Killer virus spreads unchecked through U.S. hog belt, pushing pork to record


(Reuters) – John Goihl, a hog nutritionist in Shakopee, Minnesota, knows a farmer in his state who lost 7,500 piglets just after they were born. In Sampson County, North Carolina, 12,000 of Henry Moore’s piglets died in three weeks. Some 30,000 piglets perished at John Prestage’s Oklahoma operation in the fall of 2013.

The killer stalking U.S. hog farms is known as PEDv, a malady that in less than a year has wiped out more than 10 percent of the nation’s pig population and helped send retail pork prices to record highs. The highly contagious Porcine Epidemic Diarrhea virus is puzzling scientists searching for its origins and its cure and leaving farmers devastated in ways that go beyond financial losses.

“It’s a real morale killer in a barn. People have to shovel pigs out instead of nursing them along,” Goihl said.

Since June 2013 as many as 7 million pigs have died in the United States due to the virus, said Steve Meyer, president of Iowa-based Paragon Economics and consultant to the National Pork Board said. United States Department of Agriculture data showed the nation’s hog herd at about 63 million as of March 1, 2014.

PEDv was first diagnosed in Ohio last May and has spread within a year to 30 states with no reliable cure in sight. U.S. packing plants may produce almost 2 percent less pork in 2014, according to Ken Mathews, USDA agricultural economist.

Last week the USDA responded to calls for more reliable data and classified PEDv as a reportable disease, a step that requires the pork industry to track its spread.

“It’s a positive step that I wish they had taken last summer when it became obvious this was spreading rapidly,” said Meyer.

Most farmers and researchers believe PEDv is transmitted from pig to pig by contact with pig manure.

“Something like a tablespoon of PEDv infected manure is roughly enough to infect the entire U.S. hog herd,” said Rodney “Butch” Baker, swine biosecurity specialist at Iowa State University.

The National Pork Board has spent about $1.7 million researching the virus, which is nearly always fatal in pigs younger than 21 days. With pork prices at an all-time high of $3.83 a pound, the loss of baby pigs cuts into profits for hog farmers.

“If you have four weeks of mortality in a PEDv break, that’s pretty devastating to the financial wellbeing of that operation,” said Greg Boerboom, a Minnesota hog farmer.

“I think most producers are scared,” Boerboom said. “They stay up at night.”

PEDv does not pose a risk to human health and is not a food safety issue, the USDA says.

ORIGIN MYSTERY

Months of forensic research so far have turned up no clear evidence of how the disease entered the United States.

The virus is nearly identical to one that infected pigs in China’s Anhui province, according to a report published in the American Society of Microbiology journal mBio. Researchers also are exploring whether the widespread use of pig-blood byproducts in hog feed might have introduced the disease.

There have been outbreaks in recent years in Europe, Japan, Mexico and parts of South America, though in milder forms than seen in the U.S. and China.

The disease has taken root in Canada, too, where the pork industry is deeply integrated with U.S. pork production.

LIKE A LAWN MOWER

PEDv thrives in cold, damp environments, and after slowing last summer its spread accelerated during the past winter. In mid-December, there were over 1,500 cases but by mid-April, that had more than tripled to 5,790, according to USDA data.

Altogether, of nearly 15,000 samples tested for PEDv about 32 percent have been positive.

The virus “acts like a lawn mower” on the villi in a pig’s intestines, which are the tiny projections that aid digestion, said Tony Forshey, chief of animal health at the Ohio Department of Agriculture. With their villi gone, the piglets cannot absorb nutrients from food or water, contract diarrhea and die from dehydration.

So far, no vaccine has been able to completely protect pigs from the disease. An Iowa company, Harrisvaccines Inc., has made some progress, while pharmaceutical giants Merck Animal Health and Zoetis Inc have joined with universities to begin vaccine development.

“There is no silver bullet for PEDv,” said Justin Ellis, marketing manager at Alltech, which developed a feed additive designed to reduce risk of the disease.

STRINGENT MEASURES

The disease is spreading even as farmers and truckers impose stricter cleanliness measures across the so-called Hog Belt, which stretches across most of the U.S. Midwest and Plains States and extends south to North Carolina, the nation’s No. 2 hog producer. Iowa ranks first.

