Smokers' skin may age faster

Judges who didn't know which twin smoked said the smoker looked older 57 percent of the time. That pattern held when both twins were smokers but one had smoked for many years longer than the other. "Smoking makes you look old. That's all there is to it," Dr. Elizabeth Tanzi said. "Besides lung cancer, heart attacks and strokes, just one more good reason to stop smoking is that it's definitely making you look a lot older," she told Reuters Health. Tanzi is a dermatologist at the Washington Institute of Dermatologic Laser Surgery and George Washington University Medical Center. She was not involved in the new study but said it confirms what she and others see in practice. The findings are based on standardized photos of 79 pairs of identical twins taken at the Twins Days Festival in Twinsburg, Ohio. Dr. Bahman Guyuron from Case Western Reserve University and University Hospitals of Cleveland and his colleagues showed the photos to three trained judges, then asked them to grade each person's wrinkles and age-related facial features. The twins were in their late 40s, on average. About three-quarters of them were women. Forty-five sets of twins included one smoker and one non-smoker. Smokers tended to have more wrinkles and other signs of face aging. But the differences were often small. For instance, on a 0-to-3 scale, where 0 means no wrinkles and 3 is severe wrinkles, upper eyelids were rated at 1.56 among smokers and 1.51 among non-smokers. Jowls were rated at 1.0 among smokers and 0.93 among non-smokers, on average. There was no difference in assessments of crow's feet or forehead wrinkles based on smoking. Other factors related to skin aging like sunscreen use, alcohol drinking and stress at work were similar among smoking and non-smoking twins, the researchers noted. Of the remaining 34 twin pairs, one twin had smoked for an average of 13 years longer than the other. Twins who had smoked for more years had more pronounced bags under their eyes and more wrinkles around their lower lips, according to findings published in Plastic and Reconstructive Surgery. "It really just kind of confirms a lot of stuff that most people believed," said Dr. Alan Boyd. He is a dermatologist at Vanderbilt University Medical Center in Nashville, Tennessee, and wasn't part of the study team. "I can usually spot a smoker from across the room because of some of their facial skin changes," Boyd told Reuters Health. Still, he said the study adds another layer of evidence by putting numbers on the effect of smoking on different parts of the face. The researchers didn't take into account how many cigarettes people smoked each day. And although weight was similar between smokers and non-smokers, they didn't know if differences in fat distribution affected facial appearance. Tanzi said toxins from smoking can speed up the breakdown of collagen, protein fibers that support skin and help it stick together. Smoking also reduces the amount of oxygen going to the skin, she said. In addition, having a regular source of heat close to the face may play a role in skin aging, according to Boyd. "The effects are cumulative. So you can benefit from stopping smoking at any time," Tanzi added. But, "You want to be careful, because some of those changes may be permanent." Facial creams and plastic surgery are options for people whose skin has been damaged by smoking, Guyuron told Reuters Health. But he said the goal of releasing the findings was to give people another reason never to start. "We are hoping that by again emphasizing the harms that come from smoking we can dissuade individuals from smoking … knowing how much it may damage their skin," he said.

