Britain seeks a million 'Dementia Friends'

CameronBritain is seeking a million “dementia friends” who will be trained to understand the illness and help those living with it, Prime Minister David Cameron announced Thursday.

The plan is one of a host of measures aimed at dealing with dementia as the country braces for the side effects of longer lifespans. British government officials say a quarter of hospital beds are already occupied by someone with dementia; the number of people with dementia is expected to double in the next three decades. 

“There are already nearly 700,000 sufferers in England alone but less than half are diagnosed and general awareness about the condition is shockingly low,” Cameron said.

The British numbers mirror global trends that are putting new pressures on health systems and families worldwide, as better healthcare leads to longer lives and more cases of ailments associated with aging.

Earlier diagnosis of dementia can help patients find ways to cope with the illness and reduce costs for care, health researchers have found, but stigma often steers people away from diagnosis.The World Health Organization estimates that even in wealthy countries, only 20% to 50% of cases are routinely recognized.

“Through the Dementia Friends project we will for the first time make sure a million people know how to spot those telltale signs and provide support,” Cameron said.
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Striking Egyptian doctors begin nationwide resignation campaign

This post has been updated. See the note below.

CAIRO -- Egyptian doctors began a mass resignation campaign in state-run hospitals across the country Thursday after the government failed to meet demands for higher salaries, better security and a dramatic increase in national healthcare spending.

"We're targeting at least a third of the 50,000 doctors employed through the state. This will cripple the Health Ministry,” said Dr. Ahmed Shoura, a member of the strike committee. “Our campaign is going to resume until at least 15,000 resignations have been collected, then we will submit our resignations to the ministry."

For the last three weeks, doctors in public hospitals have been on a partial strike across the country, handling only chronic cases once a week. Thousands of doctors have threatened to submit their resignations if the state did not meet their demands in a strike that has become an intensifying problem for President Mohamed Morsi's new government.

The strikers are also calling for "corrupt" Health Ministry employees and former officials loyal to ousted President Hosni Mubarak to be removed from office. 

[Updated  2:23 p.m., Oct. 18: Several doctors who helped organize the strike said the ministry has been unresponsive to their pleas for negotiations. However, Dr. Ahmed Sedeek of the Health Ministry previously told The Times that officials had been meeting with doctors to find a middle ground.

“Some of the people participating in the strike believe that the Health Ministry is against the doctors; this is not the case," Sedeek said. "We are doctors as well and the ministry needs all of its doctors to contribute.”

He said that while the doctors have legitimate demands, the new government needs more time to increase the health budget as promised and implement reform.

“Our main goal is to fix the health institution,” he said. “If the doctors don't want to give us a chance or abort the steps we've already taken, then this is just unfortunate.”]

Last week, 85 doctors resigned from one hospital in Cairo's urban slum district of Sayeda Zeinab, Shoura told The Times. He and several dozen doctors in Cairo and Alexandria have already resigned. He said he expects that they will reach their goal quickly because both doctors and patients are "fed up" with Egypt's healthcare system.

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German government drafts measure to keep circumcision legal

Germany circumcision

BERLIN -- The German government finalized its draft of a measure Wednesday to protect circumcision after a local court threw the practice into a legal quagmire in June.

The bill would allow circumcision to be carried out as long as it is performed in accordance with medical standards, does not put the child’s health in jeopardy and parents are notified of potential risks. Trained practitioners can also perform circumcisions on boys up to 6 months old even if they aren’t doctors, guaranteeing that mohels, Jews trained to perform the procedure, can do so in accordance with Jewish law.

The draft legislation by Chancellor Angela Merkel's Cabinet should help remove the legal uncertainties around the practice for religious communities in Germany, said Justice Minister Sabine Leutheusser-Schnarrenberger, who drew up the bill.

The measure came in response to a court ruling in the city of Cologne this summer that made circumcision illegal, saying it caused children bodily harm. The issue arose after a 4-year-old Muslim boy suffered complications from the practice.

