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Posts by hailong01

Docs should screen kids' daily physical activity as a 'vital sign' for health

(Reuters Health) – More than half of U.S. children may not be getting the recommended amount of physical activity and doctors can help by making exercise one of the “vital signs” assessed in routine health checks, researchers say.

“We need to start asking children and their parents questions about physical activity on a routine basis. Exercise guidelines for families should be specific, and education about what counts as ‘moderate to vigorous physical activity’ should be included,” said the lead author of a study presented November 3 at the American Academy of Pediatrics annual conference in Orlando, Florida.

Julie Young, an athletic trainer at Nationwide Children’s Hospital Division of Sports Medicine in Dublin, Ohio and her colleagues reviewed electronic medical records of 7,822 children ages 5 to 18 in their hospital’s pediatric sports medicine clinic, who were asked about their physical activity by their doctors. One of the researchers’ goals was to understand whether kids were meeting physical activity guidelines.

They found that 5 percent of the children were completely inactive, registering zero minutes of exercise per week. Nearly 50 percent were not active enough to meet guidelines, exercising less than the recommended 420 minutes per week. The remaining 45 percent of patients were sufficiently active, exercising more than 420 minutes per week.

Further questioning revealed that even the group getting sufficient physical activity still fell short in one sense. Only about 12 percent of the active kids, or 5.2 percent of the total study group, got the recommended 60 minutes of activity each day, while the rest were getting longer bouts of activity on fewer days per week. Exercising longer and for fewer days puts these kids at risk for burnout or repetitive injury, the researchers said in a statement.

Other notable findings include further evidence that boys exercise more than girls. The boys in this study averaged 61 minutes more exercise per week than girls, and as a result were 39 percent more likely to meet the guidelines.

The difference in activity levels between boys and girls was mostly a result of the number of days per week kids participated in physical activity, Young noted.

Another insight from the study is that physical activity appears to increase with age, with younger kids reporting the least exercise.

“While pediatricians often ask if children are physically active, many don’t ask specifically if children are meeting current exercise guidelines of 60 minutes on daily physical activity,” Young told Reuters Health in an email.

“There are vast benefits of physical activity,” she added. “Children who are physically active are more likely to be active as adults – lifelong (physical activity) can decrease risks of common diseases.”

“To me, the important finding is that older kids are more active,” said Dr. William Phillips, who wasn’t involved in the study. “This may be due to the greater availability of school related sports programs which may be less costly than many of the ‘private’ sports leagues/programs that younger children participate in,” said Phillips, a pediatric orthopedic surgeon at Texas Children’s Hospital in Houston.

“Defining a child’s activity level as a ‘vital sign’ is a great way to emphasize its importance,” Phillips said.

SOURCE: bit.ly/2zNyX2Z American Academy of Pediatrics National Conference & Exhibition, November 3, 2018.

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Helicopter emergency medical services uneven across Europe

(Reuters Health) – The availability of helicopter ambulance service varies widely across different European countries, a recent study suggests.

This inconsistency could lead to greater inequity in access to healthcare, the authors write in the Emergency Medicine Journal.

“These services are variable in so many ways in terms of geographic coverage and population coverage,” said senior study author Dr. Jan Jansen of the University of Alabama at Birmingham’s Center for Injury Sciences.

“This isn’t a problem confined to Europe,” he told Reuters Health in a phone interview. “We’re starting to look at the details here in the U.S. to understand the whole story of emergency medical services coverage.”

Jansen, along with colleagues in the UK, surveyed the primary helicopter emergency medical services (HEMS) in the 28 countries of the European Union as well as Iceland, Lichtenstein, Norway and Switzerland. They gathered data on the types of helicopters used by services in each country, the locations of HEMS bases, night flying capacity and medical staffing.

With the data, they calculated HEMS provision in each country by the number of helicopters per 1 million people, per 1,000 square kilometers and by gross domestic product. They also looked at HEMS availability during the day versus night services.

The research team found that the smallest and least prosperous countries had no dedicated HEMS services at all, including Croatia, Estonia, Latvia, Lithuania and Malta. In contrast, Luxembourg had the highest number of helicopters by area and population, both for day and night services.

