in less time, getting wait times down to less than 40 minutes compared with several hours.

Still, the center isn’t sure it will be able to recruit enough doctors, nurses and physician assistants to meet the demand. The center’s website has 16 job openings for doctors, nurses, and administrative positions.

Physician Churning

“The worry I have is the churning of physicians and the difficulty of finding physicians and how to deal with the burnout because it is such a fast-pace, high-acuity environment,” Mangia said. “You need a whole department of people where all they do is constantly recruit but that is a huge expense.”

Health centers in New Jersey are also bracing for an onslaught of new patients and struggling to find enough doctors. There, about 300,000 uninsured adults are expected to sign up for Medicaid by 2016 under the expansion, many of them single males who have gone years without insurance and have chronic conditions that will need a lot of care, said Grant-Davis of the primary care association.

“We don’t expect it to be a healthy population that will be showing up,” she said. “We expected them to have some complicated needs.”

‘Chronic Asthma’

The clinics she represents have been hiring doctors, nurses and administrative workers and trying to expand hours to meet the demand. They currently have openings for primary care doctors, bilingual staff, nurses and medical assistants. Still, there is only so much they can do when patients have a complex condition that requires more advanced care from a specialist.

“Most of our patients have chronic asthma, diabetes, hypertension and you can manage that, but sooner or later you may need to bring in specialists,” she said. “That gets very challenging to find.”

© Copyright 2013 Bloomberg News. All rights reserved.

Cancer studies often downplay chemo side effects: study.

(Reuters) – Doctors relying on studies published in top journals for guidance on treating women with breast cancer may not be getting the most accurate information, with the side effects of various treatments downplayed, according to a North American study.

“Investigators want to go overboard to make their studies look positive,” said Ian Tannock, senior author of the study that appeared in the Annals of Oncology.

In two-thirds of the 164 studies that Tannock and his colleagues scrutinized, that meant not listing serious side effects, whether of chemotherapy, radiation or surgery, in the paper’s abstract. Such abstracts summarize the findings, and run a few hundred words.

That’s important, said Tannock, at Princess Margaret Hospital in Toronto, because doctors have little time to read.

“Most of us are so damn busy, we only read the abstract and skim the tables and figures,” he added.

In fact, a fifth of the studies didn’t include serious side effects in results tables, and about a third failed to mention them in either the abstract or the discussion section.

Most surprising, said Tannock, was that in a third of the studies, if the treatment didn’t work as well as one might hope, researchers moved the goalposts, reporting results that weren’t what the study was originally designed to test.

Often, those so-called “secondary endpoints” may be less important and meaningful. There is a difference, for example, between showing people lived longer overall, or simply lived longer without their cancers coming back.

Cancer research is not the only area where some researchers are concerned.

In November, a group of cardiology journal editors urged authors to watch their language when describing their results, and a month earlier two pediatrics researchers warned of “spin and boasting” in their field’s journals.

Tannock, whose team analyzed reports of late-stage trials of the kind used by the U.S. Food and Drug Administration to decide whether to approve drugs, said researchers “gain more influence with positive studies.”

There are also various pressures on researchers to make their results look better than they really are, he added, including from the drug companies that often sponsor trials. But in his study, who paid for a study didn’t have any relationship with how the results were presented.

Scientists may also spin their results to increase their chances of publishing in the top journals surveyed by the study. Such marquee publications can improve the chances for tenure, promotion and grants.

One of the journals whose studies Tannock and his colleagues looked at, the New England Journal of Medicine, declined to comment, saying they don’t typically comment on other studies. Another, the Journal of Clinical Oncology, could not provide a comment by deadline.

Journals can help, Tannock said, by insisting that authors include serious side effects in abstracts.

“Even in 250 words, everybody can get that in there,” he said. SOURCE:

(Reporting from New York by Ivan Oransky at Reuters Health; editing by Elaine Lies)



Studies more firmly tie sugary drinks to obesity.


New research powerfully strengthens the case against soda and other sugary drinks as culprits in the obesity epidemic.

