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A study published Friday in the medical journal JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.


This is big news. In plain English, it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself. This is called nosocomial transmission. (Doctors use big words to hide bad things: Nosocomial means caught it in the hospital.)
What’s more, most spread doesn’t appear to have been the result of a so-called “super-spreader event,” in which a single patient transmits infection to many other people. In these events, a procedure such as bronchoscopy — where a doctor inserts a tube into the patient’s lungs — can result in many infections.
This would be a concern, but not nearly as much as what appears to have happened: Many health care workers and many patients got infected in many parts of the hospital. What’s more, since there’s a broad spectrum of infection and only patients who were sick were tested, it’s quite likely that there was even more transmission in the hospital.
So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.

What does this mean?

The virus appears to be quite infectious, health care workers are at especially high risk, and we urgently need more information about just how infectious the virus is. The virus might well be impossible to contain — just as the common cold and influenza can’t be stopped, but the health and societal impacts can be blunted.
China’s extraordinary efforts to stop the spread of the virus, even if unsuccessful, may slow its spread and improve China and the world’s ability to limit the harm the virus causes.

What do we need to do now?

We mustprotect health care workersand others who care for sick people. This is done through ahierarchy of controls: source, engineering, administrative and personal.
Source controlsinclude encouraging patients who are only mildly ill to not expose others; requiring all people who are ill to wear face masks; limiting hospital attendance by visitors who may be infectious; ensuring that ill health care workers don’t work; and minimizing the number — and ensuring the safety of — risky procedures such as bronchoscopy and sputum induction, by performing them only in isolation rooms.
Engineering controlsinclude putting partitions in triage areas, making sure potentially contaminated air is not recirculated and surfaces are cleaned meticulously, and implementing additional precautions for suspected cases.
Administrative controlsinclude asking all patients if they have symptoms and taking their temperatures; requiring those with cough or fever to wear a face mask, and isolating them from others at least by several feet until they are more thoroughly assessed. It’s especially important to recognize all potentially infectious patients quickly and to implement strict infection control procedures and early in all areas of all health care facilities.
Personal controlsincludehand washingandrespiratory hygiene. But mask use by the general public — people without symptoms who are not caring for others — has little or no benefit and potentially great harm if people who need masks can’t get them. Masks will be in short supply. The most important use is for health care workers and those caring for ill patients. In health care settings, safely reusable respiratory protection that can be disinfected can be crucially important. Useful products include personal air-purifying devices and elastomeric respirators. Patients also must be able to cover their mouths to reduce spread of infection.

What more do we need to know?

We arelearning more, but unfortunately, the answer is, a lot.
China has been working hard to keep up with the testing, care and social impacts of the virus. It’s good to see crucial epidemiological information starting to emerge.
We still don’t know the basics about who has been tested, what proportion are positive, how this is changing over time, and what the positivity rates are by location, week of testing and patient age. This is basic information. As just one example: How many children have been tested? Does the fact that there have been few infections in children reflect a lack of testing or a lack of infection?
Among those who test positive, what proportion do and don’t develop severe disease, analyzed by age, sex and underlying medical conditions? What proportion die, analyzed by the same factors?
Among all patients using selected health facilities in Wuhan and elsewhere, what proportion of those with a cough have infection, as confirmed by polymerase chain reaction (PCR) testing ofnasopharyngeal swabsamples? What proportion of those without a cough have novel coronavirus infection confirmed by PCR testing?
The answers to these questions will help determine whether the virus is already circulating widely (i.e., has become endemic and can’t be stopped), what proportion of all with infection have serious illness, and whether the epidemic is peaking or not.

Where is the novel coronavirus going next?

Only time will tell. The next few days and weeks will determine:
If sustained transmission begins in other countries, which unfortunately seems likely.
If it does, whether it can be contained, which unfortunately seems unlikely.
How severe the illness is among those who are infected, which we still don’t know.
Until we know this critical information, we won’t be able to assess how bad thisnovel coronavirusis going to get and which control measures have the best chance of slowing spread.

source: http://sutured.com/new-study-an-eye-opener-on-how-coronavirus-is-spreading-and-how-little-we-know/
more: http://sutured.com/blog/

A study published Friday in the medical journal JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.


This is big news. In plain English, it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself. This is called nosocomial transmission. (Doctors use big words to hide bad things: Nosocomial means caught it in the hospital.)
What’s more, most spread doesn’t appear to have been the result of a so-called “super-spreader event,” in which a single patient transmits infection to many other people. In these events, a procedure such as bronchoscopy — where a doctor inserts a tube into the patient’s lungs — can result in many infections.
This would be a concern, but not nearly as much as what appears to have happened: Many health care workers and many patients got infected in many parts of the hospital. What’s more, since there’s a broad spectrum of infection and only patients who were sick were tested, it’s quite likely that there was even more transmission in the hospital.
So, like SARS and MERS — other coronaviruses — before it, the Wuhan coronavirus is spreading in hospitals.

What does this mean?

The virus appears to be quite infectious, health care workers are at especially high risk, and we urgently need more information about just how infectious the virus is. The virus might well be impossible to contain — just as the common cold and influenza can’t be stopped, but the health and societal impacts can be blunted.
China’s extraordinary efforts to stop the spread of the virus, even if unsuccessful, may slow its spread and improve China and the world’s ability to limit the harm the virus causes.

What do we need to do now?

We mustprotect health care workersand others who care for sick people. This is done through ahierarchy of controls: source, engineering, administrative and personal.
Source controlsinclude encouraging patients who are only mildly ill to not expose others; requiring all people who are ill to wear face masks; limiting hospital attendance by visitors who may be infectious; ensuring that ill health care workers don’t work; and minimizing the number — and ensuring the safety of — risky procedures such as bronchoscopy and sputum induction, by performing them only in isolation rooms.
Engineering controlsinclude putting partitions in triage areas, making sure potentially contaminated air is not recirculated and surfaces are cleaned meticulously, and implementing additional precautions for suspected cases.
Administrative controlsinclude asking all patients if they have symptoms and taking their temperatures; requiring those with cough or fever to wear a face mask, and isolating them from others at least by several feet until they are more thoroughly assessed. It’s especially important to recognize all potentially infectious patients quickly and to implement strict infection control procedures and early in all areas of all health care facilities.
Personal controlsincludehand washingandrespiratory hygiene. But mask use by the general public — people without symptoms who are not caring for others — has little or no benefit and potentially great harm if people who need masks can’t get them. Masks will be in short supply. The most important use is for health care workers and those caring for ill patients. In health care settings, safely reusable respiratory protection that can be disinfected can be crucially important. Useful products include personal air-purifying devices and elastomeric respirators. Patients also must be able to cover their mouths to reduce spread of infection.