“It’s a complete lifestyle change,” said Iowa State’s Baker. “In the past the truckers haven’t thought of biosecurity much.”

Some hog farmers prohibit outside visitors. Others require workers to change clothes when entering and leaving barns. Truck drivers wipe down the step into their cabs, disinfect their steering wheels and change boots or wear disposable booties before entering farm yards.

The industry wants truck washes to use fresh water instead of recycled, since PEDv can live in room temperature water for up to 13 days, a University of Minnesota study said.

“The only truck I regularly allow on site is the feed truck and last November I told the driver not to get out of the truck,” said Bill Tentinger, an Iowa farmer who so far has kept PEDv at bay.

The extra washing, drying and disinfecting can consume at least two hours and cost up to $500 per load, industry sources said.

DEATH TOLLS

Bright yellow signs marked “PED” are popping up outside North Carolina farms warning the virus is present. One-third of North Carolina’s 3,000 hog farms have been struck by PEDv since the first diagnosed case there in June 2013, the state says.

So many piglets have died that Tom Butler, a farmer who fattens hogs for market in southeastern Harnett County, is having difficulty finding animals. His herd is down 25 percent to 6,000 pigs, costing him more than $100,000.

“We were spiraling downhill for a while but I think we’ve leveled off,” Butler said. “The industry is learning to cope.”

(Additional reporting by P.J. Huffstutter in Chicago, Marti Anne Maguire in Sampson County, N.C. and Rod Nickel in Winnipeg; Editing by David Greising and John Pickering)

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Egypt discovers first case of potentially deadly MERS virus


(Reuters) – Egypt has discovered its first case of the potentially deadly Middle East Respiratory Syndrome (MERS) in an Egyptian citizen who had recently returned from Saudi Arabia, Egypt’s Ministry of Health said on Saturday.

The virus, which can cause coughing, fever and pneumonia, has spread from the Gulf to Europe and has already caused over 90 deaths.

The patient, 27, is being treated for pneumonia at a Cairo hospital and is in a stable condition, the ministry said in a statement.

The man, who is from the Nile Delta, was living in the Saudi capital Riyadh, the ministry said.

Saudi Arabia, which has been hardest-hit by the MERS virus, announced on Friday it had discovered 14 more cases in the kingdom, bringing the total number to 313.

Although the number of MERS infections worldwide is fairly small, the more than 40 percent death rate among confirmed cases and the spread of the virus beyond the Middle East is keeping scientists and public health officials on alert.

A spokesman for the World Health Organisation in Geneva said on Friday it was “concerned” about the rising MERS numbers in Saudi Arabia urging for a speedy scientific breakthrough about the virus and its route of infection.

Saudi authorities have invited five leading international vaccine makers to collaborate with them in developing a MERS vaccine, but virology experts argue that this makes little sense in public health terms.

(Reporting by Yasmine Saleh and Mahmoud Mourad, Editing by Raissa Kasolowsky)

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Saudi Arabia says MERS virus cases top 300, 5 more die


(Reuters) – Saudi Arabia said on Friday it had discovered 14 more cases of the potentially deadly Middle East Respiratory Syndrome (MERS) in the kingdom, bringing the total number to 313.

A health ministry statement said the new cases had been reported in the capital Riyadh, the coastal city of Jeddah and the “holy capital” Mecca in the past 24 hours. Authorities had also registered five more deaths due to the virus, it said.

The jump in cases is of particular concern because Saudi Arabia will host pilgrims from around the world in July during the Muslim month of Ramadan, as well as in early October when millions of worshippers perform the annual Haj.

In total, 92 people have died of MERS in Saudi Arabia, the ministry said on its website.

Saudi Arabia has witnessed a jump in the rate of infection in recent weeks, with many of the new cases recorded in Jeddah, the kingdom’s second-largest city. A large proportion of the people infected are healthcare workers.

MERS emerged in the Middle East in 2012 and is from the same family as the SARS virus, which killed around 800 people worldwide after first appearing in China in 2002. MERS can cause coughing, fever and pneumonia.

Although the number of MERS infections worldwide is fairly small, the more than 40 percent death rate among confirmed cases and the spread of the virus beyond the Middle East is keeping scientists and public health officials on alert.

