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Diabetics with related eye damage have increased falling risk

(Reuters Health) – People with diabetes and related eye damage known as retinopathy are more likely to fall than diabetics who have not developed vision problems, a study in Singapore suggests.

Diabetic retinopathy happens when high blood sugar levels damage blood vessels in the retina leading to blurred vision, difficulty with color distinction and blindness. The condition can cause blood vessels to swell, leak, close and block blood flow, or grow abnormally on the retina.

In the study of almost 9,500 middle aged and older adults, those with moderate diabetic retinopathy were almost twice as likely as individuals with diabetes but no eye damage to experience falls during the study. Mild retinopathy, meanwhile, was associated with 81 percent greater odds of falling, researchers report in JAMA Ophthalmology.

Compared to people without diabetes, patients with diabetic retinopathy were 31 percent more likely to fall, the study also found.

“Alterations in blood glucose levels in diabetes cause changes in retinal blood vessels which swell, bleed or leak fluid into the back of the eye,” said senior study author Ecosse Lamoureux of the Singapore Eye Research Institute and the Duke-NUS Medical School in Singapore.

“Diabetic retinopathy causes not only vision loss, but also reduction in the components of the aging visual function system, such as contrast sensitivity, stereo acuity, and color perception, which can result in poor postural stability and a greater capacity to bump into objects, leading to a greater risk of falling,” Lamoureux said by email.

Approximately one in three elderly people living in the community fall each year, and roughly one in 10 falls result in traumatic injuries or fractures, the researchers note. Falls can also result in reduced social interaction, less physical activity and declines in mobility and independence.

While previous research has linked diabetes to an increased risk of falls, many of these studies have focused on diabetic nerve damage that can reduce sensation in the feet and make it harder for people to sense where they’re stepping. Some research has also tied falls to vision loss, but it’s been less clear how mild or moderate diabetic retinopathy might impact the odds of falling.

For the current study, researchers examined data on 9,481 Singapore residents of Malaysian, Chinese or Indian ethnicity who were taking part in a larger study. All had answered questionnaires that asked about any falls experienced in the prior year.

About half of participants were 59 years old or older and 6,612 of them, or 70 percent, didn’t have diabetes.

Among the 2,869 participants with diabetes, 857, or 30 percent, had diabetic retinopathy in at least one eye. Researchers ranked retinopathy cases as minimal, mild, moderate or vision threatening.

Overall, about 13 percent of people without diabetes had a history of falls, as did about 16 percent of diabetics who had no retinopathy.

Among patients with diabetic retinopathy, 14 percent of people with minimal cases had a history of falling, compared with 26 percent of mild cases, 27 percent of moderate cases and 20 percent of vision-threatening cases.

These results suggest that management of diabetes should include education on how to prevent falls, particularly for people with early stage diabetic retinopathy, the authors conclude.

The study wasn’t a controlled experiment designed to prove whether or how diabetic retinopathy directly causes falls.

Another limitation is that researchers relied on study participants to accurately recall and report on any previous falls, which might make the results less reliable than objective measurements of falls such as fall diaries, the authors note.

Even so, the findings underscore that, like other health problems that lead to vision loss, diabetic retinopathy can indeed make falls more likely, said Dr. Francesc Formiga, a researcher at Bellvitge Universitari Hospital in Barcelona who wasn’t involved in the study.

“Diabetic retinopathy often does not offer any early warnings signs,” Formiga said by email. “Therefore, it is important to perform a complete ocular exam at least once a year.”

SOURCE: bit.ly/2jjNXgL JAMA Ophthalmology, online November 16, 2017.

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Venezuelans suffer as malaria outbreak spreads in drug-short nation

CIUDAD GUAYANA, Venezuela (Reuters) – On a recent morning in Venezuela’s southern jungle state of Bolivar, Amanda Santamaria, her two sons, one daughter-in-law, and a granddaughter lined up in front of a shabby community health center in the hope of receiving treatment for malaria.

People gather outside a health center as they wait to get treatment for malaria, in San Felix, Venezuela November 3, 2017. REUTERS/William Urdaneta

All five of them are afflicted by the mosquito-borne disease, which is rapidly spreading through Venezuela as an economic meltdown strips the country of medicine and doctors.

“We don’t know if this is a curse, but the entire area is awash in malaria,” said Santamaria, 56, suffering her second bout of the illness in the last three months and relying on palliative herbal teas because she has not found regular drugs.