What more do we need to know?

We arelearning more, but unfortunately, the answer is, a lot.
China has been working hard to keep up with the testing, care and social impacts of the virus. It’s good to see crucial epidemiological information starting to emerge.
We still don’t know the basics about who has been tested, what proportion are positive, how this is changing over time, and what the positivity rates are by location, week of testing and patient age. This is basic information. As just one example: How many children have been tested? Does the fact that there have been few infections in children reflect a lack of testing or a lack of infection?
Among those who test positive, what proportion do and don’t develop severe disease, analyzed by age, sex and underlying medical conditions? What proportion die, analyzed by the same factors?
Among all patients using selected health facilities in Wuhan and elsewhere, what proportion of those with a cough have infection, as confirmed by polymerase chain reaction (PCR) testing ofnasopharyngeal swabsamples? What proportion of those without a cough have novel coronavirus infection confirmed by PCR testing?
The answers to these questions will help determine whether the virus is already circulating widely (i.e., has become endemic and can’t be stopped), what proportion of all with infection have serious illness, and whether the epidemic is peaking or not.

Where is the novel coronavirus going next?

Only time will tell. The next few days and weeks will determine:
If sustained transmission begins in other countries, which unfortunately seems likely.
If it does, whether it can be contained, which unfortunately seems unlikely.
How severe the illness is among those who are infected, which we still don’t know.
Until we know this critical information, we won’t be able to assess how bad thisnovel coronavirusis going to get and which control measures have the best chance of slowing spread.

source: http://sutured.com/new-study-an-eye-opener-on-how-coronavirus-is-spreading-and-how-little-we-know/
more: http://sutured.com/blog/

The coronavirus death toll exceeded 1,000 on Monday February 10, as health workers around the world continue working hard to contain the flu-like virus since its outbreak in Wuhan, the provincial capital of Hubei.



China's National Health Commission said the total number of deaths on the mainland reached 1,016 by midnight on Monday. 2,478 new cases of infection were also confirmed, bringing the total to 42,638.



Two senior health officials, Zhang Jin who is the party secretary of the health commission for Hubei and Ling Yingzi who is director of the Hubei Provincial Health Commission have also been removed from their posts as confirmed by the state media on Tuesday February 11.



The health workers were sacked after Chinese President, Xi Jinping visited health facilities in Beijing. Hong Kong and the Philippines have each reported one death stemming from the virus.



Recall that the World Health Organization last month, declared coronavirus to be a health emergency of "international concern."



Some countries including the U.S, Philippines, Japan and Australia have already enforced temporary travel restrictions as part of an effort to contain the virus.



20,000 medical personnel in China have been sent been sent to Wuhan and it was further gathered that more health workers are on their way. In a meeting chaired by Premier Li Keqiang on Monday, a group of leaders tasked with beating the virus said it would work to solve raw material and labour shortages and boost supplies of masks and protective clothing.

source: http://sutured.com/coronavirus-death-toll-exceeds-1000/
more: http://suture.com/blog/

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The death toll from a new coronavirus in mainland China crossed 560 on Thursday as experts intensified efforts to find a vaccine for a disease that has shut down Chinese cities and forced thousands more into quarantine around the world.



Here are the latest developments:

**The death toll in mainland China rose to 563 on Thursday, up by a record 70 from the previous day, the National Health Commission said.

**The total number of infections in China rose by 3,694 on Thursday to 28,018.

**Nearly 260 cases have been reported in 31 other countries and regions outside mainland China, according to a Reuters tally based on official statements from the authorities involved.

**There have been two deaths outside mainland China, in Hong Kong and the Philippines.

**Ten more people on a quarantined cruise liner in the port of Yokohama south of Tokyo have tested positive for coronavirus.



**In the United States, another 350 American evacuees from Wuhan were placed under quarantine at two military bases in California.

**In Hong Kong, 3,600 passengers and crew were confined to their ship docked in the city for tests after three people on board had tested positive earlier.

**Asian stocks edged up a day after U.S. S&P 500 hit a record peak following encouraging economic data, while investors keep a wary eye on the impact of the coronavirus outbreak. [MKTS/GLOB]

**The hit to Australia’s economy from a viral epidemic spreading from China is likely to be “significant”, Prime Minister Scott Morrison said.

**Hundreds of experts will meet in Geneva next week to set research and development priorities for coronavirus drugs, diagnostics and vaccines to combat the outbreak, the World Health Organization said.

**Taiwan said it would suspend entry for all Chinese citizens who live in mainland China from Thursday.

**White House economic adviser Larry Kudlow said the epidemic would delay a surge in U.S. exports to China expected from the Phase 1 trade deal set to take effect later this month.

**American Airlines Group and United Airlines said they would suspend flights to and from Hong Kong after this week.

**Several countries including Australia and New Zealand continued to evacuate citizens from Wuhan city.

**Schools in China’s financial hub of Shanghai will remain shut until at least the end of February, authorities said.

source: http://sutured.com/factbox-latest-on-the-coronavirus-spreading-in-china-and-beyond/
more: http://sutured.com

Elderly people with diets rich in flavonols – a group of antioxidants found in fruits, vegetables, and tea – may be less likely to develop Alzheimer’s disease, a new study suggests.



Researchers followed 921 people without dementia for about six years, starting when they 81 years old, on average. During the study, 220 people were diagnosed with probable Alzheimer’s disease.

People who had the most flavonols in their diet were about half as likely to develop Alzheimer’s than those who consumed the least, the study found.

“Eat your fruits and vegetables, particularly dark leafy greens, and drink some tea every now and again,” said lead study author Dr. Thomas Holland of Rush University in Chicago.

“A healthy diet that contains various fruits and vegetables is critical for continued health, especially brain health,” Holland said by email.

Flavonols are a type of flavonoid, phytochemicals found in plant pigments that are known to have antioxidant and anti-inflammatory properties, researchers write in Neurology. While some previous research has linked flavonoids in general to a lower risk of Alzheimer’s disease, less is known about the impact of flavonols specifically.