Drug pricing challenges diabetes king Novo Nordisk

Lars Sorensen is certain of one thing: the number of potential customers for his products is going to keep on rising as a global obesity epidemic tips more people into type 2 diabetes in the West and many developing nations. But he has a mounting fight on his hands when it comes to securing a good price for insulin and other diabetes treatments from cost-conscious reimbursement authorities around the world. "Pricing is going to be challenging," Sorensen said in an interview at the drugmaker's headquarters in Bagsvaerd on the outskirts of Copenhagen, where a new spiral office complex inspired by the insulin molecule is under construction. "In Europe, it is already a challenge and pricing in the United States is likely to be challenging in the future as well, with healthcare reform and concentration in the distribution chain." It has been a torrid year for the 59-year-old, who has been in the job since 2000 and acknowledges that the group is starting to think about succession planning for when he steps down, sometime before his 65th birthday. Last week he reported the group's 46th quarter of double-digit percentage sales growth in local currency terms, a record most rival drugmakers can only dream of. But the results fell short of market expectations - and a warning that sales and operating profits might only grow by high single digits in 2014 unnerved investors who have bought into the Novo story because of its long-term growth visibility. Lars Sorensen, CEO of Novo Nordisk, gestures during an interview at the company's headquarter in Bagsvaerd near Copenhagen, Credit: Reuters/Fabian Bimmer Sorensen insists the aspiration of double-digit sales growth is "still there, alive and kicking" and Novo has not given up on its long-term financial target of 15 percent operating profit growth, adding that forecasts for the following year given at this stage are "always conservative". But he admits that growing the Nordic region's biggest company by value is getting tougher, especially after a decision by the US Food and Drug Administration earlier this year to delay approval of its new long-acting insulin Tresiba. That setback opens the door to competition from Sanofi's new insulin U300, just as Eli Lilly threatens Novo's popular non-insulin diabetes drug Victoza with a potential rival called dulaglutide that may be superior. On top of all this, Novo is now encountering growing pushback on prices from healthcare insurers and governments, challenging its strategy of increasing prices and charging a premium for innovative medicines. Pricing Balance Getting the pricing mix right is a balancing act for Novo, whose giant factory at Kalundborg, 100 km west of Copenhagen, supplies half the world's insulin, making both modern products for rich markets and cheap generics for the developing world. Up until now, the West - particularly the United States - has accepted higher prices for more convenient and effective treatments. But the climate is changing, with Novo losing a major US managed care contract with Express Scripts in the face of cheaper competition to Victoza, while austerity-hit Europe is reluctant to pay up for Novo's new drugs. It is a battle in which Sorensen believes he cannot afford to give ground. "We need to price innovation at a premium, otherwise we will not be able to fund innovation going forward," he said. "We could have priced ourselves into the (Express Scripts) contract had we wanted to, but we believe Victoza is a better product and therefore demands a premium." In Europe, Novo is facing resistance to the 60-70 percent price premium it is asking for Tresiba but Sorensen said he had no plans to reduce the price, even though this may mean the new medicine is never launched in Germany. For Sorensen, fighting for a fair reward for innovation is a matter of principle and he believes Europe will have to find extra funding beyond taxation - via insurance or patient co-payments - to deal with its rising healthcare burden. The stand-off, however, is unnerving for investors anxious about Novo's long-term growth story. Even after this year's setbacks, its B shares, the class of stock open to outside investors, still trade on 18 times expected earnings, against a sector average of about 14. The stock is underpinned by the knowledge that more than half a billion people are expected to be living with diabetes by 2030, up from 370 million today, according to the International Diabetes Federation. Sorensen hopes to stay around long enough to see the company well on the way to the next stage of technological breakthrough - oral pills, rather than injections, for delivering insulin and so-called GLP-1 medicines like Victoza. He thinks a GLP-1 pill could hit the market in five years, with a 50/50 chance of an insulin tablet in 6-8 years time. Novo is trailing Israel's Oramed Pharmaceuticals in clinical testing of an insulin pill, sparking speculation of a possible deal. But Sorensen said this was not on the cards since Novo doubted Oramed's approach. At a personal level, the Danish company's boss shows no signs of flagging, having recently extended his mandatory retirement age from 62 to 65. He cycles to work most days and is a keen cross-country skier, preparing to take part again in the 90-km Vasa race in Sweden this winter. Whoever takes over will have a hard act to follow but Sorensen sees good internal candidates for the job. "We've bought a little time to work on diligent succession planning and we are doing that at the moment," he said.

Doctor’s ACRs going to private hands

The department has issued two orders, copies of which are available with bdnews24.com, to make this unprecedented move.