Overall, 24 countries had HEMS, ranging from one dedicated helicopter in Ireland to 89 in Germany.

Alpine countries tended to have high daytime HEMS coverage, and Scandinavian countries had good nighttime coverage. Most helicopters carried a doctor, although some had only paramedics or nurses, and for nine countries the researchers couldn’t obtain this data.

“In addition, the aircrafts can vary a great deal in terms of how they’re equipped and when they fly,” Jansen said. “Night flying is very common in some countries, but it is also associated with greater risks.”

Importantly, the research team was surprised that the variability didn’t seem be tied to specific factors such as GDP, population, land area or the funding source for the emergency helicopter service. Future studies may be able to tease out these details if more information is provided by HEMS groups, although it can be tough to create consistent definitions of services across the different countries, Jansen noted.

“Uniform reporting would make it easier to compare responses and systems,” said Anne Siri Johnsen of Norsk Luftambulanse, which provides air ambulance services in Norway and Denmark. Johnsen has studied HEMS responses during major disasters to better understand how the resource is used and to improve procedures.

“If there were more uniform reporting, it would be easier to see the advantages and disadvantages of different systems,” said Johnsen, who wasn’t involved in the current study.

For instance, countries with different geographies need different services. Responses and equipment in flat countries such as Denmark differ from those with mountains such as Norway, she said. Using HEMS at night, although riskier, is important in northern European countries where winter daytime hours are short and it’s dark for most of the day.

“Researchers need to see how the entire EMS system is built,” she said in an email. “In Norway, the search and rescue helicopters play a role in patient treatment and need to be accounted for.”

Future research will also focus on HEMS outside of the European Union, Jansen said. In the United States, for example, he and others are interested in looking at variations and disparities in southern states, particularly in rural areas.

“Access isn’t always straightforward, and it often comes down to where the aircraft is based,” he said. “That’s often neglected when looking at area coverage or population coverage, and we need to look into that.”

SOURCE: bit.ly/2PLb2en Emergency Medicine Journal, online October 23, 2018.

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Concussions in World Cup soccer often missed or ignored

(Reuters Health) – Concussions are still often missed or ignored in World Cup soccer games despite rule changes designed to sideline players with head injuries, a new study suggests.

After reviewing videos from this year’s World Cup games, researchers concluded that more than 63 percent of players who showed two or more concussion symptoms did not get evaluated by a licensed healthcare professional – which was slightly more than in the 2014 tournament – according to the results in JAMA Neurology.

“We examined adherence to updated and improved concussion protocols which were established after the 2014 World Cup,” said the study’s lead author, Dr. Ajay Premkumar, of the Hospital for Special Surgery in New York City. “It appears that in spite of these changes, concussion management on the field in regard to rates and length of medical evaluation for potential concussion during this summer’s tournament were grossly unchanged from 2014.”

That’s a problem for several reasons, Premkumar said by email. First, there’s the danger to players if concussions are not caught in a timely manner. “Playing with a concussion increases the athlete’s risk for more severe traumatic brain injury or ‘Second Impact Syndrome,’ which can have devastating complications,” he said. “There is also significant literature which supports increased symptom severity and a longer recovery time for those who continue to play after a concussion compared to those removed from gameplay.”

Second impact syndrome, which almost exclusively affects younger athletes, occurs when a brain that has already been injured and hasn’t yet healed is concussed a second time. That second concussion can result in disability or even death.

A second concern from Premkumar and colleagues is that younger players watching World Cup soccer – known outside the U.S. as football – may get the wrong message about concussions. “Concussion assessment protocols and their implementation by large sporting governing bodies may have widespread effects on officiating, coaching and play of countless athletes at all levels and ages around the world,” Premkumar said.

To see whether rules added in 2014 by the medical committee of the Federation Internationale de Football Association (FIFA) had improved concussion identification and management, Premkumar and colleagues reviewed video footage from all 64 games of the 2018 World Cup.