A spokesman for the World Health Organization in Geneva said on Friday it was “concerned” about the rising MERS numbers in Saudi Arabia.

“This just highlights the need to learn more about the virus, about the transmission, and about the route of infection,” he said.

Saudi Arabia’s King Abdullah replaced the health minister last week after growing public concern about the spread of the disease.

Saudi authorities say they have invited five leading international vaccine makers to collaborate with them in developing a MERS vaccine, but virology experts argue that this makes little sense in public health terms. [ID:nL6N0NH3KU]

(Reporting by Sylvia Westall. Editing by Andre Grenon)

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Cholesterol drug users may use pills as a license to overeat


(Reuters Health) – People who take the common cholesterol-lowering drugs known as statins may feel a false sense of security and eat a bit more, according to a new study.

Researchers found that U.S. adults taking statins in 1999-2000 were eating fewer calories than people not taking the drugs, but statin users were eating about the same amount as non-users by 2009-2010.

“We believe that physicians need to reemphasize the importance of a healthy lifestyle to statin-users,” Dr. Takehiro Sugiyama told Reuters Health in an email.

He is the study’s lead author from the University of Tokyo in Japan.

Eating excess calories and fat would not only compromise the cholesterol-lowering effect of statins, he said. It would also increase a person’s risk of becoming obese and developing diabetes.

Statins – such as Lipitor, Zocor and Crestor – inhibit the production of cholesterol, which is used to build new cells and keep the body functioning. Too much cholesterol increases a person’s chances of developing heart disease and fatty deposits in blood vessels, however.

Under new recommendations from the American College of Cardiology and the American Heart Association, the number of U.S. adults eligible to take the drugs may reach 56 million (see Reuters story of March 19, 2014 here: reut.rs/QFtJxR.)

The new guidelines deemphasize the use of LDL or “bad” cholesterol as a measure of when to put people on the drugs. Instead, doctors are encouraged to take several risk factors into account to target people at high risk for heart attacks or strokes (see Reuters story of November 12, 2013 here: reut.rs/QFucA3.)

Previous studies had found no evidence that statin users eat more after being prescribed the drugs, the authors write in JAMA Internal Medicine. Use of the drugs has increased substantially since those studies were conducted, however.

For the new study, the researchers used data from a national survey of U.S. adults that’s conducted every two years.

They found that statin users were consuming about 2,000 calories per day in 1999-2000, on average, compared to about 2,179 calories per day among non-users.

Sugiyama writes that it would be expected that stain users eat less in an attempt to control their cholesterol and weight.

Calorie consumption among the statin users increased as time went on, however. By 2005-2006 there were no differences between the two groups.

Overall, calorie consumption among statin users increased by about 10 percent during the decade. Statin users significantly increased the amount of calories they got from fat during the study period, too.

Meanwhile, calorie and fat consumption remained unchanged among people not taking statins.

Sugiyama said there could be two explanations for the findings.

“We suppose (patients) noticed the potency of the statin treatment because their LDL-cholesterol level would drop drastically regardless of no change on diet,” he said. “Through this process, statin users may learn that they do not need to restrict their diet to achieve the LDL-level goal.”

Alternatively, doctors may have started prescribing statins to people who tend to eat more and they may not be as reluctant to prescribe the drugs to people who don’t control their diets.

“Because of the study design, we were not able to disentangle the mechanism,” he said.

The research also can’t say for certain that statins caused people to eat more as time went on. There could be another unknown factor that influenced the results.

“I think the biggest impact of this trial is that as physicians when we put patients on statins it shouldn’t be the end of the discussion about other lifestyle interventions,” Dr. David Frid said.

Frid is a staff cardiologist at the Cleveland Clinic in Ohio. He was not involved with the new study.

“Even on a statin, you do need to continue following your dietary recommendations,” he told Reuters Health.

Sugiyama agreed that statin use should be paired with lifestyle modification.

“Over-relying on medication would cause side effects, unnecessary medical costs and perhaps an ethical concern,” he said. “I think physicians need to reemphasize the importance of dietary control for statin-users.”

SOURCE: bit.ly/1k1CVFl JAMA Internal Medicine, online April 24, 2014.