For the current study, researchers asked participants to complete annual questionnaires detailing how often they ate certain foods. They also did cognitive tests and other assessments each year to determine if participants had developed Alzheimer’s disease.



The study team used the dietary information to tally each person’s total average consumption of four flavonols in particular: kaempferol, which is found in kale, beans, tea, spinach and broccoli; quercetin, in tomatoes, kale, apples and tea; myricetin, also in tea, as well as wine, kale, oranges and tomatoes; and isorhamnetin, in pears, olive oil, wine and tomato sauce.

People in the study who had the lowest total amount of flavonols in their diets consumed an average of about 5.3 milligrams a day, compared with 15.3 milligrams for people with the highest flavonol consumption.

While 15% of people who ate the most flavonol developed Alzheimer’s disease, this rose to 54% among those who consumed the least. This difference remained even after researchers accounted for other risk factors for Alzheimer’s like diabetes, a prior heart attack or stroke, or high blood pressure.

Overall, people with the highest flavonol consumption were 48% less likely than those with the lowest to develop Alzheimer’s disease during the study period.

In addition, when researchers looked at the four different types of flavonols, they found that the highest intakes of either isorhamnetin or myricetin were tied to 38% lower odds of developing Alzheimer’s, while the highest consumption of kaempferol was tied to a 51% lower risk. Quercetin intake, however, didn’t appear tied to Alzheimer’s risk.

The study wasn’t designed to prove whether or how different foods might impact the development of Alzheimer’s disease.

Still, the results add to evidence suggesting that flavonols might be one way people can try to minimize their risk, said Dr. Glen Finney, director of the Geisinger Memory and Cognition Program in Wilkes Barre, Pennsylvania.

“Eating a healthy and diverse diet along with good socialization, physical exercise and keeping mentally active are important for brain health and can make a difference,” Finney, who wasn’t involved in the study, said by email.

“Keeping normal blood sugar levels and blood pressure on the low end of normal range are also important for brain health,” Finney added. “While dementia is an increasing risk as we age, it isn’t inevitable and there are things people can do to reduce their risk.”

source: http://sutured.com/fruits-vegetables-tea-consumption-linked-with-lower-alzheimers-risk/
more: http://sutured.com/

China stepped up measures to contain a virus that has killed 25 people and infected more than 800, suspending public transport in 10 cities, shutting temples over the Lunar New Year, and rushing to construct a hospital to treat the infected.


The week long holiday to welcome in the Year of the Rat began on Friday, raising fears that the infection rate could accelerate as hundreds of millions of people travel to their homes and abroad. The risks persuaded Shanghai Disneyland theme park to close from Saturday until further notice.

The World Health Organisation (WHO) declared the new coronavirus an emergency for China on Thursday, but stopped short of declaring the epidemic of international concern.

While most of the cases and all of the deaths have been in China, the virus has been detected in Thailand, Vietnam, Singapore, Japan, South Korea, Taiwan and the United States. It was highly likely Britain also had cases, a health official said.

At the railway station in the central Chinese city of Wuhan, where the outbreak began last month, the few passengers who took the risk of returning home put on a brave face.

“What choice do I have? It’s Chinese New Year. We have to see our family,” said one arriving traveler named Hu.

As of Thursday, there were 830 confirmed cases and 25 people had died, the National Health Commission.



Most cases have been in Wuhan, where the virus is believed to have originated in a market that traded illegally in wildlife. Preliminary research suggested it crossed to humans from snakes.

Wuhan, a city of 11 million people, and neighboring Huanggang, a city of about 7 million, were in virtual lockdown. Rail stations were largely shut, with few trains stopping, flights suspended and checkpoints on main roads in and out.

About 10 people got off a high-speed train that pulled into Wuhan on Friday afternoon but nobody got on before it resumed its journey.

“I’m not afraid. I trust the government. I need to be with my family,” said one passenger, dragging two large cases out of the station. He declined to give his name.

Wuhan was building a 1,000-bed hospital for the infected and aimed to have it ready by Monday, the official Changjiang Daily reported.

Prefabricated buildings were going up around a holiday complex originally intended for workers, set in gardens by a lake on the outskirts of the city.

Television footage showed about 30 mechanical diggers clawing at brown earth preparing the site.

Wuhan hospitals called for donations of protective equipment such as masks and suits, as supplies ran low.

Several airlines have suspended flights to Wuhan while airports worldwide have stepped up the screening of passengers from China.

CHINA EMERGENCY, NOT GLOBAL
The WHO said on Thursday it was a “bit too early” to consider the outbreak a public health emergency of international concern, a designation requiring countries to step up their response.

“Make no mistake, though, this is an emergency in China,” said WHO chief Tedros Adhanom Ghebreyesus.

The previously unknown virus, which has no cure and can spread through respiratory transmission, has created alarm because there are a number of unknowns. It is too early to know just how dangerous it is and how easily it spreads.

Symptoms include fever, difficulty breathing and coughing. Most of those killed by the virus were elderly, many with pre-existing conditions, the WHO said.

Frustration with the government response appeared to be growing in Wuhan with some fearing it was too late.

“In the very beginning, they didn’t take action and hardly offered any information to the public,” a 30-year-old Wuhan resident, who declined to provide her name, told Reuters.

Three research teams are to start work on vaccines, the Coalition for Epidemic Preparedness Innovations said. The plan is to have at least one in clinical trials by June.

Some experts believe the virus is not as dangerous as the one that caused the 2002-03 outbreak of Severe Acute Respiratory Syndrome, which also began in China and killed nearly 800 people, or the one that caused Middle East Respiratory Syndrome, which has killed more than 700 people since 2012.


TEMPLES, FORBIDDEN CITY, RAIL STATIONS SHUT
Chinese authorities have advised people to avoid crowds and 10 cities in the central province of Hubei, where Wuhan is located, have suspended some transport, the Hubei Daily reported.

In Zhijiang city, all public venues have been shut except hospitals, some markets, petrol stations and drug stores, the paper reported.

Some famous temples have also closed, including Beijing’s Lama Temple, where people make offerings for the new year.

Beijing also canceled two Lunar New Year temple fairs and closed the Forbidden City, its most famous tourist attraction.

Shanghai Disneyland will close from Saturday. The theme park has a 100,000 daily capacity and sold out during last year’s Lunar New Year holiday.