“A head collision event was defined as any event in which a player stopped playing immediately after head contact,” Premkumar explained. “Observable signs and symptoms of potential concussion were disorientation, clutching of head, motor incoordination/balance disequilibrium, slow to get up (characterized by more than five seconds in the recumbent position after contact), impact seizure, blank or vacant look, visible facial injury, loss of consciousness or unresponsiveness.”

Of the 90 players deemed to have two or more signs of concussion, 33 were evaluated by healthcare personnel for anywhere from 13 to 253 seconds, 39 were evaluated by the referee for less than a minute and 18 were evaluated by another player or not at all.

Among six players initially removed from a game after a head collision, three were ultimately allowed to keep playing after evaluation.

Overall, FIFA’s concussion protocol was not followed in at least 63.3 percent of the head collisions that resulted in two or more signs of concussion. That compares with 56.7 percent in the 2014 tournament.

“Overall this study highlights the need to recognize and remove players with suspected head injury from the field or pitch for clinical evaluation and possible removal from the game,” said Micky Collins, clinical and executive director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center and Anthony Kontos, research director of the UPMC program.

The new findings warrant changes in the way FIFA deals with head injuries, said the Pittsburgh experts, who were not involved in the study.

“The implementation of a temporary head injury substitution – that would not count against a team’s normal allotted number of substitutions per game and allow for an off-pitch evaluation – along with head injury spotters and video review for potential head injuries could improve current recognition and removal of potentially injured players,” the two noted.

“We know that it is important to identify and remove players with suspected concussions, because if they continue to play following a concussion they have an increased risk for another head injury or orthopedic injury, experience reduced performance levels, and will substantially lengthen their recovery time.”

SOURCE: bit.ly/2QADqNr JAMA Neurology, online November 12, 2018.

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Fish oil cuts heart attack risk, vitamin D lowers odds of cancer death

(Reuters Health) – A large U.S. study designed to gauge the health benefits of vitamin D and fish oil supplements concludes that the omega-3 oil can dramatically reduce the odds of a heart attack while vitamin D’s benefits seem to come from lowering the risk of death from cancer.

Neither vitamin D nor fish oil lowered the odds of stroke or of getting cancer in the first place in the trial, whose participants did not know whether they were taking the real supplements or a dummy pill.

The heart attack rate in fish oil recipients was 28 percent lower than among those who got the dummy pill, or placebo, and it was 77 percent lower among African American participants – although the lead author of the study told Reuters Health that this dramatic drop in risk among black participants needs to be confirmed.

For people taking vitamin D who developed cancer, the death rate from cancer was 25 percent lower, possibly because the vitamin “may affect the biology of the tumor so it’s less likely to spread and become metastatic,” said lead author Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital in Boston.

“Therefore, you may see a reduction in cancer death but not see a reduction in the first diagnosis, which might take a much longer trial,” she said in a telephone interview. “If you’re talking about prevention of cancer, that may take treatment for well over a decade.”

It took a few years of vitamin D use for the reduction in cancer deaths to become clear.

The results were reported Saturday at the American Heart Association Scientific Sessions meeting in Chicago and online in the New England Journal of Medicine.

Both supplements have a reputation for being beneficial based on animal tests and observational studies involving large diverse populations or ethnic groups. But large studies that directly test the benefits of vitamin D and fish oil in supplement form have given inconsistent results.

The new study, known as VITAL, is the first large test of both in the general population. Most previous research has focused on volunteers with an elevated risk of heart attack, stroke and/or cancer.

The researchers gave 2,000 international units of vitamin D per day, 1 gram of marine omega-3 fatty acids, or placebo supplements to 25,871 volunteers aged 50 or older. None had a history of cancer, heart attack or stroke. At least half stayed in the study for more than five years.

Based on the new findings, “people already taking vitamin D or fish oil will feel there’s no reason to stop,” Manson said.

Others may want to wait “because we are going to be publishing findings for other endpoints – diabetes, cognitive function, depression, autoimmune diseases – over the next six months,” she said. “These findings may help people decide if the benefits are likely to outweigh the risks for them.”