The family was waiting with some 500 others under the scorching sun in the hope of receiving treatment.

Unsanitary conditions in Bolivar are thought to have led to a recent flare-up in malaria, a life-threatening disease that had been largely brought under control in Venezuela in the 1990s.

The outbreak was likely initially caused by illegal mining. The miners cut down rainforests and often work in pools of stagnant water, which favors the spread of mosquitoes and malaria.

In a rare release of data earlier this year, government statistics showed there were 240,613 cases of malaria last year, up 76 percent compared with 2015, with most in Bolivar.

The former Health Minister was fired after the data was published, and it has not been updated since.

The government did not respond to a request for comment on the malaria outbreak.

On a visit to Bolivar in early November, the vice minister for health, Moira Tovar, said the outbreak in the state would be controlled within three months. She said that 32 people had died during just one week in late October.

A doctor assists people looking for treatment for malaria at a health center in San Felix, Venezuela November 3, 2017. Picture taken November 3, 2017. REUTERS/William Urdaneta

“What are (these deaths) due to? They’re due to people who are infected and who know about the illness but don’t visit health centers on time. Instead they wait for the condition to worsen before seeking attention,” she said.


The government has not given an overall death toll.

Slideshow (5 Images)

But health activists and doctor groups estimate that around 200 people have died from malaria over the last year nationwide, and fear the illness is starting to afflict populated urban centers.

“The mines have a high proportion of young adults, but their kids and pregnant partners are in the cities, and that’s a bigger problem: the entire family is at risk of falling ill,” said doctor and former health minister Jose Felix Oletta, a government critic.

The regional arm of the World Health Organization last month announced the arrival of over one million anti-malarial pills, which doctors deem insufficient. Patients must visit their nearest health center up to four times to complete treatment in what officials say is an attempt to avoid feeding the black market for drugs.

Still, in Venezuela’s shortages-hit economy, there is a black market for nearly everything.

“In the mines they offer you pills for a gram and a half of gold,” said Yudith Sanchez, a 28 year-old cook in an illegal gold mine.

Others have turned to brewing bark from cinchona trees, which was popular during the colonial era for its antiseptic properties.

“We’re going to die because there is no treatment,” said homemaker Yaritza Figuera, 29. Suffering from malaria, her nine year-old son sat on the floor in a health center because the waiting room was full.

Reporting by Maria Ramirez, Writing by Eyanir Chinea and Alexandra Ulmer, Editing by Rosalba O’Brien

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Border without doctors? South Koreans urge more funding for trauma care after defector drama

SEOUL (Reuters) – A defector’s treatment for critical injuries suffered during a dramatic dash from North Korea has highlighted a shortage of South Korean trauma doctors and again underscored Seoul’s lack of preparedness in the event of hostilities with Pyongyang.

The defector, identified only by his family name of Oh, was shot at least four times by his former comrades during his daring escape into South Korea last week.

American military helicopters flew the wounded soldier not to one of the many hospitals in Seoul, closer to the border, but to the Ajou University trauma center an hour south of the capital.

The center, and its lead surgeon John Cook-Jong Lee, have been thrust into the spotlight amid a push for more trauma facilities and specialist doctors in a country still technically at war and where preventable trauma death rates are already amongst the highest in the OECD.

An official at South Korea’s Ministry of Health said more than 30 percent of people who suffered fatal trauma injuries last year could have survived if they had access to proper, timely treatment. That’s far higher than the 10 to 15 percent in places such as the United States and Japan.

“Although 133 surgeons are currently entitled to perform trauma surgery, I highly doubt that all of them can actually perform,” said Park Chan-yong, general affairs manager of the Korean Society of Traumatology. “Many of them just gained the rights, but never had practiced this kind of surgery.”

By Friday, attention sparked by the defector’s case had prompted nearly 200,000 South Koreans to join a petition asking the presidential Blue House to boost funding for Lee’s trauma center, one of just nine in the country.


During increased tensions this year with heavily armed North Korea, Seoul has faced criticism over a lack of preparation for major emergencies, with many bomb shelters, for example, laying forgotten and unstocked with food or water.

The government has launched programs to raise awareness, but public emergency drills often fail to attract much response.

Despite the apparent need for specialists, Lee said he has faced “ignorance,” including from some doctors who complained he was showing off with new techniques, since returning from training in the United States in 2003.