The virus is expected to dent China’s growth after months of economic worries over trade tensions with the United States.

A National Australia Bank research team estimated China’s gross domestic product growth for the first quarter could be hit by about 1 percentage point.

source: http://sutured.com/china-shuts-transport-temples-disneyland-as-virus-toll-rises-to-25/
more: http://sutured.com/

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People who have trouble falling asleep may be at increased risk of developing cognitive problems or dementia than their counterparts who sleep well, a research review suggests.



Researchers examined data on 51 previously published studies that followed middle-aged and older people in North America, Europe and East Asia for at least several years to see if sleep issues were associated with cognitive health over time.

Individuals with insomnia were 27% more likely to develop cognitive problems, the study found. People who had what’s known as sleep inadequacy, or an insufficient amount of quality rest, were 25% more likely to develop dementia, the researchers also found.

So-called sleep inefficiency, or spending too much time wide awake in bed, was associated with a 24% greater chance of cognitive decline, the study team reports in Journal of Neurology, Neurosurgery, & Psychiatry.

“These findings suggested that sleep management might serve as a promising target for dementia prevention,” said lead study author Dr. Wei Xu of Qingdao University in China.

While the study wasn’t designed to determine whether or how sleep problems directly cause cognitive decline or dementia, there are several possible explanations, Xu said by email.

Sleep problems might lead to cognitive impairment by causing inflammation of tissue in the central nervous system including the brain and spinal cord, Xu said. Sleep difficulties might also lead cognitive problems by causing or exacerbating so-called cerebral hypoxia, or a reduction in oxygen supply in the brain, Xu added.



In addition, sleep problems could make the brain less efficient at removing waste and contribute to loss of brain cells or atrophy in key regions of the brain.

Most of the studies in the current analysis followed participants for anywhere from about three years to 10, and a few tracked people for decades. Participants were typically aged 50 or older at the start of these studies, and they were often in their 70s.

Sleep apnea, a nighttime breathing disorder, was associated with a 29% higher risk of cognitive problems, the analysis found. Spending a long time in bed was tied to a 15% greater chance of cognitive impairment.

People who slept around six or seven hours a night appeared to have the lowest risk of cognitive disorders, while the risk was elevated for people who slept less than four hours or more than 10 hours a night.

It’s possible that short sleep and other sleep problems contribute to degeneration in certain brain areas associated with dementia, the study authors note. Or, that people who already have such degeneration tend to sleep longer. Clinical trials are needed to test whether improving sleep quality and quantity affects later dementia risk, they write.

Matthew Pase, a researcher at the University of Melbourne in Australia who wasn’t involved in the study, agreed. “We still need more evidence to understand whether poor sleep leads to dementia and whether improving sleep can help mitigate risk.”

Nevertheless, Pase said by email, “sleep is vitally important for general health and should be made a priority.”

Most adults need at least seven hours of sleep a night, according to the U.S. Centers for Disease Control and Prevention.

Just because people struggle with sleep, however, doesn’t mean they’re destined to have cognitive problems, said Dr. Eric Larson of the Kaiser Permanente Washington Health Research Institute in Seattle.

“Insomnia and sleep complaints seem to cause a lot of anxiety that, in my judgment, is unwarranted if its source is brain health,” Larson, who wasn’t involved in the study, said by email. “But if sleep problems interfere with everyday activities and wellbeing during the day, that’s an issue that people should consider raising with their physician.”

Getting seven or eight hours of sleep a night also isn’t the only way to improve brain health, Larson said.

“The range of `healthy sleep amounts’ is highly variable between individuals and becomes more so as people age,” Larson said.

source: http://sutured.com/sleep-problems-in-older-adults-linked-to-cognitive-decline-and-dementia/
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Teens who binge drink or abuse prescription opioids may be more likely to engage in other risky behaviors, too, two new studies suggest.



Adolescents who binge drink are more likely to drive drunk or ride with drivers who are under the influence in early adulthood, and they’re also more apt to become extreme binge drinkers who experience blackouts, one of the studies suggests.

Teens are also more apt to engage in risky driving behaviors when they misuse prescription opioids, a second study suggests. When teens abuse opioids, they’re more likely as well to misuse alcohol and other drugs, engage in risky sexual behaviors, experience violence and attempt suicide.

“Substance use such as prescription opioid misuse may alter a misuser’s judgment and cognition, thus potentially increasing likelihood for engagement in other risky behaviors,” said Dr. Devika Bhatia, lead author of the opioid study and a researcher at the University of Colorado School of Medicine in Aurora.

“Additionally, engaging in prescription opioid misuse may have an impact on peer groups that are more likely to engage in other risky behaviors,” Bhatia said by email.

For the opioid study, Bhatia and colleagues examined survey data collected from a nationally-representative sample of almost 15,000 U.S. high school students in 2017. Overall, 14% reported misusing prescription opioids at least once.

With any history of prescription opioid misuse, teens were 23 times more likely to have used heroin, almost 19 times more likely to have tried methamphetamines, over 16 times more likely to have tried cocaine, and more than 10 times as likely to have tried marijuana, researchers report in Pediatrics.



A history of prescription opioid misuse was also associated with five to six times greater odds that teens would try smoking or vaping, as well as a more than quadrupled chance they would have at least four previous sex partners and intercourse without condoms.

In addition, prescription opioid misuse was tied to more than six times the odds of drunk driving.

The second study looked in depth at driving outcomes associated with binge drinking. Researchers followed more than 2,000 teens for about four years starting in their senior year of high school, when 27% of participants reported binge drinking.

To assess binge drinking, researchers asked how many times teen girls had four or more drinks in a row within two hours, and how often teen boys had five or more drinks in two hours.

Compared to teens who didn’t binge drink during their senior year, those who did were more than five times as likely to drive while intoxicated during the next two years. Four years after high school, young adults who were teen binge drinkers were still more than twice as likely to drive drunk, researchers report in Pediatrics.

Teen binge drinkers were also two to four times more likely to ride in cars with drunk drivers or experience blackouts in early adulthood. And young adults who were binge drinkers during adolescence were also twice as likely to become extreme binge drinkers.

Researchers also looked at whether parents’ awareness of teen drinking or parents’ efforts to discourage drinking might impact risky drinking and driving behaviors in early adulthood. Generally, young adults were less likely to engage in risky drinking or driving behaviors when they knew their parents were aware of any binge drinking during adolescence and when their parents discouraged drinking.