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U.S. military suicides fall among active duty, rise in reserves


U.S. army soldiers are seen marching in the St. Patrick's Day Parade in New York, March 16, 2013. REUTERS/Carlo Allegri

U.S. army soldiers are seen marching in the St. Patrick’s Day Parade in New York, March 16, 2013.

Credit: Reuters/Carlo Allegri


(Reuters) – Suicides among active duty U.S. forces fell 18 percent in 2013 from a peak in 2012 but climbed among reserve forces, the Pentagon said on Friday as it unveiled figures showing suicide still far outpaced combat deaths among U.S. military personnel.

Preliminary data showed 261 suicides among active duty service members, down from 319 suicides in 2012, which was the highest on record, the Pentagon said. In the National Guard and reserve, suicides increased to 213 last year from 203 in 2012.

The latest Pentagon figures represented a change in methodology from how they were calculated that separates out all reserve and guard forces, even if they have been called to active duty. Still, the trends for active duty and reserve forces were consistent with previously disclosed estimates.

The decline in overall active-duty suicides compares with a far sharper decline in hostile deaths among troops overseas as the United States winds down the war in Afghanistan. The Pentagon reported 91 hostile deaths overseas in support of that war last year, compared with 237 in 2012.

(Reporting by Phil Stewart; Editing by Nick Zieminski)

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Hiking at any altitude may benefit men with cardio risk factors


(Reuters Health) – Just three weeks of exercise and a healthy diet produced positive changes in middle-aged men with a cluster of heart risk factors known as metabolic syndrome, according to a new study from Austria.

Among two groups of men sent on a hiking vacation, one at sea level and the other at just over 5,500 feet altitude, benefits were about the same and no negatives were seen, suggesting that exercising in the thinner air at altitude is neither better nor riskier for health, the researchers say.

“The data of the AMAS-2000 study proved that daily hiking for hours at any altitude provides cardiovascular benefits and represents an excellent therapeutic opportunity for physical and mental regeneration even for individuals with a cluster of cardiovascular risk factors,” Dr. Guenther Neumayr told Reuters Health in an email.

Metabolic syndrome is a cluster of characteristics, including abdominal obesity, high cholesterol and triglycerides, high blood sugar and elevated blood pressure. People with metabolic syndrome are at greater risk for cardiovascular disease and diabetes.

Neumayr, a medical doctor practicing in Lienz, Austria, was part of the team that designed the Austrian Moderate Altitude Study 2000 (AMAS-2000) to determine if hiking at a moderately high altitude might be any different from hiking at low altitude.

Between 5,000 and 8,000 feet above sea level is considered moderate altitude. Cities within that range include Albuquerque, New Mexico; Denver, Colorado; Nairobi, Kenya; Lima, Peru and Mexico City.

The air pressure at that altitude is similar to what it feels like to be on a commercial airplane. And the oxygen concentration in the air is approximately 17 percent, compared to 21 percent at sea level.

To test whether exercise at moderate altitude posed any additional risks or offered extra benefits, the researchers recruited 71 men, ranging in age from 36 to 66 years old, and randomly assigned them to three-week vacations at one of two Austrian resorts located in Obertauem, at 5,577 feet above sea level, or in Bad Tatzmannsdorf, at 650 feet above sea level.

The men all had metabolic syndrome and were non-smokers, the researchers note in their report, published in the journal Wilderness and Environmental Medicine.

Health professionals led the men on moderate intensity hikes that lasted more than two hours each. They hiked four days a week and rested the other three. The men in both groups also had similar diets, averaging about 1,800 calories per day.

The researchers weighed the men, measured their abdominal and hip circumferences and took blood samples several times during the study.

At the end of three weeks, men in both groups had lost an average of 7 pounds and showed similar drops in blood pressure readings, heart rate, blood sugar and similar improvements in cholesterol.

In both groups, for example, resting heart rate fell by just under three beats per minute from measurements taken two weeks before the vacation to measurements six to eight weeks afterward. In the group that exercised at altitude, blood pressure dropped from an average 187/94 to 179/90, compared to the sea level group whose average readings went from 191/96 to 184/87.

“It is the daily activity, not the altitude which provides the benefits in the health effects,” Neumayr said.

