China to lift restrictions where second African swine fever outbreak found

BEIJING (Reuters) – China is set to lift restrictions on an area in central Henan province, where the country’s second African swine fever outbreak occurred last month, the agriculture ministry said on Sunday.

The local government in Zhengzhou plans to officially lift the blockade on Oct. 1, but it must take measures to prevent recurrence of the highly contagious disease, the ministry said in a statement.

On Saturday, the ministry said it had removed restrictions in Shenyang, Liaoning province, where the first such outbreak was reported.

The world’s top pork producer has seen a steady stream of outbreaks since the first case was reported in early August.

Authorities have banned the transport of live hogs and pig products from regions bordering provinces where African swine fever has been reported, shut live markets and banned the use of feed derived from pig blood in an attempt to contain the disease.

Reporting by Kevin Yao; Editing by Richard Borsuk

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China removes restrictions where first African swine fever outbreak found

BEIJING (Reuters) – China has removed restrictions on an area in Shenyang, Liaoning province, where the nation’s first African swine fever outbreak was found last month, the agriculture ministry said on Saturday.

The infected area had been sealed off for six weeks after the highly contagious disease was reported there, the statement said.

There have been no new cases in the infected area, it added.

The world’s top pork producer has seen a steady stream of outbreaks since the first case was reported in early August.

Authorities have banned the transport of live hogs and pig products from regions bordering provinces where African swine fever has been reported, shut live markets and banned the use of feed derived from pig blood in an attempt to contain the disease.

Reporting by Hallie Gu and Josephine Mason; Editing by Mark Potter

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China reports H5N6 bird flu case on poultry farm in Guizhou province

BEIJING (Reuters) – China has reported a case of H5N6 avian bird flu on a poultry farm in southwestern Guizhou province, the nation’s agriculture ministry said on Saturday.

Local authorities culled 32,352 birds at the farm following the outbreak, according to a statement published on the website of the Ministry of Agriculture and Rural Affairs.

Reporting by Hallie Gu and Josephine Mason; Editing by Mark Potter

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Childhood secondhand smoke exposure tied to arthritis in adulthood

(Reuters Health) – Women exposed to secondhand smoke as children may be more likely to develop rheumatoid arthritis than people who didn’t breathe cigarette fumes growing up, a French study suggests.

Rheumatoid arthritis is an immune system disorder that causes debilitating swelling and pain in the joints. It’s less common than osteoarthritis, which happens when cartilage on the ends of bones wears down over time.

Smoking has long been linked to an increased risk of rheumatoid arthritis. But the new study suggests that secondhand smoke may also increase this risk.

Altogether, the study involved 71,248 women, including 371 who eventually developed rheumatoid arthritis. Current and former smokers who were not exposed to smoke as children were 38 percent more likely to develop rheumatoid arthritis than those who had never smoked. When current or former smokers were also exposed to secondhand smoke during childhood, they were 67 percent more likely to develop rheumatoid arthritis.

Among women who never smoked at all, exposure to secondhand smoke during childhood was associated with a 43 percent higher risk of developing rheumatoid arthritis compared with no secondhand smoke exposure growing up, although this difference was not statistically significant, meaning it was too small to rule out the possibility it was due to chance.

“In adults exposed to active smoking, the mechanism leading to rheumatoid arthritis onset is quite well understood,” said study co-author Dr. Marie-Christine Boutron-Ruault of the INSERM epidemiology and population health research center at Paris-Sud University in Villejuif, France.

Rheumatoid arthritis happens when the immune system that’s supposed to attack invaders like bacteria and viruses mistakenly attacks healthy cells. In adult smokers, changes in some proteins in the air cells of the lungs are thought to trigger this autoimmune activity, leading to rheumatoid arthritis, Boutron-Ruault said by email.

“It is highly likely that the phenomenon described in adult smokers occurs similarly in passively exposed children,” Boutron-Ruault added. “The triggering of autoimmunity in children might not be restricted to rheumatoid arthritis risk, and could possibly increase the risk of other autoimmune diseases.”