“Parental practices may have enduring effects protecting emerging adults against driving while intoxicated, riding while intoxicated, and blackouts several years after high school,” said lead study author Dr. Federico Vaca of Yale School of Medicine in New Haven, Connecticut.

When parents actively discourage risky behaviors, and pay attention when teens get into trouble, it may also impact the chances that young people will engage in other dangerous activities, Vaca said by email.

“Other negative consequences have a high likelihood of occurring with binge drinking, extreme binge drinking and/or blacking out including risky sexual behaviors, rape, and fights/physical assaults,” Vaca said.

source: http://sutured.com/teen-drinking-drug-use-tied-to-other-risky-behaviors/
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Last August, Francys Rivero, an unemployed single mother of four, feared for her baby’s life. Two months after his birth, even though she was breastfeeding him regularly, Kenai de Jesus wasn’t gaining weight.



“I feel like my heart is breaking,” Rivero, 32, told Reuters in an interview here in the capital of the western Venezuelan state of Lara. “I don’t know what’s wrong with my son.”

She tried repeatedly to see nutritionists, but failed. One didn’t show up, another required a month-long wait. Desperate, Rivero attended a charity event offering checkups and information for families of children with nutritional problems.

At the event, organized by Caritas, the Catholic aid organization, doctors performed a check-up. With donations from the charity, and financial assistance from siblings now living abroad, Rivero began supplementing her breast milk with baby formula.

Within weeks, Kenai rebounded. By December, he reached an acceptable weight for his age. But Rivero, like many enduring a recession now in its sixth year, fears she could once again find herself short of the money needed to keep him healthy.

“How am I going to afford such expensive food?” she asks.

Venezuela’s economic crisis is taking a crippling toll on the country’s children, who face a growing risk of malnutrition as basic food is increasingly out of reach for many families. The public health system, notoriously short of medicine and other standard supplies, is unable to provide much succor, and aid groups struggle to bridge the gap.



President Nicolas Maduro, increasingly a global pariah for undermining democracy and overseeing the country’s economic collapse, blames the crisis and food shortages on U.S. sanctions meant to force him from power.

The leader, also accused of overseeing widespread human-rights abuses and turning a blind eye to suffering across the once-prosperous country, often says foreign media and global aid organizations exaggerate Venezuela’s problems.

A lack of proper nutrition is stunting growth, diminishing cognitive development and causing physical and emotional trauma among hundreds of thousands of young Venezuelans. As a result, doctors and other health experts argue, Venezuela faces a generation of young people who will never meet their full physical or mental potential.

Between 2013 and 2018, according to the United Nations Children’s Fund, or UNICEF, 13% of the country’s children suffered from malnutrition. Caritas, in a recent study conducted in five Venezuelan states and the capital, Caracas, found that 16% of children under the age of five suffer from acute malnutrition and that nearly twice as many suffer from low growth rates for their age.

Although the United Nations and other agencies import some food and nutritional aid, it isn’t enough for Venezuela’s needs and the assistance doesn’t always get where it is most required. The U.N. Office for the Coordination of Humanitarian Affairs has raised just a third of the $222.7 million it sought for Venezuela for the second half of 2019, according to official U.N. data.

“A population suffering from malnutrition implies we are going to have adults with less physical and intellectual potential,” said Raquel Mendoza, a nutritionist at Mapani, an aid group in Barquisimeto that helps poor families diagnose and treat malnourished children. “We’re going to see a regression in the development of the country because human resources are diminished.”

Venezuela’s Information Ministry, responsible for government communications including those of the Health Ministry, didn’t respond to requests for comment.

The ministry’s 2016 annual report, the last one it published, celebrated advances in nutrition since the 1980s and said child malnutrition “has stopped being a public health problem.”

For those without enough to eat, the problem is very real.

Rosa Rojas, a 32-year-old widow and mother of six, relies on rice and other carbohydrates to keep her kids fed. Rare is the day they get three full meals. “We just eat twice,” she said.

Gregoria Hernandez, a 23-year-old homemaker, recently hospitalized two young sons, Pastor and Josue Suarez, because they were malnourished. Shortly after their release, Sonia, her 7-month-old daughter, needed similar medical help.

“I feel like the worst of mothers,” Hernandez told Reuters. “I don’t have a way to help them, to give them what they need.”

Sometimes, families are torn between competing needs.

Deina Alvarez, a 6-year-old student and aspiring gymnast, is underweight and receiving nutritional supplements from a local charity. Although her parents both work, they don’t earn enough to fill a grocery cart and buy the medicines they both need as epileptics.

“Either we pay for medicine or we pay for food,” said Diana Rodriguez, Deina’s mother.

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The chemical, p-phenylenediamine (PPD), “is a strong contact allergen used in hair dye known to cause allergic contact dermatitis,” Dr. Cezmi Akdis, of the Swiss Institute of Allergy and Asthma Research in Davos Platz, and colleagues write in the Journal of Allergy and Clinical Immunology.



Both private and occupational exposure to PPD is frequent, but whether it has adverse effects in people with work-related exposure who don’t show allergic symptoms isn’t known, the study team writes.

For the current study, researchers tested the effect of PPD exposure on the activity of genes known to be involved in dermatitis and active in skin that has been damaged. They examined gene activity in skin cells after PPD exposure in seven hairdressers without any skin symptoms suggesting an allergic reaction to the chemical, in four people with mild allergic skin reactions to the chemical and in five people with severe allergic skin reactions.

The researchers found that hairdressers without obvious allergic reactions to PPD still had gene activity changes in their skin that suggest the skin can be damaged even when the PPD doesn’t cause allergic symptoms like a rash.

Hairdressers who apply hair dye to clients several times a day are particularly at risk for PPD exposure. The chemical can also cause allergic reactions in people who regularly dye their own hair, particularly if they use darker colors.

Many salons ask customers to do patch tests to see if they will have an allergic reaction to dye before they get their hair colored, but sometimes this can make people more sensitive to the chemical and lead to a rash when their hair is colored a second time.

Semi-permanent dye may cause less of a reaction than permanent color.



Wearing gloves when dying hair may also reduce the risk of skin damage from PPD.