Past research had suggested that hiking or skiing at a moderate elevation can increase the risk of cardiac arrest, however, those studies also found that cardiac events tended to happen on the first day at a higher altitude and that people who had already had a heart attack were the ones most at risk, Neumayr and his colleagues write.

All the participants in the new study tolerated the vacations well and no adverse events were seen at either altitude, they add.

“Walking and hiking are activities of low to moderate exercise intensity which can be performed by nearly everyone – even by patients with metabolic syndrome featuring obesity and poor cardio-respiratory fitness,” Neumayr said.

The difference in air pressure between the two altitudes is marginal, he pointed out.

“Therefore, there is no significant effect on the individual’s performance between these two altitudes – everyone featuring bad fitness has, of course, to exercise for some time at sea or low level to be able to start effective training,” he said.

Neumayr said that years with insufficient physical activity have led to higher rates of obesity and metabolic syndrome.

“Thus, walking and hiking – the original forms of motion – should be recommended generally and generously for both healthy people and patients with metabolic syndrome,” he said.

People with health conditions such as chronic obstructive pulmonary disease or who have been diagnosed with heart disease may have difficulty breathing at higher altitude and should talk to their doctor before traveling to cities located at moderate or higher elevations.

SOURCE: bit.ly/1ihQkX0 Wilderness and Environmental Medicine, online April 14, 2014.

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BMI linked to breast cancer risk after menopause


(Reuters Health) – Overall body size, rather than shape, is a better indicator of breast cancer risk after menopause, according to a recent study.

The analysis of U.S. women contradicts past research suggesting that having an apple shape with a large midriff measurement, regardless of weight or body mass index (BMI), might signal greater breast cancer risk.

“When we looked at both BMI and waist size, we found that BMI explained the relationship (with breast cancer risk), and that the waist circumference had little effect,” said Mia Gaudet, an American Cancer Society epidemiologist who led the new study.

BMI, a measure of weight relative to height, is used to gauge obesity. Having a BMI in the obese range (30 or greater) has also been linked to breast cancer risk up to twice that of women in the normal weight range (BMIs of 25 or less, in this study).

Fat around the waistline that contributes to the apple-shaped body – versus a pear shape, where fat settles around the hips – is associated with extra inflammation and growth signals that have been linked to both heart disease and cancer risk.

To see whether excess abdominal fat contributes to breast cancer risk independent of overall BMI, Gaudet and her team analyzed data about nearly 29,000 postmenopausal women over an average of 11.6 years.

The women were participants in the Cancer Prevention Study-II Nutrition Cohort, a long-term study that began in the early 1990s. Starting in 1997, participants in Gaudet’s study had filled out questionnaires every two years to evaluate their cancer risk and outcomes.

The survey asked for the women’s weight, which was used to calculate BMI, and also provided specific instructions for the participants to measure and record their waist circumference. Women in the study were predominantly white and those who had a prior cancer diagnosis or had taken menopausal hormones were excluded from the analysis.

Researchers examined just the group’s breast cancer diagnoses between 1997 and June 30, 2009, and found that without adjusting for BMI, a larger waist was linked to a higher breast cancer risk. For every 10-centimeter increase in waist size, the risk of breast cancer increased by 13 percent.

After including BMI in the calculation, however, waist size did not change cancer risk, but BMI did: For every one-point increase in BMI, there was a 4 percent rise in breast cancer risk.

The results were published in the journal Cancer Causes & Control.

The study may not be the last word when it comes to BMI and breast cancer, according to Victoria Seewaldt, a professor of medicine at the Duke Cancer Institute in Durham, North Carolina.

“To date, the data has been conflicting,” Seewaldt told Reuters Health in an email.

For example, a 2012 analysis published in the journal PLoS One found that although a high BMI was linked to an increased risk of breast cancer after menopause, obesity did not confer a higher risk among premenopausal women.

Seewaldt, who was not involved in the new study, said she was surprised by its results since waist size is linked to other diseases including insulin resistance – a key player in type 2 diabetes – and the so-called metabolic syndrome, which increases the risk of stroke, heart disease and other conditions.

Importantly, the study didn’t determine whether a higher BMI causes a higher breast cancer risk or whether another factor predisposed the women in the study to both obesity and breast cancer.