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New virus doesn't spread easily person-to-person, WHO says

A new virus that has killed one person and landed another in a London hospital does not appear to spread easily from person to person, the World Health Organization said Friday.

The discovery this month of a never-before-seen coronavirus, part of a family of viruses that range from the common cold to the SARS virus that killed hundreds, had caused fear that it might spread further. The fact that the two known cases were linked to Saudi Arabia added to the concern, with millions of people headed to the country for an annual Muslim religious pilgrimage.

However, no new cases have emerged since Britain informed the WHO last week that a 49-year-old Qatari man with a history of traveling to Saudi Arabia  was suffering a severe respiratory infection. The first case was a 60-year-old Saudi national who died of the infection this year.

Though the virus does not appear to be spreading, the United Nations agency said it was still monitoring the situation, given the severity of the two known cases of the new virus. It has not recommended any travel or trade restrictions for Saudi Arabia or Qatar.

European Center for Disease Prevention and Control scientists wrote in a newly published paper that the infection probably originated with animals. Though it is in the same family of viruses as SARS, it is “quite different in behavior from SARS,” the scientists wrote in the  Eurosurveillance  journal.

The two people known to have been infected with the new virus suffered from fever, coughing and shortness of breath.

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Uruguay debates bill to allow abortion; passage expected

Abortion

In a marathon  session Tuesday that stretched more than eight hours, Uruguayan lawmakers argued passionately over whether to legalize abortion in the earliest stages of pregnancy, a controversial step that would make it a rarity among Latin American nations.

Under the measure, Uruguay would allow abortions within the first 12 weeks of pregnancy, 14 weeks in cases of rape, and decriminalize later abortions to protect the life of the mother or carried out when a fetus isn’t expected to survive.

The legislation  would require women to explain why they are seeking to abort to three professionals -- a gynecologist, a mental health professional and a social worker -- and hear information about abortion risks and alternative options, such as adoption. Afterward, they would have to wait five days “to reflect” before being allowed an abortion.

The bill, which proponents said was created in hope of reducing the number of abortions, was seen as likely to pass and be signed by President Jose Mujica. The Associated Press reported Tuesday afternoon that the measure appeared to be headed for a narrow passage by 50-49 votes.

But Uruguayans on both sides of the debate were displeased by the bill. Abortion opponents showed a National Geographic video  of a fetus in its earliest weeks as they argued against the measure on Tuesday. Roman Catholic and evangelical groups have opposed any legalization.

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Ebola outbreak coming to an end in Uganda, continues in Congo

Ebola

While Ebola continues to kill in the Democratic Republic of Congo, an outbreak of the virus in neighboring Uganda appears to be coming to an end, the World Health Organization said Monday, reporting that no new cases of the deadly virus had been confirmed in Uganda for a month.

Since the Ugandan outbreak began, 24 people are believed to have suffered from the virus, including 17 who died, the United Nations agency said. The last person confirmed to be stricken recovered from the virus and was discharged more than a week ago.

“All contacts of probable and confirmed cases have been followed up daily and have completed the recommended 21 days of monitoring for any possible signs or symptoms of Ebola,” the WHO said in a statement Monday. Ebola isolation facilities remain on standby.

The Ugandan outbreak was first declared by its health ministry in late July, spurring health officials and the president to warn Ugandans against handling dead animals and burying those who might have died from the virus. Many of the recent cases have been tied back to the funeral of a baby girl whose mother was also sick, Doctors Without Borders said last month.

While the outbreak in Uganda has waned, the neighboring Congo is still grappling with a separate outbreak of the virus. As of late August, the Congo outbreak had sickened 24 people and killed 11 more in the northeastern region of Province Orientale.

The two outbreaks were caused by different kinds of Ebola and “are not epidemiologically linked,” the WHO said. The highly infectious virus, which has no known treatment or vaccine, has caused more than 1,200 deaths since it was discovered, according to the U.N. agency.