Photographers who develop film and people who get black temporary tattoos and henna tattoos can also be exposed to PPD and have allergic skin reactions as a result, the authors note.

In the study, PPD exposure resulted in damage to the epidermis, or outer layer of skin, which plays a crucial role in preventing allergens from entering the body and causing damage, the study team notes.

Because they found skin damage both in hairdressers without allergic contact dermatitis and those with mild or acute cases of dermatitis, the results suggest that occupational PPD exposure directly causes skin damage, the study team concludes.

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Usually, treatment of lipomas is not necessary, unless they become painful or restrict movement. They are usually removed for cosmetic reasons if they grow very large or for histopathology to verify that they are not a more dangerous type of tumor such as a liposarcoma. This last point can be important, as the characteristics of a tumor are not known until after it is removed and medically examined.

A lipoma removal involves simple excision. The lipoma removal can often be done under local anesthetic and takes less than 30 minutes. This cures the great majority of cases, with about 1–2% of lipomas recurring after excision.

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Four health workers fighting the Ebola outbreak in the Democratic Republic of the Congo have been killed and five injured in an attack by rebel militia.



The attacks occurred overnight on a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina.

“We are heartbroken that people have died in the line of duty as they worked to save others. The world has lost brave professionals” said Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General.



The dead include a member of a vaccination team, two drivers and a police officer. No WHO staff are among those killed, one staff member was injured.

“My heart goes out to the family and friends of the first responders killed in these attacks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

“We are doing everything possible to bring the injured and front-line workers in the impacted areas to safety. These constant attacks must stop. We will continue to work with the DRC Government, partners and MONUSCO to ensure the security of our staff and other health workers.”



In the last week, there were 7 cases of Ebola, down from a peak of over 120 per week in April 2019.

“Ebola was retreating. These attacks will give it force again, and more people will die as a consequence,” said Dr Tedros.

“It will be tragic to see more unnecessary suffering in communities that have already suffered so much. We call on everyone who has a role to play to end this cycle of violence.”



Insecurity has complicated efforts to combat the epidemic in DRC from the outset. More than 300 attacks on Ebola health workers have been recorded in 2019, leaving six dead and 70 wounded, some of them patients.

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Obese teens who have surgery to lose weight report better quality of life, less joint pain and fewer physical limitations after their operations than before, a new study suggests.



Researchers followed 242 obese teens who had so-called metabolic and bariatric surgery to lose weight over three years, starting when they were 17 years old, on average. Prior to surgery, half of the teens had a body mass index (BMI) of at least 50, making them severely obese; two-thirds had musculoskeletal pain and joint pain and half had poor physical function.

Read More: Weight Loss Surgery Cost

Three years after surgery, the teens’ average reduction in BMI was 27%, which meant they were still obese. However, previous research has shown that a BMI reduction of just 5% to 10% is enough to result in meaningful improvements in health and quality of life.

And in the current study, researchers found that every 10% reduction in BMI was associated with 6% lower odds of the teens having musculoskeletal pain and 10% lower odds of having joint pain.

“Metabolic and bariatric surgery leads to large and sustained reductions in joint pain and improvements in physical function in adolescents with severe obesity over 3 years,” Dr. Sharon Bout-Tabaku of Nationwide Children’s Hospital in Columbus, Ohio, and colleagues write in Pediatrics.

“These improvements will allow teenagers to move, be more functional, and participate in physical activity to improve their joint health and maintain their weight loss,” the study team notes.



More than one in five American teens are obese, according to the U.S. Centers for Disease Control and Prevention (CDC). Teens are considered obese when their BMI is at or above the 95th percentile for youth of the same age and sex.

An online child and teen BMI calculator is available from the CDC (here: /2QC2CWN).

Adolescent obesity is associated with chronic joint pain and with irreversible joint damage, the researchers note. But even as a growing number of obese teens get metabolic and bariatric surgery to lose weight, research to date hasn’t offered a clear picture of how these operations impact future joint health.

In the current study, the decline in BMI wasn’t directly associated with changes in poor physical function three years after surgery.

But young people who complained of joint pain after the surgery were 21% more likely than those who didn’t to also report poor physical function.

The study wasn’t designed to prove whether or how surgical weight loss might directly improve joint pain or musculoskeletal pain in obese teens.

One limitation of the study is that the data came from a research project designed to study improvements in weight and obesity-related disease, not joint pain, the study authors note.

Another drawback is that data on physical improvements was based on patient surveys, not on objective measures of physical function or body mechanics.

Even so, the results suggest that improved joint health can be added to the list of potential health benefits of weight loss surgery, the authors conclude.

“Adolescence represents a window of opportunity for caregivers to implement exercise and behavioral supports pre-and post-surgery to maintain long-term weight and joint health benefits,” the study team writes. “Future research should be focused on studying the relationship among weight loss, biomechanical and systemic inflammatory mechanisms, performance measures, and biomarkers to identify, target, and treat adolescents who are obese and at risk for knee osteoarthritis.”

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Across the world, imprisoned women have higher rates of cervical cancer and the human papillomavirus (HPV) infection that can lead to cancer, according to a research review.



Screening and treatment could address these problems in an especially vulnerable population of women, the authors conclude in the Journal of Epidemiology & Community Health.

“This relevant health issue affects underprivileged populations in a disproportionate manner,” study co-author Nadia Escobar Salinas of the Ministry of Health in Santiago, Chile, told Reuters Health.

Cervical cancer is the fourth most common cancer in women worldwide. About 570,000 cases are diagnosed annually across the world, according to the World Health Organization. The highest rates are in Latin America, Southeast Asia and sub-Saharan Africa. Most deaths occur in low-income and middle-income countries.

“People in prisons are deprived of their freedom as part of a criminal conviction, but that should not mean they are also deprived of their right to health and preventive interventions,” Escobar Salinas said by email.

She and Emma Plugge of Public Health England in Reading, UK, reviewed 35 previous studies of HPV infection and cervical cancer in imprisoned women published between 1968 and 2017. The studies involved more than 53,000 imprisoned women in the U.S., Canada, UK, Spain, Italy, Brazil, Mexico, Peru, Taiwan and Russia.

In nine of the studies, HPV infection rates among imprisoned women ranged from 10% to 55%, with the lowest percentages in Brazil and Italy and the highest in Taiwan and Spain. The worldwide prevalence of HPV among women with normal cervical cells is about 11%, the study team notes.