The researchers did take into account many lifestyle factors, such as exercise, diabetes and whether participants smoked, however.

Although the study was well-designed, it’s not clear whether BMI is an accurate indicator of breast cancer risk among women who are not Caucasian, Seewaldt noted.

“BMI is not a good measure of obesity across racial and ethnic groups. I would be hesitant to change clinical practice and switch focus from abdominal circumference to BMI only, particularly for Asian- and African-American women,” Seewaldt said.

No matter what, the age-old advice to maintain a healthy weight still stands, the study’s authors said.

“The results of our study are very consistent with the American Cancer Society’s recommendation with regards to physical activity, and to achieve and maintain a healthy weight and be physically active throughout life,” Gaudet said.

SOURCE: bit.ly/PtkQGB Cancer Causes & Control, online April 9, 2014.

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Health atlas shows risks by area








By Pippa Stephens
Health reporter, BBC News


Map showing skin cancer risk in women in England and WalesThe research mapped the incidence of a range of diseases alongside environmental factors


A new online map of England and Wales allows people to enter their postcode and find their community’s risk of developing 14 conditions, such as heart disease and lung cancer.

The map presents population-wide health information for England and Wales.

The researchers at Imperial College London pointed out that it could not be used to see an individual’s risk.

It indicated an area’s health risk, relative to the average for England and Wales, they stressed.


Twenty-five year study

Researchers at Imperial looked at 8,800 wards in England and Wales, each with a population of 6,000 people.

They collected data from the Office for National Statistics and from cancer registries for 1985 to 2009.

Data was then mapped alongside region-by-region variations in environmental factors such as air pollution, sunshine and pesticides.

The data was also adjusted for age, deprivation and to take into account small numbers.

Researchers said this was the first tool of its kind showing this level of detail.

Dr Anna Hansell, from the UK Small Area Health Statistics Unit, led the research.

She told the BBC: “We tried to present this so people do not jump to the wrong conclusions.”

Dr Hansell said people were “fascinated” by the tool when they trialled it.

She added: “The new thing about it is you can go right down to neighbourhood level – beforehand it has been at a broader scale.”

Eight communities in Bridgend and Rhondda Cynon Taff, in Wales, and Leeds, Manchester and the Wirral in England had higher patterns of health risks, Dr Hansell said.

She said within those eight communities none stood out as “doing badly for everything”, and that the statistics had not been geared up to rank the areas.

Since the study adjusted for deprivation, Dr Hansell said it raised some “surprising” variations which could be explained by changing smoking rates in the past 25 years.

Meanwhile, 33 wards were identified as having a lower risk of disease, such as parts of London, North Norfolk and Suffolk.

Although the researchers adjusted for deprivation, she said, there must be “some lifestyle factors” going on, to account for the variability.

Environmental factors, such as air pollution, accounted for roughly 5-10% of a person’s risk of disease, which was significant in terms of a population, Dr Hansell said.

She said she hoped “really important benefits” could come out of further research using the tool and that it would raise questions about disease patterns.


Maps available on the site


Map showing breast cancer risk in England and WalesA number of maps are available. In one, breast cancer risk for women is shown to vary by region


Map showing lung disease risk in England and WalesThe risk of lung disease is a mixed picture across England and Wales


Map showing air pollution levels across England and WalesMeanwhile, air pollution appears to increase around big cities


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Prof David Coggon, professor of occupational and environmental medicine at the University of Southampton, said the atlas provided a “finer level of spatial resolution” than its predecessors.

But he said there were “shortcomings” in the research, such as the possible of chance variation and the likelihood of distortion by exposure to non-environmental causes of disease, such as smoking and diet, which are not fully explained by deprivation.

Prof Coggon added: “These unavoidable shortcomings do not invalidate the analyses presented, but they are a reason for caution in interpretation.”

He said people should not focus on environmental factors, but instead eat a healthy diet, exercise regularly and avoid smoking, excessive alcohol, and “unnecessarily risky” behaviours such as dangerous driving.

Prof Paul Pharoah, professor of cancer epidemiology at the University of Cambridge, said: “This atlas does not enable anyone to judge their individual absolute risk.

“People should definitely not use this atlas to decide where to live.”