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Photo: A handout photograph released by Doctors Without Borders shows its staff launching an emergency intervention against an Ebolaoutbreak at the Kagadi hospital in western Uganda on July 31. Credit: Agus Morales / Doctors Without Borders / European Pressphoto Agency 


German lawmakers work on legislation to protect circumcision

Rabbi metzger

BERLIN -- Israel’s top rabbi is in Berlin to rally support among German political leaders regarding legislation to protect the practice of ritual circumcision in Germany, which was called into question earlier this year by a controversial court ruling that Jewish and Muslim leaders said threatened their religious freedom.

In June, after a Muslim boy suffered health complications from the practice, a court in the western German city of Cologne declared nonmedical circumcision to be criminal because it causes children bodily harm. Amid outrage from some religious groups, lawmakers quickly passed a resolution promising legislation guaranteeing legal protection for circumcision.

This week, officials have been meeting with Yona Metzger, chief rabbi of Israel's Ashkenazi Jews, to craft legislation on the issue. But the stakes were raised further Tuesday after a doctor in the southern German city of Hof, in Bavaria, reportedly filed charges with local prosecutors against a rabbi there to stop the practice. Prosecutors must still decide whether to act on the charges, which the Council of European Rabbis described as a “grave affront to religious freedom.”

“This latest development … underlines the urgent need for the German government to expedite the process of ensuring that the fundamental rights of minority communities are protected,” the council said in a statement on its website.

Though the Cologne court ruling applies only to that jurisdiction, the decision immediately called into question the legality of circumcision nationwide. The German Medical Assn. told doctors not to perform circumcisions. Even some doctors in neighboring Austria and Switzerland were advised to stop performing the procedure until legal questions were answered.

German Chancellor Angela Merkel warned that banning circumcisions would make Germany a “laughing stock.” But finding a compromise hasn’t been so simple, with opponents of the practice saying that what they see as protecting the rights of children should come above religious freedom.

The European rabbis’ council says that using anesthesia or having a doctor perform circumcision instead of a mohel would not be in accordance with Judaism. Metzger told reporters Tuesday that he suggested establishing a school for mohels in Germany with both religious training from rabbis and medical training from doctors in case of complications from circumcision.

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Photo: Israeli Rabbi Yona Metzger speaks to reporters in Berlin on Tuesday about the debate in Germany over circumcision. Credit: Kay Nietfeld / EPA


Novartis patent case in India seen as crucial for generic drugs

The Indian Supreme Court is scheduled Wednesday to take up a case that aid agencies warn could have sweeping effects on the price of medicine for the global poor.

The Swiss drug company Novartis is seeking a patent from India for a drug called Glivec, which is used to treat a rare form of leukemia and gastrointestinal tumors. The drug, known as Gleevec in the United States, has received patents in many countries and is viewed by the company as intellectual property that advances medicine and is deserving of patent protection to ensure that groundbreaking research can continue.

But those who oppose granting the patent to Novartis say that doing so could ultimately undercut the making of generic drugs that has given India a reputation as a mecca for making affordable medicine.

"The effects could be enormous," said Judit Rius, U.S. Access Campaign manager for Doctors Without Borders. "It is one of the most important cases on access to medicine right now."

Indian law allows the country to turn down patents for medicines that officials determine do not yield new benefits for patients over existing drugs. The law is meant to stop “evergreening” -- companies tweaking drugs slightly to keep them under patent longer.

The Indian law sets a higher bar than many other countries for drug patents, a frustration to pharmaceutical companies that say they need greater protection for innovation. India only started patenting medicines seven years ago when required to under a World Trade Organization agreement.

Six years ago, India turned down Novartis for a patent on Glivec, saying it was too much like older medicines on the market. Novartis argues that its form of the medicine was “a breakthrough.”

Novartis has lost earlier court challenges. Aid agencies have urged the company to drop the case, fearing that if it wins, it could open the door to rampant evergreening, paralyzing the Indian market for affordable generic drugs to treat HIV/AIDS and other maladies in the developing world.