“I had to explain whenever I met new doctors here, what a trauma surgeon was. Every day,” he said.

Often, trauma medicine is not seen as attractive or lucrative as other fields, said Park.

“Residents and medical students avoid coming to traumatology, because there is no hope and no dream.”

FILE PHOTO: Lee Cook-jong, a South Korean surgeon who operated the defected North Korean soldier with gunshots, speaks during an interview with Reuters at a hospital in Suwon, South Korea, November 23, 2017. REUTERS/Yang Hee-kyong/File Photo

The South Korean government says it recognizes the problem, and in 2014 set a goal of lowering its rate of preventable trauma fatalities to levels closer to those of other OECD countries by 2020.

But with a shortage of funding, only half of a planned 17 regional trauma centers have been built so far, a health ministry official said.

Germany, for example, has less than twice the population of South Korea, but 10 times as many operational trauma centers.


South Korea’s strict gun control laws also mean there are far fewer gunshot wounds like those suffered by the defector. Between January 2012 and August 2017, 31 people were killed and 51 wounded by guns, according to the police.

In comparison, in the United States, where Lee trained, more than 33,000 people die from gunshot wounds every year, according to annual averages of government data.

However, the kinds of industrial accidents and car crashes commonly seen in South Korea can cause equally bad injuries, Lee said.

“In South Korea, roughly speaking, more than 90 percent of trauma victims are brought to the hospital in less than an hour,” Lee said. “However, frequently, they are put in emergency rooms for a while, sometime for hours, to get proper care.”

Lee has made a name for himself and the Ajou trauma center, in part by cultivating a close relationship with the American and South Korean militaries, making it an obvious choice for the defector’s treatment.

Lee said his fascination with the American medical evacuation crews and the techniques he learned in the United States have led him to push for a series of new additions at the trauma center, including a recently completed roof-top helipad with flashing neon messages in English for American pilots.

U.S. military air crews, however, have yet to obtain Pentagon permission to use the new helipad, Lee said.

The arrival of the North Korean defector has brought Lee a new round of criticism for appearing to seek attention, including from one lawmaker, a charge he says is unfounded.

But it has also highlighted the need for more funding for his center and more trauma facilities in South Korea.

“To those who get only 10, 20 minutes of sleep while working to save emergency room patients, to those who only get to go home once a week or not even that – we should not be criticizing them but rather, discuss how to resolve problems within the system,” the petition submitted to the Blue House said.

Additional reporting by Christine Kim and Haejin Choi; Editing by Lincoln Feast

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Avatars can help schizophrenia patients control threatening voices

LONDON, Nov 23 (Reuters) – – An experimental therapy for people with schizophrenia that brings them face to face with a computer avatar representing the tormenting voices in their heads has proved promising in early stage trials.

Scientists who conducted a randomized controlled trial comparing the avatar therapy to a form of supportive counseling found that after 12 weeks, the avatars were more effective at reducing auditory hallucinations, or voices inside the head.

More research is needed to investigate the approach in other healthcare settings, so the therapy is not yet widely available.

But if further trials prove successful, experts said, avatar therapy could “radically change” treatment approaches for millions of psychosis sufferers across the world.

Schizophrenia is a psychiatric disorder that affects around one in 100 people worldwide. Its most common symptoms are delusions and auditory hallucinations.

These voices are typically insulting, tormenting and threatening, causing much distress and anxiety in patients. Drug treatments can reduce symptoms in most patients, but around one in four continue to be affected by hallucinations.

This study, published in The Lancet Psychiatry journal, involved 150 patients in Britain who had had schizophrenia for around 20 years and who had been experiencing persistent and distressing auditory hallucinations for more than a year.

Of these, 75 were given avatar therapy and 75 had a form of supportive counseling. They all continued with their usual antipsychotic medication throughout the trial.

The avatar therapy was given in 50 minute sessions delivered once a week over six weeks. Before starting treatment, patients worked with a therapist to create a computerized simulation, or avatar, of the voice they most wanted to quieten – including what the voice said, how it sounded, and how it might look.

Tom Craig, a professor who led the study at Britain’s Maudsley Hospital and King’s College London’s Institute of Psychiatry, Psychology & Neuroscience, said the results provided “early evidence that avatar therapy rapidly improves auditory hallucinations”.

“So far, these improvements appear to last for up to six months for these patients,” he said. “However … more research is needed to optimize the way the treatment is delivered and demonstrate that it is effective in other … settings.”