A huge, decades-long study involving more than 33,000 Americans has yielded the first clear proof that drinking sugary beverages interacts with genes that affect weight, amplifying a person’s risk ofobesity beyond what it would be from heredity alone.

This means that such drinks are especially harmful to people with genes that predispose them to weight gain. And most of us have at least some of these genes.

In addition, two other major experiments have found that giving children and teens calorie-free alternatives to the sugary drinks they usually consume leads to less weight gain.

Collectively, the results strongly suggest that sugary drinks cause people to pack on the pounds, independent of other unhealthy behavior such as overeating and getting too little exercise, scientists say.

That adds weight to the push for taxes, portion limits like the one just adopted in New York City, and other policies to curb consumption of soda, juice drinks and sports beverages sweetened with sugar.

Soda lovers do get some good news: Sugar-free drinks did not raise the risk of obesity in these studies.

“You may be able to fool the taste” and satisfy a sweet tooth without paying a price in weight, said an obesity researcher with no role in the studies, Rudy Leibel of Columbia University.

The studies were being presented Friday at an obesity conference in San Antonio and were published online by the New England Journal of Medicine.

The gene research in particular fills a major gap in what we know about obesity. It was a huge undertaking, involving three long-running studies that separately and collectively reached the same conclusions. It shows how behavior combines with heredity to affect how fat we become.

Having many of these genes does not guarantee people will become obese, but if they drink a lot of sugary beverages, “they fulfill that fate,” said an expert with no role in the research, Jules Hirsch of Rockefeller University in New York. “The sweet drinking and the fatness are going together, and it’s more evident in the genetic predisposition people.”

Sugary drinks are the single biggest source of calories in the American diet, and they are increasingly blamed for the fact that a third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

Consumption of sugary drinks and obesity rates have risen in tandem — both have more than doubled since the 1970s in the U.S.

But that doesn’t prove that these drinks cause obesity. Genes, inactivity and eating fatty foods or just too much food also play a role. Also, diet research on children is especially tough because kids are growing and naturally gaining weight.

Until now, high-quality experiments have not conclusively shown that reducing sugary beverages would lower weight or body fat, said David Allison, a biostatistician who has done beverage research at the University of Alabama at Birmingham, some of it with industry support.

He said the new studies on children changed his mind and convinced him that limiting sweet drinkscan make a difference.

In one study, researchers randomly assigned 224 overweight or obese high schoolers in the Boston area to receive shipments every two weeks of either the sugary drinks they usually consumed or sugar-free alternatives, including bottled water. No efforts were made to change the youngsters’ exercise habits or give nutrition advice, and the kids knew what type of beverages they were getting.

After one year, the sugar-free group weighed more than 4 pounds less on average than those who kept drinking sugary beverages.

“I know of no other single food product whose elimination can produce this degree of weight change,” said the study’s leader, Dr. David Ludwig of Boston Children’s Hospital and the Harvard School of Public Health.

The weight difference between the two groups narrowed to 2 pounds in the second year of the study, when drinks were no longer being provided. That showed at least some lasting beneficial effect on kids’ habits. The study was funded mostly by government grants.

A second study involved 641 normal-weight children ages 4 to 12 in the Netherlands who regularly drank sugar-sweetened beverages. They were randomly assigned to get either a sugary drink or a sugar-free one during morning break at their schools, and were not told what kind they were given.

After 18 months, the sugary-drink group weighed 2 pounds more on average than the other group.

The studies “provide strong impetus” for policies urged by the Institute of Medicine, the American Heart Association and others to limit sugary drink consumption, Dr. Sonia Caprino of the Yale School of Medicine wrote in an editorial in the journal.

The American Beverage Association disagreed.

“Obesity is not uniquely caused by any single food or beverage,” it said in a statement. “Studies and opinion pieces that focus solely on sugar-sweetened beverages, or any other single source of calories, do nothing meaningful to help address this serious issue.”

The genetic research was part of a much larger set of health studies that have gone on for decades across the U.S., led by the Harvard School of Public Health.