And people should not be taking higher doses than what was used in the study, Manson noted. With megadoses, “the risk may outweigh the benefit. With high doses of vitamin D there can be a risk of high blood calcium levels developing. Some have suggested a higher risk of cardiovascular disease, falls and even fractures.”

By other measures, neither supplement seemed useful.

Among fish oil recipients, the rates of death from any cause, death from cancer and death from heart disease in general were not significantly different than for people not taking fish oil supplements.

In addition, the collective odds of having a heart attack, stroke or death from any cardiovascular cause were essentially the same whether people were taking fish oil or placebo.

It was only when researchers teased out individual elements of heart disease – such as the rate of heart attack, the rate of fatal heart attack and the need for angioplasty – that a benefit stood out.

Even a little fish oil seemed to help. Volunteers who consumed less fish than average – less than one-and-a-half servings per week – and received the real omega-3 supplements saw a 40 percent reduction in the risk of a heart attack.

In the vitamin D study, which was “the largest high-dose randomized trial of vitamin D in the world,” according to Manson, supplement and non-supplement recipients had similar rates of heart attack, stroke, death from heart attack and cancers of the breast, prostate, or the colon and rectum.

It was only the odds of dying from cancer that were reduced.

SOURCES: bit.ly/2PP7RT2, bit.ly/2FcO2Ba and bit.ly/2OCRoN3 The New England Journal of Medicine, online November 10, 2018.

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Nestle raises stake in food allergy drug developer Aimmune

A Nestle logo is pictured on a coffee factory in Orbe, Switzerland May 31, 2018. REUTERS/Denis Balibouse

(Reuters) – The health science unit of Nestle SA would pay $ 98 million to increase its stake in Aimmune Therapeutics Inc, the drug developer for food allergies said on Monday.

The latest investment raises Nestle’s ownership of Aimmune to about 19 percent. The companies also extended their two-year strategic collaboration to develop therapies for food allergy by another two years, Aimmune said.

Reporting by Tamara Mathias in Bengaluru

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WHO uncovers big national variations in antibiotics consumption

GENEVA (Reuters) – Antibiotics are used far more in some countries than in others, a survey by the World Health Organization showed on Monday, suggesting that urgent action was needed to slash unnecessary consumption of the medicines.

Pharmaceutical tablets and capsules are arranged on a table in a photo illustration shot September 18, 2013. REUTERS/Srdjan Zivulovic/Illustration/File Photo

The “WHO Report on Surveillance of Antibiotic Consumption” looked at antibiotic use in 65 countries and found the Netherlands used 9.78 defined daily doses (DDD) per 1,000 people, while Britain used twice as much and Turkey almost twice as much again, at 38.18 DDD per 1,000 inhabitants.

Iran’s consumption was similar to Turkey’s, while Mongolia’s was the highest of all among the countries surveyed, at 64.41 DDD per 1,000 people.

Collecting the data is vital for tackling antimicrobial resistance, the extremely worrying trend of bacterial infections becoming immune to antibiotics, the report said.

“Findings from this report confirm the need to take urgent action, such as enforcing prescription-only policies, to reduce unnecessary use of antibiotics,” Suzanne Hill, director of the Department of Essential Medicines and Health Products at the WHO, said in a statement.

The lowest score was for Burundi, with just 4.44 DDD/1,000 people, which the WHO said reflected limited data. A low score could also suggest that consumption is too low, leaving the population at risk of infectious diseases.

The survey also looked at which types of antibiotics were being used, and showed some countries – Italy, Spain and Japan – were relatively heavy users of the most precious drugs that the WHO says need to be kept in reserve.

The WHO introduced a classification system last year, saying penicillin-type drugs were recommended as the first line of defense, and that other drugs, on the “reserve” list, were a last resort and only for use when absolutely necessary.

In Italy, 2.0 percent of daily antibiotics consumption was in the “reserve” category, four times the rate in Germany and more than six times that of Britain, where only 0.3 percent of drugs were those earmarked for use in the last resort.