Ann Mills-Duggan, a expert from the Wellcome Trust health charity which funded the trial, said the results were very encouraging: “If the researchers can show that this therapy can be delivered effectively by different therapists in different locations, this approach could radically change how millions of psychosis sufferers are treated across the world.”

Reporting by Kate Kelland Editing by Jeremy Gaunt

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Pregnant and breastfeeding women travelers underprotected from disease

(Reuters Health) – Pregnant and breastfeeding women who travel to places with high risk of diseases like malaria and yellow fever are less likely than other women travelers to be protected by vaccines and drugs, recent U.S. research suggests.

Lack of information about the safety of some preventive medications and vaccines during pregnancy and breastfeeding may be one reason some patients and doctors avoid them, the study team writes in Obstetrics & Gynecology.

“(There is) a tremendous lack of research in pregnant and breastfeeding women especially related to medication usage and vaccinations,” said Diane L. Spatz of the University of Pennsylvania School of Nursing in Philadelphia, who wasn’t involved in the study.

The research team, Stefan H. F. Hagmann of the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park and his colleagues, analyzed patient information from Global TravEpiNet, a consortium of U.S. travel clinics that collects data on clinic users planning international travel.

Travel clinics typically specialize in providing advice, immunizations and preventive medications that are needed or recommended for specific foreign destinations.

Other sources, such as the U.S. Centers for Disease Control and Prevention (CDC), also post travel advisories about disease outbreaks and recommend destination-specific measures.

Pregnant women are more susceptible to certain infectious diseases, including malaria and influenza, and in some cases experience more severe symptoms, the study team writes.

Hagmann’s team compared data on 170 pregnant women,139 breastfeeding women and 1,545 non-pregnant/lactating women who received pre-travel care at 24 Global TravEpiNet member clinics between 2009 and 2014.

They found that most pregnant and breastfeeding women intended to travel to tropical destinations where mosquito-borne illnesses such as malaria, dengue, or yellow fever are normally present; and up to one third of pregnant travelers traveled to areas in the Americas, which, since the study was conducted, have experienced chikungunya and Zika virus epidemics.

Most pregnant and breastfeeding women seen during northern hemisphere flu season had been vaccinated against the flu or received a shot during their clinic visit.

Typhoid and hepatitis A were the most commonly administered vaccines to the pregnant and breastfeeding women during clinic visits. Still, these women were about half as likely as nonpregnant, nonbreastfeeding women to get these vaccines during their visit.

Among travelers to countries where malaria is present year-round, about 50 percent of pregnant or breastfeeding women received preventive medications, compared to 73 percent of non-pregnant, non-breastfeeding women.

Despite risky travel destinations, in some cases vaccines and drugs were declined by travelers, or withheld by healthcare practitioners, the study authors note, likely due to limited research on the risks of using certain vaccines, such as those for typhoid and yellow fever, as well as antimicrobial medications, during pregnancy.

“I was not really surprised by any of the study’s findings,” Spatz said. “I am not confident that most women seek specific travel health care before traveling and their primary health care providers may or may not speak to them about these issues.”

Overall, pregnant travelers underused vaccines for typhoid, a potentially life-threatening and increasingly multidrug resistant illness, and hepatitis A, a common infection in poorer countries. Pregnant and breastfeeding travelers also received fewer provisional prescriptions than the comparison group for standby antibiotics to treat diarrhea.

Hagmann did not respond to a request for comments, but the study team acknowledges limitations in its report, notably that the women seen in Global TravEpiNet clinics may not represent all pregnant or breastfeeding women travelers.

There must be increased awareness among providers and travelers of the fact that travel advisories exist, said Dr. Diana E. Ramos of the Keck School of Medicine of the University of Southern California in Los Angeles, who wasn’t involved in the study.

“We need to encourage the public to proactively do research on their risk, and if pregnant, the risk to their fetus, if they travel,” Ramos said in an email.

SOURCE: bit.ly/2zIoEg0 Obstetrics & Gynecology, online November 3, 2017.

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Pre-surgery cognitive screen can flag elderly complications risk

(Reuters Health) – Screening older surgery patients for cognitive impairment can catch undiagnosed problems that raise risk for complications, researchers say.

Among 211 patients over age 65 having elective orthopedic surgeries such as hip or knee replacement, pre-operative screening found that about one quarter had likely cognitive impairment such as undiagnosed dementia.