Researchers checked for 32 gene variants that have previously been tied to weight. Because we inherit two copies of each gene, everyone has 64 opportunities for these risk genes. The study participants had 29 on average.

Every four years, these people answered detailed surveys about their eating and drinking habits as well as things like smoking and exercise. Researchers analyzed these over several decades.

A clear pattern emerged: The more sugary drinks someone consumed, the greater the impact of the genes on the person’s weight and risk of becoming obese.

For every 10 risk genes someone had, the risk of obesity rose in proportion to how many sweet drinks the person regularly consumed. Overall calorie intake and lifestyle factors such as exercise did not account for the differences researchers saw.

This means that people with genes that predispose them to be obese are more susceptible to the harmful effects of sugary drinks on their weight, said one of the study leaders, Harvard’s Dr. Frank Hu. The opposite also was true — avoiding these drinks can minimize the effect of obesity genes.

“Two bad things can act together and their combined effects are even greater than either effect alone,” Hu said. “The flip side of this is everyone has some genetic risk of obesity, but the genetic effects can be offset by healthier beverage choices. It’s certainly not our destiny” to be fat, even if we carry genes that raise this risk.

The study was funded mostly by federal grants, with support from two drug companies for the genetic analysis.



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By MARILYNN MARCHIONE | Associated Press

Surprising Chemical Could Help MS Patients.

A chemical previously found to cause people to break out in blistery rashes when used on furniture upholstery now shows promise as a treatment for multiple sclerosis, according to two new studies.

The results suggest the compound, called dimethyl fumarate, reduces the likelihood that patients will experience a flare-up of their MS symptoms, and the degree to which those symptoms are disabling.

In people with MS, the immune system attacks the nerve cells of the brain and spinal cord, producing symptoms such as numbness, loss of balance, weakness and tremors. Patients typically experience their symptoms in episodes called “relapses” which last days, weeks or months, and alternate with periods of remission.

In one study, dimethyl fumarate, which is given as an oral drug called BG-12, reduced the percentage of patients experiencing flare-up by about half.The drug reduced the percentage of patients who became more disabled by their MS symptoms over the study period, and reduced signs of the disease in the brain.

Because the drug is given orally, it has an advantage over many of the current treatments for MS, which are given by injection, said Dr. Nicholas LaRocca, vice president of health care delivery at theNational Multiple Sclerosis Society, who was not involved in the studies. There are currently nine treatments available to reduce MS symptoms, two of which are oral.

BG-12 has not yet been approved as a treatment for MS by the Food and Drug Administration. If approved, it would provide patients with another treatment option, LaRocca said.

“Every person with MS is unique, and not all therapies work will all people,” LaRocca said. “The more options that we have available, the more likely it is that an individual will find something that is the right fit for them.”

Both studies were funded by the pharmaceutical company Biogen Idec, and are published Thursday (Sept. 18) in the New England Journal of Medicine.

New MS drug

In one of the new studies, researchers at Ruhr-University Bochum in Germany randomly assigned about 1,200 MS patients to receive two or three doses of BG-12 daily, or a placebo.

After two years, 26 percent of patients who took the drug had experienced a relapse of their symptoms, while 46 percent of those who took the placebo had a relapse.

Sixteen percent of the patients who took the drug twice a day became more disabled over the course of the study, 18 percent of those who took the drug three times a day became more disabled, and 27 percent in the placebo group saw their condition worsen.

In the second study, conducted at the Cleveland Clinic, 1,400 MS patients were randomly assigned to take BG-12 either two or three times a day, take a placebo, or take a different MS drug called Copaxone.

Yearly relapses were reduced by 44 percent in patients who took BG-12 twice a day, 51 percent in patients who took BG-12 three times a day, and 29 percent in patients who took Copaxone, compared with those taking the placebo.

The most common side effects for BG-12 were flushing (experienced by about a third of participants) and gastrointestinal problems, such as diarrhea, nausea and abdominal pain (experienced by 36 to 41 percent of participants). The side effects were considered mild to moderate, the researchers said.

Long-term treatment?