In a surprising order, the Director General of the Directorate of Health Services Khondokar Md Shefayetullah has given a private firm full access to the Management Information System’s (MIS) ‘server room’ and ‘data centre’. He has stated in his order of Nov 6 that Nazdaq Technology will have full access to the centre to automate the Annual Confidential Reports (ACR) of 23,000 staff, most of them doctors. For this, Shefayetullah has said the firm should know the “detailed analysis of data centre, assess the capacity of all hard-ware and their connectivity, access the variety of topology of the Network, and assess disaster recovery capability of the data centre”. Giving Nazdaq access to the data centre and server room, the DG issued another order, transferring its only systems engineer to a Gopalganj hospital, leaving no government official at the centre. Following this order, Director, Administration, Dr Shah Newaj asked the Assistant Director, ACR section, to hand over the entire bulk of reports to the firm. But neither official could be reached for comments despite several attempts on Friday. The Senior Secretary to the Ministry of Public Administration and a former secretary were surprised to learn of the development when their views were sought. Senior Secretary Abdus Sobhan Sikder told bdnews24.com that he had no idea about this ‘specific’ case as the health department maintained its own records. “But in no circumstance can we share ACR with others. It’s a highly confidential document. We maintain its secrecy very strictly,” he said. “The room where it is stored and maintained is also a secret section. General people are not allowed there.” Former Secretary Dhiraj Kumar Nath, who had served at the health ministry, said the ACRs were kept under “maximum security”. “It’s the annual performance report of an officer. It is confidential,” he told bdnews24.com. Health minister AFM Ruhal Haque, too, told bdnews24.com that he had no idea about the order transferring all ACRs to a firm and giving it full access to the server and control room. “I wanted to automate all documents of the health ministry, and we have programmes for that. But that does not mean giving full access of the control room to a firm,” he said. He added that he had told the DG to report back on Saturday. According to the officials of the MIS, some staff of the Nazdaq Technology had brought along the DG’s order, seeking space in the control room. “The MIS chief had not been consulted,” said an official who cannot be named. MIS Chief Abul Kalam Azad, too, could not be reached. The move has left doctors worried. One of them said: “An ACR means a lot for our job confirmation, promotion and posting”. Officials aware of the move said an influential health directorate contractor was a Nazdaq patron. It is alleged that the DG’s office has close ties with the contractor, and the DG was quick to issue the order. Tenders had not been called before assigning the job. Some officials fear the move might hinder smooth MIS functioning, something that the present government is so proud of. The government obtained its UN South-South Award for ‘digital health for digital technology’ chiefly because of the performance of this MIS. The government equipped the centre with the state-of-the-art machines and developed, with the help of consultants, several health sector management softwares.

ACRs handing over order altered

The health directorate has changed its order to hand over all doctors’ confidential performance evaluation reports to a private firm, a day after bdnews24.com has reported it. Director of the Directorate General of Health Services Dr Shah Newaj told bdnews24.com on Saturday that they would hand over only 100 annual confidential reports (ACRs) for ‘experimenting’ the automation process. Earlier, in an order he asked the Assistant Director, ACR section, to hand over the entire bulk of reports to the firm. The health directorate has at least 23,000 ACRs of its officers. He gave the order after his Director General gave the firm, Nazdaq Technology, full access to the classified ‘server room’ and ‘data centre’ of the Management Information System (MIS) of the entire health directorate. The steps worried doctors as ACRs are confidential. Senior Secretary for public administration Abdus Sobhan Sikder told bdnews24.com that in no circumstance they share ACRs with others of their admin officials. “It’s a highly confidential document. We maintain its secrecy very strictly”. Health minister AFM Ruhal Haque on Friday told bdnews24.com that he would look into the order. An official of the DG office said the minister instructed the DG to change the order. However, the DG is yet to revoke its first order that gave full access to a private firm to the government’s data centre and server room that keep information of the entire health system.

Flexibility cuts HIV in India

Aradhana Johri, Chief of India’s National AIDS Control Organisaiton, told the Asia and the Pacific AIDS Congress their first concern was to understand the disease to know what was happening.

“When we found intravenous drug-users were driving the epidemic, we were able to address them. Today we know migration is the drive, and we trying to address that before it assumes epidemic proportions. “So it’s important to have a flexible policy that can be revised on the basis of emerging data,” she said as a lesson for countries like Bangladesh that are yet to cut down on new infections. She, however, added that "no prescription can be given from outside" and that the solution "has to come from within". The mega AIDS conference brought together more than 3,000 participants from 80 countries in the Asia-Pacific region. Being home to the world’s third largest number of HIV people, India accounts for 40 percent of the total regional numbers. But the already low-prevalence is declining, and now it is 0.27 percent. Johri said they engaged people from all levels in the government-led programme to yield the maximum benefit. The country's next five-year AIDS control plan was prepared after a six-month discussion with thousands of stakeholders, 60 percent of them out of the government sector. “So we have targeted interventions reaching out to communities. It's peer-led and run by the communities and NGOs." And that, she said, could prevent the estimated three million new infections in as many decades. She said that in order to maintain low-prevalence, they stressed prevention. “Otherwise, normally, treatment takes up everything else. But our prevention focus is balanced mix of prevention and treatment." She the Indian government had pumped in additional resources when international funding for HIV combat shrank. Funding rose to 66 percent from 12 percent for the five-year HIV/AIDS control programme. . “We are fortunate we have political leadership that has led us from the front.” Replying a question she said India and Bangladesh could work together because of cross-border migration between the two neighbours. “Many counties in the region have the issue of migration. So, the governments have to work together,” she said. But, in India, internal migration also posed a problem, she said. The conference discussed the ways to reduce new infections and achieving a series of zeros - zero new infection, zero AIDS deaths, and zero stigma and discrimination.