Japan’s overall consumption of antibiotics, at 14.19 DDD per 1,000 inhabitants, was about half that of South Korea, but 1.1 percent of Japanese consumption was in the “reserve” category, far more than 0.2 percent in South Korea, the report showed.

The United States, China and India, were not among the countries in the survey.

Reporting by Tom Miles; Editing by Peter Cooney

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African swine fever found in animal feed raises China's contagion risk

BEIJING (Reuters) – Major Chinese animal feed maker Tangrenshen Group reported on Sunday that feed produced by one of its units had been contaminated with African swine fever, raising fears of its spread further across the country.

FILE PHOTO – Piglets are seen by a sow at a pig farm in Zhoukou, Henan province, China June 3, 2018. Picture taken June 3, 2018. REUTERS/Stringer

This is the first reported contamination of feed supplies in China and increases the concerns for pig farmers trying to avoid the disease. It also raises the economic pressure on feed manufacturers already struggling with low margins and slowing demand.

In a statement to the Shenzhen Stock Exchange, the company said the disease was found in feed samples provided by its 51 percent-owned subsidiary, Bili Meiyingwei Nutrition Feedstuff.

The discovery occurred during inspections after an outbreak of African swine fever on a farm in Qingyang county located in the eastern Chinese province of Anhui.

Tangrenshen said the origin of the disease remained unclear and the matter was still under investigation.

China has struggled to stem the rapid spread of African swine fever, which has now reached most of the country’s pig-farming regions. The country produces almost 700 million pigs a year, or about half of the world’s total.

Beijing earlier said many of the cases in Anhui were caused by feeding kitchen waste to pigs that was not properly processed to kill the virus. However, many industry experts have long suspected feed supplies could be contaminated with the disease.

African swine fever, which cannot be cured and has no vaccine, is known to survive for weeks in feed ingredients like soymeal.

“I think buyers will be quite worried about purchasing feed from similar subsidiaries,” said Pan Chenjun, senior analyst at Rabobank.

She added that major pig producers are already worried about how to verify the safety of their feed supplies.

“If there’s any contamination, it’s very difficult to control.”

Tangrenshen relies on animal feed for most of its income, reporting 2017 feed sales of 12.6 billion yuan ($ 1.81 billion). Like many Chinese feed companies, it has recently moved into pig farming and processing.

It acquired Bili Meiyingwei, also known as Shenzhen PREMIXINVE Nutrition Co. Ltd, from Belgian feed maker INVE Belgium in 2016.

The company said the impact on its operations would be “relatively small,” with Bili Meiyingwei accounting for only 2.27 percent of the group’s net profit in the first nine months of 2018.

The group’s shares fell as much as 6.6 percent on Monday to 4.56 yuan ($ 0.66).

African swine fever has ravaged small pig farms in Anhui but authorities had recently lifted restrictions in four cities there after no new cases were reported for six weeks.

That run ended at the weekend when a fresh outbreak was discovered on a farm with 8,339 pigs in Qingyang county in the south of Anhui.

Reporting by Dominique Patton, Tom Daly and Liangping Gao; Editing by Nick Macfie and Christian Schmollinger

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China proposes new laws on vaccine management

FILE PHOTO: A nurse prepares a vaccine to be given to a child in a hospital in Beijing, China, April 13, 2016. REUTERS/Damir Sagolj

SHANGHAI (Reuters) – China has proposed new draft laws on vaccine management which seek to tighten the supervision and management of how vaccines enter the country’s market and will also require stricter management of their production, research and distribution.

The State Administration for Market Regulation, which published the draft laws on its website late on Sunday, is soliciting public views up to Nov. 25.

The document also proposes severe punishment for those who participate in illegal practices, such as the fabrication of data, or who impede investigations.

China has pledged to reform and improve vaccine production and management after recent scandals which involved a firm that fabricated production and inspection records and sold ineffective vaccines.

Reporting by Brenda Goh; Editing by Paul Tait

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China reports new African swine fever outbreak in Anhui province

FILE PHOTO – Piglets are seen by a sow at a pig farm in Zhoukou, Henan province, China June 3, 2018. Picture taken June 3, 2018. REUTERS/Stringer

BEIJING (Reuters) – China has confirmed a new outbreak of African swine fever in the eastern province of Anhui.