The compound has an interesting history. “In the very curious incident of the ‘poison chair,’ hundreds of people in several European cities appeared at clinics with [eczema-like sores] that had no apparent cause,” writes Dr. Allan Ropper, of Brigham and Women’s Hospital in Boston, in an editorial accompanying the studies in the journal. The sores were traced in 2008 to dimethyl fumarate, the chemical used to prevent fungi from growing in furniture.

As an MS treatment, BG-12 looks favorable in the short term, but it’s not yet known whether it can reduce disability over the long term, Ropper said.

Long-term effectiveness is important because, on average, patients are diagnosed with MS in their late 20s, Ropper said.

In addition, it is not clear whether oral drugs to prevent relapse will interact with current therapies, Ropper said.

The FDA is set to make a decision on whether to approve BG-12 as an MS treatment by the end of the year, LaRocca said.

Pass it on: A new oral drug may help MS patients who experience relapses of their symptoms.

Follow Rachael Rettner on Twitter @RachaelRettner, orMyHealthNewsDaily @MyHealth_MHND. We’re also on Facebook Google+.

Copyright 2012 MyHealthNewsDaily, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


By Rachael Rettner, MyHealthNewsDaily Staff Writer |

Work, mahjong and tea: Hong Kong’s secrets to longevity.

Covered in smog and cramped apartment towers, Hong Kong is not usually associated with a healthy lifestyle. But new figures show that Hong Kongers are the longest-living people in the world.

Hong Kong men have held the title for more than a decade and recent data show women in the southern Chinese city overtaking their Japanese counterparts for the first time, according to the governments in Tokyo and Hong Kong.

Hong Kong women’s life expectancy rose from an average 86 years in 2010 to 86.7 years in 2011, while Japanese women’s longevity was hit by last year’s earthquake and tsunami, falling to 85.9 years, census figures reveal.

So what is Hong Kong’s secret to a long life?

Experts say there is no single elixir, but contributing factors include easy access to modern health care, keeping busy, traditional Cantonese cuisine and even the centuries-old Chinese tile game ofmahjong.

“I love travelling, I like to see new things and I meet my friends for ‘yum cha’ every day,” Mak Yin, an 80-year-old grandmother of six says as she practises the slow-motion martial art of tai chi in a park on a Sunday morning.

“Yum cha” is the Cantonese term to describe the tradition of drinking tea with bite-sized delicacies known as dim sum. The tea is free and served non-stop, delivering a healthy dose of antioxidants with the meal.

“My friends are in their 60s — they think I’m around their age too, although I’m much older than them,” Mak laughs.

Mak’s favourite food is steamed vegetables, rice and fruit. Cantonese food is famous for steamed fish and vegetables — dishes that use little or none of the cooking oils blamed for heart disease, obesity and high cholesterol.

But before Mak enjoys her afternoon tea, she joins a group of elderly people for her morning exercise of tai chi, an ancient Chinese practice said to have benefits including improving balance and boosting cardiovascular strength.

A study published in the New England Journal of Medicine in February found that tai chi reduces falls and “appears to reduce balance impairments” in people with mild-to-moderate Parkinson’s disease.

Another factor behind Hong Kongers’ longevity, experts say, is work. While others long for the day they can retire and kick up their heels, many people in Hong Kong work well into their 70s and even 80s.

Hong Kong does not have a statutory retirement age and it is common to see elderly people working in shops, markets and restaurants alongside younger staff.

“Many old people in our city remain working, that contributes to better psychological and mental health,” Hong Kong Association of Gerontology president Edward Leung says.

“For older people, a lot of them are stressed because they have nothing to do and they develop ’emptiness syndrome’. This causes mental stress.”

Fishmonger Lee Woo-hing, 67, says he could not bear to sit at home and do nothing. His inspiration is local tycoon Li Ka-shing, Asia’s richest man, who still runs his vast business empire in his 80s.

“If Li Ka-shing continues working at the age of 84, why should I retire?” asks the father-of-four during a break from his 14-hour shift at a bustling market in central Hong Kong.