These patients were at increased risk of post-operative delirium, longer hospital stays and not being discharged to home, the study team reports in Anesthesiology.

“We really don’t do enough in the preoperative space to look at impairment and frailty in geriatric patients. We may test mobility, but we need more subtle measures of the brain,” said lead author Dr. Deborah Culley of Harvard Medical School in Boston.

About one of every three surgical procedures in the U.S. involves a patient aged 65 or older, the study authors write. Although most surgical centers assess an older patient’s physical condition before surgery, some are now beginning to test brain function as well, especially in patients without a history of dementia, they note.

“When you talk with a patient before surgery, you can notice an impairment in this stressful environment,” Culley told Reuters Health in a phone interview. “It’s essentially a cognitive stress test.”

Culley and her colleagues screened patients at Brigham and Women’s Hospital in Boston who were scheduled for an elective hip or knee replacement. They used the Mini-Cog test, which involves a three-item memory recall test. The research team defined patients with low scores of 2 or less on the test’s five-point scale as likely cognitively impaired.

Once the surgery was over, they looked at in-hospital medical complications, hospital length-of-stay and discharge information, such as discharge to a place other than the patient’s home, as well as 30-day emergency room visits and death.

Fifty of the 211 patients, or 24 percent, scored 2 or lower on the pre-surgery test. These patients were more likely than those with higher scores to be older, have a lower education level and poorer physical functioning. These patients were also 37 percent more likely to have a longer hospital stay after the surgery, four times as likely to be discharged to a place other than their home and four and a half times as likely to develop post-operative delirium and confusion, the study found.

“What’s novel about this is we’re looking at the brain now. Since the 1970s we’ve looked at organs such as the heart, lungs and kidney to understand surgery risk, but now we’re looking at the most vital organ,” said Dr. Thomas Robinson of the University of Colorado Anschutz Medical Campus in Denver, who wasn’t involved in the study.

“Anesthesiologists are particularly paying attention because they give so much sedation in the operating room,” he told Reuters Health by phone. “Medications have been closely associated with mental function after surgery.”

Future studies should look at different cognitive screening instruments, as well as different types of surgeries and different risk factors that make delirium worse in older patients, the study authors write. Culley said she is now following spine surgery patients, who tend to have higher rates of delirium after surgery.

“I’d like to find an online cognitive screening tool that patients can take before they get to surgery so we have an idea of what’s going on before we’ve scheduled appointments,” she added.

Robinson, who is studying postsurgical pain and ways to block it to reduce delirium, said he sees future studies measuring brain markers for cognitive impairment and identifying high-risk patients sooner to create personalized postoperative recovery instructions.

“It sounds simple, but hospitals still don’t do this well,” he said. “We have guidelines for physical therapy after operation, but we should also implement cognitive therapy.”

“With this screening tool, a daughter of an older patient with some cognitive impairment, for example, could know the likelihood of her parent going home and the higher risk of developing delirium,” Culley said. “A change could be as simple as making sure she’s in the recovery room after surgery to reorient the patient better.”

If patients or family members believe impaired cognition or dementia could be a factor in surgery, they should ask their doctors and surgeons for a plan that will improve postsurgical care, according to the American Society of Anesthesiologists Brain Health Initiative.

SOURCE: bit.ly/2A0sC5S Anesthesiology, online November 1, 2017.

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Germany reports outbreak of mild bird flu on farm: OIE

PARIS (Reuters) – Germany has reported an outbreak of low pathogenic H5N2 bird flu on a farm in the Lower Saxony region in the north of the country, the Paris-based World Organisation for Animal Health (OIE) said on Thursday.

The disease was detected on a farm in Rotenburg where 43 ducks and geese showed mild clinical signs, the OIE said, citing a report from the German authorities.

In a separate case in Lower Saxony last month, the highly pathogenic H5N8 strain of bird flu was found in a wild duck.

Reporting by Gus Trompiz; Editing by Bate Felix

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Fatty liver linked to a shrinking brain

(Reuters Health) – Fatty liver disease that is not related to excess drinking is associated with greater brain shrinkage than normally happens with age, researchers say.

The reduced brain volume linked to non-alcoholic fatty liver disease (NAFLD) is equivalent to an extra 4.2 years of aging for people in their 60s and early 70s, researchers report in JAMA Neurology, or an extra 7.3 years of aging for people under age 60.