Similarly, precancerous cervix lesions that are typically caused by HPV infection were diagnosed in up to 22% of imprisoned women, with the highest rates in the U.S., Spain and Brazil, according to 23 studies included in the review. In 20 of these studies, imprisoned women had double the rate of lesions compared with women in their own countries.

Invasive cervical cancer was assessed in seven studies, with prevalence among imprisoned women ranging from 0.1% to 1.2% in the U.S., UK and Canada. This is 100 times the rate of women in the general population, the authors note. Screening programs in England, for instance, report a 0.001% prevalence and worldwide estimates are around 0.016%.

The data also highlight worldwide health inequities, the study team writes. Most studies came from high-income countries with the smallest burden of cervical cancer, yet the ranges were still significant. Research in Africa and Southeast Asia would show even higher rates, they note.

“What surprised me the most was the lack of information about women’s health in prisons worldwide, specifically in low- and middle-income countries,” Escobar Salinas said. “We didn’t limit the search by region or continent, and after a wide search, we realized most of the available studies that came up were from high-income countries.”

Nonetheless, cervical cancer is currently preventable, the authors write, and cervical lesions usually show up years before invasive cancer occurs, so a screening program could help with early detection.

“These women who are incarcerated tend to have more health problems but less access to healthcare in the community,” said Kate Dolan of the University of New South Wales in Sydney, Australia, who wasn’t involved in the study.

The United Nations and World Health Organization say healthcare should be the same for prisoners as for the surrounding community, Dolan added.

“It is the poor and vulnerable who go to prison,” she said by email. “Prison provides a brief time when preventive healthcare can be undertaken.”

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Going back into the operating room for surgery to help a woman whose ovarian cancer has reappeared may not help her live longer – instead, it might shorten her life, according to an international study of 485 women.

“I do think this study will decrease the number” of such surgeries that now appear to be unnecessary for many women, said Dr. Robert Coleman of the University of Texas M.D. Anderson Cancer Center in Houston, Texas, lead author of the study published in the New England Journal of Medicine.

The operations are currently considered standard medical care. But the new findings suggest that women who get chemotherapy alone if their tumor reappears do as well or better than women who received surgery before their chemotherapy.

The results only apply to women whose tumors are sensitive to platinum-based drugs.
After a median follow-up period of 48.1 months, median overall survival was 50.6 months for women with recurrent ovarian cancer who got surgery and chemotherapy and 64.7 months for those who got only chemotherapy.

That corresponded to a 29% increase in the death rate for the surgery recipients.
About 22,500 women in the U.S. develop ovarian cancer each year, according to the American Cancer Society. But more than 80% of women have their disease recur, the 10-year survival rate is below 15%, and roughly 14,000 are expected to die from their tumors. Roughly half of affected women have platinum-sensitive tumors. About one quarter of patients are candidates for secondary surgery if their tumor recurs.

The trial, known as GOG-0213, ended early when preliminary results showed that surgery was not helping. The volunteers had recurrent epithelial ovarian, primary peritoneal, or Fallopian-tube cancer.

Coleman told Reuters Health in a phone interview that the findings were surprising, but the effectiveness of secondary surgery had not been tested, and the results probably reflect the fact that chemotherapy for ovarian cancer has improved significantly.

The women in the trial “ended up living three times longer than when we started the trial,” said Coleman, who is executive director of cancer network research at M.D. Anderson.

Sixty-seven percent of the patients in the surgery group survived for three years versus 74% who only got chemotherapy.

“Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery,” the study team writes. The two groups reached parity on the quality of life measure by the six-week mark.

Coleman said M.D. Anderson and other cancer centers have stopped doing routine secondary surgery in the wake of the findings, but it may take time for other medical centers to follow suit.

“There are definitely doctors out where who feel that, even though the trial did not show a benefit, in their hands and in their specific patients, there’s a benefit, and a lot of patients would want it,” he said. “Most people, when they see cancer, they want it out.”

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Dear Dr. Manny,

My kids keep getting sore throats in the winter. I can’t help but wonder. How do I know whether they have strep throat? When do I need to get them tested?

Thanks for your question.

Not all sore throats are the same. Some of them are related to allergies, some of them are from colds, and some of them are caused by the streptococcus bacteria.

You can’t verify for sure whether you or your child has strep throat without going to a doctor.

A sore throat that stems from a cold usually comes with a slew of respiratory ailments. Runny noses, coughing, sneezing, and watery eyes are all signs of a cold, not strep throat.

Strep comes suddenly. Its symptoms include a sore throat, red tonsils, white spots on the tonsils, pain when swallowing, fever, swollen neck glands, loss of appetite, headaches, and abdominal pain.

If you have any of these symptoms, check with a doctor, who can do a simple swab to verify. It’s important that you treat strep with antibiotics.

Strep is common in all ages, but it happens more in children than adults. It can also be worse in children.

Some kids are more prone to get strep more than others because they have a genetic weakness to Strep A, the bacteria which causes the infection. Typically, those children also developed tonsillitis.

Soothing a strep throat involves lots of rest and fluids. Gargling salt water will help bring the inflammation down somewhat. Eat soft, easy-to-swallow foods like mashed potatoes and applesauce. Use a humidifier.

Prevention of strep throat can be as easy as washing your hands before you eat. Another useful prevention method involves cleaning the house frequently, especially the bathroom.

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Humility is not the boldest of personality traits, but it’s an important one, studies find. And it’s hard to fake.


In their day jobs, research psychologists don’t typically need safety goggles, much less pith helmets or Indiana Jones bullwhips. There’s no rappelling into caves to uncover buried scrolls, no prowling the ocean floor in spherical subs, no tuning of immense, underground magnets in the hunt for ghostly subatomic particles.

Still, psychologists do occasionally excavate the habits of lost civilizations. In a paper published in the latest issue of Current Directions in Psychological Science, a team of researchers reviewed studies of a once-widespread personal trait, one “characterized by an ability to accurately acknowledge one’s limitations and abilities, and an interpersonal stance that is other-oriented rather than self-focused.” Humility.

“Research on humility has been growing, and fast,” said Daryl Van Tongeren, a psychologist at Hope College in Michigan and lead author of the new paper. “It was time to bring people up-to-date and lay out the open questions to guide further research.”