“If I just sit at home and stare at the walls, I’m worried that my brain will degenerate faster. I’m happy to chat with different people here in the market.”

Hong Kong’s cramped living conditions are famously unhealthy, fuelling outbreaks of disease and viruses including bird flu and severe acute respiratory syndrome (SARS) which have killed dozens of people.

The city’s reputation won it the dubious distinction of a starring role in director Steven Soderbergh‘s 2011 disaster thriller “Contagion”, about a deadly virus that spreads from Hong Kong to the United States.

But in the day-to-day habits of ordinary people, experts say Hong Kong is a great place to grow old.

A popular local way of keeping busy and meeting friends is mahjong — a mentally stimulating tile game which can help delay dementia, according to aging expert Alfred Chan, of Hong Kong’s Lingnan University.

“It stimulates the parts that control memory and cognitive abilities. It helps old people with their retention of memory,” he says.

The complex rules and calculation of scores make mahjong, also known as the Chinese version of dominoes, mentally demanding. But the social aspects of the four-player game are just as important.

“In mahjong you need to play with three other people. It is a very good social activity, you have to interact with each other constantly,” says Chan, who has studied the game’s effects on the well being of elderly people.

“It is also a self-fulfilling game because if you win — whether you play with money or not — it gives you a sense of empowerment.”

Mahjong parlours are popular in Hong Kong, and mahjong tables are a must at Chinese wedding banquets.

“I’m in semi-retirement. I work in the morning and hang out with my friends by playing mahjong in the afternoon,” says 67-year-old tailor Yeung Fook, on the sidelines of a game in his modest garment shop.

“I’m happier when I work. It’s boring to just sit at home.”


By Beh Lih Yi | AFP

Study: Tattoo infections traced to tainted ink.

  • In this Jan 2012 photo provided by the Monroe County (N.Y.) Department of Public Health a persons arm is seen after receiving a tattoo covered with a red bubbly rash. As more people get tattoos, health officials are seeing more cases of a nasty skin infection blamed on the ink. In the largest outbreak reported, 19 people in Rochester, N.Y., recently ended up with bubbly rashes over their new tattoos. Cases also occurred in Colorado, Iowa and Washington States this year, health officials say. All together, the four states had 22 lab-confirmed tattoo-related infections and more than 30 suspected additional cases. (AP Photo/Monroe County (N.Y.) Department)Associated Press/Monroe County (N.Y. – In this Jan 2012 photo provided by the Monroe County (N.Y.) Department of Public Health a persons arm is seen after receiving a tattoo covered with a red bubbly rash. …more  


  • In this undated photo provided by the University of Washington, the arm of a Washington State woman is shown after developing an infection earlier this year after receiving a tattoo. As more people get tattoos, health officials are seeing more cases of a nasty skin infection blamed on the ink. In the largest outbreak reported, 19 people in Rochester, N.Y., recently ended up with bubbly rashes over their new tattoos. Cases also occurred in Colorado, Iowa and Washington States this year, health officials say. All together, the four states had 22 lab-confirmed tattoo-related infections and more than 30 suspected additional cases. (AP Photo/University of Washington, Dr. Andrea Kalus)In this undated photo provided …

ATLANTA (AP) — An outbreak of infected tattoos has led to an unlikely source: the ink.

With the growing popularity of tattoos, health officials say they are seeing more cases of a nasty skin infection caused by a commonbacteria traced to the ink. In the largest outbreak, 19 people in Rochester, N.Y., ended up with bubbly rashes on their new tattoos, researchers reported Wednesday.

Infections from tattooing are nothing new. Hepatitis, staph infections and even the superbug known as MRSA have been tied to tattoos. Dirty needles and unsanitary conditions are often to blame.

But all the New York cases were linked to an unidentified artist who wore disposable gloves and sterilized his instruments. The problem, investigators concluded, was in the ink.

“Even if you get a tattoo from a facility that does everything right, it’s not risk free,” said Dr. Byron Kennedy, deputy director of the health department in New York’s Monroe County. He is lead author of a report on last fall’s Rochester cases was released by the New England Journal of Medicine on Wednesday.