”Liver fat may have a direct association with brain aging,” lead author Galit Weinstein from School of Public Health at the University of Haifa in Israel said in an email.

Recent studies have shown that people with NAFLD have impaired thinking and decreased brain activity compared with others, the authors note. To figure out why, they used MRI scans to measure the overall brain volume of 766 middle-aged men and women and used abdominal CT scans to examine their livers. About 18 percent of the participants had fatty liver disease.

The researchers accounted for risk factors for brain aging, including blood fat levels, heart disease, diabetes, smoking, alcohol consumption, overweight, lack of exercise and menopausal status.

People with NAFLD had more harmful risk factors than people without fatty liver disease, but even after adjusting for these risks, NAFLD was associated with significantly smaller total brain size. Even in people 75 and older, it was the equivalent of an extra 1.5 years of brain aging compared to peers without fatty liver disease.

NAFLD didn’t seem to be associated with other signs of brain injury or stroke, the researchers note.

NAFLD can be improved by lifestyle modifications, such as healthy eating and increased physical activity, Weinstein told Reuters Health.

“This is extremely important when it comes to brain health, because currently there is usually no cure for neurodegenerative diseases, such as Alzheimer’s disease. But it still remains to show in other studies that improvement in fatty liver disease is associated with lower risk of such brain diseases,” she said.

“Fatty liver can be prevented by conducting appropriate lifestyle and diet,” Weinstein added. “In turn, if one retains a healthy liver, his/her risk for other diseases, such as diabetes and heart diseases, is also reduced. In this study, we show that keeping a healthy liver may also be linked with a healthier brain.”

SOURCE: bit.ly/2jM3dXt JAMA Neurology, online November 20, 2017.

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Unhealthy lifestyle may cause half of diverticulitis cases

(Reuters Health) – Men’s risk for a painful inflammation of colon walls may be drastically reduced if they follow an overall healthy lifestyle, a recent U.S. study suggests.

Diverticulitis is an inflammation of small pouches in the walls of the colon and it has become one of the most common reasons for gastrointestinal hospital admission in the United States, costing an estimated $ 2 billion each year, researchers write in The American Journal of Gastroenterology.

“Diverticulitis is actually a very common disorder and it’s really become apparent that we need to think of ways to prevent diverticulitis given that it affects so many people,” said the study’s senior author Dr. Andrew Chan, a researcher at Massachusetts General Hospital and Harvard Medical School in Boston.

“To date, there really has been very little research done in this area, so we were interested in really understanding what places people at risk for diverticulitis, and what among (those risk factors) are modifiable so that we can try to advise people to do what they can to either prevent their first episode of diverticulitis or if they’ve had diverticulitis, potentially prevent a future episode,” Chan told Reuters Health by email.

The researchers analyzed data on more than 51,000 men who were between the ages of 40 and 75 in 1986 when they began participating in the Health Professionals Follow Up Study. More than 90 percent of the men were followed through the end of December 2012.

At the start of the study, participants answered questions about their lifestyles and medical histories, then every two years after that, they answered follow-up questionnaires.

In its analysis, the study team focused on five lifestyle risk factors associated with diverticulitis: total red meat intake, dietary fiber intake, vigorous physical activity, smoking and body mass index (BMI, a measure of weight relative to height). For each of these risk factors, the researchers divided men into 5 groups from highest to lowest.

Using these categories, the researchers defined a low-risk lifestyle as average red meat intake of less than 52 grams (about 2 ounces) per 2,000 daily calories or less than four 5-ounce servings weekly, dietary fiber intake of at least 23 grams (0.8 ounce) per day, two or more hours of vigorous physical activity per week, normal BMI and being a never-smoker.

During the follow-up years, there were a total 907 new cases of diverticulitis, and researchers found an inverse relationship between the number of low-risk lifestyle factors an individual had and his odds of getting diverticulitis.

Compared with men who met none of the low-risk lifestyle criteria, those with one low-risk lifestyle factor were 29 percent less likely to have diverticulitis, while men with two low-risk factors were 34 percent less likely to have the condition. Men with three or four low-risk factors had about half the risk of diverticulitis and men with all five low-risk factors had about 70 percent lower risk.

If everyone followed an overall low-risk lifestyle, the study team writes, 50 percent of diverticulitis cases could be averted.

There is definitely an association between one’s diet and lifestyle and their risk of developing diverticulitis, Chan said.