In an era that future historians might not immediately label “The Age of the Mensch,” the study of humility amounts to a bold contrary bet, like shorting the California cannabis market. The word “humble” travels so often now as a verb that embodying its gentler spirit, the adjective, can be an invitation to online trolling, professional invisibility or worse. Oscar Wilde wrote that, before he found humility, he spent two years behind bars experiencing “anguish that wept aloud” and “misery that could find no voice” — which sounds more like defeat than victory.

Humility is a relative newcomer to social and personality psychology, at least as a trait or behavior to be studied on its own. It arrived as part of the effort, beginning in the 1990s, to build a “positive” psychology: a more complete understanding of sustaining qualities such as pride, forgiveness, grit and contentment. More recently, humility has found a foothold in the most widely used measure of personality traits, the five- factor questionnaire. The wallflower is attracting some attention, and so far appears to be absorbing it well.

In one series of experiments, Elizabeth Krumrei Mancuso of Pepperdine University scored volunteers on a measure of what she called intellectual humility — an awareness of how incomplete and fallible their views on political and social issues were. This kind of humility was not related to I.Q. measures or political affiliation, she found; it was strongly linked to curiosity, reflection and open-mindedness.



In another, ongoing study, Dr. Krumrei Mancuso had 587 American adults complete questionnaires intended to measure levels of intellectual humility. The participants rated how much they agreed with various statements, including “I feel small when others disagree with me on topics that are close to my heart,” and “For the most part, others have more to learn from me than I have to learn from them.” Those who scored highly on humility — not that they’d boast about it — also scored lower on measures of political and ideological polarization, whether conservative or liberal.

Other research has found that people who score high for humility are less aggressive and less judgmental toward members of other religious groups than are less-humble people, even and especially after being challenged about their own religious views.

“These kinds of findings may account for the fact that people high in intellectual humility are not easily manipulated with regard to their views,” Dr. Krumrei Mancuso said. The findings, she added, may also “help us understand how humility can be associated with holding convictions.”

In the new review paper, Dr. Van Tongeren and his colleagues proposed several explanations for why humility, intellectual or otherwise, is such a valuable facet of personality. A humble disposition can be critical to sustaining a committed relationship. It may also nourish mental health more broadly, providing a psychological resource to shake off grudges, suffer fools patiently and forgive oneself.

Now that humility is attracting some research attention, Dr. Van Tongeren said, there are a number of open questions, including whether it can somehow be taught, or perhaps integrated into psychotherapy. “One of the thorny issues is that the people who are the most open and willing cultivate humility might be the ones who need it the least,” he said. “And vice versa: Those most in need could be the most resistant.”

Therapists who treat people with borderline or narcissistic personality disorders likely would agree, and so might many of their clients.

To date, no one has elaborated a dark side to humility, although presumably too much of it could lead to social retreat, self-doubt and undue reticence. In the modern age of online posturing and self-promotion, Charlie Brown would have to raise his hand and squawk just to register his presence.

For now, and thanks to psychology’s recent excavations, it is perhaps enough to know that he would still have plenty of company, temperamentally speaking. Between 10 and 15 percent of adults score highly on measures of humility, depending on the rating scale used. That’s at least 25 million humble people in this country alone.

Who knew?

source: http://sutured.com/be-humble-and-proudly-psychologists-say/
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In the latest sign that digital innovations are changing the way we learn, anatomy students at a university in Australia are using augmented and virtual reality.

The pilot of the technology is being used to help boost spatial awareness, accessibility and explorative learning, La Trobe University said in an announcement Monday.

According to Aaron McDonald, La Trobe’s head of the anatomy discipline, augmented reality (AR) offered students 24-hour access to three-dimensional anatomy images through their phones, computers or iPad. On campus, headsets are used to provide access to virtual reality technology.

“Augmented reality allows students to visualize and manipulate anatomical structures and develop a deep understanding,” McDonald said. “You can superimpose anatomical structures over a peer who can perform movements along with the app, to better understand muscle function,” he added. “It is a great resource for both team work and self-directed learning.”

The university said that, in terms of cost, the use of AR technology amounted to 10 Australian dollars ($6.74) per student compared to over 100 Australian dollars for just one textbook.

Technology is driving change across the education sector, with computers and tablets now a common site in classrooms and libraries around the world. The last few years have also seen the development of digital based learning platforms including massive open online courses, or MOOCS.

Providers such as edX — which was founded by Harvard University and the Massachusetts Institute of Technology in 2012 — offer free online courses from renowned institutions such as Columbia University and Delft University of Technology in the Netherlands. The platform provides more than 2,400 courses and its users come from all over the world.



In July this year education publisher Pearson announced that all new releases of its 1,500 active U.S. titles would be “digital first.” The company said the titles would be updated on a continuous basis “driven by developments in the field of study, new technologies, such as artificial intelligence, data analytics, and Pearson’s own efficacy research.”

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Singapore will ban advertisements of certain fizzy drinks and juices, its health ministry said on Thursday, part of a raft of measures to curb consumption of sugar in the city-state, which has some of the world’s highest diabetes rates.

Under the measures, further details of which will be released next year, high-sugar drinks will also be required to bear health warnings on labels.

Singapore’s action appears to go further than measures in other countries such as Mexico and Britain, which restrict when advertisements for high-calorie food and drinks can be shown on television to limit their exposure to children.

“We will introduce an advertising prohibition of product advertisements for the least healthy SSBs on all local mass media platforms, including broadcast, print, out-of-home and online channels,” the health ministry said in a statement, referring to sugar-sweetened beverages.

Singapore is also considering taxes on sugary drink makers and importers, and even a total ban on the sale of some beverages, the ministry said.

The Coca-Cola Company, the world’s biggest beverage maker, said it welcomed the plans and would work to reduce sugar levels in its drinks sold in Singapore.

“We will continue to rethink many of our recipes in Singapore to reduce sugar, because while sugar in moderation is fine, we agree that too much of it is not good for anyone,” said Ahmed Yehia, country manager for Coca-Cola Singapore and Malaysia.



“We foresee minimal impact on our portfolio from this announcement,” he added.

Singapore’s health ministry said it would consult consumers, drink makers and the advertising industry in coming months over the measures without giving a timeline for implementation.

Wealthy Singapore has one of the highest rates of diabetes in the world, partly caused by its fast-ageing population and a culture of eating out at inexpensive hawker centers.

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