In the past year, there have been 22 confirmed cases and more than 30 suspected cases of the skin infection in Colorado, Iowa, New York and Washington state, health officials said. The infections were tied to ink or water used to dilute the ink. Tattoo artists and ink makers should use only sterile water to dilute ink, health officials advise.

Scattered reports of the illness in tattoo customers have been reported over the past 10 years. But they may be growing more common as more people get tattoos, experts said. An estimated 1 in 5 U.S. adults have at least one tattoo, an increase from years past, according to polls.

The illnesses were caused by a bacterial cousin of tuberculosis named Mycobacterium chelonae (pronounced chell-OH-nay). The bacteria can cause itchy and painful pus-filled blisters that can take months to clear up, and involve treatment with harsh antibiotics with unpleasant side effects.

The bacteria are common in tap water, and have been seen in the past when tattoo artists used contaminated water to lighten dark ink. The ink used in New York was “gray wash,” used for shaded areas of tattoos. The ink was recalled and has not returned to the market.

Companies that make gray wash sometimes use distilled water to lighten the ink, thinking it’s clean of infection-causing contaminants. But the bacteria can live in that too, said Tara MacCannell, who led a related investigation by the Centers for Disease Control and Prevention. Her study appears in CDC’s Morbidity and Mortality Weekly Report released Wednesday.

Some ink manufacturers add witch hazel or an alcohol preservative to lower risk of certain viruses, but those additives don’t kill off the hardy chelonae bacteria, she added.

Investigators found the bacteria in opened and unopened bottles of ink at the New York tattoo parlor. They did not find it in water at the shop, MacCannell said.

Health officials say tattoo customers should ask what kind of ink is being used and what measures are in place to prevent infections.



New England Journal:

CDC report:



Associated PressBy MIKE STOBBE | Associated Press 

In US, painkiller abusers turning to heroin: research.

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  • Ever since the popular painkiller pill OxyContin became harder to crush into powder two years ago, many US drug abusers have turned to heroin instead, researchers said Wednesday. (AFP Photo/Martin Bureau)Ever since the popular painkiller …

Ever since the popular painkiller pill OxyContin became harder to crush into powder two years ago, many US drug abusers have turned to heroin instead, researchers said Wednesday.

The formula change did not appear to stop people from snorting or shooting up, but rather caused them to switch to a dangerous street drug that mimics the same high, said a letter to the editor in the New England Journal of Medicine.

Highly addictive OxyContin shot to popularity in the last decade, largely in rural parts of the eastern United States, gaining the nickname “Hillbilly Heroin,” and causing its producers to devise a new pill that would not disintegrate when pounded in a bid to stem the epidemic of abuse.

“The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin, which is like OxyContin in that it also is inhaled or injected,” said Theodore Cicero of the Washington University School of Medicine.

“We’re now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas.”

Cicero and colleagues are analyzing survey data collected from 2009-2012 and completed by 2,566 patients who were entering treatment programs for prescription opioid dependence at various locations in the United States.

At the beginning of the research period, 35.6 percent of patients said OxyContin was their primary drug of choice, a number which has since fallen to 12.8 percent, the researcher said.

When asked to identify any opioids used in the last 30 days to get high at least once, OxyContin was mentioned by nearly half at the start, but fell to 30 percent by 2012.

Meanwhile, heroin use almost doubled from around 10 to nearly 20 percent.

Further interviews with about 100 of the survey participants showed that a common reason for the switch to heroin was the decreased availability of crushable OxyContin.

“This trend toward increases in heroin use is important enough that we want to get the word out to physicians, regulatory officials and the public, so they can be aware of what’s happening,” said Cicero, who is continuing to analyze the data.

“Heroin is a very dangerous drug, and dealers always ‘cut’ the drug with something, with the result that some users will overdose. As users switch to heroin, overdoses may become more common.”

His letter concluded that “abuse-deterrent formulations may not be the ‘magic bullets’ that many hoped they would be in solving the growing problem of opioid abuse.”