Doctors Without Borders has called the court case an “attack on generic medicines,” Oxfam “a massive threat” to the poor and ill. Indian generics make up the bulk of medicines used to treat HIV/AIDS in developing countries, the groups said, and Glivec could set a perilous precedent.

Before granting patents, “the question has to be asked -- how much real innovation is going on?” said Tahir Amin, co-founder of the Initiative for Medicines, Access and Knowledge, which challenges drug patents it sees as questionable. “If you just improve the shelf life of a drug, that isn’t really a groundbreaking discovery. India has been trying to curb some of that behavior.”

Novartis says the case will not stop people in poorer countries from getting drugs they need. The vast majority of Indians who need Glivec get it for free through a company program, Novartis said. Generic drugs created before 2005 will still be available, it added.

“This case is not about changing the availability of existing generic medicines, but about protecting intellectual property to advance the practice of medicine and to serve patients’ unmet needs,” Ranjit Shahani of Novartis India wrote in Business Line, an Indian newspaper.

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South Korea: Confiscated 'health' pills made of human remains

SEOUL and BEIJING — South Korean customs said it had confiscated more than 17,000 “health” capsules smuggled from China that contain human flesh, most likely extracted from aborted fetuses or stillborn babies.

The Chinese Ministry of Health said Tuesday it had been investigating allegations that capsules were being manufactured from human remains but had found no evidence.

The South Korean customs agency said pills had been smuggled into the country through parcels and luggage carried from China. The pills were composed of "ground stillborn fetus or babies that had been cut into small pieces and dried in gas ranges for two days, then made into powders and encapsulated," the report said.

"Flesh pills have been continuously smuggled into [South Korea], camouflaged as health tonics," the statement said. The pills came mostly from cities in northeastern China: Yanji, Jilin, Qingdao and Tianjin.

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What may have caused an Argentine baby to be mistakenly declared dead?

Argentinafamily

This post has been updated. See the note below for details.

The stunning case of a baby who was declared dead only to be found whimpering in the morgue nearly 12 hours later has riveted Argentina. The family said it planned to sue the hospital where the infant, named Luz Milagros, or Miracle Light, was born and later struggled for her life in intensive care.

[Updated, 11:30 a.m. April 16: To understand how a baby might be declared dead then found alive, The Times turned to Yao Sun, director of neonatal clinical programs at UC San Francisco's Benioff Children's Hospital.]

How could a baby mistakenly be declared dead?

Obviously it’s extremely rare, and that’s why this story has fascinated people. What it sounds like to me -- gleaning what I can from what I’ve read -- is that at the time the baby was born, the baby did not have many of the clinical signs of life. As far as I can tell, this was a pretty premature infant.

So I would guess that the baby was not breathing, was limp, was most likely blue and could have had such a slow heart rate that when they listened they didn’t hear it. We will frequently attempt to resuscitate a baby like that, but there are certain circumstances in which we would not attempt it.

How would a baby like that have survived?

My understanding is that the baby was transferred to a cooled area of the morgue rather quickly. Here I’m hypothesizing, but that may have allowed the baby to survive by cooling the metabolic rate so much that the organs of the body don’t need as much oxygen and nutrients. You’d normally expect that if the heart rate was that low, the baby would have died relatively quickly.

Even though the patient is dying, it doesn’t mean that they may not, on occasion, have something like a gasp or movement. In the end stages of dying, the brain stem can still occasionally fire primitive reflexes which can result in a gasp. That’s not truly breathing effort, but a primitive breathing reflex.

I would expect that this baby is going to be at extremely high risk for having a lot of problems. The risks for mortality and long-term poor neurological outcomes are extremely high. [As of Friday, doctors said the baby had suffered cardiopulmonary failure and an infection. She was in critical condition.]

How do you make the decision whether to try to resuscitate a baby?

We consider several factors. Gestational age is one of them. Some neonatologists will attempt to resuscitate essentially any live-born infant no matter their gestational age -- but that’s not the most common. For most neonatologists, 23 to 24 weeks of gestational age is seen as viable.

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