“In particular, we know that there are components of people’s diet, as well as how active someone is and whether they smoke that could be predictive of diverticulitis.”

Doing whatever is possible to minimize the potential risk factors for diverticulitis would be a general first step for people who are concerned about developing the problem, Chan said.

The current study only included men, but women also face this problem, and some studies suggest that diverticulitis is actually more common among women, he noted.

“So, there is certainly a strong need for us to do more research in risk factors among women. One of the things that we hope to do in the future is to actually look more closely at risk factors in women because there might be some differences that would be important to determine.”

SOURCE: go.nature.com/2A4o3IB The American Journal of Gastroenterology, online November 7, 2017.

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Bayer pharmaceuticals head says there's no pipeline problem

LEVERKUSEN, Germany (Reuters) – Bayer is seeking to defend its pharmaceuticals business that will be diluted in importance by the takeover of Monsanto and faces a threat to revenues in 2024 when the blockbuster heart drug Xarelto loses its patent.

The firm’s planned takeover of U.S. seeds group Monsanto for $ 63.5 billion has prompted concerns among some of the German group’s shareholders, who say the drugs unit may not get the funding needed to deliver an adequate drugs pipeline.

The healthcare unit, covering pharmaceuticals and consumer health, now accounts for about two-thirds of Bayer’s sales. In the combined group, its revenues will be roughly on par with those of seeds and pesticides.

Bayer’s head of pharmaceuticals, fresh from a cancer drug deal worth up to $ 1.55 billion last week, said Bayer’s drugs pipeline would keep the unit buoyant and could cope with losing Xarelto’s patent protection in 2024.

“We have increased our R&D spend by more than a billion euros since I arrived and we have now more than 50 projects in clinical development. We don’t have a pipeline problem,” said Bayer’s pharmaceuticals head, Dieter Weinand, who joined in 2014 after roles at Pfizer and Bristol-Myers Squibb.

Bayer, ranked No. 16 among global pharma companies by revenue, secured rights to co-develop two promising cancer treatments with Loxo Oncology last week.[nL8N1NK748]

But Weinand dampened expectations of further major deals.

“Buying additional pipeline would require additional funding for an even larger pipeline, which I don’t actually need at the moment,” he told Reuters, adding Bayer could seek smaller bolt-on takeovers or licensing deals.

Fund managers such as Jupiter Asset Management and Union Investment said last year Bayer risked neglecting its pharmaceuticals business by pursuing Monsanto. [nL8N1BI1YY]

Two fund managers, who hold Bayer shares but asked not to be named, said on Wednesday the Xarelto patent expiration was a challenge.

“I would like to see more moves to strengthen the pipeline, but the question is, will they be able to finance them?” said one, saying there was “a danger that the pharma unit will be underinvested”.

Weinand said Bayer had proved it could maintain revenues, citing the firm’s track record in seeing late-stage drugs to market maturity, such as Xarelto, which generates almost 20 percent of sales for Bayer’s prescription drugs unit.

Some analysts are less confident about prospects.

“We’re probably unlikely to see the same level of success going forward,” said Berenberg analyst Alistair Campbell, describing Bayer’s drugs pipeline as “still relatively empty.”

Bayer said last year its six most promising drugs under development would have combined peak annual sales of at least 6 billion euros, a figure analysts called optimistic. [nL8N1BX1YL]

But progress has been mixed. Lymphoma drug copanlisip has won U.S. approval but anetumab ravtansine, a drug for asbestos-linked cancer type mesothelioma, failed the Phase II trial. [nFWN1KC0NQ]

Weinand said there was still hope in the anetumab results as about a third of trial participants showed durable tumor shrinkage, and said Bayer aimed to find diagnostic tools to predict which patients were hopeful candidates before treatment.

The recent Compass trial showed Xarelto could treat people with severe atherosclerosis, potentially adding revenues now but leaving an even steeper drop when the patent ends. [nL5N1NC1GK]

Analysts on average see annual peak sales of between $ 5.5 billion and more than $ 6 billion before Xarelto goes off patent.

Weinand said Bayer was being “prudent” with a projection of more than 5 billion euros in sales in Xarelto’s best year, up from 2.9 billion euros in 2016.

“What has changed that outlook is the really unique data on Compass that increased the revenue base at time of loss of exclusivity. Now the gap has increased, but that’s a great problem to have,” he said.

Additional reporting by Simon Jessop in London; Editing by Edmund Blair

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