The US Centers for Disease Control and Prevention said last year that about 12 million Americans report taking prescription painkillers for recreational uses, though the actual figure is suspected to be much higher.

Opioid pain relievers, including oxycodone (OxyContin), methadone and hydrocodone, better known as Vicodin, have quadrupled in sales to pharmacies, hospitals and doctors’ offices since 1999.

The number of deaths from overdoses of opioid pain relievers has more than tripled from 4,000 people in 1999 to 14,800 people in 2008, and now surpasses the number of deaths from cocaine and heroin combined, the CDC said.


AFPBy Kerry Sheridan | AFP 

Pills to prevent HIV raise many questions: studies.

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  • A pharmacist shows anti-retroviral drugs in 2006 at the Mildmay Centre in Seguku, near Kampala, Uganda. Various trials examining the use of anti-retroviral drugs in healthy heterosexuals as a way to prevent HIV have shown drastically different results, research showed Wednesday. (AFP Photo/Stuart Price)A pharmacist shows anti-retroviral …

Various trials examining the use of anti-retroviral drugs in healthy heterosexuals as a way to prevent HIV have shown drastically different results, research showed Wednesday.

The findings of three major studies in Africa, published in the New England Journal of Medicine, raise many questions about which groups would likely benefit and how to manage such treatments in the future, doctors said.

The approach is known as pre-exposure prophylaxis, or PrEP, in which healthy people take antiretroviral drugs — the kind used to treat people with HIV — in order to prevent getting the virus during sex with HIV-infected partners.

One study detailed in the journal which included heterosexual couples — each with one HIV-positive partner, one HIV-negative — showed a 67 to 75 percent reduced risk of getting HIV among uninfected partners taking the drugs.

The study, known as Partners PrEP, ran from 2008 to 2010 in Kenya and Uganda and included more than 4,700 couples. It randomly assigned the HIV-negative partners to once-daily tenofovir, a combination of tenofovir-emtricitabine, or a placebo.

Both treatments showed “significant” and a “similar magnitude” of protection for both men and women, the study said.

Adherence to the drug regimen was also high in this study, with 82 percent of samples from randomly selected participants showing detectable drug levels, and study authors estimating an overall 92 percent adherence rate.

Another study detailed in the journal however was stopped early in April 2011 because the group receiving the drug did not show any better level of protection than the group taking the sugar pill.

That study, known as FEM-PrEP, was a randomized trial of 2,120 women in Kenya, South Africa and Tanzania.

Thirty-three women taking the drug became infected with HIV, compared to 35 taking the placebo.

The study also showed a much lower rate of adherence to the medication regimen (40 percent) and a much higher rate of reported side effects such as nausea, vomiting and kidney or liver abnormalities.

Since many of the women in the study reported viewing themselves at low-risk for acquiring HIV, this may have contributed to their failure to take the drug regularly, the study authors said.

A third study, called TDF-2, enrolled 1,219 men and women in Botswana, and showed that pre-exposure prophylaxis had an efficacy rate of about 62 percent in sexually active heterosexual adults.

Previous studies on men who have sex with men have shown that the approach could reduce transmission of HIV by 44 percent overall, though much higher success rates were seen in men who took the pills most regularly.

“Why the results differ across the various studies reported to date is unclear,” said an accompanying editorial by Myron Cohen from the University of North Carolina and Lindsey Baden of Brigham and Women’s Hospital in Boston.

Learning more through future study is important because PrEP is increasingly being seen as a part of an integrated HIV prevention approach, they wrote.

Also, an advisory panel to the US Food and Drug Administration earlier this year recommended approving the first ever pill for HIV prevention. A decision is expected in September.

Therefore, doctors need to consider how to manage such an approach with patients, the authors said.

Questions to consider include which populations are best suited, when to start and stop treatment, how to avoid the risk of drug resistance, what long-term side effects may include, and how to make sure the treatment does not encourage risky behavior such as unprotected sex.

“Concern about the management of pre-exposure prophylaxis of HIV infection should not detract from the potential importance of the intervention,” Cohen and Baden wrote.