For the study, researchers examined survey data collected every three years, starting in the 1980s. Participants were 50 years old on average when they joined the study and about 54 percent of them had never smoked. About 14 percent were current smokers and 32 percent were former smokers.

The study wasn’t designed to prove whether or how secondhand smoke exposure during childhood might cause rheumatoid arthritis. Researchers also relied on women to report their smoking history and tobacco exposure during childhood, and self-reported information may not be as reliable as data from lab tests or medical records.

It’s also possible that secondhand smoke exposure during childhood increases the risk of rheumatoid arthritis just because it leads to more cumulative years of smoke exposure among people who smoke as adults, said Jill Norris, a researcher at the Colorado School of Public Health in Aurora.

While it’s not clear that avoiding smoke exposure during childhood can prevent rheumatoid arthritis in the future, there are many other good reasons not to expose kids to secondhand smoke, Norris, who wasn’t involved in the study, said by email.

“The general advice is that if a parent is going to smoke, they should not smoke in the home or in the car when their children are riding with them,” Norris said. “It is also important to ask any caregivers (nannies, relatives, etc) to do the same.”

SOURCE: bit.ly/2NHHJFm Rheumatology, online August 14, 2018.

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FDA halts imports from China’s Huahai after heart drug recall

SHANGHAI/NEW YORK (Reuters) – The U.S. Food and Drug Administration said on Friday it will no longer allow imports of drug ingredients or medicines made with ingredients produced by China’s Zhejiang Huahai Pharmaceuticals, after a recall of one of its drugs that contained a probable carcinogen.

FILE PHOTO: A view shows the U.S. Food and Drug Administration (FDA) headquarters in Silver Spring, Maryland August 14, 2012. Picture taken August 14, 2012. REUTERS/Jason Reed/File Photo

The Chinese bulk manufacturer of the high blood pressure treatment valsartan recalled the product from consumers in the United States in July because an impurity linked to cancer had been detected.

European authorities also said on Friday that they had found that Huahai did not comply with good manufacturing practices and that the company’s factory in Linhai, China, was no longer authorized to produce valsartan.

The European Medicines Agency said it was considering further action for other substances produced at the site.

The FDA said it was halting imports after it found major manufacturing process issues during its inspection of Huahai’s plant. The agency said the freeze on the imports would remain in place until the Chinese manufacturer determines how the impurities were introduced and improves its quality control systems.

Huahai’s English-language website suggests that the company makes more than 50 drugs, active pharmaceutical ingredients and intermediate products used in a variety of medicines to treat high blood pressure, depression and other conditions. It was not immediately clear how many were exported to the United States.

FILE PHOTO: U.S. Food and Drug Commissioner Scott Gottlieb attends an interview at Reuters headquarters in New York City, U.S., October 10, 2017. REUTERS/Eduardo Munoz/File Photo

FDA spokesman Jeremy Kahn said the agency had no concern about additional drug shortages due to the import ban at this time.

In a heavily-redacted inspection report to Huahai posted on the FDA’s website on Sept. 20, the health regulator pointed out a range of serious problems, including with the company’s quality management system, how it evaluates the impact of changes to its manufacturing process, and its handling of products with impurities.

In all, the Aug. 3 report listed 11 problems based on an inspection by two investigators sent to the factory for about two weeks in late July and early August.

Huahai’s public relations department could not be reached for comment.

The company, which is based in eastern China’s Zhejiang province and makes bulk ingredients for drugmakers, told customers in late June that it had found N-nitrosodimethylamine, or NDMA, which is classified as a probable human carcinogen, in its valsartan.

In September, after a global recall of valsartan products, the FDA and the European Medicines Agency announced that another known carcinogen called N-Nitrosodiethylamine, or NDEA, had also been found in valsartan made by Huahai and by India’s Torrent Pharmaceuticals, another manufacturer.