He said it would be “wrong to imply” any causal association between any of the environmental exposures and any of the health outcomes described in the atlas.

Prof Pharoah added: “What these data should do is help researchers identify important hypothesis that should be tested using research designs.”

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Exercises may help men with premature ejaculation


(Reuters Health) – Regularly practicing pelvic floor exercises helped improve lifelong premature ejaculation issues in a small group of men, a new study has found.

According to the American Urological Association, premature ejaculation affects about one in five U.S. men younger than 60.

“Pelvic floor muscles are actively involved in sexual function, and it is natural to assume that by improving the function of these muscles, one will improve one’s sexual performance and outcome,” said Yuchin Chang, a physical therapist at Professional Physical Therapy and Training in Summit, New Jersey. She was not involved in the new research.

For the study, presented at the European Association of Urology’s annual meeting in Stockholm, Sweden, researchers used the International Society of Sexual Medicine definition of premature ejaculation as that which occurs “within a minute.”

Forty men who reported having lifelong premature ejaculation problems were trained to exercise their pelvic floor muscles for 12 weeks. They also measured their time to orgasm throughout the study period.

The men, ages 19 to 46, had previously tried a variety of treatments, including creams, behavioral therapy and antidepressants, without any significant improvement.

Researchers taught the participants techniques similar to those used to help people with incontinence, including how to contract their perineal muscles to improve their strength and endurance.

They also stimulated men’s pelvic floor muscles using an electric anal probe and used a strategy called biofeedback to prompt them to practice the perineal exercises. As part of the biofeedback process, electrodes are positioned on the patient’s pelvic floor and converted into sounds or graphics that the patient sees or hears.

The men performed all the exercises three times a week, for 20 minutes each session.

Thirty-three participants, or 82 percent, noted improvement. Another two experienced improvement but dropped out before the end of the 12-week program. Five had no improvement.

At the start of the trial, men’s average time to ejaculation during intercourse was 32 seconds. By the end of the first six weeks, the 33 successful patients had an average time to ejaculation of just over two minutes. After 12 weeks, their average time to ejaculation had increased more than four-fold, to almost two and a half minutes.

Thirteen of the men continued to perform the exercises once a week and tracked their results for another six months. All reported that they maintained longer ejaculation times for the entire six months.

“These men, who had suffered from premature ejaculation their entire lives, were able to improve their ejaculation time in just 12 weeks and maintain that improvement for another six months,” lead researcher Dr. Antonio Pastore, a urologist at Sapienza University of Rome, told Reuters Health in an email.

Researchers said the exercises are a bit more complicated than those used for incontinence, such as so-called Kegel exercises.

“These exercises are designed to retrain/re-educate the pelvic floor muscles to either contract or lengthen properly on command and depending on the need,” Chang said. “For instance, to retrain the muscles to contract, one should try to contract their pelvic floor muscles as if they are holding their urine, and hold it for 10 seconds, for 10 repetitions, like the Kegel exercises. But that is just part of what is needed for men with premature ejaculation.”

The exercises might not help at all if men don’t learn to do them correctly, she noted.

“It is best for men who suffer from premature ejaculation to be properly guided by a pelvic floor physical therapist,” Chang said.

“Patients need at least four weeks of training (12 sessions) to learn the specific rehabilitation techniques and exercises described in this study,” Pastore added.

Chang said the Herman and Wallace Pelvic Rehabilitation Institute keeps a list of certified pelvic rehabilitation practitioners where men can look to find a physical therapist. The directory is online here: bit.ly/1faOywv

“The pelvic floor exercises, if done properly, should help men with premature ejaculation. And they are more cost-effective and without the potential side effects of the currently used drugs,” she said.

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Experts cast doubt on Saudi push for Middle East virus vaccine


(Reuters) – Official talk in Saudi Arabia of racing to develop a vaccine against a deadly new virus may be a way to reassure a fearful population, but it is scientifically wide of the mark and makes little sense in public health terms.

Experts in virology say the biochemical know-how is there to create a vaccine against Middle East Respiratory Syndrome, or MERS, but question why authorities would want to spend millions immunizing an entire population against a disease that has affected only a few hundred people.