China, home to the world’s largest hog herd, has reported more than 50 cases of the highly contagious disease, including in Anhui, since the first detected outbreak in early August.

The fever was found on a farm with 8,339 pigs in Qingyang county in the south of Anhui, infecting 96 of the animals and killing 47 of them, the Ministry of Agriculture and Rural Affairs said in a statement.

Transportation of pigs in and out of the area has been banned, as has movement of pork products outside the area. Last month, the ministry said it would lift African swine fever-related restrictions in four Anhui cities hit by previous outbreaks.

In a statement to the Shenzhen Stock Exchange on Sunday, Tangrenshen Group, a major Chinese pork producer, said the fever was found in feed samples provided by its 51 percent-owned subsidiary, Bili Meiyingwei Nutrition Feedstuff, during inspections in the aftermath of the Qingyang outbreak.

Tangrenshen said the origin of the detected fever remained unclear and the matter was still under investigation. It said the impact on its operations would be “relatively small,” with Bili Meiyingwei accounting for only 2.27 percent of the group’s net profit in the first nine months of 2018.

Reporting by Tom Daly and Liangping Gao; Editing by Nick Macfie

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AstraZeneca's diabetes drug curbs heart failure, kidney risks

(Reuters) – The biggest clinical trial so far to assess a new class of diabetes pills shows that AstraZeneca’s Farxiga can prevent heart failure and cut the risk of kidney problems in a broad range of patients.

FILE PHOTO: A man walks past a sign at an AstraZeneca site in Macclesfield, central England May 19, 2014. REUTERS/Phil Noble/File Photo

However, the medicine – belonging to a class of treatments known as SGLT2 inhibitors – failed to show a statistically significant benefit in preventing heart attacks or strokes, even in patients with established cardiovascular (CV) disease.

Diabetics are at increased risk of heart problems, making the CV profile of drugs to treat the condition an important focus for doctors and patients.

Dr Stephen Wiviott of Brigham and Women’s Hospital in Boston, a senior investigator on the trial, said the findings were important in building up a clearer picture of SGLT2 drugs, which until now have been targeted at patients with established heart disease.

AstraZeneca hopes the new data will help expand the use of Farxiga to a much wider range of patients.

Headline results of the 17,000-patient trial known as Declare were first announced in September but full details were only revealed on Saturday at the American Heart Association annual meeting, and published simultaneously in the New England Journal of Medicine.

These showed Farxiga cut the risk of hospitalisation due to heart failure by 27 percent, while also reducing the risk of kidney disease.

While two smaller studies involving rival SGLT2 drugs focused on people with established heart disease, Wiviott said the fuller picture from Declare showed that the broad prevention of heart failure was the key advantage.

“When you look at all three of the trials, it is pretty clear that the major benefit of this drug class in the cardiovascular realm is related to the reduction of heart failure,” he said in an interview.

For decades, diabetes doctors have focused primarily on lowering blood sugar levels to specific targets. But the susceptibility of diabetics to other problems such as heart failure – where five-year survival rates are only 50 percent – means a more holistic approach is needed, Wiviott believes.

“The message now is that how we lower blood sugar may well be more important than how much,” he said. “We should be choosing drugs that improve the outcomes of patients, not just drugs that are effective in lowering blood sugar.”

Farxiga competes with rival SGLT2 drugs including Eli Lilly and Boehringer Ingelheim’s Jardiance and Johnson & Johnson’s Invokana, which have already shown improved outcomes in patients with established heart problems – known as secondary prevention.

Because AstraZeneca’s study also looked at patients without established CV disease, it potentially opens up a larger market that also covers so-called primary prevention.

The Declare study found no increased risk of amputations, fractures, bladder cancer or gangrene in patients taking Farxiga – issues that have occasionally been noted with SGLT drugs – although there was an increase in genital infections.

Reporting by Ben Hirschler; Editing by Elaine Hardcastle

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