The FDA often redacts product-specific information in inspection reports, and the report released last week did not mention valsartan, NDMA or NDEA. However, the FDA wrote that Huahai’s “change control system to evaluate all changes that may affect the production and control of intermediates or Active Pharmaceutical Ingredients (APIs) is not adequate.”

Regulators and industry consultants say the NDMA was most likely introduced when Huahai changed the way it made valsartan in 2012. The FDA’s Kahn told Reuters in an email in August that the change in valsartan manufacturing that was believed to have led to the introduction of NDMA occurred around December 2013.

Reporting by Michael Erman in New York and Alexandra Harney in Shanghai, Additional reporting by Ben Hirschler in London and the Shanghai newsroom; editing by Chizu Nomiyama and Bill Berkrot

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What’s the Dollar Cost of Caring for a Loved One With Alzheimer’s?

News Picture: What's the Dollar Cost of Caring for a Loved One With Alzheimer's?By Steven Reinberg
HealthDay Reporter

Latest Alzheimer’s News

WEDNESDAY, Sept. 26, 2018 (HealthDay News) — Almost $200,000 over the course of two years. That is the cost of the care that a family member typically gives a loved one with Alzheimer’s disease.

That’s according to a new study that attempted to put a price tag on the burden of the day-to-day help that millions of folks with the memory-robbing disease need for shopping, cooking, cleaning, eating, taking medicine and looking after their well-being.

“The costs of caregiving depend on the needs of the [patient], and median costs range between $144,000 to over $200,000 over the course of two years,” said study author Norma Coe. She’s an associate professor of medical ethics and health policy at the University of Pennsylvania in Philadelphia.

More than 35 million Americans provided care to someone aged 50 or older in 2015, but the real costs of this so-called informal care aren’t really clear, the researchers said.

When these costs are usually taken into account, researchers multiply the hours of care by the wage that paid home health care workers would earn. But this falls short of the real-world costs of care given by family members.

That’s because family caregivers often give up activities such as leisure time or jobs, the study authors explained.

These costs totaled at least $277 billion in 2011, Coe said. “As baby boomers age and policies shift long-term care towards the community, these costs will likely rise substantially,” she added.

For this study, Coe and her colleagues looked at the costs to daughters between the ages of 40 and 70 who would be taking care of their mother in the near future.

The researchers specifically studied different scenarios of the mothers’ health. These included mothers who were healthy, those who had difficulty with daily activities, those with memory loss, those who had difficulty with daily activities and had memory loss, and moms who needed constant care.

For mothers who had memory loss but no difficulty preforming daily activities the researchers estimated the cost over two years at $163,000.

The costs of caring for someone who had difficulty with daily activities was $167,000 over the same period.

When memory problems were combined with difficulty with daily activities, however, the costs of caregiving actually dropped to $144,000, the researchers found.

But when a mother cannot be left alone for more than one hour, costs increased to more than $200,000, Coe’s team reported.

The average cost of a semi-private bed in a nursing home in 2017 was $85,775, which suggests that two years of nursing home care would cost $171,550, the study authors explained.

“As we move away from institutional care, it is important to remember the costs to the family and informal caregivers,” Coe said. “Caregiving involves significant costs, in line with the costs of a nursing home.”

Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association, said Alzheimer’s disease is exceptionally demanding for caregivers and the scope of the problem is likely to get worse.

“Our best estimate is that there are 5 million Americans with Alzheimer’s and lots of caregivers for those folks,” Fargo said. “And when you project out to 2050, that’s going to increase to 13.8 million.”

People caring for someone with Alzheimer’s need training and time off from giving care, he said. Support can include adult daycare and workplace policies that can help caregivers continue to work while they’re providing care, Fargo said.

Giving care can go on for many years, and caregiving can become more demanding over time, he said.

People need to start thinking about the cost of caring for someone with Alzheimer’s and how to manage before it happens, Fargo said. They should consider long-term care insurance and options for care in their community, he suggested.