“The health care provider who recommends pre-exposure prophylaxis needs a management plan that recognizes the effects of the intervention on the patient’s sexual behavior, safety and well-being as well as the ramifications of the intervention for the health of the public.”


AFPBy Kerry Sheridan | AFP 

Continued Infertility Treatments Drive Pregnancy Successes.

                        PHOTO: Babies conceived with infertility treatment methods are more likely to have certain birth defects than babies who are conceived naturally, according to a study published Saturday in the New England Journal of Medicine.

Babies conceived with infertility treatment methods are more likely to have certain birth defects than babies who are conceived naturally, according to a study published Saturday in the New England Journal of Medicine.  (Getty Images)

Women in their 30s and 40s who undergo multiple infertility treatments may be nearly as likely to deliver a baby as women who conceive naturally, according to new research that provides men and women with a more realistic view of their chances of becoming parents.

Until now, the success of in vitro fertilization and other assisted reproductive technology (ART) was based on live births following a single course of treatment, called a cycle. However, researchers for the first time have calculated cumulative success rates for women undergoing several treatment cycles. Among nearly 250,000 U.S. women treated with ART in 2004-2009, 57 percent achieved a live birth, they reported. In addition, 30 percent of all ART cycles were successful, they found.

“This study shows that if you keep at it …your chances of becoming pregnant continue to rise with continuing treatment,” said lead researcher Barbara Luke, a professor of obstetrics, gynecology and reproductive biology at Michigan State University‘s College of Human Medicine in Lansing. “The takeaway message from this is you may need to look at infertility treatment over a course of cycles.”

Luke noted that about 25 percent of women drop out after their first cycle for a variety of reasons that may include cost (about $7,000 to $15,000 out-of-pocket per treatment cycle) and stress. Many insurance plans will only cover a couple of cycles; Luke and her co-authors said they hoped their finding might encourage insurance companies to reconsider those limits.

PHOTO: Babies conceived with infertility treatment methods are more likely to have certain birth defects than babies who are conceived naturally, according to a study published Saturday in the New England Journal of Medicine.
Getty Images
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Success depends on many factors, most importantly a woman’s age and the quality of her embryos, which are related, Luke said. “As we age, our eggs age, and the quality of the embryo may be less. That’s why using a donor egg, from a younger woman, greatly improves the live birth rate among older women.”

Donor eggs give women “a 60 to 80 percent chance of live birth, regardless of your age,” Luke and her colleagues reported in today’s issue of the New England Journal of Medicine.

Choosing the donor egg route represents “a very personal decision,” Luke suggested. Although it may seem cold to advise women in their 40s that their best chances of becoming pregnant lie with the eggs of younger women, she said they might want to think about egg donations “within families,” with a younger sister donating to an older sister.

Luke and her co-authors found that for women under age 31 undergoing ART, the live birth rate is 42 percent for the first cycle; 57 to 62 percent for a second cycle; 63 to 75 percent by a third cycle and 66 to 83 percent in the fourth cycle. Among women 43 and over, the chances of a live birth with their own eggs are about 4 percent for the first cycle; 6 to 8 percent for the second; 7 to 11 percent for the third; and 7 to 15 percent for a fourth cycle.

For comparison, Luke and her co-authors noted that among the general population, the odds of a couple conceiving spontaneously are 45 percent at one month, 65 percent at 6 months, and 85 percent at 12 months.

“This study provides patients with important and encouraging information,” said Dr. Glenn Schattman, president of the Society for Assisted Reproductive Technology, which compiled the patient data that Luke and her colleagues analyzed. “While tracking outcomes by cycle started or single embryo transfer is a valuable method for assessing quality, having cumulative data linked to individual patients better estimates the prospect for success when they start a treatment cycle.”

“Having the data to demonstrate that medically assisted conception can nearly match rates of natural conception is an important milestone,” said Dolores J. Lamb, president of the American Society for Reproductive Medicine, which represents more than 8,000 health professionals focused on reproductive biology.


By  (@JaneEAllenABC) , ABC News Medical Unit

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