Bangladesh to host next ICAAP

Secretary for health MN Neaz Uddin made a formal announcement on the country's behalf in a press conference at the ongoing 11th International Congress on AIDS in Asia and the Pacific (ICAAP) in Thai capital Bangkok. He is leading a large Bangladeshi delegation that is also carrying on a publicity campaign, handing out information and promotional materials to woo participants to ICAAP's 12th episode in Dhaka. “I welcome you all to Bangladesh in 2015 so that we can extend our warm hospitality,” the Secretary said. “We are ready.” ICAAP is the largest regional forum in the world and second largest global AIDS meet since 1995. It draws between 3,000 and 5,000 participants from across the world, but mostly from Asia and the Pacific region. The Dhaka meet will be the first global AIDS conference after the 2015 September UN General Assembly in which the post-2015 development agenda will be passed. UNAIDS Country Coordinator in Bangladesh Leo Kenny has termed ICAAP a ‘lighthouse’ between now and 2015, saying it would bring countries and communities together “to think very careful what HIV/AIDS mean over the next decade”. “It's (next ICAAP) is so critical,” he said, reminding that HIV/AIDS has remained ‘an unfinished business’. But there was a strain of scepticism about the prospect of the next ICAAP. One delegate debated the need for a bi-annual meeting when a world conference was held each year. Population scientist Prof Nurun Nabi, also vice-chancellor of Begum Rokeya University in northern Rangpur, said ICAAP played a critical role in the region. “Asia-Pacific is the largest region in the world and the most seriously affected by HIV, and that it is also easily neglected when we put our problems into the same pot with other continents”. The health Secretary promised the global press that Bangladesh “with all of our partners will try its best to make the ICAAP 12 the most successful event”. He cited some of the reasons behind Bangladesh's interest in hosting the mega gathering. “We are a low-prevalent country, but it is high in our bordering countries and the porous borders may cause infiltration of more cases.

“Our case detection rate is also low because of people’s shyness and over-confidence arising out of low prevalence,” he said and that the ICAAP in Dhaka would create much awareness with tremendous media campaign. He felt “…that would definitely help us in more case detection and increasing coverage of HIV/AIDS care”. Inter-governmental organisation Partners for Population and Development that promotes South-South cooperation will co-host the Dhaka ICAAP. Its Executive Director Joe Thomas said the Bangladesh meeting would be on the theme of 'Be the change: towards an AIDS free generation'. “It will highlight Bangladesh’s and the region’s ambition to achieve an AIDS free generation through science, innovation, community involvement with government leadership.” He said they would involve civil society as well as HIV/STD and people living with HIV networks to make the gathering happen. The Executive Director of the Ashar Alo Society that works with people living with HIV/AIDS, Habiba Akhter, said their peer groups work ‘actively’ with the government. “We feel the need and we also know the need,” she said inviting global leaders, scientists, and activists to join the Dhaka meet.

Exercise with cold

This is an important question since this is flu season and common cold is in the air. We diagnose whether it is ok to exercise with a cold.

It is ok to exercise and do some physical activity with common cold with no fever. Exercising with a cold helps clear the nasal tract and improve breathing. Don`t let mild cold symptoms affect your daily workout routine. What you could do during these days is reduce the intensity of the workout and the duration of the exercise. Avoid exercising if: 1) You have fever 2) Muscle aches 3) No stamina 4) Stomach infection 5) Cough 6) Chest congestion Do not let common cold affect your performance after you are cured. Bounce back to your regular routine, but check with your doctor to get a clean chit, as exercising with a cold can cause serious injuries and health problems. Exercises with a cold: - Walking - Jogging - Endurance training - Yoga - Dance - Swimming