“People should look at these options before it’s too late,” he said. “No matter how you slice it or dice it, it’s very expensive.”

In the study, Coe and colleagues used data from the Health and Retirement Study, conducted by the University of Michigan.

The report was published online recently in the Journal of the American Geriatrics Society.

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SOURCES: Norma Coe, Ph.D., associate professor, medical ethics and health policy, University of Pennsylvania, Philadelphia; Keith Fargo, Ph.D., director of scientific programs and outreach, Alzheimer’s Association; Sept. 17, 2018, Journal of the American Geriatrics Society, online


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Fall risk may increase after heart attack patients leave hospital

(Reuters Health) – Three in five patients hospitalized for heart attacks or other serious cardiovascular problems have at least a moderate risk of falling after they go home, and this risk is tied to higher odds of premature death, a U.S. study suggests.

Researchers examined data on 2,456 people hospitalized for heart attacks, heart failure, or a heart rhythm disorder known as atrial fibrillation. Within one year of the hospitalizations, 362 patients died, for a one-year mortality rate of 15 percent.

Based on assessments of overall health and functioning, 22 percent of the patients had a high risk of falls and another 38 percent had a moderate risk. Compared with people at low risk for falls, individuals with moderate risk were 51 percent more likely to die within one year, and patients at high risk for falls were more than three times as likely to die.

“Increased risk of falling can be conceptualized as a proxy for frailty, or increased vulnerability to stressors,” said senior study author Dr. Veronique Roger of the Mayo Clinic College of Medicine in Rochester, Minnesota.

“The most important factor in reducing the risk of falls is to preserve muscle mass and equilibrium,” Roger said by email. “This can be achieved by regular physical activity in a safe environment.”

Patients in the study were 71 years old on average and many of them had high blood pressure, elevated cholesterol, a history of smoking and were overweight or obese.

Overall, 18 percent had at least one repeat hospitalization within 30 days of discharge. Within one year, 1,177 patients had a total of 2,325 readmissions.

Most of the repeat hospitalizations and deaths in the study were not related to cardiovascular conditions, researchers report in Circulation: Cardiovascular Quality Outcomes. Overall, 59 percent of deaths, 57 percent of readmissions within 30 days and 65 percent of repeat hospitalizations within one year were not for heart problems.

People with a higher risk of falling were much older – 81 years old, on average, compared with 71 years old for individuals with a moderate risk of falling and 65 for people with a low risk.

The study wasn’t a controlled experiment designed to prove whether or how cardiovascular problems might contribute to falls or how an elevated risk of falling might make people more likely to have serious complications or deaths from cardiovascular disease.

Even so, the results underscore the importance of maintaining mobility after a heart attack or hospitalization for other serious heart problems, said Dr. Sharon Straus, director of the division of geriatric medicine at the University of Toronto.

“When patients are admitted to the hospital with cardiac events, they are usually put to bed and older adults can become deconditioned in a hospital as a result – which means they get weak and lose muscle strength,” Straus, who wasn’t involved in the study, said by email.

“And, if they had cardiac problems prior to admission, this may have impacted their mobility and functional status prior to admission,” Straus added. “We need to assess functional status of older adults and optimize their mobility, which will impact fall risk.”

Poor mobility and functioning not only increases the risk of falls, it can also lead to more severe injuries, said Saija Karinkanta of the UKK Institute for Health Promotion Research in Tampere, Finland. Falls that result in hip fractures or head injuries may lead to more fatalities, Karinkanta, who wasn’t involved in the study, said by email.

“A good way for everybody to avoid falls is to improve mobility by training gait, lower limb muscle strength, and balance,” Karinkanta said. “Starting exercise with an expert like a physical therapist, is the safest way for cardiovascular disease patients.”

SOURCE: bit.ly/2NruuZp Circulation: Cardiovascular Quality Outcomes, online August 3, 2018.