Far better for public health, they say, would be to pin down the source of the infection – likely to be among animals, possibly camels or bats – and devise a strategy to halt the virus there.

“There are enormous problems with the idea of a MERS vaccine,” said Ian Jones, a virologist at Britain’s Reading University who has been following the outbreak from the start.

“I can see it works as an appeasement – that they want to say they can make it – and biochemically of course they could, but practically it doesn’t make any sense.”

“Who would you vaccinate? Would you vaccinate the whole population when only a tiny number of people seem to be susceptible?”

MERS first emerged in April 2012 and has caused more than 250 human infections, including 93 deaths, across the Middle East as well as in Europe, Asia and North Africa.

The infection can cause coughing, fever and pneumonia, which can be fatal. So far, its death rate is around 30 percent.

SHARP RISE IN SAUDI CASES

The number of human cases has risen sharply in recent weeks in Saudi Arabia, piling pressure on the government to be seen to be taking action to protect its people. Of the 91 new cases announced in the kingdom in so far April, 73 have been in Jeddah. Many of those infected were healthcare workers.

A Saudi Health Ministry spokesman was not immediately available for comment on Friday, but the local surge is fuelling rumor and mistrust, and has made people jittery.

Sales of face masks and hand sanitizing gels have soared, and some people are expressing concern about going to hospitals or attending funerals.

A spokesman for the World Health Organisation in Geneva said on Friday it was “concerned” about the rising MERS numbers in Saudi Arabia. “This just highlights the need to learn more about the virus, about the transmission, and about the route of infection,” he said.

Amid heightened anxieties, Saudi authorities say they have invited five leading international vaccine makers to collaborate with them in developing a MERS vaccine.

Giving no names or details, they said the companies were from North America and Europe and some would visit soon to discuss how to go about developing an affordable MERS shot.

But with worldwide cases of the respiratory infection still only in the hundreds, and deaths not yet into three figures, scientists are skeptical about why Saudi officials would want to focus on a vaccine – except for political reasons.

“I question whether there would really be any interest from vaccine companies to develop a human vaccine at this stage,” said Bart Haagmans, a virus expert at the Erasmus Medical Centre in Rotterdam in the Netherlands.

“That’s what we know already from many other viral infections where there are only a very limited number of people affected. It’s common sense and general knowledge, I’d say.”

CAMELS IN THE FRAME

Researchers around the world have been working hard to investigate the MERS virus since it first emerged in 2012.

Known as a coronavirus for the crown-like shape it has when viewed under a microscope, it belongs to the same family as the virus that caused a deadly outbreak of Severe Acute Respiratory Syndrome, or SARS, in 2003.

Scientists first linked it to bats and research has found that infections with the virus, or signs of it having been present, are widespread in dromedary camels in the Middle East.

Noting that “all the evidence at the moment points to camels” as the likely source of human infections, Haagmans agreed with Ian Lipkin, director of the Center for Infection and Immunity at Columbia University in the United States, in saying that developing a MERS vaccine for possible veterinary use might be a more effective long-term strategy to control human cases.

As a public health measure, trying to limit the spread from animals – possibly camels in this case – would be a sensible approach, he said.

With veterinary vaccines, the bar for testing and trialing a potential product is far lower than for humans – where full clinical trials taking several years would be needed before a product is passed as safe and effective and licensed for market.

And with the MERS virus apparently common in camels, the risk-benefit analysis of mass immunization would stack up far more favorably towards protecting large numbers of animals from something they really are at risk of contracting.

Yet the question as to why Saudi authorities are apparently avoiding talk of controlling the disease in camels is confusing some experts, when it appears that tackling the disease at its animal source, or even protecting animals, might be best.

Lipkin is concerned the animals’ reputation in the kingdom – where they carry high cultural and monetary value, are they are respected in sport and admired for their beauty, as well as used to provide meat and milk, may be clouding Saudi judgment.

If people begin to associate camels strongly with a dangerous and deadly virus, he said, their reputation as objects of beauty and value may be tarnished.

“Remember the hue and cry (among dog-loving Westerners) when people started killing dogs in Egypt because of fears about rabies? Well, in Saudi Arabia people feel similarly about their camels.”

(additional reporting by Tom Miles in Geneva; editing by Giles Elgood)

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