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U.S. judge dismisses Teva lawsuits against Lilly on migraine drug

BOSTON (Reuters) – A federal judge on Thursday dismissed a pair of patent infringement lawsuits by Teva Pharmaceutical Industries Ltd that sought to block Eli Lilly and Co from bringing its migraine drug Emgality to market in the United States.

FILE PHOTO: The logo and ticker for Eli Lilly and Co. are displayed on a screen on the floor of the New York Stock Exchange (NYSE) in New York, U.S., May 18, 2018. REUTERS/Brendan McDermid/File Photo

U.S. District Judge Allison Burroughs in Boston said the lawsuits failed to raise an actual controversy that would allow her to rule in advance of the U.S. Food and Drug Administration’s approving Lilly’s product on whether it infringed Teva’s patents.

The FDA approved Teva’s own migraine drug, Ajovy, on Sept. 14.

Representatives for the companies did not immediately respond to requests for comment.

Reporting by Nate Raymond in Boston; Editing by Leslie Adler

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Breastfeeding might benefit babies by reducing stress

(Reuters Health) – Mothers have long been told that “breast is best” when it comes to feeding newborn babies, but a small experiment suggests at least some of the benefits may have nothing to do with the milk itself.

Pediatricians recommend that mothers exclusively breastfeed infants until they’re at least 6 months old because it can bolster babies’ immune systems and reduce their risk of ear and respiratory infections, sudden infant death syndrome, allergies, obesity and diabetes. While there’s plenty of research documenting these benefits, less is known about exactly how breastfeeding might cause these improvements in babies’ health, researchers note in Pediatrics.

For the current experiment, researchers studied levels of the stress hormone cortisol in 21 babies who were exclusively breastfed for their first five months and another 21 babies who were not. When infants were exposed to a stressful situation – their mothers ignoring them – researchers found less evidence of a “fight-or-flight” stress response in the babies who had nursed.

“Nurturing behavior controls a specific gene that regulates the infant’s physiological response to stress,” said lead study author Dr. Barry Lester, director of the Center for the Study of Children at Risk at the Warren Alpert Medical School of Brown University in Providence, Rhode Island.

The experiment was inspired by previous studies in rats, which linked maternal care or nurturing behavior by mothers to changes in the rat pups’ physiologic response to stress, Lester said.

“More nurturing behavior makes it easier for rat pups to relax after stress,” Lester noted. “Not only that, these changes are permanent – they last into adulthood and there is evidence that these changes can be passed on to the next generation.”

While the current study in humans is small, and doesn’t span multiple generations, the results do suggest that nurturing behavior by human mothers can make their babies less reactive to stress.

To assess this, researchers tested babies’ saliva for changes along the DNA strand that might be tied to their response to stress and for evidence of cortisol production in response to stress.

“Cortisol is part of the body’s ‘flight or fight’ reaction, the body’s major response to stress, and too much or too little cortisol can be harmful and is related to a wide range of mental and physical health disorders in children and adults,” Lester said.

The experiment wasn’t designed to prove whether or how the infants’ stress responses were influenced by breastfeeding, nor does it determine if their stress responses may have been influenced directly by breast milk, by the act of holding babies to the breast, or by other nurturing behaviors.

But the results suggest that nurturing behavior by mothers like cuddling and holding infants might benefit newborns even when they drink formula from bottles, said Dr. Robert Wright, author of an accompanying editorial and a professor of pediatrics and environmental medicine at the Icahn School of Medicine at Mount Sinai in New York City.

“Much of the work in breast feeding looks at the nutritional aspect of it. That is – breast milk has different constituents than formula – with respect to essential fatty acids, vitamins and minerals,” Wright said by email. “That might play a role in the results, but this study I think is likely addressing something else about breast feeding.”

Bonding during breastfeeding may be a different experience than the nurturing babies get from bottle feedings, Wright said.

It’s possible that the increased maternal bonding that occurs with breastfeeding may alter babies’ stress response and make infants more resilient when they have stressful experiences, Wright added.

“So the beneficial impact of breast feeding may be at least two-fold: better nutrition and more resilient emotional development,” Wright said. “Emotional resilience is likely due to the maternal bonding that breast feeding induces and not from the nutritional benefits which are real, but not driving this particular finding.”

SOURCE: bit.ly/2xVdNPA and bit.ly/2QZ6pex Pediatrics, online September 26, 2018.

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Heavy drinkers and teetotalers alike may have heightened dementia risk

(Reuters Health) – Middle-aged adults who avoid alcohol altogether, and those who consume the equivalent of seven glasses of wine or more a week are both more likely than light drinkers to develop dementia in their later years, a long-term study suggests.

With heavy drinking, the increased risk of dementia may be directly caused by nutritional deficits and the toxic effects of alcohol in the brain, and indirectly caused by disorders that are common among heavy drinkers like diabetes, high blood pressure and stroke, said lead study author Severine Sabia of Paris-Saclay University in France and University College London in the UK.

Abstinence is also associated with a higher likelihood of having heart disease or diabetes, which explains part of the increased dementia risk for teetotalers, the study found. Abstinence may also be tied to dementia in people who stopped drinking due to misuse or addiction, Sabia said by email.

“Findings on abstainers should not motivate people who do not drink to start drinking alcohol due to the adverse effects of alcohol on mortality, cirrhosis of the liver and cancer,” Sabia noted. “In addition, given the detrimental effect of alcohol for several health outcomes, people who drink in an excessive manner should be encouraged to reduce their alcohol consumption.”

Globally, an estimated 3.3 million people a year die as a result of alcohol misuse, accounting for about 6 percent of all deaths, according to the World Health Organization (WHO).

For the study, Sabia’s team used a standard UK measurement, units of alcohol, where each unit contains 8 grams of pure alcohol. So a medium glass of wine (175 ml or about 6 oz) would contain about 2 units of alcohol, half an imperial pint (9.6 fluid ounces) of beer would contain 1 to 3 units of alcohol, depending on its strength, and a standard measure (25 ml or about 1 oz) of spirits would equal one unit of alcohol.

The researchers followed 9,087 adults participating in a long-term study in the UK for an average of 23 years with five assessments of alcohol consumption between 1985 and 2004. They also looked at data from questionnaires to assess problem drinking and at medical records of alcohol-related diseases between 1991 and 2017.

During the study, 397 people developed dementia, at an average age of 76, the study team reports in The BMJ.

Compared with people who had 1 to 14 units of alcohol a week in middle age, teetotalers were 47 percent more likely to develop dementia.

Among people having more than 14 units a week, each 7-unit increase in alcohol consumption was associated with a 17 percent increase in the risk of dementia.

The study also looked at how any shifts in drinking patterns after middle age might impact the risk of dementia, and they found the lowest risk among people who consistently consumed 1 to 14 units of alcohol a week.

Compared to these consistent light-to-moderate drinkers, people who maintained long-term abstinence were 74 percent more likely to develop dementia. Those who kept up a heavy drinking habit were 40 percent more likely to develop dementia. When people cut back after middle age, they were 55 percent more likely than the consistent occasional or moderate drinkers to develop dementia.

The study wasn’t designed to prove whether or how drinking habits might impact the development of dementia.

However, the results suggest that guidelines in many countries that set the bar for problem drinking at much higher than 14 units a week may need to be revised to account for the potential dementia risk, the study authors conclude.

“The study provides important support for another downside to heavy alcohol use,” said Dr. Rebecca Gottesman of Johns Hopkins University School of Medicine in Baltimore.

“Regarding the other end of the spectrum, several other studies have suggested that very modest alcohol consumption may be protective from cardiovascular disease, and this study further supports that idea, but I don’t think we understand enough about how it might do so,” Gottesman, who wasn’t involved in the study, said by email.

SOURCE: bit.ly/2MI2zUy The BMJ, online August 1, 2018.

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